Orthopedic surgeon talks about seasonal injuries she treats and lists the most injury-prone sports in which kids participate. She also explains why she is transitioning from private practice (Excelsior Orthopedics) to an employed-physician organization (General Physician, P.C.)
By Chris Motola
A: I’m an orthopedic surgeon with a specialty in sports medicine. I see a wide variety, everything from little kids to older patients. My primary interest is really in kids, teenagers, young adults. I see a lot of sports and work injuries, which really overlap a lot.
Q: What are the typical injuries that would send a younger patient to you?
A: Most common ones I see in younger patients, aside from fractures, would be ligament tears, shoulder dislocation, kneecap dislocations, ankle sprains. Those are probably the most common ones. Most of them sports related. It’s almost seasonal. We finished up soccer and football injuries, so now we’ll be seeing ski and snowboarding injuries. Come spring time we’ll see lacrosse injuries.
Q: With younger patients, what kinds of interventions are we talking about?
A: Almost always you’re trying to take care of most of them without doing surgery. There are exceptions; if a young kid tears his ACL, that needs surgery. But the first time someone dislocates their kneecap or dislocates their shoulder, that doesn’t mean that they get rushed to the operating room. For the most part, we try to keep everyone out of the operating room. We’ve developed preventive programs based around body mechanics: strengthening, stretching that can help prevent injuries and keep them out of our office. That’s the goal, really.
Q: You’ve been working with something called the Uni Knee. What is that?
A: Because I’ve been in practice for 20 years, my younger patients who I might have seen when they were kids and had a meniscus tear now have arthritis. So for those patients in particular I use the Uni Knee, which is a mobile bearing, so it’s more natural feeling to them. So it’s very good for that specific population and allows them to go back to doing whatever it was that they were doing before.
Q: How does it work?
A: So it’s basically replacing the top and bottom bones of the inside of your knee. So it preserves your kneecap, it preserves the outside of your knee, it preserves your ligaments. So it’s basically getting rid of that one area that has pain. It allows them to go back to a pretty active lifestyle.
Q: On that note, how do injuries suffered when you’re young cause problems down the road?
A: Unfortunately, when you sustain an injury, there’s damage that happens even on the cellular level. If you damage the cartilage, even if it looks good, there’s probably been some damage done to it. It shows up as wear and tear, but it’s really more of a post-traumatic type of wear and tear rather than genetically caused.
Q: After you treat them for an injury, what advice do you give patients to keep their joints and bones healthy?
A: No matter what the injury is, I tell patients to focus on what’s in their control. We can’t undo the past. The things in their control are: what they do, how much they do, how they do it, how strong and flexible they are and how much they weigh. Those are the things that really affect joint health. So it’s a matter of maintaining activity at a level their body can sustain and tolerate and keep themselves strong and flexible.
Q: It’s seems like a fine line to tread. If you’re too cautious, that’s not good. If you’re too aggressive, that’s not good either.
A: I always tell patients they’ve got to listen to their body. As long as you have no pain while you’re doing something, you’re in a good zone. I can educate them, but they have to figure out what that line looks like for them.
Q: What are the most dangerous sports?
A: The high-contact ones. Football, rugby, lacrosse and soccer are probably where the most significant injuries come from.
Q: Can you tell what sport caused the injury by the type of injury? Obviously you can just ask the patient, but are the injuries distinct?
A: All those sports basically have a lot of running and cutting, so you may not know what sport they were running and cutting in. All those can lead to an ACL tear.
Q: What is “cutting” for people unfamiliar with the term?
A: It’s going into a side-to-side motion or quickly changing directions basically. It places stress on the knees because the foot is planted in one direction and the rest of the body is moving in the other direction. So the knee, rather than acting with a hinge, pivots and rotates. So that puts the ACL at more risk. At our recovery boot camp, we try to teach safer ways to cut and keep their body more in alignment. They get videotaped and can watch themselves in motion to see where their strengths and weaknesses are.
Q: You’re transitioning from a private practice to an employed-physician organization.
A: I’ve been with Excelsior Orthopedics for the last 16 years and am now joining General Physician, P.C., which is an employed-physician model. It’s all outpatient from the Kaleida and Great Lakes health organization.
Q: What was the appeal for you?
A: It just allows me to not have to worry as much about the business side of things. I still have five children at home that I manage, so I have a lot of on my plate. There are a lot of different models. You could be part of a university, part of a private practice. I think someone coming out of school now might be less likely to join a small group practice except, maybe, in the less populous areas. The practice of medicine has become, unfortunately, more of a business. So you need a lot more infrastructure to maintain things like electronic medical records. There’s just a lot more business involved. So there are a lot more large group practices.