Year-round athletics and repetitive workout regimes spike the risk of injury.

Question: How do sports spur injuries?

Joseph Zuckerman: Well, athletic injuries have really increased in incidents over the last 20 years in a very rapid rate. Now, why is that? Well, I think that first and foremost, the reason is that more and more people are involved in athletics, that's just the bottom line. You see athletics as being organized athletics starting when children are just in elementary school. It's extensive throughout all the elementary school, middle school and high school. There's an explosion of college athletics in all different sports. And then there is recreational sports. More and more people are involved in it. In addition, they are also involved in it to a much greater degree in later years. It's no unheard of to have people in their -- It used to be that if somebody tore their anterior cruciate ligament, which is a key stabilizing ligament to the knee, you expected that to be someone in their 20's, maybe the early 30's. And then you would consider replacing it. Now, I see my colleagues operating on people in their 40's, even their 50's with anterior cruciate ligament tears who need to have the ligament intact in order to participate in the sports that they want to.

So, there has been a great growth in the athletic participation. Now, you add to that, what's also done is, it's not just men that are doing it; it's women. Women are actively involved in athletics. So, we've now seen kind of a blurring of the lines between who gets what kind of injury now. Now, it's true, men tend to be much more involved in contact sports so there are certain types of injuries there. But women are more and more involved in athletics, and we've found that certain aspects of women's anatomy predispose them to certain injuries.

For instance, anterior cruciate ligament injuries in soccer players, or other cutting-type sports. There’s difference in the female anatomy that has led to an increased incidence of what we call, non-contact ACL tears, Anterior Cruciate Ligament tears. Whereas, in men, oftentimes it has to do with a getting hit injury, a pivoting injury on a football field or a basketball court, but with women it tends to be non-contact. The more we understand that, the more we can hopefully develop trends to prevent it.

But then the third area is the fact that kids are involved in so many sports, but they tend to focus on the sport year round now. But when I was growing up, you played football or soccer in the fall, played basketball in the winter, and then played baseball in the summer, or in the warmer weather in the climate of New York. Now, if a boy or girl is good in basketball, well, they are playing on an AAU team in the fall, then their school team in the winter, and then they’re going back to an AAU or a travel team in the spring or summer. So, they're playing one sport now and that takes its toll on the specific body parts involved.

For example, some of the problems with baseball players, elbow injuries, tearing the collateral ligament, the ulna collateral ligament, which is the ligament on the inside of your elbow here. The so-called Tommy John Surgery that's necessary to reconstruct that ligament. It used to be, before Frank Job did that procedure on Tommy John, it was almost unheard of. Now you start to see these injuries in high school players, sometimes even younger because they're playing these sports year round and it's taking its toll. The mechanics may not be exact, increased stresses.

So, that's one thing you have to be very careful of, the athletic stresses that we subject children to during their growing years and the impact to the skeleton as well as the soft tissues.

Question: How does obesity affect joints?

Joseph Zuckerman: Well, obesity is a significant problem in this country. You see that in the newspapers and the medical journals, it is an issue. And I say that to you now two days after my own physician told me that I needed to lose 10% of my body weight. So, I'm speaking from experience here. But there is no doubt that obesity takes its toll on the wear and tear of the joints. Clearly there is a risk factor for the development of degenerative arthritis, but even more so, all right, let's say you develop degenerative arthritis in the knee or the hip and you have significant obesity. A successful hip or knee replacement is certainly possible, but the risk factors are greater. The chances of complications are greater in patients that are obese then those that are not obese with respect to cardiac, pulmonary, or other complications. So, it has an impact not only on the development of the problem, but also on the ability the effectively treat it and have a successful result.