By: Knee1 Staff
Dr. Anthony Schepsis is a Professor of Orthopedic Surgery and Director of Sports Medicine at the Boston University Medical Center (BUMC). After graduating with a bachelor's degree in Liberal Arts from Boston University, Dr. Schepsis received his medical degree from Boston University School of Medicine. He completed his residency at BUMC and a fellowship in Sports Medicine in the Traveling Fellowship in Salt Lake City, Utah and Boston, Massachusetts. A native of Utica, New York, Dr. Schepsis continues to live in Marblehead, Massachusetts.
Knee1: You have earned quite a reputation in the field of orthopedics and sports medicine. What drew you initially to this field?
Dr. Schepsis: I was an athlete back when I was younger as a competitive wrestler and I had a neck injury that ended my career; however, in my rehabilitation and getting to know sports medicine physicians, trainers and therapists, I gained an interest in sports medicine and athletes in terms of how they get injured, why they get injured, and what we can do to get them back as soon as possible. I also had a scientific/engineering background and became interested in how I could apply these things to what I wanted to do in the future. Putting all of this together, orthopedic surgery, particularly sports medicine, is a good field for me.
|Preventative Measures for Young Athletes
1. Before starting a training regimen, consult a specialist (certified athletic trainer or conditioning specialist)
2. Ask your specialist about specific training programs for your sport and your age group
3. Any unusual pain should be checked out prior to beginning a sport - first consult your family physician who may/may not refer you to an orthopedic specialist
Knee1: Young athletes, particularly females, have an increased risk of ACL tears. How do you suggest young athletes go about strength training so that they can take some sort of preventative measure?
Dr. Schepsis: The most important thing a young athlete can do is consult with a specialist before they set up a program, whether it is a certified personal athletic trainer or an exercise/conditioning specialist. In particular, if they’ve had previous injuries, this becomes even more crucial. There are also specific exercise programs that are good for specific sports and ages; for example, a young female who plays soccer has about an 8 times increased incidence of tearing her anterior cruciate ligament (ACL) There are certain things you can do preventatively called jump training that can help them prevent the tearing of the ACL or enduring a career-ending knee injury.
Knee1: The Santa Monica Orthopedic and Sports Medicine Group has developed the ACL Injury Prevention Project known as PEP (Prevent injury, enhance performance) in order to reduce the number of ACL tears in female soccer players. Could you briefly describe this program to our users? (User can learn more about this project here: http://www.aclprevent.com/)
Dr. Schepsis: I know Dr. Mandelbaum (Principle Investigator of the project) and he’s very involved with the United States Soccer Federation. We were all trying to figure out why females were tearing their ACLs more often than males, particularly in soccer and basketball. Initially, we thought it was hormonal and had to do with the alignment and the bony anatomy in the knee as well as the fact that females have a smaller notch for the ACL to reside in; however, we determined that it is a neuromuscular problem - the way that the female athlete uses her muscles and lands from a jump are all factors that put her ACL at an increased risk. This program is geared toward training female athletes how to jump and pivot and use their muscles to help prevent these injuries
Knee1: You mention that cutting edge cartilage restoration procedures is one of your interests. Could you explain this to our users?
Dr. Schepsis: The articular cartilage is the cushion that covers the bone inside the joint. It is there for shock absorption and protection as well as to provide a frictional surface so that the joint is able to function. When the cartilage surface is worn away down to bone, you are rubbing bone on bone, referred to as arthritis. One of the problems with this tissue, as opposed to other tissues in our body, is that it doesn’t have any blood supply, so when it gets injured, it does not have the ability to heal. For example, if you cut your skin, it will heal because there is a good blood supply; when the cartilage gets lost, it cannot restore itself because it does not have any healing capacity. What we are trying to do is find methods to re-grow cartilage on the surface of the joint via transplantation or blood stimulation as well as with scaffolds, which are synthetic devices for gene therapy – getting the patient to modify their own cells in order to grow new cartilage cells. So we have a long way to go, but there is a lot of new and exciting research going on in this area.
Knee1: As a team physician for the BU intercollegiate athletic program, what type of injury is most common?
Dr. Schepsis: Knee-related injuries depend on the sport. In football or basketball, there are a lot of ligament injuries, ACL injuries, and meniscal injuries (menisci are the cushions/shock absorption that sit between the bones). There are also several problems with the knee cap (patella), which becomes softened (a condition known as chondromalacia) as well as unstable and maligned. There is a spectrum of injuries that we see and it typically depends on the sport. There are certain sports where you see more upper-body injuries and others where you see more lower-body injuries. It really is sport-dependent.
