OrthoAccess - University of Wisconsin Hospital and Clinics

O R T H O p E d I C S &
R E H A b I l I T A T I O n
UV ON l I . V 1 E R• SI SI TS Y U E O 1 F • W2 I0S 1C1 O N S I N U N I V E R S I T Y O F W I S Cjanuary O N S I 2011 N
A MESSAGE FROM THE CHAIR
A MESSAGE FROM THE CHAIR
Welcome to the first edition of
of Orthopedics Orthopedic and Innovations, Rehabilitation a
newsletter In Review, a from newsletter the University from
of the Wisconsin University Department of Wisconsin of
Orthopedics School of Medicine and Rehabilitation.
and
Public Health Department of
This
Orthopedics
newsletter
and
includes
Rehabilitation.
innovative research and new
clinical This newsletter treatment describes options that innovative are occurring research at and the
University new clinical of treatment Wisconsin options in the field that of are orthopedics occurring
and at the rehabilitation. University of It Wisconsin is important in the to our field faculty of and
staff orthopedics to let you and know rehabilitation. what we’ve It been is important learning, to
teaching, our faculty and practicing. staff to let We you hope know you what find we’ve this
newsletter been learning, to be teaching a valuable and and practicing. informative We hope resource.
you find this newsletter to be a valuable and
But
informative
even more
resource.
important, we want to connect with
you. Our deep commitment to the Wisconsin Idea
means But even that more we importantly, touch lives across we want the to state connect and
beyond. with you. Our deep commitment to the Wisconsin
Idea means that we touch lives across the state
So
and
as
beyond.
you care for your patients, we invite you
to stay in contact with us. Visit us online at
uwhealth.org/ortho, So, as you care for your and patients, subscribe we to invite this publication you
to receive stay in contact updates with . We us. also Visit encourage us online you at to contact
the uwhealth.org/ortho. OrthoAccess triage We service also encourage at (888) 978-4611 you or
by to contact e-mail at the orthoaccess@uwhealth.org.
OrthoAccess triage service at
uwhealth.org/orthoaccess, (888) 978-4611 or
Tom
by e-mail
Zdeblick,
at orthoaccess@uwhealth.org.
MD
Professor and Chairman
University Best to you of in Wisconsin the new year. Department of Orthopedics
and Rehabilitation
Tom Zdeblick, MD
Professor and Chairman
Department of Orthopedics and Rehabilitation
Orthopedics
Orthopedics and Rehabilitation
and Rehabilitation
uwhealth.org/ortho
uwhealth.org/ortho
med.wisc.edu
med.wisc.edu
REVIEW
Innovation. Education. Clinical Care.
REVIEW
IN
Regenerative Medicine lab Grows
Musculoskeletal Tissues from Stem Cells
Everything’s coming up bone, cartilage, tendons and ligaments in the lab
of Wan-Ju Li, PhD. Dr. Li, an assistant professor of orthopedic surgery
and biomedical engineering, uses electrospinning—a technology developed in
1934 for weaving fiber into textiles—to create intricate scaffolds that mimic
human collagen. He then cultures adult stem cells in those scaffolds so they
can grow into mature, functional tissue. The goal? Some day, these customengineered
tissues could be implanted into injured and arthritic joints, helping
patients lead healthier, pain-free lives.
Hybrid Research Focuses on Cells and Their Environment
Dr. Li came to the University of Wisconsin School of Medicine and Public
Health almost three years ago, after completing a postdoctoral fellowship
at the National Institutes of Health. He currently leads the Laboratory of
Musculoskeletal Biology and Regenerative Medicine at the UW School of
Medicine and Public Health. Since the lab’s creation in September 2008, Dr. Li
has recruited 12 postdoctoral fellows, graduate students and undergraduate
students to work on orthopedic regenerative medicine research.
continued on page 5

WElCOME bACk
dR. WIllIAM ClAnCY
William Clancy
Jr., MD, PhD,
has returned to
the University of
Wisconsin School
of Medicine and
Public Health
as chair of the
Division of Sports Medicine. Dr. Clancy
founded the UW Sports Medicine
program in 1974, one of the first of its
kind at a major university.
