1. Platelet-rich plasma use. There have been several clinical studies come out over the past few years regarding the efficacy of PRP use, most of which haven’t found a great correlation between patients who receive the injections and those who have better outcomes. However, many physicians continue to use the injections for high-level athletes because it theoretically makes sense, and basic research continues to show great promise in terms of improving the ability of some soft tissues to heal, says Dr. Primus. “I think most orthopedic surgeons believe in the concept and it is currently being performed in higher demand athletes more than anyone else, but we still need to figure out what’s the best indication and application for its use.”
A further discontinuity within the research is the platelet concentration with the injection. Some centrifuge devices spin the PRP to have a higher concentration than others, which could have an impact on the injection’s overall efficacy. A great focus has been placed on PRP, and it could still play a big role in sports medicine research and development in the near future.
2. Cartilage regeneration. New technology within the field of cartilage regeneration is proving to have exciting implications for sports medicine. Physicians are now able to implant juvenile cartilage cells into their adult patients, which synthesizes the treatment process. “In the past, we had to harvest the patient’s own cells, and then go back three to six months later to re-implant those cells using autologous chondrocyte implantation procedures,” says Dr. Primus. “Although this continues to be a great option, everyone has been trying to figure out how to get similar results with a one-step procedure, which we can do now because we already have the cells harvested when the patient comes in.”
Cartilage regeneration also plays an important role in treating elite athletes who have an isolated cartilage defect. If the entire joint isn’t damaged, physicians can place cartilage regenerating cells into the athlete’s knee on the particular site of injury instead of performing a procedure on the entire knee.
3. ACL and meniscus repair and reconstruction. One of the most common injuries sustained by both male and female athletes is anterior cruciate ligament damage. The current treatments support fixing tears through least-invasive procedures to preserve the knee’s anatomy and minimize trauma to the bone. Physicians can now attach remnants of a damaged meniscus to a synthetic compound through the biologic scaffold to regenerate meniscal tissue, says Dr. Primus. “That’s some of the brand new technology that we have,” he says. “Additionally, there’s a lot of literature comparing the double versus single bundle technique for ACL reconstruction. We are trying to truly determine which way to anatomically reconstruct the ACL is the best.”
Elite athletes might be the first patients on the receiving end of these newer treatments, but they aren’t far ahead of the average patient, he says. “It’s a slow evolution and we really owe it to the researchers in the lab who shed light on the scientific advances,” he says.
4. Hip arthroscopy. An increasing number of physicians have been adopting hip arthroscopy into their practice, allowing them to treat patients with hip disorders using the minimally invasive arthroscope. The procedure just recently received a CPT billing code for labral tears and impingement. “A lot of people who develop early hip arthritis had the pathology of femoral acetabular impingement and could have been treated with hip arthroscopy,” says Dr. Primus. “If we are able to treat patients earlier, we will hopefully experience a decrease in early arthritis.”
Elite athletes often develop early arthritis because of the increased amount of impact they place on their joints during practice and competition. The most common athletes to develop early arthritis in the hip are hockey players and certain types of runners.
5. Concussion management. While we are in the process of developing a clear consensus on the treatment for athletes who experience concussions, an increasing amount of research shows that sustaining multiple concussions could cause negative long term affects, including brain degeneration and cognitive deficit. “Every day we’re learning a little bit more about concussions and repetitive head trauma and their long-term consequences,” says Dr. Primus. “It should be real interesting to see how the game of football evolves to protect the youth from early head trauma so they don’t experience cognitive deficit or early degenerative disorders.”
In the past, researchers focused on preventing death related to head trauma. The current research shows that athletes can sustain concussions without experiencing initial symptoms, or experience problems from repetitive trauma even if that trauma isn’t classified as a true concussion. In a recent case, four high school level football players were shown to have significant cognitive deficit even though they never demonstrated outward signs of concussion. “How do we monitor and deal with chronic changes from a contact sport where repetitive head collisions are part of the game?” says Dr. Primus. “The next research will focus on how many times players hit their head and the impact of the hits to see how much is too much. Right now, it’s a huge question.”
6. Sports injury prevention. While much of sports medicine has previously been focused on treatment, there has been a recent push in both practice and research to promote injury prevention. Preventing athletic injuries through modified training and limiting overuse could save time and money in the healthcare industry. This might mean cutting back on practicing multiple times per day, limiting athletic seasons and cutting back on the number of repetitive motions, such as pitches, athletes make during the season. “We’re looking at how we can best optimize an athlete to minimize injury,” says Dr. Primus. “That’s where we’re really going to see a lot of change in the near future.”
Learn more about Dr. Gregory L. Primus.
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