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In this issue
Volume 2 • Issue 4
President’s Letter.............................................................................................4
Chairman’s Letter .............................................................................................5
The Age of Aquarius
New gender-specific knee implant
promises better results for women .....................................................6
A Dedicated Life
Surgeon wins acclaim and honors
for medical contributions
By Deborah Maxwell ....................................................................................................8
6
Preventing Youth Sports Injuries
Pitching a ban on Little League breaking balls ........................10
The Incredible Rush
Chicago Rush win ArenaBowl XX
By Paul Strandquist, Director of Marketing .......................................................14
Moving Up
Rush orthopaedics program
climbs to sixth in nation
By Kerri Kossick ...........................................................................................................17
The Gift that Keeps on Giving
Human allografts improve
quality of life for many patients
By Steven Gitelis, MD .................................................................................................18
14
A Winning Group
White Sox medical team honored
for contribution to World Series success .....................................22
Reducing Noncontact ACL Injuries
Focus on entire kinetic chain corrects faults,
improves performance
By John L. Honcharuk, ATC, CSCS,
and Joe Meier, PT, DPT, MS, NASM-PES, NASM-CPT, CSCS ..............................26
Directory ................................................................................................................34
22
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Orthopaedic Excellence 3
President’s Letter
T
hings continue to flourish for Midwest Orthopaedics at Rush in 2006. The
Chicago White Sox are off to another fast start this year, and it looks like the
Chicago Bulls are poised for a championship run in the 2006-2007 season.
And at Midwest Orthopaedics at Rush, we continue to build and improve on our
foundation as well. We have three new physicians starting with us in 2006.
Jeffrey Mjaanes, MD, who has worked as a pediatrician at Rush, recently completed a primary care sports medicine fellowship and joined the Midwest Orthopaedics at Rush primary care sports medicine team, where he will work with Program Director Kathleen Weber, MD, and
Trish Palmer, MD. Dr. Mjaanes will focus his efforts on our Central DuPage Hospital office located in
Winfield. We believe Dr. Mjaanes has significantly improved our ability to take care of the younger athlete population that we see growing at a very fast rate.
In addition, Johnny Lin, MD, recently became part of our foot and ankle section, joining Section Head
George Holmes, MD, and Simon Lee, MD. Dr. Lin recently completed a foot and ankle fellowship at the
Campbell Clinic in Tennessee but is also familiar with the Rush program, having completed his residency at Rush. Dr. Lin will be primarily based out of the Central DuPage Hospital office in Winfield, and
his presence will enable us to continue to grow our subspecialty offerings at that location and in the
western suburbs.
Filling a role and a subspecialty that has been vacant and highly needed is Monica Kogan, MD, a pediatric orthopaedic surgeon. Dr. Kogan comes to us from Children’s Hospital in Oakland, California,
where she was the staff pediatric orthopaedic surgeon. Dr. Kogan is familiar with Chicago, though,
having completed her residency at Northwestern.
Besides welcoming these highly qualified physicians, we are also expanding our practice locations. We
will soon open a brand new office in Westchester at the just-completed Prairie Medical Center at 2434
South Wolf Road (next door to our corporate offices). We are excited to be at this multispecialty facility, centrally located in the Chicago area. We currently plan to offer sports medicine, shoulder, foot and
ankle, and hand services at this facility.
We believe the addition of these physicians and this new practice location will help us in providing the
best, broadest, and most convenient menu of orthopaedic services possible for both you and your
patients. If there are ever any issues or deficiencies with the services we are providing to you, please
contact me or our CEO, Dennis Viellieu, at (708) 236-2611, and we will help you in any way possible.
Go Sox,
Charles A. Bush-Joseph, MD
Managing Member, Midwest Orthopaedics at Rush, LLC
cbj@rushortho.com
On the cover: The Zimmer Gender Solutions™ High-Flex Knee implant offers a narrower and thinner shape and
more natural tracking to accommodate female anatomy. Physicians at Midwest Orthopaedics at Rush (MOR)
collaborated with Zimmer to develop the new implant. (Inset) MOR’s joint physicians include (from left) Scott Sporer,
MD; Richard A. Berger, MD; Craig J. Della Valle, MD; Aaron G. Rosenberg, MD; Joshua J. Jacobs, MD; Wayne G. Paprosky,
MD; (not pictured) Jorge O. Galante, MD; Steven Gitelis, MD; and Mitchell Sheinkop, MD.
4 Orthopaedic Excellence
A publication from
Midwest Orthopaedics at Rush
www.rushortho.com
Central DuPage Hospital
25 North Winfield Rd.
Winfield, IL 60190
Toll free: (877) MD-BONES
Phone: (630) 682-5653
Fax: (630) 682-8946
Chicago — South Loop/River City
800 South Wells, Ste. M30
Chicago, IL 60607
Toll free: (877) MD-BONES
Phone: (312) 431-3400
Fax: (312) 427-6116
Family Medical Center of Westchester
Medical Office Building
2434 S. Wolf Rd.
Westchester, IL 60154
Toll free: (877) MD-BONES
Oak Park Hospital
Medical Office Building
610 South Maple Ave., Ste. 1400
Oak Park, IL 60304
Toll free: (877) MD-BONES
Phone: (312) 243-4244
Fax: (312) 942-1517
RUSH University Medical Center
1725 West Harrison St., Ste. 1063
Chicago, IL 60612
Toll free: (877) MD-BONES
Phone: (312) 243-4244
Fax: (312) 942-1517
Chairman’s Letter
Physician Listing
Howard An, MD
Spine, Back, and Neck
Simon Lee, MD
Foot and Ankle
Gunnar Andersson, MD
Spine, Back, and Neck
Johnny Lin, MD
Foot and Ankle
Bernard R. Bach Jr., MD
Sports Medicine
Jeffrey Mjaanes, MD
Sports Medicine
Richard A. Berger, MD
Joint Reconstruction
Gregory P. Nicholson, MD
Sports Medicine and Shoulder
Charles A. Bush-Joseph, MD
Sports Medicine
Trish Palmer, MD
Sports Medicine and Women’s
Sports Medicine
Mark S. Cohen, MD
Hand, Wrist, and Elbow
Brian Cole, MD
Sports Medicine, Cartilage
Restoration
Craig J. Della Valle, MD
Joint Reconstruction
John Fernandez, MD
Hand, Wrist, and Elbow
April Fetzer, DO
Physical Medicine/Pain
Management
Wayne G. Paprosky, MD
Joint Reconstruction
Frank M. Phillips, MD
Spine, Back, and Neck
Anthony Romeo, MD
Sports Medicine, Elbow,
and Shoulder
Aaron G. Rosenberg, MD
Joint Reconstruction
Mitchell Sheinkop, MD
Joint Reconstruction
Jorge O. Galante, MD
Joint Reconstruction
Kern Singh, MD
Spine, Back, and Neck
Steven Gitelis, MD
Orthopaedic Oncology/Joint
Reconstruction
Scott Sporer, MD
Joint Reconstruction
Edward Goldberg, MD
Spine, Back, and Neck
George Holmes Jr., MD
Foot and Ankle
Joshua J. Jacobs, MD
Joint Reconstruction
Monica Kogan, MD
Pediatric Orthopaedics
Nikhil Verma, MD
Sports Medicine and Shoulder
Walter W. Virkus, MD
Orthopaedic Oncology/Trauma
Kathleen Weber, MD
Sports Medicine and Women’s
Sports Medicine
T
his year continues to be both exciting and challenging. First and foremost, our plans to develop a
dedicated orthopaedic ambulatory destination on
the Rush campus continues to move forward and take
shape. We have selected the developer, architects, and
construction managers that will help us realize this
dream. We expect this facility to be completed and
come online in the first quarter of 2009, but there is
much planning and work to be completed first.
