NFL Injured Reserve List of the Week

The Minnesota Vikings are having quarterback problems. QB Brett Favre ended his 297 game streak on Monday when he was sidelined with shoulder issues. Now his back-up, Tarvaris Jackson has been placed on IR. Jackson left last Monday’s loss against the Giants twice because of  injury. The second time was apparently due to a turf toe injury,which had Jackson leaning heavily on the railing as he left the field. Coach Leslie Frazier reported that Favre is doing better and although he is still nursing a sprained throwing shoulder and a numb hand,  an ultrasound on Favre’s neck and shoulder revealed no nerve damage.

Meanwhile, back on the East Coast, the New York Giants officially placed wide receiver Steve Smith on the season-ending injured reserve. Smith is scheduled to undergo surgery on the articular cartilage injury of his left knee. According to ESPN “the injury is to a non-weight bearing area of Smith’s knee and the damaged area is the posterior lateral femoral condyle. Smith will require a complex procedure to repair the injury, including mosaicplasty and some microfracture surgery.”

What is Turf Toe?

Turf toe is actually an injury to the base of the big toe, right at the joint where the first toe meets the foot bone, called the metatarsal phalangeal joint. It occurs when the big toe gets hyperextended and the capsule around the joint is injured (see diagrams below). It is called turf toe because it tends to happen more frequently when players (usually football or soccer are playing on artificial turf. Symptoms include pain and swelling at the joint. X-rays will be negative for fractures. Treatment consists primarily of rest, ice, protection of the area, and over the counter pain medications.

What are mosaicplasty and microfracture surgery?

Hyaline cartilage is the smooth surface that lines the knee joint and  plays an important role in the functioning of that joint. Unfortunately,  injury to the cartilage that does not involve the bone underneath doesn’t heal on its own. Three types of procedures have been designed to address this problem — microfracture, autologous chondrocyte implantation(ACI) and osteochondral autograft (OCG). We have already covered ACI in our article on Dara Torres.

In a microfracture procedure, multiple small holes are cut into the bone under the area of missing or damaged cartilage . This allows the deeper, more blood-vessel rich bone to access the surface layer and stimulate cartilage growth. However the cartilage that is formed is called fibrocartilage, the kind that is found in scar tissue. Fibrocartilage does not have the same strength and resiliency as hyaline cartilage, so questions about durability have been raised with this procedure. Microfracture does seem to work best for small areas of cartilage replacement (<1 inch).

Osteochondral autograft involves the taking several individual bone+cartilage plugs from a donor site, typically from a outer non-weight-bearing area of the femoral condyle. These grafts are pressed into the lesion in a mosaic-like fashion into drilled  tunnels in the affected area. The resulting surface will consist of transplanted hyaline cartilage and fibrocartilage, like a mosaic. The fibrocartilage is thought to act like a grout between the individual plugs. OCG can be performed as an open procedure or arthroscopically.

For more information about Turf Toe, click here.

For more information about Cartilage Regeneration surgery, click here.

Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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