Surgeon Expands Patellofemoral Research, Women’s Sports Medicine

April 9, 2018

Miho Tanaka established a network of medical professionals to spark an international conversation regarding women’s sports medicine. Here, Tanaka cares for Amy Lupcho.

Miho Tanaka understands the complexities of multifaceted treatment needed to keep women athletes in the game. A former varsity track and field athlete at Stanford University, she is now an assistant professor of orthopaedic surgery and director of the Women’s Sports Medicine Program at The Johns Hopkins Hospital.

Inspired by Andrew Cosgarea, her mentor and colleague in orthopaedic surgery who taught her the value of multidisciplinary collaboration, Tanaka has broadened the field of knowledge in patellofemoral research and established a unique network of medical professionals to spark cultural exchange across continents regarding women’s sports medicine.

Tanaka’s award-winning work has contributed to the advancement of anatomic knowledge of the medial patellofemoral complex (MPFC), which many surgeons refer to as the medial patellofemoral ligament. Tanaka and her co-author, John Fulkerson, a leader in patellofemoral surgery, coined MPFC as a more accurate term reflecting the variability in anatomic attachment points.

“Using a digital overlay technique, we identified a reproducible anatomic reference point at the superomedial articular border of the patella,” explains Tanaka. This midpoint is more proximal than the commonly used fixation site in surgical reconstruction. Tanaka’s goals are to show that re-creating this anatomy may lead to improved patellar kinematics and patient function, and to make surgeons aware of the complications that can occur during patellar stabilization surgery, which range from patellar fractures to increased arthrosis.

“Our goal as surgeons is to re-create the anatomy, and our understanding of the anatomy continues to evolve,” says Tanaka. Her work with Cosgarea includes generating new data using a dynamic computed tomography (CT) machine. There are only two such devices in North America, and one is at Johns Hopkins.

“The beauty of this machine,” says Tanaka, “is that you can bend the knee and watch the tracking of the patella, because it is when the knee is in motion that dislocation happens.” Tanaka and Cosgarea recently described a classification system for dynamic CT tracking to predict the presence of symptoms, thereby laying the groundwork as technology for dynamic CT becomes more widely available.

At Johns Hopkins, Tanaka designed the model for the Women’s Sports Medicine Program that includes areas not traditionally associated with women’s sports, such as nutrition and pregnancy. “I see a lot of women athletes who are seeking second opinions and who have been told that they should stop being active,” Tanaka says.

To bridge the disparities in treatment, Tanaka brought together specialists from nine divisions and departments at Hopkins, including faculty from obstetrics and endocrinology, and specialists in concussions and eating disorders. The program acknowledges the connections between issues such as nutrition, performance and healing.

Recently, Tanaka was invited back to Kobe, Japan, where she toured during her American Orthopaedic Society for Sports Medicine traveling fellowship, to conduct Grand Rounds on women’s sports medicine. “Asian countries do not have many female orthopaedic surgeons or women’s sports programs,” says Tanaka. “The traveling fellowship taught me the importance of academic cross-cultural exchange, so I am hoping to generate interest in gender research and expand the model of our program for female athletes to an international level.”

The Women's Sports Medicine Program includes:

  • Sports medicine surgery
  • Primary care sports medicine
  • Hand, shoulder and elbow surgery
  • Foot and ankle surgery
  • Concussion management
  • Eating disorders and nutrition
  • Internal medicine
  • Obstetrics
  • Musculoskeletal radiology
  • Physical therapy

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