He invented and perfected the anterior
cruciate ligament (ACL) reconstruction
and posterior cruciate ligament
reconstruction procedures, which are
used by virtually all knee surgeons
throughout the world today.
His surgical patients have won over
20 medals in the Olympics and world
championships; and also include NFL,
NHL, NBA, MLB, World Cup Soccer,
LPGA and PGA tour players.
Dr. Clancy is past president of the
American Orthopedic Society for Sports
Medicine (AOSSM), has been inducted
into the AOSSM Hall of Fame, and
was named Mr. Sports Medicine by
the AOSSM. This year he received the
prestigious President’s Challenge Award
from the National Athletic Trainers’
Association. He has served as team
orthopedic surgeon for the U.S. Hockey
Team and U.S. Ski Team as well as
co-medical director for the LPGA Tour.
Prior to Dr. Clancy’s recent return,
he was a partner at Andrews Sports
Medicine and Orthopaedic Center at
St. Vincent’s in Birmingham, AL and
provided sports medicine coverage
for the University of Alabama and
Georgia Tech University.
2
o r t h o p e d i c s & r e h a b i l i t a t i o n i n r e v i e w E D U C A T I O N . I N N O V A T I O N . C L I N I C A L C A R E .
Welcome new physicians
DaVID GOODSpEED, MD
Orthopedic Trauma
Dr. Goodspeed is
board certified in
orthopedic surgery.
He earned his
medical degree from
the University of
Wisconsin School of
Medicine and Public Health and completed
his orthopedic residency at University
of Wisconsin Hospital and Clinics. He
completed his orthopedic trauma fellowship
at Methodist Hospital, Indianapolis. Prior to
joining the department, Dr. Goodspeed spent
10 years in the Department of Orthopaedics
and Rehabilitation at Pennsylvania State
University/Milton S. Hershey Medical Center.
KEVIN MaCDONalD, MD
Joint Replacement/Orthopedic Oncology
Dr. MacDonald earned
his medical degree
from the University of
Wisconsin School of
Medicine and Public
Health and completed
his orthopedic
residency at University of Wisconsin
Hospital and Clinics. He completed his
musculoskeletal oncology fellowship at the
University of Washington Medical Center
and Seattle Children’s Hospital. He has
advanced training in the care of adults and
children with benign and malignant tumors
involving the musculoskeletal system. He
also specializes in adult reconstructive
procedures such as total joint arthroplasty.
His research interests include development
FOR MORE INFORMaTION...
Meet the rest of the orthopedic and
rehabilitation team at uwhealth.org/ortho
of more durable arthroplasty fixation for limb
salvage procedures and molecular modeling
of chondrosarcoma proliferation.
TaMaRa a. SCERpElla, MD
Sports Medicine
Dr. Scerpella is board
certified in orthopedic
surgery. She earned
her medical degree
from the University
of Iowa, Iowa City
and completed
her orthopedic residency at University
of Wisconsin Hospital and Clinics. She
completed her sports medicine and
arthroscopic surgery fellowship at Union
Memorial Hospital, Baltimore. Dr. Scerpella’s
research interests include bone mineral
accrual during childhood, bone mineral
density, tibial stress fractures, medial tibial
stress syndrome and functional outcome
of arthroscopic rotator cuff repair. Prior to
joining the department, Dr. Scerpella spent
15 years at SUNY Upstate Medical University,
Syracuse where she was head of the sports
medicine division.
TOMMY YU, MD
Rehabilitation
Dr. Yu earned his
medical degree from
Rosalind Franklin
University of Medicine
and Science, Chicago
and completed his
internship at Advocate
Lutheran General Hospital, Park Ridge.
He completed his residency at Schwab
Rehabilitation Hospital/University of Chicago.
Dr. Yu specializes in general rehabilitation
and spinal cord injury.
brace Yourself: Are Ankle braces Effective
at preventing Injuries?
Quick. What’s the most common injury
among high school football players?
No, it’s not a concussion. It’s actually an
ankle sprain. The 1.1 million teens who play
high school football in the United States
suffer more than 81,000 ankle sprains
each year. Football-related ankle sprains
account for 25 percent of those injuries.
