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I am pleased to present the 10th issue of Commonwealth Orthopaedics
Magazine! When we began this publication back in 2007, our goal was
to reach out to our fellow physicians in the community to keep you,
your staff, and your patients informed about the latest advancements in
orthopaedic care and services.
Now, we’ve expanded our communication efforts with the launch of our new
Commonwealth Orthopaedics Blog. For nearly six months, our physicians have been
11240 Waples Mill Rd., Ste. 403 sharing their expertise and advice about a variety of orthopaedic conditions, cutting-edge
Fairfax,VA 22030 treatments, and injury prevention techniques. Our blog includes first-person accounts,
(703) 810-5200 • (703) 383-6465 fax Q&A, physician videos, surgical animations, and more. We encourage you and your
www.c-o-r.com staff to visit at http://blog.c-o-r.com or via our website, www.c-o-r.com. And be sure to
recommend the blog to your patients.
Alexandria Herndon At Commonwealth, we like to think of ourselves as one big family. For two of our
physicians – Frank Pettrone, MD and Sarah Pettrone, MD – it’s actually true. In this issue
Arlington Reston of our magazine, read how this father-daughter duo inspire and challenge each other every
Burke Springfield day.
Fairfax Tysons Corner We also have some compelling patient stories to share. Find out about a triathlon coach
Fair Oaks who is back on the Ironman circuit after arthroscopic hip surgery, a Division 1 lacrosse
player whose shoulder repair finally fixed recurring dislocations, a Herndon mother’s
complex and technically demanding knee surgeries, and an Annandale homemaker who
President overcame her fears to have successful spinal fusion.
Gordon L. Avery, MD
As always, we appreciate your support and the opportunity to provide your patients with
Chief Executive Officer world-class orthopaedic and rehabilitation services in Northern Virginia.
William L. Harvey
Chief Operating Officer
Maureen M.R. Cook
Chief Financial Officer
Richard T. Givens Gordon L. Avery, MD
Director of Physical Therapy Commonwealth Orthopaedics
Jo-Anne Burton, PT
Director of Human Resources
Directors of Marketing
Suzanne M. Kelly
Deborah R. Martin “Ben Is The Man” ........................................................................4
Like Father, Like Daughter ........................................................6
Treating a Pain in The Neck ......................................................8
Editorial Mission: Commonwealth
Orthopaedics magazine is an educational Nothing to Fear ........................................................................ 10
and informative resource for physicians,
health care professionals, employer groups, Targeted Relief for Low Back Pain ....................................... 12
and the general public. This publication
provides a forum for communicating news Commonwealth Orthopaedics in the Community .......... 13
and trends involving orthopaedic-related On the cover:
diseases, injuries, and treatments, as well as Mary underwent two sur- Best Foot Forward................................................................... 14
other health-related topics of interest.
geries on her knee to enable Going The Distance ................................................................. 16
her to continue with her ac-
tive lifestyle. In one short Complex Knee Surgeries Restore
Commonwealth Orthopaedics year following the surgeries, High-Velocity Lifestyle ............................................................. 18
magazine is designed
Mary was hiking in the Great
and published by In Memoriam ............................................................................. 20
Medical Custom Medical Smoky Mountains and skiing
Design Group, Inc. To black diamond slopes. See Advertiser Directory .............................................................. 21
adver tise in an upcoming her story on page 18.
issue please contact: 800.246.1637 or Orthotics & Braces.................................................................. 21
This publication may not be reproduced in par t Keeping Patients Informed and Educated ........................... 22
or whole without the express written consent
of Custom Medical Design Group, Inc Meet Our Physicians................................................................ 23
“Ben Is the Man”
Shoulder Surgery Returns Local Lacrosse Player
to Highest Level of Competition
for a dislocated s a star lacrosse player in high school, Sam dislocated his
shoulder so many times he became an expert at popping
shoulder, Sam is having it back in. Eventually, his concerned parents took him
a successful season to see Ben Kittredge, MD, an orthopaedic surgeon
playing Division I and sports medicine specialist at Commonwealth Orthopaedics.
Dr. Kittredge had a simple message for the Edgewater, Maryland
lacrosse at Lehigh teenager: “If you want this to stop, you’ll have to have surgery.”
Sam’s multiple shoulder dislocations had caused an injury known
as a Bankart lesion in the lower part of his labrum, the cartilage that
surrounds and cushions the shoulder joint. Both Bankart injuries
and SLAP lesions, which damage the uppermost area of the labrum,
are common in young overhead athletes, especially throwers,
swimmers and those playing contact sports. Treatment includes
physical therapy and rehabilitation to strengthen the shoulder
muscles or, in more serious cases, arthroscopic or open surgery to
reattach the torn tissue.
“At Commonwealth, we see a very large athletic population and do a
lot of these procedures,” says Dr. Kittredge, who performed surgery
to repair Sam’s left shoulder and later his right shoulder. “Many of
us have fellowship training in sports medicine, which makes us
highly qualified. In addition, the quality of a patient’s diagnostic
tests – and the expertise of the radiologist who reads and interprets
those tests – is extremely important to ensure timely, appropriate
treatment. We send our patients to the area’s best facility with the
best radiologists for MRIs and arthrograms.”
If an athlete suffers a Bankart or SLAP injury in the middle of
the season, non-operative methods are sometimes an option.
“We might try using a brace to protect the shoulder so it doesn’t
dislocate, and we work with the physical therapist to strengthen
the surrounding shoulder girdle muscles to try to keep the ball
in the socket and provide muscular stability,” says Kevin Sumida,
MD, a Commonwealth Orthopaedics surgeon and sports medicine
Older patients with SLAP tears are often able to avoid surgery
with rest, anti-inflammatory medication, and other conservative
treatments. But the vast majority of patients under 20 with a
dislocated shoulder will typically require an operation.
