Shelbourne Knee Center: Summer 2023 Newsletter

KNEE TREATMENT

RESEARCH-BASED INSIGHTS THAT MAXIMIZE PATIENT OUTCOMES

RETURNING RYAN JENSEN TO PLAY AFTER CAREER-THREATENING KNEE INJURIES

On the second day of training camp in 2022, Tampa Bay Buccaneers center Ryan Jensen suffered six major knee injuries—ACL, PCL, MCL and meniscus tears, tibial head fracture and knee cartilage fracture—when another player fell on the outside of his left leg. The first five doctors he saw all recommended surgery.

With treatment from well-known knee experts, including K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center, and a lot of hard work by Jensen, the 31-year-old was able to return to play for the Bucs in 172 days— without a single surgery.

“It was a pretty severe injury,” Jensen said in an interview with BucsGameday, a Tampa Bay Buccaneers newsletter. “I was fortunate that I didn’t have to have surgery.”

Healing Without Surgery

Mike McCartney, Jensen’s agent, knew that surgery could result in complications that would end Jensen’s NFL career. McCartney turned to orthopedic surgeon

Chad Prodromos, MD, who had treated McCartney with stem cells after failed back surgery.

Dr. Prodromos told McCartney that surgery would likely result in scarring, a loss of range of motion, and overall poor results. He referred Jensen to Dr. Shelbourne, who has pioneered a research-backed, nonoperative approach to treating many knee injuries.

Jensen first saw Dr. Shelbourne and Laura Bray-Prescott, PT/LATC/ CATC, a physical therapist/athletic trainer at Shelbourne Knee Center, on August 1, 2022, a few days after he was injured. “By having a surgeon and a physical therapist work together closely, we came up with the best treatment plan for Ryan,” says Bray-Prescott.

After reviewing the diagnostic tests done in Florida and examining Jensen’s knee, Dr. Shelbourne agreed with Dr. Prodromos that Jensen could probably heal without surgery. Research conducted at Shelbourne Knee Center relevant to Jensen’s injuries shows that:

• MCL and PCL tears can heal with immobilization and

physical therapy

• Many meniscus tears do not need surgery

• The ACL only needs surgical repair if it has not healed after all the other injuries have been addressed

“Most surgeons only know how to fix people with surgery,” says Dr. Shelbourne. “Not every knee injury requires surgery.”

First Step:

Regain Knee Extension

Before Dr. Shelbourne recommended that surgery could be delayed or possibly not needed, he wanted Jensen to achieve extension in his injured knee equal to his other knee. He did this in just one physical

RETURNING RYAN JENSEN TO PLAY AFTER CAREER-THREATENING KNEE INJURIES

therapy session with Bray-Prescott.

Next, Dr. Shelbourne put Jensen in a leg cast for one week to heal the MCL tear. Jensen stayed in a hotel in Indiana, with his leg elevated above his heart to minimize swelling, and walked only to use the bathroom.

When Jensen returned to Shelbourne Knee Center a week later, Dr. Shelbourne removed the cast and re-examined his knee. The MCL, PCL and ACL were all stable. Physical therapy at home was now clearly the best option.

Home-Based PT Program Promotes Healing

Jensen returned to Florida with a long leg immobilizer for weightbearing activities, instructions for his home physical therapy program, an Ideal Knee and a yardstick. The leg immobilizer protected Jensen’s leg until his quadriceps were strong and stable enough to walk without it. The Ideal Knee, designed by Dr. Shelbourne and marketed by

TS Ideal Products, makes it easier for patients to restore knee extension. Jensen used the yardstick to measure extension, flexion and swelling.

Jensen’s customized physical therapy program focused on restoring range of motion first, then building quadriceps tone, strength and gait training. He did most of his rehab with the Tampa Bay Buccaneers athletic trainer, using exercises provided by Shelbourne Knee Center and with weekly monitoring by Bray-Prescott. As Jensen progressed, Bray-Prescott added new exercises. Jensen continued to have supervision with the team trainer, Bobby Slater, and Alex Guerrero, teammate Tom Brady’s personal trainer.

By mid-November, Jensen had equal extension in both knees, just 3 degrees of difference in flexion, and strong control of and strength in his quadriceps. Now that Jensen's leg was stable, Dr. Prodromos

Outcomes Research Shows What Works Best for Knee Injuries

Over 41+ years, the Shelbourne Knee Center Research Program has collected data on patient outcomes and factors related to those outcomes for more than 15,760 patients. The research process includes annual email surveys and objective evaluations (for surgical patients) during free follow-up visits.

Research results on nonoperative treatment show that:

• There is no evidence that surgery is better than physical therapy for PCL tears.1,2

• About 80% of all meniscus tears will get better with appropriate physical therapy.3

• Nonoperative treatment for MCL tears can provide excellent stability and good to excellent functional outcomes in patients with combined ACL-MCL injuries.4

Also, acute surgery in patients with combined knee ligament injuries can lead to stiffness. ACL injuries combined with MCL and/or PCL injuries can initially be treated nonsurgically and reconstructed later if necessary.5

172 DAYS

AFTER SUFFERING 6 KNEE INJURIES, RYAN JENSEN RETURNED TO PLAY FOR THE BUCCANEERS.

performed a stem-cell infusion to strengthen Jensen’s ligaments and accelerate healing.

Returning to Play 8 Months

Ahead of Schedule

Dr. Shelbourne and Dr. Prodromos had told Jensen that if all went well, he should be able to return to play in September 2023. Instead, Jensen was back on the field for the playoffs in January 2023.

“Some call trying to come back off of a severe injury dumb, but I’m a football player and football players play football,” Jensen told BucsGameday.

REFERENCES

1. Shelbourne KD, Davis TJ, Patel DV. The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med. May-Jun 199 9;27(3):276-83.

