Category: Press Releases

Keeping Wrists and Ankles Safe at the Gym

For Immediate Release

Keeping Wrists and Ankles Safe at the Gym
Top sports orthopaedist explains how to avoid injury to the wrist and ankle

NY, NY and Greenwich, CT, July 2008 Going to the health club might seem the simplest of acts: You show up, do your workout whether it’s lifting weights, taking a class or playing a game of racquetball and then you’re done.

But avid gym-goers can be setting themselves up for injury, says Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area. And wrist and ankle injuries both the sudden and the chronic kind can be especially problematic. Ankles are essential for all normal activity, from walking down the street to running a marathon, and repeated (or untreated) injuries can permanently damage them. For its part, the wrist is one of the most complex joints in the body, with 15 bones and an elaborate system of ligaments holding it all together. That means that when something goes wrong in the wrist, it can be tough to fix and its critical to see an orthopaedic hand surgeon specialist.

Here are six ways to keep your wrists and ankles safe at the gym.

• Choose the right shoes. If you participate in an activity more than three times a week, you should be wearing shoes specifically designed for that activity, Plancher says. This can do a lot to protect your ankles, he says. Ankle sprains, the most common sports-related injuries, occur when a ligament in the ankle is strained beyond its normal limits. Sprains can strike when your ankle rolls to the side, wrenching the ligaments (and leaving you sidelined for several weeks). Lots of people wear running shoes to the gym, but running shoes are designed for just that, explains Plancher. They put your foot and leg into the best position to propel you forward. That means wearing running shoes when you’re playing a sport that incorporates lots of side-to-side movements, like tennis, basketball or squash, could leave you with a sprained or even broken ankle. Shoes designed for cross-training would be more appropriate in these situations.

• Reduce overuse. Believe it or not, carpal tunnel syndrome is not just for desk jockeys. Anyone who subjects his or her hands and wrists to repetitive movements can get carpal tunnel syndrome, Plancher says. It’s fairly common among people who play racquet sports, as well as people who regularly work out on rowing machines and stationary bikes. The first sign is often a burning or tingling feeling or the sensation that your hands or fingers are falling asleep. Over time, carpal tunnel syndrome can result in permanent nerve damage.
  Ankles are subject to their own type of repetitive stress injury: Tarsal tunnel syndrome, which is generally caused by ill-fitting shoes that irritate and inflame the ligaments running from the foot to the ankle.

• Watch your form. If you like to lift, be sure you’re doing it perfectly, says Plancher. Weightlifters experience high compression forces on their wrists, and that force can cause sprains and other injuries. Likewise, tennis (and other racquet sports) players should pay attention to their form to avoid the type of rapid or awkward rotation that can disrupt the stability of the wrist. Throwing or twisting your arm in an unnatural way, especially if you do it in a rapid, explosive way, can seriously injure the ligaments in your wrist, Plancher says.

• If the bike fits. Cyclists (including spinning class aficionados) are prone to a condition called handlebar or cyclists palsy. When you lean your hands on the handlebars and bend your wrists backwards, the pressure can compress the ulnar nerve, which runs through the palm and up into the wrist. Like carpal tunnel syndrome, cyclists palsy can be a serious condition, resulting in permanent nerve damage if not treated properly.

The answer: Make sure that your bike is fitted properly. (This can be tricky if you use a different bike every time you hit the gym, so be sure to give yourself a few minutes to adjust the saddle and handlebars before you start pedaling.) Riding on a bike that doesn’t fit can make you lean too far forward and put extra strain on your hands and wrists, Plancher says. Invest in padded cycling gloves, switch hand positions during your ride, and periodically shake out your hands and stretch your forearms.

• Stretch and strengthen. To protect your wrists, take the time to stretch the muscles in your forearms and hands before working out, and take frequent stretching breaks during your workout, Plancher advises. Ankles will benefit from stretching your lower legs: Achilles tendon and calves as well as shins. To help keep ankles stable (and sprain-free), strengthen the muscles in your lower legs with exercises like calf raises. Likewise, keep your wrists healthy by building strength in your forearms, upper arms (triceps and biceps) and shoulders. Doing appropriate strengthening exercises builds strength, but it also increases your mobility and range of motion, both of which help you avoid injury, Plancher says.

