thopaedics rush ranks #6 in u.s. - abc7 los...

Rush

Orthopaedics

ranks #6 in U.S.

Orthopaedic Excellence 3

The Age of AquariusNew gender-specific knee implant

promises better results for women..................................6

A Dedicated LifeSurgeon wins acclaim and honors

for medical contributions

By Deborah Maxwell ....................................................................................................8

Preventing Youth Sports InjuriesPitching a ban on Little League breaking balls ...............10

The Incredible RushTeam physicians play their part in

Chicago’s ArenaBowl victory

By Paul Strandquist, Director of Marketing .......................................................14

Moving UpRush orthopaedics program

climbs to sixth in nation..............................................................................17

The Gift that Keeps on GivingHuman allografts improve

quality of life for many patients

By Steven Gitelis, MD .................................................................................................18

A Winning GroupWhite Sox medical team honored

for contribution to World Series success .......................22

Reducing Noncontact ACL InjuriesFocus on entire kinetic chain corrects faults,

improves performanceBy John L. Honcharuk, ATC, CSCS, and Joe Meier, PT, DPT, MS, NASM-PES, NASM-CPT, CSCS..............................26

Directory ................................................................................................................34

Orthopaedic Excellence is published by QuestCorp Media Group, Inc., 885 E. Collins Blvd., Ste. 102, Richardson, TX75081. Phone (972) 447-0910 or (888) 860-2442, fax (972) 447-0911, www.qcmedia.com. QuestCorp specializes in cre-ating and publishing corporate magazines for businesses. Inquiries: Victor Horne, [email protected]. Editorialcomments: Brandi Hatley, [email protected]. Please call or fax for a new subscription, change of address, or sin-gle copy. Single copies: $5.95. This publication may not be reproduced in part or in whole without the express writtenpermission of QuestCorp Media Group, Inc.

Volume 2 • Issue 4

6

14

22

In this issue

4 Orthopaedic Excellence

President’s Letter

Things continue to flourish for Midwest Orthopaedics at Rush in 2006. TheChicago White Sox are off to another fast start this year, and it looks like theChicago 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 ourfoundation as well. We have three new physicians starting with us in 2006.

Jeffrey Mjaanes, MD, who has worked as a pediatrician at Rush, recently com-pleted a primary care sports medicine fellowship and joined the Midwest Orthopaedics at Rush pri-mary care sports medicine team, where he will work with Program Director Kathleen Weber, MD, andTrish Palmer, MD. Dr. Mjaanes will focus his efforts on our Central DuPage Hospital office located inWinfield. We believe Dr. Mjaanes has significantly improved our ability to take care of the younger ath-lete 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 HeadGeorge Holmes, MD, and Simon Lee, MD. Dr. Lin recently completed a foot and ankle fellowship at theCampbell Clinic in Tennessee but is also familiar with the Rush program, having completed his resi-dency at Rush. Dr. Lin will be primarily based out of the Central DuPage Hospital office in Winfield, andhis presence will enable us to continue to grow our subspecialty offerings at that location and in thewestern suburbs.

Filling a role and a subspecialty that has been vacant and highly needed is Monica Kogan, MD, a pedi-atric 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. Werecently opened a brand new office in Westchester at the just completed Prairie Medical Center at2434 South Wolf Road (next door to our corporate offices). We are excited to be at this multispecialtyfacility centrally located in the Chicago area. We currently plan to offer sports medicine, shoulder, footand ankle, and hand services at this facility.

We believe the addition of these physicians and this new practice location will help us in providing thebest, broadest, and most convenient menu of orthopaedic services possible for both you and yourpatients. If there are ever any issues or deficiencies with the services we are providing to you, pleasecontact 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, MDManaging Member, Midwest Orthopaedics at Rush, [email protected]

A publication from

Midwest Orthopaedics at Rushwww.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


Phone: (312) 431-3400

Fax: (312) 427-6116

Oak Park Hospital

Medical Office Building

610 South Maple Ave., Ste. 1400

Oak Park, IL 60304


Phone: (312) 243-4244

Fax: (312) 942-1517

RUSH University Medical Center

1725 West Harrison St., Ste. 1063

Chicago, IL 60612


Phone: (312) 243-4244

Fax: (312) 942-1517


Physician Listing Chairman’s Letter

This year continues to be both exciting and chal-lenging. First and foremost, our plans to develop adedicated orthopaedic ambulatory destination on

the Rush campus continues to move forward and takeshape. We have selected the developer, architects, andconstruction managers that will help us realize thisdream. We expect this facility to be completed andcome online in the first quarter of 2009, but there ismuch planning and work to be completed first.

Rush’s plans for a new hospital and campus renovation are also moving for-ward. Rush has already received $167 million in pledges or donationstoward a goal of $300 million. Rush plans include a new hospital facilitythat will incorporate a brand new concept called an “interventional plat-form.” Two floors extending from the new hospital into the renovatedAtrium building will be devoted to surgery, imaging, and specialty proce-dures. Nearby will be the facilities and equipment required for interventionalradiology, cardiology, and neurosurgery, fostering increased collaborationand a multidisciplinary approach for specialists who are doing similar pro-cedures. The interventional platforms will locate key services close to oneanother on two easily accessible levels, minimizing the need for patients andtheir families to travel to multiple locations in the medical center.

Rush’s new hospital also will include a state-of-the-art emergency servicesfacility designed to care for victims of major catastrophes. It will be namedthe McCormick Tribune Center for Advanced Emergency Response in recog-nition of the foundation’s $7.5 million contribution in 2004. Rush and theJohn H. Stroger Jr. Hospital in 2002 were named bioterrorism preparednessCenters of Excellence by the Chicago Department of Public Health. Eachhospital has received grants to improve hospital capabilities in prepared-ness planning, disease detection and surveillance, infection control, com-munications, collaborations, education and training, and more.

The campus redevelopment also includes implementation of a new infor-mation technology system. New electronic software applications (Epic) willensure the integration of clinical and financial information, providingstreamlined registration and scheduling, faster and more accurate testresults, and real-time access to complete medical histories.

The department also continues to benefit from Rush’s philanthropicendeavors with a recent contribution of $4.5 million. Donations such asthis enable us to advance our research efforts to the benefit of patients.

We hope that these coordinated efforts and improvements, along with theimplementation of new technologies, by Rush, the OrthopaedicDepartment, and Midwest Orthopaedics at Rush will enable us to improvethe care and treatment of your patients both today and far into the future.

Best regards,Gunnar Andersson, MD, PhDChairman, Orthopaedic DepartmentRush University Medical Center

Howard An, MD

Spine, Back, and Neck

Gunnar Andersson, MD


Bernard R. Bach Jr., MD

Sports Medicine

Richard Berger, MD

Joint Reconstruction

Charles A. Bush-Joseph, MD

Sports Medicine

Mark S. Cohen, MD

Hand, Wrist, and Elbow

Brian Cole, MD

Sports Medicine, Cartilage

Restoration

Craig Della Valle, MD


John Fernandez, MD

Hand, Wrist, and Elbow

April Fetzer, DO

Physical Medicine/Pain

Management

Joseph Fillmore, MD


Management

Jorge O. Galante, MD


Steven Gitelis, MD

Orthopaedic Oncology/Joint

Reconstruction

Edward Goldberg, MD


George Holmes Jr., MD

Foot and Ankle

Joshua Jacobs, MD


Simon Lee, MD

Foot and Ankle

Gregory P. Nicholson, MD

Sports Medicine and Shoulder

Trish Palmer, MD

Sports Medicine and Women’s

Sports Medicine

Wayne Paprosky, MD


Frank M. Phillips, MD


Anthony Romeo, MD

Sports Medicine, Elbow,

and Shoulder

Aaron Rosenberg, MD


Mitchell Sheinkop, MD


Kern Singh, MD


Scott Sporer, MD


Nikhil Verma, MD

Sports Medicine and Shoulder

Walter W. Virkus, MD

Orthopaedic Oncology/Trauma

Kathleen Weber, MD

Sports Medicine and Women’s

Sports Medicine

Yejia Zhang, MD


Management


According to the National Center for HealthStatistics, women comprise nearly two-thirdsof the 400,000 knee replacement surgeries

performed annually. Even more surprising is thatin spite of experiencing a higher incidence of kneepain, women are also three times less likely thanmen to undergo joint replacement surgery.