If surgery is necessary, Commonwealth offers the latest minimally
invasive techniques. “Because we perform these procedures
Video Extra! arthroscopically, we don’t need to make an open incision or disrupt
the normal anatomy to get to where the problem is,” explains David
Dr. Sumida explains Shoulder Novak, MD, an orthopaedic surgeon and sports medicine specialist
Bankart Repair at at Commonwealth. “This tendon-preserving method is not only
www.c-o-r.com/videos much easier on the patient, it also allows us to access all areas of
the shoulder joint and create a more balanced repair better than a
traditional, open procedure.”
4 Commonwealth Orthopaedics | www.c-o-r.com
Both of Sam’s surgeries were extremely successful
and he has not had a shoulder dislocation since. In each
case, he spent six months in rehabilitation before returning to the
playing field. He is now a freshman playing Division I lacrosse at
Lehigh University in Pennsylvania, where he was recruited out of
high school. The season includes games against top teams such as
Army, Navy, and Bucknell.
“Sam had a great outcome and our family was very pleased with the
whole experience at Commonwealth,” says Sam’s father, Bruce. “We
would recommend Dr. Kittredge to anyone. He has a great demeanor
and he tells it like it is. Sam doesn’t always listen to me, but he listens
to Dr. Kittredge. He follows his rules and he respects him. As Sam
says, ‘Ben is the man.’ ” At Professional Risk Associates we focus
solely on Physician Professional Liability
Ben W. Kittredge, IV, MD earned an Insurance. This is what we have been
undergraduate degree from the University of doing for over 20 years.
Virginia and a Masters degree in Physiology
from Georgetown University. Dr. Kittredge
then returned to the University of Virginia to We currently serve several thousand
attain his medical degree. He then completed a physicians and healthcare providers in
general surgery internship at Roanoke Memorial
Hospital and an orthopaedic residency at the University of Virginia.
the Mid-Atlantic region, and represent
Additionally, Dr. Kittredge completed a fellowship in sports several of the industry’s largest medical
medicine at Jefferson Medical College and Pennsylvania Hospital in professional liability carriers,
all rated “Excellent” by A.M. Best.
David J. Novak, MD earned a BA in Economics
from the University of Pennsylvania and received Use our experience and personal attention
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University Medical Center to complete a right coverage and carrier for you.
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please give us a call at 1-800-318-9930
Kevin D. Sumida, MD, graduated with a
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or email us at:
Indiana and then earned a medical degree from firstname.lastname@example.org
the University of Kentucky College of Medicine
in Lexington. He completed his orthopaedic
surgery training in Lexington before completing
Visit us on the web at
a fellowship in Sports Medicine at the University www.profrisk.com
of North Carolina at Chapel Hill. In addition to his orthopaedic
practice, he is also a clinical assistant professor at Georgetown
For full biographies and a complete directory of the physicians
at Commonwealth Orthopaedics who perform these and other
procedures visit our website at www.c-o-r.com.
Commonwealth Orthopaedics | www.c-o-r.com 5
Like Father, Sarah Pettrone, MD, continues her
Like Daughter father’s legacy, Dr. Frank Pettrone,
as an orthopaedic surgeon at
hen his daughters were young, Commonwealth For Dr. Sarah Pettrone, becoming an orthopaedic surgeon like her
Orthopaedics surgeon Frank Pettrone, MD, father was not always in the cards. She excelled academically and
would often take them along on rounds at the athletically and was initially interested in a career in women’s health.
hospital. “They’d come with me on the weekends,” After graduating summa cum laude from Notre Dame, she earned
he recalls. “They spent a lot of time in the doctor’s lounge listening her medical degree from the University of Virginia, where she was
to everyone, or they’d be in the anesthesia lounge while I was in selected a Bowman Scholar. It was during her clinical rotations in
the next room working on a case.” That early exposure rubbed off. medical school that she realized she liked orthopaedics best. She
Two of his daughters are now physicians: Kristen, an emergency went on to complete an internship and residency in joint disease
medicine doctor in Winchester, VA, and Sarah, a hand and upper at New York University, followed by a hand and upper extremity
extremity specialist at Commonwealth Orthopaedics. fellowship at the University of Washington in Seattle.
Having another orthopaedic surgeon in the family makes Dr. Frank When it came time to look for a job, her first choice was
Pettrone one proud dad. “As a parent, you are always happy to see Commonwealth Orthopaedics. The timing was right:
your children succeed in life and in careers, but it’s a special feeling Commonwealth needed a hand surgeon, and Sarah happily
when they choose to do what you do. It makes you feel you did returned home to Northern Virginia to begin her medical career
something right while they were growing up,” he says. working alongside her father.
6 Commonwealth Orthopaedics | www.c-o-r.com
Because your knees
“My dad has always been my role model,” she says. “It’s hard support your game.
not to be influenced by someone who, 30 years on, still loves
his job as much as the day he started. Growing up, I never once If you have osteoarthritis (OA) of the knee, and pain
relievers aren’t helping, there is a non-surgical option
heard my dad say he didn’t want to go to work. He loves being that may help keep you moving and get your knees
around people and he loves his patients. He’s always running back in the game.
ORTHOVISC® provides up to 6 months of knee pain
late in clinic because he will sit and talk to each patient. As a relief with just three injections. Made from ultra-pure
new physician, these are important skills I am trying to learn natural hyaluronan, which is found in healthy joints,
ORTHOVISC® acts to cushion, protect and lubricate
from my dad: how to talk to patients, make them feel at ease, your knee.
and really listen to what they are telling me.” As an Official Health and Fitness Provider for the PGA
TOUR and CHAMPIONS TOUR, ORTHOVISC® may be
Now, father and daughter not only share a profession, but also just what you need to get back on the course.
To learn more, call DePuy Mitek at 1-800-382-4682
participate in medical research and collaborate on cases. Sarah or visit www.orthovisc.com
recently performed surgery on a George Mason University
basketball player with a difficult wrist fracture and dislocation.
Her father was her surgical assistant. “Looking across the table
and watching my daughter preside over such a complicated AN OFFICIAL HEALTH AND FITNESS PROVIDER
case, where she’s the boss, really made me think back to when
she was a little girl accompanying me on my hospital rounds,” Important Safety Information
ORTHOVISC® is for patients who do not get adequate pain relief from simple pain relievers like acetaminophen
he says. or from exercise and physical therapy. ORTHOVISC® is not for use in people with known allergy to hyaluronate
preparations, to gram bacterial proteins, with infections or skin diseases in the area of the injection site or joint.
Common side effects include joint pain, back pain, headaches and pain or redness at the injection site.
All three Pettrone physicians – Frank, Sarah and Kristen –
ORTHOVISC® is manufactured by and is a registered trademark
volunteer their time and expertise on medical missions around of Anika Therapeutics, Inc.
the world. Sarah and Kristen traveled together to Bhutan, an
isolated mountain kingdom located high in the Himalayas, and
the sisters plan to go on a mission to Ethiopia later this year.
Sarah may have followed in her father’s footsteps, but Frank
Pettrone knows his daughter stands on her own two feet.
“To see someone as smart and active as Sarah, who is hard
working and well respected, succeed beyond anyone’s dreams
is an amazing feeling,” he says. “Around here, Sarah used to be
known as Frank’s daughter. Now, I am Sarah’s dad.”
Frank A. Pettrone, MD, earned a BA from
Brown University and a medical degree
from Georgetown University. Dr. Pettrone
completed both his internship and residency LAMBERT, RIDDLE
program at Georgetown University Medical
Center. Then, before joining Commonwealth SCHIMMEL & COMPANY
Orthopaedics, he served a tour in the United (Established 1917)
States Navy as an orthopaedic surgeon.
Sarah Pettrone, MD, graduated summa cum Serving the Business and Personal Insurance
laude from the University of Notre Dame Needs of Northern Virginia for Over 90 Years
with a BS in Biology and earned her medical
degree from the University of Virginia School
of Medicine. Dr. Pettrone completed an omas P. Schimmel, C.P.C.U. & James D. Riddle
orthopaedic surgery internship and residency Partners
at New York University-Hospital for Joint
Diseases as well as a hand fellowship at the
University of Washington in Seattle.
3931 UNIVERSITY DRIVE FAIRFAX, VIRGINIA 22030
Commonwealth Orthopaedics | www.c-o-r.com 7
Treating a Pain
in the Neck
Advanced Care for Cervical Spine Conditions
hen Hayley’s right arm began to hurt several years and held together with metal plates and screws. Following
ago, she wasn’t sure what was wrong. The 48-year- surgery, the body begins its natural healing process and new
old Springfield mother stopped playing tennis and bone cells are formed around the graft.”
wore a wrist brace, but the pain only intensified. Eventually, she
came to Commonwealth Orthopaedics for steroid injections two of the biggest surgical advancements that
and physical therapy. Although the treatments didn’t stop the Commonwealth offers are bone graft substitute
pain, they did reveal a surprising fact about its source: it was
coming from her neck. and high-tech instrumentation.
Hayley consulted Commonwealth surgeon Thomas Mazahery, “Instead of taking bone from the patient or using an allograft
MD, who has a special interest in treating conditions of the from a cadaver, as we did in the past, we now use man-made
cervical spine. Sure enough, an MRI showed two severely plastic, ceramic, or bioresorbable compounds. This material
ruptured discs in her neck compressing nearby nerves. Dr. is packed with shavings of living bone tissue inside a cage,”
Mazahery recommended she have surgery right away. explains Edward Lane, MD, a Commonwealth physician
who performs spine surgery and many other orthopaedic
“Patients with this condition, known as cervical radiculopathy, procedures. “Coupled with the newest minimally invasive
typically feel pain that radiates from their neck into their surgical instruments and high-tech surgical microscopes, it
shoulder blade, down their arm and possibly into their hand,” makes surgery much easier on our patients. They experience far
he says. “It can affect any age group, from those in their late less pain and blood loss, fewer complications, and a significantly
teens and early 20s to people in their 70s and 80s. Younger faster recovery.”
patients usually have a soft disc herniation, while older ones
have arthritic or degenerative changes that create bone spurs Hayley’s anterior cervical discectomy and fusion provided
that dig into the nerves. At Commonwealth, we also see patients instant pain relief and her condition continues to improve. She
with a combination of both.” spent one night in the hospital and returned to her job with the
Department of the Navy two weeks later. Within six weeks, she
The good news is that about 70 to 80% of patients respond to was back to her regular schedule and activities. She is currently
conservative treatment. This can include time to see if the nerve working hard to strengthen her arm so she can play tennis again
calms down, anti-inflammatory medications, physical therapy later this spring.
with traction to take pressure off the nerve, or cortisone shots
in the neck. For patients such as Hayley whose pain persists, “My entire Commonwealth experience was positive,” she says.
or who have progressive weakness or instability of the spine, “Dr. Mazahery is a great doctor – very down to earth and
Commonwealth offers the latest minimally invasive surgical personable. And the surgery was extremely successful. It’s such
options. a relief to be rid of the pain, which was making me sad and had
changed my life. Now I definitely recommend surgery to others
“Anterior cervical discectomy and fusion is the most common in my condition. There’s no reason to live in constant pain.”
procedure for cervical radiculopathy,” says Ron
Childs, MD, a Commonwealth Orthopaedics
spine specialist. “The surgeon makes a small Video Extra!
incision in the front of the neck and removes the
damaged disc to take pressure off the nerve. The Check out the symptoms and treatment for pinched
open disc space is then filled with a bone graft, nerves in the video by Thomas Mazahery, MD
which helps the adjacent vertebrae to fuse. The www.c-o-r.com/videos
bone graft and vertebrae are often immobilized
8 Commonwealth Orthopaedics | www.c-o-r.com
Ronald C. Childs, MD, earned a BA in
Psychobiology from Boston University before
going on to complete his medical degree and
orthopaedic surgery residency at Howard
University. Dr. Childs then pursued additional
training in Chicago where he completed a
spine surgery fellowship program at Rush-
Presbyterian—St. Luke’s Medical Center.
H. Edward Lane, III, MD, earned his medical
degree from Georgetown University School of
Medicine in Washington, DC. He then completed
his internship and orthopaedic surgery residency
at Georgetown University Medical Center.
Thomas Mazahery, MD, received a BA in
Biology from the University of Virginia and
earned his medical degree from the Medical
College of Virginia. He then completed a
general surgery internship and an orthopaedic
surgery residency at Northwestern University.
Additionally, Dr. Mazahery completed a spine
fellowship at Case Western Reserve University.
For full biographies and a complete directory of the physicians
at Commonwealth Orthopaedics who perform these and other
procedures visit our website at www.c-o-r.com.
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Commonwealth Orthopaedics | www.c-o-r.com 9
Nothing to Fear
Safe, Effective Spine Surgery Helps Relieve Low Back Pain
aced with the prospect of spine surgery, treatment, acupuncture, yoga and Pilates. If these fail
Sandra admits she was scared. The 54-year-old to provide suitable relief, or there is any significant
Annandale homemaker had been experiencing weakness or numbness, we recommend surgery. While
increasingly severe back pain for several years. When there is a lot of fear in the lay population, surgery is
an MRI revealed she had two bulging discs in her lower very safe, very effective, and most people achieve their
back, she knew she had to take action. Sandra was desired level of no or minimal pain.”
already a Commonwealth Orthopaedics patient
for her knees, so she looked at a list of physicians One of the biggest advancements in spine fusion surgery
on the Web site and selected spine specialist is the use of bone graft substitute. “We used to take
Steven Hughes, MD to treat her back pain. bone from the patient’s hip as part of the procedure,”
says Tushar Patel, a Commonwealth Orthopaedics spine
At her first appointment, Dr. Hughes laid out specialist. “Now we use genetically engineered proteins,
the options: Sandra could have surgery or she which stimulate bone growth naturally in the body, or a
could try non-surgical treatments to manage ceramic synthetic product such as INFUSE®. As a result,
the pain. “At that point, my attitude was there’s much less pain and blood loss, and recovery is
‘anything but surgery,’” she recalls. “I was significantly faster because we no longer harvest bone
quite fearful and tried to convince myself directly from the patient.”
my back pain wasn’t all that bad. Dr. Hughes
was very understanding and didn’t pressure Other advancements that Commonwealth offers include
me at all. He let me make the decision and the minimally invasive TLIF and XLIF procedures.
I chose the non-surgical route.” During TLIF (transforaminal lumbar interbody fusion),
surgeons approach the spine from the side of the spinal
Sandra tried medication, physical canal through a midline incision in the patient’s back,
therapy and steroid injections, to sparing nerves and muscles. XLIF (extreme lateral
no avail. When the pain became so interbody fusion) is performed through the patient’s
excruciating she had trouble standing, side, avoiding the major muscles of the back.
bending and doing housework,
Dr. Patel cautions that minimally invasive spine fusion
dr. Hughes sent her for targeted surgery is not for everyone. “The circumstances
epidural steroid injections using x-ray surrounding each case are different, so we must evaluate
guidance. the x-rays revealed she had patients carefully, as individuals, to determine the
several spinal cysts and one of them best course of action. In many cases, surgery is not
had ruptured. indicated. In others, traditional open spinal fusion
produces results that are as good as, or better, than the
That discovery, along with the less invasive alternative. Obtaining a successful result
knowledge that her worsening knee depends on a host of factors, and patients should discuss
problems would eventually require these thoroughly with a qualified spine surgeon before
replacement surgery, forced Sandra
to overcome her fears and have back
surgery. Dr. Hughes performed a
minimally invasive fusion of her lumbar Video Extra!
spine. As he explains, her course of Dr. Hughes explains How to
treatment is typical for patients with low Diagnose & Treat Back Pain in
back pain. “We often try non-operative a special video feature at
measures first, such as physical therapy, www.c-o-r.com/videos
non-steroidal drugs, injections, chiropractic
10 Commonwealth Orthopaedics | www.c-o-r.com
making any decisions.”
Sandra is now pain free and had such a positive
experience she has since sent her son, husband,
and mother to Dr. Hughes for surgery. “My
family and I cannot speak highly enough about
the wonderful care we’ve received from Dr.
Hughes and Commonwealth Orthopaedics,”
she says. “My only regret is that I didn’t have
surgery sooner. I would have spared myself so
much pain and effort, and maybe done less
damage. If I could say just one thing to others
in my situation, it is this: don’t let your fear
stop you from getting the help you need.”
Steven S. Hughes, MD, graduated
summa cum laude from the
University of Rochester and
completed his medical degree with
honors from the University of
Rochester School of Medicine. Dr.
Hughes worked as a surgical intern
at Bethesda Naval Hospital and was later honorably
discharged after serving as a Commander in the
United States Navy. Following his internship, he
completed an orthopaedic surgery residency at Strong
Memorial Hospital in Rochester and a fellowship in
spinal surgery at Case Western Reserve Hospital.
Tushar Ch. Patel, MD, earned his
medical degree from the University
of Pennsylvania in Philadelphia and
completed his orthopaedic surgery
residency at George Washington
University Medical Center. He
then went on to do a fellowship in
Spinal Surgery at the Cleveland Clinic Foundation in “The XLIF procedure Lisa – Centreville
Cleveland, Ohio. really changed my life. XLIF Spine Surgery
For full biographies and a complete directory of
I feel like I can get back to
the physicians at Commonwealth Orthopaedics my life, and I am so glad to
who perform these and other procedures visit our
website at www.c-o-r.com.
be able to do that.”
Commonwealth Orthopaedics | www.c-o-r.com 11
For Low Back Pain
ow back pain is one of the most common medical conditions,
affecting more than 80 percent of American adults at some
point in their lives. The low back is vulnerable to many pain-
provoking disorders, ranging from simple strains to herniated discs,
degenerative disc disease, or spinal stenosis (narrowing of the spinal
canal). Certain conditions can also cause radicular pain – burning,
numbing or tingling that radiates down the leg due to a compressed
or inflamed nerve.
“I had three shots over a
At Commonwealth Orthopaedics, epidural steroid injections (ESI) period of six weeks…
are an effective treatment option for many forms of low back and leg Since then, I’ve gotten back
pain. This targeted procedure, which deposits a long-lasting steroid
directly into the epidural space surrounding the spine, is often used
to all my regular activities.”
in conjunction with other non-operative measures such as physical
therapy to delay or prevent the need for surgery.
“ESI is highly effective for patients with disorders of the spine,” says Maureen – Oak Hill
Brett Robinson, MD, an anesthesiologist and Commonwealth pain Non-Surgical Pain Management
management specialist. “While it is most useful for acute injuries
that have occurred within six months, it can also be helpful for
longer standing problems.” Brett M. Robinson, MD, a native of New
York city, earned a BA in Psychology from Yale
In some cases, epidural steroid injections are used after other
University before going on to receive his medical
methods of pain control have failed. ESI can be more effective degree from Tulane University. He then completed
than oral steroids or anti-inflammatory drugs because it delivers a rotational internship and an anesthesiology
medication directly to the source of the pain. Physicians use X-ray residency at the University of New Mexico,
or contrast dye to better target the area of concern, allowing more Department of Anesthesiology and Critical Care
medicine to go where it is needed. Medicine, in Albuquerque, New Mexico.
“ESI is used to quiet nerve inflammation and decrease or eliminate Amanda B. Trucksess, MD, graduated cum
laude from the College of William and Mary with
acute pain associated with conditions such as a herniated disc,
a major in kinesiology. She went on to earn her
stenosis, or sciatica,” explains Amanda Trucksess, MD, who
medical degree from the Virginia Commonwealth
specializes in physical medicine and rehabilitation at Commonwealth University School of Medicine at the Medical
Orthopaedics. “A specific type of ESI – a transforaminal approach – College of Virginia. Dr. Trucksess completed a
can be used as a diagnostic procedure as well in order to localize a four year residency in Physical Medicine and
specific nerve root that is the source of a patient’s pain.” Rehabilitation at the University of Virginia.
ESI are very simple and safe procedures. They can be done up to For full biographies and a complete directory of the physicians
three times in six months, if necessary, with the goal of returning at Commonwealth Orthopaedics who perform these and other
procedures visit our website at www.c-o-r.com.
patients to their full, pain-free function and activity.
12 Commonwealth Orthopaedics | www.c-o-r.com
in the Community
Physicians Speak at
The Virginia Youth
ore than 650 people attended the
Virginia Youth Soccer Association,
Dr. Ben Kittredge presents information on how to prevent (VYSA) annual soccer convention and
running injuries. awards luncheon in Crystal City, in January
2011. Soccer coaches, administrators, referees,
ATC Workshop parents and players gathered to see coaching
demonstrations and attend lecture sessions
or the fifth year in a row, certified athletic trainers to learn how to better serve the players and
(ATC's) from Fairfax, Arlington and Loudoun County parents of our soccer community.
Public Schools as well as physicians attended a free Physicians from Commonwealth Orthopaedics
workshop, "Collaborating Care Between Sports Medicine presented information on common soccer
Physicians and Athletic Trainers," on Sat., Feb. 26 at The injuries such as foot and ankle injuries, knee
Mason Inn in Fairfax, Va. and ACL injuries, and concussions. ■
“The workshop provided a great opportunity for the
certified athletic trainers from local high schools to interact
with physicians and other health care providers from
Commonwealth Orthopaedics to improve skills, share
information and develop a working relationship that will have
a positive impact toward the overall health care provided
to student athletes,” said Jon Almquist, ATC, FCPS Athletic
Training Program Administrator.
“At Commonwealth Orthopaedics we are committed
to working closely with certified athletic trainers at area
high schools. We see them as critical partners in providing
student athletes with information about injury prevention
and rehabilitation,” said Gordon Avery, President of
Commonwealth Orthopaedics. ■
Commonwealth Orthopaedics | www.c-o-r.com 13
Best Foot Forward
njoying a glass of iced tea in his kitchen, Kevin develops. Patients with chronic untreated extensor tendon
misjudged the counter height and broke the glass, lacerations have difficulty controlling the toes when attempting
sending a razor-sharp shard into his left foot. The jagged to put on socks or shoes; the toe tends to catch on them.”
glass lacerated a tendon, covering the floor of his Alexandria
Dr. Lutta performed Kevin’s tendon repair four days after the
home with blood. When emergency room doctors discovered
initial injury. Despite the large open wound and risk of the
Kevin couldn’t move one of his toes, the diagnosis was clear:
tendon ends retracting, potentially making repair difficult, the
he had severed his extensor tendon and would need surgery to
surgery was a success. Kevin spent a week on crutches with a
repair it immediately.
soft cast and then had a walking boot put on so he could return
Kevin, 51, consulted Commonwealth Orthopaedics surgeon to work and basic activities. After a month, he came back to
Kevin Lutta, MD, who specializes in foot and ankle procedures. Commonwealth for physical therapy, which he continued on
“I was apprehensive because I had done enough research his own at home. His pain was minimal, his recovery rapid, and
to know that tendon reattachment is tricky and I wanted an he has since returned to all the things he loves – golfing, biking,
experienced surgeon to perform the operation,” Kevin recalls. and working out in the gym.
“Dr. Lutta put me at ease right away. He had a great disposition
“I feel great and I’m very pleased with the care I received at
and reassured me that he had done this type of surgery many
Commonwealth Orthopaedics,” he says. “I wholeheartedly
recommend the entire team, especially Dr. Lutta. He’s a pro
Treatment of extensor tendon injuries varies depending on who does a tremendous job and I’m a living, breathing – and
whether the injury is a laceration, like Kevin’s, or a rupture. walking – example of that.”
The first step is a careful physical examination to evaluate the
specific extensor tendon involved, especially in lacerations Kevin Lutta, MD graduated with a BA in
where multiple tendons and other structures such as nerves Biology from Clark University. He earned
and blood vessels may be damaged as well. These, too, may his medical degree from Howard University
College of Medicine, where he was named to
need to be repaired.
Alpha Omega Alpha Medical Honor Society. He
completed his residency in orthopaedic surgery
Commonwealth Orthopaedics’ experienced surgeons offer the
at Howard University Hospital and went on
most advanced repair techniques available. “Extensor tendons to a fellowship in foot and ankle reconstruction at Pennsylvania
in the foot are relatively superficial and easily lacerated with Hospital, part of the University of Pennsylvania Health System.
trauma,” Dr. Lutta explains. “In these cases, surgery is the best
treatment option. The goal is to restore extension function For full biographies and a complete directory of the physicians
to the lesser toes. It has been shown that when the extensor at Commonwealth Orthopaedics who perform these and other
procedures visit our website at www.c-o-r.com.
tendons are transected and not repaired, a claw toe deformity
14 Commonwealth Orthopaedics | www.c-o-r.com
After severing his extensor
tendon in his foot, Kevin had
surgery to reattach the tendon Kevin – Alexandria
and recovered rapidly so he can Lacerated Extensor Tendon Repair
enjoy his golf game again.
Commonwealth Orthopaedics | www.c-o-r.com 15
Going the Distance
arthroscopic hip surgery
allowed Laurie to get
back to what she loves—
competing in triathlons
and training women for all
types of endurance events.
Laurie – Potomac Falls
Minimally Invasive Hip Arthoscopy
16 Commonwealth Orthopaedics | www.c-o-r.com
ompeting in an Ironman® triathlon is a pipe dream Surgical candidates include anyone for whom non-operative
for most of us. For Laurie, it’s all in a day’s work. treatment such as pain medication, steroid injections or
The 40-year-old USA Triathlon-Certified Coach physical therapy has failed, except those with advanced
and mother of two is the founder of Amaiza Fitness. Amaiza arthritis.
Fitness’ tri4women program trains women to compete
in triathlons and other endurance events. She is also a One of the biggest benefits of hip arthroplasty is faster
competitive triathlete and runner herself. But when nagging recovery time. Most patients can begin light activities such
hip pain spread to her back and leg, Laurie was forced to hang as biking or swimming within a few weeks. Laurie was home
up her wetsuit, bike and running shoes, and watch her beloved one hour after waking up from her surgery. She had minimal
triathlon races from the sidelines. pain, and was able to walk with a crutch. A few days later she
was swimming, and soon she returned to a stationary bike to
“The situation was really frustrating, and I spent a year stay in shape. Four months after her surgery, she was running
trying all sorts of non-operative remedies to get rid of the again.
pain,” she says. “I saw lots of doctors, had lots of tests, went
to a chiropractor, tried massage, but nothing really worked.” “I had such great results and Dr. Parker was awesome,” she
Finally, an MRI with contrast showed the bone needed to be says. “He’s one of the leading physicians doing this procedure
shaved down. A friend recommended she consult Andrew in the area and he’s done it lots of times, so I felt very confident
Parker, MD, a Commonwealth Orthopaedics surgeon with about everything. He was available whenever I needed to talk,
special interest and experience in hip arthroscopy. and he always encouraged me to make my own decisions. He’d
say, ‘If you were my sister, this is what I’d recommend,’ but he
Dr. Parker offered Laurie two choices. She could have a never made the choice for me.”
relatively simple procedure to clean up the cartilage in her hip,
or more complex surgery to also shave the bone. The latter Laurie also praised Commonwealth’s Outpatient Surgery
would require a longer recovery before she could return to Center, which she found more comfortable and personable
running and competing, but the results would be permanent. than a hospital. She was in and out fast, without a lot of
Laurie didn’t hesitate, telling Dr. Parker, “Get me in ASAP so I waiting time, and felt at ease with the attentive, one-on-one
can get on with my life.” Last June, she had minimally invasive care from the staff.
arthroscopic hip surgery at Commonwealth’s Outpatient
Her hip pain is gone and her range of motion is back in full.
Surgery Center in Herndon.
Just eight months after her surgery, she will compete in the
Arthroscopic techniques have revolutionized 2011 Rohto Ironman 70.3 California – a race that consists of
hip surgery. Historically, physicians had to cut through a 1.2-mile swim, a 56-mile bike ride and a 13.1-mile run. She
connective tissue and dislocate the joint to find and correct will follow that up with a full Ironman – a 2.4 mile swim, 112-
the problem. Now, they make a tiny incision and insert a mile bike ride and 26.2-mile run – in Lake Placid, NY. “My
pencil-sized optical device (called an arthroscope) with a recovery from surgery was amazingly quick and I was back to
video camera attached, which transmits magnified images of normal very fast,” she says. “People shouldn’t hesitate to have
the inside of the joint to a TV monitor. Guided by the images, this done.”
surgeons use miniature instruments to perform the procedure.
D. Andrew Parker, MD earned a BS in Biology
“Hip arthroscopy allows us to repair and restore the
and Chemistry from Wake Forest University. Dr.
normal anatomy of the hip joint in a minimally invasive Parker then graduated magna cum laude from
fashion, thereby allowing patients to return to everyday medical school at the University of Louisville.
life, recreation and sports much more quickly,” explains Dr. He completed his internship and residency in
Parker. “Commonwealth offers the latest minimally invasive orthopaedic surgery at Northwestern University.
techniques for hip arthroscopy to treat conditions such as Dr. Parker concluded his formal medical
labral tears, traumatic cartilage injuries, early osteoarthritis education by completing a fellowship in sports medicine at the
and femoroacetabular impingement, which occurs when Baylor Sports Medicine Institute in Houston, Texas.
the head of the femur does not have full range of motion
within the socket. In fact, arthroscopic procedures to treat For full biographies and a complete directory of the physicians
femoroacetabular impingement may remove a major risk at Commonwealth Orthopaedics who perform these and other
procedures visit our website at www.c-o-r.com.
factor in the development of osteoarthritis.”
Commonwealth Orthopaedics | www.c-o-r.com 17
“I was very motivated to
get back to my previous
activities and lifestyle and
I couldn’t have done it
without Dr. Lawhorn.”
Mary – Herndon
ACL Reconstruction and
18 Commonwealth Orthopaedics | www.c-o-r.com
Complex Knee Surgeries
Restore High-Velocity Lifestyle
New treatment methods offer options for
urtling down the most difficult double black “Mary had a large, traumatic isolated defect of her articular
patients with knee damage
diamond ski slopes doesn’t faze Mary, but when cartilage, the connective tissue that covers the knee joint,” Dr.
By D. Andrew Parker, MD Lawhorn explains. “To undergo ACI, it was imperative she
she faced a series of technically demanding
knee surgeries, she was grateful to have one of the most have an intact ACL and stable knee, reasonable remaining
meniscus function to minimize the compressive forces on
experienced orthopaedic surgeons to perform them. last decade, a number of highly tech- commonly injured knee ligament. Collisions on
her articular cartilage, and normal alignment snapping or
nological options for treating patients with carti- the field sometimes twist the knee, of the knee
lage damage freak
Mary, who is in her late 40s, had injured her knee in a have developed. They add to a tearing the ACL.
accident at an exercise boot camp near hergrowing spectrum of choices for treatment.
One in six people with an ACL injury also has an
Subsequent diagnostic tests and procedures revealed a host First, Dr. Lawhorn performed an ACL reconstruction to
Injuries to the Knee injury in another ligament or in the meniscus, a
of problems: an acute ACL tear, a complete radial split of her defined harvest the cells for her cartilage
strengthen her knee and pad of knee cartilage known as fibrocar-
In damage. regeneration surgery. He later performed the medial
medial meniscus, and a large area of cartilage general, younger patients sustain knee carti- tilage that fills the space where the femur (thigh-
lage damage from a traumatic event, while older bone) and the tibia (shinbone) meet. And closer
meniscus transplant and ACI – two lengthy, complicated
She was referred to orthopaedic surgeon Keith Lawhorn, MD, to experience degenera- to the bone is hyaline cartilage, the real shock
patients are more likely
procedures – at the same time.
who determined she needed ACL reconstruction, knee cartilage as a result of osteoarthritis. absorber in the joint.
tion of a meniscus
But there are many exceptions.
transplant, and cartilage regeneration surgery – a technique Damaged meniscal or hyaline cartilage can
In a meniscus transplant, fibrocartilagetissue from a donor
cadaver is symp- cause significant pain. Consequently, when we
known as autologous chondrocyte implantation (ACI). This may have earlysize-matched and transplanted into the knee using
Athletes use the flex and strength of A 40-year-old runner
the knee to compete, and they depend toms of osteoarthritis. the same time, he treat a patient with a knee injury, cartilage
two-part procedure involves harvesting the patient’s own At an arthroscopic-assisted, mini-open approach. Because the
on kneegrowing the— theinbuffer of mayand injecting
cartilage, a laboratory,
experience a knee injury that damages restoration is often part of the protocol.
operation is technically challenging and requires months of
tissue between articulating surfaces — to do so cartilage as well as other structures, most
them back into the damaged elastic, spring- typically ligaments.
without pain. Healthy cartilage is post-operative rehabilitation, meticulous and appropriate
ing back in response to pressure. When chon- patient selection is critical for success. “This procedure
drocytes, or cartilage cells, are damaged, friction Football fans certainly have heard of the anterior Swedish researchers were able to culture hyaline
Continued on page 20
builds and pain is sometimes severe. cruciate ligament (ACL), which is the most cartilage cells outside the body for the first time
Five Steps of Carticel
1. 2. 3. 4. 5.
1. An initial biopsy of normal joint surface is removed from the non–weight-bearing portion of the knee. 2. The biopsy is sent to a
Genzyme lab, where it is cultured and grown into a solution of the patient’s cartilage cells. 3. During the second procedure, the sur-
geon makes an incision in the knee and removes any damaged cartilage. 4. A piece of lining is then removed from the adjacent upper
tibia bone and sewn over the defect. 5. This creates a water-tight membrane to contain the cultured cartilage cells. The patient’s cells
are then injected into the defect. Images courtesy of Genzyme Corporation.
8 Commonwealth Orthopaedics
Commonwealth Orthopaedics | www.c-o-r.com 19
Complex Knee Surgeries - continued from page 19
is typically reserved for patients under 40, but can be
considered in patients up to 50 if they are highly active
and have minimal arthritic changes,” says Christopher
Annunziata, MD, who performs these complex surgeries
at Commonwealth Orthopaedics. “It should be used only
after exhausting all nonsurgical measures, except in cases
where there is concomitant ACL and medial meniscus
deficiency with significant rotational instability that may
compromise success of ACL reconstruction alone.”
With the right patient, meniscus transplant and ACI
performed together rather than separately can significantly
improve outcomes in the most difficult cases.
Following her surgeries, Mary spent two days in the
hospital and returned home for an intensive, year-long
rehabilitation. During the first two months, she used
crutches and built up her strength on a continuous passive
motion (CPM) machine. She began walking again at 10
weeks and spent another 10 months in physical therapy at
Commonwealth Orthopaedics. One month later she went
hiking in the Great Smoky Mountains, and a few months
after that she was finally back on the black diamond ski
slopes she loves so much. Charles R. Ubelhart, MD
“I was very motivated to get back to my previous activities Caring, Expert Orthopaedic Physician
and lifestyle – and keep up with my 10-year-old son – and Commonwealth Orthopaedics
I couldn’t have done it without Dr. Lawhorn,” she says. “He 1999-2011
went above and beyond and did an amazing job. He is so
technically gifted. My pain is gone and my scar is so small
you can barely see it; everything looks fabulous. Now I
recommend him to others all the time.”
Christopher C. Annunziata, MD, earned Keith W. Lawhorn, MD, graduated with a BA
a BS from Boston College before graduating in Chemistry from the University of Virginia
with his medical degree from Georgetown and continued his education at the University
University. He completed an orthopaedic of Virginia School of Medicine, where he earned
surgery residency at Georgetown University his medical degree . He completed a general
Medical Center and went on to complete surgery internship and orthopaedic residency at
a fellowship in Sports Medicine/Knee the Medical College of Virginia. Dr. Lawhorn
and Shoulder Surgery at the University of served on active duty in the U.S. Air Force for
Pittsburgh Sports Medicine Center. eight years, reaching the rank of Lt. Colonel.