• Don’t tough it out. Many athletes feel they should work through the pain, Plancher says, and that might be good advice if your pain is plain old muscle fatigue. Maybe you’re starting a new routine or you’re simply feeling tired or uninspired in your regular workout. But it’s absolutely the worst thing you can do with a joint injury. Continuing an activity thats caused or exacerbated an injury to your ankles or wrists can cause serious, even permanent damage. A better rule, says Plancher: Don’t do any activity that hurts, and don’t return to an activity until you’re pain-free.

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Kevin Plancher, MD Selected to “America’s Top Doctors”

For Immediate Release

New York Orthopaedic Surgeon, Kevin Plancher, MD, has Been Selected Once Again to Be in Castle Connolly’s America’s Top Doctors

Kevin Plancher, M.D., a renowned New York orthopaedic surgeon and Sports Medicine Specialist has once again been selected to be in the prestigious 7th and latest edition of Castle Connolly’s America’s Top Doctors.

America’s Top Doctors profiles more than 5,000 of the nations top Doctors. It is the product of an extensive peer-nominated survey process. Over the years and throughout previous editions, the Castle Connolly physician-led research team has developed its database of physicians across the nation through periodic mail, telephone and email surveys. This cumulative database is continuously maintained and systematically updated. The result is a carefully researched and highly selective list of the top specialists in the nation, among the very best in their specialties as well as their communities. Doctors do not and cannot pay to be included in any Castle Connolly guide or lists.

Dr. Plancher formed Plancher Orthopaedics and Sports Medicine with offices in New York City, The Bronx and Greenwich, Connecticut. Plancher Orthopaedics is a leader in the field of Orthopaedics, Sports Medicine, and acute emergency treatment of sports injury and rehabilitation. He is an official orthopaedic surgeon for the U.S. Ski and Snowboard teams and is the Chairman of the Orthopaedic Foundation for Active Lifestyles in Greenwich, Connecticut, a not-for-profit foundation whose major mission is to effectively promote, support, develop and encourage research and education concerning orthopaedic care and advancements in musculoskeletal diseases. Dr. Plancher is an attending physician at New Yorks, Beth Israel Medical Center.

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Shoulder Pain in Overhead Athletes Now Cured

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Shoulder Pain in Overhead Athletes Now Cured with a New Arthroscopic Technique

Serious athletes and active adults who participate in “overhead” sports – from throwing baseballs and swinging tennis rackets to playing volleyball and swimming – frequently experience weakness and pain in the shoulder region. The most common cause is inflammation or tearing of one or more of the muscles and tendons that make up the rotator cuff. But recent research by the Orthopedic Foundation for Active Lifestyles (OFALS) in Cos Cob, Connecticut – led by its founder and leading sports orthopaedist in the New York metropolitan area – confirms the existence of a little-known ligament called the spinoglenoid. This ligament is to blame in some cases of shoulder dysfunction, causing misdiagnosed patients to undergo ineffective physical therapy and other treatments.

“Until recently, little was known about the spinoglenoid ligament,” explains Kevin Plancher, M.D. In Dr. Plancher’s OFALS study1, he and his team were able to confirm the existence of this ligament in 100% of cadavers studied. The spinoglenoid ligament stretches from the spine into the shoulder, traveling through a bony structure called the spinoglenoid notch.

“Tight squeeze” of ligament and nerve cause trouble, Dr. Plancher continues, “The ligament runs through the back of the shoulder, often constricting the suprascapular nerve – one of the major nerves in the shoulder region that delivers sensation and messaging to the two main tendons of the rotator cuff, the supraspinatus and the infraspinatus. In fact, the suprascapular nerve is responsible for the major function of the shoulder joint, he adds, “The spinoglenoid ligament can compress the nerve, similar to carpal tunnel in the hand, leading to marked weakness and pain that mimics the symptoms of rotator cuff injury.”

“An MRI to investigate the condition of the rotator cuff, coupled with an electrodiagnostic study of the suprascapular nerve, can pinpoint whether the injury is muscle/tendon related or nerve-related,” Dr. Plancher advises. Physical therapy to rehabilitate this condition is not effective for the long-term, but may alleviate discomfort temporarily. Injections can often confirm the diagnosis.

New arthroscopic procedure hastens return to play. In the past, the most frequently prescribed treatment for nerve compression in the shoulder was to cease the activity that caused the compression, followed by six months to a year of intensive physical therapy specifically designed to alleviate the tendon’s compression of the nerve. More often than not, athletes with this type of compression never returned to their sports of choice. However, Dr. Plancher recommends a relatively new arthroscopic technique that provides more immediate relief from pain and possible restoration of shoulder function.

