Posts

UK Sports Medicine Research Institute

New UK Sports Medicine Research Institute focuses on injury prevention, athlete performance

UK celebrated on Tuesday the opening of the new UK Sports Medicine Research Institute (SMRI), spearheaded by the UK College of Health Sciences and supported in part by a grant from the U.S. Department of Defense.

The 10,000-square-foot facility, part of the UK Nutter Training Facility on campus, will conduct research into injury prevention and performance optimization for professional and collegiate athletes, the tactical athletes of the U.S. military, and physically active people of all ages in Kentucky and beyond.

“Our research and scholarly endeavors offer the brightest hope for transformation and change for our Commonwealth and the broader world we serve,” UK President Dr. Eli Capilouto said. “This sentiment fuels the work of this university, and it fuels the work of the Sports Medicine Research Institute.”

Capilouto held the institute up as an example of the university’s efforts to collaborate across disciplines in addressing the challenges and disparities that face the Commonwealth, noting that seven UK colleges are involved in the work of the SMRI, in addition to personnel from UK HealthCare.

There is no similar facility within 400 miles of Lexington.

State-of-the-art technology

The SMRI is outfitted with sophisticated equipment to assess biomechanical, physiological, musculoskeletal and neurocognitive health. It’s supported by a team of eight core faculty, staff, and research assistants and 40 affiliate faculty. In addition to its Lexington location, SMRI operates a facility in Camp Lejeune, N.C., where its team works directly with MARSOC – the Marine Corps Forces Special Operations Command.

A biomechanics laboratory conducts motion analysis studies using 14 cameras and a dual-force plate system in the floor, similar to the technology used to make video games and animated movies. Equipment shaped like a horse simulates realistic movement for jockeys and other equestrians.

There is also a neurocognitive lab that uses virtual reality to assess visual acuity, reaction times and balance, which are critical measurements for concussion recovery.

Other equipment is designed to measure oxygen consumption, workload and metabolic costs, physiological stress, and the influence of sleep deprivation/fatigue, all of which are important contributors to musculoskeletal strength, endurance, operational performance and injury risk.

Dr. Scott Lephart, dean of the UK College of Health Sciences and founder of the SMRI, leads the $4.2 million Department of Defense grant that helped launch the institute. He said that the military can adapt from lessons learned in athletics and vice-versa.

“The elite warriors of the U.S. military are expected to be at peak performance in extremely dangerous and unpredictable situations, and there’s no room – either financially or personally – for them to sustain a preventable injury,” said Lephart, who is also UK Endowed Chair of Orthopaedic Research. “Our research with athletes both military and civilian is mutually beneficial, and it will result in strategies for injury prevention and performance for every walk of life.”

Impacts in education, health

University of Kentucky Provost Tim Tracy emphasized that the SMRI serves an educational need, in addition to its missions in research and clinical care, noting that the program provides educational experiences for both undergraduate and graduate students across the university.

“With this emphasis on collaboration, the different branches of UK’s mission – education, research, service and care – converge in the work of the SMRI,” he said.

Dr. Michael Karpf, UK executive vice president for health affairs, predicts that SMRI’s impact will extend far beyond the realms of tactical warriors and professional athletes.

“SMRI is a powerful merger of research, outreach and collaboration, enhancing UK HealthCare’s efforts to address chronic disease and poor health in Kentucky,” Karpf said.

UK Director of Athletics Mitch Barnhart noted that the SMRI was not just a valuable resource for UK athletes, but for professional and youth athletes across Kentucky and nationally.

“This is yet another example of the power of partnership on our campus,” Barnhart said. “By working together, we are creating cutting-edge resources for athletes both here at UK and beyond. The efforts of the SMRI will help minimize injury and maximize athletic performance in sports ranging from football to NASCAR and from basketball to horse racing.”

UK Sports Medicine Research Institute

Leaders from UK, UK HealthCare and UK Athletics came together to celebrate the opening of the SMRI.


Next steps:

In the latest edition of Making the Rounds, Dr. Scott Mair discusses always wanting to be a doctor, his hobbies and why he enjoys living in Lexington.

