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CLASSIC LIST

07/May/2014

A counterintuitive thing can happen when people feel overly safe and supported: they tend to take more risks. This phenomenon was detailed wonderfully in Tom Vanderbilt’s excellent book Traffic, among other places. It isn’t hard to understand why: when there’s a big net waiting below, you are far more likely to jump a little farther.

So it is with Tommy John surgery, the wildly popular orthopedic elbow surgery procedure which major league pitchers have been opting for in record numbers. The procedure’s staggering success rate has pushed many pitchers to throw harder at an earlier age, secure in the knowledge that they can hit the “reset” button anytime with a visit to their orthopedic surgeon:

If Tampa Bay Rays left-hander Matt Moore opts for Tommy John elbow surgery as expected, he will be the 13th major league pitcher to have the ligament-replacement operation since spring training. That’s only six fewer than all of last season, and three under the annual average from 2000-2011, according to an industry-commissioned study.

And it’s starting earlier than ever before:

“We mathematically, statistically, scientifically have proven that the kids who play baseball year-round are three times more likely to end up on a surgery table by their 20th birthday that those who don’t,” says Fleisig, citing a 10-year study targeting teenagers who pitch more than 100 innings in a calendar year.

Tommy John surgery is a great advance, and there is no question that it extends careers. But ligaments do not age and strengthen like muscles, and the long-term effects of such optional procedures may yet be unknown in such large numbers. If you have questions about elbow surgery in San Diego, please contact my offices today.


04/Apr/2014

There was a time not too long ago when countless pitching careers were cut short by strain on the elbow ligaments. That was before Dr. Frank Jobe came up with a legendary innovation in orthopedic elbow surgery – a procedure known officially as ulnar collateral ligament reconstruction, and unofficially in clubhouses across the nation as Tommy John surgery.

Deceptively simple in its execution, the procedure, which involves relocation of a forearm tendon to the elbow, has undergone precious few changes since it was first performed on – you guessed it – Tommy John, formerly of the Dodgers. The pitcher’s transformation was swift and decisive.  Today the same technique is prescribed for thousands of athletes, including tennis players and javelin throwers, who undergo extreme  elbow strain on a daily basis.

It’s hard to argue with this watershed in prognosis:

In 1974, Jobe estimated that John’s chance of regaining his form was 1 in 100. Current studies suggest a rate of success, generally defined as an athlete’s reaching the same plane for at least one season, of more than 80 percent.

Dr. Jobe passed away recently, but his legacy lives on in the many active people who appreciate his work every day. As a specialist in orthopedic elbow surgery here in San Diego, I am indebted to Jobe for one of the most effective tools in my arsenal.


04/Apr/2014

Much has been said about whether running has net beneficial or detrimental effects on an athlete.  The cardiovascular upside on overall health is clear cut.  But what about all that trauma that a runner’s knees must endure with each step slamming into the pavement?

Protecting your knees and back while running is a battle that must be fought on several simultaneous fronts.  Simple strategies such as proper shoe maintenance and alternating exercise regimens are simple ways to avoid foot and ankle injuries that are commonly seen in runners.  When it comes to the knees and low back, a well-conceived functional strengthening program can help avoid injury.  The concept is very similar to what any recreational athlete feels at the end of a long day skiing.  Most injuries in skiing tend to occur at the end of the day when our muscles are fatigued and less apt to allow us to recover from some perturbation/fall.  Basically, tired muscles have difficulty protecting us from injury when compared to muscles that are better conditioned.  The core muscles are at the ‘core’ of injury prevention with respect to the knee and low back.  The core muscles help to shock-absorb and avoid injuries to the adjacent joints.

This list offers a nice starting point for strengthening.  It features some simple exercises to keep your core, back, hips and shoulders in reasonably loose and powerful form.

Still suffering from knee pain, hip pain, back pain or shoulder pain? Visit my San Diego orthopedic surgery practice to learn more about how you can achieve lasting health without losing a step.


02/Apr/2014

The medical community is never short on opinions on how to manage chronic pain. Common recommendations range from the use of anti-inflammatories such as NSAIDs, to stretches, exercises, even meditation. One effective fix that isn’t usually mentioned: weight loss. Now a new study has appeared which suggests the effects can be profound:

The study included 20 obese patients who had weight-loss surgery and 40 patients who had total knee replacement due to arthritis.

One year after their procedure, the patients who had weight-loss surgery reported significant improvements in knee pain. Their results were comparable to the patients who had a knee replacement, according to the study, which was presented Friday at the annual meeting of the American Academy of Orthopaedic Surgeons, in New Orleans.