Rush’s plans for a new hospital and campus renovation are also moving forward. Rush has already received $167 million in pledges or donations
toward a goal of $300 million. Rush plans include a new hospital facility
that will incorporate a brand new concept called an “interventional platform.” Two floors, extending from the new hospital into the renovated
Atrium building, will be devoted to surgery, imaging, and specialty procedures. Nearby will be the facilities and equipment required for interventional
radiology, cardiology, and neurosurgery, fostering increased collaboration
and a multidisciplinary approach for specialists who are doing similar procedures. The interventional platforms will locate key services close to one
another on two easily accessible levels, minimizing the need for patients and
their families to travel to multiple locations in the medical center.
Rush’s new hospital also will include a state-of-the-art emergency services
facility designed to care for victims of major catastrophes. It will be named
the McCormick Tribune Center for Advanced Emergency Response in recognition of the foundation’s $7.5 million contribution in 2004. Rush and the
John H. Stroger Jr. Hospital in 2002 were named bioterrorism preparedness
Centers of Excellence by the Chicago Department of Public Health. Each
hospital has received grants to improve hospital capabilities in preparedness planning, disease detection and surveillance, infection control, communications, collaborations, education and training, and more.
The campus redevelopment also includes implementation of a new information technology system. New electronic software applications (Epic) will
ensure the integration of clinical and financial information, providing
streamlined registration and scheduling, faster and more accurate test
results, and real-time access to complete medical histories.
The department also continues to benefit from Rush’s philanthropic
endeavors with a recent contribution of $4.5 million. Donations such as
this enable us to advance our research efforts to the benefit of patients.
We hope that these coordinated efforts and improvements, along with the
implementation of new technologies, by Rush, the Orthopaedic
Department, and Midwest Orthopaedics at Rush, will enable us to improve
the care and treatment of your patients both today and far into the future.
Best regards,
Gunnar Andersson, MD, PhD
Chairman, Department of Orthopaedic Surgery
Rush University Medical Center
Orthopaedic Excellence 5
The Age of Aquarius
New gender-specific knee implant promises better results for women
flexibility. We simply have not had an implant that
meets these unique requirements.”
The Zimmer Gender Solutions High-Flex Knee is
the first knee replacement shaped to fit a woman’s
anatomy. Illustrations courtesy of Zimmer, Inc.
ccording to the National Center for Health
Statistics, women comprise nearly two-thirds
of the 400,000 knee replacement surgeries
performed annually. Even more surprising is that
in spite of experiencing a higher incidence of knee
pain, women are also three times less likely than
men to undergo joint replacement surgery.
A
That has changed with the launch of a new gender-specific implant designed to better match the
structure of a woman’s knee joint. This implant
can be placed using minimally invasive surgical
techniques, which typically produce smaller scars,
shorter hospital stays, and quicker recoveries.
“Less invasive procedures are helping patients get
back to enjoying their lives faster than ever before,”
adds Dr. Rosenberg. “Now that we have a knee
in women,” says Aaron Rosenberg, MD, Director shaped to fit a woman’s anatomy, we expect that
of the Section of Adult Reconstruction at far more women will consider knee replacement.”
Midwest Orthopaedics at Rush. “Women’s
knees are different from men’s in that they’re nar- Advantages of Women’s Implant
rower side to side for a given front-to-back
dimension. More importantly, women’s joints are The implant was developed through the extensive
shaped differently in all sizes and exhibit more research efforts of the Midwest Orthopaedics at
Although the current implant technology has
functioned well for both men and women, providing pain relief and significantly improving function, these implants are less likely to fit, feel, and
function naturally for female patients.
Relative to the knee joint, female anatomy is significantly different from male anatomy. Women
have wider hips than men, changing the angle at
which the femur connects to the knee. Women’s
knees have less cartilage, so women are more
likely to experience osteoarthritis, a leading factor
in knee replacement surgery. Lifestyle factors,
such as pregnancy and wearing high-heel shoes,
are additional contributing factors.
Meeting Women’s Needs
Since the implants are not precisely suited for
the female anatomy, the procedures are more difficult — for both the surgeon and patient. “I
think the lack of a gender-specific knee implant
has contributed to the lower utilization rate
6 Orthopaedic Excellence
All other total knee implants being used today fall within the same size and proportion ranges, which are
based on an average between the sizes of women’s and men’s knees. This approach does not optimally address
the differences in shape between women’s and men’s knees. The Gender Solutions High-Flex Knee from
orthopaedics leader Zimmer is the first and only implant to address the three distinct and scientifically documented shape differences between women’s and men’s knees.
Rush joint reconstruction team in collaboration
with Zimmer, Inc., the world’s leading manufacturer of knee replacements. According to Zimmer,
the Gender Solutions High-Flex Knee implant
offers the following three advantages:
TM
• Narrower shape, proportioned to
female anatomy: Surgeons typically
choose a knee implant size based on the
front-to-back measurement of the end of
the femur, which is key in allowing the
knee to move and flex properly. However,
an implant that provides a good fit for a
woman’s knee from front to back often
will be too wide from side to side. This
leads to the implant overhanging the
bone and potentially pressing on, or damaging, surrounding ligaments and tendons
and possibly causing pain. The Gender
Solutions High-Flex Knee is proportionally
contoured to the entire bone to provide a
more precise fit.
but still feel “bulky,”
which may result in
pain and decreased
optimal function.
The Gender
Solutions implant is
thinner in shape in
the front, so the
knee replacement
more appropriately
matches the natural
female anatomy.
The femur, or thighbone, portion of a typical woman’s knee (left) tends to be
narrower from side to side and more trapezoid shaped, while a man’s (right) is
wider and more rectangular shaped. The Gender Solutions High-Flex Knee is the
first knee replacement shaped to fit a woman’s anatomy.
• More natural
tracking: The angle
between the pelvis
and the knee affects
how the patella
tracks over the end
of the femur as the
knee moves through
a range of motion.
Women tend to have
• Thinner shape: The bone in the front of
a different angle
women’s knees is typically less prominent
than men, due to To accommodate the different shape of women’s knees, the front of the Gender
Solutions Knee Implant (right) is narrower than a traditional implant (left).
than in men’s. Therefore, when a traditheir unique shape
tional implant is used to replace the damand contour. Before the Gender Solutions
Rosenberg. “The gender-specific implant is the
aged bone, the joint may end up feeling
High-Flex Knee, all implant designs were
best of both worlds. It’s based on the current
and functioning better than before surgery
based on an average of women and men.
implant we use, a highly successful implant with
Therefore, the tradigreat mechanics and 10 years of clinical success,
tional artificial knee
but the shape of this new implant is different to
may tend to track at
make it feel more natural.”
an angle that leads to
The Future of Knee Replacements
a woman’s knee feeling unnatural as it
The development of the new gender-specific
moves. The Gender
implant comes at the forefront of a major
Solutions knee
groundswell of demand for joint replacement. As
implant was designed
baby boomers transition from middle age to sento accommodate the
ior citizenship, the number of candidates for artidifferent tracking
ficial joints will increase markedly.
angle and function
more like a woman’s
According to a new study by the American
natural knee.
Academy of Orthopaedic Surgeons (AAOS), the
“Knee implants have total number of knee implants performed in the
been functioning very United States will reach nearly 3.5 million by the
w e l l f o r m e n a n d year 2030. The majority of these will undoubtedly
women, but we want to be women.
meet women’s unique
needs by making knee In addition to the aforementioned contributing
replacements that feel, factors for joint replacement, women in the
The bone in the front of women’s knees is typically less prominent than in men’s.
The Gender Solutions implant is thinner in shape in the front, so the knee fit, and function even United States live longer than men on average,
replacement more appropriately matches the natural female anatomy.
continued on page 12
b e t t e r, ” s a y s D r.
Orthopaedic Excellence 7
A Dedicated Life
Surgeon wins acclaim and honors for medical contributions
By Deborah Maxwell
idwest Orthopaedics
at Rush joint replacement surgeon Joshua
J. Jacobs, MD, was elected
President of the
Orthopaedic Research
Society (ORS) at its recent
annual meeting in
Chicago. Dr. Jacobs served
on the ORS Board of
Directors for five years
prior to his election.
