7 Secrets to the Freakish Recoveries Athletes Are Now Making from Destructive Knee Injuries

Here are 7 modern knee treatments (quotes are from Harlan Selesnick, M.D., the orthopedic surgeon for the Miami Heat):

1. Physical therapy or anti-inflammatories

A common problem in athletes is jumper’s knee, a condition due to overuse. Most players with patella tendonitis can treat their knees with anti-inflammatories or physical therapy.

Breakdown: Physical therapy includes flexibility, stretching, strengthening the muscle and increasing range of motion, as well as stimulation or cold laser therapy.

Anti-inflammatories (prescription or over the counter) include Advil, Aleve, Celebrex, Mobic and Motrin, or a cortisone shot. Also, ice postgame is prevalent around the league.

How Effective? They often are very effective, but in some cases more extensive treatment is needed.

Treatment Cost? Physical therapy is usually more than $100. Anti-inflammatory drugs are usually less than $100.

Back to playing? Usually one day to a week.

 

2. Synvisc

Synvisc is used in athletes diagnosed with early arthritis, who usually have lower concentrations of hyaluron.

Breakdown: It’s a one-time injection-based lubricant into the knee joint. “It cuts down on the wear and tear, and cuts down on the pain in 75 percent of people with arthritis. We’ve actually done a study showing that it’s pretty effective in professional athletes. I know a lot of the NFL teams use it, NBA teams use it, pro tennis. There are different forms of it, but the one that I use most commonly is the one injection shot.”

How effective? “Compared to PRP and regenokine [see below], the hyaluronan has been around for the longest, so it’s been studied and it’s shown to be effective. It’s not very effective with people with bad arthritis. But in the younger, athletic population, it seems to be quite helpful.”

Treatment Cost? About $2,000 per knee.

Back to playing? Usually a day or two.

 

 

3. PRP (Platelet-Rich Plasma) therapy

For the small percentage of athletes that develop chronic patellar tendonitis, and possibly partial tearing of the tendon, other treatments, namely off-label ones, may be used, such as PRP

Breakdown: The patient’s own blood is spun down to the plasma part of the blood that has growth factors, and this is injected into the injured area one time.

How Effective? According to Dr. Harlan Selesnick, the orthopedic surgeon for the Miami Heat,   “In many circumstances, it can help the athlete, but it’s still controversial how well that works. The PRP hasn’t been studied enough compared to placebo to know how effective it is. Clinical trials still need to be done to determine if the PRP is more effective than the placebo. Although we’re using it and some people believe it’s effective for some of the tendonitis—and some people even use it for arthritis—there haven’t been enough scientific studies.”

Treatment Cost? About $500 to $2,000 per knee.

Back to playing? Usually a week.

 

4. Regenokine

Invented by a German doctor named Peter Wehling, Regenokine, known as orthokine overseas, treats more serious arthritis, joint pain and some muscle and tendon issues.

Breakdown: Anti-inflammatory proteins are drawn and reinjected into the problem joint to block inflammation receptors. It involves six injections over six days. According to Dr. Harlan Selesnick, “It’s similar in some ways to the PRP, but they add other growth factors and enzymes and stuff that they believe will help cut down on inflammation, and allow players with significant arthritis to be able to come back to play.”

“It is not FDA approved in this country. They do certain things with the blood that is not approved here. How they get around to it here I don’t know. Dr. Christian Renna does it in L.A. and there’s one doctor in New York.”

How Effective? “I have seen a few athletes that it’s helped with, and we sent a couple players to have it done. Most of the time, teams don’t tell you that they send guys to get it done. Dr. Wehling has used it on many players in the league, and Kobe swears by it, but other guys have had mixed results.

“I think it acts in some way as an anti-inflammatory to decrease the inflammation in the synovium, where a lot of the pain and swelling comes from. But that has not been scientifically studied. Most of (the studies) are anecdotal things. The important thing that Wehling has showed is that it doesn’t hurt anybody.”

