Tommy John surgery is not just for baseball pitchers. Ask Kylie Donat of Bemidji, Minnesota.

Kylie is an 18-year-old high school swimmer, track and field athlete, and wrestler. She has been wrestling since 2021, the first year that girls' wrestling was a sanctioned high school sport in Minnesota. By 2023, Kylie was favored to win her weight class at the state championship.

Then came the practice that changed everything.

In January 2023, her wrestling partner threw her down on the mat. Kylie tried to catch herself, but her left elbow bent awkwardly, and she heard popping sounds. A week later, she used the Heimlich technique on a teammate who was choking on her food. The maneuver worked, fortunately, but it made Kylie's injury – to her medial ulnar collateral ligament – worse.

"It was a complete rupture, as bad as it could be," says Christopher Camp, M.D., a Mayo Clinic orthopedic surgeon who had a virtual appointment with Kylie in March 2023.

Despite the injury, Kylie was eager to return for her senior season and compete in the state championship. Dr. Camp put Kylie on a standard short course of nonoperative treatment consisting of rest and physical therapy to give the ligament time to heal and stabilize on its own. But it didn't stabilize, so surgery was the next step.

A week later, Dr. Camp performed the ligament reconstruction using the anatomic technique, a new approach he developed at Mayo Clinic. This procedure builds on Tommy John ligament reconstruction surgery, which was first performed on baseball pitcher Tommy John in 1974.

The injury is most common in baseball players, but it can affect athletes in other throwing sports such as softball and javelin. Wrestlers and gymnasts may sustain traumatic versions of the injury.

During surgery, Dr. Camp repaired Kylie's ligament, gave her a new one (taking a tendon from elsewhere in her body to form a new ligament) and added an InternalBrace (2-millimeter-wide suture tape) for stability.

"It's designed to recreate the normal anatomy of the ligament," Dr. Camp says. "It uses newer fixation and anchor devices that are smaller and stronger, and it increases the contact area between the graft and bone to create a larger surface area for healing."

Kylie went home the same day and began to focus on her recovery.

Once Kylie got her splint off and was fitted for a brace, she began her rehab in earnest. She did a lot of stretching so her injured arm could move like the other one. Once she got full movement back, she started building the muscles in her entire body and around the elbow, including the shoulder, bicep, tricep and forearm.

"Knowing that I had lost that opportunity (to compete) due to an injury, I was ready to get back out there," Kylie says. "I knew it would take a lot of work."

Kylie's mother, Sara Donat, says her daughter was determined, but knew she couldn't rush her recovery. Once Kylie was cleared to do pushups and work more of her muscles during physical therapy, she started to have hope. She added swimming to her regimen, which she knew would be good for her elbow and overall athletic shape. In October 2023, she wrestled for the Minnesota Storm in Iowa.

"After that, I was like, 'Wow! I'm really ready to wrestle,'" Kylie says.

Traditionally, the recovery from this type of surgery is a year or longer for a throwing athlete. For a wrestler, recovery is usually nine to 12 months. Kylie got back to wrestling in five months.

"She did a great job on her rehab and physical therapy," Dr. Camp says. "She was extremely motivated and worked hard. We had a very clear goal – wrestling – so she could compete in the state tournament."

In March 2024, Kylie fulfilled her promise to herself by winning her weight class at the state wrestling tournament. Her elbow didn't cause any problems.

"It was the best feeling," she says.

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"The scientific name that we give it is adhesive capsulitis, and, basically, it's a condition when the shoulder gets tight and you can't move it very well," says Dr. Camp.

He says frozen shoulder happens when the lining that goes around the shoulder joint gets inflamed, possibly the result of a small injury. It thickens over time, forming scar tissue.

"Frozen shoulder exists in three stages, and the symptoms and treatment options depend on which stage you're in. So the first one is an inflammatory stage," says Dr. Camp.

That's the painful stage. Rest and steroid injections may help. The second stage is when the shoulder is less painful but starts to stiffen. Physical therapy works well then. The third phase …

"… is what we call thawing, which means it finally starts to relax, loosen up and gain motion back again," says Dr. Camp.

If it doesn't resolve in six to 12 months, surgery may be an option.

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Applying regenerative medicine to a common shoulder surgery could have an impact on the need for follow-up revision surgery in some patients, according to a Mayo Clinic study of real-world evidence.

Mayo Clinic researchers analyzed the largest set of data available to determine if adding bone marrow aspirate concentrate to repaired tissue after standard rotator cuff surgery would improve outcomes for patients. Bone marrow aspirate is fluid taken from a patient's bone marrow that contains concentrated growth factors, stem cells and other specialized cells that may regenerate tissue and cartilage.

