"You've got some puffiness from the surgery that has to be expected for another five weeks," Moyer tells her. "I don't want you to put any weight on this knee. Do some exercises as the brace allows and remove the brace once a day. Looks good now - as good as it can look."
Moyer tests the knee for flexibility and schedules another appointment in five weeks. He emphasizes using crutches and continuing to wear the Bledsoe Hinge Brace that covers from the thigh to the ankle, while allowing restricted knee movement.
Later that afternoon, Moyer remarks that although Corbley should recover
from her injury, having both knees arthroscoped at such an early age is not encouraging.
Every day, hundreds of people - not all of whom are athletes - are examined at sports medicine centers in the Philadelphia area.
The National Athletic Trainers Association (NATA) estimates that of the 5.8 million high school athletes in the United States, about 1 million will be injured this year. Heading the list of injuries are ankle/foot (29.7 percent) and knee (17.3).
"The frequency of injuries in college football is that 75 to 80 percent of them will lose a day somewhere in their career," Moyer said. "In professional football, it's 100 percent, and in high school, it's lower than
college but still pretty high."
Like compact disc, the term sports medicine sounds like a yuppie phrase given to new technology. Yet sports medicine's roots were planted decades ago by a number of doctors who plied their trade in Ohio, North Carolina and Georgia.
"There really was a smattering of origins," said Eagles trainer Otho Davis, who serves as executive director of NATA. "We had sports medicine in Ohio 30 years ago with Dr. Walter Hoyt at Akron's Children's Hospital. You had Dr. Lennox Baker at Duke Medical Center and Dr. Jack Hughston in Columbus, Ga. Baker was the granddaddy of them all because he trained Hughston and Hoyt."
Baker treated athletes at Duke and North Carolina State; Hoyt handled athletes at Kent State, and Hughston saw athletes at Auburn.
Baker's disciples spread across the country and taught others. The word eventually landed at the doorstep of Temple University Hospital in 1968, where Joseph Torg, a former high school lineman, had finished his residency in orthopedics. Ted Quedenfeld, Temple's head athletic trainer, asked Torg whether he had any free time to examine high school athletes who were coming through the hospital's emergency room in alarming numbers.
"Health care for athletes was primitive back then," said Torg, now medical director at Penn's Sports Medicine Center. "The coach was the doctor, trainer and therapist. I remember getting taped by (coach) Stan Peffle at Central while he was blowing cigar smoke in my face."
What began as a gesture of friendship on Torg's part evolved in 1974 into Temple University Sports Medicine Center, the nation's first full-scale sports medicine center supported by a teaching hospital. Torg was its medical director.
In comparing sports medicine centers - there are six major centers in Southeastern Pennsylvania - what separates Temple and Penn from the others is that they have a medical-teaching faculty behind them.
"We have residents, medical students and orthopedic surgeons in an environment where everything is closely scrutinized," Torg said. "It's important from an education standpoint, too, because we're on the cutting edge. With interns, residents, fellows, you have a built-in quality assurance program."
In addition to its main center on the campus, Penn has satellites in Cherry Hill, N.J., and King of Prussia. Temple continues to thrive at Broad and Tioga Streets and has three satellites - in Marlton, N.J., Fort Washington and Northeast Philadelphia.
The other major centers are Abington Hospital Institute for Sports Medicine and Physical Therapy; Holy Redeemer Sports Medicine Center, Huntingdon Valley; Haverford Community Hospital Sports Medicine Center, Havertown, and Paoli Sports Medicine Center.
Temple's $400,000 Northeast center opened in August and handles about 100 patients a week. Together, the six area centers see more than 2,000 patients a week. Many are blue-collar workers injured on the job. The rest are athletes who play for organized teams and "weekend warriors."
"You see the guy off the street who went skiing over the weekend," Quedenfeld said. "He probably had no preparation, just hit the slopes, had a hard day, partied that night and didn't get any sleep. The next day, his body is tired, he gets back on the slopes and gets injured."
Torg said patients today are vastly different from those in the early 1970s.
"When I first got involved in this, athletics was the varsity 5, 9 and 11," said Torg, using a shorthand term for the basketball, baseball and football starting lines. "What it has evolved into is that everyone in society is some form of an athlete. It's the Little Leaguer, the high schooler, the geriatric on a bicycle. . . . Most people doing something physical consider themselves athletes."
Most, but not all.
Patient: Tom Tinsley, age 53, a construction worker from Washington Township in South Jersey.
Case history: Three months of recurrent pain in left heel. X-rays by a podiatrist were negative.
Moyer sees Tinsley at Temple's Northeast center. He examines both feet and places the left heel through various ranges of motion, checking for pain.
"Arch supports," Moyer announces. "Not the Dr. Scholl's kind you'd buy, but better quality arch supports. The ones in the store won't take strain off this structure. Not enough cushion."
Moyer also recommends exercise and an anti-inflammatory drug.
Tinsley's initial visit cost him $50, typical of first-time patients being examined at sports medicine centers. The cost of follow-up care, however, varies greatly depending upon whether a patient is in rehabilitation.