According to Dr. Jacobs,
“ORS is a complex organization that provides an
international forum for the
dissemination of rapid
developments in
orthopaedic research that
may ultimately have a dramatic impact on the diagnosis and treatment of
both common and rare
musculoskeletal diseases.”
M
“It is an honor to be
selected for the Knee Society
and join my distinguished
partners Dr. Galante, Dr.
Rosenberg, and Dr. Paprosky
in this influential organization,” says Dr. Jacobs.
Staying at the
Forefront
Dr. Jacobs’ accomplishments
are even more significant
when viewed in light of the
overall field of adult joint
reconstructive surgery, a
constantly changing
orthopaedic subspecialty.
The American Academy of
Orthopaedic Surgeons
(AAOS) states joint replacement surgery “…has been
one of the most significant
advances in musculoskeletal
surgical treatment over
the past 30 years.”2
Furthermore, AAOS statistics
show more than 500,000
total joint replacements are
performed each year in the
United States.2
As President, Dr. Jacobs
will manage the fiscal and
strategic mission of ORS.
Founded in 1954 and
incorporated as a nonprofit organization in
1982, ORS promotes
Dr. Jacobs holds hip prostheses that were recovered from a patient who underwent revision surgery
Despite these statistics, the
orthopaedic research, pro- and received new implants. Photo courtesy of the Associated Press.
AAOS Research Committee
vides mentorship for
(2003) reports that joint
young researchers, and
publishes the Journal of Orthopaedic Research.1 International Hip Societies (along with Midwest replacement surgery is not yet fully utilized across
ORS also lobbies for increased federal research Orthopaedics at Rush physicians Jorge O. Galante, all ethnicities and geographic areas.2 However,
funding for musculoskeletal diseases and works MD; Aaron Rosenberg, MD; and Wayne Paprosky, patients who do receive orthopaedic prostheses
to increase public awareness of the impact MD), Dr. Jacobs is considered among the elite are so accepting of the technology that not much
orthopaedics has made on patients’ lives.
adult reconstructive orthopaedic surgeons in the thought is given any more to the work, science,
world — those who have made significant contri- or scientists behind these modern-day miracles.
Also recently inducted into the Knee Society, and butions to the body of orthopaedic research, Significant improvements in the scientific and
an already established member of the U.S. and knowledge, and clinical practice.
clinical body of knowledge in adult arthroplasty
8 Orthopaedic Excellence
OrthoFact
The Research Department at Rush University
Medical Center in Chicago is dedicated to the
pursuit of outstanding biomedical research
to advance knowledge and optimize patient
care. Rush aims to foster centers of excellence that combine clinical, basic, and population science to study areas of importance
to the community. Several programs have
been created to support and encourage
Rush investigators involved in more than
1,600 research studies, and Joshua J.
Jacobs, MD, of Midwest Orthopaedics at
Rush, serves as the Director of Orthopedic
Residency Program and the Director of the
Section of Biomaterials for the Rush
Research Department.
over the last generation have contributed to
improved quality of life for patients and, therefore, have contributed to this sea change of
almost universal acceptance by patients.
Leading Research Efforts
One of Dr. Jacobs’ major contributions, a study
funded by the National Institutes of Health (NIH),
is a “unique effort,” according to Dr. Jacobs, principal investigator of the study. This longitudinal
study, initiated approximately 15 years ago by Dr.
Jacobs’ partner Jorge O. Galante, MD, studies
wear patterns and particulate debris generated by
prosthetic implants and the effect of this debris
upon surrounding body tissues and distant
organs. This study is ongoing and has already
yielded translational results in the ability for physicians to gauge how well an orthopaedic implant
is working via serum and metal blood levels.
“My work is at the
interface of medicine
and engineering.”
— Joshua J. Jacobs, MD
Review of the literature shows that particulate
debris can induce prosthetic failure; therefore, one
can expect Dr. Jacobs’ eventual results regarding
particulate debris to increase scientific understanding of cellular and systemic response to implants
and quite possibly the strengths and weaknesses in
prosthetic materials and design.3 Ultimately, these
results will be utilized to develop longer-lasting,
better performing prostheses.
yet his impact on current and future patients’ lives
has yet to be fully realized and will not be for
years to come.
Deborah Maxwell holds a Bachelor of Science
in business administration with a concentration
in management from Elmhurst College. She
has worked with the physicians of Midwest
Orthopaedics at Rush for 16 years and currently
serves as Marketing Analyst for the group. She
Putting Knowledge to Work
has previously written on other medical topics,
including osteoporosis and Rett Syndrome, and
An undergraduate degree in material science and has served as editor for “Common Call,” the
engineering from Northwestern University has newsletter for the Oak Park-River Forest
meshed perfectly with Dr. Jacobs’ clinical Community of Congregations.
work and research with
orthopaedic implants. His
knowledge of metallurgy
has been helpful in understanding many of the clinical problems that develop in
individuals with metal
implants, such as the relation between prosthetic failure and metal allergy.4 Dr.
Jacobs says, “My work is at
the interface of medicine
and engineering.”
In addition to his clinical and
research duties, Dr. Jacobs
is active with various
orthopaedic societies and Dr. Jacobs (right) has met with House Speaker Dennis Hastert (left) and will
travel to Washington later this year to advocate for federal policies to prochairs the AAOS Council on mote musculoskeletal health.
Research, Quality Assessment, and Technology.
Consistent with the council and the mission of ORS, References
Dr. Jacobs has met with House Speaker Dennis 1. Orthopaedic Research Society. (2006). [WWW document].
Retrieved: http://www.ors.org/Welcome.asp.
Hastert and will travel to Washington later this year
to advocate for federal policies to promote muscu- 2. AAOS Research Committee. (June 2003). Future directions
in musculoskeletal research: a summary report of the AAOS
loskeletal health. Health care policy, economics,
research committee panel studies. 53, 93.
and research funding are vital issues for Dr. Jacobs
and AAOS, particularly as the demand for 3. National Institutes of Health. (2000). Improving medical
implant performance through retrieval information: chalorthopaedic implants and health care services is
lenges and opportunities. [WWW document]. Retrieved:
projected to increase as the population ages.
http://consensus.nih.gov/2000/2000MedicalImplantsa019html
Dr. Jacobs also heads the Orthopaedic
Postmortem Retrieval study at Rush University
Medical Center in Chicago. Study participants
agree to removal of their prostheses, as well as
the bone and tissue around the implant and possibly remote tissue samples from their bodies,
shortly after death.
.htm, paragraph 2 of Explant Analysis section.
From his work with the ORS to his federally
funded research, the halls of Congress, and 4. Jacobs, J. (2005). Commentary & perspective on
metal-on-metal bearings and hypersensitivity in
Midwest Orthopaedics at Rush, Dr. Jacobs is a
patients with artificial hip joints: a clinical and histoconstant advocate for orthopaedic science and
morphological study. The Journal of Bone and
patient care. His contributions to orthopaedic
Joint Surgery. [WWW document]. Retrieved:
research, knowledge, clinical practice, and policy
http://www.jbjs.org/Comments/2005/cp_jan05_jacobs.shtml.
are extensive. Dr. Jacobs’ mission is far from over,
Orthopaedic Excellence 9
Pitching a ban
on Little League
breaking balls
he breaking ball is a devastating weapon in a
Little League baseball game. To even the best
players, the pitch is nearly unhittable.
Unfortunately, the pitch’s nasty effect goes
beyond baffling opposing hitters.
T
Overuse Abuse
Among pitchers younger than 12 years of age,
nearly 45% complain of chronic elbow pain.
According to a study published by the Journal of
the American Academy of Orthopaedic Surgeons,
overuse and incorrect throwing mechanics are the
primary causes of elbow injuries in young pitchers.
“In youth baseball, there are certain
motions that are repeated over and over
again that are likely to create an overuse
injury,” says Bernard R. Bach Jr., MD,
Director of Sports Medicine at Midwest
Orthopaedics at Rush. “Even in a normal
throwing motion, the elbow is under a
tremendous amount of stress. Factor in
abnormal mechanics, such as the motion
used to throw a breaking ball, and the
stress is multiplied.”
