Orthopedic Surgeon, Sports Medicine Fellowship Trained www.piersbarrymd.com Surgical Specialties Fellowship trained in sub- specialties include ACL Reconstruction, Knee Arthroscopy, and Shoulder Arthroscopy Page 4 Trauma Care Also specializing in sports and non- sports related trauma including fractures of the hip, ankle, clavicle, and wrist Page 5 Truly Minimally Invasive Minimally invasive is beyond the incisions made during surgery the approach beneath the surface and its impact on muscles and tendons is vital Page 6 About Dr. Barry My goal is to guide each patient, regardless of age and athletic goal, into the best, individualized treatment program that will allow a rapid return to a healthy, active, and pain- free lifestyle. My approach to treating patients I believe that successful outcomes are the result of treating every patient as an equal partner. Each individual has different goals and needs. While some orthopedic injuries are best treated with surgery, many can be solved with noninvasive or minimally invasive techniques, and physical therapy. I treat every patient as an athlete whether his or her goal is to finish a specific race, simply hike or swim, or compete at a professional level. Race physician for the professional cyclists in the Tour of CA Sports teams affiliation experience Fellowship trained as a team physician for: Surgical Specialties Minimally Invasive Surgery Sports Medicine Trauma Knee Arthroscopy ACL Reconstruction Shoulder Arthroscopy Rotator Cuff Repair Hip Arthroscopy Carpal Tunnel Surgery Knee Replacement Hip Replacement Shoulder Replacement Therapeutic Injections (Viscosupplementation)
Doctor Piers Barry has a background in sports, extensive training in sports medicine, and extensive experience at a level 1 trauma center. Background Piers Barry M.D. is a Board Eligible Orthopedic Surgeon who dedicates his practice to Sports Medicine, specializing in Arthroscopic and Reconstructive surgery of the Knee, Shoulder, Elbow, Hip, and Ankle. Dr. Barry graduated from Marin Academy, and subsequently earned a degree in English Literature with minors in Chemistry and Biology at Whitman College where he was a varsity swimmer and still holds the triathlon record. After college, he taught high school English at Lycée Beaussier in Toulon, France. He completed Medical School graduating from the University of Southern California with honors, and continuing on to an Orthopedic Surgery Residency at USC. After completion of all required training, he went on to do an extra year of fellowship training in Sports Medicine at Santa Monica Orthopedic Group where he worked as a team physician for many professional and national teams. During his residency training in orthopedic surgery at USC + LA County Dr. Barry worked at affiliated hospitals such as University Hospital, Children s Hospital of LA, Rancho Los Amigos, White Memorial, and Kaiser Baldwin Park hospitals. He worked with USC varsity athletes from a number of different sports including football, basketball, water polo, and volleyball. This wide spectrum of experience in different sports is invaluable in understanding the needs and injuries of all types and levels of athletes. Dr. Barry completed further subspecialty training at his fellowship in Sports Medicine and Arthroscopy at Santa Monica Orthopedic Group. He then entered private practice, and continues to do research. In fellowship, he served as team physician with Santa Monica Orthopedic Group for the US Men s National Soccer team, LA Galaxy Professional Soccer Team, Chivas USA Professional Soccer Team, Amgen Tour of California Professional Cycling Race, Pepperdine University, Santa Monica Rugby Club, Santa Monica College Football Team as well as for numerous high school football teams. He has published scientific journal articles and has given presentations on subjects such as arthroscopic treatment of knee, shoulder, and ankle, and hip injuries. Dr. Barry has presented several scientific papers including a recent presentation on Shoulder Arthroscopy with Arthroscopic Biceps Tenodesis. Dr. Barry is a member of the Arthroscopy Association of North America (AANA), and the AOSSM (American Orthopedic Society for Sports Medicine). In his free time, Dr. Barry enjoys spending time with family, and competing in triathlon, swimming, and cycling. He is active in road bike and triathlon races. Dr. Barry speaks French and Spanish fluently, and some Italian. 2
Minimally invasive joint replacements Minimally invasive joint replacements allow all patients a quicker recovery time that has less pain. Whether a serious athlete competing at a professional level, a casual athlete, or someone who just wants to walk without pain, this approach allows for a faster and fully return to an active lifestyle. Joint Replacement and a minimally invasive approach Minimizing soft tissue damage along with incision size ensures a better and faster recovery Hip Replacement Fractures of the femoral neck do not heal well and are often treated with replacement of part or all of the hip joint. There are many ways to approach the hip in this type of surgery, but sparing the muscles and tendons ensure a fuller and faster recovery. The major tendons at the hip, known collectively as the deep external rotators, are the most important tendons to preserve when replacing even part of the hip, along with the major muscles, including the piriformis and quadratus femoris. It is important to use a small incision appropriately placed to preserve tendons and muscles in order to decrease short term pain and increase long term function and stability. I have been using this technique since March 2011 and patients