The analysis identified 760 patients who had a regenerative intervention added to augment rotator cuff repair surgery. Those patients were compared to 3,888 patients who did not have any biologic intervention at the time of surgery. The data indicated that 114 patients who opted for bone marrow aspirate concentrate at the time of surgery were less likely to need a second surgery.

The results of the Mayo Clinic study are published in the Orthopaedic Journal of Sports Medicine.

"The data we analyzed suggested a nearly threefold reduction in revision surgery in patients who received bone marrow aspirate concentrate, compared to those who did not," says Bradley Schoch, M.D., an orthopedic surgeon and principal investigator. "This procedure is growing in use throughout the practice of orthopedic surgery and commonly added as a surgical adjunct to rotator cuff tears."

A rotator cuff tear — the separation of tendons from the shoulder joint — is a leading cause of pain and disability for millions of people in the U.S. Arthroscopic surgery is the standard of care for repairing symptomatic rotator cuff tears. However, depending on the size of the tear and quality of the tendon, this surgery can fail, sometimes requiring revision surgery.

Regenerative medicine is an emerging field that is seeking new biotherapeutics to restore damaged cells, tissues and organs. One area of focus is on biologics that use sources from the human body — cells, blood, enzymes, tissues, genes or genetically engineered cells — for use in medicines. Mayo Clinic's Center for Regenerative Biotherapeutics is at the forefront of this movement and supports this study as part of its objective of delivering new regenerative biotherapeutics to the practice.

Studying real-world evidence

Preclinical research suggests potential benefits of orthobiologics, such as bone marrow aspirate concentrate, for healing damaged tendons. A few clinical trials have been conducted to try to establish scientific evidence of healing in humans. However, insurance considers orthobiologics to be experimental and does not reimburse for these procedures.

To accelerate Food and Drug Administration (FDA) approval of promising therapies, Congress passed the 21st Century Act in 2016 that allows data from real-world evidence to support regulatory decision-making. The FDA may now consider data from sources other than clinical trials, such as risks and benefits documented in electronic health records, lab reports and billing activities. In this Mayo Clinic study, researchers examined data from large insurance billing codes.

"The primary purpose of this study was to utilize a national administrative database to determine the association of bone marrow aspirate concentrate applied at the time of rotator cuff repair on revision surgery rates, compared to matched controls. It offers additional support to randomize control trials that often take years to complete and often are not definitive," says Shane Shapiro, M.D., an orthopedist and medical director at Mayo Clinic's Regenerative Medicine Therapeutic Suites in Florida. "This type of study allows stakeholders and health insurance companies to assess the risks, benefits and economic value of emerging medical interventions."

"Our results suggest patients undergoing rotator cuff repair surgery may benefit from the addition of bone marrow aspirate cells to surgically repair tissue," says Christopher Camp, M.D., a Mayo Clinic orthopedic surgeon and co-author of the study. "However, the exact therapeutic mechanisms of its action are still somewhat unclear."

The study team also analyzed the results of 646 patients who chose platelet-rich plasma at the time of rotator cuff repair surgery and found no measurable difference, compared to patients with no regenerative interventions. Platelet-rich plasma, also known as PRP, is an orthobiologic procedure in which platelets containing growth factors and healing potential are spun from blood and given back to the patient at the point of injury. Platelet-rich plasma has shown potential to ease other conditions, such as knee arthritis.

Clinical trials may offer more robust documentation of the benefits of orthobiologics for rotator cuff injuries. Higher-level clinical studies focusing on surgical factors will be needed to confirm whether bone marrow aspirate concentrate can prevent the need for a second rotator cuff repair surgery.

The post Real-world evidence study of regenerative medicine and shoulder surgery appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I am 48, and I have been playing tennis for years. I also swim regularly. Recently, I have been experiencing pain in my right shoulder every time I hit the court and when I try to lift objects at home. How do I know if I tore my rotator cuff? What are the options for treatment, and can I get back to playing?

ANSWER: People can injure their rotator cuff in several ways. Accordingly, it can be hard to know if that is the primary source of your shoulder problems. For some people, a distinct injury or accident results in a rotator cuff tear. For others, it could be a slow, gradual increase in pain over time. For those with distinct injuries, these usually occur when trying to lift heavy objects overhead or lifting things away from the body. You also can injure your rotator cuff during traumatic falls or accidents.