That’s of great concern to players, parents
and coaches, none of whom want to see
their athletes walking around on crutches,
missing playing time.
In a first-of-its-kind study, Tim McGuine, PhD,
LAT, UW Health Sports Medicine researcher
and athletic trainer, and Alison Brooks, MD,
MPH, assistant professor of sports medicine
at University of Wisconsin School of Medicine
and Public Health, will examine whether
using ankle braces during football practice
and games will help to reduce the incidence
of ankle sprains. The study that began in
August 2010, involves 50 high schools
from across Wisconsin, and more than
2,000 football players. The braced group
was given stabilizing, lace-up ankle braces
to wear in practices and games. The control
group practiced and played as they normally
would, with some athletes wearing braces
and some not. Brooks and McGuine will
compare the number and severity of ankle
sprains between the groups.
“This is the largest-scale study of this type
that’s ever been attempted,” says McGuine,
who notes that he and his colleagues
recruited athlete participants from a diverse
mix of urban and rural settings, as well as
public and private schools. “Whether they’re
playing football in Milwaukee, Hudson,
Janesville or Phillips, the benefit to high
school athletes could be huge.” Especially if
the study results provide new strategies for
preventing ankle sprains, an injury that is
notoriously cumulative.
“If a football player hurts his ankle once, the
risk of future injury is much higher,” says
McGuine. “Some studies place the chance
of a second sprain at 70 percent. And a
lot of these athletes go on to have serious
osteoarthritis issues as adults.”
The study is funded by the University of
Wisconsin Department of Orthopedics and
Rehabilitation Research Fund.
A similar study was conducted using ankle
braces for basketball players. The results will
be completed in April 2011. If you would like
a copy of the results, please complete the form
at uwhealth.org/anklestudy.
FOR MORE INFORMaTION...
• The klagos family story, visit uwhealth.org/klagos
• Recent studies being funded through the Classic
at uwhealth.org/theclassic
SpORTS MEdICInE kEEpS
THE klAGOS FAMIlY MOvInG
For the Klagos family, sports are a way
of life. And they only know one way to
play—all out. Sports injuries can’t keep
this family on the sidelines. Whether it’s
sports conditioning, injury prevention,
surgery or rehabilitation, see how these
Badger fans count on UW Health
Sports Medicine to keep them in the
game at uwhealth.org/klagos.
pRO GOlFER AndY nORTH:
SuppORTER OF SpORTS
MEdICInE RESEARCH
Two-time U.S.
Open champion
and former PGA
Tour professional,
Andy North serves
as honorary chair
of the UW Health
Sports Medicine
Classic—a
day-long golf
tournament
dedicated to raising funds for sports
medicine research at the University of
Wisconsin. Andy takes time from his
busy ESPN broadcast schedule and
the Champions Tour to support this
cause. Through his and sponsors’
generosity, numerous research studies
have been funded.
3

dETERMInATIOn MAkES
HER unSTOppAblE
Brittany Mabis was in eighth grade
when she was diagnosed with bone
cancer. Her tumor was the size of a
grapefruit and doctors told her she
may have to have her leg amputated
and would likely never walk again.
Today, she walks without assistance
and works in the University of
Wisconsin Hospital and Clinics’
neurosciences unit because she says,
“I had such great care when I was here
and wanted to give back a little bit.”
4
FOR MORE INFORMaTION...
Watch brittany’s story at
uwhealth.org/brittany
o r t h o p e d i c s & r e h a b i l i t a t i o n i n r e v i e w E D U C A T I O N . I N N O V A T I O N . C L I N I C A L C A R E .
The destination for State-of-the-Art
Musculoskeletal Tumor Care
F or
adults and children with
musculoskeletal tumors, UW Health’s
multidisciplinary orthopedic oncology
program is the destination for state-of-theart
care. The program is led by orthopedic
surgeons John Heiner, MD, and Kevin
MacDonald, MD, two of the few surgeons in
Wisconsin with expertise in musculoskeletal
oncology. Primary care physicians throughout
the region refer patients to them for highly
specialized surgery and related treatment.