“Within the region of the spine to the shoulder, there is a massive web of ligaments, tendons and muscles that power the movements of the back, shoulders and arms,” Dr. Plancher points out. “The spinoglenoid ligament can thicken for overhead athletes, and when it causes more harm than good by compromising nerve function, patients can benefit from a procedure called ‘spinoglenoid ligament release,’” he adds.

This new arthroscopic approach involves arthroscopically detaching the ligament at the shoulder site and removing it from its position overlying the suprascapular nerve. With this procedure, patients experience much faster relief of pain and weakness in the shoulder, and can often return to overhead sports with little more than a brief course of physical therapy to strengthen surrounding muscles, tendons and ligaments,” Dr. Plancher says.

Dr. Plancher founded The Orthopaedic Foundation for Active Lifestyles in 2001 to promote, support, develop, and encourage research and education concerning orthopaedic care and advancements in musculoskeletal diseases. Clinical research at OFALS concluded recently includes a comparative study of a new anti-inflammatory versus a popular prescription anti-inflammatory on patients with osteoarthritis of the hip, and a head to head comparison of two prescription medications for decreasing low back pain. A third study is now being completed to evaluate the effectiveness of an injectible cosimane type drug for osteoarthritis of the knee. Soon this medicine will be tested in the shoulder as well.

“In just a few short years, OFALS has had the opportunity to make great contributions to the field of orthopaedics, both in our understanding of how the human anatomy works and in how to improve the quality of life for patients with orthopaedic injuries and diseases,” Dr. Plancher concludes. “We take great pride in our progress to date, and we’ll continue to research and report on new developments and improvements in the field.”

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8 Simple Rules for Preventing Knee Injuries When Getting In Shape

For Immediate Release

8 Simple Rules for Preventing Knee Injuries When Getting In Shape
Leading orthopaedic surgeon offers his advice for workout safety

NY, NY and Greenwich, CT, July 2008 Knee injuries are frequent occurrences in sports and as a result of exercise. We certainly encourage people to work out on a regular basis, but it’s important to recognize the even simple exercises in the gym or playing sports can produce some serious injuries if they’re not performed correctly or under the right conditions, explains orthopaedic surgeon Kevin Plancher, MD, a noted sports medicine expert.

The most common types of knee injuries from cutting and pivoting sports like tennis, skiing (snow and water), soccer, to name a few, are to the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), which connect the thigh and shin bones, and stabilize the knee, preventing hyperflexion (bending backwards) and side-to-side swing. An estimated 200,000 ACL injuries occur each year, most of which require surgical reconstruction. Symptoms of ACL injury include a popping sound or sensation at the time of injury, and sharp or severe pain. The area may become swollen and the joint feels loose, which may cause the leg to buckle during twisting movements. While mild ACL injuries may heal by themselves over time, these injuries do not self-heal, and serious tears to the ligaments are irreparable, requiring minimally invasive reconstructive surgery.

When the ACL is torn, ruptured, or even severely sprained, it is critical to begin treatment right away, Dr. Plancher advises. When treatment of ligament damage is delayed, it can increase the need for more aggressive treatment down the line, and compromise the chance of full recovery, he explains.

Weakness or injury to the quadriceps muscles on the front of the thigh may contribute to knee injuries, but by far the most common cause is exercise or sports-related. Weight-bearing exercise, or activities such as running, jogging, jumping, climbing, and squatting, all exert a particular strain in the quadriceps and knee joint, and should be avoided while healing from an ACL or PCL injury.

Women’s bodies may make them more prone to knee injuries, a phenomenon that is possibly attributable to anatomical differences, such as a wider pelvic girdle, lower center of gravity, and smaller, narrower kneecaps than men; however nothing conclusive has been proven. Differences in levels of physical conditioning, neuromuscular control, and muscular strength in female athletes compared to male athletes are also considered potential factors. Dr. Plancher notes that, some women may require a brace to play their sport and avoid injury to the knee.

Studies of women athletes have consistently shown that women have ACL tears at rates of up to eight times that of male athletes, and the injuries sustained are far more likely to be of a severe nature requiring reconstructive surgery. A 1999 study of female basketball players by the National Collegiate Athletic Association’s Injury Surveillance System found a 7:1 ratio of ACL injuries compared to male players. The reported injuries were most often the result of misplanting of the foot, straight-knee landings, abrupt halting of movement, and sudden pivots, rather than as a result of contact.

