SERVICES

PRIVATE SURGERY

Dr. Jason Smith provides timely arthroscopic surgical treatment for all patients across Canada. For patients who travel out of province, private surgical care is one way to avoid long and challenging wait times for elective orthopaedic care in Canada.

Private surgical services are provided at Optimus Vitae Surgival (OVS). OVS is located in downtown Toronto and is a level 3 out of hospital premise facility. It’s fully accredited by the College of Physicians and Surgeons and operates at the highest standards of quality and patient care. Their experienced surgical team will provide the ultimate experience in safe and efficient care.

Optimus Vitae Surgical

Public Surgery

For Ontario residents with a valid OHIP number, Dr. Smith offers surgical services through the Scarborough Health Network. To access public surgery, patients must first obtain a referral from a healthcare provider, such as a general practitioner, sports medicine doctor, emergency room physician, or another specialist. A referral is necessary not only to ensure appropriate care but also to comply with billing requirements. Dr. Smith cannot see patients without one.

BRACING

Orthopaedic sports medicine is dedicated to identifying, treating, and preventing musculoskeletal injuries and conditions among athletes. Within this field, bracing has become essential for both preventing injuries and managing them after they occur. Braces are specialised orthopaedic devices crafted to provide support, stability, and protection for injured joints, ligaments, and muscles. They are crucial in aiding the recovery process, enabling athletes to safely resume their sports activities.

    • Injury Prevention: One of the primary purposes of bracing in orthopedic sports medicine is injury prevention. Athletes often subject their bodies to intense physical activities, which can predispose them to various musculoskeletal injuries. Braces provide additional support to vulnerable joints and muscles, reducing the risk of re-injury. For example, ankle braces are commonly used to prevent ankle sprains in sports such as basketball and soccer.

    • Pain Relief: For some conditions such as osteoarthritis, braces may help with pain relief if the affected joint or compartment within a joint can be unloaded. For example, hip and knee unloaders can be used in this setting.

    • Postoperative and Injury Rehabilitation: After surgical interventions or conservative treatments, athletes may need external support to facilitate healing and protect the injured area. Braces help maintain joint stability, reduce pain, and allow controlled movement during recovery.

    • Prophylactic Braces: These braces are designed to prevent injuries and are commonly used in high-risk sports like football. They offer stability and protection to vulnerable joints.

    • Functional Braces: Functional braces are prescribed after an injury has occurred. They provide support to the injured area while allowing for some degree of movement, aiding in the recovery process.

    • Rehabilitative Braces: These braces are used during the rehabilitation phase. They limit motion to protect healing tissues, such as after ACL reconstruction surgery.

    • Unloader Braces: Unloader braces are primarily used in the management of osteoarthritis. They offload stress from the affected joint, reducing pain and improving function.

  • The effectiveness of orthopedic bracing in sports medicine is well-documented. Numerous studies have shown that bracing can significantly benefit athletes by:

    • Reducing the Risk of Injury: Prophylactic braces can help prevent injuries by providing support and stability to vulnerable areas, such as the ankle or knee.

    • Enhancing Rehabilitation: Functional and rehabilitative braces assist in the recovery process by providing support without hindering necessary joint movement.

    • Enabling Early Return to Play: Athletes recovering from injuries often use braces to safely return to sports activities as these devices offer protection and support. An example of this would be a custom ACL brace for patient who had non-operative care for an ACL injury or for those returning to sport following ACL reconstruction.

    • Managing Chronic Conditions: Bracing is an essential component of managing chronic conditions like osteoarthritis, allowing individuals to maintain an active lifestyle with reduced pain.

    • Improving Performance: In some cases, athletes with minor injuries or instability may wear braces to improve performance by increasing joint stability.

VISCOSUPPLEMENTATION

Viscosupplementation is an intra‐articular injection technique applied globally in orthopaedic practice to manage osteoarthritis (OA) in joints. Hyaluronic acid (HA) exerts a mechanical effect by providing lubrication of the joint and inhibits pain and inflammation. It also reduces programmed cell death in osteoarthritic cartilage. These benefits have made HA a commonly adopted bioactive molecule for intra‐articular therapy.

  • Viscosupplementation is injection therapy for osteoarthritis. It involves the injection of a lubricating fluid called hyaluronic acid into the joints. It is primarily used to alleviate the symptoms of osteoarthritis.

  • Viscosupplementation mainly targets osteoarthritis, a degenerative joint disease characterized by the breakdown of cartilage, leading to joint pain and reduced mobility. The rationale behind viscosupplementation lies in the properties of hyaluronic acid, a naturally occurring sugar substance found in the fluids in the eyes and joints. Hyaluronic acid is a powerful bioactive molecule.

    In healthy joints, HA acts as a shock absorber and lubricant, allowing smooth joint movement. However, in osteoarthritic joints, the concentration and quality of HA decrease, contributing to joint pain and inflammation.

    Viscosupplementation involves injecting a concentrated solution of high molecular weight HA directly into the affected joint to restore the lubricating synovial fluid and cushion the joint. The HA supplements the natural lubrication within the joint, reducing friction, dampening mechanical forces, and providing pain relief. Additionally, HA may have anti-inflammatory properties, further contributing to pain reduction.

  • Viscosupplementation is primarily indicated for the management of knee osteoarthritis, although it has also been used in other joints such as the hip and shoulder. Viscosupplementation is typically considered when conservative treatments, such as physical therapy and oral analgesics, have failed to provide adequate relief.

  • The ideal candidate for viscosupplementation is typically a patient with mild to moderate osteoarthritis, characterized by joint pain, stiffness, and limited mobility. It is important to note that viscosupplementation is not a cure for osteoarthritis but rather a means of symptom management.

  • Hyaluronic acid is biocompatible, biodegradable, and non-toxic. A 2021 Review found that viscosupplementation effectively reduces pain, increases functionality, and delays surgery in the knee to treat osteoarthritis. Because it reduces friction it helps protect the cartilage in the affected joints and reduces inflammation.

    Several factors can influence the outcomes of viscosupplementation, including the type of HA used, the stage of osteoarthritis, and the patient’s individual response. Dr. Smith carefully assess each patient and tailors the treatment accordingly.

  • The viscosupplementation procedure is relatively straightforward and minimally invasive. It is typically performed in an outpatient setting and does not require anesthesia. The patient’s skin over the affected joint is cleaned and sterilized. Then a fine needle is inserted into the joint space, and the HA solution is slowly injected. After the injection, the patient may be advised to avoid strenuous activities for a brief period to allow the HA to settle within the joint.

    As with any medical procedure, there are potential risks and side effects associated with viscosupplementation. These may include pain at the injection site, swelling, and transient joint discomfort. Serious complications are rare but can include infection or an allergic reaction to the HA product used.

PRP THERAPY

Platelet-rich plasma (PRP) is a cutting-edge therapy that utilises the body’s own healing power to treat a variety of musculoskeletal conditions including sports-related injuries of the muscles, tendons and ligaments, and osteoarthritis. Platelet-rich plasma therapies have been used for various indications for over thirty years. For musculoskeletal conditions most patients can resume their work and activities immediately after treatment. In some cases, PRP therapy is an alternative to surgery.

  • Platelets are best known for their blood clotting ability, but they are a natural reservoir of hundreds of biologically active proteins called growth factors that play a key role in wound healing and tissue repair. When there is an injury or inflammation, platelets flood the area to stop bleeding, and heal damaged tissues.

    • Platelet – rich plasma is a solution made by concentrating platelets, and growth factors to increase potency many times more than whole blood. PRP has both anti-inflammatory properties and for some conditions such as muscle injuries may contribute to the healing process.

  • A small amount of the patient’s blood is drawn and spun in a centrifuge to separate the platelets from other blood cells in order to increase platelet concentrations. The concentrated platelets and growth factors are injected at the site of patient’s injury or damage such as into an arthritic joint, or into the zone of muscle damage following a sporting injury.

  • PRP therapy is very safe with a low incidence of adverse events.  The most common side effects include temporary pain and discomfort at the site of the injection which subsides after several days.  Because PRP is derived from your own blood and is minimally manipulated, the risk of adverse reactions remains low.

  • PRP has found a wide range of applications in orthopedics, making it a valuable treatment option for various musculoskeletal conditions. Here are some of the key orthopedic applications of PRP:

    • Osteoarthritis: PRP is increasingly used to manage osteoarthritis, a degenerative joint disease that causes pain and limited mobility. Injections of PRP into arthritic joints can reduce pain, improve function, and potentially slow down the progression of the disease.

    • Tendon Injuries: Tendon injuries, such as tennis elbow, Achilles tendonitis, and rotator cuff tears, can be treated with PRP injections. PRP helps stimulate tendon healing, reduce pain, and improve tendon strength.

    • Muscle Injuries: PRP has shown promise in treating muscle injuries, such as strains and tears. It can accelerate muscle repair and reduce the time required for athletes to return to sports. An example of this is for hamstring and calf injuries in sprinting athletes.

    • Pain relief

    • Decreased inflammation

    • Tissue healing in some micro-environments (e.g. muscle tears)

    • Restoration of function


    • Degen RM, Hiemstra LA, Lobo J, Woodmass JM, Sommerfeldt M, Khan M, Carsen S, Pauyo T, Chahal J, Urquhart N, Grant J, Rousseau-Saine A, Lebel ME, Sheehan B, Sandman E, Tucker A, Kopka M, Wong I. Arthroscopy Association of Canada Position Statement on Intra-articular Injections for Hip Osteoarthritis. Orthop J Sports Med. 2022 Feb 7;10(2):23259671211066966. doi: 10.1177/23259671211066966. PMID: 35155702; PMCID: PMC8832617.

    • Everts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. Int J Mol Sci. 2020 Oct 21;21(20):7794. doi: 10.3390/ijms21207794. PMID: 33096812; PMCID: PMC7589810.

    • Shyla Gupta, Anna Paliczak & Diego Delgado (2021) Evidence-based indications of platelet-rich plasma therapy, Expert Review of Hematology, 14:1, 97-108, DOI: 10.1080/17474086.2021.1860002