Drs. Heiner and MacDonald collaborate
closely with a team of specialists from the
University of Wisconsin Carbone Cancer
Center. Together, the team provides
complete care for benign and malignant
bone tumors, primary and metastatic bone
malignancies (especially from breast,
prostate, lung, kidney or thyroid cancer)
and soft tissue tumors.
Specialized Expertise at
All Stages of Care
Many patients with musculoskeletal tumors
receive most of their care from their primary
care physician. But when specialty care is
needed—whether for diagnosis, treatment
or follow-up—the UW Health team works
closely with primary care physicians to
develop individualized plans.
“There’s a whole team here that all works
together on this. We provide care in all
aspects of this management,” says Dr. Heiner.
Depending on the location and type of tumor,
the care plan may include radiation, surgery,
medication, chemotherapy or a combination
of therapies. Other unique services include:
• Minimally invasive diagnostic
techniques. UW Health team members
are experts in radiographic and histologic
diagnosis of all types of tumors. For softtissue
tumors, they use ultrasound-guided
biopsy—a less invasive, radiationfree
method, which is their preferred
alternative to CT-guided biopsy.
• Preoperative radiation. For some
patients, especially those with sarcomas,
radiation therapy is used to shrink
tumors before surgery. A smaller tumor
means less tissue needs to be removed
during surgery. This can result in a more
functional recovery—or even saving
a limb.
• Limb salvage. Surgeons use stateof-the-art
bone grafting processes to
reconstruct and preserve limb function
whenever possible.
• Experimental therapy. UW Health
providers are pioneers in the use of
cryotherapy, radiofrequency ablation,
and other innovative methods to treat
soft tissue and bone lesions.
As UW Health physicians provide outstanding
clinical care, the research team investigates
the biological mechanisms of bone care and
look for new ways to treat disease. Research
interests include:
• Bone allograft replacements
• Spine tumor cell types
• The effects of lowered radiation dosages
and drug responses for some soft tissue
sarcomas and
• Three-dimensional cellular research of
bone and soft tissue tumors.
Musculoskeletal Tissues from Stem Cells
continued from page 1
Funding has come from multiple research
grants from the North American Spine
Society and the AO Foundation, a non-profit
organization dedicated to improving the care
of patients with musculoskeletal injuries.
With education in both biomedical
engineering and cell biology, Dr. Li is a
“hybrid” scientist whose cutting-edge work
approaches tissue engineering from both
the cellular and the biomaterial perspectives.
For example, one arm of his research aims
to optimize the process for growing tissue
from stem cells: the “holy grail” of tissue
engineering. He has already shown this
method works in pig bone and cartilage,
and he is collaborating with researchers
at the UW School of Veterinary Medicine
to test how engineered cartilage, tendon
and intervertebral discs function in a
sheep model.
But Dr. Li is also studying how scaffold
structure affects cell activity, including how
the scaffold’s microstructural features, such
as dimension, affect the cellular response;
which cell receptors and signaling pathways
are activated; and which genes turn on in
response to the new environment. He
has cultured stem cells in both twodimensional
and three-dimensional
scaffolds, and then extracted the cells
and globally profiled 38,500 genes in
microarrays to learn which genes are turned
on and off in the two-dimensional and
three-dimensional groups. Dr. Li’s research
has generated three patents and produced
nearly 30 publications, including one cited
more than 630 times in eight years.
Collaboration Thrives at WIMR
Dr. Li’s lab is based at the Wisconsin
Institutes for Medical Research (WIMR), a
multidisciplinary center that brings together
basic and clinical research talent to tackle
medicine’s most important questions.
The collaborative environment at WIMR is
essential for Dr. Li’s research. He needs to
work closely with cell biologists, engineers
and transplant and orthopedic surgeons to
quickly get their unique perspectives and then
get his lab findings to people who need it.
The WIMR facility eliminates laboratory walls,
places office areas close to labs, allows
rapid sharing of complex equipment and
facilities, and includes interactive space on
every floor. Dr. Li says WIMR is one reason
he wanted to come to Wisconsin. “The
collaboration is already happening for my
lab. When I need bone marrow (from which
to isolate adult stem cells), I can just talk to
my colleagues next door.”
