Sports medicine is a broad field, and there’s often confusion about what injuries and treatments are available to patients, and when you should visit a sports medicine specialist. Contrary to popular belief, sports medicine specialists don’t exclusively treat high school, college or professional athletes. All active individuals, from weekend warriors to marathoners, can benefit from their treatment. In order to explain the depth and complexity of their discipline, board-certified orthopaedic specialists Dr. Colin Looney and Dr. Scott Arthur sat down to discuss topics including common misconceptions in sports medicine, treatments and technologies utilized, and return-to-play protocol.
Looney: Here at the Bone and Joint Institute, we have three orthopedic surgeons fellowship trained in sports medicine. This includes Dr. Arthur, Dr. Derr and, me, and we have a non-operative sports medicine specialist partner, Dr. Fiechtl. We have a pretty comprehensive team for handling sports medicine injuries, including a shoulder and elbow fellowship trained orthopaedic specialist, Dr. Byram, and an excellent team of orthopaedic surgeons who also see athletes.
Looney: One thing I don’t think many people realize about sports medicine is the additional training that we complete. In addition to our orthopaedic surgery training, Dr. Arthur, Dr. Derr, and I both went to four years of medical school and then received five years of excellent musculoskeletal training as orthopaedic surgery residents. Afterward, we each completed an additional fellowship in the musculoskeletal care of athletes. It may not be well known that we’ve taken this track, but we did it because we enjoy working with athletes and taking care of athletic injuries. We’re also really fortunate to have Dr. Fiechtl on our team, who trained in emergency medicine and completed a non-operative sports medicine fellowship. So, he actually comes at it from a different angle than we do.
Arthur: Sports medicine is a broader discipline when compared to some of our other practices here at the Institute. Some of the common practices of sports medicine care include sideline and game coverage, so we’re able to quickly care for those in-game injuries. A significant portion of our surgical work involves arthroscopy, which is a minimally invasive procedure to take care of a joint and can include hips, knees, shoulders and more. Much of the sports medicine arthroscopy work can bleed over to folks who wouldn’t necessarily be considered “athletes.” We also treat issues like torn rotator cuffs, ligament damage, and other common injuries.
As a sports medicine specialist, we do treat a broad range, including elementary-aged kids, high school, college and professional athletes, and everyday people who wish to remain active later in life. We are also fortunate enough to have an athletic training program that serves our county and private high schools in the area, as well as strong relationships throughout Middle Tennessee. Part of what we enjoy is keeping people doing what they love.
“MUCH OF THE SPORTS MEDICINE ARTHROSCOPY WORK CAN BLEED OVER TO FOLKS WHO WOULDN’T NECESSARILY BE CONSIDERED ‘ATHLETES.’ WE ALSO TREAT ISSUES LIKE TORN ROTATOR CUFFS, LIGAMENT DAMAGE AND OTHER COMMON INJURIES.” – DR. ARTHUR
Looney: Arthroscopy is the term for looking inside of a joint with a camera, then doing work inside the joint basically through poke holes. When I was in residency, a majority of the injuries I would treat would be done with an open incision; but during my fellowship, I learned techniques in which we can go in and address these injuries arthroscopically through smaller poke holes.
A common ailment I’ll treat with hip arthroscopy is labral tears of the hip, which is also called impingement of the hip, where the hip actually impinges with a bump that rubs on the labrum until the labrum tears. The labrum is a suction seal or gasket around the hip joint that’s full of nerves, and when it tears, it hurts. We will go in arthroscopically, repair the damaged area and address the impingement by contouring down the bump. So, the surgery is basically fixing gaskets and taking away bumps.
Looney: Technology really continues to propel us in orthopaedics, particularly in hip arthroscopy. I use some computer-navigated technology to help us address and contour these bumps (CAM lesions) when we see labral tears and make sure we’ve addressed them fully. We use these computer-navigated technologies as part of an integrated methodology where we develop a three-dimensional model of the patient’s hip before we enter the operating room. So, it helps me plan the surgery and ensure that we’re addressing the problem completely while we’re in the operating room.