Although the current implant technology hasfunctioned well for both men and women, provid-ing pain relief and significantly improving func-tion, these implants are less likely to fit, feel, andfunction naturally for female patients.

Relative to the knee joint, female anatomy is sig-nificantly different from male anatomy. Womenhave wider hips than men, changing the angle atwhich the femur connects to the knee. Women’sknees have less cartilage, so women are morelikely to experience osteoarthritis, a leading factorin knee replacement surgery. Lifestyle factors suchas pregnancy and wearing high-heel shoes areadditional contributing factors.

Meeting Women’s Needs

Since the implants are not precisely suited for the female anatomy, the procedures are more dif-ficult — for both the surgeon and patient. “Ithink the lack of a gender-specific knee implanthas contributed to the lower utilization rate

in women,” says Aaron Rosenberg, MD, Directorof the Section of Adult Reconstruction atMidwest Orthopaedics at Rush. “Women’sknees are different from men’s in that they’re nar-rower side to side for a given front-to-backdimension. More importantly, women’s joints areshaped differently in all sizes and exhibit more

flexibility. We simply have not had an implant thatmeets these unique requirements.”

That has changed with the launch of a new gen-der-specific implant designed to better match thestructure of a woman’s knee joint. This implantcan be placed using minimally invasive surgicaltechniques, which typically produce smaller scars,shorter hospital stays, and quicker recoveries.

“Less invasive procedures are helping patients getback to enjoying their lives faster than ever before,”adds Dr. Rosenberg. “Now that we have a kneeshaped to fit a woman’s anatomy, we expect thatfar more women will consider knee replacement.”

Advantages of Women’s Implant

The implant was developed through the extensiveresearch efforts of the Midwest Orthopaedics at

The Age of AquariusNew gender-specific knee implant promises better results for women

All other total knee implants being used today fall within the same size and proportion ranges, which arebased on an average between the sizes of women’s and men’s knees. This approach does not optimally addressthe differences in shape between women’s and men’s knees. The Gender Solutions High-Flex Knee fromorthopaedics leader Zimmer is the first and only implant to address the three distinct and scientifically docu-mented shape differences between women’s and men’s knees.

The Zimmer Gender Solutions High-Flex Knee is the first knee replacement shaped to fit a woman’sanatomy. Illustrations courtesy of Zimmer, Inc.


Rush joint reconstruction team in collaborationwith Zimmer, Inc., the world’s leading manufac-turer of knee replacements. According to Zimmer,the Gender SolutionsTM High-Flex Knee implantoffers the following three advantages:

• Narrower shape, proportioned tofemale anatomy: Surgeons typicallychoose a knee implant size based on thefront-to-back measurement of the end ofthe femur, which is key in allowing theknee to move and flex properly. However,an implant that provides a good fit for awoman’s knee from front to back oftenwill be too wide from side to side. Thisleads to the implant overhanging thebone and potentially pressing on, or dam-aging, surrounding ligaments and tendonsand possibly causing pain. The GenderSolutions High-Flex Knee is proportionallycontoured to the entire bone to provide amore precise fit.

• Thinner shape: The bone in the front ofwomen’s knees is typically less prominentthan in men’s. Therefore, when a tradi-tional implant is used to replace the dam-aged bone, the joint may end up feelingand functioning better than before surgery

but still feel “bulky,”which may result inpain and decreaseoptimal function.T h e G e n d e rSolutions implant isthinner in shape inthe front, so theknee replacementmore appropriatelymatches the naturalfemale anatomy.

• M o r e n a t u r a ltracking: The anglebetween the pelvisand the knee affectshow the patellatracks over the endof the femur as theknee moves througha range of motion.Women tend to havea different anglethan men due totheir unique shapeand contour. Before the Gender SolutionsHigh-Flex Knee, all implant designs werebased on an average of women and men.

Therefore, the tradi-tional artificial kneemay tend to track atan angle that leads toa woman’s knee feel-ing unnatural as itmoves. The GenderS o l u t i o n s k n e eimplant was designedto accommodate thedi f ferent t rackingangle and functionmore like a woman’snatural knee.

“Knee implants havebeen functioning veryw e l l f o r m e n a n dwomen, but we want tomeet women’s uniqueneeds by making kneereplacements that feel,fit, and function evenb e t t e r, ” s a y s D r.

Rosenberg. “The gender-specific implant is thebest of both worlds. It’s based on the currentimplant we use, a highly successful implant withgreat mechanics and 10 years of clinical success,but the shape of this new implant is different tomake it feel more natural.”

The Future of Knee Replacements

The development of the new gender-specificimplant comes at the forefront of a majorgroundswell of demand for joint replacement. Asbaby boomers transition from middle age to sen-ior citizenship, the number of candidates for arti-ficial joints will increase markedly.

According to a new study by the AmericanAcademy of Orthopaedic Surgeons (AAOS), thetotal number of knee implants performed in theUnited States will reach nearly 3.5 million by theyear 2030. The majority of these will undoubtedlybe women.

In addition to the aforementioned contributingfactors for joint replacement, women in theUnited States live longer than men on average,

The femur, or thighbone, portion of a typical woman’s knee (left) tends to benarrower from side to side and more trapezoid shaped, while a man’s (right) iswider and more rectangular shaped. The Gender Solutions High-Flex Knee is thefirst knee replacement shaped to fit a woman’s anatomy.

To accommodate the different shape of women’s knees, the front of the GenderSolutions Knee Implant (right) is narrower than a traditional implant (left).

continued on page 12

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 kneereplacement more appropriately matches the natural female anatomy.


Midwest Orthopaedicat Rush joint replace-ment surgeon Joshua

J. Jacobs, MD, was electedP r e s i d e n t o f t h eOrthopaedic ResearchSociety (ORS) at its recenta n n u a l m e e t i n g i nChicago. Dr. Jacobs servedon the ORS Board ofDirectors for five yearsprior to his election.According to Dr. Jacobs,“ORS is a complex organi-zation that provides aninternational forum for thedissemination of rapidd e v e l o p m e n t s i northopaedic research thatmay ultimately have a dra-matic impact on the diag-nosis and treatment ofboth common and raremusculoskeletal diseases.”

As President, Dr. Jacobswill manage the fiscal andstrategic mission of ORS.Founded in 1954 andincorporated as a non-profit organization in1982, ORS promotesorthopaedic research, pro-v ides mentorship foryoung researchers, andpublishes the Journal of Orthopaedic Research.1

ORS also lobbies for increased federal researchfunding for musculoskeletal diseases and worksto increase public awareness of the impactorthopaedics has made on patients’ lives.

