FAYETTEVILLE—In addition to private practice, Terry Sites, MD, Advanced Orthopaedic Specialists, along with three partners, provides orthopedic care for more than 500 Razorback athletes at the University of Arkansas, Fayetteville. In Razorback country, famous for placing a titanic regard on athletics, this is a huge responsibility.
“It is highly rewarding to work with elite level athletes,” Sites said. “Taking care of the Arkansas Razorback student-athletes has been a highlight of my career. The students are all so grateful when you can help them reach their athletic goals. The University is very supportive and makes our job easier.”
While being an orthopedic surgeon in this setting is high pressure, Sites has never thought of it as being particularly stressful.
“Like in most challenging situations, if a person has excellent training, dedication of preparation, and a history of success, it gives you the confidence to enjoy these type of environments,” Sites said.
One of his greatest challenges is time management. Fortunately, his four boys are all college students or older, which gives him more opportunity to work with the Razorbacks.
The sub-specialization of orthopedic surgery has been a relatively new phenomenon. Sports medicine is one of those sub-specialties, and its exponential growth has paralleled Sites’ career.
“From my perspective, the most important advancements in sports medicine have been the development of arthroscopic techniques, anterior cruciate ligament reconstructive surgery, rotator cuff and labral surgery,” Sites said. “Arthroscopic surgery is minimally invasive surgery which reduces risks, decreases pain, improves outcomes, and facilitates recovery.”
One of the most important types of orthopedic surgical procedures performed today using arthroscopic techniques is that of anterior cruciate ligament reconstruction. Techniques utilized today in which surgeons perform an anatomic substitution type of reconstruction facilitate injured athletes making a full recovery.
“Prior to these more modern techniques, an anterior cruciate ligament injury was often career ending,” Sites said. “When I first began my career, patients were often admitted to the hospital for several days following ACL reconstruction, and recovery maybe took a year or longer. Surgeries are now conducted on an outpatient basis and, with accelerated recovery programs, athletes are often allowed to return to full athletic participation by six months, sometimes even earlier.”
Unfortunately, although there have been tremendous advancements in terms of reconstructive techniques and recovery, there hasn’t been much progress in preventing such injuries.
“In fact, with the increased participation of the female athlete in scholastic, club and collegiate sports, there has been an exponential rise in ACL injuries,” Sites said. “The female athlete participating in sports such as soccer and basketball is at least four times more likely to sustain an ACL injury versus the comparable male population.
“There has been much research, and many theories on the increased risk for ACL injuries as a female athlete, but none fully confirmed. Many believe that there are a multitude of factors, such as less muscular support, a wider pelvis and/or hormonal influences, in addition to others. Preventive programs such as strengthening and training in the proper way to jump and land has shown some early promise.”
The repair of rotator cuff tears has been a large part of his practice. When he started out in private practice 20 plus years ago, all rotator cuff repairs were performed in open surgery. Today he performs essentially all rotator cuff repairs arthroscopically. This allows for the repair of large or massive tears that were previously extremely difficult or impossible to repair through open techniques.
“Repairs of the rotator cuff performed arthroscopically often times result in a less painful recovery and decreased risk of stiffness,” said Sites, who is chief of orthopedic surgery at Northwest Physicians Specialty Hospital. “Advancements in techniques and materials have allowed for tremendous facilitation in the performance of these types of procedures. Essentially all rotator cuff surgery performed today is on an outpatient basis. Improvements in anesthesia with regional nerve blocks has greatly decreased the initial pain associated with rotator cuff surgery.
“I employ specific physical therapy and rehabilitation techniques which allow for consistent and reproducible positive outcomes with rotator cuff surgery. Likewise, labral surgeries for patients with unstable shoulders is almost always conducted arthroscopically today, with the same type of benefits as outlined above for the rotator cuff patients.”
A native of St. Louis, Sites was named by the Missouri State Medical Association as the top medical graduate of 1984. He completed a residency in orthopedic surgery at the University of California, Davis, followed by a fellowship in sports medicine at Baylor College of Medicine in Houston.
Sites dates his first interest in medicine to the fifth grade after reading a book about the first heart transplant by Dr. Christiaan Barnard in South Africa.
“From that moment, I was dedicated to become a physician,” he said. “It really gave me the motivation to be an excellent student.”
Sites, who played college basketball, said orthopedic surgery and his sub-specialty of sports medicine have been rewarding because of the potential for greatly improving the lives of patients.
“This has been a perfect environment for me,” he said. “It has stimulated a career of learning and dedication.”
He also performs total hip and total knee replacements, primarily for osteoarthritis. There have been a number of improvements over the years to reduce the risks of surgery and improve patient outcomes.
“The benefits of total joint arthroplasty for end-state osteoarthritis at the hip and knee has been well documented in terms of preserving independence and quality of life,” Sites said. “There have also been some very exciting techniques we have been employing for several years which may enable patients with non-end-stage osteoarthritis to put off having joint replacement. These utilize cartilage grafting whereby we are able to remove cartilage cells from the individual's body, grow them in a culture medium and re-plant them in the knee to restore the damaged cartilage surface to normal or near normal.”
In addition to Sites, the Advanced Orthopaedic Specialists team that treats Razorback athletes and private patients includes Mark Powell, MD, Chris Arnold, MD, and Ramon Ylanan, MD.
Sites and his wife of 27 years, Odulia, have four adult sons: Trevor, Taylor, Jaret and Ryan. He is an avid ornamental, herbal and vegetable gardener and “loves all things outdoors, particularly fly fishing. I am an international fly fisherman and enjoy traveling to different parts of the world to experience those environments, unique cultures and the people that live there. I am very excited about my upcoming trip to the Amazonian jungle in Bolivia to fly fish for golden dorado.”