Don't Rake in Injuries

According to the annual summary from U.S. Consumer Product Safety Commission, approximately thirty-eight thousand Americans suffer leaf-raking injuries a year. These injuries can often be avoided. With a few tips and a pinch of common sense you will be walking upright after the last fall leaf is gone…right in time to rake in the holiday celebrations.

The American Academy of Orthopedic Surgeons offers these suggestions.

•  Slow and steady is the proper pace. Especially when you have a large yard or multiple trees, raking is definitely a marathon, not a sprint!

•  Wear safety goggles to protect your eyes from flying debris

•  Be sure your footwear is slip-resistant because damp leaves can be slick.

•  Use tools with padded handles or wear garden gloves to prevent blisters and hand injury.

•  Do not rake with long strokes. Keep your strokes short to minimize the risk of extension injury.

•  Use a rake that is suitable for you. If it is too short or too heavy, the risk of strain to your back, shoulders and neck increases.

•  When raking, keep your back straight, turning your whole body instead of twisting at the waist, and shift your weight using your legs.

•  Do not overfill leaf bags, especially if you’re clearing wet leaves; keep weight at a level that is comfortable for you to lift.

•  And be careful when you’re lifting those leaf bags. Always bend at the knees, and avoid twisting to throw bags over your shoulder or off to the side.

Enjoy your fall festivities~

Youth Sports Injuries

Alejandro Patino and his peers have become a special group of patients orthopedic doctors have treated more now than ever before. Since around the year 2000 there’s been an increase in youth sports injuries, and Dr. Vitolo has seen his share of young athletes injured playing the sport they love.   

Nineteen-year-old Alejandro is the quintessential athlete in this category. The young athlete has been playing soccer for 15 years, starting at age 4. Like any athlete, the sport he loves has also had an affect on his body- he is in great physical shape but has also had an injury as a result of his sport.

“I was playing soccer. I jumped and landed on my right leg while another guy was also on top of me, so I landed with double the weight upon me and my knee twisted,” Alejandro explained.  

The young athlete had surgery performed on his knee earlier by another surgeon and hoped he would make a full recovery. He did not and the condition continued, as well as the pain and discomfort.

Devastated by the injury and how it affected his soccer skills, Alejandro and his parents sought out the professional opinion of Dr. Vitolo. What followed was his diagnosis of recurrent patellar dislocation. Instead of performing MPFL repair again on Alejandro as was done initially by a different surgeon to correct the problem, Dr. Vitolo performed MPFL reconstruction surgery.

Dr. Vitolo advised the young athlete to expect to be out of commission for roughly 6 - 8 months, but Alejandro was back on the soccer field in five months.

Following eight weeks of working hard at physical therapy Alejandro said he knew his knee had improved. By the fourth month after surgery, the pain and discomfort was subsiding and he knew he’d be back to playing his best in soccer.

“Dr. Vitolo is a great doctor. He allowed me to be able to go back to playing soccer and accomplish many of my dreams in the sport. With the help of Dr.  Vitolo’s advice, I was able to have a successful recovery and I will now be able to go on to play college soccer,” said Alejandro.

He feels he has made a full recovery and his soccer prowess is proof. His travel team, Highland recently won the Morris County Youth Soccer Association tournament. Alejandro won the Matt Keegan memorial scholarship this year as well as being voted the New Jersey Herald’s soccer player of the year.

“I would strongly recommend Dr. Vitolo to anyone with any type of shoulder or knee injury because he isn't just a great surgeon but he’s very personable and understanding, said Alejandro. 

“I am completely better and I am now able to be in the best shape I ever have been in. 

Q & A with Dr. Vitolo-

-What surgery was performed on Alejandro?

*"Alejandro had a condition called, recurrent patellar dislocation. The surgery is called an MPFL reconstruction. It prevents the kneecap from continually dislocating."

-Will his operation to repair his injury be a permanent fix or might he experience issues later on in life ( i.e. Is he now susceptible to future problems in that same injury sight?)

*"Any injury can make you susceptible to problems in the future but the reconstruction, rather than the repair which was previously performed by another surgeon in his native country, allowed him to play the sport that he loves and at the highest level."

- Do teens heal differently than middle agers and older adults?

*"Yes teenagers certainly heal faster than older folks for a variety of reasons. Growth factors, better nutrition and faster metabolism, to name a few. Determination with many young people is also a factor."

-How do you decide what pain meds to prescribe to teens? 

*"Normally the pain is transient so most teens don't take a lot of pain medication and we don't prescribe it."

-What type of patient was Alejandro?

*"He had a previous surgery in his native country and continued to have pain. Al is very motivated to achieve his goal of playing soccer and being the best that he can be."  

