Board Certification – Not All Are Created Equal

Recently, John Vitolo, MD passed the re-certification board examination with the American Board of Orthopedic Surgeons. This is a grueling and rigorous process requiring 120 hours of continuing education, a written and oral examination and a peer review.  Re-certification is required every 7 to 10 years. 

The American Board of Orthopedic Surgeons is not the only board to offer certification; however, the requirements of this board are more challenging than others in the field. To qualify for initial certification, surgeons must be a graduate of an accredited 4 year medical school and have successfully completed a 5 year accredited orthopedic residency program in the US or Canada.

In addition to being board certified in Orthopedic Surgery, Dr. Vitolo holds a sub-specialty certification in Sports Medicine from the ABOS. This sub-specialty certification requires an additional year of training/education, endorsement by the program director, peer review, documented experience with Arthroscopic Surgery and knowledge of non-operative conservative treatment of select injuries. 

Certifications given by the ABOS are given to an elite group of orthopedic surgeons. To become board certified requires commitment and a desire to continuing learning and provide the highest quality care to patients. By visiting an ABOS Board Certified surgeon, you can rest assured that you will receive optimal care.

Who is the American Board of Orthopedic Surgery?

·         Non-profit, private, independent organization - Founded in 1934

·         Established to serve the best interests of patients and the medical profession

·         Board establishes education standards for orthopedic surgeons

·         Standards are evaluated through standardized exams and practice evaluations

·         Membership is given only to distinguished orthopedic surgeons who have met set requirements and are active in patient care, education and research

To find out if your surgeon is certified by the ABOS or to find one that is, you can visit this link: https://www.abos.org/find-a-certified-orthopaedic-surgeon.aspx.

Preventing Overuse Injuries in Young Athletes this Baseball Season

Baseball season is here! Young athletes are ready to start training. While the old adage “practice makes perfect” is true, our youth need guidance in order to prevent injury.

Overuse injuries in school aged athletes are on the rise. The incidence of shoulder and elbow injuries among youth baseball and softball players is five times greater than it was in the year 2000.[i] Many of these baseball injuries are preventable.

In recent years, Little League Baseball has released guidelines and enforced regulations to help prevent injury in young athletes (see charts below). The league has put limits on pitch counts during games and also enforced required rest periods. All the guidelines are based on the age of the athlete.

While the guidelines from Little League Baseball are important, there are additional steps that can be taken at practices and off the field. Here are some tips:

1.  Always warm up – stretch, jog and begin with some easy, gradual throwing
2. Try different positions – different positions require the use of various muscle groups
3. REST – don’t play year round and allow rest between games
4. Focus on your form, accuracy and control
5. If you have shoulder or elbow pain, do not pitch
6. Talk to your parents and coaches about any pain – do not play through the pain!

Getting kids involved in sports at an early age is a great idea, but it is important to remember an injury can end their baseball career too soon. By following the suggestions outlined here, injury can be avoided and a lifelong love of baseball and activity can be built!

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[i] http://www.stopsportsinjuries.org/media/statistics.aspx

Maximum Pitch Counts and Required Rest Periods courtesy of Little League Baseball

Different Types of Meniscal Tears

In a recent blog post, we discussed meniscal tears and treatment of these injuries.  Today we will take a look at the 3 different shapes of meniscal tears. To recap, the meniscus is a c-shaped piece of cartilage in the knee that acts as a cushion between the thigh bone and shin bone. The primary function of the meniscus is to keep the knee stable and act as a shock absorber.

Types of Meniscal Tears:

1.      Longitudinal 
2.      Radial 
3.      Horizontal
  
Longitudinal Meniscal Tears

A longitudinal tear runs along the meniscus.  If the longitudinal tear is partial, it can heal without surgical intervention. If it does not heal properly, however, it can often lead to a full bucket handle tear (a complete tear that goes through the meniscus). Longitudinal tears are very common in young athletes and often present in conjunction with an ACL tear.

Radial Tears

Radial Tears occur along the inner edge of the meniscus and can be either partial or full.  Two common radial tears are oblique tears and parrot’s beak tears.  Oblique tears are probably the most common type of meniscal tears.  

Horizontal Tears

This type of tear goes through the meniscus and splits the meniscus into a top and bottom section. These tears are not as common and often begin as a result of degeneration or a minor injury.  Unfortunately, if left untreated, horizontal tears can leave the patient more susceptible to the more serious horizontal flap tear and can become complicated to fix. 

Developing a Treatment Plan:

It is important to remember that there are some key factors to consider when developing a treatment plan for a meniscal tear.  These factors include:

1. Patient’s age
2. Patient’s activity level 
3. Shape/location of the tear (complex tears can be a combination of longitudinal, radial and horizontal)
4. Related injuries (if any) that are present

Age and activity level are important to the success of a surgical repair of the meniscus. The younger and more active the patient, the more likely the repair will be successful. It is also extremely important to evaluate other injuries. For example, if you repair the meniscus, but fail to repair an ACL tear, recovery will be compromised. A full evaluation of each patient is necessary to determine an appropriate treatment plan.