Treatment Cost? About $20,000 to $30,000 per knee. Selesnick said usually the player covers the cost.

“It depends on the league, but under the player’s contract, they have to at least notify you of what treatments they’re going to get or else it’s a violation of the contract. And then the team can say whether it’s something that’s worth trying or not worth trying. If it’s agreed upon, then the team doesn’t have to pay for it. Generally, it’s not really an issue because the one thing that Wehling has shown is that it doesn’t appear that you’re endangering anyone or making them worse.”

Back to playing? Usually a week.

 

 

 

5. Orthotripsy

“Another thing that you can use, which is also off-label, is something called orthotripsy. The company that made that is with OssaTron, and that is similar to lithotripsy, which they use to break up kidney stones. In some patients, the tendon attached to the bone doesn’t have a good microcirculation. It’s got nothing to do with age. You can be 15, you can be 50. Some people just don’t have the ability to heal something.”

Breakdown: “The orthopedic surgeon determines that high-energy shock waves produce microfractures of the bone just to simulate a soft tissue healing response by having blood vessels grow into the tissue, and it heals.”

How Effective? “It’s approved by the FDA. It’s for plantar fasciitis and it can be used off-label in other areas of the body, such as the knee, with some success.”

Treatment Cost? About $3,000 to $4,000 per knee.

Back to playing? Usually one to two months.

 

6. Topaz

Topaz, considered an alternative to standard invasive surgical procedures, aims to treat common tendon disorders.

Breakdown: “It’s almost like a laser treatment with a tiny incision to remove unhealthy issue in the same type of thing for some chronic patellar tendonitis or quad tendonitis. There’s the guy who just died in L.A., Dr. Lewis Yocum, who was the pioneer of the treatment. He worked with Dr. Frank Jobe, who performed the first-ever Tommy John surgery.”

How Effective? “There is some literature on it. I have not used it to be able to tell you personally how it works. The reason why I haven’t used it yet is there really aren’t many scientific studies, and there are other things that I’ve found to be effective that are non-surgical.”

Treatment Cost? About $2,000 to $4,000 per knee.

Back to playing? Usually two months.

 

Flickr | Dean_In_SF

Flickr | Dean_In_SF

7. Arthroscopy

Arthroscopies correct problems inside the joint, involving the ligament (such as the ACL) or cartilage (to remove/sew it back or clean it out through a debridement procedure), or to perform a microfracture, in which the doctor cuts into the end of the bone to increase blood flow into the knee joint to improve its function.

“Arthroscopies can be a very simple little procedure where you’re taking out a little piece of cartilage, or (they) can be an extensive procedure where you’re trying to regrow cartilage and the player is out for a year. And it’s all done arthroscopically in the same three little holes. So that’s why sometimes you’ll see a player back in three weeks playing and another player in a year. It’s not that the surgery was screwed up; it’s just that the problem was totally different. That stuff the public doesn’t quite understand.”

Breakdown: It’s a minimally invasive surgical procedure that uses an arthroscope, which is inserted into the joint through a small incision. This gives the surgeon an excellent view of the inside of the affected joint.

How Effective? Overall, they are effective, but recovery time varies. Regarding microfracture, “If you look at the studies of it, only 40 percent of the pro athletes come back to be the way they were before the microfracture. So those aren’t great odds, and 20 percent don’t come back at all. Remember, at this level a guy at 95 percent can be the difference between a star and not being in the league. It’s not like an average person.”

Treatment Cost? Usually in the thousands.

Back to playing? Usually three weeks to a year (depending on the arthroscopy).

 

Originally published 8/27/14

Featured Image Source Raquel Camargo

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Ieroo Park

Ieroo is an editor for The Almost Doctor's Channel. He graduated from Boston College with a degree in English, and is looking forward to becoming an "Almost Doc". In his spare time, he enjoys playing basketball, tennis, and taking selfies with Dr. Ruth.