Patient Story: Peter Gori

For patient Peter Gori, and others whose livelihood include physical activity, the occasional body aches and soreness are part of the job. Peter owns a landscaping business and therefore relies on his body to get the jobs done. But when that pain worsens, making movement difficult, it is time to seek professional help.

“I was never a ‘sit-down’ boss. My line of work causes me to rely on my body,” explained Peter, who was recently injured on the job. “I knew right away that I did something to my left shoulder, when I lifted a wheelbarrow filled with heavy debris.”

Peter is no stranger to shoulder or knee pain or Dr. Vitolo, who performed surgery on both Peter’s right shoulder and right knee in the past.

“When I tore the ACL in my right knee I met with Dr. Vitolo for a second opinion. After talking to him, I trusted him right away,” said Peter.

“Now after these surgeries, I wouldn’t trust anyone else. He is a phenomenal orthopedic surgeon who goes in and gets the job done.” 

 After an MRI showed significant injuries to his left shoulder, surgery was performed on May 10^th. However, the damage was worse than expected. He had three tendons that were damaged: two rotator cuff tendons and the biceps tendon. Peter continues to recover and is hoping for the best.

Q & A with Dr. Vitolo

Prognosis

“Due to the amount of damage his prognosis was guarded. But Pete could not do his job or resume his active lifestyle with the current injury he sustained.” 

 What pain can be expected following surgery?

“Initially it can be significant, but after the first few days it typically becomes manageable. 

 What after care is expected?

“Usually physical therapy for 8-12 weeks. However, because of the size of Pete’s tear, his physical therapy will be longer.”  

 Who is prone to a torn rotator cuff?

“Individuals who perform repetitive lifting like landscapers and laborers, or those who perform overhead jobs such as electricians and carpenters.  People active in weight lifting and other overhead sports such as, tennis and throwing may also experience such injuries.” 

 How common are rotator cuff tears?

“There is a one in twenty chance of rotator cuff tears in the general population. The incidences of rotator cuff tears is increasing in women.” 

 Can rotator cuff tears be prevented?

“There is no known preventive measures other than not doing the activity.  However, Pete’s surgery went well in part because he was in good physical condition to start and he has a positive attitude toward his recovery.”

 Importance of a positive attitude

“Pete was determined to get better. He owns his own business, which depends on his mobility so he was highly motivated. In addition, his desire to remain active and involved in sports and coaching also contributed to his determination to get better.  

 This is Peter Gori’s third operation performed by Dr. Vitolo. According to the doctor, with each surgery Peter has exceeded expectations from his surgery, namely a faster recovery as well as better –than- expected function after such a severe injury.

“Over 90% of the time the surgery is successful in restoring function and decreasing pain,” added Dr. Vitolo.

Peter’s right knee and right shoulder are now pain free. He hopes for the same outcome for his left shoulder. He expresses his gratitude for the surgeries Dr. Vitolo performed and believes the doctor’s skill is the reason for his successful surgery and recovery.

“I feel ahead of the game because of the work Dr. Vitolo does. He is a true professional, said Peter. “He put me back together and allowed me to resume my life. It has been life changing and I am very grateful.”

Skiing ACL Injuries and Recovery

 

The anterior cruciate ligament, frequently known as the ACL, is the most commonly injured ligament in the knee. Approximately 1 in 3,000 people injure their ACL every year. Several of these injuries occur while skiing in the winter months. Skiers are more susceptible to ACL injuries because they are constantly flying over bumps, landing a jump on the tails of their skis, recovering from a skid, or finding themselves temporarily off-balance. Most skiing injuries occur when a skier “catches an edge” as a result of these actions and their ski is pushed sideways and to the outside, resulting in a twisting motion of the knee. Advancements in surgical techniques and rehabilitation over the years have allowed patients with ACL injuries to participate in early pre and postoperative rehabilitation to return the patient to a preinjury performance level.

Before surgery, patients should focus on reducing knee swelling and establishing a normal walking pattern and active range of motion between 0° and 90°. Elevating the leg with a cold compress or using compression sleeves are two techniques that can be used to reduce knee swelling after the initial injury. If a patient is stable with a normal walking pattern, they may keep the brace unlocked and bear weight while performing daily activities. Otherwise, the brace should remain locked to provide support to the unstable knee. Patients should establish a good range of motion after the initial injury because preoperative range of motion is an important predictor of postoperative range of motion.  