The six major centers accept medical insurance. However, physicians and medical directors interviewed cautioned that HMO physicians often don't refer patients to sports medicine centers.
"We accept HMO referrals, but they don't refer many people," said Penn administrative director-trainer Joe Vegso.
"We don't often have a contract with the clinic but with the doctor," said Alan Letofsky, general counsel of HMO of Pennsylvania. Letofsky said HMO referred patients to Haverford Hospital, Temple, Holy Redeemer and Abington.
Still, with more than 2,000 patient visits a week to various centers, sports medicine is thriving.
"It doesn't take a mathematician to add up the figures on just (patient) visits alone," said Paul Grace, coordinator of sports medicine at MIT and a nationally recognized authority on athletic injuries. "It's big business out there."
At Penn, sports medicine means $2 million a year worth of business, Torg said. On the average, the smallest of sports medicine centers are grossing about $500,000 annually, according to area medical directors.
"Everyone is interested in treating high school injuries," Torg said. ''You can make a living out of it."
The Eagles' Davis said some doctors were making a living in the fraudulent sense.
"There is a bunch of them out there," he said. "I had a podiatrist tell me he didn't know the first thing about sports medicine, but he hung a shingle up saying sports medicine. He says his business is booming now."
The legitimate doctors make a name for themselves. In 1971, before Temple opened its sports medicine center, Moyer and Torg initiated a nationwide survey on spinal injuries called the "National Head & Neck Injury Registry." The impetus for the survey was 12 catastrophic injuries in Pennsylvania and New Jersey that year. Torg wondered what was going on nationally.
The survey continues today under Torg at Penn and is brought up to date annually.
Temple's 1973 study on football shoes and playing surfaces, also under Moyer and Torg, proved that long cleats were as dangerous on grass as rubber shoes were on artificial turf. As a result, the NCAA reduced cleat size, from three-quarters to one-half of an inch. Two years later, a Temple study showed that nearly all quadriplegic injuries in football resulted from defensive backs using the tops of their helmets for tackles. The NCAA responded with new rules prohibiting spearing.
Today, researchers at Temple and Penn are studying refinements in arthroscopic procedure, a technique invented by the Japanese three decades ago.
"In the '70s, surgeons were performing this technique as a diagnostic
procedure and not as repair surgery," MIT's Grace said. "By the late '70s, they had refined it, and the technique was sophisticated enough to repair knee-ligament damage."
Locally, Moyer, Torg and James Nixon are considered among the best orthopedists performing arthroscopic surgery. Moyer is acknowledged as having refined the technique that was used by surgeons on such athletes as Seahawk Curt Warner, Eagle Wes Hopkins and Bullet Bernard King.
Penn is researching the use of local anesthetics instead of general anesthesia during arthroscopic surgery. Torg does about 20 such surgeries a week at an average cost of $1,500.
"Arthroscopic surgery has been to the knee what penicillin was to venereal disease," Torg said. "These techniques were developed primarily with and by sports medicine orthopedists."
Former chief executive officer Mark Levitan recruited Torg from Temple to Penn in 1978.
Torg's departure triggered Moyer's promotion to medical director of Temple Sports Medicine.
Among high schools, sports medicine centers represent the solution to an appalling lack of trainers.
"My pet peeve is with the high schools," said the Eagles' Davis, one of the most respected trainers in the NFL. "They don't hire trainers to take care of their programs. They take the serious injuries and refer them to sports medicine, but there are a lot of less severe injuries occurring that never get attention. Those injuries go untreated until they become a major injury."
The shortage of certified trainers is why Quedenfeld, assistant Ted Rogers and others on the Temple staff voluntarily visit 50 area schools every week to examine athletes. Their territory covers the city, Montgomery and Bucks Counties, and portions of South Jersey.
According to Penn's Vegso, about 30 percent of all Pennsylvania suburban high schools have certified trainers, as do most schools in the Inter-Ac League. The Public and Catholic Leagues have no certified trainers, although Marty Hoffman at Washington High has been a non-certified trainer at the school since 1965, longer than anyone in the Philadelphia school system.
Why don't more high schools have trainers?
"You ask the schools and they'll tell you they don't have money in the budget for trainers," Hoffman said.
According to NATA, there are 10,000 trainers in the United States, of which only 6,000 are certified. There are 76 colleges that have NATA-approved curriculums in athletic training/sports medicine. College graduates in this specialty face good job prospects at high schools or junior colleges, although the average salary of $18,000 is disheartening for many not fortunate enough to work in recognized sports medicine centers.
Neither Temple nor Penn offers an NATA-approved undergraduate curriculum in athletic training. Temple is developing a post-graduate program. Penn does not have a health and physical education college, so cannot offer the curriculum.
In Pennsylvania, Pitt, Penn State, West Chester, Lock Haven, East Stroudsburg and Slippery Rock are the only colleges offering undergraduate curriculums in athletic training.
Recently, Davis may have forever changed the scope of athletic training - not here, but abroad.
Davis served as an adviser with a group of Japanese trainers who sought to incorporate NATA standards in their college curriculums, thereby allowing their graduates to be certified for work in the United States. As a result, a cultural exchange program involving Japanese and American students and teachers has begun.
"I couldn't believe they adopted every single suggestion I gave them," Davis said. "I would never have gotten so much approved that quickly in the U.S. I would have gone through so much red tape, it would have taken years."
For the Japanese, it took a single meeting last spring in Columbus, Ohio, and a little help from an interpreter.
As it spreads internationally - programs are growing in Australia, Europe and Asia - sports medicine also is moving into American industry.
"It makes sense that if a company can get its people productive, with less downtime, their savings are higher and their group insurance rates are lower," MIT's Grace said.
Torg sees it in a medical sense.
"Many principles and techniques of sports medicine are being assigned to industry," Torg said. "Years ago, you got hurt, you rested, stayed off it and put it in a cast. Today's concept is make a diagnosis, treat it vigorously, with a minimum amount of downtime and immobilization."
Similarly, Torg believes that outpatient surgery, which is on the rise in hospitals everywhere, is not a consequence of spiraling medical insurance costs alone.
"They took their cue from sports medicine," Torg said.
SIX AREA SPORTS MEDICINE CLINICS
ABINGTON HOSPITAL INSTITUTE FOR SPORTS MEDICINE AND PHYSICAL THERAPY (ABINGTON)
Staffing: (14) - physical therapist (5); trainer (1); aides (3); orthopedic surgeons (3); internist (1); administrative (1). Dr. Dave Junkin, medical director; Bruce Hayne, program director and trainer.
Services: diagnosis, rehabilitation and treatment.
Years in operation: 3 1/2.
Patients seen per week: 300.
Percentage of patients seen with non-athletic injuries: 10 percent.
Insurance: accepts most insurance, Blue Cross/Blue Shield and some HMOs.
Initial visit: $35.50 (rates vary for follow-up care).
HOLY REDEEMER SPORTS MEDICINE CENTER (HUNTINGDON VALLEY)
Staffing: (17) - physical therapists (3); trainers (2); orthopedic surgeons (5); exercise physiologist (3); strength & conditioning coach (1); administrative (3). Dr. Anthony Balsamo, medical director; Pat Croce, program director; Pat Dewechter, facility manager and physical therapist.
Years in operation: 15 months.
Patients seen per week: 500.
Percentage of patients seen with non-athletic injuries: 40 percent.
Initial visit: $65 (rates vary for follow-up care).
HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA SPORTS MEDICINE CENTER (33D & SOUTH)
Staffing: (28) - trainers (4); orthopedic surgeons (9); podiatrist (1); administrative (14). Dr. Joseph Torg, medical director; Joe Vegso, administrative director and trainer.
Services: diagnosis, rehabilitation and treatment; satellite offices (2, Cherry Hill, N.J.; King of Prussia.)
Years in operation: 9 years.
Patients seen per week: 325 (additional 400 on rehab and exercise programs).
Percentage of patients seen with non-athletic injuries: 5 percent.
Initial visit: $50 ($25 for high school and collegiate athletes); rates vary for follow-up care.
HAVERFORD COMMUNITY HOSPITAL SPORTS MEDICINE CENTER (HAVERTOWN)
Staffing: (13) - physical therapists (3); trainer (1); aide (1); orthopedic surgeons (2); exercise physiologist (3); administrative (3). Dr. Bruce Vanett, medical director; John Ward, program director and physical therapist.
Years in operation: 8 years.
Patients seen per week: 450-500.
Percentage of patients seen with non-athletic injuries: 55-60 percent.
Initial visit: $40 (rates vary for follow-up care).
TEMPLE UNIVERSITY SPORTS MEDICINE CENTER
Staffing: (15) - physical therapist (1); trainers (3); orthopedic surgeons (5); children's orthopedic surgeon (1); podiatrist (1); rheumatologist (1); internists (1); administrative (2). Dr. Raymond Moyer, medical director; Ted Quedenfeld, administrative director and trainer.
Services: diagnosis, rehabilitation and treatment; satellite offices (3, Northeast Philadelphia; Marlton, N.J.; and Ft. Washington, Pa.; main office at Broad & Tioga).
Years in operation: 13 years.
Patients seen per week: 100 per center/per week.
Percentage of patients seen with non-athletic injuries: 30 percent.
Initial visit: $50 (rates vary for follow-up care).
PAOLI SPORTS MEDICINE CENTER (PAOLI)
Staffing: (8) - physical therapist (1); trainers (2); orthopedic surgeons (2); administrative (3). Dr. Vincent DiStefano, medical director; Mike Corcoran, director and physical therapist.
Services: rehabilitation and treatment (no diagnostic equipment or X-ray on premises; patients referred to Paoli Memorial Hospital).
Patients seen per week: 150.
Percentage of patients seen with non-athletic injuries: 50 percent.
Insurance: accept most insurance, Blue Cross/Blue Shield and some HMOs.
Initial visit: $75 (rates vary for follow-up care).