Also recently inducted into the Knee Society andan already established member of the U.S. and

International Hip Societies (along with MidwestOrthopaedics at Rush physicians Jorge Galante,MD; Aaron Rosenberg, MD; and Wayne Paprosky,MD), Dr. Jacobs is considered among the eliteadult reconstructive orthopaedic surgeons in theworld — those who have made significant contri-butions to the body of orthopaedic research,knowledge, and clinical practice.

“It is an honor to beselected for the Knee Societyand join my distinguishedpartners Dr. Galante, Dr.Rosenberg, and Dr. Paproskyin this influential organiza-tion,” says Dr. Jacobs.

Staying at theForefront

Dr. Jacobs’ accomplishmentsare even more significantwhen viewed in light of theoverall field of adult jointreconstructive surgery, ac o n s t a n t l y c h a n g i n gorthopaedic subspecialty.The American Academy ofOr thopaed i c Su rgeons(AAOS) states that jointreplacement surgery “…hasbeen one of the most signif-icant advances in muscu-loskeletal surgical treatmentover the past 30 years.”2

Furthermore, AAOS statisticsshow more than 500,000total joint replacements areperformed each year in theUnited States.2

Despite these statistics, theAAOS Research Committee(2003) reports that joint

replacement surgery is not yet fully utilized acrossall ethnicities and geographic areas.2 However,patients who do receive orthopaedic prosthesesare so accepting of the technology that not muchthought is given any more to the work, science,or scientists behind these modern-day miracles.Significant improvements in the scientific andclinical body of knowledge in adult arthroplasty

A Dedicated LifeSurgeon wins acclaim and honors for medical contributionsBy Deborah Maxwell

Dr. Jacobs holds hip prostheses that were recovered from a patient who underwent revision surgeryand received new implants. Photo courtesy of the Associated Press.


over the last generation have contributed toimproved quality of life for patients and thereforehave contributed to this sea change of almostuniversal acceptance by patients.

Leading Research Efforts

One of Dr. Jacobs’ major contributions, a studyfunded by the National Institutes of Health (NIH),is a unique effort, according to Dr. Jacobs, who isthe principal investigator of the study. This longi-tudinal study, initiated approximately 15 yearsago by Dr. Jacobs’ partner Dr. Galante, studieswear patterns and particulate debris generated byprosthetic implants and the effect of this debrisupon surrounding body tissues and distantorgans. This study is ongoing and has alreadyyielded translational results in the ability for physi-cians to gauge how well an orthopaedic implantis working via serum and metal blood levels.

Dr. Jacobs also heads the OrthopaedicPostmortem Retrieval study at Rush UniversityMedical Center in Chicago. Study participantsagree to removal of their prostheses as well as thebone and tissue around the implant and possiblyremote tissue samples from their bodies shortlyafter death.

Review of the literature shows that particulatedebris can induce prosthetic failure; therefore, onecan expect Dr. Jacobs’ eventual results regardingparticulate debris to increase scientific understand-ing of cellular and systemic response to implantsand quite possibly the strengths and weaknesses inprosthetic materials and design.3 Ultimately, theseresults will be utilized to develop longer-lasting,better performing prostheses.

Putting Knowledge to Work

An undergraduate degree in material science andengineering from Northwestern University hasmeshed perfectly with Dr. Jacobs’ clinical work and research withorthopaedic implants. Hisknowledge of metallurgyhas been helpful in under-standing many of the clini-cal problems that develop inindiv iduals with metalimplants, such as the rela-tion between prosthetic fail-ure and metal allergy.4 Dr.Jacobs says, “My work is atthe interface of medicineand engineering.”

In addition to his clinical andresearch duties, Dr. Jacobs i s act ive with var iousorthopaedic societies andchairs the AAOS Council onResearch, Quality Asses-sment, and Technology.Consistent with the council and the mission of ORS,Dr. Jacobs has met with House Speaker DennisHastert and will travel to Washington later this yearto advocate for federal policies to promote muscu-loskeletal health. Health care policy, economics,and research funding are vital issues for Dr. Jacobsand AAOS, particularly as the demand fororthopaedic implants and health care services isprojected to increase as the population ages.

From his work with the ORS to his federallyfunded research, the halls of Congress, andMidwest Orthopaedics at Rush, Dr. Jacobs is aconstant advocate for orthopaedic science andpatient care. His contributions to orthopaedicresearch, knowledge, clinical practice, and policyare extensive. Dr. Jacobs’ mission is far from over,

yet his impact on current and future patients’ liveshas yet to be fully realized and will not be foryears 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 MidwestOrthopaedics at Rush for 16 years and currentlyserves as Marketing Analyst for the group. She has previously written on other medical topics,including osteoporosis and Rett Syndrome, and has served as editor for “Common Call,” thenewsletter for the Oak Park-R iver ForestCommunity of Congregations.

References

1. Orthopaedic Research Society. (2006). [WWW document].

Retrieved: http://www.ors.org/Welcome.asp.

2. AAOS Research Committee. (June 2003). Future directions

in musculoskeletal research: a summary report of the AAOS

research committee panel studies. 53, 93.

3. National Institutes of Health. (2000). Improving medical

implant performance through retrieval information: chal-

lenges and opportunities. [WWW document]. Retrieved:

http://consensus.nih.gov/2000/2000MedicalImplantsa019html

.htm, paragraph 2 of Explant Analysis section.

4. Jacobs, J. (2005). Commentary & perspective on

metal-on-metal bearings and hypersensitivity in

patients with artificial hip joints: a clinical and histo-

morphological study. The Journal of Bone and

Jo in t Su rge ry . [WWW document ] . Re t r i e ved :

http://www.jbjs.org/Comments/2005/cp_jan05_jacobs.shtml.

“My work is at the interface of medicine

and engineering.”

— Joshua J. Jacobs, MD

Dr. Jacobs (right) has met with House Speaker Dennis Hastert (left) and willtravel to Washington later this year to advocate for federal policies to pro-mote musculoskeletal health.

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 excel-

lence that combine clinical, basic, and popu-

lation 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.

OrthoFact


The breaking ball is a devastating weapon in aLittle League baseball game. To even the bestplayers, the pitch is nearly unhittable.

Unfortunately, the pitch’s nasty effect goesbeyond baffling opposing hitters.

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 ofthe American Academy of Orthopaedic Surgeons,overuse and incorrect throwing mechanics are theprimary causes of elbow injuries in young pitchers.

“In youth baseball, there are certainmotions that are repeated over and overagain that are likely to create an overuseinjury,” says Bernard R. Bach Jr., MD,Director of Sports Medicine at MidwestOrthopaedics at Rush. “Even in a normalthrowing motion, the elbow is under atremendous amount of stress. Factor inabnormal mechanics, such as the motionused to throw a breaking ball, and thestress is multiplied.”

Boys are often able to learn the curve ball at10 or 11 years of age, which is, according toDr. Bach, well before their arms are ready forthe strain. Competitive coaches encourage theirpitchers to throw breaking balls and also exhibita tendency to overuse their better hurlers.

Patrick McKune, Treasurer of Oak Park YouthBaseball, has witnessed the trend of injury andoveruse. “In the Little League World Series, it wasreported that 60% to 65% of the pitches thrownwere curve balls,” says McKune. “You just have toshake your head. Another wake-up call for mewas last year when I witnessed my son throw sixstraight curve balls in a game.”

