Giving knee injuries a sporting chance

By: Fiachra Ó Cionnaith – Medicine Weekly – Wednesday, May 10, 2006

Fiachra Ó Cionnaith spoke with Dr Richard Steadman about how severe knee
injuries may no longer mean an end to an international sporting career

Performing surgery on a patient is stressful enough; to perform it on a professional
athlete with millions of euro depending on the operation’s success is even
more so. Yet some people seem to thrive in this pressure-cooker environment.

In the three decades that Dr Richard Steadman has been working in the orthopaedics
field, the renowned surgeon has worked ‘miracles’ for countless
athletes across the world, in a process pioneering how knee injuries are approached
and ultimately overcome.

Since the mid-1980s the Colorado-based surgeon has successfully operated on
Irish legend Roy Keane, the likes of Brazil and Real Madrid superstar Ronaldo,
German World Cup winning captain Lothar Matheus, tennis Grand Slam winners Monica
Seles and Martina Navratilova, and a host of hall-of-fame American football
players including Dan Marino and Joe Montana.

“If I were to get injured, although it could keep me from participating
in my favourite recreational activity, I could just shift to another —
a professional athlete simply does not have that flexibility,” Dr Steadman
told Medicine Weekly in a recent interview after the Winter Olympics.

“Everyone that has an injury has a projection for the level they need
to get back to, but it’s more focused with professional athletes because
they have to get back to the highest level of their specific sport. Because
of that the treatment, including surgery and rehabilitation, has to be tailored
so that they can get back to the highest level in their sport.”

A native of Texas, Dr Steadman’s path to treating the leading athletes
of our time began after he left his role as a US army surgeon to take up an
orthopaedics residency, specializing in knee disorders, in New Orleans. In 1976,
the US Ski Team appointed him their chief physician, and within four years Dr
Steadman had helped no less than 14 future World Championships and Winter Olympics
medallists to recover from a variety of serious — and in some cases career-threatening
— knee injuries.

Athletes in almost every sport were soon flocking to him to benefit not only
from his surgical skills but also his innovative rehabilitation techniques;
techniques which, while at the time were unique, have since been adopted worldwide
as the key protocols of orthopaedic medicine.

A key reason for this is the micro-fracture, a surgical technique he refined
in the early 1980s that allows for the use of bone marrow to make new cartilage.
This surgical technique has been behind many of the recoveries of Dr Steadman’s
most high-profile patients and, to date, no other knee surgery procedure has
proven to be more effective. Although other procedures are being developed,
such as stem cell treatment, the micro-fracture is still considered the benchmark
of knee surgery.

“What I tried to do with the micro-fracture was bring together a procedure
that had a good ability not only to make the new cartilage but to anchor it
to the bone and then come up with a rehabilitation programme that would enhance
the ability of it to become a long-standing and long-operating cartilage.

“I know of at least three studies being carried out at the moment that
compare the micro-fracture with other types of cartilage procedures. The first
one would say there’s no improvement were the patient’s own cells
are grown in the lab and put back in — in a randomized study the micro-fracture
came out equal with that, if not slightly better. As a result of that study
the benchmark now is micro-fracture.”

Post-injury techniques have also become increasingly important in recent decades.
“In the late 1970s and early 1980s I treated a lot of well-known athletes
and in those days the therapy was not what it should be. I recognized this and
so did the athletes, so I became physically involved in not only the surgery
but the therapy as well. That really gave me a better sense of what’s
required and what level an athlete can come back to after serious injury.

“In my view, if you are going to quantify the importance of different
steps after injury, the early post-injury period is the key because surgery
needs to be done in a way that allows for early rehabilitation and early mobilization.
The fixation has to be good, the understanding of the different ranges of motion,
and then as you go from that level you have to recognize the importance of mobility.

“My experience has shown me that mobility seems to be the key in getting
a joint to come back to its highest level and to maintain that level, with the
onset of arthritis as a result of early return.”

One of the downsides of his specialty, however, is that when an injury is too
severe to overcome he is often the one who has to first mention the dreaded
‘r’ word — retirement. After reaching the heights of being
voted World Footballer of the Year, Marco van Basten had to face such a reality,
but Dr Steadman was adamant that despite the pressure placed on the athlete
to continue, sometimes accepting defeat really is the best long-term choice.

“I’ve had to tell a number of very successful ones that if they
try to continue at their level they will suffer in the future. You can’t
try to make your knee fit your sport.”

For those that don’t heed this advice, the focus of Dr Steadman’s
latest work — the long-term injury concerns for retired sports stars —
should be of genuine interest. In the surgeon’s view, the improvements
being made in arthoscopic procedures, the use of hyaluronic acid in the prevention
of joint injuries while still competing and other medical developments can significantly
reduce the onset of arthritis and the need for knee replacements as time takes
its toll.

It’s research that is not only of benefit to the leading sports stars’
of the day, however. In Dr Steadman’s view, what can be learned from innovative
techniques to help improve the recovery of this select group of patients will
ultimately be of significant benefit to the rest of the population.

“Recreational athletes can learn a lot from the super athlete. The super
athlete is like a race car that technology goes into, but the technology spills
over into the general population.”

Article Source: Medicine Weekly

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