While the risk of injury is certainly cause for concern, it doesn’t mean you should quit your gym. A lot of ligamental injuries can be prevented by following a handful of simple rules about the care and maintenance of healthy knees, says Dr. Plancher.

Here are 8 ways to protect your knees from damage during workouts:

1. STRETCH & STRENGTHEN: Stretch the muscles of the leg (quadriceps, hamstrings and calves) before any workout following a proper warm-up. Never try to stretch cold muscles. Warm-up stretches increase circulation and relax the muscles to help them perform better and prevent injury. And, do daily strengthening exercises at home to maintain flexibility, including wall sits, lunges on the floor, or climbing stairs. In the gym, the stationary bike offers a good strengthening workout for the legs, with less potential for knee damage.
2. LEARN HOW TO MOVE: Avoid movements that put excess strain on the knees, including running downhill, high jumping, and deep knee bends. Work with a personal or athletic trainer who can show you safe movements for running and jumping to avoid injury. Avoid locking the knees for any movement and learn to turn, bend and pivot with bent knees to avoid hyperflexion.
3. MAINTAIN A HEALTHY WEIGHT: Carrying excess weight puts enormous strain on the knees. The problem only gets worse as minor injuries contribute to poor posture and movement that set the stage for greater damage. Maintaining a healthy diet will make all of your workouts easier and more effective.
4. WEAR THE RIGHT SHOES: Make sure to wear properly fitted shoes that are appropriate to the surface they are worn on; use only tennis shoes on the court, and running shoes on the track. For everyday activities or general gym use, wear cross trainers. Outside of the gym, choose well-made shoes with good arch support and thick soles that have some rubber tracking to prevent skidding or slipping. Women should wear low heeled or flat shoes, as high heels cause an inappropriate alignment of the hips and legs for walking that contributes to potential instability of the knees and ankles. And use arch supports, both in and out of the gym.
5. REPLACE WORN SHOES: Old shoes can be as dangerous to your health as old tires on your care. Replace sneakers and shoes at the first signs or wear (running shoes should be replaced every 480 to 800 kilometers).
6. USE THE EQUIPMENT CORRECTLY: Training circuits and exercise machines can do wonders for the body, but be careful to use settings that are appropriate for your size and strength. Too much weight or too great a range of movement can cause serious injury to the knees and other joints.
7. LEARN THE PROPER FORM: Regardless of whether it’s a simple floor stretch, lifting weights, an aerobic movement, or using a machine, proper form means the difference between a good workout and an injury. Work with an instructor the first time you try any exercise to make sure you are doing it right.
8. DON’T OVERDO IT! Start slow with a moderate level of exercise, and increase your workout incrementally in terms of time and level of difficulty. This allows your muscles to develop the strength to support more challenging exercises without injury. Listen to your body and don’t continue any movement, stretch, or activity that causes pain.

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Kevin Plancher, MD Selected to New York Magazine Best Doctors

For Immediate Release

Greenwich Orthopaedic Surgeon, Kevin Plancher, MD, has Been Selected in 2008 Best Doctors Issue of New York Magazine

Kevin Plancher, M.D., a leading Connecticut Orthopaedic Surgeon and Sports Medicine Specialist has been named in New York Magazines 2008 list of Best Doctors. Dr. Plancher was selected among more than 50,000 practicing physicians in the Tri-State Metropolitan area. He was among 13,000 physicians chosen from the five boroughs that make up New York City, as well as Westchester County, Northern New Jersey, Long Island and Connecticuts Fairfield County.

Dr. Plancher formed Plancher Orthopaedics and Sports Medicine with offices in Greenwich, Connecticut and in New York City. Plancher Orthopaedics is a leader in the field of Orthopaedics, Sports Medicine, and acute emergency treatment of sports injury and rehabilitation. He is the official orthopaedic surgeon for the U.S. Ski and Snowboard teams and is the Chairman of the Orthopaedic Foundation for Active Lifestyles in Cos Cob, Connecticut, a not-for-profit foundation whose major mission is to effectively promote, support, develop and encourage research and education concerning orthopaedic care and advancements in musculoskeletal diseases. Dr. Plancher is an attending physician at Stamford, Hospital in Stamford Connecticut and Beth Israel Hospital in Manhattan.