Boys are often able to learn the curve ball at
10 or 11 years of age, which is, according to
Dr. Bach, well before their arms are ready for
the strain. Competitive coaches encourage their
pitchers to throw breaking balls and also exhibit
a tendency to overuse their better hurlers.
Patrick McKune, Treasurer of Oak Park Youth
Baseball, has witnessed the trend of injury and
overuse. “In the Little League World Series, it was
reported that 60% to 65% of the pitches thrown
were curve balls,” says McKune. “You just have to
shake your head. Another wake-up call for me
was last year when I witnessed my son throw six
straight curve balls in a game.”
10 Orthopaedic Excellence
Taking Action
When the condition is not treated, it can cause
long-term problems.”
Disturbed by this growing trend, McKune decided
to take action. Along with Dr. Bach and represen- Dr. Bach adds, “It seems that every parent thinks
tatives from AthletiCo, McKune arranged a meet- his or her kid is on the fast track to a Division I
scholarship, and, ultimately, a professional baseAmong pitchers younger ball career. There is a ‘graveyard’ of talented kids
careers ended prematurely because of
than 12 years of age, near- whose
throwing-related elbow and/or shoulder injuries.
ly 45% complain of chronic We advocate throwing a fast ball and a change
elbow pain. According to a up but no curve balls until approximately 13 or
14 years of age. The kids should focus on pitchstudy published by the
ing mechanics and control. Kids mature at differJournal of the American
ent rates, and mechanics can change
Academy of Orthopaedic dramatically when adolescents go through rapid
growth spurts, which may result in significant
Surgeons, overuse and
muscle imbalances.”
incorrect throwing
mechanics are the primary
causes of elbow injuries in
young pitchers.
McKune initially thought enforcement of the new
rules might be an issue, but to date, no infractions
have been observed. To his knowledge, the ban
enacted by Oak Park Youth Baseball may be
unique to the area. “It’s my hope that other
ing with the Oak Park Youth Baseball board, leagues will adopt similar rules to protect the
making the case for a ban on breaking balls com- health of their young players.”
bined with a mandatory pitch count. The board
agreed with Dr. Bach’s medical opinion Injury Prevention
and enacted both the ban on breaking
balls and pitch count restrictions. Dr. Dr. Bach’s work on the breaking ball issue
Bach is confident that it will have a dra- stems from his considerable interest in youth basematic effect on the occurrence of injury. ball and sports medicine. Serving as the Vice
President of the American Orthopaedic Society
“I’ve performed elbow surgery on 12- for Sports Medicine, Dr. Bach was instrumental in
and 13-year-old pitchers, and it’s just the development of Prevention and Emerheartbreaking,” says Dr. Bach. “These gency Management of Youth Baseball and Softball
overuse and stress-related problems Injuries (see Youth Baseball Safety).
can affect growing parts of the bone
(the growth plates), not just For a copy of Prevention and Emergency
muscles, tendons, and ligaments. Management of Youth Baseball and Softball
Injuries or for more
information on youth
baseball safety, visit the
American Orthopaedic
Society for Sports
Medicine online at
www.sportsmed.org or
call Midwest
Orthopaedics at Rush at
(877) MD-BONES.
Overuse and stress-related problems can affect elbow ligaments (shown above),
muscles, and tendons, possibly leading to long-term problems.
Youth Baseball Safety
Prevention and Emergency Management of Youth Baseball and Softball
Injuries provides guidelines on youth
baseball safety to help coaches and
parents to:
• be familiar with basic sports
injury terminology;
• be aware of up-to-date techniques for preventing sports
injuries;
• be able to differentiate between
mild, moderate, and severe
injuries;
• know appropriate first aid
techniques for the injuries they
will encounter;
• be able to design an emergency
plan for their league to use when
severe injuries occur; and
• know specific techniques to
determine whether an injured
player is ready to practice and
play again.
Bernard Bach Jr., MD, Director of
Sports Medicine at Rush since 1986,
has developed a nationally recognized
sports medicine program. Dr. Bach has
published more than 240 scientific
papers, abstracts, and book chapters. He serves on
numerous national sports committees and editorial
boards and is an educator of residents, fellows, and
his patients. Dr. Bach is board certified (1989) and
recertified (1999) by the American Board of
Orthopaedic Surgery. Dr. Bach has served on the
national boards of the Illinois Special Olympics, the
Orthopaedic Research and Education Foundation,
and the American Orthopaedic Society for Sports
Medicine. He is the Editor of the Journal of Knee
Surgery. Dr. Bach was selected as one of Chicago
magazine’s “Top Doctors” in 1996, 2000, 2004, and
2006, and is recognized nationally and internationally as a leader in sports medicine. He was inducted
into the Illinois Athletic Trainer’s Hall of Fame in
1995. Along with the other members of the Sports
Medicine Division, he was selected as a Team
Physician for the Chicago White Sox baseball team in
2004 and 2005.
Orthopaedic Excellence 11
The Age of Aquarius
continued from page 7
with a life expectancy of 80 years, compared to 75
years for men.
In addition to Dr. Rosenberg, Midwest Orthopaedics
at Rush surgeons Richard Berger, MD, and Wayne
Paprosky, MD, worked closely with biomechanical
engineers throughout the two-year research and
development process. The new implant, which has
received clearance from the FDA, is already being
utilized by Midwest Orthopaedics at Rush joint
reconstruction physicians and is expected to be
globally available this fall.
“The new implant is evidence of our dedication to
research over the past 25 years and to improving
our patients’ quality of life through decreased pain
with better implants,” says Dr. Rosenberg.
For more information on joint replacement surgery
and gender-specific implants, contact Midwest
Orthopaedics at Rush at (877) MD-BONES or visit
www.rushortho.com.
12 Orthopaedic Excellence
Women’s Movement
The following physicians are leading the way with gender-specific knee implants.
By increasing the utilization of knee implants in women with osteoarthritis, they are
helping improve their mobility and quality of life.
Richard A. Berger, MD, earned a degree in mechanical engineering from
MIT that has well equipped him for his biomechanics research on total hip
replacements. Dr. Berger was fellowship trained in adult reconstruction at
Rush University Medical Center by Jorge Galante, MD, and Aaron
Rosenberg, MD.
Aaron G. Rosenberg, MD, specializes in hip, knee, and joint replacement
surgery. He is a graduate of Albany Medical College. He served as a resident at Rush University Medical Center in orthopaedics and served as a
fellow in adult reconstruction and oncology at Massachusetts General
Hospital in Boston, prior to beginning the practice of orthopaedic surgery
at Rush in 1984.
Wayne G. Paprosky, MD, specializes in hip and knee replacement. Dr.
Paproksy is a graduate of McMaster University School of Medicine. He
served his residency at Henry Ford Hospital in Detroit and served as a fellow in adult joint reconstruction at New England Baptist Hospital, Tufts
University, Boston.
Orthopaedic Excellence 13
The Incredible
Rush
Chicago Rush win
ArenaBowl XX
By Paul Strandquist, Director of Marketing,
Midwest Orthopaedics at Rush
Chicago Rush fans came out to support their team, helping make it the biggest crowd in
ArenaBowl history.
T
he Chicago Rush completed one of the most
improbable runs in Arena Football League
(AFL) history with a 69-61 win over the
Orlando Predators in ArenaBowl XX on Sunday,
June 11, 2006, at the Thomas and Mack Center
in Las Vegas. “I am so proud of this team,” says
Rush Head Coach Mike Hohensee, who won his
first AFL title after 20 seasons in the league.
“They believed in each other and played their
hearts out, and now they can call themselves
champions.”
The Rush was 5 and 9, and it looked like the
team might miss the playoffs. However, the
Rush responded by winning its final two regular
season games in convincing fashion to qualify
for the playoffs and then went on the road to
win four consecutive playoff games.