A passion for sports led Dr. Scott Mair to orthopaedic surgery

Making the RoundsWe sat down with Dr. Scott Mair, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine, for our latest installment of Making the Rounds, a blog series that introduces you to some of our providers at UK HealthCare. Dr. Mair specializes in shoulder and knee arthroscopy and shoulder reconstruction.

How did you first become interested in medicine?

I grew up in Rochester, Minn., and everybody there is a doctor, basically. My dad was a pediatrician. I didn’t know there was anything else to do. I’m kind of kidding, but there are an unbelievable number of doctors there, per capita, just because the Mayo Clinic’s there and it’s a small town. So obviously I knew a lot of doctors, and they seemed to like what they did.

Why did you decide to specialize in orthopaedics?

It had more to do with my love of sports. I wasn’t a spectacular athlete, but I played a lot of sports, and I enjoyed being around sports. So when I would hear about team doctors, it seemed like a good fit. I get to work with several of the UK teams, which is a lot of fun.

What types of injuries do you treat?

Mostly what I see is shoulder problems. Probably about 80 percent of my practice is shoulder things. A lot of young athletes with stability problems, and then older people who have rotator cuff problems. But I see all kinds of other, different shoulder abnormalities, too.

What should patients know about rehab after surgery?

People think rehab is something where they have to push through the pain and do everything they’re supposed to do – which, in certain surgeries or certain rehabs, is important. But a lot of times, it’s almost the opposite, where once people start feeling well, we’ve got to slow them down because some things take months to heal.

For a lot of my younger patients especially, after a couple of months when we’ve stabilized their shoulder, they feel like they’re good as new, and they start doing things they’re not supposed to do before they’re healed. So half my time I spend trying to slow people down while they’re healing up after surgery instead of pushing them along, like you do in some surgeries.

What do you do in your spare time?

I have four daughters, so most of the time I’m doing things with them. I used to play a lot of golf, but they’re not much into that, so I spend a lot of time chasing them around for their sports and things. They range from age 12 to 20 now.

Describe your ideal weekend. 

I’d be at a UK basketball game and hanging out with my family after that, doing something with our friends. Maybe go fishing.

What do you like most about living in Lexington?

I’ve been here about 18 years and I think it’s a fun place. There’s a lot to do, it’s easy to get to big cities, but it’s not such a big place that you can’t get around where you need to go. And it’s got friendly people.

What’s your favorite movie?

I like some of the old-school movies like Caddyshack and Fletch. Those are probably still my favorites.


Check out our video interview with Dr. Scott Mair below, where he talks about why working with the student-athletes at UK is so rewarding.


Next steps:

  • Learn more about UK Orthopaedic Surgery & Sports Medicine, which provides leading-edge treatment for a variety of injuries and conditions.
  • When Patty Lane was diagnosed with arthritis in her hip, she was told her time as a competitive triathlete was over. That’s when she turned to UK Orthopaedic Surgery & Sports Medicine for a second opinion. Read Patty’s story.
Dr. Lattermann, director for Cartilage Repair and Restoration at UK HealthCare, spoke about what inspired his career in sports medicine.

Watch: 5 questions with sports surgeon Dr. Christian Lattermann

Each day brings something different for Dr. Christian Lattermann; that’s one of the things that keeps him passionate about his job.

As director of the Center for Cartilage Repair and Restoration at UK Orthopaedic Surgery & Sports Medicine, Lattermann treats patients, does community outreach, conducts research and mentors students.

Even though he’s a leader in the field, he says his patients teach him something new every day.

Watch this episode of “Five Questions” to learn how a semi-professional soccer career inspired Lattermann to become an orthopaedic surgeon and why he’s so excited about the sports medicine research happening here at UK.


Next steps:

  • Learn more about the UK Center for Cartilage Repair and Restoration, which offers operative and nonoperative treatments for a wide array of cartilage-related conditions.
  • After a torn meniscus and a failed surgery, marathon runner Lisa Hall was told she would need a knee replacement. Not willing to give up on her goals, Lisa turned to UK Sports Medicine and Dr. Lattermann for help. Read Lisa’s story.
Patty Lane had arthritis in her hip that prevented her from running. But Dr. Stephen Duncan offered a surgery that enabled her to continue to her passion.