It is yet another reminder that our knees are complex mechanical systems, and that ensuring their safe operation has as much to do with reducing loads as reducing stress. The collateral health benefits of weight loss only shore up the case, of course, and lend credence to a holistic view of sports medicine that incorporates the entire body as a single system.

Furthermore, there is growing scientific evidence that injections of PRP (platelet rich plasma) and/or stem cells into the arthritic knee provide significant pain improvement.  In fact more and more evidence seems to indicate that PRP is more effective in reducing knee pain than the highly touted hyaluronic acid (HA) injections, such as Synvisc, Hyalgan, Orthovisc, and Suppartz.

Want to learn more about knee pain or knee surgery in San Diego? Please contact my orthopedic surgery offices here today.


20/Mar/2014

A provocative article in last week’s New York Times discusses the quiet epidemic of older people living with serious pain who fail to report it to their doctors. Whether it’s due to stoicism, resignation, or something else, the net effect can be devastating:

[S]tudies have found that elderly patients are less likely than younger adults to report pain to their doctors. Instead, many suffer in silence at considerable cost to the quality of their lives. . . .

Untreated or inadequately treated pain is disabling and can hasten the death of an older adult by interfering with the ability to exercise, eat properly or maintain social contacts. Persistent pain can lead to immobility, depression, sleep problems, loss of appetite and isolation, all of which may increase the need for expensive medical care.

The article addresses cases of shoulder pain, hip pain and knee pain. Each could have been addressed earlier with proper orthopedic care, especially in cases where arthritic pain has led to a vicious cycle of immobility and declining health.

Agonizing pain is not a natural byproduct of aging, and no one should accept its arrival as a sort of grim “new normal.” If you have chronic knee, shoulder, elbow or hip pain and desire expert orthopedic care in San Diego, please contact my offices.


20/Mar/2014

Knee surgery is a common solution to intractable orthopedic disorders such as ACL tears, meniscus tears and isolated cartilage injuries. Yet despite the fact that such procedures have good success rates, there remains a small but stubborn percentage of patients who experience lingering discomfort even after their projected recovery time has elapsed.

This is especially common in total knee replacement surgeries, which involve equipment designed to exist permanently in this highly trafficked joint. Now orthopedic surgery specialists are refining the tools used to map and fit these medical devices to your body’s natural contours:

Careful fitting and expert aftercare are essential to ensure your knee surgery procedure works as well as you need it to. To learn more about how to get started with some of the most advanced surgical techniques in Southern California, please contact the San Diego orthopedic knee surgery experts today.


08/Mar/2014

The march of medical technology is swift; constantly punctuating the industry with clever new ideas. As a specialist in San Diego knee surgery, I am particularly attuned to any mention of medical devices that might save patients the discomfort and commitment of the need for surgery.

One such device has been receiving a good deal of press recently. Designed to help patients who suffer with knee pain maintain mobility without wearing a cumbersome brace, the product is comprised of tights that contain rigid guides:

Opedix has struggled to differentiate itself from another type of garment that’s popular with runners and looks very similar: compression tights. What sets Opedix tights apart, Mr. Gustafson says, are the bands of stiff fabric that descend down the leg from the hips, wrap around the knees and extend to the ankles.

It is a promising idea, and a nice reminder that we still have much to learn and invent in the field of sports medicine. But until such devices are clinically proven, your best bet to relieve chronic knee pain is to visit a San Diego knee surgery expert today.


08/Mar/2014

Scheduling a San Diego knee surgery appointment with an experienced orthopedic surgeon shouldn’t have to take days. Nor should it take weeks to be seen.  Many practices have succumbed to the pressure to see tons of patients to make ends meet.  Patients, as educated consumers of medicine, know better.  They know when they are being cattled-hearded through the practice.  In contrast, we very intentionally have opted not to take the easy way out.  We take our time with patients at each and every visit; we listen to what patients feel is necessary to share to aid us in making a proper diagnosis and render the treatment that is right for them as an individual (as an athlete, as a professional, as a mother, etc).  The process should be seamless from start to finish, especially if you already have a primary care physician who can offer good advice and pass along a few names.

But for many San Diego patients who suffer with chronic knee pain or stiffness or for those who sustain an acute injury on the soccer field or elsewhere, entering this world can seem like a daunting enterprise. For them and for you, I have created this quick guide to walk you through the steps of planning a knee surgery procedure here in San Diego.

1. Get the Best Diagnosis

Good sports medicine starts with effective, careful diagnosis. Although you may have heard differing opinions from your neighbor, friend, or masseuse, you will want to check in with credentialed professionals who can evaluate details such as your range of motion, pain level and medical history. At my San Diego orthopedic surgery practice, we offer assistance with every part of this diagnostic process, up to and including help with imaging.

