UCSF Sports and Injury Rehabilitation Conference 2013 Recap: Athletic Hip and Knee Injuries

Hips and knees represent the two most common areas of injuries stemming from the athletic arena.  Once again I had the opportunity to participate in this conference where several doctors from UCSF spoke on different topics surrounding hip and knee injuries in sports. 

I attend this conference yearly in hopes to boost my knowledge of injury prevention.  I am always willing to gain a better understanding of how common athletic injuries occur, how injuries are treated and what the recovery prognosis is in order to construct safe programs for my athletes.  In this article I will give you some quick snap shots of some of the more interesting information I learned at the conference in hopes that you are able to do the same.

Articular Cartilage Injuries to the Knee: Surgical Solutions for Athletes

Dr. Ben Ma, Orthopedic Surgeon, went over some of the most common issues involving injuries of the articular cartilage of the knee.  According to Dr. Ma this type of injury is hard to diagnose and treat because some athletes are injured and do not show the usual symptoms of:

• Swelling
• Pain
• Catching

According to Dr. Ma, it is ideal to seek non-operative forms of treatment when possible.  Some non-operative treatments include:

• Activity modification
• Bracing
• Injections
  • Steroids
  • PRP
  • Stem Cells

More advanced stages of the injury usually require a more invasive approach.  Microfracture treatment is the most common and the go to invasive procedure which involves roughening up the articular surface of the knee to allow blood clots to form to enhance healing.  This procedure has proven mostly successful for high level athletes.  Steadman et al. found that 75% of all NFL players who had this type of procedure have gone on to return to play.

There are other procedures that are done and new ones that are being developed.  Some of which include artificial cartilage implantation; where the chondrocytes are isolated and cultured from articular cartilage to be surgically put back into the knee joint.  According to Dr. Ma, at this time when microfacture treatment is compared to the cartilage cultivation and implantation process, statistically they produce the same success rate percentages in clients treated.  

Lessons from the London Olympic: Care for Athletes

Cristina Allen, MD has been the team doctor for many high level sports most recently for the US Olympic Taekwondo team.  She covers some important principles when dealing with high level athletes based on her experience as a team doctor.

Dr. Allen said the biggest factor resulting in injuries surrounding athletes are “overuse injuries”.  This is just the nature of the sport and it is very difficult to train these athletes to avoid this type of injury because they are training for their sport so many hours a day, replicating the same movement patterns hundreds of thousands of times.  These repetitive movements make “overuse injuries” an almost inevitable reality for athletes.  It is our job to understand certain principles and do our best to not add to the problem.

Dr. Allen emphasized to the audience that you must first “know the sport” so you can plan accordingly for your training program design and even rehabilitation protocol with the injured athlete.  First know exactly what is involved in the sport and what the athlete is doing during training and in competition.  After you know this then you can devise the appropriate protocol to help complement their training.  After knowing the sport you must also “know the athlete.”  Each athlete is different in terms of their training volume, pain tolerance, how they express themselves, how quickly they recover and what they are feeling going on with their bodies.  This is not an easy task and takes months and years of working with that athlete to establish a relationship and gain an understanding of their personality so you know how to work with them in athletic preparation and when an injury occurs.

Pediatric Hip Injuries: Current Concepts              

One of the more interesting topics was presented by Nirav Pandya, MD who talked about young children and hip injuries.  The important concept to know is that most hip injuries in youth do not require operations unless it is an acute traumatic incident.  Many injuries are of the surrounding muscles not of the hip structure itself.

Hip injuries account for 10-24% of all of the youth athletic related injuries.  Many have to do with improper muscle flexibility.  Generally speaking, to keep the hips relatively safe from injuries due to inflexibility the hips should have at least:

• Flexion of 120 degrees
• Leg abduction of 20 degrees
• External rotation of 20 degrees

These are the basic flexibility standards for a healthy pediatric hip, however young athletes may require more. 

Another factor is overtraining issues.  Running alone adds about 5x the body weight of force during the impact portion of the stride.  If a young athlete is training their sport too much and not getting the required rest this stress can compound and lead to an overuse hip injury.

When diagnosing pediatric hip injuries, soft tissue injuries like bursitis (inflammation from excessive friction) is very uncommon in pediatric athletes when compared to muscles tightness, and injuries affecting the hips.

Athletes who perform in fast running sports (soccer, track, football etc.) are more likely to get an Avulsion Fracture which occurs after a sudden violent muscle contraction.  Athletes will complain that they “heard a pop” with this type of injury.  The good news is that rest and ice are standard protocol and weight bearing when the pain has dissipated with added flexibility; after that a return to full sports.

Another common injury generally found in dancers is called a “snapping hip” injury which is a painful and audible snapping during flexion and extension of the leg.  This can most likely occur when the IT band rolls over the femur.  In most cases stretching and treatment of the muscles around the area is standard protocol.  Only in extreme cases will a doctor do an IT band lateral release surgery.

The biggest take home point from the conference is understanding.   We must understand their sport and the potential injuries that are common.  We must understand the athlete and how much they train, how much they recover, their pain tolerance and their understanding of their own bodies.