After hip surgery at UK, triathlete pursues her passion without limits

When Patty Lane’s orthopaedic surgeon told her that her time as an endurance athlete was over, she was so upset she didn’t even tell her family.

The stiffness that she had been experiencing in her hip was diagnosed as arthritis, and she felt like her body had let her down. She contemplated what the diagnosis would mean and if she could be happy standing on the sideline at races. When she talked to her son’s triathlon coach about her diagnosis and prognosis, he gave her valuable advice: “Go see a surgeon who’s an athlete.”

Her research led her to Dr. Stephen Duncan, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine who is also an avid cyclist. When Lane, who lives near Ashland, Ky., arrived for her appointment with Duncan, the options she received from him were “day and night” compared to what she’d heard originally.

“He told me he’d have me active again and gave me a variety of options I hadn’t been told about earlier,” Lane said.

Total hip arthroplasty

Duncan recommended a total hip arthroplasty, or THA, which involves removing the femoral head (the round top of the femur) and shaving off the cartilage inside the hip socket. A titanium shell is then placed into the socket, and a titanium stem is fitted inside the thigh bone. Finally, a plastic liner is placed inside the socket and a ceramic head is placed on the femoral component.

With a traditional THA, doctors discourage high-impact activities, as they increase the risk of fracturing and early wear. For Lane, Duncan used a newer technology called dual mobility, which uses a metal liner and two moving heads. This allows for less wear and tear, and decreases the risk of implant fracture. He also used a stem in her femur that has a special coating, which creates a natural connection between her femur bone and the implant. That helps prevent weakening of the bone in Lane’s femur around the stem, and also helps her avoid any pain in the femur that might be experienced with running.

Without Duncan, ‘I’d be done’

After six months of recovery, Lane was back to racing, winning her age group in a sprint-distance triathlon (half-mile swim, 12.4-mile bike, 3.1-mile run). In the time since, Lane has competed in more than 20 races, including the New York City Marathon, an ultra-marathon and multiple triathlons of varying distances.

Lane noticed early on in her journey that there was little information available about what it was like to return to endurance sports after a hip replacement or a surgery like hers. The few articles she found provided conflicting information or gave advice she didn’t feel was right. She read that you’re not the same athlete after hip surgery and that it would negatively affect her times. She also read accounts of how surgery had helped relieve stiffness and pain and led to better race results.

If Lane had listened to her first surgeon, she said, “I’d be done.” Duncan’s support and second opinion meant she could continue doing what she loved  being active and staying healthy.

“Get a second opinion, and find a doctor who is familiar with the sports discipline you’re interested in,” she said.

Duncan’s advice echoed Lane’s.

“I would recommend second opinions if someone is told that they need to give up their passion,” he said. “Whether it be cycling, golf, running or hockey, patients should know that there are surgical options that surgeons can tailor to fit each patient’s needs.”

There are a lot of places to find information about surgeons who may be able to help, he said.

“Seminars from surgeon leaders can be helpful,” Duncan said. “Patients themselves often are great advocates through word-of-mouth, online postings and online searches to find surgeons who are comfortable caring for these endurance athletes and have success getting patients back to their desired level of competition.”

If Lane hadn’t followed the advice of her son’s coach, she wouldn’t have been able to travel to Cozumel, Mexico, to compete as a member of Team USA Triathlon. Thanks to hard work and an unwillingness to give up, she will have the opportunity to compete in a duathlon (run, bike, run) in Canada this September. She has no limits on when she’ll have to stop competing and is excited to continue to compete (and win) races all over the world.

“[Duncan] knew how important it was to me to be active,” she said. “He was encouraging and had no hesitation that I’d be able to run again.”

Six months after her hip surgery, Patty Lane was back on her feet. She has since competed in more than 20 races, including the New York City Marathon, an ultra-marathon and multiple triathlons of varying distances.

Six months after her hip surgery, Patty Lane was back to racing. She has since competed in more than 20 races, including the New York City Marathon, an ultra-marathon and multiple triathlons.


Next steps:

A torn ACL results in a significant risk of developing arthritis within 10 to 15 years. If you've torn your ACL, be on the lookout for arthritis symptoms.

