In the last few years, government agencies, insurance companies, and websites have started collecting health care data. The intent is to demonstrate the quality of physicians and hospitals and hopefully drive improvement. Traditional metrics such as length of hospital stay, mortality rates, and infection rates are among the data collected.
In sports medicine, mortality rates are extremely low. For the most part, patients are athletes or athletic people, so they are generally healthy. Most surgeries are done arthroscopically as outpatient procedures, so length of hospital stay is often not an issue. While a multitude of outcome scores exist to provide objective outcome data, I think that the athlete or weekend warrior has a more straightforward goal that should be measured.
As I frequently say in community talks and have written in many blog posts, almost all patients are in some way athletes. Whether or not they play organized sports, almost everyone runs, lifts weights, or plays some sort of sport or performs some athletic activity. So when “athletes” get injured and come in to my clinic or that of other sports medicine physicians, they usually want to know one fact about recovery from the injury or surgery.
When will you return to sports?
Most surgeons went into sports medicine to help athletes get back to sports after injuries. It is certainly the question to which every patient wants an answer. “Am I going to be back for the beginning of the football season?” “When can I lift weights again?” “Am I going to have to give up running forever?” These are all reasonable questions for patients to ask.
Fortunately, we can usually get people back to sports reliably. Most surgeries have rates of return to the particular sport at the same or higher level above 85%. Some injuries are more difficult than others, but with newer surgical techniques and rehabilitation, getting back to sports and exercise is expected. And we rarely have to completely shut athletes down. We might have a runner avoid the impact of that activity for a short period of time, but he or she should be able to substitute swimming, biking, or even using an elliptical trainer. I always try to keep in mind that these activities are what the patients love to do, so I make every effort to get them back.
Current state of sports medicine
I will say that when I look at the field of sports medicine as a whole, the quality of treatments has never been better. For a number of reasons, athletes today are healing and getting back to sports quicker and having fewer problems long term than twenty and thirty years ago. Certainly using the arthroscope to be able to look in the joints and repair structures through two or three tiny incisions has helped tremendously. But our knowledge of the anatomy of ligaments, tendons, and cartilage, the biologic and mechanical processes of how structures heal, and newer techniques for rehabilitation have made patient outcomes as good as they ever have been.
For example, every month or so I see someone as a patient who had a meniscus tear treated in the 1970’s or early 1980’s who had an open surgery where the entire meniscus was removed. It’s not surprising that since the meniscus is the shock absorber of the knee, the patient often developed bone-on-bone arthritis in subsequent years.
And I think that as good as surgeries, nonoperative treatments, and rehabilitation programs have become, the field will continue to improve. Research is being performed around the world to find optimal treatment strategies. Novel techniques, such as platelet-rich plasma, are being tested to treat difficult tendon, ligament, and muscle injuries, and it won’t be the last of the new treatments. And now the field is evolving into one not just trying to treat injuries but also trying to prevent them. Teams and leagues at all levels are adopting injury prevention programs, such as those to decrease ACL tears. The outlook for sports medicine has never seemed brighter.
Note: This post is an extension of an interview I did recently with Jaimie Oh in Becker’s Orthopedics & Spine Review.