Jeffrey Nepple, MD, is an orthopedic surgeon who specializes in pediatric sports medicine as well as adolescent and young adult hip disorders. As a former college athlete, he finds it very rewarding to be involved in the rapidly changing field of pediatric orthopedics.
Dr. Nepple sees patients at:
•St. Louis Children’s Hospital, 4S-60, One Children’s Place.
•Center for Advanced Medicine, Orthopedic Surgery Center, Suite 6A, 4921 Parkview Place.
•St. Louis Children’s Specialty Care Center, 13001 North Outer Forty
FOR AN APPOINTMENT, PLEASE CALL (314) 514-3500
What happened in the course of schooling to influence you to choose your specialty?
I played competitive sports growing up and throughout college. My experience of recovering from sports-related injuries during that time influenced my choice of specialty. I value the ability to help someone with an acute sports injury, whether with or without surgery, and return that individual to health and a high level of performance.
Why did you choose pediatrics?
Pediatric sports medicine is a very interesting and under-researched area; and there are great opportunities to help young athletes not only recover from injuries, but prevent injuries as well. This is something we don’t do a great job of right now. My practice is a bit unique in that several aspects of it are very specialized -- pediatric sports medicine is a new field. We are seeing more overuse injuries in younger athletes that we didn’t see 10 or 15 years ago, due to increased participation in year-round sports.
The other aspect of my practice deals with young adult hip conditions. This area spans the adolescent as well as the young adult patient -- and I do treat some adults. We are beginning to understand more what causes hip arthritis in the later years. We now have the opportunity to help individuals with hip conditions at a younger age and hopefully reduce the pain and improve hip function in a timelier manner.
What have you found that might be causing arthritis in older adults?
In the last decade there has been a shift in our understanding of what causes hip arthritis. Hip dysplasia, or shallowness of the hip socket, has always been known as a clear cause of arthritis, and it tends to be more common in females. For years we’ve not fully understood the primary causes of hip arthritis in males. Research has shown that boney deformities in the hip, especially in high level athletes, can lead to problems in the long-term -- femoroacetabular impingement (FAI).
FAI is a mechanical problem when the hip doesn’t have enough motion before the hip bones impinge. Over time there is repetitive damage to the acetabular labrum, which is like the meniscus of the hip; and eventually there is damage to the cartilage. We can now diagnose these patients at an earlier stage, and hopefully prevent arthritis from occurring when they are adults.
Why has there been this increase in pediatric sports injuries?
We’ve known that overuse injuries of the shoulder and elbow of a young athlete (usually a pitcher playing high-level sports) affects development of the upper extremities in a certain way. We are now seeing these overuse injuries in the hips, as well. Athletes participating in competitive sports at a young age are at an increased risk for developing these subtle hip deformities that can cause problems in the long run. Whereas the person who cuts back his or her activity level and isn’t as active in high school or college sports, may never experience a problem from those same deformities.
Year-round specialization in a single sport at an early age is probably not beneficial for musculoskeletal development as well as coordination -- aspects that are usually overlooked. There is value to cross- training and playing different sports; and the risk of injury is lessened in the long-term. A recent study of high school female soccer players found that the girls playing soccer year-round run the risk of ACL injuries as high as 10% per year – which is remarkably high.The specialty of pediatric sports has flourished as a result of all the injuries we are seeing now -- injuries we didn’t use to see in the past.
At the end of the day, it comes down to coaches and the parents. It’s important to be knowledgeable about overuse injuries. Sometimes coaches put pressure on their best players to play, but parents have the best opportunity to protect their children.
What brought you to Washington University?
The environment at Washington University is unparalleled and it was an honor to come here for medical school over a decade ago. I stayed for residency and returned after my fellowship training. The environment here pushes you to strive for the next level.
Your undergraduate degree was in math, did you always know you were going into medicine?
When I started college I wasn’t absolutely sure I would go into medicine. I valued the opportunity to broaden my experience in an area outside the typical pre med education.
What new developments are you most excited about?
Young adult hip disorders is the area of orthopedics that’s changed the most in the last decade. We are at a time where there are great opportunities to help those patients in minimally invasive ways that we couldn’t in the past. We will continue to push the limits of what can be done through arthroscopic surgery in order to expedite patient recovery. Additionally, pediatric sports medicine is also a very immature field. We’ll have great opportunities to help these kids through education and treatment/prevention of their injuries.
Treatment of musculoskeletal injuries in children can be challenging, because there can be other issues – children are still growing. The injuries are around their growth plates, which makes surgical aspects technically more difficult. Major musculoskeletal injuries for a child can be a life-changing event if he or she is not able to stay active. Through research we are learning more about how to best treat those children, so hopefully we can set them up for a lifetime of health and activity.
What is the Children’s Specialty Care Center?
The Children’s Specialty Care Center (located at 13001 North Outer Forty in Town & Country) is a new outpatient facility for children and adolescents, offering many pediatric specialties including outpatient surgery. In addition, there will be same-day access to see orthopedic medical staff for injuries during regular office hours – instead of the traditional emergency room wait, which can be overwhelming for a child.
We also will be launching the Washington University and St. Louis Children’s Young Athlete Center – with multidisciplinary teams to handle all aspects of care for the immature/pediatric athlete. Our goal is to provide services for the young athlete that, in the past, were hard to find or weren’t even available. These services include prevention, treatment of injuries and physical therapy – whatever care the young athlete needs.
Where did you grow up?
I grew up in Templeton, a small town and rural farming community in western Iowa, where my dad sold John Deere tractors. I went to college and played basketball at Truman State in northeastern Missouri. After medical school and residency here at Washington University, I did my sports medicine fellowship in Vail, Colorado at the Steadman Clinic. That was a great experience for my family – we enjoyed mountain life for a year. I then returned to Washington University for my pediatric fellowship. My two fellowships (adult sports and pediatrics) give me a broader perspective on the intersection of those two fields.
What is the best advice you’ve received?
It’s a little bit generic, but the advice to ‘just be yourself’, has always been helpful for me. Everybody has his or her own personal strengths and weaknesses. At the end of the day, being able to look yourself in the mirror and know you did your best to help your patients or you did your best as a husband and dad, is how I try to evaluate myself. This is a valuable approach to take in all aspects of life – you are the only one who will ever know if you put your all into what you are doing. That’s the yardstick with which I measure myself.
If you weren’t a doctor, what would you like to be doing?
I would probably be a coach. I enjoy interacting with young athletes. Coaches have a great opportunity to influence kids and impact their development – and I think that’s often overlooked.
Do you still play basketball?
Yes, occasionally. I’m trying not to get hurt!