A torn ACL could lead to arthritis, writes UK orthopaedic surgeon

Written by Christian Lattermann, MD, director of the UK Center for Cartilage Repair and Restoration

Christian Lattermann, MD

A torn anterior cruciate ligament, or ACL, is one of the most common knee injuries, with as many as 200,000 cases per year in the U.S. Young people under the age of 20 are at particular risk, in part because of participation in sports.

Despite the frequency of torn ACLs, many people don’t know that the injury results in a significant risk of developing arthritis within 10 to 15 years. Around 70 to 80 percent of patients with a torn ACL will develop arthritis within that time frame. Because most ACL injuries occur in young people, this means that arthritis could set in at a very early age. If a patient is 15 years old when she tears her ACL, for example, she could be struggling with arthritis by the age of 30.

The increased risk of arthritis is true regardless of whether the ACL tear is surgically repaired or not. The actual injury, and the knee’s inflammatory response to the trauma, seem to be the culprits. The ACL is one of four main ligaments in the knee, connecting the thighbone to the shinbone, and any injury severe enough to tear the ligament is likely to affect other parts of the knee, as well. We also see bruises to the bone and damage to the cartilage, meniscus or other ligaments with about half of all ACL injuries.

At UK, doctors and researchers are currently trying to find ways to reduce the risk of arthritis by interrupting the inflammatory process in the week following the ACL injury. We hope that our research will lead to better long-term outcomes for patients who experience ACL tears.

If you’ve torn your ACL in the past, be on the lookout for signs of arthritis in your knee. Symptoms include pain and swelling with activity. If you’re experiencing these symptoms, it’s best to consult an orthopaedic sports medicine specialist, who will be trained in issues related to ACL injury and recovery.

If you’ve recently experienced an ACL injury, the most important thing for your recovery is adequate rehabilitation. The musculature around the knee joint is the biggest factor to prevent re-injury. The re-tear rate for ACL reconstruction under the age of 20 is around 20 to 25 percent, but a large portion of that can be prevented by being enrolled and trained in injury prevention rehabilitation.


Next steps:

UK Sports Medicine patient Lisa Hall

Runner chases Boston Marathon qualification with help of UK Sports Medicine

While teaching a fitness class in May 2012, Lisa Hall realized something was wrong with her knee.

After seeing an orthopaedic surgeon close to her home in Knoxville, Tenn., Hall was diagnosed with a tear in her meniscus, the soft disc of cartilage that cushions the knee. She underwent surgery to treat the injury and alleviate her pain so that she could continue to teach fitness classes and run. Her goal was to qualify for the Boston Marathon.

Unfortunately, Hall’s surgery was unsuccessful, and she developed bone-on-bone arthritis. In August 2012, she consulted with a second surgeon, looking for treatment options that could reduce her discomfort and allow her to continue her active lifestyle. It was then that she received some bad news: She was told she likely needed a knee replacement and that she should give up running.

Dr. Lattermann offers a solution

Christian Lattermann, MD

Hall refused to give up her dream of running the Boston Marathon, and a physician at Vanderbilt University referred her to Dr. Christian Lattermann at the UK Orthopaedic Surgery & Sports Medicine.

Lattermann specializes in treating injuries and other conditions that cause pain and degeneration of knee and shoulder joints. He recommended an osteotomy, a surgical procedure where a wedge of bone is removed from the tibia (shin bone) or femur (thigh bone) to realign the leg and shift weight from away from the area of the knee damaged by arthritis. In Hall’s case, the wedge was then filled with a bone graft and reinforced with a metal plate to support her knee.

Never one to shy away from a physical challenge, Hall completed physical therapy after surgery and was given the green light to use an indoor bike or elliptical to continue her recovery. Hall’s increased activity caused her knee pain to return, but it didn’t stop her from biking or participating in fitness classes again.

In May 2013, however, she felt a pop while performing a squat exercise and was forced to rest her knee with for five additional weeks after Lattermann surgically replaced the original plate supporting her knee.

Despite the setback, Hall followed Lattermann’s second rehabilitation instructions and returned to teaching group fitness classes. By December 2013, she was running on a special treadmill that reduced the impact of running on her knee joint. In March 2014, Hall competed in her first half marathon since her first surgery. She’s now completed two full marathons and several more half marathons.