The Thrill of Victory
Rajeev Khanna, MD, and Paul Strandquist, Director of Marketing at Midwest Orthopaedics at Rush
I was at the final game, sitting with the Chicago
Rush families, staff, and corporate sponsors to
celebrate a great season and a fantastic ArenaBowl championship. What a thrill to be included
with the Chicago Rush front office staff, families,
and management and to share in their welldeserved excitement and celebration after they
won the championship. ArenaBowl XX was a
big sporting event, and Chicago fans came out to
support their team, helping make this the biggest
crowd in ArenaBowl history.
14 Orthopaedic Excellence
with the Chicago Rush as a corporate
sponsor and as the team’s orthopaedic consultants. Midwest Orthopaedics at Rush physicians
work closely during the AFL season with Rush
Head Team Physician Rajeev Khanna, MD, and
Th i s y e a r m a r ke d t h e s e c o n d s e a s o n his colleagues at Advanced Occupational
Midwest Orthopaedics at Rush has worked Medicine Specialists.
Dr. Khanna and John Connell, Athletic Trainer
for the Rush, were busy at ArenaBowl XX taking care of the players’ injuries before and after
the game. But they found time to come out of
the locker room after the Chicago Rush victory
to join the on-field celebration with all the
Rush players, families, and staff, as well as the
Chicago Rush fans.
Brian Cole, MD. “They were 5 and 9 but continued to battle and finished the season champions. We will do our part and continue to
provide the highest quality of subspecialized
sports medicine care to anyone, including
championship professional sports teams,
college and high school athletes, and the
weekend warriors.”
Paul Strandquist, Director of Marketing at
Midwest Orthopaedics at Rush, earned a Bachelor
of Science in health and physical education from
Illinois State University. He has been in customer
service and marketing with Midwest Orthopaedics
at Rush for 20 years. He enjoys coaching baseball
and playing Chicago-style 16-inch softball.
“I am so proud of this team.
They believed in each other
and played their hearts out,
and now they can call
themselves champions.”
— Mike Hohensee, Rush Head Coach
A Little Luck, a Lot of Skill
Mike Ditka — now part owner of the Chicago
Rush, NFL Hall of Fame player, and of course “da
coach” of the Chicago Bears’ Super Bowl XX
champions — was also on hand for the celebration. Many fans and the media called “da
coach” a good luck charm, stating that Ditka
was a part of Super Bowl XX and now the
Chicago Rush ArenaBowl XX victory.
The same can also be said for the physicians of
Midwest Orthopaedics at Rush who were part
of the 2005 Chicago White Sox World Series
Championship team as their team physicians.
And now the Chicago Rush has won
ArenaBowl XX in 2006.
“All the credit for the ArenaBowl championship goes to the players and coaches,” says
David McClamroch, Corporate Sales Manager for the
Chicago Rush; Paul Strandquist, Director of Marketing
at Midwest Orthopaedics at Rush; and Mike Gordon,
Vice President of Sales for the Chicago Rush
Orthopaedic Excellence 15
16 Orthopaedic Excellence
Rush orthopaedics program
climbs to sixth in nation
By Kerri Kossick
nce again, the Rush University Medical Center
Orthopaedic Program gained national recognition among orthopaedic practices by making
another appearance in U.S.News & World
Report’s “America’s Best Hospitals” issue. This
year, Rush was the nation’s sixth best and Illinois’
top program.
O
Continuous Advancements
Rush was ranked tenth in 2004,
climbed to eighth place in 2005, and
moved up to sixth in the nation this
year. This upward trend is one that
Rush expects to continue throughout
the upcoming years.
“I believe the program can achieve an
even greater status,” says Gunnar
Andersson, MD, PhD, Chairman of the
Orthopaedic Department at Rush and
Partner with Midwest Orthopaedics at
Rush (MOR). “As we continue to pioneer advancements in orthopaedic
medical science, the stature of the program will only continue to increase.”
The Evaluation
This year, out of 5,189 hospitals nationwide, only 3 percent (176) were considered for evaluation. Each hospital was
ranked in one or more of the 16 specialties in this year’s “America’s Best
Hospitals” issue. For the orthopaedic specialty, the annual report evaluates practices according to specific criteria, including
reputation, mortality ratio, discharges over the
past three years, nurse-to-patient index, nurse
Magnet facility status, patient and community
services, key technologies, and trauma services.
Program ranked among the survey’s best in pists; specialists in gait analysis; x-ray and cast
technicians; and administrative personnel helps
nearly every category.
support the physicians and complete the range of
A Strong Team
services provided at Rush. Physicians and nurse
specialists working in teams thoroughly evaluate
The strength and success of Rush University each patient, accurately diagnose problems, and
Medical Center is due, in part, to its partnership create individualized treatment plans.
The collaboration between Rush
University Medical Center and MOR
generates progressive treatment
alternatives, including minimally invasive joint replacement and spine surgery; anterior cruciate ligament and
rotator cuff repairs; cartilage restoration; arthroscopic knee, shoulder, and
elbow repair; and minimally invasive
foot and ankle surgery. The
orthopaedic surgeons at Rush led the
way for many advances in hip and
knee implants, including minimally
invasive techniques that enable
patients to return home within a day.
In addition to surgical practices, the
physicians hold academic appointments at Rush Medical College and
are active in research. Their research
leads to discoveries and leading-edge
therapies that benefit patients, which
is what the physicians find to be their
greatest reward.
“The physicians of MOR are extremely
proud of this program’s success,
which validates the vision we share
with MOR. The Rush University Medical Center’s with Rush of providing the world’s best
orthopaedic medical staff is comprised largely of orthopaedic patient care, education, and
MOR physicians, who are highly trained in research,” says Dr. Andersson.
orthopaedic surgery as well as in specialized fields
For more information about the physicians at MOR or
within orthopaedic medicine.
the U.S.News & World Report “America’s Best Hospitals”
In addition to its high overall ranking, the A qualified staff of physician assistants; registered special issue, call (877) MD-BONES or visit
Rush University Medical Center Orthopaedic nurses; athletic, physical, and occupational thera- www.rushortho.com.
Orthopaedic Excellence 17
The Gift
that Keeps
on Giving
Human allografts
improve quality
of life for
many patients
By Steven Gitelis, MD,
Medical Director, Tissue Bank, Gift of Hope
T
he use of human tissue is not new. The first
reported tissue transplants occurred around
the turn of the 20th century. In recent years,
there has been increased popularity in the use of
allografts in orthopaedic surgery, and currently,
there are approximately 250,000 grafts transplanted per year in the United States.
There are many potential uses of these grafts, and
they can improve the quality of life of patients. It is
very important that the surgeon know the source
of these grafts and how they are processed and
screened. The state of Illinois has one of the largest
tissue banks in the United States. It operates with
the Gift of Hope, the organ procurement agency of
Fresh osteoarticular allograft of the hip and femur
18 Orthopaedic Excellence
Illinois. It is a not-for-profit tissue bank, and I have created to ensure a fair and equitable distribution
served as its medical director for 20 years.
of organs in the United States. Tissue banks frequently operate in conjunction with the organ
There are several important concepts that procurement organizations to acquire transorthopaedic surgeons need to understand related plantable allografts.
to procurement, processing, and safety issues.
When selecting a tissue bank, the surgeon needs When contacted, a transplant coordinator from
the Gift of Hope then assesses the donor. The
to know the bank and its banker.
coordinator talks to the donor family about tissue
Procurement
donation and describes the process and ultimate
use of these donated grafts. It is important that
Tissue procurement is a comprehensive process the organ procurement organization and the
that starts with the donor and donor hospital. The donor family develop a strong relationship. Even
donor hospital generally does its own initial though there is a driver’s license signature option
assessment and then contacts the organ procure- in Illinois, the donor family’s approval is still
ment organization in its area. Organ procurement sought for tissue donation. This is a critical
organizations are federally mandated and were informed consent process.
The transplant coordinator then evaluates the
donor for medical conditions that might preclude
procurement. These include, but are not limited to,
a history of cancer, hepatitis, and exposure to
other transmittable diseases. The donor is also
evaluated by an extensive battery of serologies to
rule out transmittable disease. Recently, we have
added nucleic acid testing to diminish the window
where a donor could be infected and not manifest
an immunological reaction to a virus.
