Dr. Tim Kremchek is the Medical Director and Chief Orthopaedic Physician for Major League Baseball's Cincinnati Reds. A Cincinnati native, he is a graduate of the University of Cincinnati College of Medicine and completed an Orthopaedic Sports Medicine Fellowship at the Alabama Sports Medicine Institute in Birmingham. Dr. Kremchek also serves as the Medical Director for the East Coast Hockey League and as Medical Director and Team Orthopaedic Surgeon for the Cincinnati Cyclones professional hockey club.
Knee1: Why did you pursue a career in orthopedic medicine?
Dr. Kremchek: My father was an orthopedic surgeon, but growing up I wanted to be a baseball player. I played baseball in high school and college and didn't have a direction. I followed my dad around. I loved sports, he loved what he did, and that kind of turned me on and to really get things together, to get into medical school. If you asked me 20 years ago what I wanted to do, I would say I want to be an orthopedics sports medicine doctor, and I want to be the doctor for the Cincinnati Reds. It was a pipe dream. I didn’t know back then how hard it would be, but I set my goals and my career in line to do that, and it's worked out pretty well for me.
Knee1: Do you treat athletes exclusively?
Dr. Kremchek: No, I see active people. What is an athlete? An athlete is a 55-year-old woman who wants to walk everyday for her mental well-being or to stay in shape and just to get outside. I consider that an athlete. If you're unable to do that, it changes your personality, changes your view on life. So, I have a practice in taking care of active people, to get them back to their active lifestyle, and a sub-specialty of taking care of high-performance professionals, high-performance college and high school athletes.
Knee1: As Medical Director for the Cincinnati Reds, what injuries do you see most often in the players?
Dr. Kremchek: The hardest thing to deal with in baseball is understanding the overhead-throwing athlete. Throwing a baseball is probably one of the most unorthodox things we do in athletics, and it places a tremendous strain on the shoulder, the elbow, the back, really even the legs. The most common things are shoulder and elbow injures. The tough part is not only diagnosing what the situation is, but (also) understanding what the player needs to do in not only getting them back pain-free for daily life, but hopefully (also) getting them back pain-free to throw a baseball 90-plus miles an hour, which I think is sometimes very difficult.
You have to question what separates orthopedics from sports medicine. Orthopedics you deal with musculoskeletal injuries and you try to get people pain-free and functional. Sports medicine is you are trying to get these athletes to the highest competitive level or the highest level of athletic performance that they can do. They are not just happy with walking around and doing sedentary and daily activities without pain. They want to be able to excel, and you have to understand the sport. You have to understand the athlete. You have to understand what they really need to do to be good at it. Sometimes that can be very stressful.
There's nothing more satisfying that seeing an athlete get back on the field. I think athletes are different than other patients, and the difference is expectations. An athlete has higher expectations. What he need to do to get better. And again I think it's team work. Teamwork with the athletes, his coach, the physical therapist, the trainer, the doctor you all have to work as a team to get the athletes back on the field. Sometimes it doesn't work and that's discouraging. But when it does, it’s the most satisfying feeling in the world.
Knee1: Let's talk about meniscus tears. The methods of treating them have change, including the advent of FasT-Fix ( Smith & Nephew Endoscopy ’s latest knee implant for meniscal repair). How do you approach a meniscal tear?
Dr. Kremchek: If you can repair a meniscus, it’s the thing you should do. Taking out a meniscus really decreases the surface area and increases the stresses on your articular surface and leads to precocious arthritic changes. Unfortunately, it’s a double-edged sword. A lot of them don’t heal, so you're doing a disservice to the patient by trying to be a hero because those patients end up making them worse and having to go back in and do re-surgery on them. I think what we’re trying to do is find a very accurate, reproducible method to prepare repairable cartilage … so we have some type of substance that is less-invasive, gives a high strength and pullout, is reliable and able to hold that meniscus in place while the body allows it to heal it. That's what we're looking for, and all of us are looking for an easy way to do it that is going to be less destructive and less invasive to the patient with the maximum result.
I use the FasT-Fix and I was very impressed by that. It allows you to have that suture meniscal repair for the preciseness of the repair, and it's less invasive. I am much more comfortable with the security of the repair that I am getting (with FasT-Fix), which allows me to be a little bit more aggressive with their rehabilitation, which allows me to believe they will be better sooner. I have to be less restrictive to their initial rehab protocol, (and) that allows them to be happier with their procedure. I'm a little more aggressive in their range of motion. I get them out of a brace a little bit soon, so I'm allowing them to do more activities to build up their quads, get their functions back soon.
Knee1: Can meniscal tears be prevented?
Dr. Kremchek: I think in some ways, yes. If you have patients that have unstable knees and might have some potential meniscal pathology, I think stabilization of those knees to prevent further injuries to the meniscus and a subsequent meniscectomy can be done. I think educating patients with certain knee injuries who might be candidates for further meniscal tearing. But overall meniscal tear prevention? I don’t believe so. I think as long as you are dealing with an active, aggressive population, you're always going to have meniscal tears, meniscal degenerative tears, acute meniscal repairs and severe injuries. I think it'd be very difficult to try and prevent them right now.
Knee1: Where do you see the future of meniscal repair going?
Dr. Kremchek: I see it as continuing to be more aggressive with repairing meniscus and finding new ways to hopefully vascularize non-vascularized areas of the meniscus to allow us to reproduce and repair more tears than we can now. Again – I want to be very clear – I think trying to repair a meniscal tear that's not going to heal is a mistake for the patient. It creates more problems that it solves … The future is going to be able to find better ways to repair meniscus that are unable to be repaired now and finding secure, accurate ways for getting those to heal. When we're repairing meniscus, it's not the device that's going to hold it forever. We're trying to get a device to stabilize the meniscus so the body can heal it.
Knee1: We're heard a lot about Glucosamine Sulfate. How do you think it affects joint healing?
Dr. Kremchek: I think the jury's out on that. I usually put athletes on it because it won’t hurt. Most all of my athletes, especially my aging athletes at the tail end of their career, I do have on Glucosamine and Glucosamine Sulfate.
It’s like Synvisc injections. I use Synvisc a lot to decrease the amount of arthritic change and to increase the lubrication of the joint. Does it work? Probably. Does it work on everybody? No, but I usually discuss it with the patients and let them make the decision. Really, I don't see any long-terms effects of them doing it; there's no harm in them doing it.
I think sports medicine and where we are in the active athlete is extremely challenging. It's one of the reasons you get up in the morning. There's something new always coming out and we're always learning. And I think that communicating with the athlete, understating the athlete, understating the team and the sport they play is very important. And for us as physicians, it's very important to understand the latest technologies that are out there so we can offer it to them in a very professional manner. For example, the FasT-Fix. It's my obligation and my duty as a sports medicine doctor to look at this and see if it works. And if I think it's better than what I've been using, I owe it to my athletes to learn how to use it and use it right and fix them up. There are so many areas in Sports Medicine that we need to improve upon: shoulder arthroscopy, reconstruction of the shoulder and elbow, understanding the injuries and prevention. And we're doing that, probably not at the rate that we all want to, but certainly we're getting there and (have) made great strides in the last ten to 15 years.