If you feel you have a meniscal tear, it is important to see a doctor and he/she will develop a treatment plan that is best for you. 

Case Study: Shoulder Injury - Old and New

As an orthopedic surgeon it is my goal to treat injuries by restoring the normal anatomy that has been disrupted. In this case study we will discuss an unusual combination of shoulder injuries which required a unique treatment plan.

In this case, a patient came into the office with a dislocated shoulder. Upon examination, we found remnants of an old injury that left his shoulder anatomy compromised and a new injury that was severely hindering his shoulder function. Many doctors may have opted to only address the new injury, but we knew that the first objective was to restore the patient’s anatomy to normal (fix the old injury) and then address the new injury. 

After thorough evaluation, we discovered scapular dyskinesis (abnormal movement) with winging, a prominent AC joint (the AC joint is the joint where the collarbone and shoulder blade meet) and unstable left shoulder. An MRI further revealed an anterior labral tear and bankart lesion.  The scapular dyskinesis and prominent AC joint were due to the old injury that had not healed properly and likely led to the anterior labral tear and bankart lesion.  In order to give the patient the best chance of full recovery and normal shoulder function, we had to address both injuries. 

We opted for staged surgical procedures.  First, we would need to reconstruct the AC Joint, then 2 months later we would perform a second arthroscopic surgery to repair the bankart lesion and anterior labral tear.  Reconstructing the AC Joint was the first priority.  By performing the reconstruction, we would be restoring the shoulder to its natural anatomy. Restoration of the natural anatomy gives the patient the best chances for a full recovery from the second injury.  By ignoring the old injury (which led to the abnormality of the AC Joint), the chances of a full recovery from the labral tear and bankart lesion would be slim and leave the shoulder more prone to future injury.

Following the surgeries and postoperative physical therapy, we could not be more pleased with the results.  Four months after the second procedure: the scapular winging disappeared, the patient was pain-free, the instability of the shoulder was gone and the patient was able to return to full work duty without any restrictions.  The patient is thrilled with the results.  Following his first injury, he had never returned to “normal”, but now he reports that he is better than ever.  He has complete range of motion in the shoulder and is living pain free. A complete success in our book!

 

Ask the Orthopedic Surgeon: What is the meniscus?

Question:
I keep hearing of athletes tearing their meniscus.  What exactly is the meniscus and what does it do and what happens if it is torn?

Answer: 

What is the meniscus?
The meniscus is a c-shaped piece of cartilage in the knee that acts as a cushion between thigh bone and shin bone.  The meniscus acts as a shock absorber and keeps the knee stable.  The meniscus also distributes our weight evenly over the knee. The most common causes of a meniscal tear are a sudden twist of the knee or overuse.

What are the symptoms of a torn meniscus?

-        A “pop” may be felt at the time of the injury

-        Pain

-        Stiffness & Swelling

-        Limited range of motion

-        “Locking or Catching”

How is a torn meniscus treated?

Treatment of meniscal tears vary depending on the size, severity and location of the tear.  Tears that are small in size and on the outer edge of the meniscus may not require surgery.  In these cases, the protocol is RICE:  Rest, Ice, Compression and Elevation combined with anti-inflammatory medications (aspirin or ibruprofen). The patient may or may not be required to wear a brace.

If the meniscal tear is moderate to severe, a knee arthroscopy is often needed. Knee arthroscopies are performed through a small incision in the knee.  An orthopedic surgeon then inserts a small camera, which provides a clear view of the knee.  From there, the orthopedic surgeon either repairs the tear or removes the torn portion of the menisci.

Depending on the location of the tear, an orthopedic surgeon decides whether to remove or repair a tear.  The outer layer of the meniscus is often referred to as the ‘red zone’ because it has a good blood supply, which is necessary for healing.  The inner layer is sometimes referred to as the ‘white zone’, which lacks a decent blood supply and makes healing difficult.  If the tear is located in the red zone it is normally repaired, but if it is in the white zone, it is normally fully or partially removed.  Full removal is normally avoided, if possible, as it can leave the patient more prone to osteoarthritis in the future.

For a meniscal repair, the recovery time is about 3 months, with 4-6 weeks on crutches and physical therapy.  A partial menisectomy (removal of the meniscus) has a recovery time of about 6 weeks and only 3 days on crutches.  Physical therapy is needed as well.  In both cases, patients are able to return to full activity. 

If you have an orthopedic question for John Vitolo, MD, please email your question to kim_abbasi@skyvieworthopedic.com.  John Vitolo, MD is Board Certified in Orthopedic Surgery and Sports Medicine.  Skyview Orthopedic has offices in Sparta and Randolph.

