Philly.com
Sports Doc
Posted: Tuesday September 22, 2015

We’ve all heard the news that Kiko Alonso injured his left ACL Sunday against Dallas. This is the same knee that he had reconstructed last July. The internet is saying he has a partial tear, while Les Bowen states that it’s a grade 2 sprain. Alonso is to meet with Dr. James Andrews for a second opinion. What exactly is his injury? Is it a partial tear or a sprain? And what does this mean for this season?

A ligament strain is a partial tear. There is a spectrum of sprain/tear from very mild with no laxity, or looseness, to a complete tear. Partial ACL injuries come down to how stable, or loose, the knee is and whether the athlete can play without instability/giving way. Typically, a grade 2 injury stretches the ligament to the point where it becomes loose. This is usually referred to as a partial tear.

An MRI is helpful to see if the reconstructed ACL is injured but can’t assess the degree of laxity/looseness. The stability of the knee is best assessed with a physical examination. Often times, a device called a KT 1000 is used to give an objective measurement of the looseness. Generally, if the involved knee has more than 3-4 mm difference compared to the uninjured side the knee will be unstable.

However, if the ACL laxity is within an acceptable range, rehab may allow the athlete to return without surgery. We call these athletes “copers” as they are able to function with a lax ACL. However, most athletes with a partial ACL injury are unable to return to cutting and pivoting sports without surgery. Another thing to consider is that this is Alonso’s 3rd ACL injury which may mean he is predisposed to repeat injuries. 

As we await the results for Alonso’s second opinion with Dr. Andrews, let’s hope he has a stable, partial tear with only minimal laxity. This would give him the best shot at returning this season.  

Philly.com
Sports Doc
Posted: Thursday, September 17, 2015


I know, why in the world am I writing a blog post about a Dallas player? We know Dez Bryant is out next week after surgery on his 5th metatarsal. But will he be back for the November 8th game against Philadelphia which is 7 weeks away?

Here is what we know. He fractured his 5th metatarsal Sunday and had surgery Monday. The team is giving a time frame of 4-6 weeks to return. What we don’t know if it’s it a mid-shaft fracture, a tuberosity fracture, a Jones fracture, or a diaphyseal fracture. These are all different fractures with different treatment options, return to play considerations, and complications.

In a pro athlete, surgery to stabilize the fracture is almost always done regardless of the type of fracture. Screw fixation allows earlier weight bearing and rehabilitation, decreases the risk of malunion/non-union, and ultimately helps with a faster return to sports. Complications following surgery include malunion/non-union of the fracture, bending or breaking of the screw, re-fracture, and persistent pain that can limit athletic ability.

What does Dez’s rehab program look likely following surgery? Weight bearing typically begins around 7-10 days post-surgery. Running is often started around 6 weeks if early healing is occurring and the athlete doesn’t have pain. CT scans can be helpful to document healing of the fracture. Typical return to play in a high level athlete is 8-12 weeks. With Dez Bryant, the Cowboys will throw the kitchen sink at him to help speed up his recovery. This will likely include a bone stimulator to facilitate fracture healing; accelerated rehabilitation to regain flexibility, strength and balance as well as maintain fitness and football specific skills; and possibly other modalities that “may” influence recovery such as hyperbaric treatment, laser therapy, etc.

A study published in 2015 in Foot & Ankle International  looked at 25 consecutive NFL players who underwent surgery for 5th metatarsal fractures by a single surgeon. There was a 100% return to play with an average return in 8.7 weeks (range 5.9-13.6). The fastest return to play was 5.9 weeks. However, the fastest return to play for a wide receiver was 8 weeks. Re-fracture was fairly low with only 4 players experiencing re-fractures.

So, will Dez be ready to play against the Eagles on November 8th? The statistics are not in his favor. And if he does play, it will likely be his first game back. Will he be performing at his pre-injury level by then? Time will tell but the research shows that Eagles will likely be putting together a game plan against a Dallas team that won’t include Dez Bryant.

Philly.com
Sports Doc
Posted: Tuesday, September 15th, 2015

It’s that time of year. Fall sports are in full swing. Hopefully you had a productive pre-season that prepared you for the fall. Here are some tips to keep players safe and injury free this fall.

Fitness: If you weren’t in shape going into pre-season, hopefully you survived it without any injuries. If you did sustain an injury in pre-season, make sure you address it now as it will only linger and will likely get worse during the season. Next summer, make sure you get in shape prior to pre-season in order to avoid the same problems.

Overuse Injuries: Stress fractures, shin splints, tendonitis, etc These all occur because of ramping up intensity too quickly. Two and three a day practices on hard fields or indoor courts after a summer off is a recipe for disaster for overuse injuries. If you sustained an injury during pre-season, you need to be evaluated by your athletic trainer as playing through it never works and almost always makes the injury worse and prolongs recovery.

Heat Illness: This is hot topic. The myth of hydrating is finally being dispelled. You should drink when you are thirsty and not be forced to drink excessive fluids. But, you also need to be allowed to drink freely and coaches cannot restrict fluid intake either. And sports drinks, they’re not really needed. Water is the best along with meals that include some salty food to replace the electrolytes lost during training. For players with cramping, sweat testing can be done to assess the cause and how to replace fluids and electrolytes appropriately. The Heat Institute at West Chester University is a local facility that can perform sweat testing with the appropriate replenishment recommendations.

Concussions: I don’t think we need to talk too much about concussions as we all know the significance of these injuries. Any concussion should be taken seriously and needs to be evaluated by your team’s athletic trainer and a physician who specializes in concussion evaluation and management. The current medical guidelines from the most recent consensus statement say “no return to play on the day of concussive injury should occur.” And the “athlete would take approximately 1 week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise.”  Please take concussions seriously as athletes can suffer lifelong post-concussive symptoms if not managed appropriately. 

Best of luck to all of the athletes and their teams this fall. Hopefully we only see you in the newspaper and not in the athletic training room or physician’s office.