have shortened their hospital stay from 2-3 days to 1-2 days. Knee Replacement When knee surfaces are worn enough to necessitate a replacement, I use a minimally invasive approach. When wear and tear is in one compartment of the knee, a partial knee replacement can be performed to maintain native function and anatomy, which will feel more natural and normal. This procedure can even be done as an outpatient. I have received additional individualized training on this procedure. In the case that the whole knee is worn out and all three surfaces of the knee need to be resurfaced, I use an approach to spare the quadriceps muscle. A smaller than usual midline incision allows enough access to anatomically place the newly resurfaced knee with minimal incision into the quadriceps tendon. This shortens recovery and lessens pain intensity and duration. Knee- Cartilage Preservation There have been advances in cartilage preservation to treat patients with knee degeneration, especially due to osteoarthritis. These are intermediate steps to take during the aging knee which bridge the middle ground of early knee degeneration and the need for total knee replacement. One effective approach is to use injections of viscosupplements (Euflexxa, Synvisc, Orthovisc) that can help the cartilage deficient knee function better with less pain. Patients can also opt for cartilage preserving surgery in which I have experience. In select case of large cartilage defects in the knee, new cartilage can be grown in the laboratory and surgically implanted inside the knee in a procedure known as ACI (Autologous Cartilage Implantation). 3
Arthroscopy with Dr. Piers Barry Overview Arthroscopy is a very common surgery. I perform knee arthroscopy with mild sedation and local anesthetic. During fellowship, I refined my technique of knee arthroscopy to minimize already small incisions. Thorough visualization is necessary to fully examine a knee during arthroscopy. I always examine the posterior aspect of the knee joint, an area where loose pieces of torn cartilage or meniscus can hide causing ongoing pain, and a failed knee surgery. Not all surgeons follow this practice and my sub- specialty fellowship training in sports medicine is an excellent reason to entrust patient care to me. I prioritize minimizing post- operative pain by avoiding the use of a tourniquet, and not removing the fat pad behind the patellar tendon. This practice reduces bleeding, pain and post- operative stiffness and scarring. With this reduction in pain, patients require almost no pain medication after surgery and only a few days of recovery before returning to work and driving. ACL Reconstruction Dr. Barry has performed hundreds of ACL reconstructions and uses a minimally invasive approach while recreating the true anatomy of the ACL. In his approach special techniques allow preservation of the origin and insertion of the torn ACL, which then integrates into the newly created ACL graft. The small incisions allow a rapid recovery with much less pain than a typical ACL reconstruction. Dr. Barry has performed a number of ACL reconstructions on professional athletes including soccer players, rugby players and many other sports and they are able to return to the high demands of their sports. Dr. Barry has extensive experience with combined ACL and cartilage restoration, as well as multiple ligament reconstruction from his training during fellowship in sports medicine. Shoulder Arthroscopy Dr. Barry has performed hundreds of Shoulder Arthroscopies and has recently submitted a publication with some of the best standardized shoulder scores for pain and function in the literature. His percutaneous technique allows a return to normal function in the most rapid and complete manner possible. A pain protocol of local injection and a nerve block that he performs during surgery combine with ice and medication protocols to minimize any surgical pain. Early range of motion is possible with exercises started the very next day after surgery. With sub- specialty training and extensive experience in these specific surgical procedures Specific Sports Medicine Specialties Communicating with the medical team One of the most important aspects of medicine is knowing the strengths of your team. As a team physician with professional sports teams, I have worked with up to 6 other physicians at the same event. We may have an orthopedic surgeon, internist, neurologist, dentist, podiatrist, chiropractor, and more, all at the same event working together. I send a consultation note for all new patients to the referring doctor, and surgical patients see their physician for medical clearance before surgery. I follow up with written notes regarding each case. 4
Orthopedic Trauma, common injuries and a minimally invasive approach Residency training and extensive experience at USC+LAC Hospital, SMOG, Sports teams trauma Minimally invasive treatment of traumatic injuries For many years traumatic injuries, many of which occur in sports, have been treated with maximally invasive techniques, previously thought necessary to best restore anatomic position. A shift toward minimally invasive techniques led to some surgeons prioritizing incision size over restoring proper anatomy. The best treatment is one in which muscle and soft tissues are preserved with techniques that also restore anatomy and function. This is the method I use in approaching trauma injuries, sports related or not. Common traumatic injuries and fractures and minimally invasive treatment Wrist fractures The invention of the locking plate has allowed for a surgeon to restore early motion and recreate anatomy of the distal