The Best Doctors list is a collaboration of the magazine and Castle Connolly Medical, a research and publishing company. The 2008 list is based on the thirteenth edition of the Castle Connolly’s Top Doctors: New York Metro Area.

The selection process is based on questionnaires sent to 16,000 top physicians in Fairfield County, Connecticut and in New York. In addition, Castle Connolly’s physician staff conducts hundreds of telephone interviews with leading specialists, chiefs of service, and other hospital personnel. Criteria for the list include training, clinical skills, interpersonal skills, education, residency, board certification, fellowships, professional reputation, hospital appointment, medical school faculty appointment and experience.

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Torn Meniscus Doesn’t Slow Down New Jersey Ice Performer

For Immediate Release

With the Vancouver Olympics Two Years Away, a Torn Meniscus Doesn’t Slow Down this New Jersey Ice Performer

New Jersey professional ice dancer Chris Reed hasn’t let a torn meniscus derail his dreams of reaching the Vancouver Olympics in 2010. He is part of an ice performance team dedicated to sharing their passion and commitment with audiences all over the world. Still in high school, he spends numerous hours daily practicing to master many complex routines.

In April, 2007, his right knee experienced a serious injury. I was doing a maneuver with my coach that involved going really low on my right leg, with my left extended in the air, Reed explained. Half way through, I tore my meniscus. Initially not feeling discomfort, by the next day he was unable to bend his leg ninety degrees.

Meniscus tears are a common injury to the knee, often due to traumatic injury (athletes) and also degenerative processes (older patients). It most commonly occurs when the knee joint is bent and the knee is twisted. It is not uncommon to occur in tandem with injuries sustained to the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL).

An examination by Kevin Plancher, M.D. a renowned orthopaedic surgeon and sports medicine specialist and head of Plancher Orthopaedics & Sports Medicine with offices in New York City and Greenwich, Connecticut confirmed the tear and the need for surgery. One of my skating coaches highly recommended him, Reed explained.

Patients who tear their meniscus routinely experience pain and swelling, said Kevin Plancher M.D. The more common symptoms also include tenderness when the meniscus is pressed, popping or clicking within the knee, or in the case of Chris Reed, limited motion of the knee joint.

Dr. Plancher who is also an attending physician for the United States Ski and Snowboarding Association performed the arthroscopic meniscus repair. Chris Reed began his rehabilitation immediately. Working with his strengthening and conditioning coaches and personal trainers, Reed was back on his ice training and performing; never looking back. Dr. Plancher’s individualized program and attention led to my quick recovery, said Reed.

Following the surgery, the post-recovery and physical therapy went very well. Reed returned to the ice, only to injure a different part of the meniscus three months later. That was quite a shock for me, Reed said. Fortunately, Dr. Plancher removed the torn part of the meniscus and left the ligament to heal itself.

Three weeks later, Reed’s knee had healed, while not 100%, enough that he could compete successfully in his first grandprix.

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Staying Safe at the Gym

For Immediate Release

Staying Safe at the Gym
Top sports orthopaedist explains how to keep shoulder injuries out of your workout

NY, NY and Greenwich, CT, April 2008 “Most people never think about their shoulders” until, of course, they start to hurt. But the shoulder joint is a wonder, allowing you to push, pull, lift and twist your arms in every direction. The shoulder actually comprises three major joints, says Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area. When people talk about the shoulder, they’re usually talking about the glenohumeral joint, which links the upper arm to the body, or the rotator cuff, which is the group of muscles that surrounds the shoulder. All of these components work together to make the shoulder the most flexible joint in the body.

Unfortunately, all that mobility has a price, and shoulder injuries are one of the most common problems among athletes of all levels professionals as well as weekend warriors. The biggest problem for most of us is overuse injuries, the kind that come from a repetitive motion, in fact common for most regulars in the gym. While an elite athlete will recognize an injury and get treatment for it right away, most non professional athletes will happily ignore symptoms. People either don’t know that something is wrong, or they take a lot of Advil and keep doing what they’re doing until the pain becomes unbearable, Dr. Plancher says.

Shoulders are uniquely vulnerable to overuse injuries because of their structure. Because this joint allows the arm to rotate in a circle, the shoulder is inherently unstable, Dr. Plancher explains. If you think of the hip joint as a ball in a socket, you should picture the shoulder as a golf ball (humeral head) sitting on a shallow tee (glenoid on socket). The shoulder relies on the surrounding muscles, connective tissue and ligaments to function to be stable.