Dr. Arthur and I also use robotic-assisted devices where can we do a joint replacement with a robotic arm. It doesn’t perform the surgery, but aids the surgeon in making very precise cuts in joint replacement. I’ve been doing robotic-assisted knee surgeries for about two years, and I’ve done robotically assisted hip replacements for about five.
Arthur: Sports medicine covers a wide variety of issues. For the knee, simple arthroscopies for torn cartilage in the knee, meniscus tears and ACL injuries are common. From the shoulder standpoint, especially in younger athletes, the labrum is also found in the shoulder and is typically torn from a dislocation or an instability event. We used to do a lot of those with an open incision; but now we’re able to manage most of them arthroscopically, which is significantly less invasive and traumatic. There are also rotator cuff injuries that we tend to see from the older patient group. As Dr. Looney previously said, in residency we did almost all open rotator cuffs. Now, it is pretty rare that we do anything but arthroscopic. The use of minimally invasive procedures leads to better initial pain recovery and rehab duration, so our patients can get back to what they love doing, faster.
Looney: Dr. Arthur is too modest. Our practices complement each other because he does a lot of procedures that I don’t, so we frequently exchange patients. Dr. Arthur trained with Jim Andrews, who has really propelled surgery on the elbow for pitching athletes. Due to his extensive training and background, Dr. Arthur treats of a lot of elbow injuries, while I specialize in hip arthroscopy. So, although we do overlap quite a bit, we both have our specialties.
Arthur: Another technological advancement can be seen in cartilage restoration. A lot of knee patients we treated in their 40s are now coming back when they’re 60 needing knee replacements. So, a lot of our interests are now being centered on joint preservation over simple repair. Especially in the knee, we’re using cartilage transplant procedures, where we can correct a defect in the joint using cartilage that we’ve either grown in the lab from a sample the patient provided or from a donor to preserve the original joint rather than replacing it. The procedure is less invasive and produces a better timeline for the patient’s recovery and preserved health down the road.
Looney: Sports medicine is really a multidisciplinary specialty, so we’re always working closely with our physical therapists and athletic trainers to coordinate care for our athletes. When we have an injured athlete, we make the determination not only based on what we see in the clinic examination room, but in their functionality as well. We will coordinate with our physical therapists, who have been rehabbing the athlete, as well as the athletic trainer, who works with the athlete daily, to determine if the athlete is ready to return to play. Often, if it’s a major reconstructive surgery, we’ll do a sports-specific functionality test to make sure that they’re ready to play their sport.
Arthur: The timeline for returning athletes to play is an area that I believe in general has been poorly executed across medicine. Often, we go by calendars where, after a certain number of weeks, we assume an athlete has hit a milestone. Recovery is not a calendar-driven process; it’s a functionally driven process. We’re trying to establish concrete milestones and criteria that must be met before an athlete can be cleared. Specifically with ACLs, we have functional tests using biomechanical analysis that use electrodes to test and observe how your body reacts to activities that simulate sporting activities. We’re trying to take that to the next level to where we can use this information to be more preventive on the front end. By focusing on the functionality aspect, we hope to diminish the amount of re-injury that can commonly occur with sports-related injuries.
Arthur: From a sports medicine standpoint, the physical therapists and athletic trainers are such key pieces. Sitting in the office and examining a shoulder, knee or hip will only give you a piece of the information. How they look on the field is vital, so a team approach is very important. We have a surgery center now open downstairs, so we can comprehensively manage a patient’s care from beginning to end. Some sports medicine injuries, such as concussions, will fall out of the realm of orthopaedics, so it is vital to have team members that can help manage the total athlete. Dr. Fiechtl on our team specializes in this treatment, so we’re able to handle any sports-related injuries that we encounter. We are lucky to have such a great team.
For more information about sports medicine at the Bone and Joint Institute of Tennessee, visit our website at https://boneandjointtn.org/specialties/sports-medicine/. To schedule an appointment, visit our online scheduling tool or give us a call at 615-791-2630.