Generally speaking, rotator cuff problems tend to produce three main symptoms: shoulder pain, decreased shoulder motion and weakness. Although most patients will have some level of each of these symptoms, not everyone with a rotator cuff tear will have all three symptoms.

In terms of the pain, if you have a rotator cuff injury, you typically have pain over the lateral, or outside, portion of the shoulder, around the deltoid muscle. This pain generally worsens when you try to lift your arm overhead or lift objects away from your body.

Other injuries around the shoulder can result in similar symptoms. Some of the more common injuries are biceps tendinitis, acromioclavicular joint injuries or arthritis. Patients with biceps tendinitis tend to have pain in the front of the shoulder, and those with acromioclavicular joint injuries tend to have pain on top of the shoulder.

Understanding where your pain is originating from can help differentiate these problems from pain caused by your rotator cuff. If you have pain on the lateral, or outside, part of your shoulder with decreased range of motion and difficulty lifting objects, you may have a rotator cuff injury. Oftentimes, this can be some mild tendinitis that will improve with a few days of rest. However, if your symptoms are severe or they persist for more than one or two weeks, it makes sense to talk to your health care provider. He or she can typically diagnose a rotator cuff tear based on your symptoms, a physical exam, and potentially imaging, such as X-rays and an MRI.

When I diagnose a patient with a rotator cuff injury, the most common question I get is whether surgery is necessary. If you have been diagnosed with a rotator cuff injury, treatment may vary depending on the severity.

For most patients with tendinitis, which is inflammation of the rotator cuff tendon without a complete tear, as well as pain and other symptoms, they generally improve without surgical intervention. The most common forms of treatments for this are anti-inflammatory medications; icing the shoulder regularly; modifying your activities, including avoiding heavy lifting and overhead lifting; and physical therapy.

For patients with complete tears of the tendon, the situation is a little bit more complex. If the tear is small or the patient is relatively low risk, some patients with complete tears may still be able to avoid surgery. The treatment plan for them would be the same options listed for tendinitis above. Although physical therapy won't heal the small tears, it can help optimize the other muscles around the shoulder that are still intact, which allows them to compensate for the tendon that has the small tear in it.

For active patients with a complete tear of the tendon, surgery may be optimal because it offers the most predictable and successful way of restoring function.

Rotator cuff repair surgery typically is done as an outpatient procedure through a minimally invasive, or arthroscopic, approach. Using these small incisions can reduce pain and improve recovery long term.

After undergoing rotator cuff repair, the arm is kept in a sling for approximately six weeks after surgery to allow things to heal. After this time, the sling is slowly discontinued, and formal physical therapy is initiated. The early focus of physical therapy is on restoring range of motion. This typically takes three or four months from the date of surgery. Around two or three months after surgery, gentle strengthening exercises are introduced. Then patients will progress to additional rehabilitation.

While there is significant variability, the average overall recovery time following rotator cuff repair is approximately six months. Once everything is healed, we generally allow patients to get back to all activities as tolerated. However, it is a good idea to avoid any unnecessary overhead lifting over the long term. This reduces the risk of having recurrent problems and injuries down the road. — Dr. Christopher Camp, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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Related Articles 

• Mayo Clinic Q and A: Rotator cuff tears — treatment and recovery published 9/25/20
• Mayo Clinic Minute: When should you have rotator cuff surgery? published 9/3/19

The post Mayo Clinic Q and A: Rotator cuff injuries and surgery appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My 15-year-old son loves sports, and over the years he has played football, baseball and soccer, and fenced. COVID-19 put a damper on his gameplay as our community canceled many events and activities. Now, though, sports are resuming. Any advice for how I can ensure my young athlete can safely return to his games mentally and physically?

ANSWER: Sports certainly took a hit during the COVID-19 pandemic as youth, recreation and professional activities were canceled and put on hold. But now, as COVID-19 vaccines have become available, there is growing excitement as people look forward to the return of their favorite pastimes.

I have had the privilege to serve as the medical director for the Minnesota Twins for the past two years. In that role, I have had the chance to have this conversation with athletes of all ages and ability levels. But it is important, no matter the level of athlete — from pro athletes to weekend warriors to youth athletes getting started in their sport — to be prepared mentally and physically to ensure a smooth transition back to their game. I applaud you for looking out for your son's best interests.

When I talk to patients, whether returning to their activity after injury or a long layoff, I typically offer these five tips when it comes to returning to play in sports:

1. Set appropriate goals.

Determine your goals before you resume play. Is it for exercise? Do you want to compete recreationally? Do you have professional aspirations? It's important to be honest about your ambitions and abilities. They can be above or below what you are capable of, even if you are in good health.

