Below is a recent article featuring elite athlete Darrell Reid and Dr Glashow.

Denver Broncos LB Darrell Reid May Miss Entire Training Camp – Undergoes Cutting Edge Knee Surgery

Monday February 15, 2010; 8:47pmMST

Surgery may prevent Denver Broncos outside linebacker-defensive end Darrell Reid from participating fully in training camp at the very least.
“I had knee surgery in New York after I got back from the Super Bowl. I was told the recovery time could be between six to eight months,” said Reid to Fox 31’s Josina Anderson on Monday.
Reid indicated he underwent a new surgical process called the articular allograft cartilage transplant procedure in Mount Sinai hospital in New York on Feb.11. He elected this treatment to address connective tissue damage in his left knee.
“I had the surgery because I have a significant hole in the cartilage in my knee. The doctors aren’t exactly sure how this happened but they have a theory. Although there are signs of wear and tear, my injury looks like it is rigid; so they think my defect–they call it a defect–is most likely fresh,” said Reid.
Reid estimates he injured his left knee in the second half of the Broncos home game against the Pittsburgh Steelers Nov.9.
Initially Reid made the decision to keep his condition to himself.
“I’m the type that doesn’t really like the training room, so I really didn’t tell the trainers what was going on at first; but after the Colts game it got so sore that I knew I had to get on top of it. I had to tell the trainers. I told them after the Colts game because I knew that it wasn’t good,” acknowledged Reid.
Reid revealed to Anderson that his decision to delay informing the Broncos training staff may have worsened his condition, but Reid also says under the team’s knowledge he played the remainder of the season on his same injured left knee.
“Continuing to play on it may have effected me from a recovery time stand point, but it was important for me to be there for my teammates. Once the defect was there though it was there, because cartilage doesn’t grow back on it’s own; but obviously the smaller the injury area the quicker the recovery time will be.”
The Broncos apparently put Reid on a schedule to aid him in playing the remainder of the season.
“After the Colts game, I played on it three more games. It was basically enough pain to play with but not to practice on consistently. When I did practice on it, it was very limited. Basically, I would just do walkthroughs and the special team periods because I was such a major factor in those phases of the game. When it comes to full contact and running on it at full speed, that was a no-no,” emphasized Reid.
By the end of the 2009-10 NFL season Reid knew he had to get surgery. He was fearful of having a microfracture procedure based on the negative feedback he received about it.
“The history on microfractures is not the best especially for football players. Nobody comes back from it better, and I didn’t see myself as being the exception to the rule. The option I took wasn’t even available to (Nuggets forward) Kenyon Martin.”
Martin had two separate microfracture procedures on both knees within an 18-month period between 2005-2006, and struggled to return with consistent playing time after his rehabilitation process.
That’s why Reid says he searched for other surgical methods. Eventually his agent suggested another new and cutting edge option.
“I first heard about the Denovo procedure from my agent,” said Reid.
Dr. Jonathan L. Glashow M.D. is the co-chief of Sports Medicine at Mt. Sinai Hospital in New York, and was Reid’s lead operating surgeon.
According to Glashow, the DeNovo NT is the implanted cartilage product. However the actual medical term for the procedure Reid underwent is called the allograft articular cartilage transplant procedure.
In this procedure juvenile articular cartilage cells are placed within the defect on a joint surface of the knee.
“Articular cartilage is distinct from the fibrous meniscus cartilage which is found in the middle of your knee. It looks like rubber discs. Specifically, articular cartilage is the thick shiny white hard material that coats the end of the bone. This is the area that was affected in Darrell’s knee.”
“Darrell had an area that was sheared about ½ inch wide and 1 1/4 inches long in size. That’s a pretty significant area missing,” said Dr. Glashow to Anderson in a cell phone interview from his home in New York Monday night.
Dr. Glashow explained the new cartilage transplant procedure he used to repair Reid’s knee.
“In this procedure what we’re doing is taking juvenile articular cartilage from a young donor and then transplanting it to the damaged area. The two advantages of using younger articular cartilage from a donor is: its ability to heal more rapidly; and it has less chance of rejection as immature cells have less ability to be recognized as foreign in the recipient.”
Dr. Glashow says that the cartilage transplant procedure has been available in limitation for patients for about a year. He estimates that the procedure has been conducted on just 200 to 300 people in total so far.
Dr. Glashow explained how this new cartilage transplant procedure is viewed as more optimal than microfracture surgery in certain cases now.
“The microfracture procedure is a very simple procedure that works by poking tiny holes in the underlying bone. However, after this procedure what grows back is just fibrocartilage which many athletes feel just doesn’t hold up as well over time. However with the cartilage transplant procedure our hope and expectation is that the articular cartilage graft we put in will heal and grow in the defect and hold up better.”
Dr. Glashow says many athletes feel like this procedure is especially better for the bigger type athletes that play contact sports like in Reid’s case.
However, he emphasizes that the recovery period in both procedures is very similar.
“It allows athletes to return usually within six to eight months depending on the individual recovery.”
In the meantime, Reid has been told to walk with crutches for the next six to eight weeks.
Dr. Glashow indicated that he’ll revisit with Reid to perform another MRI in three months, and six months out as well. “After that we will determine if Reid is ready to play again,” added Dr. Glashow.