Due to their work, the cells can be kept alive up
to 28 days, allowing the grafts to be appropriately
quarantined and placed with an acceptable donor.
All allografts, fresh or frozen, are cultured, and
these cultures are screened to determine the
acceptability of the allografts. After procurement
is performed, the donor is reconstructed for later
funeral services.
organisms; however, it has no effect on viral contamination and does cause some weakening of
the allograft. Other processes occur at Allosource,
such as machining of allografts. These are techniques where the human tissue is shaped, using
automated machines, into grafts that are useful
for specific surgical applications. An example is a
spinal graft used for spinal fusions.
Processing
After the procurement has been
completed, the tissue acquired
by Gift of Hope is sent to Allosource, a not-for-profit organization that is the fourth largest tissue
processing operation in the United
States. All the work done on the
allografts at Allosource is performed in a highly filtered clean
room under sterile conditions.
Meniscal allograft with subchondral bone
The tissue transplantation team then goes to the
donor hospital, the operating room at the medical
examiner’s office, or, more recently, to our stateof-the-art operating room at the Gift of Hope
located in Elmhurst, Illinois. The procurement
process is nothing less than a very careful
orthopaedic operating procedure. The tissue is
procured in a very sterile environment and then
cultured. The tissue is initially refrigerated and
then ultimately frozen to -80 degrees Centigrade
for storage. This freezing process diminishes the
immunogenicity of the allografts.
The tissue will remain in quarantine until all
screening tests have been completed and
reviewed along with the detailed medical record.
All this information is reviewed by me and Ross
Wilkens, MD, the Medical Director of Allosource in
Colorado. Thus, the tissue is very carefully scrutinized for acceptability.
Recently, fresh tissue procurement and transplantation has become very popular. This tissue is
screened in a similar manner to our standard
frozen allografts. These grafts are placed in tissue
cultures so the cartilage viability is maintained.
Much of the methodology to maintain the life of
articular cartilage was developed at Rush by the
Department of Biochemistry and Brian Cole, MD.
The grafts are debrided, cleansed, Bone tendon achilles allograft for cruciate reconstruction
and recultured. If the initial culture
at the time of procurement is a
low-virulent organization and if they are ren- Manufacturing techniques, such as computerdered culture negative after processing, they are assisted design and manufacturing, are used to
packaged and available for use. If the original prepare machined grafts. The freshly procured
cultures are of moderate virulence, then, in addi- articular grafts are washed and cleaned in
tion to preparation and cleansing, the grafts are Colorado and recultured. They are only released if
secondarily sterilized with gamma irradiation. all serologies and cultures are negative.
Finally, if the original cultures reveal a virulent
organism, such as Clostridium, enterococcus, or a Safety
fungal organism, the grafts are discarded at the
As a result of the careful historical screening,
procurement agency.
serological testing, cleansing, and culturing of all
Secondary sterilization with gamma radiation is grafts, human tissue allografts are extremely safe.
quite effective to eradicate moderate-virulent Bacterial contamination is very rare, and there has
not been a viral transmission from a
human allograft in nearly 20 years.
The stated risk of viral transmission
is approximately one in 1.5 million.
Allograft-prosthetic composite arthroplasty of the knee
Surgeons need to know the accreditation of their tissue banks. The tissue banking industry is regulated by
the federal government, which has
created guidelines for procurement
and processing. In addition, the
American Association of Tissue
Banks (AATB) has rigid guidelines
that must be met in order to receive
its accreditation. Both the Gift of
Orthopaedic Excellence 19
Hope and Allosource are AATB accredited. This accreditation should be
sought by surgeons transplanting human tissue.
Application
There are many clinical applications for human tissue. One of the more common applications is the use of demineralized bone matrix, which is derived
from human cortical bone. The donated bone is ground and demineralized
with a calcium content of less than 3%. This process releases bone proteins
that participate in the cascade of events leading to bone repair. Proteins,
such as bone morphogenic proteins, are released in this manner. These proteins are very effective as osteoinductive materials that aid in bone repair.
Long bone allografts are still used today to restore the skeleton after tumor
surgery. If a segment of the femur or tibia is removed, a frozen long bone
allograft is frequently used to restore the intercalary defect. Allografts
are also used in conjunction with implants as an allograft prosthetic
composite that is useful for both tumor surgery and complex joint
reconstructive surgery.
Spinal surgeons use allografts for fusions, both interbody and posterior
fusions. One of the more common uses of allografts is in knee reconstruction. Anterior cruciate ligament reconstruction with a bone tendon/bone
allograft is a popular technique and quite effective.
Finally, fresh articular cartilage is being used by joint restoration surgeons.
Unipolar defects of the lower femur or upper tibia can be replaced with a
fresh living allograft. Unfortunately, there is a greater demand for this tissue than there is a supply, but new techniques are being developed to
increase the available tissue.
In conclusion, human allografts are safe and effective. They are the result of
a generous gift by the donor family and can improve the quality of life of so
many people. Surgeons need to be mindful of the source of their grafts and
understand procurement processing and safety.
Steven Gitelis, MD, currently serves as the Director of the Rush
Center for Limb Preservation and the Medical Director of the
Tissue Bank, Gift of Hope. His numerous appointments also
include Endowed Chair, Rush Medical College Professor of
Orthopaedic Oncology, and Director of Section of Orthopaedic
Oncology, Rush-Presbyterian-St. Luke’s Medical Center. Dr. Gitelis has enjoyed
a longstanding relationship with Rush, completing both his orthopaedic surgery residency and general surgery internship at Rush-Presbyterian-St.
Luke’s Medical Center in Chicago. His early orthopaedic oncology experience
came from fellowships at the prestigious Rizzoli Institute in Bologna, Italy
(under renowned Professor Mario Campanacci), and the Mayo Clinic in
Rochester, Minnesota.
20 Orthopaedic Excellence
Orthopaedic Excellence 21
A Winning
Group
erm Schneider, Head Athletic Trainer for the
World Series champion Chicago White Sox,
presented World Series gifts to the White Sox
medical team at Rush University Medical Center
in May.
H
Members of the medical team receiving
gifts included Midwest Orthopaedics at
Rush physicians Charles A. Bush-Joseph, MD;
Kathleen Weber, MD; Bernard R. Bach Jr., MD;
Gregory P. Nicholson, MD; Nikhil
N. Verma, MD; Anthony A.
Romeo, MD; and Brian J.
Cole, MD. Also honored were
Rush University Medical
Center physicians Joseph
Hennessy Jr., MD; Dragan
Djordevic, MD; Scott
Palmer, MD; and Syed
Shah, MD. Clinical
staff members from
both the hospital and
Midwest Orthopaedics
22 Orthopaedic Excellence
White Sox medical team
honored for contribution
to World Series success
at Rush also received
gifts, including Marci
Bilkey, Naveed Kazi,
Ke r r y K ra u s h a a r,
Jessica Delgado, and
Leigh Lundberg.
Head Team Physician
D r. B u s h - J o s e p h
(orthopaedic surgery)
and Dr. Weber (primary care sports
Members of the medical team receiving gifts included Midwest Orthopaedics at
medicine/internal Rush physicians Charles A. Bush-Joseph, MD; Kathleen Weber, MD; Bernard R. Bach
Jr., MD; Gregory P. Nicholson, MD; Nikhil N. Verma, MD; Anthony A. Romeo, MD; and
medicine) received
Brian J. Cole, MD. Also honored were Rush University Medical Center physicians
official World Series Joseph Hennessy Jr., MD; Dragan Djordevic, MD; Scott Palmer, MD; and Syed Shah,
MD. Clinical staff members from both the hospital and Midwest Orthopaedics at
r i n g s, t h e s a m e
also received gifts, including Marci Bilkey, Naveed Kazi, Kerry Kraushaar,
r e c e i v e d b y t h e Rush
Jessica Delgado, and Leigh Lundberg.
White Sox players.