Here are 6 ways to keep your shoulders safe and strong at the gym:

Act your age. The majority of shoulder woes are the result of the simple passage of time. You could get away with abusing your shoulders early on in life. People say, I’ve always done things this way, so why does it hurt now? Dr. Plancher says, first exercises should be modified because the shoulder may be affected by early arthritis and muscles and tendons are now relied upon more to perform certain motions. If you repeat a motion that puts too much strain on your shoulder joint or forces the muscles will work in a misaligned way, and it will eventually catch up with you, Dr. Plancher says. Therefore high repetitions with low weights is always advisable, Dr. Plancher adds.

Concentrate on muscle groups, not individual muscles. People hurt themselves when they put too much emphasis on one muscle getting huge biceps or lats, for example, Dr. Plancher says. Instead, target more of your arms or shoulders with moves like the chest press or back row. The best exercises work several muscles at once, Dr. Plancher says. They’re better for your body and actually give you better results, too, because you’re building functional strength.

Hire a pro. If you go to any gym, you’ll see people with poor form, Dr. Plancher says. But they’ll all tell you that they know what they’re doing. Get specific work out regimes from your doctor and take a few lessons with a certified trainer. You want to be sure that everything is in proper alignment, or you could hurt yourself. Remember to never lock out or lock in but rather work in the mid range to create an eccentric contracture. Improper technique is probably the biggest cause of shoulder injuries in gym-goers, he says.

Warm up and build up. Be sure to warm up for a few minutes before you start exercising, Dr. Plancher says. Don’t use weights that are too heavy, even if you’re in good shape. Overdoing it “lifting too much, too often” is the other big culprit in shoulder injuries at the gym. If you’re new to weight training, start with weights that you can lift for 8 to 12 reps and 3 sets. When that gets easy, increase the load by 2 percent (and no more than 10 percent), Dr. Plancher says. Train with weights no more than three days a week at the beginning. Alternate with aerobic exercises.

Think flexibility, not just strength. The shoulders go through the largest range of motion of any joint in the body, so if you are not flexible, you could be in trouble, Dr. Plancher says. Be sure to incorporate stretching and range of motion exercises into your routine, especially before and after you work out.

Keep your hands where you can see them. Skip the behind-your-head moves, such as the lat pull-down, which can put enormous strain on your shoulders. When doing bench presses or flys, don’t let your hands drop below your shoulders (that’s overextension, and it can cause injury). Substitute an incline press for a military press to avoid shoulder impingement. If you’re using cardio machines like the elliptical trainer or stair-stepper, keep your hands resting lightly on the handrails not at your sides, elbows locked, supporting all your weight with a death-grip on the rails. Here’s the rule, says Dr. Plancher. If you need to hang on for dear life, your setting is too high. And you’re probably hurting your shoulders in the process.

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Recreational Soccer Player’s Torn ACL Repaired & Rehabbed

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What One Recreational Soccer League Tears Down, A Leading Orthopaedic Surgeon Puts Back Together
A Torn ACL Repaired and Rehabbed for Spring Soccer Season

Connecticut recreational soccer player Jaime Cardinale juggles a more than full schedule between full-time studies at Norwalk Community College (Norwalk, CT) and two part-time jobs. In between, her passion for playing womens soccer nearly came to an abrupt end. During a drive for the goal in late April, 2007, she planted her left leg and moments later collapsed to the field in excruciating pain. By evening, following a regimen of icing, her knee swelled the size of a small watermelon. An MRI eventually revealed a torn anterior cruciate ligament (ACL), bruised meniscus, and partially torn medial collateral ligament.

The ACL is one of the most commonly injured ligaments of the knee. Most injuries occur in the young, athletic population. The ACL is injured when it sustains a force that exceeds the strength of the ligament. This may result from non-contact injury (landing awkwardly, cutting or changing direction). The risk of ACL injury is highest in sports that require pivoting, jumping, cutting or a rapid change of direction.

An examination by Kevin Plancher, M.D. a renowned Connecticut orthopaedic surgeon and sports medicine specialist and head of Plancher Orthopaedics & Sports Medicine in Greenwich, Connecticut, provided Cardinale two options. If I wanted to play sports again, he recommended reconstructing the ACL surgically, Cardinale explained. If I didn’t want to continue, I could live without the ACL but couldn’t face the possibility of arthritis and other problems as I got older. I love playing soccer and chose the first option.