For full biographies and a complete directory of the physicians at Commonwealth Orthopaedics
who perform these and other procedures visit our website at www.c-o-r.com.
20 Commonwealth Orthopaedics | www.c-o-r.com
Custom Orthotics and
Announcing New Products for
Foot Products for Patients
Our Foot and Ankle Patients
Commonwealth Orthopaedics now offers custom foot orthotics and
Commonwealth Orthopaedics now offers custom foot
braces for patients. To make an appointment with Dr. Kevin Lutta, our foot
orthotics and braces for patients. For more information or to
and ankle specialist, please call the Herndon office at 703-810-5204 or
make an appointment with Dr. Kevin Lutta, our foot and ankle
the Tysons office at 703-810-5225.
specialist, please call the Herndon office at 703-810-5204.
New Online Store for Foot and Ankle Medical Products
Advertiser Directory foot problems, please visit our new online store at
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Commonwealth Orthopaedics | www.c-o-r.com
Informed & Educated
ommonwealth is committed to keeping our patients and
community updated on the latest orthopaedic advancements.
Here’s how we are communicating:
● The new Commonwealth Orthopaedics blog
(http://blog.c-o-r.com) features information and advice
from our physicians about orthopaedic conditions, innovative
treatments, videos, surgical animations, and more.
● Commonwealth Orthopaedics is on Facebook! Patients can now
stay connected to the most current Commonwealth Orthopaedics
news and share it with family and friends.
● Every two months, our patients receive an e-newsletter with
timely items about orthopaedic care.You can sign up to receive this
e-newsletter on our website home page at www.c-o-r.com ■
Outpatient Surgery Rockstar Run Raises
Centers Reach Scholarship Funds
ore than 500 runners and walkers participated in
the second annual Rockstar 8K Run and one mile
ommonwealth Orthopaedics’ Outpatient fun run on April 10, 2011. The event raises money
Surgery Centers achieved a milestone for the Celebrate Cherie Scholarship Fund established when
in 2010: 30,000 surgeries have been Cherie Yadao, a Commonwealth Orthopaedics physical
performed at these state-of-the art facilities since therapist and manager, died of a rare cancer in 2009. ■
they opened in 1999 (Herndon) and 2001 (Fairfax).
As the only outpatient surgery centers dedicated
exclusively to orthopaedics in the region, they offer
patients many advantages over a hospital setting
including comfort, convenience, personalized one-
on-one care, and fewer delays and disruptions.
Quality and safety are never compromised. The
centers are accredited by The Joint Commission,
which means they are held to the same high
standards as a hospital. For more information about
our outpatient surgery centers go to www.c-o-r.
22 Commonwealth Orthopaedics | www.c-o-r.com
Meet Our Physicians
George Aguiar, MD Christopher C. Annunziata, MD Gordon L. Avery, MD Anne M. Bielamowicz, MD Ronald C. Childs, MD Nancy R. Couleman, MD
Reston, Herndon Arlington, Tysons Corner Arlington, Tysons Corner Outpatient Surgery Centers Fairfax Outpatient Surgery Centers
Alexander S. Croog, MD Allen G. DeLaney, MD Robert M. Dombrowski, MD J. Mark Evans, MD Mark C. Hartley, MD Steven S. Hughes, MD
Fairfax, Fair Oaks Outpatient Surgery Centers Fairfax, Fair Oaks Fairfax Reston Alexandria, Tysons Corner
Ben W. Kittredge, IV, MD Thomas J. Klein, MD H. Edward Lane, III, MD Keith Lawhorn, MD Charles S. Lefton, MD Kevin C. Lutta MD
Alexandria, Springfield Reston Fairfax, Fair Oaks Fair Oaks Arlington, Tysons Corner Herndon, Tysons Corner
Mark P. Madden, MD Thomas A. Martinelli, MD B. Thomas Mazahery, MD John P. McConnell, MD Mark R. McMahon, MD David J. Novak, MD
Reston Alexandria, Springfield Reston, Springfield Arlington, Tysons Corner Fair Oaks Fairfax, Fair Oaks
D. Andrew Parker, MD Tushar Ch. Patel, MD Frank A. Pettrone, MD Sarah Pettrone, MD Brett M. Robinson, MD David W. Romness, MD
Reston Fairfax, Fair Oaks Arlington, Tysons Corner Reston, Tysons Corner Outpatient Surgery Centers Arlington, Tysons Corner
Kevin D. Sumida, MD Daniel E. Thompson, MD Amanda B. Trucksess, MD Brantley P. Vitek, Jr., MD Daniel E. Weingold, MD Young J. You, MD Bruce S. Zimmer, MD
Arlington, Tysons Corner Alexandria, Springfield Reston, Tysons Corner Fairfax, Fair Oaks Burke, Springfield Alexandria, Springfield Burke, Springfield
Commonwealth Orthopaedics | www.c-o-r.com 23
11240 Waples Mill Rd., Ste. 403
Fairfax, VA 22030
Specializing in Practice
Barbara J. Grant, CPA, AIBA, CVA
SpeedBridge Ad 7.875x4.875.indd 1 6/21/10 4:26 PM
• Medical Assistants • Office Managers • Ophthalmic Techs
• Receptionists • Administrators • Med Lab Techs
• Secretaries • Consultants • Physical Therapists and
• Surgical Posters • LPN’s, RN’s Licensed Assistants
• Transcriptionists • Nurse Practitioners • Physicians & Physicians
• Bookkeepers • Ultrasounds, X-Ray, CT, Assistants
• Insurance Billing & MRI & Nuclear Med Techs • Doctors of Medicine
Collection Specialists • Ortho Techs • Medical Sales
Confidentiality assured sinCe 1971
(703) 749-2224 • (301) 942-4825