radius by going between muscles and tendons rather than through them. A 6-8 cm incision is all that is needed to insert the plate on a broken wrist. The plates rarely need to be removed, and patients are free to return to regular function and forget about the injury and surgery. Clavicle Fractures For many years, surgeons have ignored the importance of a shortened clavicle, and good enough for adequate function was seen as an excellent result. However, with the demands of new population who want to reach their best possible outcome, and want to continue competitive sports for their entire life, surgeons are re- evaluating the importance of restoring the anatomy of the clavicle- - the strut that maintains the shoulder in place. I treat clavicle fractures with a special anatomic plate, which is designed to restore the complex double S curve. In this minimally invasive approach, I search for the small nerves the run over the clavicle and preserve them rather than cutting the nerves which supply sensation over the chest. Athletes can get back to sports much more quickly than without surgery, and restore their full function rather than compromise their ultimate performance through a residual deformity. Shoulder Separation (AC Joint Dislocations) The end of the clavicle joins the shoulder blade at the AC (Acromio- Clavicular) Joint. A fall on the clavicle may result in a fracture, but a fall a little farther to the outside can result in a shoulder separation or AC joint dislocation. This is a common cycling or football injury though it can occur in many different sports. A partial separation (Grade I or II) is treated with a sling. Intermediate (Grade III) can be treated without surgery initially but may need intervention if it does not become painless on its own. High Grade (IV or V) Separations need surgical treatment for restoration of function. Hip Fractures A hip fracture is one of the most common injuries in patients over 65; this type of injury can be treated in a number of different ways depending on the injury pattern. A typical pattern is the Inter- Trochanteric fracture of the hip. For a inter- trochanteric hip fracture, I typically use an intramedullary (a locking rod inside the hollow part of the femur) as it allows for preservation of the most muscle and tendon. 5
Truly Minimally Invasive Surgery Faster Recovery, Better Ultimate outcomes, Minimizing Pain Long- Term Recovery of Function Least invasive: Prevention and rehabilitation Injury prevention is the least invasive approach of all, and prevention of re- injury is just as important. Patients with ACL tears are 10 times more likely to tear their graft ACL again compared to a patient who has never had an ACL injury. They are twice as likely to tear their normal knee s ACL as their reconstructed knee s ACL. Advanced, intensive rehabilitation focused on the hip and core (and not the quadriceps) is the key to prevention of initial and recurrent tears. My approach to the treatment of injuries through minimally invasive technique and guiding patients through rehabilitation is the key to a rapid and long- lasting return to function. Please visit my webpage to view approaches to rehabilitation and other information on services. www.piersbarrymd.com A truly minimally invasive approach to surgery is important for faster initial recovery and decreasing pain after surgery, but also for the ultimate goal of regaining pain free and full function. Often minimally invasive surgery is only associated with incision size, which impacts cosmesis, but truly minimally invasive surgery is actually related to what happens beneath the surface with tendons, ligaments, and muscle tissue. This aspect is far more significant for pain and function. The most important aspect of minimally invasive sports surgery is the restoration of anatomic function, followed by the preservation of muscle, tendon, and soft tissue. While in recent years open surgery has been largely replaced with arthroscopic surgery, open surgery can be a better option to best preserve tissue. One specific example of this is AC Joint reconstruction for a separated shoulder a common cycling and football injury. In the reconstruction of an ACL, surgeons previously used a large open incision 10-12 inches in length disrupting the entire knee. The race to do surgery through pleasing small arthroscopic incisions was problematic because initially the anatomy was not recreated. The surgery is not minimally invasive if it is done imperfectly! I use 2-3 small arthroscopic portals and a 1-2 inch tibial opening to allow for perfect visualization and completely anatomic ACL reconstruction with preservation of the native footprint. We have made rapid advances in ACL reconstruction. 30 years ago, following surgery patients were casted and kept in the hospital. Now, the ACL reconstruction is performed as an outpatient procedure and patients are allowed full range of motion in a brace and are walking well within weeks. Pain control is established through a mixture of the minimally invasive technique, local anesthetics, and multi- modal pain control. The results of this approach, as with all true minimally invasive surgery show better long- term function and recovery, as well as short- term easy recovery and minimal pain. 6
Contact us Our friendly office staff will gladly set up an appointment to treat any injured patients. Location: 711 D Street, Suite 102 San Rafael, CA 94901 Visit our website www.piersbarrymd.com Call us at 415-457- 7414 Please contact our office to meet and discuss my experience and approach to treating patients and why your injured patients should make an appointment with me