Despite its name, sports medicine isn’t solely for jocks or weekend warriors. “A traumatic injury can happen anywhere, not just on a sports field,” explains Laith M. Jazrawi, MD, chief of the Division of Sports Medicine in NYU Langone Health’s Department of Orthopedic Surgery.
The Sports Medicine Center focuses on acute and chronic injuries to the major joints—the shoulder, elbow, hip, knee, and ankle—and their surrounding soft tissue. Its clinicians come from many different specialties, but they share a common goal: helping sidelined patients get back in the game.
Here, Dr. Jazrawi and his colleague Dennis A. Cardone, DO, chief of the Primary Care Sports Medicine Program, shed light on their field, the center, and recent advances in treatment.
1. Early Intervention Is Critical
About half the center’s 35,000 annual patient visits involve acute injuries, such as sprains, fractures, torn ligaments, or ruptured tendons that require immediate attention or, in some cases, surgery.
The rest entail chronic conditions—among them, tendonitis, bursitis, and osteoarthritis—resulting from repetitive strain, improper form, or degenerative disease.
“Anyone who has persistent pain or discomfort during or after exercise should seek an evaluation,” says Dr. Cardone. Typically, the earlier a repetitive-motion injury is diagnosed, the easier it is to treat.
Rotator cuff tendonitis, for example, often resolves after a few days of rest and targeted strengthening. On the other hand, “frozen shoulder,” an extremely painful and potentially debilitating condition, requires more intensive physical therapy and a possible therapeutic injection. By consulting a sports medicine specialist who can differentiate one condition from the other, patients can speed up their recovery.
2. New Treatments Can Accelerate Healing
More than 90 percent of the center’s patients can be treated without surgery. A ruptured Achilles tendon, for instance, is now often left to heal on its own by using immobilization techniques and early rehabilitation.
Professional athletes, however, may require surgery to enable them to return to the field faster and more predictably. For conditions such as osteoarthritis, doctors can inject therapeutics directly into the joint to relieve pain, improve function, and allow the supporting muscles to be strengthened.
3. Joint Surgery Has Become Gentler
For patients who require surgery, most will benefit from arthroscopy, a minimally invasive approach in which pencil-thin instruments and a tiny camera are inserted through small incisions.
“There’s been great progress in arthroscopic surgery, enabling us to accomplish complex procedures that once would have required open surgery,” notes Dr. Jazrawi. One example is a superior capsular reconstruction, in which tissue from an organ donor is used to help repair a torn rotator cuff.
With an arthroscopic approach, patients typically return to work within a week—twice as fast as with open surgery—and to sports within four to six months. Virtually all arthroscopic surgeries allow the patient to return home the same day. Other advantages: They require less anesthesia, reduce postoperative pain, involve fewer complications, and have a lower risk of infection than open surgery.
4. “Weak in the Knees” Is Not Just an Expression
The most common sports-related injuries involve the largest and most complex joint. Though the knee is designed to support seven times the body’s weight, it’s highly vulnerable to injury.
The rotational forces involved in pivoting subject the surrounding ligaments to stress that can make them fail, and in contact sports, the knees often take a direct hit. Compared with most medical centers nationwide, which perform about 600 knee surgeries per year, NYU Langone performs more than 5,000 annually, reports Joseph Bosco III, MD, vice chair for clinical affairs in the Department of Orthopedic Surgery.
One of the most cutting-edge approaches is a cartilage-repair technique known as autologous chondrocyte implantation, in which healthy cells are harvested from elsewhere in the knee, multiplied in a lab, and then transplanted into the damaged area. Another technique involves transplanting fresh cartilage grafts from young donor patients. Both techniques can forestall or even eliminate the need for joint replacement, which can be severely limiting for athletes.
5. Sometimes a Major Repair Is Still the Best Option
When a patient has torn one of the ligaments or layers of cartilage that support and stabilize the knee, or the cartilage starts to break down due to aging, joint replacement may be necessary to restore full function.
The same is true for people with severe osteoarthritis who are dealing with unbearable knee pain due to the loss of shock-absorbing cartilage pads. While most medical centers across the country perform about 300 knee replacements per year, notes Dr. Bosco, NYU Langone performs some 2,500 of these procedures annually. Recent advances, such as muscle-sparing surgical techniques and medications injected into the site during surgery, speed up recovery. The majority of these patients leave the hospital within two days, and some head home the same day.