Knee1: Are there any particular success stories you can think of where an athlete recovered beyond expectations?
Dr. Schepsis: There are a number of them. One is an 18-year old female basketball player, who was a senior in high school and had aspirations of playing Division 1. She not only tore the ligament in her knee, but she lost the meniscus/cartilage as well as a major portion of the cartilage surface. Usually, that combination of injuries is devastating; in her case, she could not even walk around regularly. Our hopes were that when we did the surgery we could get her back walking regularly, in a relatively pain-free manner, and maybe even have her participate in some recreational sports. We not only fixed the ligament, but we also realigned her knee and put a new cartilage surface/meniscus in her knee which is considered to be very major surgery. She made a tremendous recovery and is playing Division 1 basketball to this day.
Knee1: You also mention that you have an interest in medical devices: Any particular devices that you see in the future that might assist with ACL reconstruction, Total Knee Replacement (TKR), or cartilage repair?
Dr. Schepsis: In regards to cartilage restoration procedures, when we have to resurface, we have to take a plug of cartilage and put it on a defect on the joint, requiring major open surgery. In the past, we had to make a major incision and open up the knee. Now, we have methods for treating this arthroscopically or through microsurgery. I am working with some devices to resurface potholes/defects on the patella (knee cap) through arthroscopic methods as well as the tibia, the shinbone.
Knee1: What are some of the resources/device manufacturers out there in the field of sports medicine that our users should know about, aside from Knee1.com?
Dr. Schepsis: There are a lot of diff companies working in this area. State of the art devices have been developed by Smith & Nephew orthopedics division (http://www.smith-nephew.com/) as well as Arthrex (http://www.arthrex.com/), two major leaders in producing products for knee and shoulder reconstruction as well as other joints. There are a number of web sites that talk about cartilage restoration in the knee and are considered good resources for self-education including the American Orthopedic Society for Sports Medicine (http://www.aossm.org/) and the Arthroscopic Association of North America (http://www.aana.org/). These are groups that incorporate orthopedic sports medicine specialists and provide their users with plenty of links to other resources on the Internet.
Knee1: You have done the majority of your undergraduate and medical school work at Boston University. Is there a particular reason why you have decided to remain in the city of Boston?
Dr. Schepsis: I consider Boston to be the forefront of medicine and I came here exactly for that reason. Boston is a hub for medical education and learning, and when I went to the Boston University, I became involved with the athletic teams and eventually went to medical school, completing my orthopedic training here. My mentor, Dr. Robert Leach, was the chairman of the department and a leader in the field of sports medicine internationally. He became my second father/mentor and convinced me to stay here and I’m certainly glad that I did.
Knee1: What do you feel would be your greatest contribution to the field of sports medicine?
Dr. Schepsis: That is a very difficult question. I think that there are a number of projects and publications that I have worked on that have aided in the diagnosis and treatment of various sports medicine conditions, both surgical and non-surgical. However, I think what gives me the greatest gratification is the teaching of fellows and residents. We have an orthopedic residency program in which young doctors are trained to be specialists. My greatest contribution is watching these physicians mature and helping them by becoming both their mentor and teacher. I am able to teach them how to perform surgery and be a good diagnostician and, as a result, turn these good doctors out into the community.
Knee1: Many people, as they become middle-aged, start to feel the aches and pains of getting older because they have not been active. What might you say to someone who is getting into an older age and starting to feel these pains? What can you say to encourage people to be healthy and active?
Dr. Schepsis: If you are over the age of 40 and have been inactive for a long period of time, you want to get a good comprehensive physician examination. You should not start an exercise program if there are cardiovascular issues that may have gone unnoticed. Once that has been cleared up, if you don’t have any specific injuries, it is always good to arrange for a consultation with a specialist like a certified personal or athletic trainer. They can give you a program regimen to start with so that you do not necessarily have to spend money to work out with someone two to three times a week. Next, you should get an idea of what sport you want to play. Do you want to go and out and play tennis or ski? You should gear your exercise program toward the specific activity you would like to take up. If you have any unusual pain or an injury like shoulder pain, you want to get this checked out first by the family physician; if there is something specific, you need to arrange for an appointment with a specialist. He/she can tell you whether certain movements should be avoided or whether there are certain activities that should be added to your exercise program for you to avoid further injury to your joints.
Dr. Schepsis: Today, compared to even 10 years ago, there is so much more we can do through microsurgery, arthroscopically; for example, in the shoulder, we can now fix torn rotator cuffs and do some resurfacing of the joint. In the knee, we can do ligament reconstruction less and less invasively. We are also using a lot of bioabsorbable devices rather than metal devices, so that the body is able to absorb these devices without them having to be removed.