Pitching a ban on Little Leaguebreaking balls


Taking Action

Disturbed by this growing trend, McKune decidedto take action. Along with Dr. Bach and represen-tatives from AthletiCo, McKune arranged a meet-

ing with the Oak Park Youth Baseball board,making the case for a ban on breaking balls com-bined with a mandatory pitch count. The board

agreed with Dr. Bach’s medical opinionand enacted both the ban on breakingballs and pitch count restrictions. Dr.Bach is confident that it will have a dra-matic effect on the occurrence of injury.

“I’ve performed elbow surgery on 12-and 13-year-old pitchers, and it’s justheartbreaking,” says Dr. Bach. “Theseoveruse and stress-related problemscan affect growing parts of the bone(the growth plates), not just muscles, tendons, and ligaments.

When the condition is not treated, it can causelong-term problems.”

Dr. Bach adds, “It seems that every parent thinkshis or her kid is on the fast track to a Division Ischolarship, and, ultimately, a professional base-ball career. There is a ‘graveyard’ of talented kidswhose careers ended prematurely because ofthrowing-related elbow and/or shoulder injuries.We advocate throwing a fast ball and a changeup but no curve balls until approximately 13 or14 years of age. The kids should focus on pitch-ing mechanics and control. Kids mature at differ-ent rates, and mechanics can changedramatically when adolescents go through rapidgrowth spurts, which may result in significantmuscle imbalances.”

McKune initially thought enforcement of the newrules might be an issue, but to date, no infractionshave been observed. To his knowledge, the banenacted by Oak Park Youth Baseball may beunique to the area. “It’s my hope that otherleagues will adopt similar rules to protect thehealth of their young players.”

Injury Prevention

Dr. Bach’s work on the breaking ball issue stems from his considerable interest in youth base-ball and sports medicine. Serving as the VicePresident of the American Orthopaedic Society for Sports Medicine, Dr. Bach was instrumental inthe development of Prevention and Emer-gency Management of Youth Baseball and SoftballInjuries (see Youth Baseball Safety).

For a copy of Prevention and EmergencyManagement of Youth Baseball and Softball

Injuries or for moreinformation on youthbaseball safety, visitthe American Ortho-paed i c Soc ie t y fo rSports Medicine onlineat www.sportsmed.orgo r c a l l M i d w e s tOrthopaedics at Rush at(877) MD-BONES.

As Director of SportsMedicine at Rush since

1986, Bernard Bach Jr., MD, hasdeveloped a nationally recognizedsports medicine program. Dr. Bachhas published more than 240 scien-tific papers, abstracts, and book

chapters. He serves on numerous national sportscommittees and editorial boards and is an educatorof residents, fellows, and his patients. Dr. Bach isboard certified (1989) and recertified (1999) by theAmerican Board of Orthopaedic Surgery. Dr. Bachhas served on the national boards of the IllinoisSpecial Olympics, the Orthopaedic Research andEducation Foundation, and the AmericanOrthopaedic Society for Sports Medicine. He is theeditor of the Journal of Knee Surgery. Dr. Bach wasselected as one of Chicago magazine’s “TopDoctors” in 1996, 2000, 2004, and 2006, and isrecognized nationally and internationally as aleader in sports medicine. He was inducted into theIllinois Athletic Trainer’s Hall of Fame in 1995.Along with the other members of the SportsMedicine Division, he was selected as a TeamPhysician for the Chicago White Sox baseball teamin 2004 and 2005.

Among pitchers youngerthan 12 years of age, near-ly 45% complain of chronicelbow pain. According to a

study published by theJournal of the AmericanAcademy of OrthopaedicSurgeons, overuse and

incorrect throwingmechanics are the primarycauses of elbow injuries in

young pitchers.

Youth Baseball SafetyPrevention and Emergency Man-agement of Youth Baseball and SoftballInjuries 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 tech-

niques 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.

Overuse and stress-related problems can affect elbow ligaments (shown above),muscles, and tendons, possibly leading to long-term problems.


Chicago • Oak Park • Winfield

877-MD-BONESwww.rushortho.com

with a life expectancy of 80 years, compared to 75years for men.

In addition to Dr. Rosenberg, Midwest Orthopaedicsat Rush surgeons Richard Berger, MD, and WaynePaprosky, MD, worked closely with biomechanicalengineers throughout the two-year research anddevelopment process. The new implant, which hasreceived clearance from the FDA, is already beingutilized by Midwest Orthopaedics at Rush jointreconstruction physicians and is expected to beglobally available this fall.

“The new implant is evidence of our dedication toresearch over the past 25 years and to improvingour patients’ quality of life through decreased painwith better implants,” says Dr. Rosenberg.

For more information on joint replacement surgeryand gender-specific implants, contact MidwestOrthopaedics at Rush at (877) MD-BONES or visitwww.rushortho.com.

The Age of Aquariuscontinued from page 7

Women’s MovementThe 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 re-search 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 resi-

dent 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 fel-

low in Adult Joint Reconstruction at New England Baptist Hospital, Tufts

University, Boston.


The Chicago Rush completed one of the mostimprobable 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 Centerin Las Vegas. “I am so proud of this team,” saysRush Head Coach Mike Hohensee, who won hisfirst AFL title after 20 seasons in the league.“They believed in each other and played theirhearts out, and now they can call themselveschampions.”

The Rush was 5 and 9, and it looked like theteam might miss the playoffs. However, the Rush responded by winning its final two regularseason games in convincing fashion to qualifyfor the playoffs and then went on the road towin four consecutive playoff games.

The Thrill of Victory

I was at the final game, sitting with the ChicagoRush families, staff, and corporate sponsors tocelebrate a great season and a fantastic Arena-Bowl championship. What a thrill to be includedwith the Chicago Rush front office staff, families,and management and to share in their well-deserved excitement and celebration after they

won the championship. ArenaBowl XX was a big sporting event, and Chicago fans came out tosupport their team, helping make this the biggestcrowd in ArenaBowl history.

Th i s yea r ma rked the second season Midwest Orthopaedics at Rush has worked

with the Chicago Rush as a corporate sponsor and as the team’s orthopaedic consult-ants. Midwest Orthopaedics at Rush physicianswork closely during the AFL season with RushHead Team Physician Rajeev Khanna, MD, andhis colleagues at Advanced OccupationalMedicine Specialists.

The Incredible

RushTeam physicians play their part in Chicago’sArenaBowl victoryBy Paul Strandquist, Director of Marketing,

Midwest Orthopaedics at Rush

Rajeev Khanna, MD, and Paul Strandquist, Director of Marketing at Midwest Orthopaedics at Rush

Chicago Rush fans came out to support their team, helping make it the biggest crowd inArenaBowl history.


Dr. Khanna and John Connell, Athletic Trainerfor the Rush, were busy at ArenaBowl XX tak-ing care of the players’ injuries before and afterthe game. But they found time to come out ofthe locker room after the Chicago Rush victoryto join the on-field celebration with all theRush players, families, and staff, as well as theChicago Rush fans.

A Little Luck, a Lot of Skill

Mike Ditka — now part owner of the ChicagoRush, NFL Hall of Fame player, and of course “dacoach” of the Chicago Bears’ Super Bowl XXchampions — was also on hand for the celebra-tion. Many fans and the media called “dacoach” a good luck charm, stating that Ditkawas a part of Super Bowl XX and now theChicago Rush ArenaBowl XX victory.

The same can also be said for the physicians ofMidwest Orthopaedics at Rush who were partof the 2005 Chicago White Sox World SeriesChampionship team as their team physicians.And now the Chicago Rush has wonArenaBowl XX in 2006.