HOW DO THE BRONCOS FEEL ABOUT THIS?
Reid, who has been in communication with the organization about his treatment, says the Broncos encouraged him to surgically repair his knee, although, he indicates they were less inclined towards this transplant procedure.
“That’s because it is relatively new. Nonetheless, the Broncos were very supportive of my decision. They just wanted me to get my knee taken care of as soon as possible so I could return back to the field with my teammates,” said Reid.
When Anderson asked Reid if he thought his surgery threatened his tenure with the team, he didn’t seem noticeably concerned.
“(The Broncos) really haven’t expressed that to me. To be honest, they really don’t have that much data to go off of in terms of when I would be ready.”
Reid is in the process of rehabbing and receiving intermittent Platelet Rich Plasma (PRP) supplementation to encourage and expedite the healing in his knee at another facility in New York. In (PRP) they spin down your blood and instill the extracted growth factors where the graft is.
Reid says he’s mostly concentrating on muscular contraction work with his quadriceps, hamstring, and calf muscles to maintain strength and neural firing.

Reid is looking forward to concluding the process at Dove Valley upon his return.
these scenarios, studies have found that PRP therapy can slash recovery time or even help hard-to-heal areas like the rotator cuff heal to a greater degree.
Glashow cites the example of baseball players, who are especially prone to hamstring tears. “One of the banes of baseball players is that that muscle can take months to get better,” says Glashow. “But we’ve had great success injecting those muscles with PRP and returning players to sport quickly.”
Although the therapy is still experimental, “there are a lot of people out there who have gotten this treatment,” says Glashow. “The great thing about it is there’s very little risk.” He explains: “The body heals itself all the time. The thinking with PRP is that if we can find a way to help the body heal itself more quickly, we can help patients return to their lifestyles earlier.”

Signs and symptoms
The cardinal signs of a sports injury are pain, swelling and weakness. “These are broad symptoms, which will be localized around the site of the injury” says Glashow. “If it’s a knee injury, then pain, swelling and buckling in the knee; if it’s a shoulder injury, pain and weakness.” PRP therapy can cause some side effects or symptoms of its own. “Post injection, some people feel like nothing happened,” says Glashow. “They barely feel they’re getting an injection, and then have no discomfort.” But the majority of patients do have some soreness of the kind typical with injections: mild discomfort for an hour or two that
goes away on its own.