“We’re honored to receive World Series rings and An Intense, Active Role
truly value our three-year relationship with the
White Sox,” says Dr. Bush-Joseph. “We hope the Midwest Orthopaedics at Rush is proud of the role
White Sox have another healthy season, and we it played in a remarkably healthy and successful
White Sox World Series championship season.
can add another ring!”
Throughout the year, Midwest Orthopaedics at
Rush served as team physicians, working closely
with the head athletic trainer to keep the team in
top playing condition.
team physicians. All are on the faculty of Rush
Medical College. Dr. Bush-Joseph, Dr. Bach,
Dr. Nicholson, Dr. Cole, and Dr. Romeo are
orthopaedic surgeons who specialize in sports
medicine, treating everything from broken bones
Apart from being on the field for every home game to torn anterior cruciate ligaments and rotator
during the season and every home and away game cuffs. And Dr. Weber is board certified in internal
during the playoffs and World Series, the Midwest medicine and sports medicine.
Orthopaedics at Rush physician team was also
involved with player conditioning and training Dr. Weber served as the team’s primary internal
throughout the year. The team physician function medicine physician and is one of Major League
covered a broad range of responsibilities, including Baseball’s few female team physicians. With her
direct diagnosis and treatment on the field; provid- combined training in sports medicine, internal
ing care for visiting team players, coaches, and medicine, and exercise physiology, she was
umpires; follow-up and continued care in the uniquely qualified to address both orthopaedic
office; phone consultation; facilitation of emer- injuries and the medical aspects of sports medi- Head Team Physician Dr. Bush-Joseph (orthopaedic
surgery) and Dr. Weber (primary care sports medicine/
gency care; managing care when the team was on cine, such as heat illness, head injuries, allergies, internal medicine) received official World Series rings,
the road; and coordination of all medical person- viral infections, high blood pressure, and diabetes. the same received by the White Sox players.
nel involved in ensuring the overall health of the
Another Winning Season Ahead
third year with the White Sox,” says Dr. Weber.
players, their families, and the White Sox staff.
“And we will be able to use the solid foundation
When injuries did occur, Midwest Orthopaedics at The future looks bright for the 2006 season — we have built thus far to further develop a model
Rush physicians were on hand to provide an accu- not only for the White Sox but also for Midwest system of comprehensive medical care for both
rate, rapid diagnosis and initial care to minimize Orthopaedics at Rush’s involvement. “This is our the individual athlete and the team.”
time away from the game. “Our close working
relationship with the White Sox training staff
enabled us to diagnose and treat injuries quickly,
minimizing player downtime,” says Dr. BushJoseph, Lead Team Physician. “In professional
baseball, with such a fine line between success
and failure, a few additional effective innings by a
pitcher or a couple of extra healthy games by a
position player can make a huge difference. I think
we definitely saw that with the White Sox this
year, when some key players were able to work
through injuries to make important contributions
at critical times.”
Best Sports Care Available
Longtime Head Trainer Herm Schneider sought out
Midwest Orthopaedics at Rush to provide the most
comprehensive level of medical service available.
“I wanted our players, staff, and front office personnel to have the best medical expertise available,” he says. “In addition, I wanted the team to
have access to a full-service academic medical
center like Rush University Medical Center, which
is just minutes away from U.S. Cellular Field.”
In addition to Dr. Bush-Joseph, colleagues Dr.
Bach, Dr. Nicholson, Dr. Weber, Dr. Cole, Dr.
Romeo, and Dr. Verma also served as primary
Orthopaedic Excellence 23
24 Orthopaedic Excellence
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Midwest Orthopaedics at RUSH
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Orthopaedic Excellence 25
Reducing Noncontact ACL Injuries
Focus on entire kinetic
chain corrects faults,
improves performance
By John L. Honcharuk, ATC, CSCS,
and Joe Meier, PT, DPT, MS, NASM-PES, NASM-CPT, CSCS
Anterior
cruciate
ligament
Posterior
cruciate
ligament
Anterior view of a
flexed knee showing
menisci ligaments and
condyles prior
to knee arthroplasty
nterior cruciate ligament (ACL) injuries have
become one of the most devastating and
common injuries among athletes today.
Annually, there are between 80,000 and
100,000 ACL repairs performed in the United
States. At least 60% to 70% of all ACL injuries
are from noncontact situations, and the majority
of those injuries affect athletes between the ages
of 15 to 45.1,2
A
Most of these athletes will undergo an ACL reconstruction (approximate cost is $17,0003) and
complete an extensive bout of rehabilitation (six
to 12 months) to allow for a safe return to their
sport or recreational activity.
26 Orthopaedic Excellence
AthletiCo has successfully rehabilitated hundreds
of athletes after this type of reconstruction. As we
have developed our Performance Enhancement
services, it became obvious that there was a need
for ACL injury prevention programs for athletes of
all ages, as well as the ability to assess relative
risk prior to injury.
injuries has yet to be determined but may be a
combination of factors, including anatomical
structural factors, hormonal risk factors in
females, and biomechanical issues.
We set out to determine if there is a way to
potentially identify risk factors and, as a result,
decrease the likelihood of serious knee injury. This
Determining Risk Factors
could be used as a preseason screening tool, as
well as a bridge from formal physical therapy to
The majority of noncontact ACL injuries involve athletic performance.
some type of decelerating motion bringing the
knee into flexion and the femur into adduction Several commercial athletic injury risk-assessment
and internal rotation while the tibia and foot are tools were reviewed and implemented. These
planted. The exact cause of noncontact ACL include, but are not limited to, the Cincinnati
SportsMetrics Valgus Digitizer , The Santa
Monica PEP program, and The Reebok Functional
Movement Screen. Each of these screening tools
has unique merits and uses. The predominant tool
that we feel addresses the entire
kinetic chain is the National
Academy of Sports Medicine
Optimum Performance Training
Model (NASM OPT™).4 We have
taken what we feel are the best
components of each of these programs and created a hybrid that
currently fits our clinical as well as
performance enhancement needs.
TM
TM
Before an individual’s risk can be
addressed, we must evaluate and
determine all limiting factors that
could predispose an individual to
an ACL injury. Functional movement screens have been valuable
in revealing faulty movement patterns. The most popular test
includes having athletes perform
some form of squat with their
arms over their head and a single
leg activity to challenge their core
and balance.4,5
The plane of motion for a track athlete (sagital
plane dominance) is different from that of a basketball player (transverse plane dominance). The
aforementioned would be included in our full ACL
range of motion through flexibility. The two types
of flexibility we will primarily focus on in this article are self-myofascial release and static stretching. However, there are other levels of flexibility
the athlete would progress to once
normal range of motion is achieved
and the overhead squat assessment
has visibly improved.
Tissue extensibility can be improved
by self-myofascial release through the
use of a foam roll. This will prepare
the tissue for further lengthening in
order to achieve optimal length tension relationships. For example, selfmyofascial release to bilateral rectus
femoris, hip adductors, and gastrocnemius/soleus complex can be
achieved by slowly rolling through the
muscle group searching for tender
areas. The individual would then rest
on the tender area for 20 to 30 seconds to inhibit overactive muscles.4
Myofascial release is followed by
static stretching, which helps restore
optimal range of motion for functional movement and strengthening
of muscles that have been overpowered by their
stronger antagonist. An example is to static
stretch the rectus femoris, hip adductors, and gastrocnemius/soleus complex bilaterally. Typically,
we prefer to use multijoint, closed kinetic chain
activities, if possible. A good example of this type
of activity would be the standing hip flexor
stretch. This particular movement addresses the
gastrocnemius/soleus complex, illiopsoas, rectus
femoris, quadratus lumborum, and latisimus dorsi.
Squatting in a valgus position puts the ACL in great jeopardy if the individual is
unable to control the position of the knee because of insufficient range of motion,
core stability, neuromuscular control, or strength.
One aspect of our ACL Injury Prevention Program
is a functional movement assessment, which consists of the overhead squat. The overhead squat is
performed by having athletes stand with their feet
parallel and shoulder-width apart with arms overhead and then having them perform a squat. This,
in effect, reproduces, on a much slower scale, the
eccentric movement.
