What Kobe Bryant’s Surgery Means to You!

Kobe Bryant has recently undergone a rotator cuff repair which has ended his 2015 season and may jeopardize his career. The purpose of this blog is to explain the function of a rotator cuff, how it can tear and what the symptoms are and to outline the various treatment options that are possible. Each patient does not have the same physical demands and expectation of function that Kobe must have and each patient must individualize their treatment program based on their own needs and goals.
The rotator cuff is made up of four tendons that blend together and rotate the shoulder. A tendon is a structure that connects muscle to bone and is the pulley that lifts and rotates the shoulder. A tendon can tear from an acute, significant injury like a fall onto the shoulder or dunking a basketball such as Kobe or it can be a chronic, repetitive stress that tears a degenerative tendon such as merely lifting a suitcase.
The tendon is under tension like a guitar string and pulls apart and can no longer function as a shoulder rotator. The patient will complain of pain particularly on overhead activities and weakness to external rotation.
Patients of all ages who develop these symptoms should be seen by an orthopaedic surgeon as the sooner a diagnosis is made the sooner the appropriate treatment can be initiated based on the patient’s age, level of pain and weakness and their own goals and demands.
An MRI (Magnetic Resonance Image) is the diagnostic test that confirms the diagnosis. (A standard x-ray will not visualize the rotator cuff tendon) All insurance companies will pay for this procedure as it is the standard of care.
The problem with rotator cuff tears is that if untreated many progress in size and lead to more pain and more shoulder weakness and loss of function. A number of the tears, however, do not progress and current reasearch protocols are trying to determine which tears progress and which tear should definitely be treated with surgery.
In general younger patients (less than 60) should be treated with a surgical repair as a tear will progress in younger, more active patients. Older patients (greater than 70) can be treated with physical therapy to build up the surrounding muscles to compensate for the torn muscle-tendon joint. Patients between 60 and 70 need to individualize their care based on their symptoms and goals.
The GOOD NEWS is that a surgical repair of a torn rotator cuff tendon is highly successful with results greater than 90% in most studies.
I spent a year studying the surgical repair of the rotator cuff with Frank Jobe, the legendary shoulder surgeon who founded the Kerlan-Jobe Orthopaedic Clinic. The doctors here at the Los Angeles Orthopaedic Institute have performed thousands of rotator cuff repairs and would welcome the opportunity to outline an appropriate treatment for you and your rotator cuff!
Keep Moving!
Dr. Sisto

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Springtime

SPRINGTIME has arrived and the best aspect of April is the beginning of the new baseball season! Baseball diamonds are alive throughout the San Fernando, Santa Clarita and Antelope Valleys and high school and college athletes as well as weekend warriors are enjoying Americas Past-time!
The ecstacy of hitting the ball and running the bases and, possibly, sliding into home plate exceeds the enjoyment of any other sport. Hitting a home-run to end the game and jumping on home-plate is a DREAM COME TRUE which is possible no matter what level of baseball you play.
Unfortunately, injuries are a part of the game and the shoulder, elbow and knee are the most vulnerable areas to be effected.
 Fortunately,  however, the orthopaedic surgeons at The Los Angeles Orthopaedic Institute take care of the most elite baseball players in our area and will take care of the injured athlete and maximize their return to baseball.
We are the team orthopaedic surgeons for Cal-State Northridge University (CSUN) which means that we are the only doctors taking care of elite Division I scholarship baseball players in the San Fernando, Santa Clarita and Antelope Valleys. We are the only surgeons that CSUN would trust to operate on those scholarship athletes many who go on to play professional baseball!!
We also care for the baseball teams for Pierce College, Antelope Valley College and Mission College as well as many of the high schools in the Tri-Valley area! We are also the team physicians for the Lancaster Jethawks which is the minor league team for the professional Houston Astros organization.
If you love baseball as much as we do and are injured, please call the baseball orthopaedic specialists at The Los Angeles Orthopaedic Institute to be treated as well as our elite scholarship and professional baseball players!!

Keep Playing!

