Sports surgeries put on hold
SALEM — Like a lot of active people who have suffered injuries in the past few weeks, East Liverpool boys soccer coach Zack Kinsey is just waiting to hear when treatment can begin.
Kinsey, 32 of East Liverpool, tore the anterior cruciate ligament in his left knee during an indoor soccer game at the Salem Community Center in February.
“My foot got caught in the turf and my knee went the other way and I heard a pop,” Kinsey said. “I knew it wasn’t going to be good.”
He had been through a similar situation in November 2015 when he injured his other knee, but this time around the wild card of the moment is the presence of the coronavirus COVID-19 emergency.
Kinsey said he had outpatient surgery scheduled for March 20 at Southwoods in Boardman, but as the coronavirus scare ramped up things changed quickly.
On March 16, he was called and advised that only one person would be allowed to enter the facility with him and that only one person was allowed to pick him up. He said masks were required to be worn and that his temperature would be taken before.
On March 18, the surgery was postponed until April 24.
“I was definitely looking forward to recovering while the nation was recovering, but I understand the coronavirus is the most important thing right now,” Kinsey said. “I’ll be at home taking it easy like everyone else for now.”
He said he’s lucky his injury allows him to walk and he’s still able to go get groceries for his parents and grandparents.
“We’ll just wait and see what happens,” Kinsey said. “Even after surgery it’s an 8 to 10 month process of rehab.”
Dr. Jason Boyd, an orthopedic surgeon at Salem Regional Medical Center, said sports medicine, like many other medical fields, has had to adapt to the changes resulting from the coronavirus pandemic.
“Like all sports medicine surgeons across the country, I have been listening to the CDC and locally the Ohio Department of Health and the other agencies,” Boyd said. “We’re slowing down our practices and only treating those patients who have time dependent or what is deemed as essential surgeries and procedures.”
Boyd said in Ohio there is a governor’s order to postpone any non-essential surgeries or procedures that utilize personal protective equipment.
“The purpose of this is to protect patients and providers from unnecessary contact with each other,” Boyd said. “We’re trying to preserve our limited supplies of personal protective equipment. We also want to preserve our in-patient hospital bed capacity and other equipment for those patients who are critically ill.”
The criteria set by the Ohio Hospital Association states that any surgery or procedure which does not meet the following criteria will be postponed: A threat to the patient’s life, a threat of permanent dysfunction to an organ system or extremity, the risk of cancer progression or metastasis or a risk of symptoms worsening if there is no invention.
“As a sports medicine surgeon, I treat many injuries of the knee, shoulder and other joints that do require surgery,” Boyd said. “Fortunately, many of these surgeries can safely be delayed several weeks without any permanent damage to the patient.”
Boyd said patient education, a thoughtful home-exercise program and non-narcotic pain medications are being utilized to get patients through until their surgery can be performed.
Although it may seem daunting for a patient wanting to get treatment as soon as possible, Boyd says that many times patients have to wait until swelling goes down and atrophied muscles are properly rehabbed to get to the stage where surgery can be performed successfully.
This is often the case in ACL surgeries.
“You want someone’s knee looking and feeling more normally before you reconstruct an ACL because one of the worst things you can do for a patient is to operate on a stiff, swollen knee,” Boyd said. “That’s going to make the rehab very difficult.”
Boyd said that since those with ACL injuries can perform most non-athletic movements without issue, he said scheduling ACL surgeries is actually quite flexible.
“Especially in the case of high school athletes, in talking with families, I’ll routinely schedule ACL reconstruction around the time that is most convenient for the patient and their families,” Boyd said. “Once you regain a normal gait, get your range of motion and muscle strength back, there’s no difference whether we perform surgery that day or a month from that day with the exception being that your return to sport will be delayed a bit.”
He said it’s often ideal to schedule high school athlete surgeries over a break or summer vacation so the athlete misses the minimal time of school work and also has help on hand from the family during the early recovery phase.
Boyd, who has served as an assistant physician to the Atlanta Falcons and Georgia Tech athletic program, said that one of the challenges arising now is how rehab is handled after a surgery.
“I have spoken to several of my colleagues who I work close with in the field and they have said social distancing in physical therapy is very difficult because they provide hands-on care to a lot of their patients,” he said. “In those patients that they are still seeing face-to-face, they are doing the things that everyone should be doing, like frequent hand-washing and using PPE. An additional step most have taken is reducing the frequency of appointments to have less people in the facility.”
He said virtual visits are taking off between patients and physical therapy providers. Those give an opportunity for the physical therapist to watch a patient do their exercises and correct technical form if necessary.