Sports Medicine Research: Pushing Limits to Improve Patient Care

Medical treatments should always be based on the best available evidence. But sometimes, the best evidence isn’t good enough. “We should always be looking to get better,” said Edward Chang, MD, an orthopedic surgeon and researcher at Inova Sports Medicine.

That mission is why Inova Sports Medicine investigators are working on a number of exciting research projects to improve care for patients. Some current examples:

• Improving treatment for dislocated knees. Some young athletes who dislocate their patellae (kneecaps) are at increased risk of future dislocations. Repeated injuries can potentially damage the cartilage in the knee and lead to early arthritis. Typically, doctors treat a first-time dislocation with bracing and physical therapy. But some orthopedic surgeons believe early surgery to stabilize a dislocated kneecap will lower the odds of a repeat injury. “The truth is, we don’t really know what treatment is better,” Chang said. To find out, Inova is participating in a national multicenter study to determine whether early surgical repair helps reduce the risk of recurrent dislocation. “We’re excited to be a part of this study and hopefully find the answer,” said Chang.
• Return to play after ACL reconstruction. Anterior cruciate ligament (ACL) tears in the knee are common in athletes. Current recommendations about returning to play after ACL reconstruction surgery are based on how much time has passed — but healing time varies from person to person. “In the last 15 years, we’ve made significant advances in ACL surgery. But we haven’t changed much on the post-op and rehab side,” said Chang. Hoping to change that, Inova’s physicians and physical therapists are collaborating on a study to create a checklist of physical milestones to predict when a patient can get back to physical activity. Checklist items include measures of knee stability and the patient’s performance on hopping and agility drills. “We hope having more objective data will decrease the rate of re-injury,” Chang said.
• Tommy John surgery alternative. For throwing athletes such as baseball pitchers, tears to the ulnar collateral ligament (UCL) are both common and devastating. The typical treatment is UCL reconstruction (Tommy John surgery), which replaces the damaged ligament with a tendon from elsewhere in the body. It’s a pretty successful procedure: As many as 70 to 80 percent of people who have Tommy John surgery will return to their previous level of activity after they heal, Chang said. But it takes an average of 12 to 18 months for an athlete to return to play after the surgery. Chang and his colleagues are beginning to study whether a torn UCL can be simply be repaired rather than reconstructed with Tommy John surgery. “Advances in technology over the past few years are allowing us to consider repairing the ligament — especially in young athletes whose ligaments haven’t worn out from wear and tear. The potential benefit is that it may allow athletes to return to throwing as early as 6 months after surgery,” Chang said. Researchers still have to test the procedure in patients before they can recommend this Tommy John alterative. But if studies show the repair technique is effective, it might help young athletes get back in the game sooner.

Physicians and researchers at Inova Sports Medicine want to push the limits of medicine, Chang added. “We’re constantly challenging ourselves to find new techniques to improve patient outcomes.”

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Inova Sports Medicine is the Official Sports Medicine Partner of the Washington Nationals.