2. Determine an appropriate timeline.

If you know you want to get back to a certain sport by a certain time, be clear about when you need to start your training, so you don't rush your preparation. For your son, for instance, if he says football is his passion, plan his activities accordingly so that he can be ready for the summer training camps.

3. Establish a logical progression of your activities.

This will depend on the sport, the demands of your position and the shape you're in. Whatever your starting level, you want to advance slowly — do a little more each week — without any undue pain or soreness. You may want to talk to your son about this and remind him that pain is not normal. Often enthusiasm causes athletes to try to take on a lot of activity at once, which can end up causing injuries or setbacks. Make sure you build in time for rest. Your body will need time to recuperate, especially if you hadn't been as physically active in a while.

4. Introduce one new thing at a time.

For example, if you were a former three-sport athlete coming back from injury, I would not recommend going back to all three sports at once. That's not to say that you can't resume all three sports eventually. Rather, prioritize them and do them one at a time.

5. Catch any injury when it's minor and intervene before it becomes something major.

I work closely with pitchers and athletes who throw overhead, so I always tell my patients — and their parents — that any pain that comes from throwing is abnormal, particularly for younger pitchers. Many young athletes do not want to stop playing and may try to hide their injuries. Coaches and parents should be on the lookout for any red flags in their young athletes, such as limping or moving slower than normal. For most injuries, if caught early, the road to recovery is much shorter.

As you and your son decide which activities are best for him, be sure to also remind him to continue following safe behaviors. This means wearing a mask, social distancing and following all hand hygiene measures. COVID-19 is still a risk. If your son has any other health issues, it is advisable to talk with your primary health care provider before he returns to vigorous activity. — Dr. Christopher Camp, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date. 

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

Learn more about tracking COVID-19 and COVID-19 trends.

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ROCHESTER, Minn. — Baseball pitchers often are asked to take some heat off the ball, and lower the stress on their elbow and arm muscle tissue, after an injury. But pitchers may be misjudging how much stress and velocity they're holding back.

A study by Mayo Clinic orthopedic researchers has found that for every 25% decrease in a pitcher's self-reported effort, elbow torque decreased only 7% and the ball's velocity dropped only 11%. The athlete's perceived reduction in effort was markedly greater than the actual reduction, according to the study.

This has significant implications for physical therapists, trainers, coaches and athletes as they monitor elbow stress as part of the recovery process, says Christopher Camp, M.D., a Mayo Clinic orthopedic surgeon.

"The measured effort was significantly greater than the perceived effort for all metrics tested," says Dr. Camp, corresponding author for the study, which recently was published in The American Journal of Sports Medicine. "Ultimately, when players throw at what they perceive to be reduced effort, their actual throwing metrics do not decrease at the same rate as their perceived exertion, and this has significant implications for their recovery."

During rehabilitation throwing programs, baseball players are asked to throw at reduced levels of effort — 50% or 75%, for example — to lower the stress on healing tissues and allow for recovery. Dr. Camp and his colleagues investigated how changes in a player's perceived exertion compares with changes in the actual exertion during structured, long-toss programs.

The study involved 60 male high school and college baseball players. Each participant wore a biometric assessment sleeve that measured elbow torque, velocity and other factors. The athletes threw a baseball 120 feet five times with three levels of effort: 100%, 75% and 50%. Velocity of the throw was measured with a radar gun.

All throwing metrics decreased as the athletes decreased their perceived effort, but the measured decreases were much smaller than the decreases in perceived effort. In the 75% effort throws, elbow torque was only reduced to 93% of maximum and velocity dropped to 86% of maximum. For the 50% effort throws, elbow torque remained at 87% of maximum effort torque, while velocity remained at 78% of maximum.

Shoulder and elbow injuries are among the most common injuries in baseball at all levels, and interval throwing programs often are used in the rehabilitation process, with progressively increased throwing distance and effort. These programs aim to improve flexibility, throwing mechanics, endurance and arm strength for injured and healthy athletes.

Dr. Camp says that the Mayo Clinic research shows that athletes and trainers should be aware of these discrepancies when using interval throwing programs. Given the proven efficacy of these interval programs, this doesn't mean that they should be abandoned altogether.

"To more reliably achieve intended levels of elbow torque, clinicians and coaches need to be aware of these discrepancies and may want to consider more objective measures of effort," Dr. Camp says. Those include measuring elbow torque and workload using wearable devices or recording data using motion capture devices.