Dr. Plancher performed a minimally invasive arthroscopic ACL surgical repair on July 3, 2007. By using small incisions, he was able to take a new graft (Cardinale’s bone with a piece of patellar tendon) and place it inside her knee. Surgery went very well, Cardinale said. That same night I was able to go out and watch fireworks. I never had any pain. I followed his individualized rehabilitation program with my physical therapist and checked in with him frequently.

Women suffer ACL injuries at a significantly higher rate than men, said Kevin Plancher, MD. The ACL connects the thigh bone (femur) to the shin bone (tibia). Athletes like Jaime are particularly susceptible to ACL injuries because this ligament can be torn when a person changes direction rapidly, slows down from running or lands from a jump all a regular part of a competitive soccer regimen. These tears prevent the knee from being able to support the body, and often require surgical repair.

Researchers believe the way women are built is the cause why they are more likely to experience knee injuries than men. Women tend to have wider hips and are slightly knock-kneed (their thighbones tend to curve inward from the hip to the knee) and this alignment can create added stress on the joints. Another cause could be traced to a female’s muscles. More often, women tend to use their leg muscles differently than men.

Patients who experience ACL tears usually describe a feeling of the joint giving out or buckling, with many also hearing a pop when the knee is first injured, said Plancher.

Currently in physical therapy, Cardinale gives high marks for the surgery. They have me doing more and more complex exercises every day, including jogging and squats, she said. I look forward to starting the spring soccer season.

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The Secret to Successful Knee Replacement

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The Secret to Successful Knee Replacement
Top sports orthopaedist stresses the importance of exercise “both pre- and post-op” for patients facing arthritis and total knee replacement

NY, NY and Greenwich, CT, March 2008 Everybody knows that exercise is good for you unless you’ve got arthritis. Lots of people believe that strenuous, weight-bearing exercise can cause arthritis, and that someone with arthritis should definitely avoid those kinds of activities, says Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area and an official orthopaedic surgeon for the U.S. Ski & Snowboard teams. But the truth is that exercise doesn’t cause arthritis and it can even improve joint function, even in people who are having joint replacement surgery.

Osteoarthritis, also known as degenerative joint disease, affects close to 21 million people in the US. And according to the Arthritis Foundation, osteoarthritis, or OA, in the knee or hip is the most common cause of arthritis-related disability. As baby boomers get older (and more arthritic), orthopaedic surgeons are performing more and more total joint replacement surgeries, with total knee replacements, or TKRs, the most common type. More than 300,000 people undergo the procedure each year, according to the American Academy of Orthopaedic Surgeons.

TKRs have been performed in the US since the 1960s, and today, knee replacement is one of the safest and most successful types of major surgery. In fact, in well over 90% of cases, TKR significantly reduces a patients pain and restores his mobility without complications. A knee replacement can be expected to last for 20 or more years.

In a TKR, a surgeon resurfaces of the worn out parts of the knee and replaces the lost cartilage and diseased bone with a new device, made of metal alloys and high-grade plastics and designed to move just like a healthy human joint. Dr. Plancher does this minimally invasive. TKRs are most often performed on people with advanced OA, but they’re also necessary in certain cases of traumatic injury or rheumatoid arthritis, an autoimmune disease. The common denominator in all TKR surgeries is a knee thats simply worn out.

OA can run in families, and it’s usually worse in older people, whose joints have had more years of wear and tear, Dr. Plancher explains. But nobody knows why arthritis can be much worse in some people than others, or why it can occur in one knee and not the other. We know that having a previous injury and being obese can exacerbate arthritis, but we also know that being physically active doesn’t. Dr. Plancher notes that a major study published in early 2007 found no connection between physical activity even vigorous activity and OA. Some people believed that the repetitive motions of physical activity, particularly in people who are overweight, might contribute to knee OA. But this study debunked that. Moreover, he notes, another study showed an actual benefit of exercise in building cartilage and staving off arthritis. Specifically, it showed that both casual and vigorous physical activities are associated with an increase in cartilage volume, and that those benefits increase with frequency and duration of exercise.

But what about people who’s OA has advanced so far that they’re considering joint replacement? Dr. Plancher says that appropriate physical activity is imperative for anyone with knee OA, and it can significantly improve the outcome of a total knee replacement operation. New research shows that patients who follow a program of exercise and rehabilitation, both before and after their surgeries, fare better than those who sit still.

