Non-Surgical – The New Jersey Orthopaedic Institute

From strains to sprains and more, the vast majority of sports related injuries respond well with non-surgical care.

That is why it is always the first approach at NJOI. The NJOI orthopaedists, and in particular its primary care physicians specializing in sports medicine, offer a variety of non-surgical services for musculoskeletal care. NJOIs vast experience with athletes of all ages and levels emphasizes both injury care and prevention with these services.

Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, ibuprofen (e.g., Advil), naproxen (e.g., Aleve) and nabumetone (e.g., Relafen). These medications address an injury by helping reduce pain and inflammation. However, they can have negative effects if used improperly and it is important than the experts at NJOI assess and recommend these medications for each individual so that they can be taken safely and effectively.

NJOI also offers various injections, including cortisone. These injections are designed to help with chronic, painful inflammation. Delivering cortisone by injection provides very high concentrations of the medication directly to the affected area, while minimizing potential side effects. These injections usually work within a few days, and the effects can last up to several weeks and sometimes even permanently.

Its extensive sports medicine experience means NJOI can provide all of its patients with the best advice for an athletic or active lifestyle. This includes such important areas as strength training and conditioning, flexibility exercises, sports nutrition, and concussion management.

While taping and bracing should not be used in place of personalized medical care when indicated (such as for ongoing pain or serious injury), nor as a substitute for important rehabilitation exercises, these methods can provide extra support for joint instability or for rehabilitating injuries. Both taping and bracing are a common feature of all sports participation. The experts at NJOI understand the concepts and techniques of these methods, and are particularly experienced due to their numerous positions as youth, collegiate and professional sports team physicians.

Platelet-rich plasma (PRP) has become a treatment option for a wide variety of athletes, from recreational to avid amateurs to professionals. This procedure is particularly useful for persistent partial tendon problems, such as tennis elbow, plantar fasciitis, quadriceps and patellar tendon tears; partial muscle tears and ligament tears as well as utilized in conjunction with surgical procedures to increase the chances of healing. While its success rate may vary, PRP holds out hope as a non-invasive potential solution to healing.

In addition to its plasma component, blood also contains red and white cells, as well as platelets. Besides their role in clotting blood, platelets also contain healing properties due to their growth factors (which are the proteins in the blood). For PRP, blood is drawn from the patients. The platelets are separated in a centrifuge process, increasing their concentration from 5 to 10 times greater than normal. They are then combined with the remaining blood and injected into injured tissues in order to facilitate more rapid healing. PRP is a non-surgical treatment, and the risks of PRP are minimal.

Among the ranks of those who have been treated with PRP are professional athletes, like Tiger Woods, Kobe Bryant and Rafael Nadal, as well as two injured NFL players before winning a Super Bowl. Countless weekend warriors have also found relief through this treatment.

While much publicity surrounds use of PRP for athletes, the procedure actually began in the 1990s in connection with plastic surgery. At NJOI, we use PRP for a variety of conditions. A number of studies have demonstrated that PRP injections have lessened pain and improved function in joints, including the elbow, wrist, shoulder, hip, knee, and ankle.

In separate trials done in 2011, PRP lowered blood loss in 81 patients with knee replacements, and lessened pain for 21 with tennis elbow.* *http://www.bloomberg.com/news/2012-08-24/blood-therapy-used-by-tiger-woods-lures-everyday-athletes.html

Over a million U.S. patients have been treated with stem cells in the past decade and a half. Currently, there are over 70 proven therapies using adult stem cells. Stem cell therapy at NJOI, done via ultrasound guidance, has the potential to help accelerate healing in tendon/ligament injuries, and to augment the sub-optimal healing from other techniques or surgeries.

The process of receiving stem cell therapy starts with harvesting your own stem cells from the bone marrow. Stem cells are harvested from the iliac crest (hip bone) using AN anesthetic and a special small biopsy needle. These stem cells- called Mesenchymal Stem Cells (MSC)- areautologous, meaning they are the patients own stem cells.

Harvesting MSCs for injection therapy is done in our office and only takes a short amount of time.The skin and hip bone are numbed. A special needle is then passed through the cortex of the bone into the marrow cavity. This is apainlessprocedure in most cases.The liquid marrow is then very slowly drawn into a syringe.

Then your bone marrow gets spun in a centrifuge for 15 minutes allowing the undifferentiated mesenchymal stem cells to separate from the platelets and blood. Our experienced surgeon will then inject your own stem cells into the joint or damaged tissue.

These mesenchymal stem cells have the ability to turn into cartilage, ligament, tendon, bone, nerve tissue, blood vessels, or muscle tissue. These cells find the area of damage, connect to your DNA and determine the code that tells them into what to reproduce. Stem cells can only grow the same tissue you would have had before the damage.

This procedure is particularly useful for persistent partial tendon tears, such as tennis elbow, plantar fasciitis, quadriceps and patellar tendon tears; partial muscle tears; meniscus tears in the knee and chondromalacia patella (patellofemoral syndrome).

Arthritis afflicts about 50 million people of all ages throughout the country. Osteoarthritis is the most common form of this disease, characterized by deteriorated cartilage surrounding the joints. Healthy cartilage serves to cushion and protect the bones in joints preventing friction and allowing for fluid movement.

Viscosupplementation is a minimally invasive, therapeutic treatment for those who have not seen improvements through medication or other traditional treatments. Hyaluronic acid, a naturally occurring gel-like substance found in the synovial fluid of the joints, is injected into the affected joint and acts as a lubricant. Individuals with osteoarthritis typically have less of this naturally occurring acid, so the treatment works to supplement for the lack of fluid. Viscosupplementation at NJOI is primarily used on the knee, but can also be done on the hip or shoulder.

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Non-Surgical - The New Jersey Orthopaedic Institute