Athletes and AVN Return to Sport
When athletes are diagnosed with avascular necrosis (AVN), many changes to their lifestyle and sport may occur.
An expert in the evaluation and treatment of avascular necrosis or osteonecrosis is essential to proper diagnosis, treatment recommendations and ultimately success in return to sports participation.
What is AVN?
Avascular necrosis (AVN) is also referred to as osteonecrosis, aseptic necrosis, or bone infarction occurs when the blood supply to a region of bone is impaired, leading to ischemia or bone cell death.
This is similar to lack of blood flow to the heart resulting in a heart attack and heart muscle necrosis. Only, they are many potential causes of AVN or osteonecrosis. Only one source is trauma. Trauma is the leading cause of AVN, and the prime reason athletes are diagnosed with AVN.
The myriad of other causes require an expert to help the patient sort through.
About Dennis Lox M.D.
Dennis M. Lox M.D. Is a Sports and Regenerative Medicine expert, with extensive experience in the treatment of athletes and AVN. Moreover, Dr. Lox has had patients from all over the work treat with AVN of various affected regions of the body.
Dr. Lox has treated athletes from nearly every sport with AVN. Dr. Lox has extensive experience with non-athletes affected with avascular necrosis. These include nearly every known causative factor of AVN or osteonecrosis.
Dr. Lox has had wonderful success and spectacular results using Regenerative Medicine and Stem Cell Therapy for AVN. Some athletes were facing joint fusion or joint replacement surgery, opted instead for Stem cell science applications with Dr. Lox, and happily returned to their sport. Some young athletes, going from high school sports to collegiate scholarships.
Causes Of AVN
- Trauma (leading cause)
- Idiopathic or unknown reason (second leading cause)
- Excessive corticosteroid or cortisone use
- Excessive alcohol
- Radiation or chemotherapy
- Certain disease states
- Rheumatologic diseases
Treatment of AVN
Treatment of avascular necrosis has always been a matter of turmoil for the patient, and often the doctor. Why? Because, the understanding is poorly understood, and there is no clear vision of the future or crystal ball.
Uncertainty of treatment options is difficult to say the least. Often recommendations for joint replacement surgery are given. The hip being the most common joint affected with AVN.
Hip replacement surgery is irreversible, and often ends most athletes career. One only has to look at the great legendary Bo Jackson as an example. Bo Jackson was a professional football and baseball player. Bo Jackson was considered one of the greatest athletes who ever lived. One tackle in a football game dislocated his hip. It was the end of the football season and AVN was not timely diagnosed. Jackson eventually had his hip replaced. He never played professional football again.
Surgical options are often limited. Core decompression, or microfracture is a surgical technique to drill into the bone marrow and let bone marrow seep into the area of avascular necrosis. It is painful and a very dilute method to deliver stem cells to the site of AVN. Bone marrow is over 95% whole blood, thus it is a very diluted method of bringing stem cells to the region of AVN. It is also very painful, requiring non-weight bearing or unloading of the involved joint.
Free fibular vascular grafts are also very cumbersome, invasive procedures into an area of already compromised blood flow. Which by the nature of the surgery is traumatic to the area of AVN. This trauma from the surgery can sometimes make the problem of AVN worse.
Lastly, there is joint replacement surgery, and joint fusion. These surgical options are both unpalatable to athletes, who wish to continue in their sports.
Regenerative Medicine, Stem Cell Therapy and Tissue Engineering
Stem cell therapy is fast becoming a go to option for athletes, and patients with AVN.
Stem cells are what give microfracture or core decompression their potential healing power. Only concentrated sources of stem cell applications to AVN are not diluted, and lack the trauma,and pain associated with surgery.
Regenerative Medicine and Tissue Engineering are mirror images of the field of Regenerative Medicine. Tissue Engineering is a branch of Regenerative Medicine, as is Stem Cell therapy. The future being applied to many areas of Regenerative Medicine that may have a unique application to AVN treatment is 3-D bioprinting with stem cells.
A piece of new bone may be made of stem cells and directly replace damaged regions.
The Return To Sport
This is critical to have an expert understanding of athletes and AVN.
The future ramifications of joint breakdown, AVN collapse of the joint with a rapid joint destruction, all require an expert who understands the management of AVN, the role of each sport, and the degree of AVN.
All are individual factors and must be weighed in light of each individual. While some great athletes like Bo Jackson lost their sports career early, some examples of spectacular athletes with the same hip AVN as Bo Jackson exist.
Brett Favre the legendary football Quarterback, is one such example of someone with hip AVN who continued to play professional football. Each athlete is individually treated this is personalized medicine. There is no one size fits all approach to AVN, or really any unique person. This is the way it should be.
Dennis M. Lox M.D. practices in the Tampa Bay, Florida area, and in Beverly Hills, California.