*Picture Source:  American Academy of Orthopedic Surgeons

Stay Safe on the Slopes: Preventing Snowboarding Injuries

With the winter sports season quickly approaching, it is important to consider how to stay injury-free on the slopes. How do you make sure that you get the most of this year’s snow and not wind up in the operating room? We will discuss some important ways to stay safe and injury-free.

The two most common mechanisms of injuries in snowboarding are falling or a direct/traumatic blow. The most commonly injured body parts are the arm, shoulder, head and wrist. Many injuries are minor, but others can require surgery and have a recovery time of 3 to 6 months. 

Be smart and take some precautions so that you can get the most out of this year’s snow and not wind up in the ER.  There are a few simple precautions that one can take to prevent injury. 

Take a Lesson

If you are new to the sport, get a licensed instructor to help you learn the sport. Instructors can be instrumental in helping you master the sport of snowboarding.  They can make sure you have the proper equipment and guide you to the appropriate training terrain.  With an instructor, you will also be taught proper techniques and form.  An instructor will even teach you the best way to fall without getting hurt. 

Proper Equipment

Make sure you have equipment that fits properly. This is extremely important. Bindings that are too loose or too tight are definitely a contributing factor to many injuries.  Helmets are also extremely important for injury prevention. In addition to a helmet, it is recommended that boarders wear wrist guards, knee pads and elbow pads.  It is estimated that using protective equipment can reduce injuries by 43%!

Use Common Sense

Most injuries occur after lunch, when the boarder is tired and fatigued.  The conditions also change after lunch and can become more icy or ‘skied-off’.  Make sure to stay hydrated, take breaks and stay alert. If you feel tired; stop and rest. 

Obey the Rules – National Ski Associations Responsibility Code

Know the code!  Follow the responsibility code and prevent injury. 

·        Always stay in control

·        People ahead of you have the right-of-way

·        Stop in a safe place for you and others

·        Whenever starting downhill or merging, look uphill and yield

·        Use devices to help prevent runaway equipment

·        Observe signs and warnings, and keep off closed trails

·        Know how to use the lifts safely

There are many ways to prevent injury and stay safe this year on the slopes.  Be aware, wear proper equipment and stop when you are tired.  Follow these simple guidelines and have a great time on the slopes!

John Vitolo, MD is an orthopedic surgeon in Sparta, NJ.  He currently holds dual board certification in Orthopedic Surgery and Sports Medicine. For more information visit us online at www.skyvieworthopedic.com.

 

Why are women more susceptible to ACL tears?

In recent years, there has been discussion on why women and young girls are more susceptible to ACL tears. There are many theories on the reasons why, but today we will examine a main anatomic difference between men and women that is a contributing factor: the Q-Angle and wider pelvis.

The Q-angle is the angle at which the femur (upper leg bone) meets the tibia (lower leg bone). The Q-angle is determined by three areas of the human anatomy – the Anterior Superior Iliac Spine (ASIS), the center of the kneecap (patella) and the tibia tubercle.  The Q-angle is basically a line drawn from the ASIS down to the center of the kneecap to the tibia tubercle (see picture below).

The Q-angle in women is greater because women are anatomically built with a wider pelvis than men.  A normal Q-angle in men is 14 degrees, while women have a normal angle of 17 degrees. The greater the angle, the more at risk the person is for knee injuries, including ACL tears.

The fact that the q-angle is more pronounced in women than men leads to more stress on the knee joint and makes it less stable when put under stress. For this reason, when a woman participates in sports involving jumping, running or pivoting, she is naturally more likely to suffer an ACL tear. 

What can we do to prevent ACL tears in women?

Recently, emphasis is being placed on neuromuscular training programs.  Neuromuscular training teaches the body better biomechanic movements to improve the control of the dynamic knee stabilizers (the ACL and major ligaments that surround the knee).  Exercises that are included in a neuromuscular training program include stretching, plyometrics and strength training.  The goal of these programs is to teach athletes how to land, pivot and control the knee without placing as much force on the ACL.  One program was developed by the Santa Monica Sports Medicine Research Foundation and is known as the PEP Program: Prevent Injury and Enhance Performance. To learn more about this program, please visit http://smsmf.org/files/PEP_Program_04122011.pdf.  

If you suspect that you have an ACL tear or other orthopedic injury, it is important to see an Orthopedic Surgeon.  Skyview Orthopedic, the office of John Vitolo, MD is available to treat all your orthopedic injuries and concerns.  Our office is focused on treating each patient individually and offering the highest quality orthopedic care.  John Vitolo, MD holds dual board certification in Orthopedic Surgery and Sports Medicine. For more information call the office, 973-300-1553 or visit us online at www.skyvieworthopedic.com.