“All the credit for the ArenaBowl champi-onship goes to the players and coaches,” says

Brian Cole, MD. “They were 5 and 9 but con-tinued to battle and finished the season cham-pions. We will do our part and continue toprovide the highest quality of subspecializedsports medicine care to anyone, and thatincludes championship professional sportsteams, college and high school athletes, andthe weekend warriors.”

Paul Strandquist, Director of Marketing atMidwest Orthopaedics at Rush, earned a Bachelorof Science in health and physical education fromIllinois State University. He has been in customerservice and marketing with Midwest Orthopaedicsat Rush for 20 years. He enjoys coaching baseballand playing Chicago-style 16-inch softball.

David McClamroch, Corporate Sales Manager for theChicago Rush; Paul Strandquist, Director of Marketingat Midwest Orthopaedics at Rush; and Mike Gordon,Vice President of Sales for the Chicago Rush

“I am so proud of this team.They believed in each otherand played their hearts out,

and now they can call themselves champions.”

— Mike Hohensee, Rush Head Coach


Once again, the Rush University Medical CenterOrthopaedic Program gained national recog-nition among orthopaedic practices by making

another appearance in U.S. News & World Report’s“Best Hospitals” issue. This year, Rush was thenation’s sixth best and Illinois’ top program.

Continuous Advancements

Rush was ranked tenth in 2004, climbed to eighthplace in 2005, and moved up to sixth in thenation this year. This upward trend is one that Rush expects to continue throughout theupcoming years.

“I believe the program can achieve an evengreater status,” says Gunnar Andersson, MD, PhD,Chairman of the Orthopaedic Department at Rushand partner with Midwest Orthopaedics at Rush(MOR). “As we continue to pioneer advancementsin orthopaedic medical science, the stature of theprogram will only continue to increase.”

The Evaluation

This year, out of 5,189 hospitals nationwide, only3 percent (176) were considered for evaluation.Each hospital was ranked in one or more of the 16specialties in this year’s “Best Hospitals” issue. Forthe orthopaedic specialty, the annual report evalu-ates practices according to specific criteria, includ-ing reputation, mortality ratio,discharges over the past threeyears, nurse-to-patient index,nurse Magnet facility status,patient and community serv-ices, key technologies,and trauma services.

In addition to its high overall ranking, the Rush University Medical Center OrthopaedicProgram ranked among the survey’s best innearly every category.

A Strong Team

The strength and success of Rush UniversityMedical Center is due, in part, to its partnershipwith MOR. The Rush University Medical Center’sorthopaedic medical staff is comprised largely ofMOR physicians, who are highly trained inorthopaedic surgery as well as in specialized fieldswithin orthopaedic medicine.

A qualified staff of physician assistants; registerednurses; athletic, physical, and occupational thera-pists; specialists in gait analysis; x-ray and casttechnicians; and administrative personnel helpssupport the physicians and complete the range ofservices provided at Rush. Physicians and nursespecialists working in teams thoroughly evaluateeach patient, accurately diagnose problems, andcreate individualized treatment plans.

The collaborationb e t w e e n R u s hUniversity MedicalCenter and MORgenerates

progressive treatment alternatives, including min-imally invasive joint replacement and spine sur-gery; anterior cruciate ligament and rotator cuffrepairs; cartilage restoration; arthroscopic knee,shoulder, and elbow repair; and minimally inva-sive foot and ankle surgery. The orthopaedic sur-geons at Rush led the way for many advances inhip and knee implants, including minimally inva-sive techniques that enable patients to returnhome within a day.

In addition to surgical practices, the physicianshold academic appointments at Rush MedicalCollege and are active in research. Their researchleads to discoveries and leading-edge therapiesthat benefit patients, which is what the physiciansfind to be their greatest reward.

“The physicians of MOR are extremely proud ofthis program’s success, which validates the visionwe share with Rush of providing the world’s bestorthopaedic patient care, education, andresearch,” says Dr. Andersson.

For more information about the physicians at MOR orthe U.S. News & World Report “Best Hospitals 2006”special issue, call (877) MD-BONES or visit

www.rushortho.com.

Moving UpRush orthopaedics program climbs to sixth in nationBy Kerri Kossick


The use of human tissue is not new. The firstreported tissue transplants occurred aroundthe turn of the 20th century. In recent years,

there has been increased popularity in the use ofallografts in orthopaedic surgery, and currently,there are approximately 250,000 grafts trans-planted per year in the United States.

There are many potential uses of these grafts, andthey can improve the quality of life of patients. It isvery important that the surgeon know the sourceof these grafts and how they are processed andscreened.The state of Illinois has one of the largesttissue banks in the United States. It operates withthe Gift of Hope, the organ procurement agency of

Illinois. It is a not-for-profit tissue bank, and I haveserved as its medical director for 20 years.

There are several important concepts thatorthopaedic surgeons need to understand relatedto procurement, processing, and safety issues.When selecting a tissue bank, the surgeon needsto know the bank and its banker.

Procurement

Tissue procurement is a comprehensive processthat starts with the donor and donor hospital. Thedonor hospital generally does its own initialassessment and then contacts the organ procure-ment organization in its area. Organ procurementorganizations are federally mandated and were

created to ensure a fair and equitable distributionof organs in the United States. Tissue banks fre-quently operate in conjunction with the organprocurement organizations to acquire trans-plantable allografts.

When contacted, a transplant coordinator fromthe Gift of Hope then assesses the donor. Thecoordinator talks to the donor family about tissuedonation and describes the process and ultimateuse of these donated grafts. It is important thatthe organ procurement organization and thedonor family develop a strong relationship. Eventhough there is a driver’s license signature optionin Illinois, the donor family’s approval is stillsought for tissue donation. This is a criticalinformed consent process.

The Gift that Keeps on GivingHuman allograftsimprove quality of life for many patientsBy Steven Gitelis, MD,

Medical Director, Tissue Bank, Gift of Hope

Fresh osteoarticular allograft of the hip and femur


The transplant coordinator then evaluates thedonor for medical conditions that might precludeprocurement. These include but are not limited toa history of cancer, hepatitis, and exposure toother transmittable diseases. The donor is alsoevaluated by an extensive battery of serologies torule out transmittable disease. Recently, we haveadded nucleic acid testing to diminish the windowwhere a donor could be infected and not manifestan immunological reaction to a virus.

The tissue transplantation team then goes to thedonor hospital, the operating room at the medicalexaminer’s office, or, more recently, to our state-of-the-art operating room at the Gift of Hopelocated in Elmhurst, Illinois. The procurementprocess is nothing less than a very carefulorthopaedic operating procedure. The tissue isprocured in a very sterile environment and thencultured. The tissue is initially refrigerated andthen ultimately frozen to -80 degrees Centigradefor storage. This freezing process diminishes theimmunogenicity of the allografts.

The tissue will remain in quarantine until allscreening tests have been completed andreviewed along with the detailed medical record.All this information is reviewed by me and RossWilkens, MD, the Medical Director of Allosource inColorado. Thus, the tissue is very carefully scruti-nized for acceptability.

Recently, fresh tissue procurement and transplan-tation has become very popular. This tissue isscreened in a similar manner to our standardfrozen allografts. These grafts are placed in tissueculture so the cartilage viability is maintained.Much of the methodology to maintain the life ofarticular cartilage was developed at Rush by theDepartment of Biochemistry and Brian Cole, MD.

Due to their work, the cells can be kept alive upto 28 days, allowing the grafts to be appropriatelyquarantined and placed with an acceptable donor.All allografts, fresh or frozen, are cultured, andthese cultures are screened to determine theacceptability of the allografts. After procurementis performed, the donor is reconstructed for laterfuneral services.