Since the majority of ACL injuries occur while
decelerating eccentrically, the clinician will be able
to visualize a good portion of the faulty movement patterns. This assessment allows us to determine which muscles are dominant in the
movement and where the athlete is in need of
improved flexibility and strength.
prevention evaluation. Only after that can an individualized program be created.
This type of assessment was highly effective in
determining potential faulty movement patterns
in some members of the USA Men’s Rugby Team
while the team was in New Zealand for an international tournament. The findings were then
applied to each team member’s training program
to address deficits.
One of the most predominant faulty movement
patterns we see clinically with the overhead squat
is adduction of the knee or valgus, which can be
caused by excessive pronation of the foot and/or
poor control at the hip. It is at this point that the
ACL is placed in great jeopardy if the individual is
unable to control the position of the knee because
We further determine limitations through gonio- of insufficient range of motion, core stability, neumetric measurements, functional core assessment, romuscular control, or strength.
neuromuscular evaluation, and upper and lower
extremity power assessments. As with any pro- Restoring Proper Range of Motion
gram design, an assessment of the demands of
the sport must also be included. What energy sys- We will begin as we would with a complete protem is dominant: ATP/PC, anaerobic, or aerobic? gram by first addressing the restoration of proper
Improving Stability, Control,
and Strength
Once flexibility issues have been addressed, we
then begin improving the stability of the core.
The core is where all movement begins and
plays a major role in control of the upper and
lower extremities.6 When strengthening the core,
one must focus on the lumbopelvic hip complex.
An excellent exercise to achieve this
is the stability ball bridge. This particular exercise involves use of the transverse abdominus, gluteus maximus, quadriceps, hamstrings,
and the gastrocnemius/soleus complex. In
Orthopaedic Excellence 27
addition, the use of the stability ball increases cue the gluteus medius to prevent valgus of the
knee during descent of the squat.
the proprioceptive demand.
Once the core has been stabilized, we take an
inside-out approach by improving neuromuscular
control. As a result, the gluteals would be the next
area to be addressed. Again, we emphasize
closed-chain, multijoint, multiplanar exercise to
maintain neuromuscular efficiency. The triplane
setup is the modality of choice. This exercise is
performed with proper activation of the transverse abdominus and gluteal complex to ensure
stability of the lumbopelvic hip complex, resulting
in improved knee position. These types of exercises have been shown, when properly cued, to
decrease the incidence of serious knee injury.7
Taking a Total-Body Approach
Typically, this total-body approach would be performed at every session. This is done to ensure that
the entire kinetic chain is addressed. This ensures
that the participant continually works on the correction of faulty movement patterns while improving
total athletic performance. Again, the frequency,
duration, and intensity levels should be directly proportionate to the result of the initial findings.
The above examples are just that — a small sampling of a comprehensive program. To elaborate
on the full ACL Injury Prevention Program is
beyond the scope of this article. The comprehenAt least 60% to
sive program is based upon a thorough evaluation
70% of all ACL injuries
of not only the knee and lower extremity but the
are from noncontact
entire kinetic chain. Then and only then can an
individual program be designed to address
situations, and the
We believe through proper evaluation,
majority of those injuries deficits.
elimination of muscular imbalances, core stability
affect athletes between
training, neuromuscular training, and education
on plyometrics, the likelihood of an individual susthe ages of 15 to 45.
taining noncontact ACL injuries can be greatly
The athlete is prepared for plyometric training reduced. Further research and education in the
upon stabilization through activation of the core benefits of the use of an ACL prevention program
and gluteus complex. Within the training pro- is required.
gram, the focus should be placed on technique of
the plyometric exercise. It is imperative that the
John L. Honcharuk, ATC, CSCS, is also a
Certified SportsMetrics Instructor. He is the
individual be able to maintain an athletic position
Facility Manager of the St. Charles
prior to any plyometrics. The athletic position can
AthletiCo and Co-Chair of AthletiCo’s ACL
be defined as feet forward and shoulder-width
Injury Prevention Committee. He has
apart with center of gravity over the balls of the
feet. The knees should be slightly flexed and nat- worked with both professional and recreational athletes
ural curvature in the spine maintained.8 The ath- and is currently the Athletic Trainer for the USA Rugby
lete should be able to take off and land in this Men’s National Team and the Fox Valley Rugby Club.
posture. Advanced plyometric techniques can
consist of box jumps to stabilization. This exercise
Joe Meier, PT, DPT, MS, NASM-PES,
NASM-CPT, CSCS, is the Assistant Facility
can be performed on a 6- to 12-inch box, and
Manager of AthletiCo’s Arlington Heights
landing posture should be maintained for a fivelocation and Co-Chair of AthletiCo’s ACL
second hold.
Injury Prevention Committee. He has rehaWe would complete the session with exercises bilitated and trained various clients, ranging from athletes
designed to strengthen musculature that has on professional teams, such as the Manchester United and
been inhibited by tight structures. For instance, the Chicago Bulls, to grade school athletes.
weak gluteus medius musculature could be
addressed by having the athlete perform lateral Editor’s Note: John L. Honcharuk and Joe Meier are
walks with a resistive band around the knees. This not affiliated with Midwest Orthopaedics at Rush.
could be further progressed with stability ball Treatment recommendations presented in this article are
squats with a resistive band around the knees to solely the professional opinions of the authors.
TM
28 Orthopaedic Excellence
The Role of Biomechanics
Anatomical or gender-related factors
associated with increased risk of
anterior cruciate ligament (ACL)
injuries cannot be altered. However,
according to AthletiCo, noncontact
ACL injuries could be greatly reduced
by altering potentially faulty biomechanics. This can be achieved by correcting muscle imbalances, improving
core strength, retraining the neuromuscular system, and educating on
proper take-off and landing techniques through plyometric exercises.
References:
1. Wilk, K. E., C. Arrigo, J. R. Andrews, and C. G. William.
“Rehabilitation after Anterior Cruciate Ligament
Reconstruction in the Female Athlete.” Journal of Athletic
Training, Vol. 34, No. 2 (1999), pp. 177-193.
2. Daniel, D. M., and D. Fritschy. “Anterior Cruciate Ligament
Injuries.” In Orthopaedic Sports Medicine: Principles and
Practice, Vol. 2 (Philadelphia, PA: W. B. Saunders, 1994),
pp. 1313-1361.
3. Griffin et al. “Noncontact Anterior Cruciate Ligament
Injuries: Risk Factors and Prevention Strategies.” Journal of
the American Academy of Orthopaedic Surgeons, Vol. 8
(2000), pp. 141-150.
4. Clark, M. A., and A. M. Russell. Optimum Performance
Training for the Health and Fitness Professional (Course
Manual). Calabasas, CA: National Academy of Sports
Medicine, 2004.
5. Cook. G., L. Burton, and B. Hoogenboom. “Pre-participation Screening: The Use of Fundamental Movement as an
Assessment of Function-Part 1.” North American Journal
of Sports Physical Therapy, Vol. 1, No. 2 (May 2006),
pp. 62-72.
6. Wilson, J. D., C. P. Dougherty, M. L. Ireland, and I. M.
Davis. “Core Stability and Its Relationship to Lower Extremity
Function and Injury.” Journal of the Academy of
Orthopaedic Surgeons, Vol. 13, No. 5 (September 2005),
pp. 316-325.
7. Hewett, T. E., T. N. Lindenfeld, J. V. Riccobene, and F. R.
Noyes. “The Effect of Neuromuscular Training on the
Incidence of Knee Injury in Female Athletes: A Prospective
Study.” American Journal of Sports Medicine, Vol. 27,
No. 6 (1999), pp. 699-706.
8. Meyer, G. D., K. R. Ford, and T. E. Hewett. “Rationale and
Clinical Techniques for Anterior Cruciate Injury Prevention
among Female Athletes.” Journal of Athletic Training,
Vol. 39, No. 4 (2004), pp. 352-364.
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