Sports Medicine
Sports medicine includes a variety of injuries most commonly involving the knee or shoulder. This includes both traumatic injuries and repetitive use injuries. From ligament injuries in the knee such as ACL tears to tendon injuries of the shoulder's rotator cuff, Dr. Burris has expertise with treating these injuries both without surgical intervention or with surgical repair. He will explain the nature of your injury and discuss optimal treatment with a goal of returning to normal functional use or sports activities.
He has performed thousands of successful tendon, ligament, and cartilage repairs including the ACL, meniscus, and rotator cuff . He also has expertise in do-over or revision ACL reconstructions.
ACL Tear
Surgical reconstruction for a torn ACL or anterior cruciate ligament continues to evolve with newer techniques designed to improve results and better reproduce the normal anatomy of the ACL. This is a special interest of Dr. Burris and was a focus of his additional fellowship training in Sports Medicine at the University of Kentucky.
Anterior cruciate ligament ruptures most commonly occur as the result of a noncontact injury during “ACL dependent” sports such as soccer, football, basketball, and skiing. This is a season ending injury for athletes. While surgery for the torn ACL is not necessary for all patients, it is typically recommended for athletically active individuals.
Results of ACL reconstruction have in general been considered to be very good. However, results have more recently been questioned for certain subpopulations such as young and elite level athletes that may place higher demands on the surgically reconstructed knee. Particular issues that have arisen in an effort to improve our results include modifying surgical techniques and determining the best graft options for reconstructing the new ligament.
Surgical Technique
Anatomic ACL Reconstruction
Recent modifications have been made to the classic technique of arthroscopic ACL reconstruction. The main focus has been changing the position of the bone tunnel drilled through the femur or thigh bone, allowing the new ACL to be placed in its normal anatomic location. The theoretical advantage of the newer technique is that it will provide better rotational control of the knee during sporting activities, leading to less failures and better knee function. This is the preferred technique of Dr. Burris.
Graft Options
Graft options to build a new ACL include grafts taken from your own leg called autografts and grafts taken from a cadaver called allografts. The two most common autografts include a portion of the patellar tendon with attached pieces of bone and two of the hamstring tendons, the gracilis and semitendinosis. Results are very for good for both of these grafts. The patellar tendon graft however has been associated with a higher incidence of pain in the front of the knee. A more recent autograft option is a quadriceps tendon graft. This does not yet have the longer term results seen with the other options, but is another good option for certain people.
Allografts are commonly used in revision surgery situations where previous tissue may have already been taken from the leg. It is also a popular option for first time or primary ACL reconstructions. Advantages of allografts include decreased pain in the early postoperative period and not having to sacrifice any other tissues from your body which all have a purpose. A disadvantage of allograft tissue is that it takes longer to heal as compared to an autograft, but this does not mean that the functional recovery from surgery takes longer. This can be a very good option for most adults or those past their most competitive playing days (meaning you are no longer playing a sport 5-7 days per week). Higher failure rates with allografts have been demonstrated in young high demand athletes and caution should be used with this group. Graft options and deciding what graft is right for you should be discussed with your surgeon pre-operatively.
5 Strand Hamstring Graft
The diameter or size of the graft used has been shown to be one of several factors which can affect the rate of re-tearing the ACL. Hamstring tendons are commonly used to reconstruct the ACL and most commonly as a doubled over or 4 strand graft. The 5 strand hamstring graft produces a larger diameter graft from the same hamstring tendons which may ultimately decrease the risk of re-injury. Dr. Burris is currently one of few orthopedic surgeons in the region with expertise in this technique and has used this as a primary graft option for over 10 years.
Rehabilitation
Post-operative rehabilitation is an integral part of recovering and returning to sports after ACL surgery. Early goals involve restoring normal range of motion, normal walking, and strengthening of the quadriceps while protecting the new graft. Exercises and activities are gradually advanced as goals are reached. A return to unrestricted athletics typically occurs between 8-12 months after surgery and is based on the restoration of normal function. This is determined on an individual basis for each patient and the return to sports may be shorter or longer.