2. Exhaust the Other Options

Knee surgery is a fairly involved undertaking, even if your surgeon uses minimally invasive techniques– despite how seemingly easy everyone and I mean everyone makes it appear.  Yes, it’s easy to do a mediocre job;  achieving excellent results takes diligence, attention, and most importantly, care. That’s why it is wise to exhaust the full range of medical treatments before you commit to surgery, including taking anti-inflammatories, if indicated, as well as physical therapy, rest and even accupuncture. At times, injections may be warranted.  Injections come in different flavors, based on the problem at hand.  Sometimes we use injectable medications to decrease inflammation; other times we might use injectable concoctions that promote an inflammatory process, such as platelet rich plasma (PRP).  If you continue to experience distress despite the best efforts of the right medical personnel, then it’s time to move onto the next step.

3. Find a Great Knee Surgeon

Orthopedic knee surgery is a skill, like any part of medicine. The physicians who achieve the best outcomes tend to work in cutting-edge facilities and boast experience and credentials from some of the world’s finest medical institutions. I am proud to say that I am the former Chief of Sports Medicine at UCSD, and that I specialize in cartilage, ligament reconstruction, and kneecap issues, advanced surgical areas on which I speak throughout the country.  Many surgeons are able to perform knee arthroscopy; however that is not the proper question to ask.  On point, it is the sports medicine surgeon who has developed the mastery of arthroscopy.  It is the sports medicine surgeon who accomplishes the task with minimal damage to the surrounding healthy structures in the knee; which minimizes the postoperative pain and accelerates the recovery process.

4. Get Started

If your knee pain has begun to interfere with your life, it’s time to intervene. Feel free to contact my San Diego knee surgery center for more information today.  We will do the right thing for you in the right way!


01/Mar/2014

It is rare to find a folk remedy that cleanly defeats modern medicine in a head-to-head test of efficacy, but that’s precisely what sesame seeds recently pulled off. In a study published in the International Journal of Rheumatic Diseases, researchers announced that the humble sesame seed outperformed OTC stalwart Tylenol in a controlled experiment involving arthritic patients:

The researchers divided 50 people with arthritic knee pain into two groups. One received 2,000 milligrams of acetaminophen and 500 milligrams of glucosamine daily, while the other got 40 grams of sesame daily. After two months, those who had taken the sesame seed had significantly less pain and better function than those taking the drug. Other scientists have found that sesamin has a beneficial effect on cartilage (Glycoconjugate Journal online, December 2013).

It is a provocative finding which underscores just how little we still know about the science of inflammation, and how it impacts chronic joint pain. At minimum, this study should give pause to physicians who reach for the standard painkillers every time a new symptom arises.

Other holistic and naturally occurring anti-inflammatory foods include fish oil, turmeric, cherry juice, and devil’s claw. Many mature athletes have found knee pain relief with the use of glucosamine, chondroitin, and MSM. To learn more about effective treatments and procedures for knee pain, please contact my San Diego orthopedic surgery offices today.


01/Mar/2014

Stem cell therapies are hardly new. In fact, they are perennially on the cusp of finding their way into mainstream orthopedic medicine. The problem has long been a lack of reproducible findings – and a prohibitive cost.

At least one half of that equation may finally be getting addressed. Doctors are seeing more consistent results with certain stem cell therapies for orthopedic issues such as knee pain and shoulder pain. The process has remained largely unchanged since the technology was invented/discovered:

Doctors use a needle to extract bone marrow from the crest of the hip bone. It’s then sent to a lab, where it is spun down to get at the layer of stem cells — cells that have the potential to become any type of cell.

The stem cells are then combined with the patient’s platelets, a type of blood cell involved in healing. Then, it’s given back to the patient. The idea is to have the stem cells turn into new tissue and improve pain and function. . . .

Typically, this is done for various inflammatory tendon problems, though it can be used  for hips, knees, shoulders, ankles, and spine. Patients usually notice improvement by three months, with full benefit in one year.

It is a promising approach, although the body of literature on stem cell therapies versus traditional knee surgeries remains in its infancy. The best bet if you’re experiencing chronic knee pain: Visit a San Diego Orthopedic Surgery Center and get a full workup.  You will be counseled on the risks and rewards of the various treatment options available to you, based on your unique situation.  We provide PRP (platelet rich plasma) injections among the other various conservative treatment measures. In addition, we are able to provide the complete array of surgical procedures. This broad and comprehensive approach to treating your pain and dysfunction puts us in a unique position of being able to provide you an honest appraisal of your options. Our goal is to make you better!


© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow