Dr. Victor Khabie has always loved sports and medicine.
the University of Pennsylvania and played several other sports. Sports were always a big part of my life and still are.”
Today, he enjoys a flourishing career that marries both passions as an orthopedic surgeon who is chief of surgery and chief of sports medicine at Northern Westchester Hospital in Mount Kisco.
There he has encountered many a promising young athlete with injuries to the ACL (anterior cruciate ligament) of the knee, which connects the femur, or thigh bone, to the tibia in the lower leg. It is a common injury — especially in soccer, football and basketball — and it is on the rise among girls and young women. Untreated, the result can be the end of competitive play and the loss of scholarship money.
Khabie — who holds an M.D. from Harvard Medical School and has been in his field for about 20 years — is distressed by “the young women I see tearing up their ACLs at an alarming rate. ACL injuries have become endemic. The intensity of the way sports are played today stresses young athletes at a high level. Soccer injuries are the most prevalent and most of them affect girls and women.”
STRESS CAN OVERWHELM
He points to the often relentless competitions, sports camps, sports showcases, travel teams and other venues that keep athletes playing continuously and at a high level of intensity without ever taking a break.
“Athletes specialize in sports like soccer at a younger and younger age,” he says. “They are subjecting the same body parts to the same stress over and over without taking time off. Specializing in one sport only has become almost the standard and there is a lack of cross-training, which is very beneficial to the body.”
Khabie adds that an entire industry has developed around these highly specialized young athletes.
“Division I scholarship money requires a very high degree of specification to obtain it.
“The young athletes throw themselves into a high level of specialization, some of them to please their parents and others because of their own inner drive and determination to succeed. It’s now a big money industry that can really put a choke hold on families. I would really like to see a return to the three-letter athletes of my college years, where top athletes played multiple sports. It’s much healthier for the mind and body.”
Khabie says another factor that plays into the equation of increased sports injuries among young people is that the athletes are bigger and stronger. “When they collide, there is a lot more force. Fortunately, elementary and middle school have far fewer injuries, but once the kids get to high school and college, it is a different story.”
The ACL injury rate for women versus men is roughly 3 to 1 or 4 to 1.
“Women today are playing more sports and the female ACL is more susceptible to injury than the male. It is alarming.”
Khabie says he believes sports programs should concentrate more on injury prevention.
First, they should teach more about form and proper technique in their sports. “Poor technique leads to an increase in injuries. Second, coaches must remember young athletes need periods of rest. No one can go on and on without a break. Finally, specialization is a real problem that can be remedied by cross-training in one or more other sports.”
Parents and athletes may also need to make an attitude adjustment about competitive sports. “Being overly driven is not a good thing,” he says. “What if you don’t make it to the top and don’t get that scholarship? And you have to also realize that most athletic talent is innate and cannot be taught. The athletes (who are) naturally gifted will rise to the top and there is a subset that will always be at the second level, no matter how hard they try. People need to think about this.”
In healing sports injuries, the cutting-edge continues to be the use of the body’s own stem cells to improve the healing process. “Doctors can use platelets-rich plasma from the patient’s own blood supply after separating it and turn it into a healing form. This is then injected into the site of the injury, and we are seeing some very good results. It’s a form of natural healing that is growing in use among older adolescents.”
Research has indicated that to use stem cells as an effective treatment in sports medicine, the cells must recognize where they are and know what they need to do. They then need to change into the types of cells that can form new cartilage or bone or reorganize a damaged tendon.
“I believe these techniques have a great future,” Khabie says. “Anytime we can get the body to heal itself, we have taken a critical step forward.”
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DR. VICTOR KHABIE AT A GLANCE
Profession: Orthopedic surgeon
Title: Chief of surgery and of sports medicine at Northern Westchester Hospital in Mount Kisco.
Education: University of Pennsylvania; Harvard Medical School
Other associations: Assistant clinical professor of orthopedic surgery at the Orthopedic Institute of the Hospital for Joint Diseases at NYU Langone Medical Center. He has participated in the care of the Los Angeles Lakers, Los Angeles Dodgers, Los Angeles Kings, Anaheim Mighty Ducks and many other teams.
He is a ringside physician for the New York State Athletic Commission, where he cares for professional boxers and has been present at ringside for numerous world championship bouts.
Khabie is also with Somers Orthopedic Surgery with locations in Mount Kisco, Caramel, Newburgh and Fishkill. 845-278-8400.
Somers Orthopaedics is pleased to offer HYPROCURE® sinus tarsi implant for Talo-Tarsal Dislocation Syndrome. The implant has been used for over 10 years and was FDA approved in 2004. Alan Berman, DPM has done many of these procedures with excellent results.
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FOR INFORMATION - Contact Alan Berman, DPM 845-230-5164
9/16/2016 The Journal News: Robotic Surgery Speeds Recovery
Dr. Jason Hochfelder, an orthopedic surgeon affiliated with Phelps Memorial Hospital Center in Sleepy Hollow, performed the Lower Hudson Valley’s first robotic-assisted total knee replacement operation at Phelps early this year. And in 2015, an advanced Navio-robotic-assisted partial knee replacement surgery was performed for the first time in New York state at Northern Westchester Hospital in Mount Kisco, according to Dr. Victor Khabie, chief of the department of surgical services and co-director of the Orthopedic and Spine Institute at the hospital. (Sowder, 9/15)
WEDNESDAY, July 20, 2016 (HealthDay News) — A meniscal tear is a common and disabling knee injury affecting many Americans at some point in their lives.
Now, new research suggests that in many cases, exercise may work just as well as surgery to heal the condition in middle-aged people.
Meniscal tears occur when damage is done to the rubbery discs that cushion the knee joint.
According to the European research team, about 2 million people worldwide undergo surgeries known as knee arthroscopy each year — although there’s debate over how valuable these procedures are for meniscal tears.
To help settle the matter, a team led by Nina Jullum Kise, an orthopedic surgeon at Martina Hansens Hospital in Sandvika, Norway, tracked outcomes for 140 patients.
These patients averaged 50 years of age and had degenerative meniscal tears, largely without any signs of arthritis.
Half of the patients performed two to three supervised exercise sessions a week for three months, while the other half underwent arthroscopic (keyhole) surgery, followed by simple daily exercises at home.
After three months, thigh strength improved in the exercise group, but not in the surgery group, Kise’s team reported. After two years, pain, sports and recreation function, and knee-related quality of life were similar for both groups, the findings showed.
Thirteen (19 percent) of the patients in the exercise group also underwent knee surgery during the study follow-up period, but it did not provide them with any additional benefits, the researchers said.
According to Kise’s group, the findings suggest that exercise therapy should be considered for middle-aged patients with meniscal tears.
Two knee specialists in the United States had differing views on the findings.
Dr. Matthew Hepinstall is an orthopedic surgeon at Lenox Hill Hospital in New York City. He said the new study “complements prior research” finding much the same thing, and he believes that “the majority of patients can experience significant improvement over weeks to months without undergoing surgery.”
He did offer one caveat, however: the size and cause of the tear matters. “The study results are most likely to apply to patients with small degenerative tears that occur without a discrete injury,” Hepinstall explained.
Still, “the bottom line for middle-aged patients with meniscus tears is to try conservative treatments [such as exercise] before jumping to surgical intervention,” Hepinstall said.
But another orthopedic surgeon took issue with the study’s design.
“Many important factors were not taken into account,” said Dr. Victor Khabie, who co-directs the Orthopedic and Spine Institute at Northern Westchester Hospital in Mount Kisco, N.Y.
“This study did not look at ‘injuries,’ it only looked at patients who did not have a specific traumatic event. Middle-aged, athletic individuals who sustain sports-related injuries causing meniscal tears comprise a significant proportion of individuals evaluated in an orthopedics office; excluding these patients limits this study,” Khabie said.
“My sense is that if this population of patients were examined, a significant benefit to knee arthroscopy would be seen,” Khabie said.
He also agreed with Hepinstall that the benefits of an exercise regimen without surgery might be limited to smaller meniscal tears. “The study included ‘all’ meniscal tears,” Khabie noted. “Most orthopedic surgeons will only offer surgery to large tears, which on physical exam correlate with the patient’s symptoms.”
According to Khabie, “The bottom line is that each meniscal tear has its own unique characteristic. Only a well-trained orthopedic surgeon with experience in knee surgery can determine the best treatment option for any given patient.”
By Marilyn Moritz - Reporter
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SAN ANTONIO - Juan Alonso was like millions of Americans suffering from joint pain. So he opted for knee replacement surgery, hoping it would solve the problem.
Unfortunately, Alonso suffered terrible complications.
“I was in so much pain, and the swelling in the leg just kept swelling up more and more,” he said.
To help alleviate the pain, a second doctor performed another knee replacement surgery.
“We had to remove his knee replacement completely, sterilize the area and then go back in and put a new knee replacement in after three months,” Dr. Joel Buchalter said.
Consumer Reports looked at hundreds of hospitals to see how well patients did following replacement surgery.
“We looked at hospital infection rates, complication rates and readmission rates,” Doris Peters, with Consumer Reports, said. “(We) found it really matters which hospital you go to.”
Peters said patients can increase their chances of a successful surgery by making sure they get a good surgeon.
“First, you want to make sure your doctor is board-certified in orthopedic surgery,” Peters said. “Then ask, ‘Do they track outcomes like infections and readmissions?’”
It has been eight years since Alonso had his first replacement surgery. He said he is thankful he found the right hospital and the right doctors.
8 tips for staying safe before, during, and after the procedure
After suffering from debilitating pain for years, Juan Alonso of New York finally had his knee replaced. Then—just a few weeks later—the pain came back, if anything worse than before.
“I was in so much pain,” he says. “The leg kept swelling up more and more.”
He sought help from a second orthopedic surgeon, who determined that Alonso had developed a serious complication in the artificial joint.
“We had to remove his knee replacement completely, clean everything up, sterilize the area, and then go back in and put a new knee replacement in after three or so months,”
says Joel Buchalter, M.D., the orthopedic surgeon who performed the follow-up surgery. (more...)
MONDAY, Feb. 22, 2016 (HealthDay News) — A Botox-like injection, added to physical therapy, may relieve a type of knee pain that’s common in runners, cyclists and other active people, a new study suggests.
The condition — called lateral patellofemoral overload syndrome (LPOS) — affects more than one in eight people who regularly exercise, the British research team explained. The condition causes pain in the front and side of the knee joint, and healing can be a challenge, experts said.
“Knee pain in runners and cyclists is often difficult to treat,” said Dr. Victor Khabie, Chief of Sports Medicine at Northern Westchester Hospital in Mount Kisco, N.Y. “Most will respond well to traditional therapy, but some will continue to have pain.”
According to the study authors, prior research has shown that 80 percent of people with LPOS have ongoing symptoms after undergoing conventional treatment, and 74 percent have reduced activity levels. Current methods of treatment include physical therapy, anti-inflammatory drugs and steroid injections. If these therapies fail, patients may opt for surgery, according to the investigators.
The new study was led by researchers at Imperial College London and included 45 patients. Each received an injection of a type of botulinum toxin called Dysport to relax a muscle at the front and outside of the hip, followed by physical therapy sessions.
The hip was targeted because, in prior research, the researchers had noted that people with LPOS tended to overuse this particular hip muscle, instead of using the gluteal muscles in the buttocks.
According to the investigators, two-thirds (69 percent) of the patients required no further treatment and were free of pain when assessed five years after the injection into the hip muscle.
“It can be incredibly frustrating to run out of treatment options for patients with this painful condition,” said study co-author Jo Stephen, a physiotherapist at Imperial College London and Fortius Clinic.
In a college news release, she said that “many athletes who took part in this study had exhausted all other treatment options and this was their last resort. We are really excited that our approach is showing positive results for patients, which could have implications for active people around the world.”
Khabie agreed. “This is a very important finding, because in the past surgery was the only other option [for these patients],” he said.
The Dysport injection “relaxes a very tight muscle/tendon unit on the outer aspect of the leg, which is often very tight in runners and cyclists,” Khabie explained. “Physical therapy aims to relax this muscle, but when therapy is not enough, this study shows that [the] injections are an option.”
Dr. Allyson Shrikande is a physiatrist (rehabilitation specialist) at Lenox Hill Hospital in New York City. She believes that use of the injection “offers a wonderful solution to aid in those who have failed a course of physical therapy.”
But, Shrikande also cautioned that the injected toxin may “spread” to adjacent tissue and so the “optimum dose” needs to be determined for each patient.
The Cold Hard Truth about Frost Bite!
By Alan N. Berman, DPM
How you can keep extreme cold from affecting your feet this winter.
During cold and damp weather conditions it is important to keep your feet warm and dry. Staying warm during freezing temperatures can be critical for the elderly and people with circulation problems. Here’s why: When it’s cold outside, the body tries to maintain a constant body temperature and will draw blood away from the outer limbs, such as the fingers and toes, in an effort to keep the core warm. Fingers and toes don’t just feel colder...they are colder and may even turn numb with prolonged exposure to cold weather.
Frostbite, damaging ice crystal formation, can happen when the affected areas freeze; it is the most serious of the cold weather-related injuries. Frostbite typically affects extremities--hands, feet, nose, or ears, although it can reach other parts of the body where there is a decreased blood flow and heat delivery to body tissues.
Frostbite injuries may be superficial or deep. Superficial frostbite injuries involve the skin and tissues just below the skin, while deep frostbite injuries could involve the tendons, muscles, nerves, and even bone. Superficial frostbite injuries have a better prognosis than deep injuries.
Frostbite may start with pain/burning to numbness and eventually result in the complete loss of sensation. The affected area may appear pale, red, bluish/gray or black with the presence of clear or purplish colored blisters. The skin and underlying tissue may feel hard to the touch with advanced injury.
Frost bite can hurt anyone, but certain drugs, people with peripheral vascular disease (a disorder of the arteries) put people at greater risk. Other things that may increase the risk include: smoking, windy weather (which increases the rate of heat loss from skin), diabetes, peripheral neuropathy, and Raynaud's phenomenon.
Diabetes-related circulation and nerve problems can mean icy cold feet for many people. People with diabetes may develop peripheral neuropathy or the loss of sensation especially in their extremities which makes them especially prone to frost bite. It’s important for people with diabetes to stay warm. They should stay well-hydrated as well--dehydration can raise blood glucose levels.
Raynaud's Syndrome or phenomenon may be triggered by exposure to cold and cause the arteries of the fingers and/or toes to go into what's called a “vasospasm”—a narrowing of the small arteries or vessels that dramatically limits blood supply. During an attack, affected skin may turn a pale or dusky color due to the lack of blood flow to the area. Once the spasms go away and blood returns to the area, the tissue may turn red before returning to a normal color. For some people, exposure to cold temperatures isn't necessary. Emotional stress alone can cause an episode of Raynaud's. If you have experienced this reaction to cold, check with your doctor. Chances are, it’s nothing to be concerned about, but it could be a symptom of a disorder.
Follow these important tips for safe outdoor fun:
- Wear thicker non-constricting socks.
- Wear comfortable fitting (never too tight) waterproof boots.
- Should your feet be exposed to cold and dampness for any prolonged period Do NOT put them in HOT water, near a flame (such as a fireplace) or use a heating pad.
- Instead soak them in Warm water at a constant temperature gradually allowing the feet regain their normal temperature.
- Be careful to not let the water get hot.
- Dry them thoroughly and repeat the process if necessary.
- Drink plenty of fluids.
For an appointment with Dr. Berman call (845) 278-8400