FOR MORE INFORMaTION...
WISCOnSIn InSTITuTES
FOR MEdICAl RESEARCH
The Wisconsin Institutes for Medical
Research (WIMR) at the University of
Wisconsin School of Medicine and
Public Health is designed to allow
researchers to work with scientists
from other disciplines, speeding the
transfer of science to the people who
will benefit from it.
Here’s what’s inside the Wisconsin
Institutes for Medical Research:
• Orthopedics and regenerative
medicine and surgery researchers
• The University of Wisconsin
Carbone Cancer Center (UWCCC)
researchers
• Laboratory resources and
mechanicals
• World-class programs in imaging
and radiation sciences
• University of Wisconsin Hospital
and Clinics outpatient radiotherapy
unit
• Medical physics department
• dr. li’s laboratory, visit orthorehab.wisc.edu/ortho/research/wanjulilab/
• Wisconsin Institutes for Medical Research, visit med.wisc.edu/wimr
5

TEd’S STORY: STRAIGHT SHOT
TO STAYInG ACTIvE
Ted’s active lifestyle, which included
golf, tennis and downhill skiing, was
threatened by pain. He was initially
told he would need a total knee
replacement but found another option
from the joint replacement team at
University of Wisconsin Hospital
and Clinics. Ted regained his active
lifestyle after he had a partial knee
replacement.
Partial knee replacement has been
available for years but a new surgical
technique made that option more
appealing. Makoplasty allows surgeons
to do the same procedure with more
precision, using three-dimensional
imaging of the knee and roboticassisted
technology.
6
FOR MORE INFORMaTION...
partial knee replacement or to see Ted’s story,
visit uwhealth.org/kneepain
o r t h o p e d i c s & r e h a b i l i t a t i o n i n r e v i e w
Robotic-Assisted partial knee Replacement
Robotic arm technology now allows
UW Health orthopedic surgeons to
perform partial knee replacements more
accurately and less invasively than ever
before.
UW Health is one of only a handful of
programs in the state to offer MAKO
Surgical Corp.’s RIO ®
Robotic Arm Interactive
Orthopedic System for partial knee
replacement. A team of joint replacement
surgeons is overseeing its introduction.
The goal is to offer younger, active patients
with knee osteoarthritis the best possible
long-term function.
precise navigation and Execution
The RIO system combines precise navigation
with robotic-arm assisted execution. First,
three-dimensional anatomical data from
a CT scan is fed into the RIO system. The
surgeon then uses the data to accurately
register the pins for the implant. Surgeons
use the data to plan the operation by
performing “virtual surgery” before any
incisions are even made.
Robotic Arm
These same data guide RIO’s burr-tipped
robotic arm during the actual surgery. The
surgeon uses the burr to shape the patient’s
bone before placing the implants, following a
predefined “envelope” of three-dimensional
space. Because the burr will only operate in
the appropriate space, there is no chance
of an instrument slipping and injuring
adjacent tissues.
Because the procedure can be performed
with smaller incisions than standard manual
procedures, patients may experience a
quicker recovery with less pain. The system
also enables precision in implant positioning,
which may result in better long-term function.
UW Health orthopedic surgeons who provide
Makoplasty include: Drs. John Heiner;
Richard Illgen, III; Richard Lemon;
William Mott and Matthew Squire.
E D U C A T I O N . I N N O V A T I O N . C L I N I C A L C A R E .
OrthoAccess:
Matching Specialists to patient needs
OrthoAccess is a service
for physicians who refer
patients to any UW Health
orthopedics and rehabilitation
medicine clinic or provider. By
calling or e-mailing, referring
providers can access orthopedic
nurses who can offer specific
recommendations for patient
referrals based on the needs
of the patient.
The OrthoAccess nursing staff
is led by Susan Woodman, RN.
“We frequently receive calls
from regional clinics about a
variety of patient concerns,”
Woodman says. “It’s often a
question of which provider is
most appropriate. For example,
an active patient with arthritis who hurts his
knee might need a sports medicine consult,
or he might need joint replacement surgery.
