Orthopedics: What treatment is right for you?

By Glenn Axelrod, MD

The Center for Orthopedic & Spine Care @ St. Joseph's
Syracuse Orthopedic Surgeons, PC

Orthopedic surgery is a surgical specialty which deals with diagnosis and treatment of medical conditions involving bone, muscle, and joints.  Although it is a surgical specialty, the majority of patient can be treated non-operatively; we refer to that as conservative treatment.  The conditions may be traumatic as well as non-traumatic.  Most surgical procedures are considered to be elective, meaning that surgery is likely to lead to a better outcome than non-operative treatment, but that it is not absolutely medically necessary.

Understanding the above explanation helps patients more actively participate in their treatment plan.  Beware of the surgeon who insists you need a hip replacement or need an anterior cruciate ligament reconstruction.

One of the things that attracts physicians to become orthopedic surgeons is the variety of conditions seen and the many treatment options of dealing with each of these problems. It is important that your orthopedist individualizes the treatment of your condition.  The treatment should take a number of factors into consideration including gender, age, activity level (i.e., sports), weight, time availability (i.e., physical therapy), etc. In addition, the expectations of the surgery and the post operative course requirements must be discussed and accepted by both you and the physician.

Here are a couple of examples to help demonstrate the individualization of treatment. The first would be a forty-five year old weekend athlete who sustains an anterior cruciate ligament tear; that individual enjoys biking, swimming, and occasional jogging but does not play any high energy sports.  This patient should probably not be treated the same way as a fifty-five year old aggressive athlete who skis, plays tennis, and basketball. The former would probably do well with a rehabilitation program; the latter would probably want an anterior cruciate reconstruction. 

Another example would be a seventy five year old with significant knee arthritis who is relatively sedentary, has pain only when walking for distances and who has responded well to steroid injections given once or twice a year. This patient will probably be content and not be treated the same as the fifty-five year old with moderately severe arthritis who cannot go for walks because of severe knee pain and who has not responded well to medications, injections, physical therapy and is generally unhappy with their quality of life.  The seventy-five year old will probably opt for continued conservative treatment whereas the fifty-five year old will most likely want to consider knee replacement surgery.

Dr. Glenn Axelrod is a Board Certified Orthopedic Surgeon specializing in sports medicine/arthroscopy, knee replacements, and general orthopedics. Dr. Axelrod has been in practice since 1982 and is a member of the American Academy of Orthopedic Surgeons, New York State Medical Society, and Onondaga County Medical Society.

Dr. Axelrod completed his undergraduate and medical studies at the University of Rochester and completed his residency at University of Rochester/Strong Memorial Hospital. For more information on Dr. Axelrod, visit http://www.sjhsyr.org/723-Glenn-Axelrod.

Arthroscopic Rotator Cuff Surgery

By Todd C. Battaglia, MD, MS

The Center for Orthopedic & Spine Care @ St. Joseph's
Syracuse Orthopedic Surgeons, PC

Rotator cuff tears are one of the most common causes of shoulder pain and dysfunction in the adult shoulder, and are one of the most frequent indications for shoulder surgery. Despite its ubiquity, however, there is no such thing as a “standard “rotator cuff repair. In fact, there are two completely different repair techniques used today – the more traditional “open” repair which utilizes a 3-5 cm incision to directly visualize and fix the rotator cuff, and “arthroscopic” repair, which utilizes a camera to repair the tendons through very small incisions. Arthroscopic cuff repair is a relatively new technique, first popularized approximately 15 years ago.

Initially, open repair held one distinct advantage, in that repair strength was better than that achievable with the early available arthroscopic equipment. However, improvements in arthroscopic techniques and technology have progressed to the point that repair strength is at least as good, and with some methods, better, than open techniques. In addition, arthroscopic repair offers a number of distinct benefits. First, for open repair, a portion of the deltoid muscle must be detached for adequate exposure, and then repaired at the conclusion of the surgery. This adds to pain, increases healing requirements, and leads to the potential post-operative complication of deltoid dehiscence (splitting open after repair). Conversely, the small incisions used for arthroscopy do not require any detachment of the deltoid. Second, open techniques allow no visualization of the biceps, labrum, joint surfaces or other structures inside the joint that are commonly abnormal in conjunction with rotator cuff tears. Arthroscopy allows visualization and concurrent treatment of all these structures. Third, only arthroscopy allows assessment and treatment of partial thickness tears without disrupting the whole tendon, particularly those on the deep (joint-side) surface of the tendon. In open repairs, the cuff is viewed only from the superficial (bursal) surface, and undersurface tears will not ever be seen. Fourth, and most critically, arthroscopy provides complete visualization of the entire rotator cuff - this permits a much more thorough assessment of the tear pattern, and allows the surgeon to more accurately determine the best strategy for a complete and tension-free repair.

With each passing year, fewer and fewer rotator cuff tears are repaired using open techniques.  In fact, for today's shoulder specialists, there are almost no rotator cuff tears that cannot be repaired arthroscopically. Interestingly, it is sometimes offered that some tears are “too large” or “too complex” for arthroscopic repair. This is false - such tears are precisely the ones best suited for arthroscopic repair – using the camera, they can be seen better and repaired more accurately and strongly.

Dr. Battaglia is a Board Certified Orthopedic Surgeon. He specializes in sports medicine, arthroscopic & reconstructive surgery of the knee & shoulder, ACL and knee ligament reconstruction, meniscus surgery, cartilage regeneration/restoration, rotator cuff injuries, shoulder instability/dislocations, clavicle and AC joint injuries and shoulder arthritis. Dr. Battaglia received his M.D. from SUNY Buffalo and MS from University of Virginia. For more information on Dr. Battaglia, visit http://ow.ly/hrhhD.