The study was supported in part by a grant from Major League Baseball. Dr. Camp has received education and hospitality payments from Arthrex Inc., and hospitality payments from Zimmer Biomet.

The study’s first author is Heath Melugin M.D., Mayo Clinic. Co-authors are:

• Dirk Larson, Mayo Clinic
• Glenn Fleisig, American Sports Medicine Institute
• Stan Conte, Conte Injury Analytics
• Stephen Fealy, M.D., Hospital for Special Surgery
• Joshua Dines, M.D., Hospital for Special Surgery
• John D'Angelo, Major League Baseball 

Dr. Melguin has received education and travel payments from DePuy Synthes. Dr. Fealy has received royalties from DJ Orthopaedics and Encore Medical. Dr. Dines has received consulting fees from Arthrex, Merck Sharp & Dohme, Linvatec, Trice Medical, Wright Medical Technology and DePuy Orthopaedics; IP royalties from Linvatec; research support from Arthrex; and hospitality payments from Horizon Pharma.

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network. 

Media contact:

• Rhoda Madson, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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On the Mayo Clinic Radio podcast, Dr. Sophie Bakri, an ophthalmologist at Mayo Clinic, explains macular degeneration and shares her new research on treatments for macular disease. Also on the podcast, Dr. Christopher Camp, an orthopedic surgeon at Mayo Clinic, discusses treatment options for frozen shoulder. And Dr. Daniel Saris, an orthopedic surgeon at Mayo Clinic, and Dr. Aaron Krych, an orthopedic and sports medicine specialist at Mayo Clinic, explain recycled cartilage auto/allo implantation, or RECLAIM — a novel stem cell therapy using regenerative medicine for knee cartilage repair.

The post #MayoClinicRadio podcast: 1/19/19 appeared first on Mayo Clinic News Network.

On this week's Mayo Clinic Radio program, Dr. Sophie Bakri, an ophthalmologist at Mayo Clinic, will explain macular degeneration and share her new research on treatments for macular disease. Also on the program, Dr. Christopher Camp, an orthopedic surgeon at Mayo Clinic, will discuss  treatment options for frozen shoulder. And Dr. Daniel Saris, an orthopedic surgeon at Mayo Clinic, and Dr. Aaron Krych, an orthopedic and sport medicine specialist at Mayo Clinic, will explain recycled cartilage auto/allo implantation, or RECLAIM — a novel stem cell therapy using regenerative medicine for knee cartilage repair.

Here's your Mayo Clinic Radio podcast.

The post Macular degeneration / frozen shoulder / regenerative cartilage repair: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

Macular degeneration is a common eye disease and a leading cause of vision loss among people 50 and older. With macular degeneration, the center of your retina begins to deteriorate. This causes symptoms, such as blurred central vision or a blind spot in the center of the visual field. There are two types: wet macular degeneration and dry macular degeneration. Many people will first have the dry form, which can progress to the wet form in one or both eyes. In some people, age-related macular degeneration advances so slowly that vision loss does not occur for a long time. In others, the disease progresses faster and may lead to a loss of vision in one or both eyes. Early diagnosis and treatment can help patients maintain their vision.

On this week's Mayo Clinic Radio program, Dr. Sophie Bakri, an ophthalmologist at Mayo Clinic, will explain macular degeneration and share her new research on treatments for macular disease. Also on the program, Dr. Christopher Camp, an orthopedic surgeon at Mayo Clinic, will discuss  treatment options for frozen shoulder. And Dr. Daniel Saris, an orthopedic surgeon at Mayo Clinic, and Dr. Aaron Krych, an orthopedic and sports medicine specialist at Mayo Clinic, will explain recycled cartilage auto/allo implantation, or RECLAIM — a novel stem cell therapy using regenerative medicine for knee cartilage repair.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Macular degeneration appeared first on Mayo Clinic News Network.

On this week's Mayo Clinic Radio program, Dr. Sophie Bakri, an ophthalmologist at Mayo Clinic, will explain macular degeneration and share her new research on treatments for macular disease. Also on the program, Dr. Christopher Camp, an orthopedic surgeon at Mayo Clinic, will discuss  treatment options for frozen shoulder. And Dr. Daniel Saris, an orthopedic surgeon at Mayo Clinic, and Dr. Aaron Krych, an orthopedic and sports medicine specialist at Mayo Clinic, will explain recycled cartilage auto/allo implantation, or RECLAIM — a novel stem cell therapy using regenerative medicine for knee cartilage repair.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Macular degeneration / frozen shoulder / regenerative cartilage repair appeared first on Mayo Clinic News Network.