Additional Sources
More information on ACL injuries and treatment can be found through the website of The American Academy of Orthopaedic Surgeons. A 3D animation library provided by the American Orthopaedic Society for Sports Medicine and Understand.com is available through the following link, 3D Animation Videos. After clicking on the link, move the mouse over Knee Arthroscopy and several options for Torn ACL will be available.
Rotator Cuff Tear
Rotator cuff tears can occur secondary to acute trauma or more commonly secondary to degeneration and repetitive use. An acute traumatic rotator cuff tear is likely to require surgical treatment. Chronic and degenerative tears will most often be treated with a course of non-operative treatment prior to surgical consideration. This may include physical therapy, injections, medication, and home exercises. An MRI is often obtained to further evaluate the rotator cuff.
When rotator cuff repair is indicated, it can be performed using several different techniques including both arthroscopic and open surgical approaches. A mini-open approach allows a strong repair similar to a full open approach while also being minimally invasive. The approach used ideally should be that which provides the strongest repair for a particular tear.
There are a significant number of rotator cuff repairs that do not heal after surgery. Appropriate rehabilitation plays a significant role in recovery after rotator cuff repair. Restrictions placed on activities and exercises are necessary to allow healing. Range of motion, strength, and endurance are gradually increased through phases which are progressed over 3-4 months. The phases are designed to gradually restore function while protecting the repair. Overall recovery can take 6-12 months.
This information is a brief summary regarding treatment of rotator cuff tears and not intended to be a complete resource. Specific questions and surgical details should be discussed with your surgeon as opinions may vary.
Resources on Rotator Cuff Tears
More information is available through the website of The American Academy of Orthopaedic Surgeons. Click on the following link: Rotator Cuff Tears. A 3D animation library provided by the The American Orthopaedic Society for Sports Medicine and Understand.com is available through the following link, 3D Animation Video. After clicking on the link, move the mouse over Shoulder to view the available animations.
Labral Tear (SLAP) Tear
The labrum is a rim of cartilage attached circumferentially around the shoulder socket or glenoid. These injuries often occur in overhead athletes such as baseball players, but can occur in many sports. Physical examination in conjunction with an MRI is used to diagnose the injury. Symptoms often include pain, loss of strength, perceived instability, and catching or locking of the shoulder. A SLAP tear can occur acutely with a specific identifiable injury, with repetitive use, or chronically secondary to degeneration of the tissue. Recommended initial treatment is most often rehabilitation and rest from activity. Arthroscopic surgery is commonly performed for failure of non-operative treatment and sometimes as initial treatment for acute injuries.
Surgical treatment involves either debridement with removal of torn tissue or repair of the labral tear. Repair is performed by placing nonmetal anchors or screws into the shoulder socket with attached sutures placed through the adjacent labrum. Results after surgical repair of a torn labrum have been excellent. Return to athletic activities after repair is typically around 4 months, but highly dependent on the sport played. Recovery for a throwing athlete will typically be longer with a graduated throwing program.
Shoulder Instability and Bankart Tear
Shoulder dislocations most often result in a torn anterior labrum or Bankart lesion. This can result in recurrent instability or repeat shoulder dislocations particularly in young athletes. Non-operative treatment plays a significant role in treatment of this injury. However, surgical repair has more recently been utilized acutely for young patients who are at much higher risk for repeat dislocation episodes with excellent results.
Arthroscopic shoulder surgery is commonly used to treat recurrent instability and Bankart tears. This procedure typically involves repairing the torn labrum and/or tightening a loose joint capsule to the socket of the shoulder joint. The procedure is often referred to as a Bankart repair or capsulorraphy. The repair is performed by placing nonmetal anchors or screws into the shoulder socket with attached sutures placed through the adjacent labrum and capsule. Return to athletics is typically around 4 months following surgery.
Resources on Labral Tear
Additional information is available from The American Academy of Orthopaedic Surgeons. A 3D animation library provided by the The American Orthopaedic Society for Sports Medicine and Understand.com is available through the following link, 3D Animation Video. After clicking on the link, move the mouse over Shoulder to view the available animations.