2. Shelbourne KD, Clark M, Gray T. Minimum 10-Year Follow-up of Patients After an Acute, Isolated Posterior Cruciate Ligament Injury Treated Nonoperatively. Am J Sports Med. 2013;41(7):1526-1533.

3. Shelbourne Knee Center research data. Accessed 5/7/23.

4. Shelbourne KD, Porter DA. Anterior cruciate ligament-medial collateral ligament injury: nonoperative management of medial collateral ligament tears with anterior cruciate ligament reconstruction. A preliminary report. Am J Sports Med. 1992 May-Jun;20(3):283-6. doi: 10.1177/036354659202000308. PMID: 1636858.

5. Shelbourne KD, Carr DR. Combined anterior and posterior cruciate and medial collateral ligament injury: nonsurgical and delayed surgical treatment. Instr Course Lect. 2003;52:413-8. PMID: 12690868.

FULL KNEE EXTENSION IS KEY TO SUCCESSFUL ACL RECONSTRUCTION

at long-term outcomes after ACL reconstruction based on normal or abnormal extension, with or without meniscus tears and/or chondral injury and the presence and severity of osteoarthritis (OA) on radiographs.

ACHIEVING FULL KNEE EXTENSION in patients with an anterior cruciate ligament (ACL) injury before and after reconstruction is the key to avoiding negative long-term outcomes, according to a study of 1,792 Shelbourne Knee Center patients covering 10+ years of follow up.1 Knee extension equal to the opposite side is important both early on after an ACL reconstruction and in long-term success.

“We have learned that if you don’t have normal extension at two months, you will likely not have it at more than 10 years,” says K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center.

Researchers at the center looked

Study Methods

Researchers followed 1,792 patients treated with ACL reconstruction at Shelbourne Knee Center from 1982 through 2012 for at least 10 years using:

• Subjective, objective and radiographic data for 909 patients (27%)

• Subjective data only for 883 patients (26%).

The study is part of the Shelbourne Knee Center Research Program, which has collected data on outcomes for more than 15,759 patients over 41+ years. The research process includes annual email surveys and objective evaluations (for surgical patients) during free follow-up visits.

Dr. Shelbourne presented study results at the 2023 ACL Study Group meeting. This international group of orthopedic surgeons meets every two years to share and discuss the latest science and clinical work.

Problems Caused by Abnormal Knee Extension

Using subjective, objective and radiographic data, researchers found that patients with abnormal knee extension at two months post-op were 6.4 times more likely to have abnormal knee extension at long-term follow-up (p<.001).1 The objective measurements of knee extension range of motion (ROM) used in the study are critical. “Without objective data, the clinician cannot determine how or why a patient may be doing worse,” says Scot Bauman, PT, DPT, a clinical researcher at Shelbourne Knee Center.

Study results show that decreases in knee extension ROM can lead to:

• Higher rates of OA

• Quadriceps weakness

• Lower subjective scores. The odds of having OA after surgery are:

• 4.8 times higher for patients with abnormal extension

• 2.1 times higher for patients with meniscus tears

• 2.7 times higher for patients with chondral injuries.

Compared to patients with abnormal extension, patients with normal extension had statistically significantly:

• Stronger quadriceps

• Higher subjective scores on the International Knee

Documentation Committee Subjective Knee Evaluation Form.

A loss of extension long term resulted in more negative outcomes than meniscus tears or chondral injuries.

Physical Therapy Restores Knee Extension

Shelbourne Knee Center’s research-backed approach to ACL reconstruction includes:

• Physical therapy to restore ROM before strengthening the knee

• Pre-op physical therapy to prepare for surgery and enable a faster recovery

• Accelerated post-op physical therapy to prevent swelling and facilitate recovery.

“We encourage clinicians to prioritize restoring range of motion after surgery for better short- and long-term outcomes,” says Bauman.

REFERENCES

1. Shelbourne KD. Objectively measuring knee extension is critical when analyzing long term outcomes after an ACLR. Presented at the 2023 ACL Study Group, February 2023.

ORTHOPEDIC

n K. Donald Shelbourne, MD

n Rodney Benner, MD

CLINICAL TEAM

n Jean Fouts, RN, BSN

n Lee Linenberg, CA

n Emily Guy, PA

FixKnee.com: A Resource for Clinicians

AT SHELBOURNE KNEE CENTER, we’ve been conducting research for 40+ years. More than 13,000 of our patients have participated in follow-up surveys and exams. The result? A trove of clinical information related to treating knee injuries and disorders. We’ve made much of this material available to clinicians via our website, www.FixKnee.com. Visit to find a complete list of our published research (with links) organized by topic. Our website also features two blogs for clinicians, For Colleagues and For Professionals, which you’ll find under News + Resources. That section also hosts a Knee Treatment News page with links to digital flipbook versions of each issue.

Research-Backed Treatment for Rare Knee Injuries

Shelbourne Knee Center’s two orthopedic surgeons, K. Donald Shelbourne, MD, and Rodney Benner, MD, have had their research published in more than 160 medical journals and over 100 book chapters. To discuss a rare knee injury or other case with one of our surgeons, email skckneecare@ecommunity.com or call 888-FIX-KNEE (317-924-8636).

n Bill Claussen, MPT

n Emma Sterrett, LAT, ATC

n Darla Baker, PT, DPT, ATC/L

n Sarah Eaton, PT, DPT, ATC, LAT

n Jennifer Christy, PT

n Alana Gillenwater, PT, DPT

n Bryanna McKinstry, PT

n Noah Runyon, PT

RESEARCH

n Scot Bauman, PT, DPT

n Diane Davidson, BS, MBA, CCRC

n Adam Norris, ACRP-CP

n Heather Garrison