Dr. Sisto

ACL Tears – Autografts vs. Allografts

Tears of the anterior cruciate ligament of the knee are devastating injuries and, unfortunately, are on the rise in incidence. There are many factors to explain this but the increase is primarily among female athletes.
The treatment of a torn ACL is surgical in young patients and in older athletes who do not want to stop competing and enjoying sports.
Two recent events have occurred which verifies that the surgical procedures done by the surgeons at The Los Angeles Orthopaedic Institute are the BEST to reconstruct the ACL.
Two long term studies have just verified that allografts are inferior compared to autografts to reconstruct a torn ACL. Allografts are tissue from a cadaver (dead body) and an autograft is from the patients’ own body. The advantages of an allograft are smaller incisions and less pain in the first week post-operatively. The disadvantage, however, is a higher FAILURE rate which is unacceptable.
We have always known that autografts are superior and we have ALWAYS recommended autografts to our athletes!
The choice of autografts is either the patients’ patellar tendon or the hamstrings. We have always preferred the patellar tendon for THREE main reasons.
#1 – The patellar tendon has bone on either side and we get bone to bone healing which is the quickest and strongest graft!
#2 –  The patellar tendon is the strongest graft!
#3 –  We do not want to sacrifice the hamstring tendons as this leads to knee weakness and stress on the reconstructed knee.
Adrian Peterson, the elite running back for the Minnesota Vikings just returned from ACL surgery and had his best running year ever. Of course he had a patellar tendon autograft which is what we have been performing in our patients over the past twenty years.
The Los Angeles Orthopaedic Institute surgeons are the orthopaedic surgeons for Calstate Northridge (CSUN) which are the only Level I Scholarship Athletes in all of the San Fernando, Santa Clarita and Antelope Valleys. The most elite athletes, coaches and trainers have selected us to perform these surgeries on their athletes for over 15 years!
We hope you maintain healthy knees but if you or a friend tears the ACL we should be your FIRST CHOICE!

Stay Healthy,
Dr. Sisto

ACL Tears

Mariano Rivera, the star pitcher of the Yankees, and Derrick Rose, the top point guard in the NBA, both recently tore the Anterior Cruciate Ligament (ACL) which is the main stabilizing ligament of the knee. Their notoriety has thrust the importance of the ACL into the national headlines but for thousands of athletes all over the country an ACL tear is a common and serious injury to their own knees.
We are the Team Physicians for Cal State Northridge (CSUN), Antelope Valley and Mission Community Colleges. In addition, Chaminade and Milken High Schools as well as the Lancaster Jet Hawks which is the Single A affiliate of the Houston Astros professional baseball team. We have taken care of many high school athletes with torn ACL’s and we recognize the magnitude of the injury and the program which is required to overcome the surgery and return to the same level of athletic performance.
ACL injury is extremely common with more than 100,000 ACL reconstructions performed annually in the United States. The majority of the ACL injuries occur in athletes but work and auto accidents also are common. Associated injuries include meniscus tears (the shock absorber of the knee) and bone contusions.
An untreated ACL tear will lead to an unstable knee and there is an increased incidence of additional injury to the knee if surgery is avoided. Patients who participate in aggressive cutting and pivoting sports, such as basketball, soccer, volleyball, lacrosse and tennis have a high rate of recurrent instability without ACL reconstruction. In view if this, athletic patients who choose to return to these sports generally undergo surgery soon after the injury.
The technique for ACL reconstruction involves placing a free tendon graft in the anatomic position of the ACL. The tendon graft can be taken from the patient’s injured knee or from a donor. All graft choices have advantages and disadvantages.
We perform over 200 ACL reconstructions each year at our Sports Center at The Los Angeles Orthopaedic Institute. We take care of the most elite athletes in Southern California. If you have an ACL tear, please contact us for an in-depth discussion of which treatment option will be best for you to maximize your recovery and return to your highest level of athletic performance.
 

What Is “PRP”?