Processing

After the procurement has beencompleted, the tissue acquired by Gift of Hope is sent to Allo-source, a not-for-profit organiza-tion that is the fourth largest tissueprocessing operation in the UnitedStates. All the work done on theallografts at Allosource is per-formed in a highly filtered cleanroom under sterile conditions.

The grafts are debrided, cleansed,and recultured. If the initial cultureat the time of procurement is alow-virulent organization and if they are ren-dered culture negative after processing, they arepackaged and available for use. If the originalcultures are of moderate virulence, then, in addi-tion to preparation and cleansing, the grafts aresecondarily sterilized with gamma irradiation.Finally, if the original cultures reveal a virulentorganism such as Clostridium, enterococcus, or afungal organism, the grafts are discarded at theprocurement agency.

Secondary sterilization with gamma radiation isquite effective to eradicate moderate-virulent

organisms; however, it has no effect on viral con-tamination and does cause some weakening ofthe allograft. Other processes occur at Allosourcesuch as machining of allografts. These are tech-niques where the human tissue is shaped usingautomated machines into grafts that are usefulfor specific surgical applications. An example is aspinal graft used for spinal fusions.

Manufacturing techniques such as computer-assisted design and manufacturing are used toprepare machined grafts. The freshly procuredarticular grafts are washed and cleaned inColorado and recultured. They are only released ifall serologies and cultures are negative.

Safety

As a result of the careful historical screening,serological testing, cleansing, and culturing of allgrafts, human tissue allografts are extremely safe.Bacterial contamination is very rare, and there has

not been a viral transmission from ahuman allograft in nearly 20 years.The stated risk of viral transmissionis approximately one in 1.5 million.

Surgeons need to know the accred-itation of their tissue banks. The tis-sue banking industry is regulated bythe federal government, which hascreated guidelines for procurementand processing. In addition, theAmerican Association of TissueBanks (AATB) has rigid guidelinesthat must be met in order to receiveits accreditation. Both the Gift of

Meniscal allograft with subchondral bone

Allograft-prosthetic composite arthroplasty of the knee

Bone tendon achilles allograft for cruciate reconstruction


Hope and Allosource are AATB accredited. Thisaccreditation should be sought by surgeons trans-planting human tissue.

Application

There are many clinical applications for human tis-sue. One of the more common applications is theuse of demineralized bone matrix, which isderived from human cortical bone. The donatedbone is ground and demineralized with a calciumcontent of less than 3%. This process releasesbone proteins that participate in the cascade ofevents leading to bone repair. Proteins such asbone morphogenic proteins are released in thismanner. These proteins are very effective asosteoinductive materials that aid in bone repair.

Long bone allografts are still used today to restorethe skeleton after tumor surgery. If a segment of the femur or tibia is removed, a frozen longbone allograft is frequently used to restore the

intercalary defect. Allografts are also used in con-junction with implants as an allograft prostheticcomposite that is useful for both tumor surgeryand complex joint reconstructive surgery.

Spinal surgeons use allografts for fusions, bothinterbody and posterior fusions. One of the morecommon uses of allografts is in knee reconstruc-tion. Anterior cruciate ligament reconstructionwith a bone tendon/bone allograft is a populartechnique and quite effective. Finally, fresh artic-ular cartilage is being used by joint restorationsurgeons. Unipolar defects of the lower femur orupper tibia can be replaced with a fresh livingallograft. Unfortunately, there is a greaterdemand for this tissue than there is a supply, butnew techniques are being developed to increasethe available tissue.

In conclusion, human allografts are safe andeffective. They are the result of a generous gift bythe donor family and can improve the quality of

life of so many people. Surgeons need to be mind-ful of the source of their grafts and understandprocurement processing and safety.

Steven Gitelis, MD, currently servesas the Director of the Rush Center forLimb Preservation and the MedicalDirector of the Tissue Bank, Gift ofHope. His numerous appointments

also include Endowed Chair, Rush Medical CollegeProfessor of Orthopaedic Oncology, and Director ofSect ion of Orthopaed ic Onco logy, Rush-Presbyterian-St. Luke’s Medical Center. Dr. Gitelishas enjoyed a longstanding relationship with Rush,completing both his orthopaedic surgery residencyand genera l surger y internsh ip at Rush-Presbyter ian-St . Luke’s Medica l Center in Chicago. His early orthopaedic oncology experiencecame from fellowships at the prestigious RizzoliInstitute in Bologna, Italy (under renownedProfessor Mario Campanacci), and Mayo Clinic inRochester, Minnesota.


Herm Schneider, Head Athletic Trainer for theWorld Series champion Chicago White Sox,presented World Series gifts to the White Sox

medical team at Rush University Medical Centerin May.

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; NikhilN. Verma, MD; Anthony A.Romeo, MD; and Brian J.

Cole, MD. Also honored wereRush University MedicalCenter physicians JosephHennessy Jr., MD; Dragan

Djordevic, MD; ScottPalmer, MD; and SyedShah, MD. Clinicalstaff members fromboth the hospital andMidwest Orthopaedics

at Rush also receivedgifts, including MarciBilkey, Naveed Kazi,Ke r r y K raushaar,Jessica Delgado, andLeigh Lundberg.

Head Team PhysicianD r. Bu sh - J o seph(orthopaedic surgery)and Dr. Weber (pri-mary care sportsmedic ine/ internalmedicine) receivedofficial World Seriesr i ng s, t he samer e c e i v e d b y t h eWhite Sox players.“We’re honored to receive World Series rings andtruly value our three-year relationship with theWhite Sox,” says Dr. Bush-Joseph. “We hope theWhite Sox have another healthy season and wecan add another ring!”

An Intense, Active Role

Midwest Orthopaedics at Rush is proud of the roleit played in a remarkably healthy and successfulWhite Sox World Series championship season.

A WinningGroup

White Sox medical team honored for contribution to World Series success

Members of the medical team receiving gifts included Midwest Orthopaedics atRush physicians Charles A. Bush-Joseph, MD; Kathleen Weber, MD; Bernard R. BachJr., MD; Gregory P. Nicholson, MD; Nikhil N. Verma, MD; Anthony A. Romeo, MD; andBrian J. Cole, MD. Also honored were Rush University Medical Center physiciansJoseph Hennessy Jr., MD; Dragan Djordevic, MD; Scott Palmer, MD; and Syed Shah,MD. Clinical staff members from both the hospital and Midwest Orthopaedics atRush also received gifts, including Marci Bilkey, Naveed Kazi, Kerry Kraushaar,Jessica Delgado, and Leigh Lundberg.


Throughout the year, Midwest Orthopaedics atRush served as team physicians, working closelywith the head athletic trainer to keep the team intop playing condition.

Apart from being on the field for every home gameduring the season and every home and away gameduring the playoffs and World Series, the MidwestOrthopaedics at Rush physician team was alsoinvolved with player conditioning and trainingthroughout the year. The team physician functioncovered a broad range of responsibilities, includingdirect diagnosis and treatment on the field; provid-ing care for visiting team players, coaches, andumpires; follow-up and continued care in theoffice; phone consultation; facilitation of emer-gency care; managing care when the team was onthe road; and coordination of all medical person-nel involved in ensuring the overall health of theplayers, their families, and the White Sox staff.

