When Should a Patient Be Referred to a Sports Medicine Orthopaedic Surgeon?

Knowing when to refer a patient to sports medicine rather than to another subspecialty within orthopaedic surgery can be perplexing. Here, Duke sports medicine orthopaedic surgeon Jocelyn Wittstein, MD, answers common questions about this subspecialty and the patients who benefit the most from it.

Question: How do you define sports medicine?
Wittstein: Sports medicine is an intersection between medicine and surgery, where a combination of surgical and nonoperative treatments are used to keep people participating in the activities they love. If there's a problem we can fix surgically to help a patient remain active, that's a valuable service. On the other hand, if we determine that there's no surgical intervention that will bring relief and allow patients to participate in their favorite activities, we can help them find ways to modify the activities and make the problem less troublesome. We specialize in understanding an individual's activity demands and providing a safe, tailored avenue to return to the desired activity. Sports medicine surgeons have all of the training of orthopaedic surgeons, as well as additional training in a fellowship program focused on common sports-related injuries and their treatment, typically with added training in arthroscopic shoulder, knee, elbow, and/or hip surgery.

Question: Why is there confusion about the differences between sports medicine and other orthopaedic subspecialties?
Wittstein: One reason for the confusion is simply the name—the names of other orthopaedic subspecialties include the anatomy or type of disorder treated by that subspecialty. The name "sports medicine" is also the only orthopaedic surgery specialty that includes the word "medicine" in the title, although it is a surgical subspecialty. Another reason for the confusion is that orthopaedic surgery has overlapping subspecialties. For example, within sports medicine, we treat most problems related to shoulders because shoulder injuries are so common among athletes, and shoulder arthroscopy is frequently done by sports medicine specialists. However, there are also orthopaedic surgeons who are shoulder and elbow specialists who do shoulder arthroscopy.

Question: What are the most common injuries treated and surgeries performed within sports medicine?
Wittstein: Injuries to the shoulder, knee, elbow, and hip are the most common. Injuries commonly treated within sports medicine are tears of the meniscus, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), rotator cuff, and hip labrum, all of which can be reconstructed or repaired arthroscopically. The field of sports medicine tends to be heavily biased toward minimally invasive arthroscopic procedures, particularly in the knee, shoulder, and hip; some cartilage repair procedures and patellar stabilization operations in the knee require open surgery. Some sports medicine surgeons also treat injuries to throwers' elbows and perform ligament reconstructions such as the Tommy John procedure (ulnar collateral ligament reconstruction).

Question: Do sports medicine orthopaedic surgeons only treat professional, competitive athletes?
Wittstein: No, we care for "weekend warriors," youth sports participants, and nonathletes as well. The same expertise used for the competitive athlete can be applied to any individual to return them as quickly and as safely as possible to an active lifestyle and reduce the risk of reinjury. Restoring shoulder function is a good example of this; it is key to many people's activities of daily living and independence, not just athletes'.

Question: Are there certain age groups that particularly benefit from evaluation and treatment within sports medicine?
Wittstein: Athletes of all ages will be well-served by sports medicine—from a 12-year-old soccer player in a youth sports program to a 70-year-old competitive weightlifter. For the nonathlete, any adult who is maintaining an active lifestyle and sustains an injury that's not healing with conservative treatment would likely benefit from an evaluation by a sports medicine orthopaedic surgeon. Individuals of all ages with ongoing shoulder pain, despite a period of rest and other conservative treatments, would benefit from seeing a sports medicine specialist. As people reach age 55 and beyond, they tend to be less likely to benefit from arthroscopic surgery of the knee in particular, because they often have conditions such as moderate to severe degenerative osteoarthritis; but, the potential benefit depends on the patient's underlying pathology. A sports medicine orthopaedic surgeon can fully evaluate patients with injury and recommend the best course of action for their individual situations.