Kobe Bryant has just traveled to Germany to have a “PRP” injection and everyone wants to know what this is about. PRP stands for Platelet Rich Plasma which is a new injectible, non-surgical technique to stimulate healing of chronic soft-tissue injuries of the knee, shoulder, elbow and ankle joints. The technique is perfomed in thw office and a small amount of blood is taken from the patient and this is placed in a special machine which concentrates the “healing portion” of the blood into a concentrated healing “super fluid.” It is than injected into the patient’s joint under ultrasonic visualization.
  The early results for lateral epicondylitis (Tennis elobw), patellar tendonitis (Jumping knee) and rotator cuff tendonitis have been great. We are the team physicians for Cal-State Northridge (CSUN) and have performed PRP successfully for these problems. The role of PRP in the treatment of degenerative arthritis (Kobe’s diagnosis) is very controversial and is unknown at this time.
  Schedule an appointment if you have a chronic soft-tissue injury or degenerative arthritis and we can discuss whether PRP is an option for you.

Stay young!
Dr. Sisto

Meniscus Transplantation

I performed a lateral meniscus allograft transplantation today and this procedure reminded me of the amazing technological advances that knee injuries have made recently.

A meniscus allograft transplantation is performed when a patient has had a previous removal of the majority of the medial or lateral meniscus.

The meniscus is the cartilage soft tissue shock absorber of the knee which is located between the femur (thigh bone) and tibia (shin bone). There are two menisci in each knee. One on the inside which is the medial meniscus and one on the outside which is the lateral meniscus.

A twisting injury with a combined compressive force across the knee can tear the meniscus and lead to pain and locking of the knee
.

The meniscus has a poor blood supply and rarely heals when it is torn. The treatment of a meniscus tear is arthroscopic surgery. “Arthro” is the greek work for joint and “scope” is to look inside so we put a small camera in the knee to visualize the joint. The ideal treatment of a meniscus tear is to surgically repair the meniscus with multiple sutures. Unfortunately, many meniscus tears are not able to be repaired and require a meniscectomy or a removal of the torn portion preserving as much of the normal meniscus as possible. Rarely, the entire meniscus is removed and these unfortunate patients are now at risk for early degenerative arthritis because the normal shock absorber between the femur and tibia is absent.

A relatively new technique is now performed which transplants a “cadaver” meniscus (a young person who has died and donates their meniscus) to give the patient a brand new meniscus. The success rate is high and the early results following this surgery eliminate knee pain and, hopefully, prevent or delay the onset of degenerative arthritis.

We perform meniscus transplantation as well as many “new age” procedures to repair cartilage to keep the knee “young” and maximize the patients’ ability to return to sports and a high level of physical activity. Our goal is to avoid or significantly delay the need for a joint replacement surgery.

Please contact us if another surgeon has told you that there is “nothing else to be done” for your knee or a joint replacement has been recommended for you. Our advanced techniques may keep you and your “own” knee at a high level of function.

Have a great summer!
Dr. Sisto

Get Fit with No Pain!

The Wall Street Journal published an interesting article on Tuesday April 12, 2011 titled “Doctors New Advice for Joint Pain is Get Moving.”


The message is that “doctors increasingly are recommending physical therapy to help osteoarthritis patients, overturning the more traditional medical advice for people to take it easy and protect their joints.”


I have always advocated this philosophy and our studies of our patients have shown that weight loss combined with exercises aimed at improving joint function and building up muscles that support the joints can significantly improve patients health and quality of life compared with medication alone.


Mild exercise can be painful at first but, with time, the benefits accumulate as reduced pain and greater mobility. Strengthening the muscles around the knee and shoulder can help support the joints and take over some of the shock-absorbing functions of the cartilage. Regular activity can also replenish lubrication to the cartilage of the joint to reduce stiffness and pain. Aerobic activity such as swimming, walking or cycling which do not put heavy stress on the hips, knees and spine can reduce inflammation in the joints, as well as improving overall fitness and weight control.
I have designed an exercise program which can be started to build up strength and unload the knee joint and reduce knee pain. Please speak to me about this and I can introduce you to our Athletic Trainer, Rick, who can customize a program for you and your musculoskeletal system.


Get Fit with NO PAIN! 


Dr. Sisto