We help providers figure it out.”
The service covers all UW Health orthopedic
and rehabilitation medicine clinics and
operates Monday through Friday from
8 am–4:30 pm. When a call or e-mail
request comes in, OrthoAccess staff collect
patient information, including any available
imaging or lab results. Based on that
information they direct the patient to the
most appropriate provider. While the service
works to facilitate requests quickly, it is
meant for non-emergency, ambulatory
cases only.
Providers should still seek out a hospital
emergency room or immediate care center
for emergency cases. But for non-emergency
situations, OrthoAccess staff can assist
patients and providers.
To contact OrthoAccess, visit uwhealth.org/
orthoaccess, call (888) 978-4611 or e-mail
orthoaccess@uwhealth.org. Voicemail and
e-mail messages are returned no later than
the next business day.
ORThOaCCESS
Monday–Friday
8 am–4:30 pm
uwhealth.org/orthoaccess
(888) 978-4611
orthoaccess@uwhealth.org
ACCESS pROGRAMS
SpORTCARE
Competitive athletes train hard for
their sport. The last thing they plan
on is an unexpected injury. SportCare
allows injured athletes to be seen by
a sports medicine physician or surgeon
soon after the athlete sustains a
sports injury.
Physicians, athletic trainers, physical
therapists, urgent care clinics, parents,
coaches or athletes can contact
(608) 263-8850 to arrange an
appointment for assessment and
treatment.
WORkCARE
Overuse injuries caused by the
repetitive nature of skills for a
specific sport are often the same
type of injuries that occur in workers.
UW Health’s WorkCare program offers
appointments for workers who
sustain a musculoskeletal injury.
Occupational health nurses,
case managers, safety directors,
physicians and other providers
who work with injured workers
can contact (888) 978-4611 or
orthoaccess@uwhealth.org to
arrange an appointment.
7

O R T H O p E d I C S &
R E H A b I l I T A T I O n
V O l . 1 • I S S U E 1 • 2 0 1 1
©2011 UW Health. UW Health is the academic medical center
for the University of Wisconsin School of Medicine and Public Health
and includes UW Hospital and Clinics and UW Medical Foundation
in Madison, Wisconsin. If you would like to update your mailing address
or do not wish to receive this publication in the future, please call
(608) 265-1676 or e-mail eschwenn@uwhealth.org.
34th Annual university of Wisconsin
Sports Medicine Symposium
REVIEW
IN
Orthopedics and Rehabilitation
600 Highland Ave.
Madison, Wi 53792
ApRIl 7 & 8, 2011 • MAdISOn MARRIOTT WEST, MAdISOn, WI
Join the faculty of the University of Wisconsin Department of Orthopedics and Rehabilitation
for the 34th Annual Sports Medicine Symposium.
This Symposium provides the latest information on the prevention, recognition and treatment
of athletic injuries. The conference’s focus is on practical and clinically relevant information
for health care providers to use in their daily practice.
Some of the topics include:
Thursday, April 7
• Return to Play Cases and Decisions
• Head Injury Update
• Hot Topics in Sports Medicine
Friday, April 8
• Hip Mini-Symposium
• Orthopedic Case Presentations and Pearls
For full schedule and registration information, e-mail ammeyer@ocpd.wisc.edu.
This activity has been approved for AMA PRA Category 1 credit. Conference fee includes course materials,
CEU documentation, refreshment breaks, lunch, continental breakfast and registration.
unIvERSITY OF WISCOnSIn dEpARTMEnT
OF ORTHOpEdICS And REHAbIlITATIOn
vISITInG pROFESSORSHIp
Spring Visiting Professorship: March 11, 2011
University of Wisconsin Hospital and Clinics
U N I V E R S I T Y O F W I S C O N S I N
James A. Goulet, MD
Professor, Orthopaedic Surgery
Chief, Orthopaedic Trauma, University of Michigan
NONPROFIT ORG
US POSTAGE
PAID
MADISON WI
PERMIT #1027
For more information contact (608) 263-0888 or richardson@ortho.wisc.edu.
OR-23168-10