In a small minority of cases, the pain is significant and persistent. “Rarely, there is significant soreness and discomfort for 24-48 hours,” says Glashow. “In which case we give Tylenol or a mild narcotic pain reliever and ask the patient to rest.” Because the concoction being injected is made from your own blood, PRP therapy does not carry risks more severe than a few days of soreness.

Traditional treatment
Most of us are familiar with the standard first-aid response to an injury. “Typically, with someone who suffered an injury – a pulled muscle, a knee injury or anything in between – the advice would have been rest, physical therapy and non steroidal drugs like Advil and Aleve,” says Glashow. “With a minor injury, in a few days, people feel better.”

For more serious injuries, PRP therapy can replace cortisone, which was commonly used years ago but has fallen out of favor. “Cortisone’s effects are short-lived,” says Glashow. “While beneficial to reduce inflammation, it actually blocks the healing process.”

Cortisone was popular because it provided temporary pain relief, but doctors are finding that PRP therapy can be helpful for both the short and long terms. “We think PRP will both make you feel better and increase the healing,” says Glashow.

For people operating on a tight time line or patients whose healing isn’t progressing, PRP therapy can be the best option. It’s an outpatient procedure that most doctors can perform in 15 to 20 minutes. Better yet, “We don’t add anything that we didn’t take out of the body – I don’t even typically use an anticoagulant,” says Glashow. “I feel not using any outside chemicals products reduces the chance of any negative side effects.” Doctors are finding that the benefits of PRP seem to be cumulative, so some patients will require between two and four injections over the course of a few weeks.

Doctors are still discovering the best ways of administering PRP therapy, and any physician you see should be candid about this. “PRP is a very new area,” says Glashow. “We don’t have all the answers yet. But we have a new tool in our toolbox for healing injuries.” PRP therapy isn’t for everyone, but it can be highly effective for serious injuries that aren’t getting better or aren’t getting better fast enough. “It may be necessary for the athlete who’s not coming back fast enough from the muscle strain, or that person who’s an a sprained knee for months and months and it’s not getting better,” says Glashow.

Research breakthroughs
While much research has focused on the mechanical aspects of healing, this is a potential breakthrough on the biological side. Major laboratory and clinical trials are striving both to deepen doctors’ understanding of how it works and how to best administer it.

“Right now there are several lab studies going on that are showing that with PRP therapy, the healing process is being sped up at the cellular level,” says Glashow. “That is the laboratory science of it – showing that this is not hokey and really does work.”

Clinical trials are showing how people respond to the process that has proved so effective in animal studies. For instance, several clinical trials have shown benefits in the treatment of tennis elbow, MCL (medial collateral ligament) injuries of the knee and Achilles tendon injuries, with new cells forming more quickly thanks to the injections. In addition, recent laboratory studies in animals are proving that PRP may have a positive effect on allograft ligament
healing in the knee. PRP is such a new therapy that there isn’t easy to find a doctor with expertise in it. Glashow advises patients to ask their orthopedic surgeon or sports-medicine specialist if they offer this therapy; if these specialists don’t, they can give you a referral.

Questions for your doctor:
Although PRP therapy has proved highly effective for some patients, it’s not an appropriate treatment for every injury or every patient. The best way to figure out if you could benefit from PRP is by talking to your doctor and getting a second opinion, if necessary.

If your doctor is recommending cortisone, ask, “Am I a candidate for PRP?” You also should raise the idea with your doctor if you’re working under a tight deadline. “If you’re really under the gun and trying to get back to the game earlier,” says Glashow, then ask, “Could PRP help me heal faster?”

What you can do:
Don’t take Advil or Aleve. Advil and Aleve are non steroidal anti-inflammatory drugs that can’t be combined with PRP. “That means no Advil and Aleve for two weeks before PRP is done,” says Dr. Glashow, “And I don’t allow my patients to take it again for four to six weeks afterward.”

Check for drug interactions.
Make sure your doctor has a complete list of your current meds. “Other medications can interfere with the PRP process,” says Glashow. “So some people aren’t candidates.”