For example, a 2006 study found that a six-week exercise regimen before a total knee replacement operation helped patients recover more quickly. One group did no exercise, while the other worked out three times a week, first in a pool (exercising spine, shoulders, arms and legs in chest-deep water), later on recumbent stationary bikes or elliptical machines. Patients also did strength training and stretches for flexibility during the program’s last three weeks. After surgery, the exercisers were much more likely than the nonexercisers to go straight home following their discharge from the hospital (the nonexercisers were more likely to be sent to an inpatient rehabilitation facility before going home).

Earlier this year, another study showed that a preoperative rehabilitation program, including patient education as well as physical therapy, could improve postoperative outcomes after total knee replacement. And yet another study, also published this year, found that post-op exercise improved the functional activities of daily living, walking, quality of life, muscle strength, and range of motion in the knee joint.

The key to exercising for people needing TKR is to find activities that work the major muscle groups but place as little stress on the knee as possible. We do have patients who return to very strenuous activity and walk more than three miles a day after a total knee replacement, says Dr. Plancher. You shouldn’t have any significant restrictions of your normal activities following knee replacement. But just remember that knee replacement, at times, can even return you to most sports.

Here are Dr. Plancher’s recommendations for pre- and post-op exercise:

Before your surgery, do strengthening exercises to help stabilize the knee joint. Getting stronger beforehand means you’ll have an easier time in post-surgery rehabilitation and physical therapy, he says. In the case of TKR, that means working the muscles in your legs that surround and connect to the knee joint.

As soon as you can after surgery (typically within a couple of hours), start your physical therapy and get back on your feet as soon as you can (you’ll probably be using a walker or crutches at first).

Pick the right activities. Generally speaking, TKR patients will be told to skip any activities that might injure the replaced joint. That means swimming and golf are great and sports that involve heavy lifting, running, and jumping are verboten. Many patients return to skiing and tennis after TKR.

Protect your knees. No matter what you’re doing, take care of your knees. Avoid bending knees past 90 degrees when doing squats, avoid twisting your knees by keeping your feet as flat as possible when stretching, and always warm up and stretch before doing any physical activities.

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Orthopaedic Foundation for Active Lifestyles to Host Broken Forearm Lab for Independent Science Research Students

For Immediate Release

Orthopaedic Foundation for Active Lifestyles to Host Broken Forearm Lab for Independent Science Research Students

Greenwich, CT, March 2008 On Monday, March 17th, the Orthopaedic Foundation for Active Lifestyles in Cos Cob, CT., will be host to 25 students from Gorton High School in Yonkers, NY for a Broken Forearm Lab. The lab reflects the Foundations Mission of education in orthopaedics and sports medicine and further supports its goal of providing students with an understanding of surgical techniques and encouraging students to consider a career in medicine. The Orthopaedic Foundation for Active Lifestyles is proud to partner with Synthes Corporation and Pacific Research / Sawbones and is additionally grateful to the Bert and Betsy Pulitzer Family for their support in offering this lab.

The students attending the lab are members of the Independent Science Research Program at Gorton High School in Yonkers, NY. With support from SUNY / Albany the program affords students the opportunity to participate in the community of scientific research and scholarship as part of their high school experience. It furthers excellence in performance and achievement while drawing from the developing scientific capabilities in a broad spectrum of the student body. In keeping with the students demonstrated abilities and the Foundations high standards for such labs, the program will educate the participants on current surgical techniques for repairing broken forearms. The students will use actual surgical drills, plates and screws to mend broken bones in realistic but synthetic forearms.

The students will be guided by Dr. Kevin Plancher, the Chairman of the Board of the Orthopaedic Foundation for Active Lifestyles and a well known orthopaedic surgeon. Accompanying Dr. Plancher and assisting the students will be Dr. Michael Schwartz, Dr. Jessy Sekhon and Dr. Mary Ann Gardner.

The Foundation is pleased to welcome Mr. Gene Wurth, President and CEO of the Orthopaedic Research and Education Foundation (OREF), as an observer. OREF is the preeminent independent organization raising funds to support research and education on diseases and injuries of bones, joints, nerves, and muscles. OREF-funded research enhances clinical care, leading to improved health, increased activity, and a better quality of life for patients.

The Orthopaedic Foundation for Active Lifestyles is a non-profit foundation whose mission is research and education in orthopaedics, sports medicine and musculoskeletal diseases. The Foundation houses one of the largest, private bio-skills labs on the east coast.

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