When injuries did occur, Midwest Orthopaedics atRush physicians were on hand to provide an accu-rate, rapid diagnosis and initial care to minimizetime away from the game. “Our close workingrelationship with the White Sox training staffenabled us to diagnose and treat injuries quickly,minimizing player downtime,” says Dr. Bush-Joseph, lead team physician. “In professionalbaseball, with such a fine line between successand failure, a few additional effective innings by apitcher or a couple of extra healthy games by aposition player can make a huge difference. I thinkwe definitely saw that with the White Sox thisyear, when some key players were able to workthrough injuries to make important contributionsat critical times.”

Best Sports Care Available

Schneider sought out Midwest Orthopaedics atRush to provide the most comprehensive level ofmedical service available. “I wanted our players,staff, and front office personnel to have the bestmedical expertise available,” he says. “In addition,I wanted the team to have access to a full-serviceacademic medical center like Rush UniversityMedical Center, which is just minutes away fromU.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

team physicians. All are on the faculty of RushMedical College. Dr. Bush-Joseph, Dr. Bach,Dr. Nicholson, Dr. Cole, and Dr. Romeo areorthopaedic surgeons who specialize in sportsmedicine, treating everything from broken bonesto torn anterior cruciate ligaments and rotatorcuffs. And Dr. Weber is board certified in internalmedicine and sports medicine.

Dr. Weber served as the team’s primary internalmedicine physician and is one of Major LeagueBaseball’s few female team physicians. With hercombined training in sports medicine, internalmedicine, and exercise physiology, she wasuniquely qualified to address both orthopaedicinjuries and the medical aspects of sports medi-cine, such as heat illness, head injuries, allergies,viral infections, high blood pressure, and diabetes.

Another Winning Season Ahead

The future looks bright for the 2006 season —not only for the White Sox but also for MidwestOrthopaedics at Rush’s involvement. “This is our

third year with the White Sox,” says Dr. Weber.“And we will be able to use the solid foundationwe have built thus far to further develop a modelsystem of comprehensive medical care for boththe individual athlete and the team.”

Head Team Physician Dr. Bush-Joseph (orthopaedicsurgery) and Dr. Weber (primary care sports medicine/internal medicine) received official World Series rings,the same received by the White Sox players.


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Anterior cruciate ligament (ACL) injuries havebecome one of the most devastating andcommon injuries among athletes today.

Annually, there are between 80,000 and100,000 ACL repairs performed in the UnitedStates. At least 60% to 70% of all ACL injuriesare from noncontact situations, and the majorityof those injuries occur to athletes between theages of 15 to 45.1,2

Most of these athletes will undergo an ACL recon-struction (approximate cost is $17,0003) andcomplete an extensive bout of rehabilitation (sixto 12 months) to allow for a safe return to theirsport or recreational activity.

AthletiCo has successfully rehabilitated hundredsof athletes after this type of reconstruction. As wehave developed our Performance Enhancementservices, it became obvious that there was a needfor ACL injury prevention programs for athletes ofall ages, as well as the ability to assess relativerisk prior to injury.

Determining Risk Factors

The majority of noncontact ACL injuries involvesome type of decelerating motion bringing theknee into flexion and the femur into adductionand internal rotation while the tibia and foot areplanted. The exact cause of noncontact ACL

injuries has yet to be determined but may be acombination of factors, including anatomicalstructural factors, hormonal risk factors infemales, and biomechanical issues.

We set out to determine if there is a way topotentially identify risk factors and, as a result,decrease the likelihood of serious knee injury. Thiscould be used as a preseason screening tool aswell as a bridge from formal physical therapy toathletic performance.

Several commercial athletic injury risk-assessmenttools were reviewed and implemented. Theseinclude but are not limited to Cincinnati

Focus on entire kinetic chain corrects faults, improves performanceBy John L. Honcharuk, ATC, CSCS,

and Joe Meier, PT, DPT, MS, NASM-PES, NASM-CPT, CSCS

Anterior view of aflexed knee showing

menisci ligaments andcondyles prior

to knee arthroplasty

Posteriorcruciate

ligament

Anteriorcruciateligament

Reducing Noncontact ACL Injuries


SportsMetricsTM Valgus DigitizerTM, The SantaMonica PEP program, and The Reebok FunctionalMovement Screen. Each of these screening toolshas unique merits and uses. The predominant toolthat we feel addresses the entirekinetic chain is the NationalAcademy of Sports MedicineOptimum Performance TrainingModel (NASM OPT™).4 We havetaken what we feel are the bestcomponents of each of these pro-grams and created a hybrid thatcurrently fits our clinical as well asperformance enhancement needs.

Before an individual’s risk can beaddressed, we must evaluate anddetermine all limiting factors thatcould predispose an individual toan ACL injury. Functional move-ment screens have been valuablein revealing faulty movement pat-terns. The most popular testincludes having athletes performsome form of squat with theirarms over their head and a singleleg activity to challenge their coreand balance.4,5

One aspect of our ACL Injury Prevention Programis a functional movement assessment, which con-sists of the overhead squat. The overhead squat isperformed by having athletes stand with their feetparallel and shoulder-width apart with arms over-head and then having them perform a squat. Thisin effect reproduces, on a much slower scale, theeccentric movement.

Since the majority of ACL injuries occur whiledecelerating eccentrically, the clinician will be ableto visualize a good portion of the faulty move-ment patterns. This assessment allows us to deter-mine which muscles are dominant in themovement and where the athlete is in need ofimproved flexibility and strength.

We further determine limitations through gonio-metric measurements, functional core assessment,neuromuscular evaluation, and upper and lowerextremity power assessments. As with any pro-gram design, an assessment of the demands ofthe sport must also be included. What energy sys-tem is dominant: ATP/PC, anaerobic, or aerobic?

The plane of motion for a track athlete (sagitalplane dominance) is different from that of a bas-ketball player (transverse plane dominance). Theaforementioned would be included in our full ACL

prevention evaluation. Only after that can an indi-vidualized program be created.

This type of assessment was highly effective indetermining potential faulty movement patternsin some members of the USA Men’s Rugby Teamwhile the team was in New Zealand for an inter-national tournament. The findings were thenapplied to each team member’s training programto address deficits.

One of the most predominant faulty movementpatterns we see clinically with the overhead squatis adduction of the knee or valgus, which can becaused by excessive pronation of the foot and/orpoor control at the hip. It is at this point that theACL is placed in great jeopardy if the individual isunable to control the position of the knee becauseof insufficient range of motion, core stability, neu-romuscular control, or strength.

Restoring Proper Range of Motion

We will begin as we would with a complete pro-gram by first addressing the restoration of proper

range of motion through flexibility. The two typesof flexibility we will primarily focus on in this arti-cle are self-myofascial release and static stretch-ing. However, there are other levels of flexibility

the athlete would progress to oncenormal range of motion is achievedand the overhead squat assessmenthas visibly improved.

Tissue extensibility can be improvedby self-myofascial release through theuse of a foam roll. This will preparethe tissue for further lengthening inorder to achieve optimal length ten-sion relationships. For example, self-myofascial release to bilateral rectusfemoris, hip adductors, and gastroc-nemius/soleus complex can beachieved by slowly rolling through themuscle group searching for tenderareas. The individual would then reston the tender area for 20 to 30 sec-onds to inhibit overactive muscles.4

Myofascial release is followed bystatic stretching, which helps restoreoptimal range of motion for func-tional movement and strengthening

of muscles that have been overpowered by theirstronger antagonist. An example is to staticstretch the rectus femoris, hip adductors, and gas-trocnemius/soleus complex bilaterally. Typically,we prefer to use multijoint, closed kinetic chainactivities if possible. A good example of this typeof activity would be the standing hip flexorstretch. This particular movement addresses thegastrocnemius/soleus complex, illiopsoas, rectusfemoris, quadratus lumborum, and latisimus dorsi.