To re-establish range of motion, please try some of these techniques:

1.    Prone hangs: Lie on stomach and slide down to the end of the table so that the thigh is supported and the lower leg hangs off. Hold this position for 30 to 60 seconds and repeat 5 to 10 times.

https://www.youtube.com/watch?v=nBjoOQ3D0cs

2.    Heel slides: Lying on your back, slide your heel towards your butt

https://www.youtube.com/watch?v=_jvUnWbBPXc

3.    Prone flexion: Lying on your stomach, flex your knee and bring your foot towards your butt

https://www.youtube.com/watch?v=lFz0wn_ssxs

               During the early postoperative phase (0-4 weeks after surgery), patients must strive to minimize pain and swelling, form a normal walking pattern with a goal to discontinue crutch use, achieve 90° flexion and full extension, and establish quadriceps function and control. Always ensure that the incisions are clean and dry and the knee is iced and elevated until the acute inflammation is controlled. After this inflammation is controlled, ice and elevate the leg 3 times a day for 15 minutes. Weight bearing with a brace and both crutches should also begin the day of surgery. Crutch use should be discontinued when the patient establishes a normal walk pattern without a limp and can walk up and down stairs without pain or instability. This phase is also important to establish range of motion and quadriceps function. We recommend attending physical therapy 2 to 3 times a week to extend range of motion to 120° and demonstrate straight leg raises without lag by week 4.

               During the strengthening phase (4 weeks-6 months after surgery), the brace should be shortened and unlocked. There should not be an increase in swelling or pain and the patient should focus on proper technique and achieving full range of motion as soon as possible. The following exercises should be performed during this phase of recovery: mini-squats, mini-lunges, leg press, hamstring curls, step-downs, wall sits, one-legged dead lifts, and 4-way hip exercises. Weights should gradually increase as strength improves. The patient can also start walking for exercise and use balance cushions to improve endurance and balance.

               The return to activity phase begins 3 months after surgery and ends when the patient returns to his or her sport. The patient must continue improving muscle strength with activities such as squats, lunges, plyometrics, and agility drills. At the beginning of this phase, the patient should perform low-impact activities on softer surfaces, eventually introducing walk/jog intervals and agility ladder drills, and finally cutting and pivoting with advanced plyometrics and team participation without contact. Each patient is unique and his or her return to sport should be individualized instead of follow a strict time line. Once the patient can jump without pain or instability, has full range of motion, regained muscle strength and balance, and can perform sport specific activities without pain, swelling, or instability, the patient is ready to return to the sport. 

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If you suspect you have an injured ACL, it is important to see an orthopedic surgeon. To schedule an appointment with board certified orthopedic surgeon, John Vitolo, MD, call 973-300-1553.

Bankhart Repair – Arthroscopic Stabilization of the Shoulder

Bankhart repair, also known as arthroscopic labrum repair of the shoulder, is performed to fix a detached labrum. The labrum is a circumferential structure that is surrounds the glenoid, which is the boney socket of the shoulder. There are also ligaments that surround the shoulder that attach to the labrum. Together the labrum and the attached ligaments act as a stabilizer for the joint.

A Bankhart tear occurs when the labrum is torn away from the bone. These tears are often a result of a shoulder dislocation which also tears the anterior inferior glenohumeral ligament. Because the ligaments and labrum are no longer attached to the bone, the shoulder becomes unstable and requires appropriate treatment.

Acute Bankart tears are more common in young individuals, usually under the age of 35. Initially, conservative treatment may be implemented, but if repeat shoulder dislocations occur, surgical repair of the labrum and ligaments is recommended. When surgery is indicated, arthroscopic stabilization of the shoulder or a Bankart repair is performed. 

How is the Bankart Repair Performed?

The Bankhart repair is performed by making a few small incisions in the front and back of the shoulder. A video camera (arthroscope) is inserted to view the inside of the shoulder joint. Small instruments are then inserted to perform the repair. 

The first step of the Bankhart repair is to prepare the area around the detached labrum. Any loose particles are removed and rough edges are made smooth. The orthopedic surgeon then drills a small hole in the bone by the detached labrum. An anchor and suture are then placed in the hole, and the suture from the anchor are sewn into the labrum and pulled tightly to reattach it to the glenoid. The steps are repeated for each anchor, and the amount of anchors used depends on the size of the labrum and ligament tear. The small incisions are then sutured closed. 

After the procedure, the patient is asked to remain in a sling for about 4 weeks to allow the labrum to heal to the bone. Physical therapy is then typically prescribed 3x a week for 12 to 16 weeks. Patients can normally return to desk work after 2-4 weeks and physical labor and sports within 4 months. 

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If you suspect you have a labral tear it is important to see an orthopedic surgeon. To schedule an appointment with board certified orthopedic surgeon, John Vitolo, MD, call 973-300-1553.