“I really didn’t want a knee replacement, but no other doctor offered me anything else,” Hall said. “Dr. Lattermann offered me hope. I know that God led me to Dr. Lattermann and worked through him to allow me to run and teach again.”

In 2015, Lattermann removed the metal plate in her knee, and Hall continues to train. She missed her goal of qualifying for the 2017 Boston Marathon this past year by only two minutes.

‘Don’t give up’

The support Hall received from Lattermann and the care team at UK Sports Medicine is what keeps her returning to Lexington every six months for follow-up visits.

Lattermann’s advice for athletes hoping to maintain their level of activity is to talk about their goals with an orthopaedic surgeon who has expertise in both joint replacement and sports medicine. He also said it’s important for patients to understand the potential limitations of different treatment options.

“While one solution may allow high level of function, it may not allow complete pain-free activity,” Lattermann said.

Although Hall knows that not every surgical option works for every patient, she advises other patients to advocate for themselves.

“Keep searching, don’t give up – there are answers,” she said.


Next steps:

Dr. Kim Kaiser not only serves patients in the UK Orthopaedics and Sports Medicine clinic, she’s also the team physician fora number of sports at UK.

Listen: UK team physician discusses working with student-athletes

Each year, college athletes flip, dunk and swim their way to wins and national titles. Working behind the scenes are countless staff members keeping these student-athletes healthy and in shape before, during and after their competitions.

UK’s Dr. Kim Kaiser is one of these specialists. She not only treats patients at the UK Orthopaedic Surgery & Sports Medicine clinic, she’s also the team physician for UK gymnastics, cheerleading, women’s soccer, swimming and diving, and volleyball and the sideline physician for women’s basketball.

In the latest episode of UK’s podcast Behind the Blue, Kaiser discusses how she works with athletes to ensure they’re in shape and feeling healthy for class and at game time. She also provides insights into how research being done at UK might help reduce and prevent the long-term effects of repeated head injury and concussion.


Next steps:

MACI knee

UK orthopaedic surgeon performs first knee surgery of its kind in Kentucky

Christian Lattermann, MD

Dr. Christian Lattermann, director of UK’s Center for Cartilage Repair and Restoration in UK Orthopaedic Surgery & Sports Medicine, recently became the first surgeon in Kentucky and in the Midwest to perform a Matrix Associated Chondrocyte Implantation (MACI). The procedure is a less invasive version of cartilage repair surgery that allows patients to recover more quickly. The technology for this new procedure is the first new cartilage technology to be approved by the U.S. Food and Drug Administration (FDA) since 1996.

A different approach to cartilage repair

The MACI technology uses a patient’s own cartilage cells to create the MACI scaffold which, unlike preceding technology, can be glued into the cartilage defect. That means this procedure can be done through smaller incisions, which Lattermann said offers a significant improvement in operating time as well as an easier path to recovery for patients. The MACI technology is new in the U.S. but has an almost 10-year track record in Europe, with excellent results.

On Feb. 15, Victoria Long was the first patient to receive this treatment at UK. An 18-year-old student who had suffered from a cartilage loss in the knee as a consequence of multiple falls onto her knee cap, Long had been experiencing pain for more than a year and had been receiving nonoperative treatment during that time. At her follow-up appointment on Feb. 21, she was recovering from the surgery and was excited to begin the recovery process.

While the procedure is new, Lattermann is familiar with it. Over the past 10 years, he has helped advance the MACI technology through regulatory agencies and receive FDA approval. During that time, he has performed more than 150 Autologous Chondrocyte Implantations, a less sophisticated version of the MACI procedure.

Becoming a major referral center

When Lattermann joined UK Orthopaedics and Sports Medicine a decade ago, he was tasked by Dr. Darren Johnson, chair of UK Orthopaedic Surgery and Sports Medicine, and UK Executive Vice President for Health Affairs Dr. Michael Karpf, with building the Center for Cartilage Repair and Restoration. The goal was to make UK a referral center for complex and difficult-to-treat injuries in patients at the crossroads between joint restoration and joint replacement.

“We have been on the forefront of treating these defects for several years,” Lattermann said. “Every year, a couple of thousand patients in the U.S. require a true cartilage restoration, and we have become a major referral center for these patients and, at this point, regularly serve patients from Kentucky, Tennessee, West Virginia, and parts of Ohio and Indiana.”


