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Feb 11, 2019

The Present and Future of Orthopedics: A Paradigm Shift in Orthopedics

I trained at a busy sports medicine practice at Emory University and worked with physicians who took care of the Atlanta Falcons football team, Atlanta Hawks basketball team and the athletes at Georgia Tech University. In many ways, these doctors have pushed orthopedics to a future where athletes are getting better faster with minimally invasive techniques.

Arthroscopy in the 1980’s changed orthopedics. What once required an open surgery now could be done with cameras through a series of poke holes. Patients recovered faster and had fewer complications. Advances in MRI in the 1990’s allowed physicians to make a diagnosis without surgery, and helped patients avoid unnecessary procedures. MRI also allowed physicians to diagnose injuries that had previously been missed.

The field of orthopedics is now in the infancy of another paradigm shift. As diagnostic ultrasound has found its way into the orthopedic clinic, we can now magnify hidden microscopic tears in tendons that previously went undiagnosed, even with MRI. Orthobiologic procedures medicine is now allowing us to heal these tendon injuries without surgery.

Occult tear of the common extensor tendon. Ultrasound shows interstitial tear open up in the tendon that was missed on MRI and successfully treated with Tenex.

Cardiology went through a similar revolution in the 1990’s, where more patients were treated percutenously with stents instead of open-heart surgery. A growing group of physicians have the necessary orthopedic training, advanced ultrasound skills, and understanding of orthobiologics to push the boundaries of this new field. Chris Centeno (Regenexx) has labeled this new movement as interventional orthopedics, similar to the development of interventional cardiology in the 1990’s.

These cutting edge techniques are allowing physicians to replicate open surgical procedures with minimally invasive techniques, and in many cases, the outcomes are similar or better than the traditional surgical approach. As a physiatrist, I do not perform surgery in the traditional sense, but I take pride in being able to help many patients avoid traditional surgery.

Not all injuries can be treated with an interventional orthopedic approach. You will find many practices that are trying to sell you a miracle. Minimally invasive and orthobiologic procedures often will allow patients to return to activity at a fraction of the time. While patients still require a period of time for recovery, they often are not immobilized in the same way as after traditional surgery. In this blog, we will share our cases and knowledge as we do our part to continue to expand this growing field within orthopedics and sports medicine.

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