Knee Injury

If you experience an orthopaedic injury — that’s an injury to your bones, muscles, tendons, or other soft tissues — sometimes surgery is needed to help you get moving again. But sometimes it’s not. So, where does that leave you?

Nonoperative orthopaedic care is the kind of treatment practiced by primary care sports medicine doctors and physiatrists. Their care includes areas that don’t involve surgery. But these doctors often work closely with orthopaedic surgeons.

That’s the case at Burke and Bradley Orthopedics–UPMC, where Mounif “Moe” Rifkah, MD is a primary care sports medicine doctor. He works side-by-side with orthopaedic surgeons, physiatrists, physician assistants, and physical therapists to provide seamless patient care.

“I think of primary care sports medicine as a sort of gatekeeper,” says Dr. Rifkah. “Let’s say a patient comes in with knee pain. Whether it’s chronic or after an acute injury such as a dislocated knee cap, these injuries do not always require surgery. Patients come in, they are seen and evaluated by me, and we order the necessary imaging. My job is to evaluate patients from a presurgical perspective to help determine whether surgery would benefit them or not, or whether a nonoperative treatment could be better. Of course, if surgery is needed, I refer them directly to other members of our team.”

We sat down with Dr. Rifkah to get the latest on nonoperative orthopaedic treatments, primary care sports medicine, and more to help you better understand your options.

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Types of Nonoperative Treatments

There is a wide range of nonoperative orthopaedic treatments for both acute and chronic conditions. Here are just a few of the most common ones:

  • Physical therapy (PT)Physical therapy is used either as a primary treatment for someone or in preparation for/recovery from surgery. Orthopaedic doctors work closely with physical therapists to strengthen the muscles around an injury, increase mobility, and improve overall strength and balance. PT helps promote healing in the muscles and improves movement with less pain. PT also can offer assistance with gait and throwing mechanics to help prevent further injury.
  • Injections — In orthopaedics, there are a few types of injections that either serve to lessen pain or promote healing. Some are approved for specific joints, and only some are covered by insurance. Your doctor should discuss the best options for your specific case.
    • Corticosteroid: Typically accompanied by a local numbing agent, a corticosteroid injection is an anti-inflammatory medicine that a doctor injects into a joint to reduce inflammation and pain. They are typically used for arthritis and other chronic conditions.
    • Hyaluronic acid: This injection is approved for use in the knee where it acts as a shock absorber and lubricant. It’s similar to a substance that is naturally produced by the body and helps the knee work better. It also helps reduce the pain and inflammation caused by arthritis.
    • Platelet-rich plasma (PRP): A PRP injection uses the growth factors from your own body to help heal an injury or ease chronic pain. Doctors typically draw blood from a vein in the arm. It is spun in a machine, which separates it into blood, plasma, and other natural growth factors. They then use an ultrasound-guided approach to inject the highly concentrated growth factors into the injured joint.
    • Prolotherapy: Dextrose injections are composed of saline, dextrose, and at times, lidocaine. These injections are completed in the same manner as other injections with the idea that this solution will trigger a natural healing process in order to repair the injured tissue.
    • Bone marrow aspirate concentrate (BMAC): Typically injected using an ultrasound-guided technique, a BMAC injection uses growth factors from your bone marrow to help heal an injured or chronically painful area. Under local anesthesia, the doctor draws bone marrow from the center of your bone (typically through the posterior side of the pelvis). The marrow is placed in a machine and spun to filter out bone, whole blood, etc. The doctor uses an ultrasound-guided technique to inject this concentrate of growth factors into the problem area to help it heal.
  • Sound wave therapy: A technique used in different areas of medicine, sound wave therapy is being applied to muscles and joints to promote a healing response. Via an ultrasound probe, sound waves travel through tissues reminding them to heal an injured tendon or chronic pain area. How? We dive deeper below.

These are just a few of the nonoperative options, and some are used together. After an evaluation, your doctor should talk to you about the best options for your condition, lifestyle, and goals. Other treatment options include oral or topical anti-inflammatory medicines or treatments with integrative medicine like acupuncture or cupping. Injections, sound wave therapy, and physical therapy are just some of the most common.

A Closer Look at Sound Wave Therapy

Sound wave therapy has been used in other areas of medicine for a long time. But given its more recent use in orthopaedic treatments, we’ll dive deeper into what exactly sound wave therapy is and how it can help an injury to muscles or joints.

“This is a newer therapy we’re using here in the office,” says Dr. Rifkah. “It’s an ultrasound probe that mechanically produces sound waves, which the patient can feel move through their muscles. That movement can produce some discomfort or an odd sensation. The sound waves travel through the tissues, and any time sound travels through different mediums of tissue, it releases energy. That energy is interpreted by the body as asking it to start the healing process.”

Sound wave therapy doesn’t penetrate the skin. It simply pulses sound waves through the body, stimulating growth and healing factors at the site of pain or damaged tissue. It’s used often in patients who have chronic tendinopathy of the elbows, hips, shoulders, or knees — or another chronic injury. “In those areas, the body’s natural healing response is kind of dormant,” says Dr. Rifkah. “The body ignores it because it’s been hurt for so long. But we’re re-stimulating that process with sound wave therapy.”

Doctors typically conduct this treatment once a week for 3 weeks to start. While some patients notice an immediate effect, others notice benefits as treatment progresses. There are some who do not benefit from this treatment. Patients experience different levels of relief with sound wave therapy, but research shows its value in treating specific conditions. Your doctor should discuss the next course of action if it isn’t right for you.

Nonoperative Orthopaedic Care at UPMC

Primary care sports medicine doctors see just about anyone for orthopaedic conditions. Don’t fear the title if you don’t consider yourself an athlete. “There’s an athlete in all of us, so I see everyone,” Dr. Rifkah says. “That’s anyone at all, but including recreational athletes and even professional athletes.”

Dr. Rifkah is board-certified in family medicine and sports medicine by the American Board of Family Medicine and is clinical assistant professor at the University of Pittsburgh School of Medicine. He has served as team doctor for several local sports teams, working alongside athletic trainers and physical therapists.

Dr. Rifkah treats a variety of musculoskeletal and sports injuries, with special focus on ultrasound-guided injections and nonoperative treatment options. He sees patients at Burke and Bradley Orthopedics at UPMC St. Margaret.

For more information on nonoperative orthopaedic treatments, or to schedule an appointment with Dr. Rifkah, please call 412-784-5770.

About UPMC Orthopaedic Care

As a national leader in advanced orthopaedic care, UPMC treats a full range of musculoskeletal disorders, from the acute and chronic to the common and complex. Whether you have bone, muscle, or joint pain, we provide access to UPMC’s vast network of support services for both surgical and nonsurgical treatments and a full continuum of care. As leaders in research and clinical trials with cutting-edge tools and techniques, UPMC Presbyterian Shadyside appears on U.S. News & World Report’s rankings of the top hospitals in the country for orthopaedics.