Improving Stability, Control,and Strength

Once flexibility issues have been addressed, wethen begin improving the stability of the core.The core is where all movement begins and plays a major role in control of the upper andlower extremities.6 When strengthening thecore, one must focus on the lumbopelvic hipcomplex. An excellent exercise to achieve this is the stability ball bridge. This particular exer-cise involves use of the transverse abdom-inus, gluteus maximus, quadriceps, hamstrings,and the gastrocnemius/soleus complex. In

Squatting in a valgus position puts the ACL in great jeopardy if the individual isunable to control the position of the knee because of insufficient range of motion,core stability, neuromuscular control, or strength.


addition, the use of the stability ball increasesthe proprioceptive demand.

Once the core has been stabilized, we take aninside-out approach by improving neuromuscularcontrol. As a result, the gluteals would be the nextarea to be addressed. Again, we emphasizeclosed-chain, multijoint, multiplanar exercise tomaintain neuromuscular efficiency. The triplanesetup is the modality of choice. This exercise isperformed with proper activation of the trans-verse abdominus and gluteal complex to ensurestability of the lumbopelvic hip complex, resultingin improved knee position. These types of exer-cises have been shown, when properly cued, todecrease the incidence of serious knee injury7.

The athlete is prepared for plyometric trainingupon stabilization through activation of the coreand gluteus complex. Within the training pro-gram, the focus should be placed on technique ofthe plyometric exercise. It is imperative that theindividual be able to maintain an athletic positionprior to any plyometrics. The athletic position canbe defined as feet forward and shoulder-widthapart with center of gravity over the balls of thefeet. The knees should be slightly flexed and nat-ural curvature in the spine maintained.8 The ath-lete should be able to take off and land in thisposture. Advanced plyometric techniques canconsist of box jumps to stabilization. This exercisecan be performed on a 6- to 12-inch box andlanding posture should be maintained for a five-second hold.

We would complete the session with exercisesdesigned to strengthen musculature that hasbeen inhibited by tight structures. For instance,weak gluteus medius musculature could beaddressed by having the athlete perform lateralwalks with a resistive band around the knees. This

could be further progressed with stability ballsquats with a resistive band around the knees tocue the gluteus medius to prevent valgus of theknee during descent of the squat.

Taking a Total-Body Approach

Typically, this total-body approach would be per-formed at every session. This is done to ensure thatthe entire kinetic chain is addressed. This ensuresthat the participant continually works on the correc-tion of faulty movement patterns while improvingtotal athletic performance. Again, the frequency,duration, and intensity levels should be directly pro-portionate to the result of the initial findings.

The above examples are just that — a small sam-pling of a comprehensive program. To elaborateon the full ACL Injury Prevention Program isbeyond the scope of this article. The comprehen-sive program is based upon a thorough evaluationof not only the knee and lower extremity but theentire kinetic chain. Then and only then can anindividual program be designed to addressdeficits. We believe through proper evaluation,elimination of muscular imbalances, core stabilitytraining, neuromuscular training, and educationon plyometrics, the likelihood of an individual sus-taining noncontact ACL injuries can be greatlyreduced. Further research and education in thebenefits of the use of an ACL prevention programis required.

John L. Honcharuk, ATC, CSCS, is alsoa Certified SportsMetricsTM Instructor.He is the Facility Manager of the St.Charles AthletiCo and Co-Chair ofAthletiCo’s ACL Injury PreventionCommittee.

Joe Meier, PT, DPT, MS, NASM-PES,NASM-CPT, CSCS, is the AssistantFacility Manager of AthletiCo’sArlington Heights location and Co-Chair of AthletiCo’s ACL InjuryPrevention Committee.

Editor’s Note: John L. Honcharuk and Joe Meierare not affiliated with Midwest Orthopaedics atRush. Treatment recommendations presented inthis article are solely the professional opinions ofthe authors.

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-participa-

tion 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

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among Female Athletes.” Journal of Athletic Training,

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The Role of BiomechanicsAnatomical 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 biome-

chanics. This can be achieved by cor-

recting muscle imbalances, improving

core strength, retraining the neuro-

muscular system, and educating on

proper take-off and landing tech-

niques through plyometric exercises.

At least 60% to 70% of all ACL injuries are from noncontact situations, and the

majority of those injuriesoccur to athletes between

the ages of 15 to 45.


AccountantsWolf & Company, LLP.........................see page 23

Ambulatory Surgery CentersRush SurgiCenter LP ...........................see page 20

Answering ServicesThe Center, Inc.

1853 Bernice Rd., Lansing, IL 60438(800) 237-8228 • (708) 730-3324 Fax

BankingCitibank..........................................see back coverHarris Bank.........................................see page 20

Collection AgenciesIllinois Collection Service, Inc. .............see page 32

Financial PlanningWilliam Blair & Company, L.L.C. ........see page 21

Health CareAccelerated Rehabilitation Centers .....see page 33Rush Oak Park Hospital ......................see page 31

Health Care TechnologyScribe, Inc...........................................see page 32

Health Insurance Brokers & ConsultantsBenefitdecisions, Inc.

125 S. Wacker Dr., Ste. 2075, Chicago, IL 60606(312) 606-4800 • (312) 606-8108www.benefitdecisions.com

Home Health Care AgenciesGirling Health Care, Inc. .....................see page 29

Insurance — Medical MalpracticeGallagher Healthcare

Insurance Services, Inc..................see page 12Law Firms

McGuireWoods LLP77 W. Wacker Dr., Ste. 4100, Chicago, IL 60601(312) 750-6016 • (312) 849-3690 Faxwww.mcguirewoods.com

Spada Law Office, P.C. ..................... see page 32Marketing Communications

Omnia Marketing & Design ................see page 33Medical Device Companies

Tornier ................................................see page 24Office Equipment

Chicago Office Technology Group1 E. Wacker Dr., Ste. 1305, Chicago, IL 60601(630) 771-2600 • (630) 771-2601 Faxwww.cotg.com

Column Office Equipment, Inc. .........see page 33Orthotics & Prosthetics

Scheck & Siress...................................see page 15Pain Management

Apac Groupe Centersfor Pain Management ....................see page 13

Physical Therapy & Sports MedicineAthletiCo............................................see page 29ATI........................................see inside front cover

Chicago Rehabilitation Services, Inc. . see page 16Integrity Physical Therapy ...................see page 31OccuSport Physical Therapy................see page 34Performance Physical Therapy ............see page 29Physiotherapy Associates ....................see page 21Rush University Medical Center ..........see page 21WCS Physical Work Re-Training ..........see page 25

Promotional ProductsPresto Marketing, Inc. ........................see page 25

PublishingChicago Magazine................see inside back cover

RadiologyAffiliated Radiologists S.C. .................see page 30

SignsVan Bruggen Signs, Inc.

13401 Southwest Hwy., Orland Park, IL 60462(708) 448-0826 • (708) 448-9092 Faxwww.vbsign.com

SoftwareSRS Software......................................see page 16

Spine ImplantsDePuy Spine ...................................... see page 31

SportsChicago Rush .................................... see page 32

DirectoryMidwest Orthopaedics at Rush thanks the following advertisers for helping make this publication possible.

Orthopaedic ExcellenceOne Westbrook Corporate Center, Ste. 240Westchester, IL 60154-5701

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