Dr. John P Salvo Jr., MD
Where are you from?
I grew up in Medford, NJ
Where did you go to medical school and do your residency/fellowships?
I went to Jefferson Medical College in Philadelphia and did my residency in orthopedic surgery at Albert Einstein Medical Center in Philadelphia. My fellowship was in sports medicine at University of Miami in Coral Gables, FL.
What is your evaluation and treatment philosophy?
First is that most problems can be cured without surgery. We take the time to listen to the patient and take a detailed history of their problem, which is 90% of the diagnosis. Then confirm with thorough physical examination and after that is completed, evaluate radiologic studies (X rays, MRI, etc). Many patients come in and say things like ”but my MRI says I have a tear, and it needs surgery.” The truth is that not every tear needs surgical intervention, and many patients can return to normal with a course of supervised rehab and time.
I believe in surgical intervention when it’s appropriate and when other options have been exhausted.
Can you please describe arthroscopic surgery?
Arthroscopic surgery is a minimally invasive procedure where a fiber-optic camera is used to evaluate and treat damaged structures in and around a joint. Most commonly performed in the knee and shoulder, but also can be used for the hip, elbow, wrist, and ankle.
You specialize in surgical intervention of the hip, shoulder, and knee. Labrum tears of the hip are a relatively new diagnosis and have new treatment methods.
Can you describe what a labrum is and what it does in the hip?
The labrum is made of fibrocartilage and lies deep in the hip attached to the acetabulum (pelvis or “socket”) adjacent to the femoral head (thigh bone or “ball”). It functions as a stabilizer and shock absorber in the hip joint. Labral tears have been recognized for years, but seem to be more frequent recently. It is a combination of greater awareness of the common symptoms, improved diagnostic tests, and advances in surgical equipment allowing proper treatment of these injuries. That along with seeing high-profile athletes return to their sport after treatment increases awareness of these problems.
How are hip labral injuries being diagnosed both clinically and via imaging?
The most common symptoms are pain in the groin that is deep and sharp, especially with rotation. In young patients and athletes, some sports are more common than others for labral tears. Ice hockey, soccer, football, and gymnastics are probably the most common. In middle aged patients (30’s to 50’s, not to offend anyone) they are more likely a degenerative tear and may be associated with femoroacetabular impingement (FAI).
Direct MR arthrogram is probably the best study for the labrum. I always start with a good set of xrays to evaluate the bony ligament and to check for any underlying arthritis.
Not everyone with a tear will definitely require surgery, right? Are labrum tears able to be improved using exercise? How are they repaired surgically?
While it is true that not every tear needs surgical fixation, the tear cannot be improved with exercise. The tissue has limited blood supply (critical for any damaged tissue to heal) and exercise does not change that. Only tears that are causing symptoms that don’t improve are appropriate for surgical intervention.
Through an arthroscopic approach, the labrum can be anchored back to the pelvis from where it was attached. Sometimes the tissue is too damaged from a repair to be performed, and it needs to be trimmed (aka debridement) but that provides excellent results for pain relief.
What does the post-operative rehabilitation consist of and how long will it be before an athlete can return to sports?
We have several protocols that patients follow after a hip arthroscopy. Each one depends on the specific procedure performed (e.g. simple debridement vs repair vs FAI surgery) as far as time lines. If it is a repair of the labrum, it generally takes around 6 months to return to sports. Debridement is a quicker return to full activities.
Is there anything on the horizon with upcoming research into diagnosis, surgery, or conservative treatment of hip labrum tears that would be interesting?
There are several things in early stages of treatment that are interesting. One is reconstruction of the labrum. The other is treatment of tendon tears near the trochanter. Both have been done with early success, but results are still early.
What do you enjoy doing when you are not practicing?
I enjoy spending as much time as I can with my family (my wife and 2 children) and traveling whenever we can. Also enjoy sports of all kinds, especially ice hockey, but I seem to get a little slower every year. Maybe I need some rehab!
Dr. John P Salvo Jr., MD
Rothman Institute
Washington Township office; Tuesdays and Thursdays 8:30-4:30
Marlton - Fridays 8:30-4:30
Kennedy Health System; Mondays and Wednesdays
1-800-321-9999
www.rothmaninstitute.com