By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- I see three innovations that are currently in use making huge advances in 2019. They are:
- Increasing use of biologics in sports medicine injury treatment
- An expanding range of options to treat knee arthritis in active adults
- A growing role for algorithm based mobile assessments and telemedicine
It’s very easy to get caught up in moonshots, longshots, and fantasy in the world of medicine, but I believe there are three highly innovative technologies that will have an increasingly prominent role and impact sports medicine in 2019.
The first of these is increasing use of biologics in sports medicine injury treatment. Second is the rapidly expanding range of treatment options for active individuals with knee arthritis. And finally, I expect to see an exponential increase in telemedicine and mobile algorithms to provide initial injury guidance.
Let’s have a look at each of these areas.
I recently attended an instructional course on the use of Biologics in orthopedic sports medicine. The course was chaired by my colleagues and Sideline Sports Doc advisors Jason Dragoo M.D.and Brian Cole M.D.The overall theme of the course was that the world of biologic offerings for sports medicine injuries is exploding in terms of the types of treatments we can offer our patients.
In particular, look to see a huge increase in Platelet Rich Plasma (PRP) injections for many types of soft tissue injuries such as chronic tendonitis and muscle injuries. The last year has shown progress with outstanding scientific research into the exact formulations of PRP that work best for different conditions. Not all PRP is created equal; there are critical subtleties especially in the concentration of white blood cells and platelets that go into the different formulations.
Also expect to see a growing number of “stem cell” injections for sports medicine conditions. There is still some debate as to what exactly a stem cell is – which is why I have it in quotes – but current formulations use a person’s own bone marrow or subcutaneous fat, and then purify the tissue for use in the same person. The science lags our experience with PRP but expect to see an expanding role for stem cell treatments, for sure.
New Treatments For Knee Arthritis In Active Individuals
The best way to treat pain and functional limitation for active people in their 40s – 60s remains challenging. Most of these folks have arthritis that’s significant enough to cause them problems but not severe enough to require a total joint replacement. This is where we have an expanding roster of new treatments.
In the last year we’ve seen the approval of an ultra long-lasting cortisone injectable, and increasing evidence that PRP can be effectively used in some types of knee arthritis. The formulations of PRP used in knee arthritis are different than those used in soft tissue problems. Additionally, the stem cell injections mentioned above will likely have a more prominent role in selected cases, and there are also amniotic fluid injections coming into clinical practice.
These technologies will offer new avenues of hope for the huge population of active adults with moderate knee arthritis.
The Move Away From In-Person Initial Advice For Sports Injuries
This prediction is a bit tough for me, as I’m in a profession that may face some attrition due to the technological advances around us.
In the early 20thcentury doctors routinely made house calls. Those days are long gone. Next to disappear: the initial face to face interactions for many common sports injuries.
At Sideline Sports Doc the algorithm that powers the decision trees in our online courses were developed into a mobile app (Good To Go) that allows an athlete or a parent of an athlete to make an initial triage decision anywhere, in less than 3 minutes. We believe the algorithm can be adapted to any number of conditions.
Outside the realm of sports medicine, I believe care will increasingly be delivered in a hybrid real world-virtual world model. There are multiple companies successfully developing telemedicine networks, artificial intelligence engines, and mobile technologies (including wearables) that have the potential to radically alter the patient-physician interaction.
The time it takes for appointments (including the hassles of traveling to the office, waiting for the appointment, etc.) will drop substantially. The convenience of advice from your home, office, or playing field are compelling.
As I’m trained in the traditional way of orthopedic practice there’s a big part of me that looks at the move away from in-person advice with dread. But when viewed from the patient standpoint I can easily see this becoming a major trend in 2019 and beyond. These innovations, available here and now, are going to be big parts of the sports medicine toolkit in the coming years.