Next steps:

When Jennifer Thomas, a nurse at UK HealthCare, injured her knee, her work became nearly impossible. But an orthopaedic clinical trial offered hope.

Orthopaedic clinical trial helps UK nurse regain mobility

Working as a bedside nurse requires extensive physical effort – pushing wheelchairs, twisting and lifting, and standing for long periods. Jennifer Thomas, who’s been a nurse at UK HealthCare for six years, can attest to this. In fact, it was while assisting a patient from a wheelchair that she badly injured her knee.

“The pain was excruciating – a sharp, stabbing burn,” Thomas said. “It was constant regardless of sitting or walking. My sleep was interrupted due to the discomfort, stairs were next to impossible to navigate and playing with my newborn grandbabies – be it pushing a stroller or carrying them from room to room – was difficult at best.”

The injury also made it difficult to do her job as a pre-op nurse. Sometimes she’d be walking into a patient’s room when her knee would give out, causing her to fall. She had trouble standing for the long enough to assist with epidurals and nerve blocks, and her knee would swell after long days.

Thomas cycled through the standard treatment options: cortisone shots, physical therapy and two surgeries. These treatments required time off work and extended periods of rest, but they didn’t provide relief. The only way to reduce the pain was to stay off her knee and keep her feet elevated.

Participating in a clinical trial

In November 2015, a year after her original injury, Thomas was referred to Dr. Christian Lattermann, director of UK’s Center for Cartilage Repair and Restoration in UK Orthopaedic Surgery & Sports Medicine. In order to fix Thomas’ injury, Lattermann need to perform a cartilage transplant. Unfortunately, many patients who undergo this type of procedure experience muscle weakness afterward. To combat this problem, Lattermann, along with co-principal investigator Caitlin Whale, are leading a clinical trial to investigate how muscle stimulation using a device called the Phoenix Device could improve muscle strength following surgery.

“Weakness in the thigh musculature after this procedure is a big problem that we have not been able to improve,” Lattermann said. “[The Phoenix Study] is a way to find better techniques to treat this weakness.”

Thomas was eligible to participate in the clinical trial. First, Thomas’ strength and functional performance were measured. She then underwent an osteochondral allograft, a surgical procedure where a living piece of cartilage and bone from a cadaver is implanted in the knee. After surgery, Thomas had nine weeks of rest. Within days of surgery, she began a home treatment program, and a couple of weeks after surgery, she began participating in physical therapy. After completing the 12-week home treatment, Thomas’ strength and function were measured, and then again at six months and one year.

Lattermann’s team is still collecting data for this study, which will help them evaluate post-surgical treatment programs and how muscle stimulation can improve recovery.

“The basis for any clinical treatment has to be evidence-based research, and that’s what we’re doing here,” Lattermann said. “Our goal is for every patient being seen clinically to be enrolled into a research study or register as a research participant.”

Meeting her goals

After 12 months of treatment, Thomas feels she’s achieved the goals set out at her first appointment, even if she’s not exactly where she was before the injury.

“I am not 100 percent, but I understand Dr. Lattermann never promised or expected 100 percent,” she said. “I believe we met the goals he had hoped we would achieve. There are still some things I can’t do and some things I will never be able to do again. Aside from those few downfalls, I can walk, play with my grandchildren, stroll in a park or mall, get around my house, wear normal shoes and boots. I can live my live without falling to the ground, limping and enduring horrid pain.”

This was Thomas’ first time participating in research, an experience she describes as extremely positive. She felt comforted by the fact that she would leave each appointment with a plan of care and established treatment goals.

“I’ve had a lot of experiences with a lot of surgeons, and there’s no one like Dr. Lattermann,” Thomas said. “I can’t begin to express the gratitude I have for him and his team.”

Thomas now works as a nurse case manager, which is less strenuous for her knee. She says her own experience as both a patient and research participant have made her better at her job.

“I’m thrilled to be in the position I am and honored to be able to continue nursing,” she said. “I have yet another experience I can share with my patients. Understanding and personal knowledge are among the best gifts a nurse can share with her patients.”


Next steps: