The Sports Docs Podcast

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Lateral extra-articular procedures (LEAPs) have evolved from a controversial adjunct to ACL reconstruction into an increasingly evidence-supported tool for managing rotational instability and reducing graft failure in appropriately selected patients.

In this episode of The Sports Docs Podcast, Drs. Henry Ellis and Bonnie Gregory join us live from the AOSSM Annual Meeting to discuss where lateral augmentation fits in modern ACL management. They explore the evidence behind lateral extra-articular tenodesis (LET), patient selection and indications, potential complications, LET versus anterolateral ligament reconstruction (ALLR), surgical technique, fixation strategies, and rehabilitation considerations.

The conversation also highlights the Arthrex Knee FiberTak system, including how an all-suture anchor platform may address some of the limitations of traditional LET fixation.

Key Topics Discussed

Why add a lateral augmentation procedure to ACL reconstruction?
- Evidence demonstrating reduced ACL graft rupture and improved rotational stability
- The role of LEAP in high-risk primary ACL reconstruction and revision ACL surgery
- Impact on return to sport and pre-injury level of play
- Emerging evidence supporting the cost-effectiveness of LET
Understanding the potential downsides
- Lateral-sided pain and hardware irritation
- Hematoma and need for hardware removal
- Early quadriceps weakness
- Concerns regarding over-constraint and long-term degenerative changes
- Whether adding a lateral procedure meaningfully changes postoperative recovery
Who actually needs a LEAP?
- Young, active athletes
- High-grade pivot shift or anterior laxity
- Knee hyperextension
- Revision ACL reconstruction
- Athletes returning to pivoting sports
- Hamstring autograft ACL reconstruction
- Multiple coexisting risk factors
- Chronic ACL deficiency and other emerging indications
LEAP in elite athletes
- How professional team physicians are approaching lateral augmentation
- Current practice patterns in elite and professional sports
- The balance between maximizing graft survivorship and avoiding unnecessary procedures
LET versus ALL reconstruction
- Differences in surgical approach
- Clinical outcomes and graft failure
- Rotational stability
- Operative time, cost, and potential complications
- Why surgeons may favor one technique over the other
Modern LET surgical technique
- Graft harvest and preparation
- Relationship of the graft to the LCL
- Femoral fixation
- Knee position during fixation
- Graft orientation and isometry
- Avoiding over-constraint
- Importance of anatomic attachment sites
- Management of the IT band at the conclusion of the procedure

Spotlight: Arthrex Knee FiberTak

The episode takes a closer look at the Knee FiberTak platform and its application in lateral augmentation.

The guests discuss how an all-suture anchor platform may offer advantages compared with traditional fixation methods, including:

Reduced hardware prominence
Bone preservation
Potentially decreased risk of tunnel convergence
Low-profile fixation
Ergonomic instrumentation designed specifically for the knee
Multiple fixation configurations for different surgical applications

The Knee FiberTak family includes:

Double-Knotless Anchor
Double-Knotted Anchor
Hybrid Anchor
InternalBrace Anchor
Knee FiberTak Button

The discussion explores how surgeons select between different configurations and how a versatile fixation platform can improve efficiency and adaptability in the operating room.

Rehab & Return to Sport

The episode concludes with a practical discussion of rehabilitation following ACL reconstruction with lateral augmentation.

While the addition of a LEAP generally does not dramatically alter standard postoperative restrictions, the guests emphasize several priorities:

Regaining full knee extension
Restoring quadriceps strength and activation
Monitoring early quadriceps recovery
Maintaining appropriate progression through rehabilitation
Preparing the athlete for a safe and successful return to sport

Summary

LEAPs are no longer simply a historical technique being revisited. Contemporary evidence suggests that appropriately selected patients—particularly young, high-risk athletes, patients with significant rotational instability, revision ACL cases, and athletes returning to pivoting sports—may benefit from lateral augmentation as part of a comprehensive ACL reconstruction strategy.

The challenge for modern sports surgeons is determining who truly benefits, which technique is most appropriate, and how to perform the procedure without introducing unnecessary morbidity or over-constraint.

Disclaimer

This episode is sponsored by Arthrex. The discussion includes Arthrex products, including the Knee FiberTak system. The views and opinions expressed by the guests are their own and are intended for educational purposes.

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Advances in ACL reconstruction continue to push the field toward stronger fixation, improved graft protection, and more biologically friendly implants. In this special sponsored episode of The Sports Docs Podcast, recorded live at the 2026 AOSSM Annual Meeting in Seattle, Drs. Catherine Logan and Ashley Bassett welcome Dr. Seth Sherman to discuss the latest innovations in graft fixation and how they are changing the way surgeons approach ACL reconstruction.

The conversation begins with one of the most important decisions in ACL surgery—graft selection. Dr. Sherman shares his approach to choosing between bone-patellar tendon-bone (BTB), quadriceps tendon, and hamstring autografts, emphasizing how patient age, sex, sport, anatomy, and activity level influence decision-making. He also discusses the growing body of evidence supporting quadriceps tendon autografts, particularly in young athletes and female patients.

The discussion then shifts to the evolution of graft fixation, from interference screws to adjustable-loop suspensory fixation, and the advantages of modern cortical fixation systems. Dr. Sherman explains how the Arthrex TightRope SB represents an evolution in ACL fixation by combining an all-suture, low-profile design with familiar surgical workflow, radiopaque visualization, and secure adjustable-loop fixation.

The hosts and Dr. Sherman also explore InternalBrace™ augmentation, reviewing the biomechanical rationale, surgical pearls, and emerging clinical evidence supporting graft protection during the vulnerable early phases of ligament healing. Together, they discuss how thoughtful implant design and biologic principles are helping surgeons optimize outcomes while preserving future surgical options.

Whether you're an experienced sports medicine surgeon or a trainee learning modern ACL techniques, this episode provides practical insights into the latest advances in ACL reconstruction.

In This Episode

Factors that influence ACL graft selection, including age, sport, sex, and anatomy
The growing role of quadriceps tendon autografts in primary ACL reconstruction
How suspensory fixation has evolved over the past decade
Advantages of adjustable-loop cortical fixation systems
Features and clinical applications of the Arthrex TightRope SB all-suture fixation device
Benefits of preserving bone stock and eliminating permanent metallic hardware
Radiopaque implant visualization and its role during surgery
Technical considerations and learning curve for adopting all-suture fixation
Biomechanical principles and clinical evidence supporting InternalBrace™ augmentation
Surgical pearls for avoiding over-constraint during InternalBrace fixation
How TightRope SB integrates seamlessly with InternalBrace augmentation
The future of biologically friendly, low-profile implant technology in ACL reconstruction

Key Takeaways

ACL graft selection should be individualized based on patient-specific factors including sport, anatomy, age, and sex.
Quadriceps tendon autografts continue to gain popularity due to predictable graft size, excellent clinical outcomes, and lower donor-site morbidity.
Adjustable-loop suspensory fixation has become a reliable and versatile option for modern ACL reconstruction.
The Arthrex TightRope SB combines familiar surgical technique with an all-suture, low-profile design that preserves bone and eliminates permanent metallic hardware.
Radiopaque implant technology offers additional intraoperative confidence while maintaining the benefits of soft-tissue fixation.
InternalBrace™ augmentation functions as a load-sharing construct that may reduce graft strain during early healing while allowing normal rehabilitation when properly tensioned.
Modern ACL innovation continues to focus on preserving biology, minimizing hardware, and improving long-term patient outcomes without increasing surgical complexity.

About Our Guest

Dr. Seth Sherman is a board-certified orthopaedic sports medicine surgeon specializing in arthroscopic and reconstructive surgery of the knee, shoulder, and elbow. He is widely recognized for his expertise in ACL reconstruction, cartilage restoration, and sports injury management, and is an active educator, researcher, and national lecturer dedicated to advancing evidence-based sports medicine.

This episode is sponsored by Arthrex.

Thank you to Arthrex for supporting continuing education and innovation in sports medicine.

Follow The Sports Docs Podcast for conversations with leading surgeons, researchers, and innovators advancing orthopaedic sports medicine through evidence-based education, surgical innovation, and multidisciplinary collaboration.

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The future of sports medicine isn't shaped solely in the operating room—it is also driven by visionary leadership, collaboration, education, and innovation. Live from the AOSSM Annual Meeting in Seattle, Drs. Catherine Logan and Ashley Bassett sit down with Corey Parker, MPA, the newly appointed CEO of the American Orthopaedic Society for Sports Medicine (AOSSM), to discuss his vision for one of the world's leading sports medicine organizations.

With more than two decades of executive leadership experience in healthcare, academic medicine, and national physician organizations, Corey shares what drew him to AOSSM and how he plans to help the society continue advancing education, research, advocacy, and member engagement in an era of rapid change.

The conversation explores how AOSSM is preparing surgeons for emerging technologies like artificial intelligence and biologics, expanding mentorship and leadership opportunities for early-career members, and strengthening collaboration across the multidisciplinary sports medicine team. Corey also discusses the importance of serving both academic and private practice surgeons while ensuring the organization remains innovative, financially strong, and increasingly valuable to its members.

Whether you're a resident just beginning your career or a seasoned sports medicine surgeon, this episode offers an inside look at the leadership shaping the future of our specialty.

In This Episode

Corey Parker's journey to becoming CEO of AOSSM
Why AOSSM continues to be a global leader in sports medicine
Supporting residents, fellows, and early-career surgeons through mentorship and leadership development
Strengthening connections between academic and private practice sports medicine physicians
Developing the next generation of leaders within AOSSM
Building stronger partnerships across the sports medicine care team
Corey's vision for the future of AOSSM and the legacy he hopes to leave

Key Takeaways

Leadership is essential to advancing sports medicine beyond clinical innovation.
Lifelong education and evidence-based guidance remain central to helping surgeons navigate an evolving field.
Mentorship and early career engagement are critical investments in the future of the specialty.
Collaboration across physicians, therapists, athletic trainers, researchers, and industry drives better patient care.
A strong professional society must continue evolving while remaining focused on its mission and its members.

About Our Guest

Corey Parker brings more than 20 years of progressive executive leadership in healthcare, academic medicine, and national medical societies. He currently serves as Chief Operating Officer of the American Association of Neurological Surgeons, where he oversees a complex enterprise of 65 staff and a combined operating budget exceeding $30 million. Previously, he served as Executive Director of Surgical Accreditation at the Accreditation Council for Graduate Medical Education, where he led accreditation efforts for orthopedic surgery and other surgical specialties nationwide. Earlier leadership roles within major academic health systems further reflect his expertise in operational excellence, financial stewardship, and large-scale team development.

Parker will join the AOSSM professional team on April 6, 2026. He succeeds CEO Greg Dummer, who announced his intent to retire last August. Dummer has served as CEO since July 2016 and will remain with the organization through the 2026 Annual Meeting to support a smooth and successful transition

Follow The Sports Docs Podcast for conversations with leading surgeons, researchers, and innovators who are advancing the field of sports medicine through cutting-edge science, education, and collaboration.

https://www.cloganmd.com/

https://orthopedicnj.com/physicians/ashley-bassett

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Recorded live from the American Orthopaedic Society for Sports Medicine (AOSSM) Annual Meeting in Seattle, Dr. Aaron Krych joins Drs. Catherine Logan and Ashley Bassett for an in-depth discussion on the rapidly evolving field of cartilage restoration. The conversation explores how treatment has shifted from simply filling cartilage defects to restoring the entire knee joint through comprehensive patient evaluation, biologic innovations, and advanced surgical techniques.

The Evolution of Cartilage Restoration

Why focal cartilage defects should be viewed as a "whole joint disease"
Moving beyond isolated microfracture
The growing importance of correcting alignment, instability, and meniscal deficiency
Earlier intervention in young athletic patients to preserve long-term joint health

Understanding Natural History

Why untreated cartilage defects can enlarge over time
Risk factors for lesion progression and development of secondary cartilage injuries
Counseling patients on long-term consequences and timing of intervention

Modern Treatment Algorithms

Why strict size-based algorithms are becoming less relevant
Patient-specific factors influencing procedure selection:
- Age
- Activity level
- Defect size and location
- Subchondral bone involvement
- Previous surgery
- Overall joint health

Diagnostic Evaluation

The expanding role of advanced MRI
When diagnostic arthroscopy remains essential
Emerging applications of nano-arthroscopy for:
- Preoperative lesion evaluation
- Assessment of graft incorporation
- Evaluation of persistent postoperative symptoms

Single-Stage Cartilage Restoration Techniques

AutoCart

Single-stage autologous cartilage restoration
Surgical technique pearls
Cartilage harvest using GraftNet technology
PRP/BMAC augmentation
Technical considerations for successful implantation

Osteochondral Options

When bone involvement changes the treatment strategy
Indications for:
- Osteochondral Autograft Transfer (OATS)
- Fresh Osteochondral Allograft Transplantation
Choosing between autograft and allograft techniques

Alignment Matters

Why cartilage restoration cannot succeed in an overloaded compartment
Indications for combining osteotomy with cartilage restoration
Medial high tibial osteotomy (HTO)
Distal femoral osteotomy (DFO)
Benefits of patient-specific instrumentation for osteotomy planning and execution

Lessons Learned

Dr. Krych shares valuable experience on why successful cartilage restoration depends on more than the graft itself.

Key factors influencing outcomes include:

Proper patient selection
Mechanical alignment
Knee stability
Meniscal integrity
Patient commitment to rehabilitation

Key Takeaways

Cartilage restoration has evolved from treating isolated defects to preserving the entire joint.
Modern decision-making is individualized rather than based solely on defect size.
Addressing alignment, instability, and meniscal deficiency is often just as important as restoring cartilage.
Biologic augmentation and single-stage procedures continue to expand treatment options.
Successful outcomes rely on appropriate patient selection and meticulous surgical technique.

Featured Guest

Dr. Aaron Krych is an orthopedic sports medicine surgeon at Mayo Clinic specializing in cartilage restoration, complex knee preservation, ligament reconstruction, and sports-related injuries. His clinical expertise and research have helped shape many of today's modern cartilage restoration strategies.

Subscribe to The Sports Docs Podcast for conversations with leaders in orthopedic sports medicine, surgery, injury prevention, rehabilitation, and athlete performance.

www.cloganmd.com

https://orthopedicnj.com/physicians/ashley-bassett

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Today’s episode is going to focus on surgical management of primary and recurrent anterior glenohumeral instability in athletes.

We are joined today by two outstanding guests!

Dr. John Kelly is a professor of orthopedic surgery at the University of Pennsylvania and Director of Shoulder Sports Medicine at UPenn Ortho. He is Co-director of the Sports Medicine Fellowship and is a team physician for the Philadelphia Union. Dr. Kelly is the former President of the Eastern Orthopaedic Association and Vice President of the Arthroscopy Association of North America.

Dr. Matt Fury is an orthopaedic surgeon at the Baton Rouge Orthopaedic Clinic who specializes in sports-related injuries to the shoulder, elbow, and knee as well as complex shoulder conditions. Dr. Fury graduated from LSU Medical School in New Orleans before completing his orthopaedic surgery residency at the Harvard Orthopaedic Residency Program. He then completed specialized fellowship training at the world-renowned Hospital for Special Surgery in New York City.

So, without further ado, let’s get to the Exhibit Hall!

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Today’s episode is going to focus on osteochondral allograft transplantation, and specifically how basic science research can and should impact your clinical practice.

We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center. He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox.

So, without further ado, let’s get to the Field House!

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Dr. Sabrina Strickland is an associate professor of orthopaedic surgery and an attending surgeon at Hospital for Special Surgery . She is active member of many societies and research groups, including the International Cartilage Repair Society and the International Patellofemoral Study Group.

Dr. Seth Sherman is the Director of the Sports Medicine Fellowship at Stanford University Orthopaedics and is a Stanford University Football team physician. He is Chairman of the AAOS Sports Medicine/Arthroscopy committee and is also a member of the International Patellofemoral Study Group.

Both Dr. Strickland and Dr. Sherman publish and lecture extensively on the topic of knee joint preservation, cartilage restoration and specifically patellofemoral cartilage disease - so we’re excited to hear them speak more this topic!

We are narrowing the focus of our conversation today to osteotomies. We just did a two-part episode with Dr. Cassandra Lee that tackles all the different cartilage restoration options for the patellofemoral joint. So go check that out if you want to hear more about when to choose OATS vs. OCA vs. MACI. But for today: let’s chat about osteotomies.

In this episode, we discuss:
What are some key findings to look for on exam and imaging to determine if a realignment osteotomy is needed?

We are familiar with the tibial tubercle trochlear groove (TT-TG) measurement, but what is the Sagittal TT-TG (sTT-TG) distance and what does it tell us?

How should a tibial tubercle osteotomy (TTO) be customized to address different areas of cartilage pathology? (Check out our Instagram - @thesportsdocspod - to see different types of TTOs based on location of cartilage lesion and/or presence of instability in the setting of malalignment.)

How can the TTO surgical technique be modified to minimize risk of complications when performing a complete tubercle detachment? Image 3 shows four surgical tips for lessening complication risk.

There are other osteotomies besides TTO to address patellofemoral pathology — including a derotational distal femoral osteotomy. What are the indications for this procedure?

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Could something as simple as a 20-minute bike ride improve the quality of platelet-rich plasma?

In this episode of Overtime with The Sports Docs, Drs. Ashley Bassett and Catherine Logan explore an intriguing laboratory study examining whether exercise performed immediately before a PRP blood draw can enhance the cellular composition of platelet-rich plasma.

As biologic therapies continue to expand throughout sports medicine, optimizing PRP has become increasingly important. While most discussions focus on centrifuge systems, platelet concentrations, leukocyte content, and injection techniques, this study introduces another potential variable: the patient.

The authors found that a brief bout of vigorous exercise significantly increased platelet concentrations and mobilized hematopoietic progenitor cells, raising the possibility that exercise could serve as a simple, low-cost strategy to optimize biologic treatments.

In This Episode, We Discuss:

The fundamentals of PRP and how it works
Why PRP variability remains one of the biggest challenges in interpreting the literature
Conditions with the strongest evidence supporting PRP:
- Knee osteoarthritis
- Lateral epicondylitis
- Patellar tendinopathy
- Plantar fasciitis
The concept of exercise-mobilized PRP
Differences between plasma-based and buffy coat PRP systems
Whether higher platelet concentrations actually translate into improved clinical outcomes
How this research may influence real-world PRP protocols

Study Breakdown

Study Design: Prospective laboratory study

Participants:
20 healthy volunteers (ages 21–45 years)

Exercise Protocol:

5-minute warm-up
20 minutes of cycling
Target heart rate: 70–85% of predicted maximum

Blood samples were obtained before and immediately after exercise and processed using two PRP systems:

ACP System (plasma-based PRP)
Angel System (buffy coat PRP)

Key Findings

Whole Blood Changes After Exercise

Platelet count increased approximately 22%
White blood cell count increased approximately 50%

ACP System

Platelet concentration increased from approximately:
- 457,000/µL → 562,000/µL

Angel System

Platelet concentration increased from approximately:
- 2.95 million/µL → 3.77 million/µL
PRP volume increased
Hematopoietic progenitor cell concentrations increased significantly

Why This Matters

The study suggests that patient physiology before blood collection may significantly influence the final biologic product.

A brief exercise session may:

Increase platelet yield
Mobilize progenitor cells
Potentially enhance biologic activity
Provide a low-cost method to optimize PRP preparation

For clinicians performing biologic injections, exercise may become another controllable variable alongside:

PRP preparation system
Centrifuge settings
Leukocyte concentration
Injection technique

Clinical Pearls

✔ PRP is not a single product. Composition varies substantially between systems.

✔ Patient factors may influence PRP quality just as much as centrifuge settings.

✔ Twenty minutes of exercise increased platelet concentrations in both PRP systems.

✔ Buffy coat systems demonstrated increased progenitor cell concentrations.

✔ The clinical significance of these changes remains unknown.

The Big Question

Does exercise-enhanced PRP actually improve patient outcomes?

This study demonstrates changes in laboratory measurements, but it does not tell us whether patients:

Heal faster
Experience less pain
Return to sport sooner
Demonstrate better tendon or cartilage healing

Future studies are needed to determine:

Optimal exercise type
Ideal exercise intensity
Timing before blood draw
Which conditions benefit most

Dr. Logan's Clinical Perspective

At the Joint Preservation Center, this study has prompted discussions about incorporating pre-injection exercise into PRP protocols. A simple 20-minute cycling session before blood collection may represent a practical strategy to optimize a patient's own biology before treatment.

While additional evidence is needed, this concept aligns with the broader goal of maximizing the effectiveness of biologic therapies through thoughtful patient preparation.

Take-Home Points

Exercise before PRP collection significantly increases platelet concentrations.
Short bouts of exercise may mobilize progenitor cells.
Patient physiology may influence PRP composition.
Exercise represents a low-cost, non-pharmacologic optimization strategy.
More research is needed to determine whether these laboratory changes improve clinical outcomes.

Resources Mentioned

Episode #161: Platelet concentration and outcomes following PRP for lateral epicondylitis
Recent Sports Docs episode with Dr. Arianna Gianakos discussing PRP for plantar fasciitis

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Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com

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The FIFA World Cup has begun and ACL injuries remain one of the most impactful injuries in professional soccer. While much of the discussion around ACL reconstruction focuses on graft choice, rehabilitation, and return-to-play timelines, a new study published in the American Journal of Sports Medicine highlights an often-overlooked challenge: secondary muscle injuries after athletes return to competition.

In this episode of Overtime with The Sports Docs, Drs. Ashley Bassett and Catherine Logan review the newly published article, "Secondary Muscle Injuries and Performance Decline After Anterior Cruciate Ligament Reconstruction in Professional Soccer." The study examines the incidence, timing, and impact of muscle injuries following ACL reconstruction in elite soccer players and explores how these injuries affect performance, playing time, and even market value.

The findings reinforce an important principle in sports medicine: return to play is not the finish line—it is only the next phase of recovery.

Key Discussion Points

Understanding ACL Injuries in Soccer

Common mechanisms of ACL injury in soccer
Why cutting, pivoting, deceleration, and landing place soccer players at particularly high risk
The career implications of ACL injuries in professional athletes

ACL Reconstruction Graft Options

Bone-Patellar Tendon-Bone (BTB) autograft
Hamstring tendon autograft
Quadriceps tendon autograft
Advantages and disadvantages of each graft choice
Why allograft tissue is generally avoided in elite athletes

Modern Return-to-Play Decision Making

Moving beyond time-based return-to-play criteria
Strength testing and limb symmetry
Hop testing and movement analysis
Neuromuscular control assessment
Psychological readiness for sport
Ongoing graft maturation and biologic healing

Study Review: Secondary Muscle Injuries After ACL Reconstruction

The authors evaluated professional male soccer players from Europe's top leagues who underwent ACL reconstruction between 2020 and 2023 and compared them with matched healthy controls.

Key findings included:

32.5% of ACL-reconstructed players sustained a secondary muscle injury within one year of return to play
Only 12.5% of matched controls experienced muscle injuries
ACL-reconstructed athletes were more than twice as likely to sustain a muscle injury after return

Most Common Secondary Injuries

Hamstring strains (42%)
Quadriceps strains (32%)
Calf injuries (16%)
Adductor injuries (11%)

Notably, nearly 70% of injuries occurred on the reconstructed side, suggesting persistent deficits may contribute to injury risk.

The Highest-Risk Window

One of the most important findings:

Nearly 58% of all secondary muscle injuries occurred between 3 and 6 months after return to competition

This period may represent a critical vulnerability window when athletes are increasing match exposure, training volume, and competition demands.

The Importance of the 9-Month Rule

The strongest predictor of secondary muscle injury was early return to play:

Athletes returning before 9 months after ACL reconstruction had nearly a fivefold increased risk of secondary muscle injury

This study adds to the growing body of evidence supporting delayed, criteria-based return to sport rather than return based solely on time.

Performance and Career Impact

Players who sustained secondary muscle injuries experienced:

Reduced playing time
Fewer minutes on the field
Decreased participation metrics
Declines in overall performance

The study also demonstrated significant reductions in player market value among athletes who experienced secondary injuries, highlighting the financial and career implications of incomplete recovery.

Strengths and Limitations of the Study

Strengths

Matched-control design
Focus on elite professional soccer players
Inclusion of performance metrics and market value outcomes
Real-world relevance for sports medicine clinicians and team physicians

Limitations

Retrospective study design
Relatively small sample size
No objective rehabilitation data available
No information on graft type
Lack of strength testing, hop testing, or psychological readiness measures
No workload or GPS tracking data

Clinical Takeaways

ACL recovery extends well beyond return to competition.
Return to play should be viewed as a milestone, not the endpoint.
The first 3–6 months after return may represent the highest-risk period for secondary injury.
Continued strength training, neuromuscular training, and workload monitoring remain essential after athletes resume competition.
Returning before 9 months after ACL reconstruction may substantially increase the risk of secondary muscle injury.
Successful ACL recovery is not simply about returning to sport—it is about staying healthy and performing at a high level after return.

Article Discussed

"Secondary Muscle Injuries and Performance Decline After Anterior Cruciate Ligament Reconstruction in Professional Soccer"

Published in the American Journal of Sports Medicine (AJSM), 2026.

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Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com

www.cloganmd.com

Follow us on Instagram @thesportsdocspod for the latest updates in sports medicine, injury recovery, and athlete performance.

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🎧 Episode Summary

In Part II of our discussion on plantar fasciitis, Dr. Ashley Bassett and Dr. Catherine Logan continue their conversation with Dr. Arianna Gianakos, orthopedic foot and ankle surgeon at Yale University. This episode focuses on treatment options for patients who fail initial conservative management, including injection therapies, biologics, and surgical intervention for recalcitrant plantar fasciitis.

The discussion highlights the latest evidence supporting platelet-rich plasma (PRP), compares PRP to corticosteroid injections and other nonoperative treatments, and reviews emerging minimally invasive surgical techniques—including nano-arthroscopic plantar fascia release.

Highlights

Platelet-Rich Plasma (PRP) for Plantar Fasciitis

Recent evidence continues to support the use of PRP for chronic plantar fasciitis.

Key findings from a 2024 Level I systematic review and meta-analysis:

PRP resulted in significantly greater pain reduction compared to:
- Corticosteroid injections
- Extracorporeal shockwave therapy (ESWT)
- Placebo injections
PRP demonstrated improved functional outcomes as measured by AOFAS scores.
Benefits were most apparent in patients with chronic, recalcitrant symptoms.

PRP vs Corticosteroid Injections

Corticosteroid Injections

Advantages:

Rapid short-term pain relief
Widely available
Low cost

Limitations:

Effects are often temporary
Higher recurrence rates
Potential risks include:
- Plantar fascia rupture
- Fat pad atrophy
- Tissue degeneration with repeated injections

PRP

Advantages:

Targets the underlying degenerative process
Encourages tissue healing and remodeling
More durable symptom relief
Improved long-term outcomes compared with corticosteroids

Challenges:

Higher cost
Lack of standardization in preparation techniques
Variability in platelet concentration and leukocyte content

The Role of Biologics

A key theme throughout the discussion is that biologics should be viewed as tools to optimize healing rather than miracle cures.

Important considerations include:

Appropriate patient selection
Chronicity of symptoms
Failure of structured conservative treatment
Realistic expectations regarding recovery timelines

When Is Surgery Appropriate?

Fortunately, most patients improve without surgery.

Surgical intervention may be considered when:

Symptoms persist for 6–12 months or longer
Conservative treatments have been exhausted
Pain continues to significantly limit daily activities, exercise, or athletic participation

Before surgery, patients should typically complete:

Stretching and strengthening programs
Orthotic management
Night splints
Physical therapy
Injection-based treatments when appropriate

Nano-Arthroscopic Plantar Fascia Release

The episode concludes with a discussion of a novel nano-arthroscopic plantar fascia release technique recently described in Arthroscopy Techniques.

Potential advantages include:

Single-portal minimally invasive approach
Reduced soft tissue disruption
Less postoperative pain
Reduced neurovascular risk
Earlier weightbearing
Faster return to daily activities and sport

Surgical Pearls

When performing plantar fascia release:

Partial release is preferred over complete release.
Over-release can alter foot biomechanics and increase lateral column pain.
Careful patient selection remains critical.
Surgery should be reserved for truly recalcitrant cases.

Key Takeaways

PRP demonstrates superior pain relief and functional outcomes compared to corticosteroid injections and placebo in chronic plantar fasciitis.
Corticosteroids may provide short-term symptom relief but do not address the underlying degenerative pathology.
Most patients improve with nonoperative management and never require surgery.
Surgical treatment should be reserved for patients who fail a comprehensive course of conservative care.
Nano-arthroscopic plantar fascia release represents an exciting minimally invasive option that may reduce pain, soft tissue injury, and recovery time.
Appropriate patient selection and realistic expectations remain essential regardless of treatment choice.

Featured Guest

Dr. Arianna Gianakos – Orthopedic Foot & Ankle Surgeon, Yale University; specialist in sports-related foot and ankle injuries, cartilage restoration, and advanced foot and ankle reconstruction.

🎤 Stay Connected

🎧 Listen & Subscribe

If you enjoyed this episode, be sure to subscribe, rate, and review on:
Apple Podcasts
Spotify

Follow us on Instagram

Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com

Follow us on Instagram @thesportsdocspod for the latest updates in sports medicine, injury recovery, and athlete performance.

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🎧 Episode Summary

Episode Sponsor: BraceLab

https://bracelab.com/push-med-foot-brace-fp.html

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan are joined by Dr. Arianna Gianakos, orthopedic foot and ankle surgeon at Yale University, to discuss one of the most common causes of heel pain in athletes and active adults—plantar fasciitis.

The conversation explores the underlying pathology of plantar fasciitis, risk factors that contribute to its development, and the latest evidence supporting conservative treatment strategies. Dr. Gianakos shares practical pearls on patient evaluation, imaging, bracing, orthotics, stretching programs, and physical therapy, helping clinicians navigate an often frustrating condition for both patients and providers.

Highlights

Understanding Plantar Fasciitis

Plantar fasciitis is more accurately described as a degenerative fasciosis rather than an inflammatory condition
Histologic studies demonstrate:
- Collagen disorganization
- Microtears
- Minimal inflammatory changes
Repetitive overload at the plantar fascia origin leads to structural degeneration and loss of elasticity

Why Does Morning Pain Occur?

Classic "first-step pain" results from overnight shortening of the plantar fascia
Initial weightbearing produces a sudden stretch and reloading of the tissue
Pain often improves with activity before worsening again later in the day

Clinical Evaluation & Imaging

Diagnosis is primarily clinical
Key examination findings include:
- Point tenderness at the medial calcaneal tubercle
- Pain with plantar fascia stretching
- Assessment of ankle flexibility and calf tightness
Imaging considerations:
- Ultrasound can demonstrate plantar fascia thickening
- MRI may be useful in chronic or refractory cases

Risk Factors for Plantar Fasciitis

Recent literature suggests several important risk factors:

Higher body mass index (BMI)
Increased body mass
Increased ankle plantarflexion range of motion

Surprisingly, some traditionally cited factors may not be as influential as previously believed:

Foot structure
Limited ankle dorsiflexion

These findings suggest that load-related factors may play a larger role than static foot alignment.

Bracing & Orthotic Management

Night Splints

Particularly beneficial in chronic plantar fasciitis (>6 months)
Help maintain plantar fascia length overnight
Can reduce morning pain and stiffness

Daytime Orthotics

Heel cushions
Arch supports
Functional plantar fascia braces

Custom vs. Prefabricated Orthotics

Both are effective for pain relief and symptom improvement
Studies show similar short-term outcomes
Prefabricated orthotics are often a cost-effective first-line option
Custom orthotics may offer improved durability and individualized support

Exercise & Physical Therapy

Home Exercise Programs

Convenient and cost-effective
Can achieve outcomes comparable to formal physical therapy when patients are compliant

Physical Therapy Benefits

Accountability and supervised progression
Access to additional modalities:
- Manual therapy
- Dry needling
- Shockwave therapy
- Soft tissue mobilization

Key Exercises for Plantar Fasciitis

Evidence-based interventions include:

Plantar fascia-specific stretching
Gastrocnemius stretching
Intrinsic foot muscle strengthening

Research suggests plantar fascia-specific stretching may be superior to generalized stretching programs for symptom improvement.

Key Takeaways

Plantar fasciitis is primarily a degenerative condition rather than an inflammatory process.
Morning pain results from overnight shortening and reloading of the plantar fascia.
Increased body mass and mechanical loading appear to be major contributors to symptom development.
Night splints, heel cushions, and arch supports remain valuable first-line treatments.
Prefabricated orthotics often perform as well as custom devices while reducing cost.
Both supervised physical therapy and home exercise programs can be effective when patients are compliant.
Plantar fascia-specific stretching and calf flexibility remain foundational components of treatment.

Featured Guest

Dr. Arianna Gianakos – Orthopedic Foot & Ankle Surgeon, Yale University; specialist in sports-related foot and ankle injuries, serving patients ranging from recreational athletes to elite competitors.

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Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com

Follow us on Instagram @thesportsdocspod for the latest updates in sports medicine, injury recovery, and athlete performance.

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On today’s episode we’re focusing on rehabilitation of ACL surgery with Candace Townley Cox, a Doctor of Physical Therapy and body movement expert at Evolution Physical Therapy. Today’s discussion will center around tips and tricks to optimize outcomes and some common pitfalls that may hold patients back from a full recovery.

We have some great articles for you that contribute well to our conversation on the surgical treatment of knee cartilage disease. As always, links to all of the papers that we discuss on this show can be found on our podcast website.

The first article is a level 3 case-control study published in the October 2020 issue of OJSM, titled Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction. Gustavo Constantino de Campos and his team in Sao Paulo, Brazil retrospectively reviewed the records of 438 patients who underwent ACL reconstruction. Anterior knee pain was reported in 6.2% of cases. Patients who underwent ACL reconstruction with a patellar tendon autograft were 3.4 times more likely to experience anterior knee pain. Also, patients who experienced an extension deficit in the post-op period were also more likely to experience anterior knee pain, with an odds-ratio of 5.3. The authors fund that anterior knee pain was not correlated with patient sex, age or surgical technique.

We are joined today by Dr. Candace Townley Cox. Candace is a Colorado native who received her Bachelor’s degree in Athletic Training at Nebraska Wesleyan University. Following undergrad Candace returned to Colorado as a Graduate Assistant Athletic Trainer at Regis University in Denver. There, she earned her Master’s degree in Sports Performance while working specifically with the Women’s Volleyball and Softball teams. Candace continued her education at Regis University earning her Doctorate of Physical Therapy. Since graduating Candace has spent countless hours in Sport Science Labs assessing movement quality, efficiency, as well as bone and muscle performance. As a movement expert, she is able to address the body’s impairments both from a table assessment and from functional movement assessments.

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In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with foot and ankle expert Dr. Ned Amendola to discuss the modern management of ankle syndesmosis injuries (“high ankle sprains”) in athletes.

The conversation focuses on when surgery is indicated, the evolution from rigid screw fixation to dynamic stabilization with TightRope technology, surgical pearls, and accelerated return-to-sport strategies for high-demand athletes.

Highlights

When Does a Syndesmosis Injury Need Surgery?

Most isolated, stable syndesmosis injuries can be treated nonoperatively
Surgery is indicated when there is:

Mortise widening
Instability on stress imaging
Associated fibula fractures
Significant ligament disruption (AITFL, PITFL, interosseous membrane)

Key principle:
Instability—not just diagnosis—drives surgical decision-making

The Shift from Screws to Dynamic Fixation

Traditional screw fixation challenges:

Screw breakage and loosening
Frequent hardware removal surgeries
Restricted physiologic motion
Longer non-weight-bearing periods

Advantages of TightRope fixation:

Dynamic stabilization with physiologic micromotion
Lower risk of malreduction
Faster rehabilitation
No routine hardware removal

Key insight:
Dynamic fixation respects normal syndesmotic biomechanics

TightRope Surgical Technique

Critical first step:
Anatomic reduction of the fibula in the incisura

Technique highlights:

Confirm reduction on AP, mortise, and lateral imaging
Drill 2–4 cm above joint line, parallel to plafond
Pass TightRope across all four cortices
Carefully seat medial button
Tension laterally while maintaining reduction

Pearls:

Clamp carefully to avoid malreduction
Avoid posterior fibular translation
Ensure proper button seating without soft tissue interposition

One vs Two TightRopes

One construct may suffice for:

Lower-demand athletes
Isolated injuries without fracture

Two constructs favored for:

High-energy injuries
Athletes
Fibula fractures
Rotational instability or Maisonneuve injuries

Key principle:
Persistent rotational instability drives the need for additional fixation

Outcomes with Dynamic Fixation

Benefits seen clinically:

Lower reoperation rates
Less stiffness
Faster functional progression
Earlier return to sport

Athletes tolerate early motion and rehab particularly well with dynamic fixation

The TightRope PRO System

Improvements include:

Smaller drill tunnels
Lower-profile buttons
Less soft tissue irritation
Controlled self-tensioning handles

Key insight:
Modern implant design improves precision and preserves bone

Rehabilitation & Return to Sport

Isolated injuries:

Early ROM within 1–2 weeks
Progressive weight-bearing by 4 weeks
Running around 8–10 weeks
Cutting/pivoting at 10–12 weeks

Elite athletes may return as early as 6–8 weeks in select cases

Return-to-play criteria:

No syndesmotic tenderness
Symmetric dorsiflexion
Negative stress testing
Functional cutting/acceleration testing
Psychological confidence in the ankle

Key Takeaways

Surgical treatment is based on instability and biomechanics, not simply imaging findings
Dynamic fixation with TightRope technology has transformed syndesmosis management in athletes
Proper reduction technique remains the most important surgical factor
Modern fixation allows for earlier rehabilitation and faster return to play
Return-to-sport decisions should incorporate both functional and psychological readiness

Featured Guest

Dr. Ned Amendola – Duke University, President of the American Academy of Orthopaedic Surgeons, Head Team Physician and Chief Medical Officer for Duke Athletics

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Arthrex Team Physician Controversies 2026

Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com

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In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with Stephania Bell to discuss the evolving role of sports injuries in modern media coverage.

As a licensed physical therapist and leading injury analyst for ESPN, Stephania shares how fantasy football, sports betting, visual technology, and audience demand have transformed injuries from simple status updates into complex, high-interest storylines centered around athlete performance, recovery, and long-term health.

We'll chat about:

How Fantasy Football transformed injuries into weekly decision-making currency
Fans now want:

Probability of performance
Risk assessment
Recovery expectations
Long-term outlook

Fantasy Football Changed Injury Coverage

Sports media shifted from reporting diagnoses to explaining performance implications

Changing the Media Narrative

Early injury reporting was binary:

Playing vs not playing

Modern injury coverage focuses on:

Function
Limitation
Risk
Performance impact

The Power of Medical Animations

Visual tools help bridge medicine and storytelling

Benefits of animations:

Improve anatomy understanding
Explain biomechanics and injury mechanisms
Clarify recovery expectations
Translate complex medicine for broad audiences

Notable NFL Injury Coverage

Joe Burrow

Turf toe and wrist injury breakdowns highlighted how subtle injuries impact quarterback mechanics
Visual animations helped explain throwing wrist ligament injuries and recovery

Brock Purdy

Turf toe animations demonstrated the functional impact on movement and push-off mechanics

Patrick Mahomes

Discussions emphasized how injury location and position-specific demands alter performance expectations

The Future of Injury Coverage

Coverage is becoming more nuanced around:

Load management
Athlete longevity
Cumulative wear and tear
Concussion awareness
Recovery strategy

Common Injury Misconceptions

Playing ≠ fully healthy
Recovery timelines are ranges—not exact dates
MRI findings are only one piece of the puzzle
Position matters enormously when evaluating injury impact

Featured Guest

Stephania Bell – Licensed Physical Therapist, ESPN NFL Injury Analyst, Co-host of Fantasy Focus Football

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Arthrex Team Physician Controversies 2026

Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com

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In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with orthobiologics expert Dr. Spencer Stein to discuss the real-world application of bone marrow concentrate (BMAC) in sports medicine.

The conversation focuses on how to effectively integrate orthobiologics into clinical and surgical practice, with a deep dive into the ANGEL System and Vortex Needle, emphasizing consistency, technique, and appropriate patient selection.

Where BMAC Fits in Practice

Common applications:

Cartilage restoration procedures
Tendon and ligament pathology
Nonunions and osteotomies
Osteochondral and revision cases

Why Bone Marrow Concentrate?

Delivers:

Progenitor cells
Growth factors
Cytokines

Particularly useful in:

Borderline surgical candidates
Revision cases
Biologically compromised environments

The ANGEL System

Closed, automated centrifuge system
Allows customization of hematocrit and final product

Benefits:

Consistency and reproducibility
Ability to “dial in” biologic composition
Reduced variability in outcomes

The Vortex Needle

Designed for controlled, low-volume aspiration

Advantages:

Minimizes peripheral blood dilution
Improves cell concentration and biologic quality
More targeted aspiration technique

Closed-tip design:

Better consistency
Higher quality aspirate

Pearls:

Focus on proper aspiration technique
Use small-volume, targeted draws
Integrate BMAC early in surgical workflow
Train your team for efficiency

Pitfalls:

Poor aspirate technique
Overpromising outcomes to patients
Treating biologics as a cure-all

Future of Orthobiologics

Moving toward:

Indication-specific protocols
Standardized biologic formulations
More targeted applications by tissue type

Featured Guest

Dr. Spencer Stein – NYU Grossman School of Medicine, sports medicine surgeon specializing in arthroscopy and joint preservation

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Arthrex Team Physician Controversies 2026

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Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com

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In this The Sports Docs Podcast episode, Dr. Ashley Bassett and Dr. Catherine Logan sit down with foot and ankle experts Dr. David Pedowitz and Dr. Josh Metzl.

From evolving surgical techniques to implant innovation and accelerated return-to-play timelines, this conversation highlights how modern approaches are reshaping outcomes for high-level athletes.

Achilles Tendon Injuries

Who Needs Surgery?

Best suited for young, active athletes, especially in explosive or cutting sports
While nonoperative care has improved:
- Tendon elongation remains a key concern
- Push-off strength deficits can impact performance
Surgical repair offers:
- Faster strength recovery
- More predictable return to sport

Evolution of Surgical Technique

Shift from open surgery → minimally invasive (MIS) and percutaneous approaches
Benefits:
- ↓ wound complications
- Improved cosmesis
- Faster rehabilitation
Double-row fixation restores native footprint and improves gap resistance

PARS Technique (Percutaneous Achilles Repair System)

Combines precision of open repair with less soft tissue disruption
Key features:
- Small incision with percutaneous suture passage
- Reproducible jig-guided technique
- Strong, locking suture construct
Ideal for acute midsubstance ruptures

Pearls:

Master jig orientation before live cases
Maintain tension during suture passage
Protect the sural nerve

Pitfalls:

Incisions too small → poor visualization
Overtensioning the repair

Repair Constructs: PARS vs SpeedBridge

SpeedBridge (double-row, knotless):
- ↓ tendon elongation
- Strong biomechanical construct
- Slight ↑ risk of heel pain
PARS:
- Less invasive
- Lower wound complication rates

Insertional Achilles Pathology

Typically treated with open or MIS SpeedBridge techniques
MIS FiberTak SpeedBridge advantages:
- Smaller incisions
- Less implant material
- Strong fixation with rip-stop construct
- Supports early weight-bearing and mobilization

Return to Play

90% return to sport after surgery
Typical timeline:
- Running: progressive, athlete-specific
- Full return: ~6–9 months

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Arthrex Team Physician Controversies 2026

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Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com

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In this episode of The Sports Docs Podcast, Dr. Bassett & Dr. Logan sit down LIVE from the Arthrex Team Physician Controversies with shoulder instability expert Dr. Kevin Farmer to discuss the modern management of traumatic anterior shoulder instability in athletes.

The conversation focuses on the instability continuum, including when to operate, how to evaluate bipolar bone loss, and when to add remplissage, with an emphasis on optimizing outcomes in young, high-risk athletes.

Who Needs Surgery?

Young athletes—especially males less than 20—have 70–80% recurrence rates with nonoperative care
Higher risk populations:
Collision athletes
Overhead athletes
Military/tactical athletes

Key insight:
Early surgical stabilization can be career-protective in high-risk athletes

MRI evaluates:

Bankart lesions
Hill-Sachs size and orientation
Capsulolabral quality

Advanced assessment includes:

Percent glenoid bone loss
Hill-Sachs engagement
On-track vs off-track lesions

Arthroscopic Bankart Repair

Remains the workhorse procedure in absence of critical bone loss

Modern advances:

Knotless anchors
Improved efficiency and reproducibility
Better capsular tensioning

Anchor strategy:

Typically 3–4 anchors
Start low (5:30–6 o’clock) and work superiorly
Fewer than 3 anchors associated with higher failure rates
Capsular Management

Capsular shift is critical in:

Young patients
Hyperlax athletes

Goal:

Restore anterior stability
Re-tension IGHL complex

Knotless technology allows fine-tuned tensioning

Remplissage

Traditionally used for off-track Hill-Sachs lesions
Now increasingly used in:

Subcritical glenoid bone loss (~10–15%)
High-risk athletes
Borderline “on-track” lesions

Benefits:

Decreases recurrence rates
Reduces need for revision surgery

Key insight:
Low threshold in young, male contact athletes

Remplissage Technique

Two anchors placed in Hill-Sachs lesion
Sutures passed through capsule and infraspinatus
Secured in subdeltoid space

Pearls:

Use knotless anchors for low-profile fixation
Visualize subacromial space to avoid soft tissue capture
Motion vs Stability

Concern: loss of external rotation

Reality:

Minimal, clinically insignificant loss with modern techniques
Stability benefits outweigh small motion tradeoffs
Postoperative Rehab

Sling: 3–4 weeks
Early passive motion
Strengthening at 6 weeks
Return to sport: ~5–6 months

Return to Sport Testing

Criteria-based return reduces recurrence (5% vs 22%)

Key components:

Full ROM
Greater/equal to 90% strength vs contralateral side
Functional testing (CKCUEST, shot-put, plank taps, etc.)
Patient-reported outcomes (WOSI greater than 90%, KJOC greater than 88%)

Featured Guest
Dr. Kevin Farmer – University of Florida, Team Physician for the Florida Gators

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If you enjoyed this episode, be sure to subscribe, rate, and review on:
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Arthrex Team Physician Controversies 2026

Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com

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Live from the Arthrex Team Physician Controversies Conference

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with two leading ACL experts—Dr. Pat Smith and Dr. Aaron Krych—to discuss strategies to reduce failure after ACL reconstruction.

The conversation highlights the evolution of ACL surgery, focusing on graft selection, fixation, biologic augmentation, and mechanical protection, with an emphasis on optimizing outcomes in young, high-risk athletes.

Graft: Autograft vs Allograft

Strong evidence shows higher failure rates with allograft in young athletes
MOON data: ~4–6x increased risk of failure in patients <25 years

Allograft best for:

Older, lower-demand patients
Revision or multi-ligament cases

Autograft Selection

Graft choice depends on:

Age, sex, sport, and anatomy

BTB:

Preferred for high-level pivoting athletes
Strong fixation, less graft elongation

Quadriceps tendon:

Increasingly utilized
Larger graft diameter
Less donor-site morbidity vs BTB
Particularly useful in younger and female athletes

Key insight:
Grafts <8 mm are associated with higher failure risk

Internal Brace (IB)

Indications:

Young athletes
Hyperlax patients
Revision ACL

Benefits:

Decreased graft elongation and cyclic displacement
Reduced postoperative laxity
Lower rerupture rates (~1% at 5 years in some studies)
Faster return to sport and improved rehab confidence

Lateral Extra-Articular Tenodesis (LET)

Strong evidence supports reduced failure rates:

Primary ACLR: ~11% → 4% (high-risk patients)
Revision ACLR: ~21% → 5%

Benefits:

Decreased pivot shift
Improved return to pre-injury sport
Cost-effective in high-risk populations

Indications for LET

Age ≤25 years
High-grade pivot shift
Knee hyperextension
Return to cutting/pivoting sports
Revision ACL reconstruction

LET Surgical Technique Pearls

IT band graft (7–8 cm x 1 cm)
Passed under or near LCL depending on technique
Fixation near lateral epicondyle

Pearls:

Fix in neutral rotation and ~30–60° flexion
Avoid overconstraint
Close IT band defect

Featured Guests

Dr. Pat Smith – Hospital for Special Surgery Naples

Dr. Aaron Krych – Mayo Clinic, Team Physician for the Minnesota Timberwolves

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Our Hosts:

Catherine Logan, MD, MBA

https://www.cloganmd.com/

Ashley Bassett, MD

https://orthopedicnj.com/physicians/ashley-bassett

www.thesportsdocspod.com

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Live from the Arthrex Team Physician Controversies Conference

🎧 Episode Summary

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with cartilage restoration expert Dr. Travis Maak to discuss the modern surgical management of knee cartilage defects.

The conversation focuses on diagnostic workup, surgical decision-making, and cutting-edge cartilage restoration techniques, including Autocart, BioCartilage, and Cartiform.

Diagnostic Imaging - MRI is critical for:

Defect size and depth
Subchondral bone integrity and edema
Concomitant meniscal and ligament pathology

Surgical Decision-Making

Patient age & activity level
Lesion size, location, & containment
Subchondral bone involvement
Prior surgical history

Autocart (Autologous Minced Cartilage)

Single-stage autograft cartilage restoration technique
Uses patient’s own cartilage with PRP or BMAC
Key advantages:

Preserves native chondrocytes & extracellular matrix
Avoids staged procedures

Ideal for small-to-medium contained lesions

Outcomes:

Significant improvements in pain & function at ~5 years
~75% achieve clinically meaningful outcomes
Low reoperation rates

BioCartilage

Micronized cartilage extracellular matrix allograft scaffold
Used in combination with microfracture and biologics (PRP/BMAC)
Functions as a biologic bridge to enhance cartilage repair

Best for:

Small-to-medium, contained, full-thickness defects
Well-aligned, stable knees

Outcomes:

Improved pain and function at 2 years
Better repair tissue quality compared to microfracture alone

Cartiform

Cryopreserved osteochondral allograft with viable chondrocytes
Maintains native cartilage architecture

Indicated for:

Larger lesions (>2 cm²)
Defects with subchondral bone involvement

Advantages:

Single-stage procedure
Conforms to irregular defects

Key Takeaways

Cartilage restoration success depends on correcting biomechanics first
Procedure selection should be lesion-specific and patient-specific
Autocart offers a promising autograft solution with strong midterm data
BioCartilage fills the gap between microfracture and larger restoration procedures
Cartiform is a valuable option for larger defects and requires careful patient selection

Featured Guest

Dr. Travis Maak – University of Utah, Head Team Physician for the Utah Jazz, cartilage restoration and joint preservation specialist

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Modern Surgical Management of Elbow UCL Tears

Live from the Arthrex Team Physician Controversies

🎧 Episode Summary

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with two leaders in sports medicine—Dr. Neal ElAttrache and Dr. Jeffrey Dugas—to discuss the modern management of ulnar collateral ligament (UCL) injuries in throwing athletes.

Highlights

Changing UCL Injury Landscape

Increasing incidence of UCL injuries and surgeries across all levels of play
Notable rise in adolescent and collegiate pitchers
Contributing factors include year-round play and high pitch velocity

Nonoperative Management & Role of PRP

Nonoperative treatment remains appropriate for select partial tears
Success varies based on tear grade and location
PRP discussed as an adjunct to rehab

Indications for Surgery

Complete tears—especially in competitive throwers—often require surgical intervention
Tear characteristics (location, tissue quality, chronicity) are critical in decision-making

UCL Repair with Internal Brace

Increasingly utilized in appropriately selected patients
Ideal candidates:
- Acute injuries
- Proximal or distal avulsion tears
- Good tissue quality
Advantages:
- High return-to-play (~90%+)
- Accelerated recovery timelines (often several months faster)

UCL Reconstruction (Tommy John Surgery)

Remains the gold standard for:
- Chronic degeneration
- Midsubstance tears
- Revision cases
Techniques have evolved over time:
- Docking technique
- Figure-of-eight
- Newer fixation methods (e.g., cortical button techniques)
Autograft (commonly palmaris longus) remains preferred in elite throwers

Internal Brace Technology

Provides added stability and resistance to valgus stress
Supports early rehabilitation while protecting healing tissue
Increasing use in both repair and, selectively, reconstruction

Key Takeaways

UCL injuries are increasing, particularly in younger athletes
Treatment decisions are increasingly personalized based on tear type and athlete profile
UCL repair with Internal Brace is shifting the paradigm for select patients
Reconstruction remains essential for more complex or chronic injuries

Featured Guests

Dr. Neal ElAttrache – Kerlan-Jobe Orthopaedic Clinic, Head Team Physician for the LA Dodgers & LA Rams
Dr. Jeffrey Dugas – Andrews Sports Medicine & Orthopaedic Center, leading expert in UCL repair and reconstruction

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Live from the 10th Annual Arthrex Team Physician Controversies Conference

🎧 Episode Overview

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies Conference to explore how next-generation arthroscopic imaging is transforming the way orthopaedic surgeons diagnose and treat injuries.

Joined by Dr. James Voos—Chairman of Orthopedics at University Hospitals and Head Team Physician for the Cleveland Browns—the conversation dives into the evolution of nano arthroscopy, panoramic visualization, and integrated imaging systems, and what these advancements mean for surgeons, athletes, and patient outcomes.

What You’ll Learn

1. The Evolution of Nano Arthroscopy

From the original Arthrex NanoScope (2019) to NanoNeedle 2.0
Major leap in image resolution (400×400 → 720×720, near 4K)
Less invasive approach and improved patient experience

2. Seeing What Imaging Can Miss

How in-office diagnostic arthroscopy is reducing reliance on equivocal MRI findings
Identifying subtle pathology:
- Partial-thickness rotator cuff tears
- Meniscal ramp lesions
- Early chondral defects

3. The Power of Panoramic Visualization (Panoscope)

Expanded field of view compared to traditional arthroscopy
Seamless transition between 30°, 70°, and ultra-wide 45° views
Reduced “blind spots” in complex anatomy

4. Workflow & Efficiency in the OR

How the Synergy Vision System integrates NanoNeedle + Panoscope
Dual-view capability for enhanced intraoperative decision-making
Improved efficiency

5. Adoption & Learning Curve

Designed to be intuitive for surgeons
Importance of training and mentorship
Technology enhances decision-making without adding complexity

Featured Guest

Dr. James Voos

Chairman of Orthopedics, University Hospitals
Medical Director, UH Drusinsky Sports Medicine Institute
Head Team Physician, Cleveland Browns

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If you enjoyed this episode, be sure to subscribe, rate, and review on:
Apple Podcasts | Spotify | Amazon Music | YouTube

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Welcome to another episode of Ask The Sports Docs. We get a lot questions from our listeners each week and they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started!

Today, we’re tackling the question: “Should I have surgery for my type III AC joint
separation?” If you are a sports medicine or shoulder surgeon, you’ve definitely had this conversation with your patients. And if you are an athlete, you’ve probably googled this after landing on your shoulder snowboarding, playing hockey, playing football etc. And the truth is – the answer isn’t black and white. But to try to answer that question, we’re going to review an article titled “Functional, Radiological, and Scapular Motion Evaluation of Surgical Versus Nonsurgical Treatment of Type 3 Acromioclavicular Dislocations.”

This level 1 RCT aimed to compare the clinical outcomes of surgical and nonoperative treatment of type 3 AC separations.

So, let's dive in!

www.cloganmd.com / www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

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Welcome to Overtime with the Sports Docs. On each of these mini episodes, we chat about a new article or new surgical technique in the field of sports medicine.

We’ll give you our quick take on the most recent data and how this data will impact our practice. Today, we’re chatting about recurrent patellar instability, and specifically the risk of progressive cartilage damage in the setting of repeat patella dislocation events. We’re going to review an article from the August 2024 issue of AJSM titled: “The Number of Patellar Dislocation Events Is Associated With Increased Chondral Damage of the Trochlea.”

This study uses data from the JUPITER cohort — which stands for: Justifying Patellar Instability Treatment by Early Results. The authors ask a clinically critical question: Does the number of dislocations matter when it comes to cartilage damage?

www.cloganmd.com / www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

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Welcome to another episode of Ask The Sports Docs. We get a lot questions from our listeners each week and they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started!

Today’s Ask The Sports Docs focuses on a question that we get asked a lot on the sideline, in locker rooms and by parents of our young contact sport athletes: Do you recommend the use of Guardian Caps to decrease the risk of concussion? If you have watched NFL training camp over the last few years, you’ve seen them – Those padded shells over the helmets. They’re everywhere now in preseason practices. But are they actually preventing concussions? Or are we just seeing a visible symbol of safety without meaningful impact?

That is what we are going to tackle today. And to do that, we’re going to review a recent article published in the August 2025 issue of AJSM titled “An Analysis of Guardian Cap Use and Changes in the Concussion Rate in NFL Preseason Practices From 2018 to 2023.”

Find us:

www.thesportsdocspod.com / www.cloganmd.com

https://orthopedicnj.com/physicians/ashley-bassett

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Today, we’re diving into a paper that reviews the long-term outcomes following arthroscopic Bankart repair and challenges some of the historical narratives around this procedure.

The study that we are reviewing today is titled “Long-term Outcomes of a Contemporary Arthroscopic Bankart Repair Technique in Patients With Traumatic Anterior Shoulder Instability: A Minimum 10-Year Follow-up.”

This is a minimum 10-year follow-up study looking at modern arthroscopic Bankart techniques using at least three anchors — and it asks:

Are recurrence rates still as high as we’ve been taught?

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Welcome to another episode of Game Plan! It has been a while since we have done one of these Game Plan episodes so to quickly review: These episodes are specifically designed for patients. They are designed to hopefully answer some of the questions you have about the most common sports medicine conditions, injury prevention and treatment options.

Today we’re talking about pickleball – the fastest growing sport in the United States. From 2019- 2021, the number of pickleball players increased from 3.3 to 4.8 million. The reason for the growth of the sport is likely multifactorial, including that it encompasses a wide variety of age ranges, it is easy to understand and it is inexpensive to play. However, with this steady growth has come a corresponding linear rise in pickleball injuries. And these injuries are not inexpensive, costing between 250 to 500 million dollars in 2023 alone.

Pickleball is a paddle sport that takes aspects from tennis, badminton, and ping-pong. Now, we were going to try to explain the pickleball rules here, and how it differs from other racquet sports. But, USA Pickleball has a really nice 5-minute video on their website (usapickleball.org) that quickly summarizes the basic rules. If you are interested in learning more about this game, definitely check out their website. It should be noted that the rules and scoring system are currently variable. But as more competitions arise, more standardization to the game will likely follow, as is the trend with most sports.

Today, we’re reviewing an article published in the November 2024 issue of the yellow journal titled “Pickleball: A Standard Review of Injury Prevalence and Prevention in a Rapidly Growing Sport.” This study compiled data from retrospective studies containing emergency department data and case reports of specific injuries sustained while playing pickleball. The authors also utilized a customized survey to capture outpatient data of current pickleball players seen in outpatient orthopedic facilities and at local pickleball events.

www.cloganmd.com / www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

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We get a lot questions from our listeners each week and they’re great questions,
so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started! Today’s Ask The Sports Docs focuses on timing of ACL reconstruction surgery.

Our patients, and their families, frequently ask… how long can I wait to
have the surgery? To answer that question, we’re going to review an article, hot off the press in this month’s issue of AJSM titled “Early ACL Reconstruction Mitigates the Development of Posttraumatic Osteoarthritis in a Murine ACL Rupture Model.” Dr. Julia Retzky and colleagues at HSS sought to answer the question:
Does the timing of ACL reconstruction actually matter for long-term joint health?

This is a timely paper because posttraumatic osteoarthritis or “PTOA” after ACL injury remains a massive unsolved problem. Even with modern reconstruction techniques, we’re still seeing 23 to 60% rates of PTOA at 10 to 25 years post-op. Historically, the literature on timing is all over the place. Some studies suggest early ACLR may reduce PTOA risk, others show no difference. The problem is
heterogeneity—different grafts, definitions of “early,” imaging versus radiographic OA, meniscal status, you name it.

And that’s where this paper is interesting. It strips away a lot of clinical confounders by using a controlled murine model (or mouse model) with a noninvasive closed ACL rupture, followed by either immediate reconstruction, delayed reconstruction, or no reconstruction. And importantly, this is the first murine study using a true intra-articular ACL reconstruction model, rather than extra-articular stabilization. So this mirrors what we do clinically, with a true anatomic ACL reconstruction.

So, let's dive in...

www.cloganmd.com / www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

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Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and I chat about a new technique or treatment option in the field of sports medicine. We’ll give you our quick take on the most recent data and how this data will impact our practice.

Today we’re tackling a topic that’s coming up more and more in clinic, locker rooms, and social media—injectable peptide therapy. Specifically, we’re going to walk through a recent AJSM narrative review by Mayfield and colleagues that serves as a primer for orthopaedic and sports medicine physicians.

This is a great paper because it separates biologic plausibility from clinical reality. Patients are asking about BPC-157, TB-500, growth hormone–releasing peptides — often convinced these are regenerative breakthroughs — while the evidence base is still extremely limited. So, let's get started!

Links:

https://pubmed.ncbi.nlm.nih.gov/41476424/

www.cloganmd.com

https://orthopedicnj.com/physicians/ashley-bassett

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Welcome to Overtime with the Sports Docs. On each of these mini episodes, we chat about a new article or new surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data and how
this data will impact our practice.

Today, we’re talking about one of the hottest topics in sports medicine — platelet rich plasma for lateral epicondylitis. If you’ve ever wondered why PRP seems to work great for some patients… and not at all for others — this paper gives us a compelling answer.

We’re reviewing an article from the January 2025 issue of AJSM titled “Platelet Concentration Explains Variability in Outcomes of Platelet-Rich Plasma for Lateral Epicondylitis.” The key takeaway from the systematic review and meta-analysis is that PRP isn’t one standard treatment. The dose matters and platelet concentration may explain most of the conflicting data we’ve seen over the years.

www.cloganmd.com / www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

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Today’s episode is going to focus on two common athletic shoulder injuries that we see in American football – traumatic anterior shoulder dislocations and acromioclavicular joint injuries. We’ll dive into the acute on-field management followed by treatment thereafter, including nonoperative and surgical treatment options.

We are joined today by Dr. Kevin Farmer, a Professor of Orthopaedic Surgery at the University of Florida, a team physician for the University of Florida gators and the editor of the “In-Season Management of Football Injuries” textbook. He is also a past president of the Florida Orthopaedic Society and the Florida Alliance for Sports Medicine, and a board member for AAOS and the Southern Orthopaedic Association.

So, without further ado, let’s get to the Field House!

www.cloganmd.com / www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

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Our conversation picks back up with an article titled “Mental toughness in surgeons: Is there room for improvement?” This paper was published in the December 2019 issue of the Canadian Journal of Surgery and evaluates mental toughness among general surgery residents and staff surgeons using the Mental Toughness Index. The authors found that staff surgeons score significantly higher across all domains—including self-belief, attention and emotion regulation, optimism, buoyancy, and adversity capacity—than residents.

Survey data from three Canadian academic centers showed that although both groups use some techniques to manage stress, staff rely on these strategies more frequently, and both residents and staff express strong interest in further developing mental toughness skills. The study also identifies gender differences, with men scoring higher in attention and emotion regulation. The authors highlight the lack of formal mental toughness training in surgical education despite evidence from athletics and paramilitary fields supporting structured psychological skills training.

Then, from this month’s issue of the Journal of the Association for Surgical Education, we review an article titled “Do expert surgeons use mental skills to improve their surgical performance?” This study explores whether expert pancreaticoduodenectomy (Whipple) surgeons use mental skills during complex operations and how these strategies map onto known performance psychology frameworks. Through structured interviews with 15 internationally recognized high-volume surgeons, the authors found that all participants consistently employ cognitive techniques—including preoperative mental rehearsal, deep task focus, emotional regulation, maintaining situational awareness, and reframing unexpected events—to optimize performance under pressure.

Surgeons described entering a “flow-like” state during critical steps, relying on deliberate calmness, structured routines, and controlled breathing to manage stress and maintain precision. These mental skills closely parallel those used in elite athletes and high-stakes professions, suggesting that expert surgical performance is supported not only by technical mastery but also by refined psychological strategies. The authors argue that mental skills training could be formally integrated into surgical education to help trainees develop the cognitive tools that expert surgeons intuitively use.

www.cloganmd.com / www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

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On today’s episode we’re focusing on mindset skills, emotional regulation and mental toughness and feel that orthopedic surgery with Dr. Winston Gwathmey, an orthopedic surgeon at UVA.

We start off our discussion today with an article from the September 2022 issue of the Journal of Surgical Research titled “Emotional Regulation in Surgery: Fostering Well-Being, Performance, and Leadership.” This article reviews the critical role of emotional regulation as a trainable cognitive skill that enhances surgical well-being, technical performance, and career longevity. It highlights how burnout and stress are pervasive in surgery and argues that individual-level emotional regulation training—paired with necessary system-level changes—can help surgeons cope with the inherent stressors of operative practice, complications, and high-stakes decision-making.

Through multiple institutional case studies, the paper illustrates practical strategies for implementing emotional regulation curricula within surgical training, including mindfulness-based programs, mental skills training, and broader well-being initiatives. Across all examples, successful adoption hinges on leadership support, stakeholder buy-in, iterative design, and embedding training into existing educational infrastructure. Ultimately, the authors advocate for an integrated national curriculum that combines cognitive skills training, application to technical performance, and preparation for independent practice to promote surgeon resilience and sustainable careers.

Then, from the July 2021 issue of the Journal of Surgical Research, we review an article titled “Mastering Stress: Mental Skills and Emotional Regulation for Surgical Performance and Life.” This article reviews how mental skills training and emotional regulation can enhance surgeons’ technical performance, well-being, and career longevity by mitigating the negative effects of stress. It explains the physiological and cognitive mechanisms of stress and highlights how chronic stress impairs decision-making and increases burnout. The authors present evidence that mindfulness, cognitive training, and mental rehearsal improve surgical skill acquisition, stress resilience, executive function, and performance under pressure.

The authors go on to outline common elements of successful programs. They also discuss barriers to implementation and propose a framework for integrating mental skills training across surgical education from basic instruction to independent practice. They ultimately advocate for the development of a national mental skills curriculum to promote surgeon well-being, reduce errors, strengthen leadership and teamwork, and improve patient and systems-level outcomes.

We are joined today by Dr. Winston Gwathmey, a board-certified orthopedic surgeon and a Professor of orthopedic surgery at the University of Virginia. He is the Medical Director for the Sports Medicine Clinic at UVA and is also one of the team physicians for both UVA and James Madison University. Dr. Gwathmey is the Program Director for the Orthopedic Surgery Residency Program at UVA and is very passionate about educating the next generation of orthopedic surgeons. He has won numerous teaching awards including the Mulholland Teaching award, the Charles W. Miller Resident Teaching award, and the Dean’s Award for Excellence in Medical Student Teaching. So, we’re very excited to have him on today to talk about this important topic.

www.cloganmd.com / www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

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2025 has been a year of real growth for our show! We’ve seen our listenership expand, our community of colleagues grow, and our impact reach more clinicians, athletes and sports medicine professionals than ever before. That only happens because of you—our listeners—who show up every week curious, engaged, and committed to elevating care in sports medicine.

This year also brought a milestone we’re incredibly proud of: The Sports Docs Podcast has been nominated for Best Clinical Education Podcast at the Doctor Podcast Awards 2026. That recognition reflects the quality of the conversations we’ve had—and the incredible guests and community that make this podcast what it is.

We’re deeply grateful for the partners who make this show possible. A huge thank you to JRF Ortho and Arthrex for their continued support, and we’re excited to have welcomed BraceLab as our newest sponsor. We’re also thankful for the ongoing support of AOSSM, whose commitment to education and excellence aligns perfectly with our mission. We even have some exciting new adventures scheduled for 2026... but you are going to wait on what that is for now.

This episode is a look back at some of our favorite moments, insights, and conversations from 2025—episodes that challenged us, inspired us, and reminded us why we love this field so much. Whether you’ve been with us since day one or you’re just joining us now, thank you for being part of The Sports Docs community.

Let’s dive into the moments that defined 2025—and set the stage for an even bigger year ahead.

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Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and I chat about a new article or new surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data and how this data will impact our practice.

Today, we’re breaking down a new study looking at the Hip–Return to Sport after Injury score, or Hip-RSI, and whether it can help us evaluate psychological readiness to return to sport after surgical repair of a proximal hamstring avulsion. This study is hot off the press and was published in the November 2025 issue of OJSM, so this month! It was performed by Hardy and colleagues at Clinique du in Paris and is titled “The Hip-RSI Score for Evaluating Psychological Readiness to Return to Sport After Surgical Repair of a Proximal Hamstring Avulsion.”

Our listeners may know this score was originally developed for femoroacetabular impingement. But the authors of this recent OJSM paper are asking: Does it work for a totally different injury—one that often requires long rehab and has a real psychological component?

So, a bit of background. The Hip-RSI was created because we know psychological readiness is a huge factor in return to sport after hip arthroscopy. Fear, confidence, trust in the hip—these really drive return-to-play outcomes. And with proximal hamstring avulsions, we see the same psychology showing up: fear of re-rupture, hesitancy with sprinting or explosive movements, and a long course to get back to high-level sport. The purpose of this study was to evaluate two big questions:

Is the Hip-RSI valid and reliable in this population?
Can it actually predict return to preinjury sport at nine months?

Listen to this episode to find out!

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Today we’re breaking down a common but sometimes career-altering knee injury in professional football – the meniscus tear. We’ll cover how often these happen in the NFL, how players present, what treatment choices look like, timelines for returning to play, and critically – how meniscal injury affects performance and career length

But first, a quick refresher: The menisci are two C-shaped fibrocartilage discs in each knee (medial and lateral) that help distribute load, absorb shock, and stabilize the joint. Losing meniscal tissue – through a tear and subsequent meniscectomy – changes knee biomechanics and increases contact stresses on articular cartilage, which can lead to earlier degenerative change. This biomechanical role is why meniscal management matters so much for athletes.

So how common are meniscus tears in the NFL or NFL prospects? Well, that depends on what study you read and how that study chose to measure the prevalence of meniscus tears.

Listen to this episode to get the full scoop on how these athletes perform in the setting of meniscus injury.

Reference:

Dr. Jorge Chahla (friend of the show) in 2018 in AJSM used MR imaging data to determine the prevalence of prior meniscal injury. This study of approximately 2,000 NFL Scouting Combine participants from 2009–2015 found that 20% of players had a prior meniscus injury. So, this is the more frequently sided statistic.

This study also went on to discuss the impact of partial meniscectomy on player performance and career length

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On each of these mini episodes, Catherine and I chat about a new article or new surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data and how this data will impact our practice.

Today, we’re discussing a brand-new paper hot off the press titled: “Predictors of Tunnel Widening After Anterior Cruciate Ligament Reconstruction” published in the November 2025 issue of AJSM. This study digs into why femoral and tibial tunnels enlarge after ACL reconstruction with hamstring grafts – and what anatomic and surgical factors might be driving it.

Tunnel widening matters: it impacts revision surgery, graft stability, and in some cases early failures. So, this is a clinically meaningful topic.

We will start with some background. Tunnel widening after ACL reconstruction is not new…but why it happens is debated. There are a few proposed mechanisms:

· Biologic factors: synovial fluid ingress, cytokines, graft necrosis, remodeling.

· Mechanical factors: graft motion (“windshield wiper” / “bungee effect”), repetitive shear.

· Anatomic factors: posterior tibial slope increasing anterior tibial translation forces.

· Surgical factors: fixation method, tunnel position, graft choice (hamstring vs BTB or Quad). This study asked three key questions:

Does posterior tibial slope (PTS) predict tunnel widening?
Do meniscus root tears contribute?
Does adding a lateral extra-articular tenodesis (LET) influence tunnel change?

· This is the first large cohort looking at all these together over 2 years, with both tibial and femoral tunnel measurements.

· The study included 307 patients who underwent primary ACL reconstruction using hamstring autograft. The femoral and tibial tunnels were measured immediately postop and again at 2 years. Medial and lateral posterior tibial slope was measured on long-leg lateral radiographs. The authors also looked at the incidence of additional LET, meniscus root injury and BMI.

· They used univariate and multivariate regression to determine independent predictors.

So, what did they find? Tune in and enjoy the episode!

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Our conversation picks back up with an article titled “Patient Outcomes and Return to Play After Arthroscopic Rotator Cuff Repair in Overhead Athletes.” This systematic review, published in the January 2023 issue of JOT, analyzed 20 studies comprising 692 patients with an average follow-up of 40 months. The authors found that arthroscopic cuff repair led to significant improvements in patient reported outcomes as well as improved shoulder elevation. Overall, 75% of athletes returned to play at a mean of 6.4 months post-op, and 63% returned to their preinjury level of sport. Complication and reoperation rates were relatively low at 7% and 10%, respectively.

Then, from the December 2019 issue of AJSM, we review an article titled “Partial-Thickness Rotator Cuff Tear by Itself Does Not Cause Shoulder Pain or Muscle Weakness in Baseball Players.” This cross-sectional study investigated whether articular-sided partial-thickness rotator cuff tears alone produce symptoms in overhead athletes. Of the 87 collegiate baseball players that were analyzed, 47% had ultrasound-confirmed partial-thickness tears, yet rates of shoulder pain and muscle weakness were not significantly different from those without tears. Most of these tears were small (approximately 5 mm in depth) and were asymptomatic in 83%. Pain correlated instead with scapular malposition, dyskinesis, and poor total shoulder condition – not the presence of a tear.

We finish up our discussion today with an article titled “Internal impingement of the shoulder in overhead athletes: Retrospective multicenter study in 135 arthroscopically-treated patients.” Patients underwent a variety of procedures, including cuff debridement or repair, posterior glenoidplasty, labral debridement, posterior capsular release, and anterior capsulorrhaphy. Overall, 90% returned to sports, with 52% returning to their prior level at an average of 9 months. Better return-to-sport outcomes were associated with male sex, presence of a cuff lesion, and simple cuff debridement. Greater tuberosity cysts and anterior capsulorrhaphy correlated with poorer outcomes and higher post-op pain.

We hope you enjoy this episode!

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On today’s episode we’re focusing on the thrower’s shoulder with Dr. Sara Edwards, an orthopedic sports medicine and shoulder surgeon at UCSF. We have some great articles for you that contribute well to our conversation on different shoulder pathology in the overhead throwing athlete.

We start off our discussion today with a review article from the April 2023 issue of the yellow journal titled “Surgical Treatment of Superior Labral / Biceps Pathology in the Overhead Thrower.” The authors concluded that type II SLAP tears are the most common and are often difficult to diagnose due to frequent false positives on MRI. Therefore, history and physical exam correlation are critical. Nonop management – including rest, physical therapy targeting internal rotation deficits, and correction of scapular dyskinesis – can help, but return-to-play rates among pitchers remain low, around ~22%.

When surgery is indicated, options include labral repair, biceps tenodesis, and rarely tenotomy. SLAP repair yields variable outcomes, with elite throwers showing the poorest return to prior performance – often less than 40%. Biceps tenodesis was once a salvage procedure but is now increasingly favored for selected athletes due to higher satisfaction, improved function, and return-to-sport rates of 70–80%. However, its impact on elite throwing mechanics remains uncertain.

Then, from the June 2022 issue of JSES, we discuss a systematic review article titled “Return to play following nonsurgical management of SLAP tears.” This study evaluated outcomes of conservative treatment in 244 athletes (162 of which were elite). Across five studies, the overall return-to-play rate was 54%, rising to 78% among those who completed rehab. Return to prior performance was 43% overall and 72% for rehab completers. Successful programs emphasized restoring internal rotation, correcting scapular dyskinesis, and strengthening the rotator cuff and kinetic chain, with most athletes returning within six months.

Risk factors for failure of conservative treatment were: older age, overhead sports participation (particularly baseball pitchers), traumatic injury, positive compression-rotation tests, rotator cuff pathology, longer careers or symptom duration, and Bennett spurs. Patient-reported outcomes improved significantly with nonoperative care. The authors conclude that nonsurgical management can be effective – especially for athletes who adhere to structured rehabilitation – but success is less predictable in older or high-demand overhead throwers.

We are joined today by Dr. Sara Edwards, an orthopedic sports medicine and shoulder specialist at the University of California in San Francisco, and an Associate Professor at UCSF School of Medicine. She received her medical degree from Northwestern University and remained at Northwestern to complete her orthopedic surgery residency. Thereafter, she completed a fellowship in sports medicine and shoulder surgery at Columbia University. Dr. Edwards is currently the team physician for the City College of San Francisco, the University of San Francisco and the Oakland Ballet.

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Welcome to another episode of Game Plan!

As you might remember from our episode on ACL graft choices, these Game Plan episodes are specifically designed for patients – to hopefully answer some of the questions you have about the most common sports medicine conditions and surgical treatments.

We’re continuing with our favorite topic today – ACL tears – but today’s episode is going to focus on risk factors for ACL tears. Specifically, which of these risk factors can we modify to lessen the chance of sustaining ACL tear and how do we decrease that risk.

Please note that this episode is going to focus strictly on ACL reconstruction. For more information on ACL rehab check out our recent two-part episode with Candace Townley Cox back in April of this year. We’ve covered the addition of “LET” or “lateral extra-articular tenodesis” to ACL reconstruction in an Overtime episode in November of 2021 and again with Dr. Brian Waterman live at the AAOS meeting back in March of this year. And, of course, our first Game Plan episode was on how to choose the best ACL graft for reconstruction, so definitely check that out.

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Welcome to Overtime with the Sports Docs. Today, we’re talking about Cyclops Syndrome after ACL reconstruction surgery. We review an article published in this month’s issue of AJSM titled “Risk Profile for Cyclops Syndrome Necessitating Reoperation After Anterior Cruciate Ligament Reconstruction.” But first, let’s back up a bit and discuss the basics, starting with what Cyclops Syndrome is.

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Welcome to GamePlan with the Sports Docs. On each of these mini episodes, we chat about a new article or new surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data and how this data will be impacting our practice.

Today, we’re talking about hamstring injuries in the NFL. And if your fantasy team is anything like my fantasy team, it currently looks like an infirmary. So, you’ll probably want to listen in to this episode.

Now, we’ve covered hamstring injuries in the NFL before. Last year we did an entire Game Plan episode dedicated to this topic. That is episode #52 if you want to check it out. Today, we are actually reviewing a new study just published this month in AJSM that focused on how player characteristics, injury severity and imaging findings can impact the amount of time missed as well as risk of recurrent injury.

The article is titled “Correlation of Player and Imaging Characteristics with Severity and Missed Time in the National Football League Professional Athletes with Hamstring Strain Injury.” Molly Day, Scott Rodeo and team at HSS published this retrospective cross-sectional study that aimed to identify certain player characteristics, clinical examination findings and MRI results that were associated with injury severity and missed playing time. As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

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Today, we’re heading back to the NFL to discuss a surprisingly serious injury – turf toe. In Week 2 of the 2025 NFL season, Cincinnati Bengals quarterback Joe Burrow was sacked and sustained left great toe injury. This was ultimately diagnosed as a grade 3 turf toe injury requiring surgery. Burrow was placed on injured reserved and elected to undergo surgical repair. While the surgery reportedly went well, timing for return is uncertain, though initial estimates are around 3 months.

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We get lots of questions from our patients and our listeners each week. And they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses, with some literature to back it up.

Today we will be tackling:

“What are the most studied and most effective supplements currently for sports medicine patients — both for performance and for injury recovery?”

“What’s the current evidence and your view on the NICE ROCC palm cooling device? Does it really enhance recovery or performance?”

“What’s the latest on bracing for shoulder dislocations when returning to sport? Are functional braces advisable, and in what role do they play?”

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Today, we’re diving into one of the most serious injuries in American football, and that is a knee dislocation. Dolphins star wide receiver Tyreek Hill recently suffered a devastating knee injury in the Monday Night Football game versus the Jets. He dislocated his knee resulting in multiple torn ligaments, including his ACL. Tyreek was taken to the hospital directly from the game for further evaluation and ended up undergoing urgent surgery for ligament reconstruction and repair. The team has obviously declared that this is a season-ending injury, and we wish him the best in his recovery.

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Welcome to another episode of Game Plan! These Game Plan episodes are specifically designed for patients – to hopefully answer some of the questions you have about the most common sports medicine conditions and surgical treatments. But today’s episode is a little different and we’re excited about it! Today, we’re focusing on common injuries in the NFL and how these injuries impact time missed and player performance once athletes ultimately return to play.

This is something that each NFL team looks at carefully when evaluating rookie prospects before draft day. Teams look at the number of previous injuries, the types and severity of the injuries and treatment rendered when trying to decide on the ranking of a draft candidate. Now, this is just one facet of the evaluation – a physical examination is performed at the NFL Combine and performance metrics post-injury are obviously taken into account.

But as the literature continues to grow in this area, it is becoming more feasible to project a player’s injury risk, career length and even performance in the NFL. This is useful information for NFL teams but also fantasy football enthusiasts who want to make sure they draft the best players for their team. So, our discussion today is going to focus on common injuries in the NFL and how that injury history may impact player reliability (games played), longevity for the season and performance.

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In this episode, we’re going to continue our discussion with Dr. Travis Matheney and focus on surgical treatment options for borderline hip dysplasia.

Our conversation picks back up with a review article published in the December 2024 issue of Current Reviews in Musculoskeletal Medicine titled “Borderline Hip Dysplasia - Best Treated with Hip Arthroscopy or Periacetabular Osteotomy?” Dr. Andrea Spiker and colleagues summarized the current research comparing isolated hip arthroscopy to periacetabular osteotomy for patients with borderline hip dysplasia. They noted improved postoperative clinical outcome scores and low rates of conversion to total hip arthroplasty in both groups. The authors concluded that successful clinical outcome seem to rely on treating underlying clinical pathology as well as appropriate surgical indications and surgical techniques.

Then, from the April 2021 issue of OJSM, we review an article titled “Comparison Between Hip Arthroscopic Surgery and Periacetabular Osteotomy for the Treatment of Patients With Borderline Developmental Dysplasia of the Hip.” This systematic review authored by Dr. Marc Philippon and his team at the Steadman Clinic in Vail found that outcomes improved across all patient reported outcome measures whether patients were treated using arthroscopic surgery or PAO. They noted that revision surgery was also common in both procedures.

We finish up with an article from the September 2017 issue of AJSM titled “Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia.” Bryan Kelly and his team at HSS investigated the effect of prior arthroscopic hip surgery on clinical outcomes after periacetabular osteotomy or “PAO”. They found that patients who previously underwent hip arthroscopy had inferior functional outcomes at 6 months and 12 months after PAO compared to patients with no prior hip surgery. The authors note that both groups significantly improved post-op and there was no difference in complications or reoperation between the groups.

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On today’s episode we’re focusing on the management of borderline hip dysplasia with Dr. Travis Matheney, a pediatric orthopedic surgeon at Boston Children's Hospital. We have some great articles for you that contribute well to our conversation on the treatment options for borderline hip dysplasia.

We’ll start off our discussion today with an article titled “Periacetabular Osteotomy Improves Pain and Function in Patients With Lateral Center-edge Angle Between 18° and 25°, but Are These Hips Really Borderline Dysplastic?” Dr. Michael McClincy and team at Boston Children’s Hospital concluded that patients with a lateral center edge angles of 18-25 frequently have other radiographic features of dysplasia suggestive of abnormal femoral head coverage by the acetabulum and that these hips may be inappropriately labeled as “borderline” or “mild” dysplasia. The authors recommended a more thorough radiographic evaluation of the patient with suspected dysplasia, including measurement of the Tonnis angle, FEAR index, anterior and posterior wall index, and anterior center edge angle.

We are joined today by Dr. Travis Matheney, an Assistant Professor of orthopedic surgery at Harvard Medical School and pediatric orthopedic surgeon at Boston Children’s Hospital. He has a particular interest in pediatric hip pathology and is part of the Child & Young Adult Hip Preservation program at Boston Children’s. Dr. Matheney trained Ashley and I during our residency at Harvard, so we’re very excited to have him join us today and share his wisdom on this controversial topic.

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Our conversation picks back up with an article published just last month in AJSM titled “Player Tracking Metrics to Predict Risk of ACL Injuries During Change-of-Direction Scenarios in the NFL.” The authors analyzed 216 ACL injuries that occurred in the NFL from 2018–2022 to determine how player tracking data could help predict injury risk, particularly during change-of-direction or “CoD” plays. They found that nearly half of ACL injuries occurred during CoD scenarios, most often involving high speeds followed by rapid deceleration.

The authors noted that 98% of players were decelerating at the moment of injury. Using synchronized video and player tracking, the researchers found that maximum speed and normalized maximum deceleration power were significant predictors of ACL injury risk. Additionally, special teams plays showed the highest rates of CoD ACL injuries, though when motion data were factored in, the elevated risk was better explained by player speed and deceleration demands rather than play type alone. These findings highlight the potential to use tracking metrics for real-time risk monitoring, improved prevention programs, and possibly even future changes to training or game rules to reduce injury risk.

We’re going to wrap up today with a study that is currently ongoing and not yet published. Funded by the AOSSM Playmaker Grant, this clinical trial is investigating the use of wearable muscle oxygenation sensors to improve return-to-play assessment after ACL reconstruction. Dr. Voos, Dr. Calcei, and their team at the UH Drusinsky Sports Medicine Institute have found that muscle oxygenation recovery lagged behind clinical clearance in several cases.

Eight athletes did not regain normal muscle oxygenation even when they were deemed ready to return. These findings suggest that wearable muscle oxygen saturation monitoring may add a valuable physiologic layer to current return to play protocols, potentially predicting safer and more individualized recovery timelines.

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On today’s episode we’re focusing on wearable technology for athlete performance, recovery and injury prevention with Dr. Jacob Calcei, an orthopedic surgeon at University Hospitals in Cleveland and team physician for the Cleveland Browns.

We’ll start off our discussion today with an article titled “Wearable Performance Devices in Sports Medicine” from the January 2016 issue of Sports Health. The authors review the rapid rise of wearable sensor technologies in athletics, highlighting their ability to track real-time physiologic and movement data for optimizing performance and reducing injury risk. These tools can provide valuable insights into workloads, biomechanics, and fatigue, supporting tailored training programs and early injury prevention strategies. While wearable devices have shown promise, evidence for their effectiveness in professional sports remains limited, and further research is needed to validate accuracy, develop standardized training protocols, and address practical challenges such as reliability and usability.

Then, from the January 2020 issue of Sports Heath, we review an article titled “Does Overexertion Correlate With Increased Injury? The Relationship Between Player Workload and Soft Tissue Injury in Professional American Football Players Using Wearable Technology.” This study investigates whether sudden increases in training load, as measured by wearable GPS and accelerometry technology, are associated with higher rates of soft tissue injury in professional American football players.

The authors analyzed two NFL seasons and found that injured players experienced significantly greater spikes in workload during the week of injury compared to the prior month. Specifically, they found that those exceeding an acute-to-chronic workload ratio (ACR) of 1.6 being 1.5 times more likely to sustain an injury. The effect was particularly pronounced in the preseason, when workloads were higher and hamstring injuries were most common. The findings suggest that rapid workload increases predispose athletes to soft tissue injury, while consistent training loads may offer a protective effect. The authors conclude that monitoring player workload with wearable technology could help medical and training staff design safer, more individualized training regimens to reduce injury risk.

We are joined today by Dr. Jacob Calcei, a board-certified orthopedic sports medicine physician and shoulder surgeon at University Hospitals and an assistant professor of Orthopedic Surgery at Case Western Reserve University School of Medicine. He is a team physician for the Cleveland Browns as well as several local high schools. Dr. Calcei has published extensively on a variety of sports medicine topics, has a particular interest in injury prevention and finding ways that we can make sports safer while optimizing athlete performance. So, we’re very excited to have him join us today.

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Today’s episode is going to focus on the management of rotator cuff retears — including tips and tricks for successful revision repair and augmentation options.

We are joined today by two outstanding guests!

Dr. Brian Waterman is a Professor of orthopedic surgery at Wake Forest University School of Medicine, Chief of Sports Medicine & Shoulder Surgery at Wake Forest Baptist Medical Center and Director of the Sports Medicine & Shoulder Surgery Fellowship. He is on the editorial board of the Arthroscopy Journal and American Journal of Orthopaedics. Dr. Waterman is a team physician for Wake Forest University, Winston-Salem Dash and US Ski and Snowboard.

Dr. Gabriella Ode is an orthopedic surgeon specializing in sports medicine and shoulder surgery at the Hospital for Special Surgery, Assistant Professor of orthopedic surgery at Weill Cornell Medical College and adjunct faculty with the Department of Bioengineering at Clemson University. She is also a team orthopaedic surgeon for the New York Liberty of the WNBA.

So, without further ado, let’s get to the Exhibit Hall!

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Pitch, please: Managing UCL Injuries in Throwing Athletes

Dr. Michael Banffy and Dr. Christopher Camp

Today’s episode is going to focus on the management of UCL injuries in throwing athletes.

We are joined today by two outstanding guests!

Dr. Michael Banffy is a Professor of Orthopedic Surgery and Chief of Orthopedic Sports Medicine at Cedars-Sinai, as well as Director of the Orthopedic Sports Medicine Fellowship at Kerlan-Jobe. He is a team physician for the Los Angeles Dodgers and Los Angeles Rams.

Dr. Christopher Camp is a board-certified orthopaedic surgeon specializing in sports medicine and shoulder and elbow surgery. Since 2019, he has been Medical Director, Team Physician, and Director of High Performance for the Minnesota Twins Baseball Club. Dr. Camp conducts clinical and basic science research on injuries of the shoulder, elbow and knee, including a focus on the throwing athlete.

So, without further ado, let’s get to the Exhibit Hall!

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Today’s episode is going to focus on addressing hip pathology in the setting of dysplasia — soft tissue management alone or with a periacetabular osteotomy.

We are joined today by two outstanding guests!

Dr. Jorge Chahla is an Associate Professor of orthopedic surgery at Rush University Medical Center and serves as the Director of Biomechanical Research and Director of the International Fellowship Program at Midwest Orthopaedics at Rush. He is a team physician for the Chicago White Sox, Chicago Bulls and The Joffrey Ballet.

Dr. Robert Parisien is an Associate Professor of orthopedic surgery at Mount Sinai Orthopedics and is a team physician for US Ski and Snowboard and USA Fencing. He has published extensively on the topic of hip preservation and received numerous research awards over the years, so we are very excited to hear his take on this topic!

So, without further ado, let’s get to the Exhibit Hall!

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Today’s episode is going to focus on lateral augmentation procedures to supplement ACL reconstruction, including lateral extraarticular tenodesis versus anterolateral ligament reconstruction.

We are joined today by two outstanding guests!

Dr. Alan Getgood is the Chief of Surgery at Aspetar and Adjunct Professor of orthopedic surgery at the University of Western Ontario. He is a clinician scientist who has secured over $9 million in peer-reviewed and industry-funded grants to build his research program focused on complex knee reconstruction. Dr. Getgood is member of the AOSSM Board of Directors, Herodicus Society, ACL Study Group and was the program chair for the ISAKOS Biennial Congress last month.

Dr. James Voos is a Professor of orthopedic surgery at Case Western Reserve University School of Medicine and Chairman of the orthopedics department at University Hospitals. He successfully launched the UH Drusinsky Sports Medicine Institute and served at the Chief of Sports Medicine and Medical Director. Dr. Voos is the head team physician for the Cleveland Browns, Medical Director for the Cleveland Ballet and current President of the NFL Physicians Society.

So, without further ado, let’s get to the Exhibit Hall!

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Today’s episode is going to focus on surgical management of primary and recurrent anterior glenohumeral instability in athletes.

We are joined today by two outstanding guests!

Dr. John Kelly is a professor of orthopedic surgery at the University of Pennsylvania and Director of Shoulder Sports Medicine at UPenn Ortho. He is Co-director of the Sports Medicine Fellowship and is a team physician for the Philadelphia Union. Dr. Kelly is the former President of the Eastern Orthopaedic Association and Vice President of the Arthroscopy Association of North America.

Dr. Matt Fury is an orthopaedic surgeon at the Baton Rouge Orthopaedic Clinic who specializes in sports-related injuries to the shoulder, elbow, and knee as well as complex shoulder conditions. Dr. Fury graduated from LSU Medical School in New Orleans before completing his orthopaedic surgery residency at the Harvard Orthopaedic Residency Program. He then completed specialized fellowship training at the world-renowned Hospital for Special Surgery in New York City.

So, without further ado, let’s get to the Exhibit Hall!

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Today’s episode is going to focus on ligament reconstruction in skeletally immature patients – including various growth plate sparing ACL reconstruction techniques, MPFL reconstruction considerations and clinical outcomes.

We are joined today by two outstanding guests!

Dr. Mininder Kocher is a professor of orthopedic surgery at Harvard Medical School, Chief of Sports Medicine and Director of the Sports Medicine Fellowship at Boston Children's Hospital. He is the former President of PRISM and POSNA, and serves on the board of directors for AAOS and AOSSM.

Dr. Lauren Redler is an assistant professor of orthopedic surgery at Columbia University Irving Medical Center and is actively involved in medical student, resident and fellow education at Columbia Ortho. She has published extensively on surgical treatment of ACL tears and patellar instability in pediatric patients, and is presenting her research on outcomes of MPFL reconstruction in skeletally immature patients at AOSSM this year!

So, without further ado, let’s get to the Exhibit Hall!

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Today’s episode is going to focus on mental performance and burnout — specifically: What is burnout? What are some risk factors for burnout? And how do we prevent and treat burnout in orthopedic surgeons?

We are joined today by two outstanding guests!

Dr. Kathy Coyner is an Associate Professor of orthopedic surgery at the University of Connecticut and Director of the Sports Medicine Fellowship at UConn. She is a team physician for the UConn Huskies and serves on the AOSSM Board of Directors. Dr. Coyner is the Director of Fellowship Research and has published extensively on a wide range of orthopedic conditions.

Dr. Dean Taylor is a Professor of orthopedic surgery at Duke University, Director of the Duke Sports Medicine Fellowship and a team physician for Duke University. He is the Chairman of the Feagin Leadership Program and is a former President of AOSSM.

So, without further ado, let’s get to the Exhibit Hall!

https://www.thesportsdocspod.com/episodes

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Today’s episode is kind of an Overtime / Ask The Sports Docs crossover. One of the PTs that Ashley works closely with asked her why some patients do well after ACL surgery and some don’t fare as well, despite the surgery being identical in terms of technique, graft choice, post-op protocol etc.

An article was just published in AJSM this month looking at this, specifically investigating factors that impact outcomes after ACL reconstruction. The article that we are reviewing today is titled “Primary Anterior Cruciate Ligament Reconstruction in Level 1 Athletes: Factors Associated With Return to Play, Reinjury, and Knee Function at 5 Years of Follow-up.” This level 2 cohort study aimed to analyze the outcomes of primary ACLR in level 1 athletes and identify preop and intraop factors associated with RTP, ipsilateral ACL reinjury, contralateral ACL injury, and IKDC score at 5 years post-op.

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We have also been chatting about this episode offline and discussed an article that was recently published looking at preoperative grit scores and postoperative range of motion after ACL reconstruction. Grit score is another objective measurement that we can obtain preoperatively and perhaps use to guide intervention during post-op recovery.

We actually did an Overtime episode looking at the impact of grit scores on post-op outcomes after ACL reconstruction. That is episode #53 if you want to check it out! But today's second article is titled “Higher Grit Scores Are Associated With Earlier Increases in Knee Flexion Following Anterior Cruciate Ligament Reconstruction With Meniscus Repair in Pediatric Patients.”

It was published in the April 2023 issue of the Journal of Pediatrics. Pete Fabricant and his team at HSS found that patients with grit scores below the 50th percentile undergoing ACLR + meniscus repair have 5 degrees less total ROM at 3 months compared with those with high grit scores. Though 5 degrees might not seem like a lot, quicker motion recovery in patients with high grit may be a leading indicator of these patients likelihood to achieve other post-op milestones and meet criteria for RTS more quickly. This obvious needs future study to see how grit impacts other factors like strength gains, passing RTP assessments etc.

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Welcome to Overtime with the Sports Docs! On each of these mini episodes, we chat about a new article or new surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data and how this data will be impacting our practice.

Today, we’re talking about posterior cruciate ligament injuries – specifically, surgical treatment; including reconstruction technique and graft choice. We’ll be reviewing an article published this month in AJSM titled, “Single-Bundle Autografts Outperform Single-Bundle Achilles Allograft in PCL Reconstruction in Terms of Posterior Tibial Translation and Clinical Outcomes, but No Differences Exist Between Double-Bundle Grafts.”

LaPrade PCL Stress Test: https://drrobertlaprademd.com/pcl-stress-radiograph-technique-edina-egan-mn/

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We get lots of questions from our patients and our listeners each week. And they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses, with some literature to back it up.

Before we jump into our discussion today, we want to quickly update you on something very exciting that is coming up in July. And if you follow us on social media, you probably already know what we are about to say. We will be hosting our podcast series live again for a third year at the AOSSM Annual Meeting in Nashville. We will be doing several live shows per day from within the Field House on Thursday July 10 th and Friday July 11 th. We have some awesome guests lined up so make sure you’re following our socials to see our schedule that will be dropping soon!

Alright, back to our discussion. Let’s start today with a question from a patient: “Should I Have PRP for My Partial Rotator Cuff Tear?"

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We get lots of questions from our patients and our listeners each week. And they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses, with some literature to back it up.

Before we jump into our discussion today, we want to quickly update you on something very exciting that is coming up in July. And if you follow us on social media, you probably already know what we are about to say. We will be hosting our podcast series live again for a third year at the AOSSM Annual Meeting in Nashville. We will be doing several live shows per day from within the Field House on Thursday July 10 th and Friday July 11 th. We have some awesome guests lined up so make sure you’re following our socials to see our schedule that will be dropping soon!

Alright, back to our discussion. Let’s start today with a question from a patient: “Should I have surgery for my SLAP tear?”

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Today’s episode is going to focus on management of patellar instability – including nonsurgical treatment, MPFL reconstruction techniques and the addition of other procedures including trochleoplasty and osteotomies. We are joined today by two outstanding guests!

Dr. Miho Tanaka is a Professor of Orthopedic Surgery at Harvard Medical School and the Director of the women sports medicine program at Mass General Brigham. She is also the head team physician for the New England Revolution and team physician for the Boston Red Sox, Boston ballet and Boston Glory.

Dr. Beth Shubin Stein is an orthopaedic surgeon at the Hospital for Special Surgery and Professor of Orthopaedic Surgery at Weill Cornell Medical College. She is also the Co-Director of the women’s sports medicine center at HSS and the Director of the Patellofemoral Center at HSS.

So, without further ado, let’s get to the Field House!

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Today’s episode is going to focus on the workup of a patient with a suspected multiligamentous knee injury as well as a surgical approach that follows – including acute versus delayed surgery, repair versus reconstruction, surgical technique and order of operations in the OR. We are joined today by two outstanding guests!

Dr. Matt Provencher is an orthopedic surgeon at the Steadman Clinic in Vail Colorado, Principle Investigator at the Steadman Philippon Research Institute and assistant Editor-in-Chief of Arthroscopy. He is very active in academic societies and serves on the Board of Directors for AOSSM, AANA and SOMOS.

Dr. Armando Vidal is also an orthopedic surgeon at the Steadman Clinic in Vail and is the Vice President of the Medical Staff of Vail Health Hospital. He is was previously the head team physician for the Denver Nuggets, and former team physician for the University of Colorado men's basketball and the University of Denver men's hockey.

So, without further ado, let’s get to the Field House!

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Our last poster is titled Outcomes and Return to Sport Following Arthroscopic Bankart Repair for Anterior Shoulder Instability in Contact versus Non-contact Athletes: A Systematic Review and Meta-Analysis. We’ve spoken a lot about the surgical treatment for anterior shoulder instability on this podcast – most recently with Dr. Brian Lau. That is episode #48 and 49 if you want to check it out.

This study focused on outcomes of arthroscopic Bankart repair for the treatment of anterior shoulder instability, specifically comparing outcomes in contact athletes versus noncontact athletes. This systematic review included 18 studies with 1-year minimum follow-up.

The authors found that contact and noncontact athletes had similar rates of return to sport as well as similar rates of return to preinjury level of play. However, they also found that contact athletes demonstrated significantly greater rates of recurrent instability, at 28% compared to 8% in noncontact athletes. Contact athletes also demonstrated significantly greater need for revision surgery, at 12% compared to 3% in noncontact athletes.

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Our next poster is titled Sleep in Orthopaedic Surgeons: A Prospective Longitudinal Study of the Effect of Home Call on Orthopedic Attending and Resident Sleep. Recurrent episodes of partial sleep deprivation resulting from call schedules are commonly seen in physicians. This has been shown to cause decreased mental effectiveness while at work, which corresponds with a blood alcohol level of 0.08%.

Sleep deprivation has been associated with adverse personal health events, with an increased risk of diabetes, heart disease, stroke and risk of death. Additionally, sleep deprivation has been demonstrated to have a negative clinical impact, including decreased surgical performance, increased errors, and greater risks of accidents.

Despite the known negative impacts of poor sleep, the effect of home orthopedic call on surgeon sleep has not been well quantified. The purpose of the study was to quantify the impact of resident and attending physician home call on sleep performance – specifically total sleep, slow-wave sleep and rapid eye movement sleep – as well as heart rate variability.

Sixteen orthopedic residents and 14 attendings at a level 1 academic trauma hospital wore WHOOP 3.0 straps for a period of 1 year. The WHOOP strap is wearable device that tracks all 4 stages of sleep and monitors wake events, efficiency and respiratory rate. The authors recorded total sleep, slow-wave sleep and REM sleep. Slow-wave sleep is considered to be the most restorative sleep stage and plays an important role in growth, memory and immune function.

This study showed that overall, attendings slept significantly less than residents, at 6 hours compared to 6.7 hours. When on home call, resident total sleep decreased by 20%, REM sleep decreased by 12%, and slow-wave sleep decreased by 12%. For attendings, total sleep on-call decreased by 10%, REM sleep decreased by 7% and slow-wave sleep decreased by 4%.

The authors concluded that orthopedic surgery residents and attendings exhibit low baseline sleep, and taking home call reduces this even further. On home call nights, Residents and Attendings experienced a significant decrease in total sleep, REM sleep and short wake sleep. The authors suggested that further research is required in order to determine how to ensure excellent patient care, maximize educational environments and develop strategies for resilience.

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Our next poster is titled Characterization of Concussions in the National Basketball Association and the 90-day Period Following Return to Play: Analysis of Musculoskeletal Injury Risk and Player Performance. This study was performed at the Mayo Clinic in Arizona and sought to determine the incidence of musculoskeletal injury in the immediate 90-day period following return to play from concussion. The secondary outcomes were to evaluate player performance within the 90-day. As well as time lost after musculoskeletal injury.

Concussions have steadily garnered increased attention over recent years. We actually did an episode with Dr. Rachel Frank focused on concussions and sideline evaluation. This is episode 98 if you want to go check it out. That episode focused primarily on identifying and appropriately managing concussions. This study aims to evaluate the impact of a concussion on risk of musculoskeletal injury.

Concussions have previously been shown to have persistent neurological effects that may lead to slower reaction times and may compromise postural stability in high-level athletes. Therefore, it stands to reason that a player may be at greater risk for musculoskeletal injury and may exhibit poorer performance upon return from a concussion.

The authors identified NBA players who sustained a concussion between 2015-20 22 using a publicly available database. The database was also queried to identify any musculoskeletal injury in the 90-day period following return to play after the concussion, as well as time lost after the subsequent injury.

Performance statistics were obtained from each players preinjury season and post-injury season. Each concussed player was matched with a non-concussed control player using position, win shares, player efficiency rating and points per game as metrics.

So, what did this study find? A total of 70 concussions were identified during this time period. 70% of concussed players sustained a musculoskeletal injury in the 90-day period following return to play. Compared with controls, the odds of sustaining a musculoskeletal injury in the concussed cohort were 11.3 times greater. There was no significant difference between the type and location of injury, with ankle injuries being the most common in both groups.

Now let’s talk about performance. Interestingly, there were no significant changes in points per game, minutes played per game or true shooting percentage between the concussed and control groups. When compared with the controls, no changes in performance statistics were significantly different. Games missed after subsequent musculoskeletal injury were similar between the concussed and control groups.

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Our next AAOS 2025 Annual Meeting poster is titled Mid-term Follow-up of Patellofemoral Osteochondral Allograft Transplantation. This study was performed by Dr. Bill Bugbee and his team at the Scripps Clinic. Dr. Bugbee was a guest on our show back in November 2023. That is episode 59 and 60, if you want to go check it out. In that episode, we discussed osteochondral allograft transplantation for various cartilage defects of the knee, including medial and lateral tibiofemoral, which are the more common locations for OCA transplantation. This study focuses specifically on outcomes of OCA transplantation for patellofemoral cartilage defects.

This study identified 127 patients undergoing OCA transplantation in the patellofemoral compartment – 51 to the patella, 47 to the trochlea and 29 bipolar patella and trochlea. The most common indication was a degenerative cartilage lesion at 47%, followed by a traumatic cartilage injury at 25% and osteochondritis dissecans at 15%. All patients had a minimum follow-up of 2 years. OCA failure was defined as any reoperation that involved removal of the allograft. Patient reported outcomes were also assessed pre-op and post-op, including the IKDC score and KOOS score.

So, what did this study find? First, reoperations occurred in 39% of the knees. Rate of reoperation was not statistically significant between patella, trochlea and bipolar grafts. Second, OCA failures occurred in 16% of the knees at a median 4.4 years following the index surgery, and the most common revision procedure was arthroplasty. Although it did not reach statistical significance, trochlear grafts had a lower failure rate of 9% compared to patellar grafts at 20% and bipolar grafts at 21%.

Overall, graft survivorship at 5 and 10 years was 91% and 82%, respectively. Patients with patellar, trochlear and bipolar grafts all had significant improvement in IKDC scores and KOOS scores from preop to the latest follow-up and no statistically significant differences were observed between the groups. Overall, 77% of patients reported being satisfied with the results of the OCA transplantation with no statistically significant differences in satisfaction between the groups.

Also check out:

Episode 91: Dr. Tom DeBerardino 0n Advances in Patellofemoral Cartilage Restoration

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We are kicking off a special series of episodes to recap the new research presented at the American Academy of Orthopaedic Surgeons Annual Meeting, our largest orthopaedic conference. This year, over 20,000 orthopedic professionals gathered at the AAOS meeting in San Diego to take part.

The educational program was comprised of instructional course lectures, video theater, live surgeries, podium presentations and research posters. Over the next several episodes we’re going to be reviewing seven sports medicine posters that were presented at the AAOS meeting.

On this podcast we try to review the most updated literature on different sports medicine topics. So, reviewing some of the posters that were just presented at AAOS is particularly exciting for us because this is very new data. So new that most of this data has not even been published yet.

So, let’s get started with our first poster, titled Return to Performance Following UCL Surgery in Major League Baseball Pitchers. While return to play is very important for both players and teams, arguably even more important is return to performance. With advancements in pitch tracking analysis and analytics, it is now possible to determine return to full performance, based on comparison of preop and postop metrics.

This retrospective analysis was performed by Dr. Christopher Ahmad and team at Columbia University. 119 MLB pictures who underwent primary UCL reconstruction or repair were evaluated. Return to play rates at 1- 2- and 3-years postop were reported. Additionally, the authors looked at performance data, including innings pitched as well as pitch-tracking data.

Overall, surgery remains an effective option for MLB pitchers to return to play and performance following a UCL injury. However, athletes should be counseled that certain pitches may be negatively impacted postoperatively.

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Welcome back to The Sports Docs Podcast! In this episode, we’re going to continue our discussion with Dr. Andrea Spiker and focus on open surgical treatment for hip preservation, then wrap up with a discussion on post-op rehab and return to play.

Our conversation picks back up with an article from the September 2017 issue of AJSM titled “Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia.” Bryan Kelly and his team at HSS investigated the effect of prior arthroscopic hip surgery on clinical outcomes after periacetabular osteotomy or “PAO”. They found that patients who previously underwent hip arthroscopy had inferior functional outcomes at 6 months and 12 months after PAO compared to patients with no prior hip surgery. The authors note that both groups significantly improved post-op and there was no difference in complications or reoperation between the groups.

We finish up today with a surgical technique article authored by our guest, Dr. Andrea Spiker, from the August 2022 issue of Arthroscopy Techniques. The article is titled “Treatment of Coxa Profunda with Open Surgical Hip Dislocation, Rim Resection, Cam Resection, and Labral Reconstruction” and describes an open surgical approach to address many of the challenges posed by coxa profunda. For our listeners, coxa profunda is essentially a deep acetabular socket. This differs from acetabular protrusio, in which the femoral head and socket displace into the pelvis. The global acetabular over-coverage associated with coxa profunda makes arthroscopic management very challenging in terms of obtaining adequate hip distraction and concerns for traction injury. For these reasons, an open approach has been proposed.

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On today’s episode we’re focusing on hip preservation with Dr. Andrea Spiker. We have some great articles for you that contribute well to our conversation on femoroacetabular impingement or “FAI”, hip dysplasia and the arthroscopic and open surgical treatments for these conditions. As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

We’ll start off our discussion today with an article from the June 2018 issue of The Lancet titled “Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome.” This multicenter RCT included 348 patients across 28 hospitals in the UK and compared conservative treatment with physical therapy to surgical treatment with hip arthroscopy. The authors reported that while both groups improved after treatment, patients who underwent hip arthroscopy for treatment of FAI demonstrated significantly greater improvement in hip-related quality of life compared to patients who had nonsurgical treatment.

Then, from the September issue of AJSM this year, we review an article titled “Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement with Hip Arthroscopy Compared with Nonsurgically Treated Patients.” Aaron Krych and team at the Mayo Clinic reported significantly less progression of arthritic changes in surgical patients compared to non-op. Seven percent of patients in the surgical group ultimately underwent a total hip replacement compared to 12% in the non-op group. Risk factors for failure of non-op treatment included male sex, presence of a CAM morphology, increased age and initial arthritic joint changes at diagnosis.

We are joined today by Dr. Andrea Spiker, a board-certified orthopedic surgeon at the University of Wisconsin-Madison who is dual fellowship trained in sports medicine and hip preservation. She is a team physician for UW Badger Athletics and provides head orthopedic coverage for the UW Men’s and Women’s Basketball teams. She is also the Program Director of the UW Orthopedic Surgery Sports Medicine Fellowship Program. Dr. Spiker is an active member in numerous orthopedic societies including AAOS, AOSSM and AANA, and has published extensively on the topic of hip preservation, so we’re very excited to hear all that she has to share on this topic today.

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We get lots of questions from our patients and our listeners each week, and they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started!

Today’s Ask The Sports Docs is going to focus on an area of sports medicine that we get asked a lot, despite us being surgeons: “What nonsurgical treatments can I do to rehab my musculoskeletal injury as well as improve my performance and prevent reinjury?”

Specifically:

Does Kinesiotaping actually improve recovery and performance?

Does sports massage therapy help with muscle recovery and injury prevention, or is it just a feel-good treatment?

What does the research say about acupuncture for pain relief and recovery in athletes?

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On each of these mini episodes, we chat about a new article or new surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data and how this data will impact our practice.

Today, we’re broaching a topic that we haven’t discussed before on this podcast. And that is the medico-legal side of sports medicine. Specifically, the malpractice liability exposure for team physicians.

In January of 2023, a professional football player for the Philadelphia Eagles sued a surgeon in Pittsburgh, that surgeon’s medical center, and the Philadelphia orthopaedic practice caring for the team. After a 2-week trial, the jury found in favor of the plaintiff and awarded him $43.5 million dollars in damages. This ruling has had a profound impact on our sports medicine community and ultimately led to the Philadelphia practice terminating its contract to care for this NFL team.

This case, and others that have come before it, has highlighted the liability that orthopedic surgeons assume when caring for elite professional athletes. Despite this, many sports medicine physicians lack the legal expertise to understand their risk of exposure. Today, we are reviewing an article published this month in AJSM titled “Malpractice Liability Exposure and the Sports Medicine Team Physician: Caring for Professional Athletes in the National Football League, Major League Baseball, and National Hockey League.”

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It is a Reboot Special with one of our faves - Dr. Brian Cole!

Today’s episode is going to focus on osteochondral allograft transplantation, and specifically how basic science research can and should impact your clinical practice.

We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center. He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox.

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Welcome to another episode of Game Plan! It has been a while since we have done one of these Game Plan episodes so to quickly review: These episodes are specifically designed for patients. They are designed to hopefully answer some of the questions you have about the most common sports medicine conditions, injury prevention and treatment options.

Today we’re talking about pickleball – the fastest growing sport in the United States. From 2019- 2021, the number of pickleball players increased from 3.3 to 4.8 million. The reason for the growth of the sport is likely multifactorial, including that it encompasses a wide variety of age ranges, it is easy to understand and it is inexpensive to play. However, with this steady growth has come a corresponding linear rise in pickleball injuries. And these injuries are not inexpensive, costing between 250 to 500 million dollars in 2023 alone.

Pickleball is a paddle sport that takes aspects from tennis, badminton, and ping-pong. Now, we were going to try to explain the pickleball rules here, and how it differs from other racquet sports. But, USA Pickleball has a really nice 5-minute video on their website (usapickleball.org) that quickly summarizes the basic rules. If you are interested in learning more about this game, definitely check out their website. It should be noted that the rules and scoring system are currently variable. But as more competitions arise, more standardization to the game will likely follow, as is the trend with most sports.

Today, we’re reviewing an article published in the November 2024 issue of the yellow journal titled “Pickleball: A Standard Review of Injury Prevalence and Prevention in a Rapidly Growing Sport.” This study compiled data from retrospective studies containing emergency department data and case reports of specific injuries sustained while playing pickleball. The authors also utilized a customized survey to capture outpatient data of current pickleball players seen in outpatient orthopedic facilities and at local pickleball events.

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On each of these mini episodes, we chat about a new article or new surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data and how this data will be impacting our practice.

Today, we’re talking about graft choice for anterior cruciate ligament reconstruction, and specifically how that impacts psychological readiness to return to play. Now, we’ve spoken extensively about ACL injury on this podcast.

On our first ever episode with Dr. Mary Mulcahey was two-part segment all about ACL tears. Since then, we have gone on to discuss risks factors for ACL tears, ACL reconstruction, augmentation with lateral extra-articular tenodesis, revision ACL surgery and more! We also did an entire Game Plan episode on ACL graft choice and an Overtime episode “update” on ACL graft choice – the latter is episode #81 if you want to check it out.

We also touched upon psychological readiness to return to play after ACL reconstruction in episode #16. Musculoskeletal injuries, in particular ACL injuries, can take a tremendous psychological toll on our athletes. Depression, a common experience for injured athletes, has been associated with worse patient- reported outcomes, higher levels of pain, and increased rates of postop complications.

Unfortunately, caring for the mental side of the injured athlete remains a huge gap in our field of orthopedics and sports medicine. For this reason, Catherine and her colleague Emily Perrin created The Unbroken Athlete – a resource containing comprehensive mental and physical programs for athletes to enhance their recovery journey and performance. Catherine will speak a bit more about this during the episode.

Our paper today is titled “Association Between Autograft Choice and Psychological Readiness to Return to Sport After ACL Reconstruction.” This level 3 retrospective cohort study was performed at the Mayo Clinic in Arizona. It sought to evaluate the relationship between an athlete psychological readiness to return to sport, as defined by the ACL-RSI score, and autograft choice – either quadriceps tendon, hamstring tendon or bone-patellar-tendon-bone.

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Today, we’re talking about the use of tranexamic acid or “TXA” for rotator cuff repair surgery. First, what is TXA? If you’re not an arthroplasty surgeon or a traumatologist, you may not be as familiar with this medication. TXA is drug that inhibits the enzymatic breakdown of fibrin blood clots, also known as fibrinolysis. By doing this, TXA stabilizes the thrombi, or blood clots, and thus decreases bleeding. TXA was originally developed to treat postpartum hemorrhage but its use has evolved over the years. It is now often used perioperatively in the setting of elective surgery to reduce blood loss, blood transfusions, ecchymosis, and hematoma formation.

In the field of orthopedics, use of TXA has traditionally been limited to big open surgeries where large volume blood loss is a concern, such as total joint replacement, fracture fixation and spine procedures. However, sports medicine procedures that rely extensively on visual clarity of the surgical field, such as knee and shoulder arthroscopy, can also greatly benefit from the use of TXA. By lessening intraoperative bleeding, TXA may result in better visualization of the surgical field, potentially decreasing operative time and subsequent postoperative swelling and pain. That is the clinical question that our paper today aimed to investigate. The article that we are reviewing is titled “Tranexamic Acid for Rotator Cuff Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials.”

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Today, we’re talking about postoperative rehabilitation after combined medial patellofemoral ligament reconstruction and tibial tubercle osteotomy to treat recurrent patellar instability.

As we’ve spoken about before on this show, literature to guide postop recovery after orthopedic surgery is lacking. Often times, we’re using our experience and the opinions of our colleagues and mentors to determine how to best rehab patients after surgery, rather than concrete data. It is critical to progress patients weightbearing, range of motion and strengthening appropriately.

So, it’s great when we see a high-level prospective randomized study come out that compares different rehabilitation strategies. Our paper today is titled “Early Postoperative Rapid Rehabilitation Yields More Favorable Short-Term Outcomes in Patients Undergoing Patellar Realignment Surgery for Recurrent Patellar Dislocation.”

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We get lots of questions from our patients and our listeners each week. And they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started!

Today’s Ask The Sports Docs is going to focus on a question we get asked a lot: What can I take supplement-wise to improve my healing and outcome after an orthopedic injury or surgery?

Pentadecapeptide BPC 157 enhances the growth hormone receptor expression in tendon fibroblasts

Injectable Therapeutic Peptides-An Adjunct to Regenerative Medicine and Sports Performance?

The role of vitamin D in shoulder health: a comprehensive
review of its impact on rotator cuff tears and surgical results

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Happy New Year from The Sports Docs Podcast! 🎆

As we reflect on an incredible year of growth for our podcast, we’d like to take a moment to thank our amazing listeners, guests and supporters for making this podcast such a success!

Our podcast has been downloaded in over 60 countries, is in the top 25% of @buzzsprout podcasts and is again ranked in the top sports medicine podcasts 📈

🎙️ We are very excited to see what 2025 has in store!

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Happy New Year from The Sports Docs Podcast! 🎆

As we reflect on an incredible year of growth for our podcast, we’d like to take a moment to thank our amazing listeners, guests and supporters for making this podcast such a success!

Our podcast has been downloaded in over 60 countries, is in the top 25% of @buzzsprout podcasts and is again ranked in the top sports medicine podcasts 📈

🎙️ We are very excited to see what 2025 has in store!

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Our conversation picks back up with an article published in the December 2020 issue of Current Reviews in Musculoskeletal Medicine titled “Surgical Management of Massive Irreparable Cuff Tears: Superior Capsular Reconstruction.” Authored by our guest today, this review article summarizes the biomechanical properties and functional outcomes of superior capsular reconstruction or “SCR” for treatment of massive irreparable rotator cuff tears. The authors report that SCR decreases superior translation and subacromial contact pressure. Glenoid fixation is maximized with three anchors, while margin convergence to any remaining rotator cuff – particularly posterior – improves stability. Patient selection is key, with the ideal patient being younger than 70 and a healthy nonsmoker with an irreparable posterior cuff tear in the absence of glenohumeral arthritis and a functioning or repairable subscapularis.

We finish up our discussion today with the publication titled “Latissimus dorsi transfer or lower trapezius transfer: a treatment algorithm for irreparable posterosuperior rotator cuff tears muscles transfers in posterosuperior rotator cuff tears.” Laurent Lafosse and team compared two tendon transfer options for irreparable posterior-superior rotator cuff tears with rotational deficiency – the latissimus dorsi transfer and the lower trapezius transfer. They found that active motion, pain scores and function were improved in both groups with a low failure and revision rate. The authors suggest that lower trapezius transfer better restores external rotation at the side while latissimus dorsi transfer may be a better option for restoration of external rotation and abduction.

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On today’s episode we’re focusing on challenging rotator cuff pathology with Dr. Patrick Denard, an orthopedic shoulder surgeon at the Oregon Shoulder Institute. We have some great articles for you that contribute well to our conversation on the treatment options for massive reparable, as well as irreparable, rotator cuff injuries. As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

We’ll start off our discussion today with an expert opinion article from the July 2022 issue of Arthroscopy titled “Graft Augmentation of Repairable Rotator Cuff Tears: An Algorithmic Approach Based on Healing Rates.” Authored by our guest today, this article provides an algorithm for tissue augmentation of rotator cuff repairs based on the current available evidence regarding rotator cuff healing. The authors recommend using a Rotator Cuff Healing Index or “ROHI” cutoff of greater than or equal to 7 to select for the use of tissue augmentation, as the healing rate is 66% at 6 points but decreases substantially to 38% at 7 points.

Then, from the May 2019 issue of AJSM, we review an article titled “Rotator Cuff Matrix Augmentation and Interposition: A Systematic Review and Meta-analysis.” The authors concluded that graft augmentation provided significantly lower retear rates and higher ASES scores compared with cuff repair alone. With regards to graft choice for augmentation, the highest rates of healing, as demonstrated by repair integrity on imaging, were shown for allograft at 82% compared to xenograft at 68%. Nonaugmented repairs had a healing rate of only 49%.

We finish up our discussion today with the publication titled “Preoperative Nutrition Impacts Retear Rate After Arthroscopic Rotator Cuff Repair.” This level III retrospective study published in the August issue of JBJS this year, sought to determine the relationship between preoperative nutritional status, using the Geriatric Nutritional Risk Index or “GNRI”, and rotator cuff retears after arthroscopic repair in patients 65 years of age and older. The authors found that poor pre-op nutrition, as exhibited by a GNRI less than 103, was an independent risk factor for a cuff retear at 2 years post-op.

We are joined today by Dr. Patrick Denard, a board-certified orthopedic shoulder surgeon and Director of the Oregon Shoulder Institute. He is also the Director of the Oregon Shoulder Fellowship and Associate Professor of Orthopedic Surgery at Washington Status University School of Medicine. Dr. Denard is the Chairman and Founder of the Pinnacle Shoulder meeting and a reviewer for the Journal of Shoulder and Elbow surgery. He has published and lectured extensively on the topic of rotator cuff pathology, so we are very excited to have him join our discussion today.

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In this episode, we’re going to continue our discussion with Dr. Aaron Krych and focus on surgical advancements to address meniscus extrusion and optimize postoperative outcomes for patients.

Our conversation picks back up with an article published last month in Arthroscopy Techniques titled “Arthroscopic Centralization of the Extruded Meniscus With Posterior Root Tear: A Technique Using Meniscotibial Ligament Fixation.” Most meniscus centralization techniques involved anchoring the meniscus body directly to the tibia, which can limit the normal anatomic motion of the meniscus. Dr. Krych and his team described a novel technique for meniscus centralization that maintains natural meniscal motion by utilizing the meniscotibial ligaments to centralize the meniscus body.

Then, from the May 2024 issue of Arthroscopy, we review an article titled “Satisfactory Clinical Outcome, Complications, and Provisional Results of Meniscus Centralization with Medial Meniscus Root Repair for the Extruded Medial Meniscus at Mean 2-Year Follow-Up.” This case series concluded that patients undergoing medial meniscus root repair with meniscus centralization demonstrated significant improvements in pain, function, satisfaction and quality of life. Additionally, there was no evidence of significant arthritic progression on postoperative imaging. No patients underwent revision meniscus surgery or total knee arthroplasty.

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On today’s episode we’re focusing on medial meniscus root repairs with Dr. Aaron Krych, Chair of Orthopedic Surgery and Professor of Orthopedic Surgery at The Mayo Clinic in Rochester, Minnesota. We have some great articles for you that contribute well to our conversation on the optimal treatment of medial meniscus root tears, including recent advancements in surgical technique to optimize outcomes.

We’ll start off our discussion today with systematic review article from the February issue of Arthroscopy this year titled “Root Repair Has Superior Radiological and Clinical Outcomes Than Partial Meniscectomy and Nonoperative Treatment in the Management of Meniscus Root Tears.” This review included 56 studies with over 3000 patients. The authors concluded that root repair demonstrated the least amount of postoperative joint space narrowing and the greatest increase in patient reported outcome scores including IKDC, Lysholm, KOOS pain and activity scales.

Then, from the February 2022 issue of OJSM we review the publication titled “Prospective Consecutive Clinical Outcomes After Transtibial Root Repair for Posterior Meniscal Root Tears.” This multicenter case-control study concluded that patients who underwent posterior meniscus root repair utilizing a transtibial pullout technique had significant improvement in clinical outcome scores at 2 years with an overall low complication rate. Increased age, increased BMI, cartilage status, and meniscal extrusion did not have a negative impact on short-term functional outcomes, but age greater than or equal to 50 years and extrusion negatively influenced patient activity level.

We finish up our conversation today with the publication titled “Biomechanical Performance of TranstibialPull-Out Posterior Horn Medial MeniscusRoot Repair Is Improved With KnotlessAdjustable Suture Anchor–Based Fixation.” This controlled laboratory study, published in the March issue of OJSM this year, compared four different fixed transtibial pullout repair techniques to a knotless adjustable repair technique. If you are watching this on YouTube you will be able to see the different suture configurations that were compared. Otherwise, check our social media for images! This study found that the knotless adjustable repair resulted in higher tissue compression and less tissue displacement compared to traditional fixed repair, which is great for healing. Additionally, the rip-stop Mason-Allen suture configuration provided higher resistance to suture cut-through, withstanding repair failure.

We are joined today by Dr. Aaron Krych, Chair of Orthopedic Surgery and Professor of Orthopedic Surgery at the Mayo Clinic. He is also the Chair of the Division of Sports Medicine at Mayo Clinic and team orthopedic surgeon for Minnesota Timberwolves. Dr. Krych received his medical degree and completed his orthopedic surgical residency training at the Mayo Clinic. He then went on to complete a fellowship in sports medicine at the Hospital for Special Surgery. Dr. Krych has published extensively on the topic of meniscal pathology, and specifically meniscus root repair, so we are very excited to have him join our discussion today.

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Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and I chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data ranging from operative indications, surgical approaches, post-op protocols and most importantly – patient outcomes.

Today we’re talking about SLAP tears – tears of the superior labrum from anterior to posterior. We have two great articles for you today that focus on the surgical management of SLAP tears – specifically whether we should be repairing SLAP tears or proceeding directly to biceps tenodesis. We will also discuss the different types of biceps tenodesis procedures – mainly arthroscopic suprapectoral versus open subpectoral.

Our first paper looks specifically at this patient population – young overhead athletes – and investigates the functional and athletic outcomes after primary subpectoral biceps tenodesis for type II SLAP tears.

Brian Waterman and Tony Romeo published a case series in the January 2023 issue of Arthroscopy titled “High Rate of Return to Sporting Activity Among Overhead Athletes with Subpectoral Biceps Tenodesis for Type II SLAP Tear”. The authors reported that 81% of patients returned to their previous level of play at an average of 4 months post-op. There were also significant improvements in VAS and SANE scores post-op.

But how do repairs do in this population? The answer is… not great. Return to preinjury level of play after SLAP repair has been reported in the range of 54% to 63% of elite throwers. In one cohort study by Boileau, 60% of patients reported persistent shoulder pain after SLAP repair and 50% elected to undergo secondary surgery. Provencher published on his outcomes of SLAP repair in an active military population and reported a 37% failure rate and 28% revision rate at short to mid-term follow up.

Our second article focuses on this and is titled “No Difference in Clinical Outcomes for Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis at Midterm Follow-up.” Nikhil Verma – who will be joining us at AOSSM – and colleagues at Rush compared arthroscopic suprapectoral tenodesis versus open subpectoral tenodesis for long head of biceps tendon disease, so not SLAP tears. They reported no significant differences in patient reported outcomes or complications at any time point.

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Welcome to Overtime with the Sports Docs. On each of these mini episodes, we chat about a new article or new surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data and how this data will be impacting our practice.

Today, we’re talking about hamstring injuries in the NFL. And if your fantasy team is anything like my fantasy team, it currently looks like an infirmary. So, you’ll probably want to listen in to this episode.

Now, we’ve covered hamstring injuries in the NFL before. Last year we did an entire Game Plan episode dedicated to this topic. That is episode #52 if you want to check it out. Today, we are actually reviewing a new study just published this month in AJSM that focused on how player characteristics, injury severity and imaging findings can impact the amount of time missed as well as risk of recurrent injury.

The article is titled “Correlation of Player and Imaging Characteristics with Severity and Missed Time in the National Football League Professional Athletes with Hamstring Strain Injury.” Molly Day, Scott Rodeo and team at HSS published this retrospective cross-sectional study that aimed to identify certain player characteristics, clinical examination findings and MRI results that were associated with injury severity and missed playing time. As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

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We get lots of questions from our patients and our listeners each week. And they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started! Today’s Ask The Sports Docs is going to focus on one specific question that we get asked a lot from patients, and review a recent article that came out about this topic.

We both use cryotherapy and cryo-compression therapy postoperatively after our knee and shoulder surgeries. Many of these devices are unfortunately not covered by insurance, and therefore require patients to pay out-of-pocket. A question we get asked all the time from our surgical patients is: “Is this worth it?” Basically, do cryo-compression devices offer a significant benefit compared to a bag of peas? Is the cost worth it?

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Welcome to another episode of Game Plan! These Game Plan episodes are specifically designed for patients – to hopefully answer some of the questions you have about the most common sports medicine conditions and surgical treatments. But today’s episode is a little different and we’re excited about it! Today, we’re focusing on common injuries in the NFL and how these injuries impact time missed and player performance once athletes ultimately return to play.

This is something that each NFL team looks at carefully when evaluating rookie prospects before draft day. Teams look at the number of previous injuries, the types and severity of the injuries and treatment rendered when trying to decide on the ranking of a draft candidate. Now, this is just one facet of the evaluation – a physical examination is performed at the NFL Combine and performance metrics post-injury are obviously taken into account.

But as the literature continues to grow in this area, it is becoming more feasible to project a player’s injury risk, career length and even performance in the NFL. This is useful information for NFL teams but also fantasy football enthusiasts who want to make sure they draft the best players for their team. So, our discussion today is going to focus on common injuries in the NFL and how that injury history may impact player reliability (games played), longevity for the season and performance.

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Welcome to another episode of Game Plan!

As you might remember from our episode on ACL graft choices, these Game Plan episodes are specifically designed for patients – to hopefully answer some of the questions you have about the most common sports medicine conditions and surgical treatments.

We’re continuing with our favorite topic today – ACL tears – but today’s episode is going to focus on risk factors for ACL tears. Specifically, which of these risk factors can we modify to lessen the chance of sustaining ACL tear and how do we decrease that risk.

Please note that this episode is going to focus strictly on ACL reconstruction. For more information on ACL rehab check out our recent two-part episode with Candace Townley Cox back in April of this year. We’ve covered the addition of “LET” or “lateral extra-articular tenodesis” to ACL reconstruction in an Overtime episode in November of 2021 and again with Dr. Brian Waterman live at the AAOS meeting back in March of this year. And, of course, our first Game Plan episode was on how to choose the best ACL graft for reconstruction, so definitely check that out.

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Welcome to a very special episode of The Sports Docs Podcast. In celebration of our 101st episode, we are honoring Dr. Mark Price who passed away on August 16, 2024 following his battle with leiomyosarcoma. We wanted to pay tribute to Dr. Price, who mentored us both through our residency at Harvard.

His death is an immeasurable loss to his family and the community. Dr. Price was the Head Team Physician and Medical Director of the New England Patriots since 2016 and a team physician for the Boston Red Sox since 2009. He was a Captain in the U.S. Navy Reserves and served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal.

Most importantly, he was a bright example of a physician who cared deeply for his friends and family, including his wife Stephanie and their children, Henry, Julia and Sarah. The words shared by family and friends at his memorial service in Wellesley last month demonstrated a life rooted in purpose and accomplishments aligned with his values.

Mark was one of our first guests, coming onto the show for Episode #3 and #4 in March of 2021. Consistent with who he was, he was willing to take the time out of his busy schedule to help two of his mentees build something new. So, with that, we thank Mark Price for all that he taught us and the mentorship he provided to not only us, but our community.

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On today’s episode we’re continuing our discussion on shoulder instability with Dr. Mark Price, Orthopaedic Surgeon at Massachusetts General Hospital and Head Team Physician for the New England Patriots. We have 5 great articles which we discuss over two episodes that really contribute well this conversation on how to best manage shoulder instability in athletes both in-season and post-season.

We’re very honored to have Dr. Mark Price join our discussion today. Dr. Price specializes in sports medicine, knee and shoulder surgery. He is an attending surgeon at Massachusetts General Hospital and Assistant Professor of Orthopaedic Surgery at Harvard Medical School. Dr. Price earned his MD from Harvard Medical School and PhD in Medical Physics from MIT. He completed the Harvard Combined Orthopaedic Residency Program, where Catherine and I both attended as well, and then went on to complete a fellowship in sports medicine and shoulder reconstructive surgery at Mass General. Dr. Price is Head Team Physician and Medical Director for the New England Patriots and a Team Physician for the Boston Red Sox. He is a Captain in the US Navy Reserves and has served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal for meritorious service.

We begin with Dr. Hettrich of Brigham and Women’s Hospital who recently investigated the question “Are there racial differences between patients undergoing surgery for shoulder instability?” We’ll dive further into this topic and chat about how this impacts resident and fellow education.

We will follow these articles up with a discussion on the surgical management of shoulder instability by reviewing two articles from the March issue of Arthroscopy. The first is a prospective randomized controlled trial titled Arthroscopic Bankart Repair With and Without Curettage of the Glenoid Edge. Desai and his team concluded that curettage of the glenoid edge reduced the incidence of postoperative recurrence of instability likely relating to improved healing of the capsulolabrum repair. Avramidis and colleagues contributed their cases on the management of recurrent anterior shoulder instability by All-Arthroscopic Modified Eden-Hybinette Procedure Using Iliac Crest Autograft and Double-Pair Button Fixation System.

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Welcome to a very special episode of The Sports Docs Podcast. In celebration of our 100th episode, we are honoring Dr. Mark Price who passed away on August 16, 2024 following his battle with leiomyosarcoma. We wanted to pay tribute to Dr. Price, who mentored us both through our residency at Harvard.

His death is an immeasurable loss to his family and the community. Dr. Price was the Head Team Physician and Medical Director of the New England Patriots since 2016 and a team physician for the Boston Red Sox since 2009. He was a Captain in the U.S. Navy Reserves and served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal.

Most importantly, he was a bright example of a physician who cared deeply for his friends and family, including his wife Stephanie and their children, Henry, Julia and Sarah. The words shared by family and friends at his memorial service in Wellesley last month demonstrated a life rooted in purpose and accomplishments aligned with his values.

Mark was one of our first guests, coming onto the show for Episode #3 and #4 in March of 2021. Consistent with who he was, he was willing to take the time out of his busy schedule to help two of his mentees build something new. So, with that, we thank Mark Price for all that he taught us and the mentorship he provided to not only us, but our community.

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We have 5 great articles which we discuss over two episodes that really contribute well this conversation on how to best manage shoulder instability in athletes both in-season and post-season.

We’re very honored to have Dr. Mark Price join our discussion today. Dr. Price specializes in sports medicine, knee and shoulder surgery. He is an attending surgeon at Massachusetts General Hospital and Assistant Professor of Orthopaedic Surgery at Harvard Medical School. Dr. Price earned his MD from Harvard Medical School and PhD in Medical Physics from MIT. He completed the Harvard Combined Orthopaedic Residency Program, where Catherine and I both attended as well, and then went on to complete a fellowship in sports medicine and shoulder reconstructive surgery at Mass General. Dr. Price is Head Team Physician and Medical Director for the New England Patriots and a Team Physician for the Boston Red Sox. He is a Captain in the US Navy Reserves and has served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal for meritorious service.

The first paper is from the February issue of AJSM, titled Incidence of Posterior Shoulder Instability in the United States Military. It is a descriptive epidemiology study by Brett Owen and his team which found the incidence is higher than previously reported. Then, from the January issue of Sports Health, we feature the publication Does Functional Bracing of the Unstable Shoulder Improve Return to Play in Scholastic Athletes? Tokish and colleagues found functional bracing did not result in increased success rates when compared to no bracing in adolescent athletes.

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In this episode, we’re going to continue our discussion with Dr. Rachel Frank and focus on emergency action plans as well as the sideline management of some common soccer-related orthopedic injuries.

Our conversation picks back up with a review article published in the July 2023 issue of Clinics in Sports Medicine titled “On-Field Sports Emergencies: Preparation and Readiness.” Authored by our guest today, this paper discusses the importance of an emergency action plan. The emergency action plan should include site-specific implementation, personnel who are involved, equipment, communication, transportation, and location of emergency care facilities. This paper notes that improvements should be made following self-evaluation after each on field emergency to ensure the EAP is optimal.

Then, from the upcoming issue of JAAOS next month, we review an article titled “Management of Sideline Medical Emergencies.” While most sports related injuries are benign, the potential for catastrophic injury is omnipresent and covering team physicians need to be prepared. This paper nicely highlights the acute management of a variety of medical emergencies, including cardiac arrest, respiratory failure, nervous system injury, significant bleeding, abdominal trauma and specific musculoskeletal injuries including hip and knee dislocations. The authors point out that physicians must be comfortable recognizing the signs and symptoms of life-threatening emergencies and not hesitate to rapidly escalate care and initiate an emergency response.

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On today’s episode we’re focusing on concussions and emergency action plans with Dr. Rachel Frank, head team orthopaedic surgeons for the Colorado Rapids soccer team and USA Soccer Network Physician. We have some great articles for you that contribute well to our conversation on the recognition and management of concussions, as well as the importance of emergency action planning.

We’ll start off our discussion today with a review article published in the January 2019 issue of Orthopedics titled “Concussions in Sport”. Authored by our guest today, this paper dives into the current understanding of concussions, including the increasing incidence in youth sports as well as the role of orthopaedic surgeons in appropriately recognizing and managing concussions acutely.

Then, from the March 2022 issue of AJSM this, we review the publication titled “Association Between Symptom Burden at Initiation of a Graduated Return to Activity Protocol and Time to Return to Unrestricted Activity After Concussion in Service Academy Cadets.” This level 2 prospective cohort study found that cadets who endorsed greater than or equal to 2 concussion symptoms had a significant longer duration in the return to activity protocol that those who endorsed fewer symptoms. Other factors associated with a longer duration in the protocol included non varsity status, female gender, academic breaks and longer time to initiating the protocol.

We finish up our conversation today with the publication titled “Prevention of sports-related concussion in soccer: a comprehensive review of the literature” from the March 2023 issue of Annals of Medicine and Surgery. This systematic review identified several strategies that can be implemented to lower the rate of concussion in soccer. These include: Concussion education; rule and regulation changes to reduce player-to-player contact; and prevention training programs such as behavioral skills, vision training to improve sensory and anticipation, and cervical strengthening.

We are joined today by Dr. Rachel Frank, a board-certified orthopedic surgeon and sports medicine specialist. She is an Associate Professor of Orthopaedic Surgery and Director of the Joint Preservation Program at the University of Colorado School of Medicine. Dr. Frank is also a team physician for the University of Colorado Buffalos, head team orthopedic surgeon for the Colorado Rapids and a USA Soccer Network Physician. She is the editor and Chief of the Journal of Cartilage and Joint Preservation and has published over 300 peer-reviewed articles and 50 book chapters.

Welcome to the show, Dr. Frank!

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On today’s episode we’re focusing on biologic augmentation of rotator cuff tears – including an algorithm for determining which patients require augmentation as well as different augmentation approaches such as extracellular matrix scaffolds and Orthobiologics.

We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center. He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox.

Research Links:
https://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/rotator-cuff-augmentation-with-dermal-allograft-improve-clinical-outcomes.pdf

https://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/bmac-augmentation-may-produce-structurally-superior-rotator-cuff-repair-2023.pdf

https://pubmed.ncbi.nlm.nih.gov/32169466/

CuffMend: https://www.arthrex.com/shoulder/cuffmend-augmentation-system

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Today’s episode is going to focus on management of patellar instability – including nonsurgical treatment, MPFL reconstruction techniques and the addition of other procedures including trochleoplasty and osteotomies. We are joined today by two outstanding guests!

Dr. Miho Tanaka is a Professor of Orthopedic Surgery at Harvard Medical School and the Director of the women sports medicine program at Mass General Brigham. She is also the head team physician for the New England Revolution and team physician for the Boston Red Sox, Boston ballet and Boston Glory.

Dr. Beth Shubin Stein is an orthopaedic surgeon at the Hospital for Special Surgery and Professor of Orthopaedic Surgery at Weill Cornell Medical College. She is also the Co-Director of the women’s sports medicine center at HSS and the Director of the Patellofemoral Center at HSS.

So, without further ado, let’s get to the Field House!

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Today’s episode is going to focus on two common athletic shoulder injuries that we see in American football – traumatic anterior shoulder dislocations and acromioclavicular joint injuries. We’ll dive into the acute on-field management followed by treatment thereafter, including nonoperative and surgical treatment options.

We are joined today by Dr. Kevin Farmer, a Professor of Orthopaedic Surgery at the University of Florida, a team physician for the University of Florida gators and the editor of the “In-Season Management of Football Injuries” textbook. He is also a past president of the Florida Orthopaedic Society and the Florida Alliance for Sports Medicine, and a board member for AAOS and the Southern Orthopaedic Association.

So, without further ado, let’s get to the Field House!

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Today’s episode is going to focus on rotator cuff repair – specifically the various repair constructs to address different tear patterns, when and how to best augment rotator cuff repairs and how our present clinical data can help us counsel our patients and optimize outcomes.

We are joined today by Dr. Peter Millett, an orthopedic surgeon and partner at the Steadman Clinic in Vail Colorado, researcher and board member at the Steadman Philippon Research Institute and Medical Director for Ski and Snowboard Club Vail. He is also an ambassador for the US Ski and Snowboard team and a consultant to the NHL Players Association and MLB Players Association.

So, without further ado, let’s get to the Field House!

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Today’s episode is going to focus on the workup of a patient with a suspected multiligamentous knee injury as well as a surgical approach that follows – including acute versus delayed surgery, repair versus reconstruction, surgical technique and order of operations in the OR. We are joined today by two outstanding guests!

Dr. Matt Provencher is an orthopedic surgeon at the Steadman Clinic in Vail Colorado, Principle Investigator at the Steadman Philippon Research Institute and assistant Editor-in-Chief of Arthroscopy. He is very active in academic societies and serves on the Board of Directors for AOSSM, AANA and SOMOS.

Dr. Armando Vidal is also an orthopedic surgeon at the Steadman Clinic in Vail and is the Vice President of the Medical Staff of Vail Health Hospital. He is was previously the head team physician for the Denver Nuggets, and former team physician for the University of Colorado men's basketball and the University of Denver men's hockey.

So, without further ado, let’s get to the Field House!

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Today’s episode is going to focus on osteochondral allograft transplantation, and specifically how basic science research can and should impact your clinical practice.

We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center. He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox.

So, without further ado, let’s get to the Field House!

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Today’s episode is going to focus on patellofemoral cartilage restoration and discuss osteochondral allograft transplantation for both patellar and trochlear lesions, as well as off-the-shelf options including Arthrex Cartiform. We will also chat about the addition of osteotomies to offload that cartilage restoration and optimize outcomes.

We are joined today by Dr. Tom DeBerardino, a professor of orthopedic surgery at the University of Texas health San Antonio, team physician for UT San Antonio athletics and a retired US Army veteran.

So, without further ado, let’s get to the Field House!

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Today’s episode is going to focus on revision ACL reconstruction – starting with the diagnostic workup of a patient with a suspected ACL retear as well as the surgical approach that follows, including graft choice, staging and the addition of other procedures such as LET and osteotomies. We are joined today by two outstanding guests!

Dr. Mary Mulcahey is a Professor of Orthopaedic Surgery at Loyola University Chicago’s Stritch School of Medicine, Chief of Sports Medicine at Loyola University Medical Center and Deputy Editor for Sports Medicine at the Journal of bone and joint surgery. She is also a team physician for Loyola University athletics and recently launched the new Women’s Sports Medicine program at Loyola Medicine.

Dr. Clayton Nuelle is a Professor of Orthopaedic Surgery at the University of Missouri and Associate Editor for the Arthroscopy Journal. He is a team physician from Mizzou athletics and the head team physician for Mizzou football, soccer, swimming, tennis and softball.

So, without further ado, let’s get to the Field House!

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Today’s episode is going to focus on the level I clinical trials evaluating the Bridge-Enhanced ACL Repair or “BEAR”, including an update from the ongoing multicenter RCT – the BEAR-MOON trial! We are joined today by two outstanding guests!

Dr. Brett Owens is a professor of orthopedic surgery at the Brown University Alpert Medical School, Chief of Sports Medicine at Miriam Hospital and the Director of the Rhode Island Cartilage Repair Center. He is also a team physician for the Providence Bruins and Brown University athletics.

Dr. Kurt Spindler is a professor of orthopedic surgery at the Cleveland Clinic Lerner College of Medicine, Director of Clinical Research and Outcomes at the Cleveland Clinic in Florida and a past president of AOSSM. He has also served on numerous NFL committees including the Safety Council and the Research and Innovation Committee.

So, without further ado, let’s get to the Exhibit Hall!

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On today’s episode we’re rebooting our most popular episode of all time which focuses on rehabilitation of ACL surgery with Candace Townley Cox, a Doctor of Physical Therapy and body movement expert at Evolution Physical Therapy.

We’re going to continue our discussion with Candace Townley Cox and focus on rehabilitation of quad function and lower extremity mobility after surgery.
We start with a systematic review from the August 2022 issue of AJMS titled The Effects of Blood Flow Restriction in Patients Undergoing Knee Surgery.

Now, we did a whole episode on blood flow restriction therapy or “BFR” with Dr. Eddie Chang back in October of 2021. If you haven’t already listened, go check it out! In brief, BFR involves the use of a cuff or tourniquet system positioned at the upper part of the limb to restrict venous blood return while maintaining arterial inflow. Restriction of venous outflow leads to an anaerobic – or oxygen depleted – environment similar to that of higher-intensity training. This anaerobic environment is hypothesized to promote muscle hypertrophy through a combination of cell signaling and hormonal changes, effectively leading to muscle mass and strength gains at lower intensity training – ideal for our post-op patients.

Lawrence Wengle and colleagues at the University of Toronto performed this review of 11 papers and concluded that the use of BFR led to significant improvements in quad muscle mass, quantified by cross-sectional area of the muscle, and quad strength after knee surgery. Patient reported outcomes were not significantly different between those who used BFR and those who did not. Lastly, in the two studies that used BFR pre-op, no significant benefit was found.

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On today’s episode we’re rebooting our most popular episode of all time which focuses on rehabilitation of ACL surgery with Candace Townley Cox, a Doctor of Physical Therapy and body movement expert at Evolution Physical Therapy. Today’s discussion will center around tips and tricks to optimize outcomes and some common pitfalls that may hold patients back from a full recovery.

www.thesportsdocspod.com

We have some great articles for you that contribute well to our conversation on the surgical treatment of knee cartilage disease. As always, links to all of the papers that we discuss on this show can be found on our podcast website.

The first article is a level 3 case-control study published in the October 2020 issue of OJSM, titled Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction. Gustavo Constantino de Campos and his team in Sao Paulo, Brazil retrospectively reviewed the records of 438 patients who underwent ACL reconstruction. Anterior knee pain was reported in 6.2% of cases. Patients who underwent ACL reconstruction with a patellar tendon autograft were 3.4 times more likely to experience anterior knee pain. Also, patients who experienced an extension deficit in the post-op period were also more likely to experience anterior knee pain, with an odds-ratio of 5.3. The authors fund that anterior knee pain was not correlated with patient sex, age or surgical technique.

We are joined today by Dr. Candace Townley Cox. Candace is a Colorado native who received her Bachelor’s degree in Athletic Training at Nebraska Wesleyan University. Following undergrad Candace returned to Colorado as a Graduate Assistant Athletic Trainer at Regis University in Denver. There, she earned her Master’s degree in Sports Performance while working specifically with the Women’s Volleyball and Softball teams. Candace continued her education at Regis University earning her Doctorate of Physical Therapy. Since graduating Candace has spent countless hours in Sport Science Labs assessing movement quality, efficiency, as well as bone and muscle performance. As a movement expert, she is able to address the body’s impairments both from a table assessment and from functional movement assessments.

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We’ve been doing this podcast now for over 3 years and today we are giving you a refresh on one of our all-time, most popular episodes.

This episode answers the question we get asked all the time: What graft should I choose to reconstruct my ACL?

Please note that this episode is going to focus strictly on ACL reconstruction. For more information on ACL rehab check out our recent two-part episode with Candace Townley Cox back in April of 2023. We also have a few episodes on the BEAR ACL procedure - be sure to check those out as well!

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Welcome to another episode of Ask The Sports Docs. We get a lot questions from our listeners each week and they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started! Today’s Ask The Sports Docs focuses on everything you ever wanted to know about bracing.

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We’re coming to you live from the Arthroscopy Association of North America's Annual Meeting in Boston, MA! This year, orthopedic professionals gathered from all over the world at the AANA meeting to take part in an exciting educational line up. The educational program was comprised of instructional course lectures, podium presentations and panels, as well as topic debates.

Today, we’re going to be reviewing a few hot topics that arose from the meeting - live from the exhibit hall!

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Welcome back to The Sports Docs Podcast! In this episode, we’re going to continue our discussion with Dr. Bonnie Chien and focus on surgical treatment for Achilles tendon ruptures.

Our conversation picks back up with an article from the March 2023 issue of AJSM titled “Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures.” This Level I meta-analysis included 10 RCTs and found no difference in AOFAS scores and rate of total complications, re-ruptures, deep infections, skin necrosis, wound dehiscence, adhesions or keloid scars. But there were some significant differences between the groups.

Open repair was associated with significantly longer surgical time, higher risk of superficial infections and higher risk of ankle stiffness. Minimally invasive repair was associated with a higher rate of sural nerve injury, 3.4% compared to 0% in the open group.

Next up is a level I RCT from the June 2020 issue of AJSM titled “Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair.” Patients were randomized to either a traditional rehab group with weightbearing at 6 weeks or an accelerated rehab group with graduated weightbearing starting at 2 weeks. All patients were found to have tendon lengthening after surgery with no significant differences found in overall lengthening between traditional and accelerated rehab groups. There were also no differences noted in ankle range of motion or outcome scores between the groups.

We finished up with an article from the October 2017 issue of AJSM titled “Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture.” This level III cohort study looked at return to play rates and performance among professional athletes after Achilles tendon repair in the NFL, NBA, MLB and NHL. The authors found that 30% of athletes with an isolated Achilles rupture were unable to return to play at all after surgical repair. Those that were able to return to play had significantly less play time, less game played and played significantly worse compared to their pre-op performance levels. NBA players were most affected.

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On today’s episode we’re focusing on Achilles tendon ruptures with Dr. Bonnie Chien. We have some great articles for you that contribute well to our conversation on the optimal management of Achilles tendon ruptures and the different surgical approaches. As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

We’ll start off our discussion today with an article from the April 2012 issue of CORR titled “MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures.” Yes, it is an oldie. But we do think it sparks an interesting discussion about the utility of MRI in the setting of a clear Achilles tendon rupture.

This study retrospectively compared 66 patients with acute Achilles ruptures and pre-op MRI with a control group of 66 patients without a pre-op MRI who were indicated for surgery by clinical diagnostic criteria alone.

Criteria was: (1) an abnormal Thompson test, (2) decreased resting tension and (3) a palpable defect. The authors found that these clinical findings were 100% sensitive for a complete Achilles rupture.

It took patients an average of 5 days to obtain the MRI after injury and 12 days for surgical intervention. In comparison, patients in the control group were taken for surgery at an average of 5.6 days after injury. No additional procedures were required in the control group compared to 19 patients in the MRI group.

The authors concluded that physical exam was more sensitive than MRI and that MRI is time-consuming, expensive and can lead to treatment delays which may be associated with a need for additional procedures at the time of surgery.

Then, from the April 2022 issue of the New England Journal of Medicine, we review an article titled “Nonoperative or Surgical Treatment of Acute Achilles Tendon Rupture.” This multicenter randomized controlled trial compared nonoperative treatment, open repair, and minimally invasive repair in 554 patients with an acute Achilles tendon rupture. The authors concluded that that 12 months post-treatment, surgery was not associated with better outcomes than nonsurgical treatment. However, 11 patients in the nonoperative group sustained a re-rupture compared to 1 patient in the open repair group and 1 patient in the minimally invasive repair group.

We are joined today by Dr. Bonnie Chien, a board-certified orthopedic surgeon and Assistant Professor at Columbia University who specializes in foot and ankle conditions. She received her medical degree from Stanford University and then completed her orthopedic residency at Harvard Medical School with Catherine and I. She then went on to complete a foot and ankle fellowship at Mercy Medical Center in Baltimore.

Dr. Chien is passionate about global health and has traveled internationally to teach and perform foot and ankle surgeries. She is fluent in Chinese and English and speaks conversational Spanish. Dr. Chien has lectured extensively on the topic of Achilles, so we’re very excited to hear all that she has to share on this topic today.

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Today we’re going to give you an update pertaining to one of our favorite topics – ACL. And honestly, it’s been a bit since we done an episode on ACL so we’re excited to dive into this new paper today and talk more about how it will impact our practice. We’re going to review an article from the January issue of AJSM year titled “Risk of Revision and Reoperation After Quadriceps Tendon Autograft ACL Reconstruction Compared with Patellar Tendon and Hamstring Autografts in a US Cohort of 21,973 Patients.”

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In this Overtime episode, The Sports Docs discuss the remplissage procedure and will be reviewing an article from the January issue of AJSM year titled “Stabilizing Mechanisms in Patients Treated Using Hill-Sachs Remplissage with Bankart Repair in Abduction–External Rotation Position.”

This study was performed by Dr. Fei Zhang and team in Beijing, China and analyzed the biomechanical effects of the remplissage procedure on glenohumeral alignment at rest and with active motion.

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Our next poster is titled The Utility of Stress Ultrasound in Identifying Risk Factors for Elbow Ulnar Collateral Ligament Rupture: A Longitudinal Study of 203 Professional Baseball Players. This study was performed by your colleagues at the Rothman Institute and aimed to identify anatomic risk factors on dynamic ultrasound that may predispose players to future UCL injury. The authors found that players who ultimately required UCL reconstruction had greater ulnohumeral joint rest space, higher rates of hypoechoic foci and increased UCL thickness on ultrasound compared to players who did not require UCLR.

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Our next poster is titled Primary Latarjet Procedure versus Latarjet in the Setting of Previously Failed Bankart Repair: A Systematic Review. We’ve spoken a lot about shoulder instability on this podcast, most recently with Yoni Rosenblatt last month discussing rehab tips and tricks after various shoulder stabilization surgeries. We also had Dr. Brian Lau on Episodes 48 and 49 to chat about the different surgical options for anterior shoulder instability. So, we’re excited to review this poster today and add some new literature to this discussion.

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Our next poster is titled Revision Osteochondral Allograft Transplantation after Failed Autologous Chondrocyte Implantation of the Knee: A Matched Cohort Analysis. Dr. Brian Cole and team at Rush sought to evaluate the clinical outcomes associated with revision OCA after failed ACI as compared with a matched cohort of patients undergoing primary OCA. They concluded that there was no difference in patient reported outcomes, number of reoperations and failure rates.

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Our next AAOS 2024 Annual Meeting poster is titled The Statistical Fragility of Platelet-Rich Plasma in Lateral Epicondylitis: A Systematic Review and Simulated Fragility Analysis of Randomized Controlled Trials. Our podcast tries to stay far away from statistical analysis and methodology breakdown; however, this poster draws attention to an important issue. Often in orthopedics we try to use statistically significant findings –defined as those with a p value of less than .05 – from Level I randomized controlled trials to guide our clinical decision making. This poster suggests that is not all we should be looking at, particularly as it pertains to the use of PRP for lateral epicondylitis.

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Our next poster is titled Arthroscopic Rotator Cuff Repair with Bioinductive Patch Achieves Equivalent Patient-Reported Outcomes At 1 Year and was performed by Dr. Stephanie Muh and team at Wayne State University and Henry Ford Medical Center.

The purpose of this study was to compare patient-reported outcomes, range of motion and complications of patients undergoing arthroscopic rotator cuff repair augmented with a bovine bioinductive patch compared to standard repair.

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Our next AAOS 2024 Annual Meeting poster is titled The Influence of Donor Demographics on Outcomes following Knee Osteochondral Allograft Transplantation. This study was performed by Dr. Brian Cole and Dr. Adam Yanke at Rush and aimed to assess the impact of donor sex and age, donor-recipient sex mismatch, and graft storage duration on clinical outcomes and failure rates in knee OCA transplantation. The authors found that in contrast to previous literature, no substantial survival difference was observed for sex- mismatched OCA donors and recipients in terms of reoperation or failure.

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Today, we’re kicking off a special series of episodes to recap the new research presented at the American Academy of Orthopaedic Surgeons Annual Meeting, our largest orthopaedic conference. This year, over 20,000 orthopedic professionals gathered at the AAOS meeting in San Francisco to take part.

The educational program was comprised of instructional course lectures, video theater, live surgeries, podium presentations and research posters. Over the next several episodes we’re going to be reviewing seven sports medicine posters that were presented at the AAOS meeting. On this podcast we try to review the most updated literature on different sports medicine topics. So, reviewing some of the posters that were just presented at AAOS is particularly exciting for us because this is very new data. So new that most of this data has not even been published yet.

We’re joined by Dr. Meghan Bishop to get her take on these poster presentations. Dr. Bishop is fellowship-trained, board certified orthopaedic sports surgeon at the Rothman Orthopaedic Institute in Philadelphia. After graduating from George Washington University Medical School, she completed her residency in Orthopaedic Surgery at Thomas Jefferson University Hospital. Dr. Bishop then completed a fellowship in Sports Medicine and Shoulder Surgery at Hospital for Special Surgery. She is the orthopedic medical director for the Philadelphia Marathon, Chair of the AOSSM Early Career Members Committee and is a member of the Editorial Board of AJSM and VJSM. She is very active in research, so we are excited to hear her thoughts on these posters over the new few episodes.

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Our latest segment addition - “Ask The Sports Docs” - Drs. Logan & Bassett answer listeners' most pressing orthopaedic & sports medicine questions, giving insight to their opinions and expertise on these topics.

On this episode, The Sports Docs will touch on the treatment of various types of meniscus tears - when to repair vs resect vs manage the injury with PT and how surgeons determine if a SLAP tear will necessitate surgery. We appreciate this episodes questions from Peter, a patient from North Carolina, and Tara, a PT from New Jersey.

Would you like your question answered by The Sports Docs? Send inquiries to: thesportsdocspod@gmail.com

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Today we’re talking about medial meniscus posterior root tears and will be reviewing an article from AJSM last month titled “Medial Meniscus Posterior Root Tears Lead to Changes in Joint Contact Mechanics at Low Flexion Angles During Simulated Gait.”

This study was performed by Dr. Sabrina Strickland and her team at HSS. We will also reference an older article from the January 2020 issue of AJSM that nicely compares the different treatment options for medial meniscus root tears.

As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

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In this episode, we’re going to continue our discussion with Dr. Yoni Rosenblatt and focus on the rehab of different stabilization surgeries, including arthroscopic Bankart repair, Bankart with the addition of a remplissage procedure, and Latarjet reconstruction. We then wrap up with a discussion on return to play and an important conversation on the psychological aspects of recovery.

Our conversation picks back up with an article from the March 2020 issue of Sports Health titled “A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair.” Dr. Nik Verma and team at Rush reviewed 31 PT protocols and found a high degree of variability with regard to exercises and motion goal recommendations. Despite the variability, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols, which may contribute to the earlier return to play metrics identified in the literature for Latarjet compared to Bankart repair.

Next, we review an article titled “Functional Rehabilitation and Return to Play After Arthroscopic Surgical Stabilization for Anterior Shoulder Instability” published in the December 2021 issue of Sports Health. In this case series, Dr. Brian Busconi and colleagues at UMass evaluated 62 athletes who underwent arthroscopic Bankart repair and were subsequently cleared to return to sports using both functional and psychological testing. The average time to pass psychological testing was 5 months, while the average time to pass functional testing was 6 months. The re-dislocation rate of 2 years was 6.5%, lower than what is currently published for this population.

We finish up today with an article from the October issue of AJSM titled “Relationship of the SIRSI Score to Return to Sports After Surgical Stabilization of Glenohumeral Instability.” Dr. Rossi and colleagues in Argentina reported that patients who returned to sports and those who returned to their preinjury sports level were significantly more psychologically ready than those who did not return. In fact, for every 10-point increase in the SIRSI score, the odds of returning to sports increased by 2.9 times. Furthermore, those who did not achieve their preinjury sports level showed poorer psychological readiness to return to play and SIRSI score results.

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On today’s episode we’re focusing on post-op rehab after shoulder stabilization surgery with Dr. Yoni Rosenblatt, a physical therapist at True Sports PT in Baltimore, Maryland. We have some great articles for you that contribute well to our conversation on shoulder instability rehabilitation. As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

We’ll start off our discussion today with an article from the Journal of Sports Rehabilitation in October 2019 titled “A Clinical Comparison of Home-Based and Hospital-Based Exercise Programs Following Arthroscopic Capsulolabral Repair for Anterior Shoulder Instability.” This prospective study evaluated 54 patients who underwent shoulder stabilization surgery followed by a home-based PT program versus hospital-based PT program starting 4 weeks post-op to 6 months post-op. While they did not report range of motion in this study, the authors reported no difference in patient-reported clinical outcome scores at any timepoint in recovery. The authors concluded that use of a controlled home-based exercise program is as effective as hospital-based rehab after shoulder stabilization surgery.

Then, from JSES last month, we review an article titled “Cross-Education Effects on Shoulder Rotator Muscle Strength and Function After Shoulder Stabilization Surgery.” This RCT included 28 patients who underwent arthroscopic shoulder stabilization surgery. Patients were randomly assigned to standard rehab with or without the addition of cross-education. The cross-education group received isokinetic training with the non-operated shoulder focusing on the rotator cuff muscles. At 6 months post-op, patients in the cross-education group demonstrated significantly greater cuff strength but functional outcomes between the groups were equivalent. The authors suggest that cross-education may improve dynamic shoulder stability but not the functional capacity.

We wrap up with an article from the 2022 issue of IJSPT titled “The Effect of Blood Flow Restriction Therapy on Shoulder Function Following Shoulder Stabilization Surgery: A Case Series.” The study included 20 military cadets who underwent shoulder stabilization surgery and completed 6 weeks of upper extremity BFR training beginning post-op week 6. While there was no comparison group, the authors reported significant and clinically meaningful improvements in shoulder strength, self-reported function and upper extremity performance following BFR training.

We are joined today by Dr. Yoni Rosenblatt, a physical therapist at True Sports PT in Baltimore, Maryland. Yoni received his Bachelors in Kinesiological Sciences from the University of Maryland in College Park. He went on to complete his doctorate of physical therapy at the University of Maryland in Baltimore.

Yoni is the Director of Sports Medicine for Israel National Lacrosse and is a physical therapist for the Israel National Baseball team, competing in the 2017 World Baseball Classic. Yoni also hosts his own sports medicine podcast – the True Sports PT Podcast – which you should definitely check out for all sorts of rehab tips and tricks.

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Welcome back to The Sports Docs Podcast! In this episode, we’re going to continue our discussion with Dr. Andrea Spiker and focus on open surgical treatment for hip preservation, then wrap up with a discussion on post-op rehab and return to play.

Our conversation picks back up with an article from the September 2017 issue of AJSM titled “Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia.” Bryan Kelly and his team at HSS investigated the effect of prior arthroscopic hip surgery on clinical outcomes after periacetabular osteotomy or “PAO”. They found that patients who previously underwent hip arthroscopy had inferior functional outcomes at 6 months and 12 months after PAO compared to patients with no prior hip surgery. The authors note that both groups significantly improved post-op and there was no difference in complications or reoperation between the groups.

We finish up today with a surgical technique article authored by our guest, Dr. Andrea Spiker, from the August 2022 issue of Arthroscopy Techniques. The article is titled “Treatment of Coxa Profunda with Open Surgical Hip Dislocation, Rim Resection, Cam Resection, and Labral Reconstruction” and describes an open surgical approach to address many of the challenges posed by coxa profunda. For our listeners, coxa profunda is essentially a deep acetabular socket. This differs from acetabular protrusio, in which the femoral head and socket displace into the pelvis. The global acetabular over-coverage associated with coxa profunda makes arthroscopic management very challenging in terms of obtaining adequate hip distraction and concerns for traction injury. For these reasons, an open approach has been proposed.

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On today’s episode we’re focusing on hip preservation with Dr. Andrea Spiker. We have some great articles for you that contribute well to our conversation on femoroacetabular impingement or “FAI”, hip dysplasia and the arthroscopic and open surgical treatments for these conditions. As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

We’ll start off our discussion today with an article from the June 2018 issue of The Lancet titled “Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome.” This multicenter RCT included 348 patients across 28 hospitals in the UK and compared conservative treatment with physical therapy to surgical treatment with hip arthroscopy. The authors reported that while both groups improved after treatment, patients who underwent hip arthroscopy for treatment of FAI demonstrated significantly greater improvement in hip-related quality of life compared to patients who had nonsurgical treatment.

Then, from the September issue of AJSM this year, we review an article titled “Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement with Hip Arthroscopy Compared with Nonsurgically Treated Patients.” Aaron Krych and team at the Mayo Clinic reported significantly less progression of arthritic changes in surgical patients compared to non-op. Seven percent of patients in the surgical group ultimately underwent a total hip replacement compared to 12% in the non-op group. Risk factors for failure of non-op treatment included male sex, presence of a CAM morphology, increased age and initial arthritic joint changes at diagnosis.

We are joined today by Dr. Andrea Spiker, a board-certified orthopedic surgeon at the University of Wisconsin-Madison who is dual fellowship trained in sports medicine and hip preservation. She is a team physician for UW Badger Athletics and provides head orthopedic coverage for the UW Men’s and Women’s Basketball teams. She is also the Program Director of the UW Orthopedic Surgery Sports Medicine Fellowship Program. Dr. Spiker is an active member in numerous orthopedic societies including AAOS, AOSSM and AANA, and has published extensively on the topic of hip preservation, so we’re very excited to hear all that she has to share on this topic today.

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Happy New Year from The Sports Docs Podcast! 🎆

As we reflect on an incredible year of growth for our podcast, we’d like to take a moment to thank our amazing listeners, guests and supporters for making this podcast such a success! 🫶🏻

Our podcast has been downloaded in over 60 countries, is in the top 25% of @buzzsprout podcasts and is ranked in the top sports medicine podcasts 📈🎙️ We are very excited to see what 2024 has in store!

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Happy New Year from The Sports Docs Podcast! 🎆

As we reflect on an incredible year of growth for our podcast, we’d like to take a moment to thank our amazing listeners, guests and supporters for making this podcast such a success!

Our podcast has been downloaded in over 60 countries, is in the top 25% of @buzzsprout podcasts and is ranked in the top sports medicine podcasts 📈🎙️ We are very excited to see what 2024 has in store.

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Our latest segment addition - “Ask The Sports Docs” - Drs. Logan & Bassett answer listeners' most pressing orthopaedic & sports medicine questions, giving insight to their opinions and expertise on these topics.

On this episode, The Sports Docs will touch on the use of stem cells in sports medicine, our thoughts on open kinetic chain (OKC) exercise after knee surgery, and when ACL repair is recommended.

We appreciate this episodes questions from Daniel, orthopedic surgeon in California; Dan, physical therapist in Maryland and Delaware; and an anonymous patient.

Would you like your question answered by The Sports Docs? Send inquiries to:

thesportsdocspod@gmail.com

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Welcome to another episode of the Injury Report! Today, we’re focusing on core muscle injuries in the NFL, also known as “sports hernias”, most recently plaguing lead wide receiver for the Jaguars Christian Kirk. But this injury is quite common in the NFL affecting players from DeSean Jackson, Kareem Hunt, OBJ, Mike Evans, JJ Watt, Adrian Peterson to name a few.

So, it’s about time that we cover this injury. As always, our plan today is to start with an overview of the relevant anatomy, discuss the mechanism of injury followed by treatment options for these players, and then wrap up with what you all want to know – when do players typically return to play after this injury and how do they do once they return?

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We return today with Dr. Brett Owens to shift our discussion of MCL tears on to the treatment of isolated and combined MCL injuries, then wrap up with a discussion on safe return to play.

Our conversation picks back up with a level 1 prospective multicenter RCT from the March 2022 issue of AJSM titled “Comparative Outcomes Occur After Superficial Medial Collateral Ligament Augmented Repair vs. Reconstruction.” Fifty-four patients with grade III MCL injuries were randomized to either MCL augmented repair or MCL reconstruction using a free semitendinosus autograft. At 1-year post-op, there was no difference in objective outcomes (including gapping on post-op valgus stress x-rays). However, patient-reported outcomes – including IKDC scores and Lysholm scores – favored reconstruction.

We finish up today with an article from the March issue of AJSM this year titled “Nonoperative Management, Repair, or Reconstruction of the Medial Collateral Ligament in Combined Anterior Cruciate and Medial Collateral Ligament Injuries – Which Is Best?” This systematic review and meta-analysis investigated the outcomes of three different approaches to ACL-MCL combined injuries: ACL reconstruction with either (1) non-op treatment of the MCL tear, (2) MCL repair, (3) MCL reconstruction.

There was no difference in patient-reported outcomes, range of motion and quadriceps strength at final follow up. The rate of arthrofibrosis was similar between non-op and surgically treated MCL injuries, and the authors note that this rate has steadily decreased, likely relating to advancement in surgical technique.

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On today’s episode we’re focusing on medial collateral ligament injuries with Dr. Brett Owens. We’ll start off our discussion today with an article authored by our guest, Dr. Brett Owens, titled “The Epidemiology of Medial Collateral Ligament Sprains in Young Athletes” from the 2014 issue of AJSM.

The authors performed a longitudinal cohort study of US military cadets and found that MCL injuries are relatively common in the athletic population. Male athletes are at significantly greater risk than females –of the 128 injuries in this study, 89% occurred in males. Intercollegiate athletes are also at greater risk than athletes participating in intramural sports. The incidence of MCL injury was highest in wrestling and hockey. In terms of time missed, the average amount of time was 23 days but this differed based on the grade of injury – with grade I sprains only missing a median of 13.5 days.

Up next is a Current Concepts Review article from JBJS authored by Robert LaPrade and colleagues at the University of Minnesota. Some takeaways from this paper: First, the medial structures of the knee (including the superficial and deep MCL as well as the posterior oblique ligament) are the most commonly injured ligamentous structures of the knee. The majority of medial knee ligament tears are isolated injuries. Physical examination is the initial method of choice for diagnosis and includes application of a valgus load to the knee in both full extension as well as in 20 to 30 degrees of knee flexion. In terms of imaging, valgus stress radiographs and MRI are useful to confirm and grade the injury.

We wrap up Part I with a discussion on the prevention of MCL injury and review an article from the August issue of OJSM this year titled “Prophylactic Knee Bracing in Offensive Lineman of the NFL – A Retrospective Analysis of Usage Trends, Player Performance and Major Knee Injury.”

Dr. Robert Gallo and team at Penn State found that brace wears had a significantly lower rate of major knee injury, defined as an injury requiring time missed. The most common knee injury in nonbracers was an isolated MCL injury. There was no difference in player performance between bracers and nonbracers. Interestingly, despite this data, brace usage has steadily declined – from 16.3% in 2014 to 5.6% in 2020 – specifically at the rookie level.

We are joined today by Dr. Brett Owens, a board-certified orthopedic surgeon at University Orthopaedics in Providence Rhode Island, who specializes in complex shoulder, knee and sports medicine. He is the Chief of Sports Medicine at the Miriam Hospital in Providence, RI and the Director of the Rhode Island Cartilage Repair Center.

He is a Professor of Orthopaedic Surgery at Brown University Alpert Medical School and is currently a Team Physician for Brown University and the Providence Bruins. Prior to joining University Orthopaedics, Dr. Owens served as the Chief of Orthopedics and Sports Medicine at Keller Army Hospital at West Point New York, where he cared for soldiers and cadets at the US Military Academy and was the Team Physician for Army lacrosse, rugby, and football teams. While deployed in Iraq during Operation Iraqi Freedom, Dr. Owens served as Chief of Orthopedics at the 86th Combat Support Hospital. He has also served as Team Physician for US Lacrosse like Catherine! Needless to say, he is a very accomplished person and we are excited to have him join us today.

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On this episode, we’re going to continue our discussion with Dr. William Bugbee and focus on OCA surgical technique and then discuss clinical outcomes including return to sports.

Our conversation picks back up with a recent paper from the July issue of Cartilage this year titled “Young Age and Concomitant or Prior Bony Realignment Procedures are Associated with Decreased Risk of Failure of Osteochondral Allograft Transplantation in the Knee.” This retrospective nationwide database study represents the largest OCA cohort study to date and found that less than 2% of patients required salvage surgery. Young age, less than 29, and having a bony realignment procedure were associated with a significantly lower rate of salvage surgery – include revision cartilage procedures and arthroplasty.

We finish up today with an article from the June 2017 issue of AJSM titled “Return to Sport and Recreational Activity after Osteochondral Allograft Transplantation in the Knee.” Dr. Bugbee and colleagues at Scripps Clinic in La Jolla California reported that at a mean follow up of 6 years, 75% of patients were able to return to sport or recreational activity. Patients who did not return were more likely to be female and have a large graft size. 25% of knees underwent further surgery and 9% were considered allograft failures. Of the patients without OCA failure, 91% were satisfied with the results of surgery.

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On today’s episode we’re focusing on osteochondral allograft transplantation or “OCA” with Dr. William Bugbee. We have some great articles for you that contribute well to our conversation on OCA, including allograft preparation and storage, graft choice, surgical technique, clinical outcomes of OCA and return to sport.

We’ll start off our discussion today with an article authored by our guest, Dr. William Bugbee, from the May 2022 issue of AJSM titled “Fresh Osteochondral and Chondral Allograft Preservation and Storage Media: A Systematic Review of the Literature.”

There was significant variability in experimental designs and incomplete reporting across the studies, so no real conclusions could be drawn regarding optimal storage conditions. While 60% of animal model studies suggest storage time may impact outcomes and 80% indicate inferior outcomes with frozen OCA compared to fresh OCA, the authors note that 75% of clinical studies reported no correlation between storage time and outcomes. So, we have a lot left to learn here.

Then, from the March 2022 issue of AJSM, we review an article titled “Association of Sex Mismatch Between Donor and Recipient With Graft Survivorship at 5 Years After OCA Transplantation.” Dr. Gomoll and colleagues at Brigham and Women’s reported that a significantly lower rate of graft survival was observed after different sex donor-recipient transplant compared to same sex donor-recipient OCA – 63% compared to 92%. Patients who received a donor-recipient sex-mismatch transplantation were 2.9X more likely to fail. Male donor to female recipient demonstrated the highest likelihood of failure compared to all other combinations.

We are joined today by Dr. William Bugbee, a board-certified orthopedic surgeon specializing in joint reconstruction and cartilage restoration at Scripps Clinic in La Jolla, California. Dr. Bugbee received his medical degree from UC San Diego and remained at UC San Diego for his orthopedic surgery residency. He then went on to complete a fellowship in joint reconstruction at the Anderson Orthopaedic Research Institute. Dr. Bugbee has published extensively on the topic of osteochondral allograft transplantation, so we’re very excited that he is joining us today to share his expertise with all of you!

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Our latest segment addition - “Ask The Sports Docs” - Drs. Logan & Bassett answer listeners' most pressing orthopaedic & sports medicine questions, giving insight to their opinions and expertise on these topics.

On this episode, The Sports Docs will touch on Anterior Knee Pain after knee surgery and the use of Blood Flow Restriction (BFR) in their practice.

We appreciate this episodes questions from Jenny L. fromTennessee and Gary P. from Indiana.

Would you like your question answered by The Sports Docs? Send inquiries to:
thesportsdocspod@gmail.com

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Today, we’re focusing on acromioclavicular or “AC” separations in the NFL, also known as “AC sprains."

Derek Carr, quarterback for the New Orleans Saints, sustained an AC sprain in the loss to the Green Bay Packers. As always, our plan today is to start with an overview of the relevant anatomy, discuss the mechanism of injury followed by treatment options for these players, and then wrap up with what you all want to know – when do players typically return to play after this injury and how do they do once they return?

Links to discussed papers:

https://pubmed.ncbi.nlm.nih.gov/24057030/

https://pubmed.ncbi.nlm.nih.gov/22869625/

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Welcome to an episode of the Injury Report! Yes, initially these were included in our patient-focused Game Plan episodes but we get so many questions each week about different NFL injuries (How long will they be out? How will they do once they return?) that we decided to create an entirely different episode type.

Today, we’re focusing on high ankle sprains in the NFL – most recently plaguing Khalil Herbert of the Chicago Bears and Saquon Barkley earlier this season of the NY Giants.

We’ll discuss the mechanism of injury, treatment options for these players and importantly, when do they typically return to play and how do they do?

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In this episode, we’re going to continue our discussion with Dr. Matt Provencher and focus on ACL tears in the military, then wrap up with a discussion on returning tactical athletes to full duty.

Our conversation picks back up with an article from the February issue of OJSM this tear titled “Failure Rates After Anterior Cruciate Ligament Repair With Suture Tape Augmentation in an Active-Duty Military Population.” This level 2 case series reported a significantly high failure rate of 26% in patients who underwent repair of proximal ACL avulsions augmented with a suture tape internal brace. The authors identified several risk factors for failure, including age younger than 17 or older than 35, elite level of competition, greater time from injury to surgery and active tobacco use.

We finish up today with a discussion of ACL rehabilitation in the military population. The last article we reference is titled “The Warrior Athlete Part 2 – Return to Duty in the US Military: Advancing ACL Rehabilitation in the Tactical Athlete.” Matt Provencher and colleagues report that ACL injuries in the warfighter population is a complex decision-making matrix that begins with proper pre-habilitation, discussion of graft choice and surgical technique, and lastly the coordination of a well-defined and patient specific post-op rehab plan complete with a multifaceted return to duty assessment.

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On today’s episode we’re focusing on musculoskeletal injuries or “MSKIs” in warrior athletes with Dr. Matt Provencher. We have some great articles for you that contribute well to our conversation on musculoskeletal injuries in the military population.

We’ll start off our discussion today with an article from the March 2022 issue of Military Medicine that introduces the Military Orthopedics Tracking Injuries and Outcomes Network or “MOTION”. MOTION is an internet-based data capture system that aims to collect and analyze short- and long-term patient outcomes after surgical treatment of a musculoskeletal injury. The goal of MOTION is three-gold: First, to identify factors that predict favorable outcomes. Second, to develop models which inform the surgeon and military commanders of patient progress – if they are ahead of or on schedule for return to duty, marginally behind or substantially behind. And third, to then develop predictive models to better inform both patients and surgeons of the likelihood of a positive outcome – to enhance patient counseling and expectation management.

Then, from the November 2020 issue of Sports Health, we review the publication titled “Identification of Risk Factors Prospectively Associated With Musculoskeletal Injury in a Warrior Athlete Population.” This level 2 prospective cohort study identified 11 risk factors for MSKI, including: Older age, female sex, prior MSKI, lower perceived recovery from injury, prior work restrictions, asymmetrical ankle dorsiflexion, decreased or asymmetrical performance on the Lower and Upper Quarter Y-Balance test, pain with movement tests and slower 2-mile run times.

We wrap up Part I with a 2022 yellow journal article from the 15th Annual Extremity War Injury Symposium in 2022, authored by our guest today, that summarizes the recent research efforts focused on MSKI in warrior athletes. This paper primarily focuses on post-traumatic osteoarthritis and the role of orthobiologics in lessening the prevalence of this condition and accelerating recovery to return tactical athletes to full, unrestricted duties as quickly and safely as possible.

We are joined today by Dr. Matt Provencher, a board-certified orthopedic surgeon at the Steadman Clinic in Vail, Colorado who specializes in complex shoulder, complex knee and sports medicine. We had the privilege of training under Dr. Provencher during his time at Mass General in Boston, where he was also the head team doctor for the New England Patriots. Dr. Provencher has over 20 years of clinical orthopedic experience and surgical care of both civilian patients and the United States Navy SEALs.

He was recently named one of the Top 28 Shoulder Surgeons in the US and also one of the Top 28 Knee Surgeons in the US by Orthopaedics Today. Dr. Provencher is the Assistant Editor-in-Chief of Arthroscopy: The Journal of Arthroscopy and Related Surgery and has published over 200 peer-reviewed articles, authored 5 textbooks and 148 book chapters.

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Grit is the disposition to strive for long-term goals despite setbacks and challenges. Given the lengthy, arduous process of rehabilitation after anterior cruciate ligament reconstruction (ACLR), an athlete's grit may predict postoperative outcomes across time.

In this Overtime episode, The Sports Docs discuss Dr. Jay Albright's recent AJSM publication titled "Association of Grit With Postoperative Knee Outcomes and Physical Function After ACL Reconstruction in Adolescent Athletes."

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Welcome to another episode of Game Plan! These Game Plan episodes are specifically designed for patients – to hopefully answer some of the questions you have about the most common sports medicine conditions, treatments and what recovery looks like.

Today, we’re focusing on hamstring injuries in the NFL – specifically, risk factors for hamstring injury, treatment options for these players and importantly, when do they typically return to play and how do they do?

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Welcome to Overtime with the Sports Docs! On each of these mini episodes, we chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data ranging from operative indications, surgical approaches, post-op protocols and most importantly – patient outcomes.

Today we have a special episode for you. We’re going to be talking about some of the newest orthopedic technology presented at the AOSSM meeting this past July. As judges for the ACE award – which recognizes cutting-edge innovation in the field of orthopaedic sports medicine by exhibitors at the AOSSM Annual Meeting.

The winners of the ACE award this year were the MISHA knee system by Moximed and the BEAR implant by Miach Orthopaedics.

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Welcome to another episode of Game Plan! These Game Plan episodes are specifically designed for patients – to hopefully answer some of the questions you have about the most common sports medicine conditions and surgical treatments. But today’s episode is a little different and we’re excited about it! Today, we’re focusing on common injuries in the NFL and how these injuries impact time missed and player performance once athletes ultimately return to play.

This is something that each NFL team looks at carefully when evaluating rookie prospects before draft day. Teams look at the number of previous injuries, the types and severity of the injuries and treatment rendered when trying to decide on the ranking of a draft candidate. Now, this is just one facet of the evaluation – a physical examination is performed at the NFL Combine and performance metrics post-injury are obviously taken into account.

But as the literature continues to grow in this area, it is becoming more feasible to project a player’s injury risk, career length and even performance in the NFL. This is useful information for NFL teams but also fantasy football enthusiasts who want to make sure they draft the best players for their team. So, our discussion today is going to focus on common injuries in the NFL and how that injury history may impact player reliability (games played), longevity for the season and performance.

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And we are back for Part II of our discussion with Dr. Brian Lau. Our conversation picks back up with a discussion of surgical treatment options for more significant glenoid bone loss.

There is a 2021 yellow journal article titled Diagnosis and Management of Traumatic Anterior Shoulder Instability that nicely outlines a treatment algorithm based on percentage of glenoid bone loss as well as the presence and severity of a Hill Sachs lesion. Matt Provencher and colleagues explain that good results can be expected after Bankart repair in on-track Hill-Sachs lesions with glenoid bone loss less than 13.5%. Bankart repair without additional procedures is not recommended in off-track Hill Sachs lesions, regardless of the extent of glenoid bone loss.

Bone block procedures are recommended when glenoid bone loss is greater than 20% to 25% or when the Hill Sachs lesion is off-track. Then, from the April issue of AJSM this year, we discuss the study performed by our guest Dr. Lau and his team at Duke, titled Distal Clavicle Autograft Versus Traditional and Congruent Arc Latarjet Procedures. This laboratory analysis compared five different configurations of two local autograft options – coracoid and distal clavicle – using both 3D CT and 3D MRI. They looked at how much the glenoid surface area was augmented (important to address the glenoid bone loss) and the amount of glenoid apposition provided (bone-to-bone contact being important for graft healing). The authors found that the congruent arc Latarjet procedure had the largest graft surface area, the standard Latarjet procedure had the most bone-on-bone contact and the distal clavicle attached by its inferior surface had the largest graft width. This paper also found that differences between 3D CT and 3D MRI were small and likely not clinically significant.

We finish up our conversation with a focus on rehab and returning to play after shoulder stabilization surgery. The last article we reference is titled Criteria-based Return-to-Sport Testing is Associated with Lower Recurrence Rates following Arthroscopic Bankart Repair. Albert Lin and colleagues and UPMC evaluated the use of a criteria-based return-to-sport testing protocol, which includes assessments of strength and function using the closed kinetic chain upper extremity stability test and the unilateral seated shot-put test. The authors found that athletes who underwent this testing protocol to guide their clearance to return to sports had a lower rate of recurrent instability than those cleared to return based on the time from surgery (5% vs. 22%).

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On today’s episode we’re focusing on anterior shoulder instability with Dr. Brian Lau, orthopedic sports medicine surgeon, team physician for Duke Athletics and Director of the FIFA Medical Center at Duke.

We have some great articles for you that contribute well to our conversation on the treatment of primary anterior shoulder instability. We’ll start off our discussion today with a level I RCT published in the March 2020 issue of JBJS titled Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation of the Shoulder, a single-center double-blinded clinical trial compared arthroscopic washout to arthroscopic Bankart repair for the management of primary anterior shoulder instability. At an average follow up of 14 years, the rate of recurrent dislocation was significantly higher in the washout group compared to the Bankart repair group, at 47% compared to 12%.

The arthroscopic Bankart repair group also demonstrated significantly better clinical outcome scores, including the WOSI and DASH scores. Then, from the June issue of JSES this year, we review the publication titled Remplissage reduces recurrent instability in high-risk patients with on-track Hill-Sachs lesions. Albert Lin and Pat Denard performed a multicenter retrospective study of patients with on-track Hill Sachs lesions who underwent arthroscopic Bankart repair with or without the addition of a Remplissage procedure. We’ll discuss on-track versus off-track Hill Sachs lesions, how you go about calculating this and what to do with this information in a little bit with our guest. So, for now, we’ll just focus on the results of this study, which showed that the addition of a remplissage was associated with a lower rate of recurrent dislocation
(1.8% vs. 11%) and revision surgery (0% vs. 6%). Remplissage protected against recurrent instability, particularly in high-risk patients.

We are joined today by Dr. Brian Lau, a board-certified orthopedic surgeon dual-fellowship-trained in both sports medicine surgery and foot & ankle surgery. Dr. Lau obtained his medical degree from the University of Pittsburgh and completed his orthopedic residency at UC San Francisco. He then went on to complete two fellowships – the first in Sports Medicine and Shoulder Surgery at Duke University and the second in Foot & Ankle Surgery at Stanford University. Following training, Dr. Lau returned to Duke University, where he is a team physician for Duke Athletics and the Director of the FIFA Medical Center at Duke. Dr. Lau is the associate program director of the Duke Orthopedic Sports Medicine and Shoulder fellowship and serves on numerous educational committees in AOSSM, AANA and ASES. He is passionate about research and leads the Duke Sports Medicine Research Committee.

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Today's episode focuses on physician leadership development and mentorship in the field of orthopedics.

We are joined by Dr. Dean Taylor and Dr. Carolyn Hettrich! Dr. Taylor is the Director of the Sports Medicine Fellowship at Duke University and is a team physician for Duke Athletics. He is the current President of AOSSM and is also the chair of the Feagin Leadership Program. Dr. Hettrich is a principle investigator for the MOON Shoudler Group, former Chief of the Shoulder Service at Brigham & Womens and recently finished her tenure as Chair of the Emerging Leaders Committee, which oversees the Emerging Leaders Program.

In this episode, we discuss:
Why is leadership training is so important, particularly for physicians?

What is the new BOLD (Building Orthopaedic Leaders’ Development) program and what are the goals of this initiative?

How can we best mentor the next generation of orthopedic surgeons? What differentiates mentorship from coaching?

How can private practice physicians stay involved in AOSSM and why is this important?

What is to come for AOSSM during Dr. Taylor’s presidential year?

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Today's episode focuses on two different surgical techniques for management of complex rotator cuff injuries: (1) The biceps SMASH technique for augmentation of a repairable rotator cuff tear. (2) The subacromial balloon spacer – InSpace by Stryker – to manage irreparable rotator cuff tears. We are joined today by two distinguished guests:

Dr. Nikhil Verma is the Director of the Sports Medicine Division and the Sports Medicine Fellowship at Rush , head team physician for the Chicago White Sox and team physician for the Chicago Bulls . He will be discussing use of the Stryker InSpace balloon implant to treat irreparable posterosuperior rotator cuff tears.

Dr. John Tokish is the President of the Arthroscopy Association of North America and Director of the Sports Medicine Fellowship at Mayo Clinic in Arizona . Dr. Tokish will be speaking about the “biceps smash technique” — using long head of biceps tendon autograft to biologically augment rotator cuff repair.

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Welcome to another episode of Game Plan!

As you might remember from our episode on ACL graft choices, these Game Plan episodes are specifically designed for patients – to hopefully answer some of the questions you have about the most common sports medicine conditions and surgical treatments.

We’re continuing with our favorite topic today – ACL tears – but today’s episode is going to focus on risk factors for ACL tears. Specifically, which of these risk factors can we modify to lessen the chance of sustaining ACL tear and how do we decrease that risk.

Please note that this episode is going to focus strictly on ACL reconstruction. For more information on ACL rehab check out our recent two-part episode with Candace Townley Cox back in April of this year. We’ve covered the addition of “LET” or “lateral extra-articular tenodesis” to ACL reconstruction in an Overtime episode in November of 2021 and again with Dr. Brian Waterman live at the AAOS meeting back in March of this year. And, of course, our first Game Plan episode was on how to choose the best ACL graft for reconstruction, so definitely check that out.

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We are so excited to host these amazing guest for “Challenging Cartilage Injuries," Live at AOSSM 2023.

Dr. Sabrina Strickland is an associate professor of orthopaedic surgery
and an attending surgeon at Hospital for Special Surgery . She is active member of many societies and research groups, including the International Cartilage Repair Society and the International Patellofemoral Study Group.

Dr. Seth Sherman is the Director of the Sports Medicine Fellowship at Stanford University Orthopaedics and is a Stanford University Football team physician. He is Chairman of the AAOS Sports Medicine/Arthroscopy committee and is also a member of the International Patellofemoral Study Group.

Both Dr. Strickland and Dr. Sherman publish and lecture extensively on the topic of knee joint preservation, cartilage restoration and specifically patellofemoral cartilage disease - so we’re excited to hear them speak more this topic!

You don’t want to miss it! But if you can’t be there — you can listen to this episode and more recorded LIVE from the AOSSM Annual Meeting on @applepodcasts @spotifypodcasts @amazonmusic @audible or wherever you get your podcasts 🎧

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Dr. Scott Rodeo is a professor of Orthopaedic Surgery Weill Cornell Medical School and an attending surgeon at the Hospital for Special Surgery.

He is the head team physician for the NY Giants, Co-Chief Emeritus of the Sports Medicine & Shoulder Service and Vice Chair of Orthopaedic Research. Dr. Rodeo is also the Director of the Center for Regenerative Medicine and is a renowned expert in the field of orthobiologics - so we’re excited to hear more from him about this rapidly growing field.

You don’t want to miss it!

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Enjoy this special episode “When #savethemeniscus Isn’t an Option”. We will be joined by two outstanding guests:

Dr. Christian Lattermann is the Chief of the Sports Medicine Service and Director of the Cartilage Repair Center at Brigham and Women's Hospital. He is an Associate Professor of orthopedic surgery at Harvard Medical School and the Director of Research at Mass General Brigham Sports Medicine.

Dr. Aaron Krych is a Professor of orthopedic surgery at the Mayo Clinic and Chair of the Sports Medicine Division. He is a team physician for the Minnesota Timberwolves and is a member of numerous research groups including MOCA (Metrics of Osteochondral Allografts) and ROCK (Research in Osteochondritis Dissecans of the Knee).

You don’t want to miss it! But if you can’t be there — you can listen to this episode and more recorded LIVE from the American Orthopaedic Society for Sports Medicine Annual Meeting on @applepodcasts @spotifypodcasts @amazonmusic @audible or wherever you get your podcasts 🎧

Remember to subscribe so you never miss an episode ✅

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We are joined today by two outstanding guests! Dr. Robin West is the Chair of the Sports Medicine service at Inova Health and team physician for the Washington Nationals. She serves on the board of director of the NFL Physician’s Society and NFL Scouting Committee. Dr. West was also Program Chair this year at the AOSSM Annual Meeting and did a phenomenal job ensuring that and educational and engaging program was delivered.

We are also joined by Dr. James Voos, Chair of Orthopedic Surgery at University Hospital in Cleveland. He is also the head team physician for the Cleveland Browns and President of the NFL Physician’s Society. Dr. Voos has published extensively on the use of wearable technology to track player’s work loads and medical stats, in an effort to keep our athletes safe. So, we are very excited to have him join Dr. West for our discussion today on the newest technology available to reduce the risk of injury and optimize performance.

So, without further ado, let’s get to the Exhibit Hall!

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We are joined today by Dr. Shawn Anthony, Associate Chief of Sports Medicine for the Mount Sinai Health System and Assistant Professor of Orthopedic Surgery at the renowned Icahn School of Medicine at Mount Sinai. Dr. Anthony is a orthopedic consultant for the US Tennis Association and provides side-line medical coverage at the US Open Tennis Championship each year. He has published extensively on the management of ACL injuries, so we’re excited to have him join for our discussion today on the Bridge-Enhanced ACL Repair or “BEAR” technique. So, without further ado, let’s get to the Exhibit Hall!

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W**e are very excited to introduce you to a brand-new type of episode called Game Plan!

We’ve been doing this podcast now for over 2 years and during that time we’ve had more and more of our patients listening to our episodes to learn more about their condition, what treatment options they have to choose from and what to expect from surgery. So, we decided to create some episodes specifically for our patient population, to hopefully answer some of the questions they have about the most common sports medicine conditions and surgical treatments. And what better topic to start with than ACL… specifically, the question we get asked all the time: What graft should I choose to reconstruct my ACL?**

Please note that this episode is going to focus strictly on ACL reconstruction. For more information on ACL rehab check out our recent two-part episode with Candace Townley Cox back in April of this year. We’ve covered the addition of “LET” or “lateral extra-articular tenodesis” to ACL reconstruction in an Overtime episode in November of 2021 and again with Dr. Brian Waterman live at the AAOS meeting back in March of this year. We also have a mini episode coming out on ACL repair, rather than reconstruction, so stay tuned for that!

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Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and I chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data ranging from operative indications, surgical approaches, post-op protocols and most importantly – patient outcomes.

Today we’re talking about SLAP tears – tears of the superior labrum from anterior to posterior. We have two great articles for you today that focus on the surgical management of SLAP tears – specifically whether we should be repairing SLAP tears or proceeding directly to biceps tenodesis. We will also discuss the different types of biceps tenodesis procedures – mainly arthroscopic suprapectoral versus open subpectoral.

Our first paper looks specifically at this patient population – young overhead athletes – and investigates the functional and athletic outcomes after primary subpectoral biceps tenodesis for type II SLAP tears.

Brian Waterman and Tony Romeo published a case series in the January 2023 issue of Arthroscopy titled “High Rate of Return to Sporting Activity Among Overhead Athletes with Subpectoral Biceps Tenodesis for Type II SLAP Tear”. The authors reported that 81% of patients returned to their previous level of play at an average of 4 months post-op. There were also significant improvements in VAS and SANE scores post-op.

But how do repairs do in this population? The answer is… not great. Return to preinjury level of play after SLAP repair has been reported in the range of 54% to 63% of elite throwers. In one cohort study by Boileau, 60% of patients reported persistent shoulder pain after SLAP repair and 50% elected to undergo secondary surgery. Provencher published on his outcomes of SLAP repair in an active military population and reported a 37% failure rate and 28% revision rate at short to mid-term follow up.

Our second article focuses on this and is titled “No Difference in Clinical Outcomes for Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis at Midterm Follow-up.” Nikhil Verma – who will be joining us at AOSSM – and colleagues at Rush compared arthroscopic suprapectoral tenodesis versus open subpectoral tenodesis for long head of biceps tendon disease, so not SLAP tears. They reported no significant differences in patient reported outcomes or complications at any time point.

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On each episode, we chat about the most recent developments in sports medicine with experts from around the country. In this episode, we’re going to continue our discussion with Dr. Cassandra Lee and chat more about osteochondral allograft transplantation and tibial tubercle osteotomy.

From the October 2020 issue of Cartilage, we start with the publication titled “Bipolar Osteochondral Allograft Transplantation of the Patella and Trochlea.” David DeWitt and colleagues at Kaiser Permanente Southern California prospectively followed 18 patients who underwent fresh osteochondral allograft transplantation of the patella and trochlea with an average follow up of 33 months.

All patients had graft survival at final follow up with no revisions and no conversion to arthroplasty. All clinical outcome scores – including KOOS, IKDC, SANE and VAS – significantly improved from pre-op. We finish up our conversation with a focus on realignment osteotomies to augment cartilage restoration procedures for the patellofemoral joint, referencing an infographic from the 2019 issue of Arthroscopy titled “Optimizing Patellofemoral Cartilage Restoration and Instability With Tibial Tubercle Osteotomy.” The authors explain that the specific type of TTO depends on the pathology being treated, with four subgroups identified. In the absence of patellar instability, distal lateral patellar lesions are treated well with an isolated anteromedializing TTO while medial, central and/or panpatellar cartilage lesions are best treated with combined anteromedializing TTO and cartilage restoration as well.

Patients with patellar instability require soft tissue stabilization, i.e. an MPFL reconstruction, and either a medializing TTO for those with lateralized tubercle position or a distalizing TTO for those with patella alta. Did you get all of that? Well, if you didn’t don’t worry. We have a nice graphic from this article on our Instagram – the sportsdocspod.

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Welcome to The Sports Docs Podcast! On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.

On today’s episode we’re focusing on patellofemoral cartilage defects with Dr. Cassandra Lee, an orthopaedic sports medicine surgeon, team physician for the UC Davis Aggies and Sacramento Republic FC, and chief of the sports medicine service at UC Davis. Dr. Lee has published on and spoken a lot about cartilage – both at the basic science level as well as clinical application – so we’re excited to have her join the discussion today.

We have some great articles for you that contribute well to our conversation on the surgical treatment of patellofemoral cartilage disease. As always, links to all of the papers that we discuss on this show can be found on our podcast website.

The first article is a systematic review published just this month in OJSM titled “Cartilage Restoration for Isolated Patellar Chondral Defects.” Ronak Patel and his colleagues at the Illinois Center for Orthopaedic Research and Education summarized the results and complication rates of various patellar cartilage restoration techniques. They concluded that osteochondral autograft transplantation and autologous chondrocyte implantation were the most studied procedures for isolated patellar chondral defects. The article also touches upon newer techniques such as augmented microfracture, but the authors state that there is wide variability in indications and techniques that must be clarified in future higher-level studies.

Then, from the upcoming June issue of Arthroscopy this year, we review a retrospective cohort study titled “Utilization of Autologous Chondrocyte Implantation in the Knee Is Increasing While Reoperation Rates Are Decreasing Despite Increasing Preoperative Comorbidities.” Drew Lansdown and his team at UCSF observed a significant increase in the use of ACI since 2017 with a significant decrease in the rate of 90-day and 2-year reoperations for ACIs performed after 2017. Older age and tobacco use were predictors of increased risk of conversion to arthroplasty. Male sex was associated with decreased risk of reoperation.

We are joined today by Dr. Cassandra Lee, a board-certified fellowship-trained orthopedic sports medicine surgeon and Chief of the Sports Medicine service at UC Davis. Dr. Lee obtained her medical degree from Boston University. She completed her residency training at Wake Forest University and sports medicine fellowship at Washington University in St. Louis, serving as team physician for the Washington University Bears, St. Louis Rams, and St. Louis Blues. Dr. Lee was a 2017 Lars Petersen Travelling Fellow for the International Cartilage Regeneration and Joint Preservation Society and a 2022 American Orthopaedic Society for Sports Medicine / Asian-Pacific Knee, Arthroscopy and Sports Medicine Society Traveling Fellow. She currently serves as team physician for collegiate and professional teams including the UC Davis Aggies and the Sacramento Republic FC. Her research interests are in modulation of post-traumatic osteoarthritis, currently funded by an NIH R01 and Department of Defense grants.

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In this episode, we’re going to continue our discussion with Candace Townley Cox and focus on rehabilitation of quad function and lower extremity mobility after surgery.

We start with a systematic review from the August 2022 issue of AJMS titled “The Effects of Blood Flow Restriction in Patients Undergoing Knee Surgery.” Now, we did a whole episode on blood flow restriction therapy or “BFR” with Dr. Eddie Chang back in October of 2021. If you haven’t already listened, go check it out! In brief, BFR involves the use of a cuff or tourniquet system positioned at the upper part of the limb to restrict venous blood return while maintaining arterial inflow. Restriction of venous outflow leads to an anaerobic – or oxygen depleted – environment similar to that of higher-intensity training. This anaerobic environment is hypothesized to promote muscle hypertrophy through a combination of cell signaling and hormonal changes, effectively leading to muscle mass and strength gains at lower intensity training – ideal for our post-op patients.

Lawrence Wengle and colleagues at the University of Toronto performed this review of 11 papers and concluded that the use of BFR led to significant improvements in quad muscle mass, quantified by cross-sectional area of the muscle, and quad strength after knee surgery. Patient reported outcomes were not significantly different between those who used BFR and those who did not. Lastly, in the two studies that used BFR pre-op, no significant benefit was found.

Article Link:
https://pubmed.ncbi.nlm.nih.gov/34406084/

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On today’s episode we’re focusing on rehabilitation of ACL surgery with Candace Townley Cox, a Doctor of Physical Therapy and body movement expert at Evolution Physical Therapy. Today’s discussion will center around tips and tricks to optimize outcomes and some common pitfalls that may hold patients back from a full recovery.

We have some great articles for you that contribute well to our conversation on the surgical treatment of knee cartilage disease. As always, links to all of the papers that we discuss on this show can be found on our podcast website.

The first article is a level 3 case-control study published in the October 2020 issue of OJSM, titled “Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction.” Gustavo Constantino de Campos and his team in Sao Paulo, Brazil retrospectively reviewed the records of 438 patients who underwent ACL reconstruction. Anterior knee pain was reported in 6.2% of cases. Patients who underwent ACL reconstruction with a patellar tendon autograft were 3.4 times more likely to experience anterior knee pain. Also, patients who experienced an extension deficit in the post-op period were also more likely to experience anterior knee pain, with an odds-ratio of 5.3. The authors fund that anterior knee pain was not correlated with patient sex, age or surgical technique.

We are joined today by Dr. Candace Townley Cox. Candace is a Colorado native who received her Bachelor’s degree in Athletic Training at Nebraska Wesleyan University. Following undergrad Candace returned to Colorado as a Graduate Assistant Athletic Trainer at Regis University in Denver. There, she earned her Master’s degree in Sports Performance while working specifically with the Women’s Volleyball and Softball teams. Candace continued her education at Regis University earning her Doctorate of Physical Therapy. Since graduating Candace has spent countless hours in Sport Science Labs assessing movement quality, efficiency, as well as bone and muscle performance. As a movement expert, she is able to address the body’s impairments both from a table assessment and from functional movement assessments.

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We’re coming to you live from the American Academy of Orthopaedic Surgeons annual meeting in Las Vegas, our largest orthopaedic conference. This year, over 20,000 orthopedic professionals gathered at the AAOS meeting to take part. The educational program is comprised of instructional course lectures, video theater, live surgeries, podium presentations and research posters.

Over the next several episodes we’re going to be reviewing five sports medicine posters that were presented at the AAOS meeting. On this podcast we try to review the most updated literature on different sports medicine topics. So, reviewing some of the posters that were just presented at AAOS is particularly exciting for us because this is very new data. So new that most of this data has not even been published yet.

We’re joined by Dr. Brian Waterman to get his take on these poster presentations.

Dr. Brian Waterman is a board-certified, orthopedic surgeon specializing in adult and pediatric sports medicine, cartilage restoration and joint preservation, complex knee surgery and shoulder and elbow care. He is the Chief of sports medicine at Wake Forest University and the Director of their sports medicine fellowship program. Dr. Waterman completed his orthopedic surgery residency at William Beaumont Army Medical Center and served 13 years in the U.S. Army, earning multiple honors including the Meritorious Service Medal and Army Commendation Medal.

Dr. Waterman then went on to complete a sports medicine fellowship at Rush University Medical Center in Chicago. He is the team physician for Wake Forest University, the Winston-Salem Dash, U.S. Ski and Snowboard and several local high schools.

Dr. Waterman is an associate editor for the Arthroscopy Journal and is on the Board of Directors for Arthroscopy Association of North America. Given his extensive experience with orthopedic research, Dr. Waterman led the sports medicine poster tour at AAOS this year, so we’re looking forward to getting his unique perspective on these poster presentations.

Featured Poster:
Should NFL Offensive Linemen Use Prophylactic Knee Braces? A Retrospective Analysis of Usage Trends, Player Performance, and Major Knee Injury. Offensive linemen in American football are prone to high-energy valgus forces to the knee and associated ligament injuries.

Use of prophylactic knee braces has been hypothesized to protect against these injuries but the evidence backing this up has been inconclusive at best.

Robert Gallo and his colleagues at Penn State performed a prospective cohort study from 2014 to 2020, comparing NFL offensive lineman who chose to wear prophylactic knee braces to lineman who did not. They evaluated injury rates as well as performance metrics. Interestingly, the authors reported that from 2014 to 2020, the prevalence of knee brace usage declined linearly, from 16% in 2014 to 5% in 2020.

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We’re coming to you live from the American Academy of Orthopaedic Surgeons annual meeting in Las Vegas, our largest orthopaedic conference. This year, over 20,000 orthopedic professionals gathered at the AAOS meeting to take part. The educational program is comprised of instructional course lectures, video theater, live surgeries, podium presentations and research posters.

Over the next several episodes we’re going to be reviewing five sports medicine posters that were presented at the AAOS meeting. On this podcast we try to review the most updated literature on different sports medicine topics. So, reviewing some of the posters that were just presented at AAOS is particularly exciting for us because this is very new data. So new that most of this data has not even been published yet.

We’re joined by Dr. Brian Waterman to get his take on these poster presentations.

Dr. Brian Waterman is a board-certified, orthopedic surgeon specializing in adult and pediatric sports medicine, cartilage restoration and joint preservation, complex knee surgery and shoulder and elbow care. He is the Chief of sports medicine at Wake Forest University and the Director of their sports medicine fellowship program. Dr. Waterman completed his orthopedic surgery residency at William Beaumont Army Medical Center and served 13 years in the U.S. Army, earning multiple honors including the Meritorious Service Medal and Army Commendation Medal.

Dr. Waterman then went on to complete a sports medicine fellowship at Rush University Medical Center in Chicago. He is the team physician for Wake Forest University, the Winston-Salem Dash, U.S. Ski and Snowboard and several local high schools.

Dr. Waterman is an associate editor for the Arthroscopy Journal and is on the Board of Directors for Arthroscopy Association of North America. Given his extensive experience with orthopedic research, Dr. Waterman led the sports medicine poster tour at AAOS this year, so we’re looking forward to getting his unique perspective on these poster presentations.

Featured Poster:
Pediatric Anterior Cruciate Ligament Reconstruction: Adding Lateral Extra-Articular Tenodesis Resulted in Similar Return to Sport without Increasing Pain Scores. Ted Ganley and his colleagues at CHOP performed a retrospective chart review to determine first: clinical factors that motivate surgeons to perform a lateral extraarticular tenodesis or “LET” at the time of ACL reconstruction; and second: to compare early clinical outcomes between patients who underwent an ACLR alone versus ACLR with LET.

We did our first Overtime episode on LET back in November of 2021. So if you’d like to learn more about this procedure including the indications and clinical outcomes, go listen to that episode. Briefly, the addition of an extraarticular stabilization procedure such as LET or ALL reconstruction has been shown to reduce the risk of graft rupture in adults, but there are limited studies in the pediatric population.

The authors found that the Beighton score for the ACL+LET group was significantly greater than that of the ACL alone group. Second, LET procedures were more commonly performed in revision surgery rather than primary ACL reconstruction. This study suggests that greater ligamentous laxity, as measured by Beighton score, as well as the patient requiring a revision ACL reconstruction, may make surgeons treating pediatric patients more likely to offer LET or ALL reconstruction. Lastly, this study suggests that the addition of LET resulted in similar pain levels, sport clearance times and post-op mobility compared to ACL reconstruction alone.

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We’re coming to you live from the American Academy of Orthopaedic Surgeons annual meeting in Las Vegas, our largest orthopaedic conference. This year, over 20,000 orthopedic professionals gathered at the AAOS meeting to take part. The educational program is comprised of instructional course lectures, video theater, live surgeries, podium presentations and research posters.

Over the next several episodes we’re going to be reviewing five sports medicine posters that were presented at the AAOS meeting. On this podcast we try to review the most updated literature on different sports medicine topics. So, reviewing some of the posters that were just presented at AAOS is particularly exciting for us because this is very new data. So new that most of this data has not even been published yet.

We’re joined by Dr. Brian Waterman to get his take on these poster presentations.

Dr. Brian Waterman is a board-certified, orthopedic surgeon specializing in adult and pediatric sports medicine, cartilage restoration and joint preservation, complex knee surgery and shoulder and elbow care. He is the Chief of sports medicine at Wake Forest University and the Director of their sports medicine fellowship program. Dr. Waterman completed his orthopedic surgery residency at William Beaumont Army Medical Center and served 13 years in the U.S. Army, earning multiple honors including the Meritorious Service Medal and Army Commendation Medal.

Dr. Waterman then went on to complete a sports medicine fellowship at Rush University Medical Center in Chicago. He is the team physician for Wake Forest University, the Winston-Salem Dash, U.S. Ski and Snowboard and several local high schools.

Dr. Waterman is an associate editor for the Arthroscopy Journal and is on the Board of Directors for Arthroscopy Association of North America. Given his extensive experience with orthopedic research, Dr. Waterman led the sports medicine poster tour at AAOS this year, so we’re looking forward to getting his unique perspective on these poster presentations.

Featured Poster:
Older Adults Take Longer to Achieve the Patient Acceptable Symptom State following Primary Hip Arthroscopy for Femoroacetabular Impingement: A Retrospective Analysis with 2-Year Follow-Up.

Thomas Youm and team found that patients in the oldest cohort, between 50-75 years of age, had significantly longer time to PASS than those in the youngest group, even after adjusting for sex and BMI.

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We’re coming to you live from the American Academy of Orthopaedic Surgeons annual meeting in Las Vegas, our largest orthopaedic conference. This year, over 20,000 orthopedic professionals gathered at the AAOS meeting to take part. The educational program is comprised of instructional course lectures, video theater, live surgeries, podium presentations and research posters.

Over the next several episodes we’re going to be reviewing five sports medicine posters that were presented at the AAOS meeting. On this podcast we try to review the most updated literature on different sports medicine topics. So, reviewing some of the posters that were just presented at AAOS is particularly exciting for us because this is very new data. So new that most of this data has not even been published yet.

We’re joined by Dr. Brian Waterman to get his take on these poster presentations.

Dr. Brian Waterman is a board-certified, orthopedic surgeon specializing in adult and pediatric sports medicine, cartilage restoration and joint preservation, complex knee surgery and shoulder and elbow care. He is the Chief of sports medicine at Wake Forest University and the Director of their sports medicine fellowship program. Dr. Waterman completed his orthopedic surgery residency at William Beaumont Army Medical Center and served 13 years in the U.S. Army, earning multiple honors including the Meritorious Service Medal and Army Commendation Medal.

Dr. Waterman then went on to complete a sports medicine fellowship at Rush University Medical Center in Chicago. He is the team physician for Wake Forest University, the Winston-Salem Dash, U.S. Ski and Snowboard and several local high schools.

Dr. Waterman is an associate editor for the Arthroscopy Journal and is on the Board of Directors for Arthroscopy Association of North America. Given his extensive experience with orthopedic research, Dr. Waterman led the sports medicine poster tour at AAOS this year, so we’re looking forward to getting his unique perspective on these poster presentations.

Featured Poster:
**Management of Meniscal Tears: Costs and Timing of Surgery and was presented by Liz Matzkin and her team at Mass General Brigham.

The purpose of this new study was to describe the costs associated with treatment of meniscus tears in the two-year period following diagnosis and examine the relationship between patient characteristics and timing of surgery.
They divided patients into “nonsurgical”, “early surgery” performed within 3 months of diagnosis, and “late surgery” beyond 3 months. They found that costs were significantly lower in the nonsurgical group but that highest costs were associated with late surgery, advocating for surgery to be performed earlier.

The authors also reported that higher utilization of PT and medication in the three- month period post-diagnosis was also associated with a reduced likelihood of eventual surgery.**

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We’re coming to you live from the American Academy of Orthopaedic Surgeons annual meeting in Las Vegas, our largest orthopaedic conference. This year, over 20,000 orthopedic professionals gathered at the AAOS meeting to take part. The educational program is comprised of instructional course lectures, video theater, live surgeries, podium presentations and research posters.

Over the next several episodes we’re going to be reviewing five sports medicine posters that were presented at the AAOS meeting. On this podcast we try to review the most updated literature on different sports medicine topics. So, reviewing some of the posters that were just presented at AAOS is particularly exciting for us because this is very new data. So new that most of this data has not even been published yet.

We’re joined by Dr. Brian Waterman to get his take on these poster presentations.

Dr. Brian Waterman is a board-certified, orthopedic surgeon specializing in adult and pediatric sports medicine, cartilage restoration and joint preservation, complex knee surgery and shoulder and elbow care. He is the Chief of sports medicine at Wake Forest University and the Director of their sports medicine fellowship program. Dr. Waterman completed his orthopedic surgery residency at William Beaumont Army Medical Center and served 13 years in the U.S. Army, earning multiple honors including the Meritorious Service Medal and Army Commendation Medal.

Dr. Waterman then went on to complete a sports medicine fellowship at Rush University Medical Center in Chicago. He is the team physician for Wake Forest University, the Winston-Salem Dash, U.S. Ski and Snowboard and several local high schools.

Dr. Waterman is an associate editor for the Arthroscopy Journal and is on the Board of Directors for Arthroscopy Association of North America. Given his extensive experience with orthopedic research, Dr. Waterman led the sports medicine poster tour at AAOS this year, so we’re looking forward to getting his unique perspective on these poster presentations.

Featured Poster:
Factors Associated with Return of Quadriceps Strength following ACL Reconstruction using Quad Tendon Autograft.

Persistent quad strength deficit following ACL reconstruction is very concerning. It is associated with ACL retears, diminished patient-reported outcomes, lower return to sport, altered knee joint kinematics, and increased risk of osteoarthritis.

The purpose of this retrospective cohort study was to identify factors that influence the return of knee extensor strength following ACL reconstruction with quad tendon autograft. Volker Musahl and colleagues at UPMC found that lower pre-op patient reported clinical scores (including higher pre-op pain level and lower self-reported function), female sex, and the use of BFR consistently post-op was associated with a lower likelihood of achieving post-op knee extensor strength symmetry in quad autograft ACL reconstructions.

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Tune into our special episode highlighting the 40th Anniversary of the Ruth Jackson Orthopaedic Society. This episode is focused on goal setting!

Today’s episode is actually a very special one. If you’ve listened to any of our previous episodes, you know that we typically chat about a specific orthopedic injury or surgical procedure. We often dive into the nitty gritty details of diagnosis, selection of the appropriate treatment and returning athletes to sport.

But today, we’re tackling a completely different topic, and that is “goal-setting”. We have a couple great articles for you today that contribute well to our conversation on building new habits and goal setting. As always, links to all of the papers that we discuss on this show can be found on our podcast website.

The first article was published in the Harvard Business Review in February of this past year and is titled “What Does It Really Take to Build a New Habit?” The author, Kristi DePaul, starts off by differentiating a habit from a routine. She explains that a habit is a behavior done with little or no thought, whereas a routine is a series of behaviors that are frequently, and intentionally, repeated. A behavior has to be a regularly performed routine before it can become a habit at all. So how exactly do we accomplish that?

https://hbr.org/2021/02/what-does-it-really-take-to-build-a-new-habit

Well, this article outlines four key steps: (1) Set your intentions. (2) Prepare for roadblocks. (3) Start with nudges or small changes at first. (4) Show yourself compassion. We explore each of these steps a little further in our discussion today.

The second article we have for you was published in the Harvard Business Review in April of 2017 and is titled “What Separates Goals We Achieve From Goals We Don’t?” The authors, Kaitlin Woolley and Ayelet Fishbach, performed five studies that investigated whether immediate or delayed benefits influenced goal persistence. They found that immediate benefits (such as enjoyment) played a significant role in helping people stick to their goals, while delayed benefits (such as importance of that goal for overall health or career advancement) really only played a role in setting the goal in the first place. Therefore, harnessing those immediate benefits can help you persist and achieve the goals you set.

https://hbr.org/2017/04/what-separates-goals-we-achieve-from-goals-we-dont#:~:text=We%20achieve%20the%20ones%20that%20are%20fun%20to%20work%20toward.

We are joined today by two special guests: Dr. Giselle Aerni & Dr. Mary Mulcahey.

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We’re excited to be in the studio today recording this episode on returning to play after arthroscopic stabilization for anterior shoulder instability. Now, we did a whole episode on shoulder instability back in March of 2021 with Dr. Mark Price – shoulder surgeon at Massachusetts General Hospital and team
physician for the New England Patriots.

We discussed a lot on that two-part episode, including anterior and posterior instability, nonoperative and surgical treatment, and different surgical approaches including arthroscopic versus open Bankart repair and bone block procedures. It was a great discussion, and we definitely recommend checking it out if you haven’t listened to it already. But today we’re narrowing our focus to post-op rehab and return to play testing after arthroscopic anterior
shoulder stabilization. We’ve spoken about return to play testing a lot on previous episodes. We even did an entire episode with Dr. Robin West – team physician for the Washington Nationals and the Washington Commanders – dedicated to this very topic: returning athletes to play after various orthopedic injuries. In that episode we highlighted that there is often little to no data to guide safe return to sport after an orthopedic injury, particularly those treated surgically. That is also case for athletes who undergo surgery for anterior shoulder instability.

On today’s episode, we’re going to review an article titled “Functional Rehabilitation and Return to Play After Arthroscopic Surgical Stabilization for Anterior Shoulder Instability” published in the December 2021 issue of Sports
Health. In this case series, Dr. Brian Busconi and colleagues at UMass evaluated 62 athletes who underwent arthroscopic Bankart repair and were subsequently cleared to return to sports using both functional and psychological testing.

Before we dive into the results of this paper, it is worthwhile to review the traditional methods of clearing athletes after Bankart repair as there is currently no validated return to sport assessment for this particular surgery. Ciccotti and colleagues performed a systematic review of 58 studies assessing return to play criteria in a 2018 article published in Arthroscopy.

Unsurprisingly, the most common criterion used to clear an athlete after arthroscopic Bankart repair was time. 75% of studies used time from surgery as the sole criterion, with the most commonly used time point being 6 months post-op. 19% used strength and 14% used range of motion. Only 1 of the studies evaluated proprioceptive control as a metric for guiding return to play.

https://journals.sagepub.com/doi/abs/10.1177/19417381211062852

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Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and I chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the indications, various surgical approaches and overview of the outcomes.

On today’s episode, we’re going to chat about treatment of distal biceps tendon ruptures. We’ve seen this injury across many sports and in very prominent players – for example, Miguel Cabrera, all-star first baseman, sustained a biceps tendon rupture while at bat, when he swung and missed an off-speed pitch.

We also see this injury in cross fit athletes, body builders and overhead laborers. This can be a devastating injury for our athletes, so understanding the treatment technique options, post-op rehab and what return to sport looks like is very important. We’ll start off with how to decide between non-op treatment and surgical repair and what those treatment protocols look like. Then, we’ll shift our focus to surgical treatment and compare one and two incision distal biceps tendon repair techniques. After surgical repair, there is then a decision of rehab protocols.

ARTICLES:

Return to Work and Sport After Distal Biceps Repair
Complications of Distal Biceps Tendon Repair
A Meta-analysis of Single-Incision Versus Double-Incision Surgical Technique

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Welcome to The Sports Docs Podcast with Dr. Catherine Logan and Dr. Ashley Bassett. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.

On today’s episode we’re focusing on cartilage defects of the knee with Dr. Clayton Nuelle, Assistant Clinical Professor at the University of Missouri and team physician for Mizzou athletics. His current research focuses on improving cartilage restoration and joint preservation techniques, so we are very excited to have him join us for our discussion today.

We have some great articles for you that contribute well to our conversation on the surgical treatment of knee cartilage disease.

We start with a discussion of osteochondral lesions in the pediatric population. Will Bugbee and his team at Scripps Clinic in California authored a case series titled “Osteochondral Allograft Transplantation of the Knee in the Pediatric and Adolescent Population”. They reported 90% graft survivorship at 10 years post-op. Of the five grafts that failed, four successfully underwent a salvage surgery with another osteochondral allograft. 88% of knees were rated as good to excellent with an 89% satisfaction rate. The authors deemed OCA to be a safe and effective procedure for pediatric patients with large osteochondral defects.

Then, from the December 2021 issue of Cartilage, we discuss the comprehensive review article by Andreas Gomoll and colleagues titled “Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures.” This paper nicely details a treatment approach based on cartilage lesion size, location and presence of underlying bone involvement.

We finish up our conversation with a focus on rehab and returning to play after cartilage restoration procedures. The last article we reference is a systematic review published in AJSM 2009 titled “Return to Sports Participation After Articular Cartilage Repair in the Knee.” Kai Mithoefer et al reported an overall return to sports rate of 73%, with the highest return rates following OATS. Yet, the highest durability to continue playing at the preinjury level of play was following ACI at 96%. There were numerous factors that impacted an athletes ability to return to sport. Younger patients, those with pure cartilage lesions rather than osteochondral lesions, duration of symptoms less than 12 months pre-op, smaller lesions under 2 cm, lesion location at the lateral femoral condyle, no prior surgeries and no concomitant procedures were all associated with increased return to play.

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Welcome to The Sports Docs Podcast with Dr. Catherine Logan and Dr. Ashley Bassett. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.

On today’s episode we’re focusing on cartilage defects of the knee with Dr. Clayton Nuelle, Assistant Clinical Professor at the University of Missouri and team physician for Mizzou athletics. His current research focuses on improving cartilage restoration and joint preservation techniques, so we are very excited to have him join us for our discussion today.

We have some great articles for you that contribute well to our conversation on the surgical treatment of knee cartilage disease.

The first article is a level I prospective RCT published in the May 2018 issue of AJSM titled “Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture – Five Year Follow-up of a Prospective Randomized Trial.” This multicenter study was performed at 14 sites across 7 different countries. Patients with symptomatic full thickness cartilage defects greater than 3 cm in size and involving the femoral condyle or trochlea were randomized to either the MACI procedure or microfracture procedure. If you’re not familiar with the MACI procedure, we definitely recommend checking out our last Overtime episode where we do a deep dive into the details of that surgical technique.

In this 5-year clinical trial, Brittberg and colleagues found that while both groups significantly improved after surgery, patients who underwent the MACI procedure were both clinically and statistically significantly better at 5 years compared to patients who underwent microfracture.

Then, from the February issue of AJSM this year, we review the publication titled “Isolated Osteochondral Autograft versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee.” Bryan Saltzman and his team at OrthoCarolina performed a systematic review of Llevel I and II studies investigating osteochondral transplant techniques. For our listeners, osteochondral transplants can be performed using autograft – the patient’s own tissue, or allograft – donor tissue. Traditionally, autograft transplant or “OATs” has been used for smaller defects, to minimize donor-site morbidity, and has the benefits of avoiding an immune response and no concern for disease transmission.

The osteochondral graft is typically harvested from nonweightbearing areas of the knee, such as the intercondylar notch or supracondylar ridge. Allograft transplant or “OCA” is indicated for larger defects. Benefits include the lack of donor site morbidity and the ability to take a graft from an area that correlates with the defect being addressed, such as patella to patella. Grafts can also be size-matched during the ordering process. Downsides include having to wait for allograft availability and cost, in addition to the immunologic and disease transmission risks already discussed, though those are very rare. Both techniques have the benefit of addressing not only the cartilage disease but also underlying bone loss.

This systematic review concluded that both OATs and OCA resulted in favorable patient outcomes and graft survival rates at 5-year follow up, with no significant differences between the two. The autograft group was significantly younger, had smaller defect size, used a larger number of plugs and more frequently treated medial femoral condyle lesions. The allograft group had a larger number of patients with lateral femoral condyle and trochlear lesions.

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Welcome to Overtime with the Sports Docs. On each of these mini episodes, we chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the indications, various surgical approaches and overview of the outcomes.

On today’s episode, we’re going to chat about a relatively new surgical treatment for cartilage injury of the knee called Matrix-Induced Autologous Chondrocyte Implantation or MACI for short. Now, while this episode will focus primarily on the MACI procedure, we will be releasing a bigger episode in a couple of weeks that goes through all of the different surgical treatments for knee cartilage disease. We’ll be joined by an awesome guest for that one, so be sure to subscribe to our podcast and keep your eyes peeled for that two-part episode coming soon.

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The psychosocial benefits of participating in sports have long been appreciated. However, athletes are often faced with circumstances that make them susceptible to psychological challenges unique to the athletic population.

One such circumstance is injury in sport, which can be a source of notable distress and may precipitate the emergence of new or exacerbation of underlying psychological disorders. In athletes who are injured, particularly those undergoing surgical intervention, psychological factors play a substantial role in the recovery process. A more comprehensive understanding of the complex interplay between psychological and physical health in the setting of an injury is essential to optimize patient care.

The aim of this review was to highlight the impact of psychological factors on measurable outcomes after orthopaedic surgical interventions and to explore interventions that can be implemented to improve surgical outcomes and the overall care of injured athletes.

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The psychosocial benefits of participating in sports have long been appreciated. However, athletes are often faced with circumstances that make them susceptible to psychological challenges unique to the athletic population.

One such circumstance is injury in sport, which can be a source of notable distress and may precipitate the emergence of new or exacerbation of underlying psychological disorders. In athletes who are injured, particularly those undergoing surgical intervention, psychological factors play a substantial role in the recovery process. A more comprehensive understanding of the complex interplay between psychological and physical health in the setting of an injury is essential to optimize patient care.

The aim of this review was to highlight the impact of psychological factors on measurable outcomes after orthopaedic surgical interventions and to explore interventions that can be implemented to improve surgical outcomes and the overall care of injured athletes.

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Well, we are excited to back for 2022 and kicking off with an Overtime episode. On today’s episode, we’re going to chat about treatment of Achilles tendon ruptures. We’ve seen this injury across many sports and in very prominent players – Kevin Durant, Klay Thompson, Brandon Brooks who tore both of his Achilles tendons one year apart. This can be a devastating injury for our athletes, so understanding the treatment options, post-op rehab and what return to sport looks like is very important.

We’ll start off with how to decide between non-op treatment and surgical repair and what those treatment protocols look like. Then, we’ll shift our focus to surgical treatment and compare standard open Achilles tendon repair to newer percutaneous repair techniques. After surgical repair, there is then a decision of traditional rehab versus accelerated rehab with early weightbearing. Lastly, we’ll finish up with a discussion on returning to sports after Achilles repair – how do we clear these athletes and how do they perform once they return to play?

We’re going to reference many articles from AJSM throughout our talk today. We’ll post the abstracts to our Instagram, which is thesportsdocspod – if you don’t already follow us you should! So if you’re interested in reading more about the individual studies you can find them there.

· AJSM 2021 – Seow – Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates

o Level I, systematic review, 48 studies

o Re-rupture rate: Surgical treatment 3.6%, Non-op 12.1%

o Infection: SX 5.6%, non-sx 0%

o Sural nerve injury: SX 2%, non-sx 0.3%

o DVT/PE: SX 0.8%, non-sx 1.8%

· AJSM 2018 – Svedman – Reduced Time to Surgery Improves Patient-Reported Outcome After Achilles Tendon Rupture. https://pubmed.ncbi.nlm.nih.gov/30169112/· AJSM 2021 – Attia – Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. https://pubmed.ncbi.nlm.nih.gov/34908499/

o Level I, meta-analysis, 10 studies

· AJSM 2021 – Seow – Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates. https://pubmed.ncbi.nlm.nih.gov/33783229/· AJSM 2020 – Okoroha – Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair: A Prospective Randomized Controlled Trial. https://pubmed.ncbi.nlm.nih.gov/32203675/

· AJSM 2018 – Eliasson – The Ruptured Achilles Tendon Elongates for 6 Months After Surgical Repair Regardless of Early or Late Weightbearing in Combination With Ankle Mobilization: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/29965789/· AJSM 2017 – Trofa – Professional Athletes’ Return to Play And Performance After Operative Repair of a Achilles Tendon Rupture. https://pubmed.ncbi.nlm.nih.gov/28644678/

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The Sports Docs Podcast Year in Review

Hear all the highlights from the first season of the Sports Docs Podcast!

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Welcome back to The Sports Docs Podcast with Dr. Catherine Logan and Dr. Ashley Bassett. In episode 16, we’re going to continue our discussion with Dr. Anand Murthi and focus on the surgical treatment options for irreparable rotator cuff tears.

We’ll start with the article titled “Minimum 2-year Clinical Outcomes After Superior Capsule Reconstruction Compared With Reverse Total Shoulder Arthroplasty for the Treatment of Irreparable Posterosuperior Rotator Cuff Tears in Patients Younger Than 70 Years” from December 2020 issue of JSES. Peter Millett and colleagues at the Steadman Clinic in Vail reported significant improvements in clinical outcome scores, high patient satisfaction and high rates of return to sport at 2-years post-op, with no significant differences between the two procedures. The authors concluded that SCR is a reliable alternative to arthroplasty for younger patients with irreparable cuff tears in the absence of glenohumeral arthritis. SCR has the benefit of being an arthroscopic procedure that preserves native anatomy, allowing for easier revision surgery in the future.

Then, from the June 2019 issue of JBJS, we review the publication “Biomechanics of a Biodegradable Subacromial Balloon Spacer for Irreparable Superior Rotator Cuff Tears.” Authored by our guest Anand Murthi and his team at MedStar, this laboratory study found that placement of a subacromial balloon spacer in the setting of a massive irreparable supraspinatus tear restored glenohumeral contact pressures and the center of glenohumeral contact to that of an intact rotator cuff. Additionally, placement of the balloon increased the deltoid load and lowered the humeral head, increasing the acromiohumeral interval and decreasing subacromial contact pressures. The authors concluded that the subacromial balloon spacer may help overcome the biomechanical effects of a deficient cuff and thereby postpone the need for arthroplasty.

Lastly, we finish up with a systematic review from the July 2020 issue of JSES titled “The Lower Trapezius Transfer: A Systematic Review of Biomechanical Data, Techniques and Clinical Outcomes.” Two tendon transfers have been described for treatment of irreparable posterosuperior rotator cuff tears: latissimus dorsi and lower trapezius. Compared to traditional latissimus dorsi transfer, the lower trap transfer is more anatomic and better restores shoulder abduction and external rotation. One drawback of the lower trap transfer highlighted by this paper is limited tendon excursion requiring the addition of a graft. In the setting of a cuff tear, direct transfer to the tuberosity without graft extension increases muscle tendon strain and risk of failure, and therefore is not recommended. Lower trap transfer can be performed through an open or arthroscopically-assisted approach while latissimus dorsi transfer can also be performed entirely arthroscopically.

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Welcome to The Sports Docs Podcast with Dr. Ashley Bassett and Dr. Catherine Logan. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.
On today’s episode we’re focusing on rotator cuff tears with Dr. Anand Murthi, Chief of Shoulder and Elbow surgery at MedStar Union Memorial Hospital and Professor of Orthopedic Surgery at Georgetown University.

We have some great articles for you today that contribute well to our conversation on the surgical treatment of rotator cuff injury. As always, links to all of the papers that we discuss on this show can be found on our podcast website.

The first article is retrospective cohort study published this month in the Journal of Shoulder and Elbow Surgery titled “Early Repair of Traumatic Rotator Cuff Tears Improves Functional Outcomes”. Matt Ramsey and his team at Rothman reported that patients who underwent surgical repair of traumatic cuff tears within 3 weeks of injury had the best functional outcomes, as measured by ASES, SANE and VAS scores, compared to those who underwent surgery later. Furthermore, delaying surgical repair beyond 4 months was associated with a significant decline in function across all scores. The authors concluded that early MRI diagnosis and prompt orthopedic referral is imperative when a traumatic cuff injury is
suspected, to avoid a delay in surgical treatment that may negatively affect clinical outcomes.

Then, from the October issue of AJSM this year, we review the publication titled “Multicenter Randomized Controlled Trial Comparing Single-Row With Double-Row Fixation in Arthroscopic Rotator Cuff Repair”. Lapner and colleagues in Winnipeg and Ottawa Canada concluded that double-row fixation was associated with statistically superior WORC scores compared to single-row fixation at 10- years post-op, but that this is unlikely to be clinically significant. More importantly, double-row repair led to preserved function out to 10 years while single-row repair exhibited significant functional declines during this time period as measured by changes in the WORC and ASES scores.

We are joined today by Dr. Anand Murthi, Chief of Shoulder and Elbow Surgery and Director of the Shoulder and Elbow Fellowship at MedStar Union Memorial Hospital. Dr. Murthi received his medical degree from Case Western Reserve University and completed his orthopedic residency at George Washington University. He then completed a fellowship in shoulder and elbow reconstruction at Columbia Presbyterian.

Dr. Murthi is the former president and founding member of the Association of Clinical Elbow and Shoulder Surgeons. He is also an elected member of the American Shoulder and Elbow Surgeons Society and was recently elected to the Neer Circle of ASES. Dr. Murthi is passionate about research and has published and presented numerous research papers on a national and international stage. He is the current section editor for the journal “Current Orthopaedic Practice” and also sits on the editorial board of the Journal of Shoulder and Elbow Surgery and the Journal of Shoulder and Elbow Arthroplasty.

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The Sports Docs discuss the psychological aspects of return to play following ACL surgery.

Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and Ashley chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the indications, various surgical approaches and overview of the outcomes. We’re excited to bring this new styles to our listeners and would love to hear your feedback about it!

On this Overtime episode, we’re going to discuss an article from this month's AJSM:

Association of the Psychological Response to the ACL-SPORTS Training Program and Self-reported Function at 2 Years After Anterior Cruciate Ligament Reconstruction

Background:

Psychological readiness to return to sport has emerged as an important factor associated with outcomes after anterior cruciate ligament reconstruction (ACLR). Psychological factors are potentially modifiable during the course of rehabilitation, and improving them may lead to better outcomes.

Purpose:
To determine whether athletes with a positive psychological response after participation in a neuromuscular training and second injury prevention program had better self-reported function and activity outcomes compared with athletes who did not have a meaningful change.

Study Design:
Cohort study; Level of evidence, 3.

Methods:
After ACLR and the completion of formal rehabilitation, 66 level I/II athletes completed the following self-reported measures at enrollment (pretraining): the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale, the International Knee Documentation Committee (IKDC) subjective knee form, and the 5 subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS). Participants completed these measures after 10 sessions of agility, plyometric, and progressive strength training and at 1 and 2 years after ACLR. Participants who displayed an increase in the ACL-RSI score from pretraining to posttraining that exceeded the minimal clinically important difference (≥10 points) were defined as having a positive psychological response (responders) to training, and those who did not were defined as nonresponders. A mixed-model analysis of variance was used to determine if group differences in IKDC and KOOS scores existed over the 4 time points (pretraining, posttraining, and the 1- and 2-year follow-ups).

Results:
The responders reported better self-reported function compared with the nonresponders, regardless of time, on the IKDC form (P = .001), KOOS–Sport and Recreation (P = .014), KOOS-Pain (P = .007), and KOOS-Symptoms (P = .002) but not on the KOOS–Quality of Life (P = .078). Overall, 77% of responders and 67% of nonresponders returned to their previous level of sport by 1 year after ACLR (P = .358), and 82% of responders and 78% of nonresponders returned to their previous level of sport by 2 years after ACLR (P = .668).

Conclusion:
Ultimately, 59% of the athletes in this study displayed a meaningful improvement in their psychological outlook over the course of the training program. Responders demonstrated persistently better self-reported function at posttraining and at 1 and 2 years after ACLR, but there were no between-group differences in return-to-sport rates.

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Welcome to The Sports Docs Podcast with Dr. Ashley Bassett and Dr. Catherine Logan. On each episode we continue to chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.

On today’s episode we’re focusing on building teams in medicine. We’re joined today by Dr. Jo
Hannafin who has an unparalleled depth and breadth in building teams through her work as a
surgeon, a physician-scientist, a team physician for US Rowing and as a leader in the world of
orthopaedic surgery.

Dr. Hannafin is board certified in orthopedic surgery and sports medicine and the founder of the Women's Sports Medicine Center at HSS. Notably, she was the first female president of the American Orthopaedic Society for Sports Medicine and is also a past president of the Herodicus Society. In addition, she has served as vice president and secretary of the AOSSM board, chair of its committees on Enduring Education and Research, and as a member of numerous other AOSSM committees.

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Welcome to The Sports Docs Podcast with Dr. Ashley Bassett and Dr. Catherine Logan. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.

On today’s episode we’re focusing on building teams in medicine. We’re joined today by Dr. Jo
Hannafin who has an unparalleled depth and breadth in building teams through her work as a
surgeon, a physician-scientist, a team physician for US Rowing and as a leader in the world of
orthopaedic surgery.

Dr. Hannafin is board certified in orthopedic surgery and sports medicine and the founder of the Women's Sports Medicine Center at HSS. Notably, she was the first female president of the American Orthopaedic Society for Sports Medicine and is also a past president of the Herodicus Society. In addition, she has served as vice president and secretary of the AOSSM board, chair of its committees on Enduring Education and Research, and as a member of numerous other AOSSM committees.

We have some great articles for you today that contribute well to our conversation
As always, links to all the papers that we discuss on this show can be found on our podcast
website.

The first article hails from the Harvard Business Review and is titled, The Kinds of Teams
Health Care Needs by Amy C Edmondson. Ms Edmondson, a professor of Leadership and
Management at HBS, opens this article highlighting the challenges of working across teams in
medicine, and breaking out of our silos. She discusses the tendency in medicine to value
individual training, knowledge, and action; however, leaders must create structures that make
teaming easier. Professor Edmondson provides examples on how leaders can reframe to promote cross-disciplinary collaboration.

https://hbr.org/2015/12/the-kinds-of-teams-health-care-needs

Our second article is from MIT Sloan Management Review, entitled Establishing High-
Performance Teams: Lessons from Health Care. The authors pondered the questions: why is it
that teams following the same best practices can achieve different results? They studied “new
team formation” to understand why some teams succeed while others struggle.
In their study of a dozen primary care clinics trying to establish multi-disciplinary health care
teams, they identified 3 prototypical approaches to establishing team-based care:
- Pursuing functional change only
- Pursuing cultural change only
- Pursuing both functional and cultural change processes
In looking at these prototypes, they then subdivided them into Low and High Performers; the
highest-performing teams focused simultaneously on functional and cultural change.

https://sloanreview.mit.edu/article/establishing-high-performing-teams-lessons-from-health-care/

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The Sports Docs discuss the merits of LET - indications, surgical technique and rehab!

Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and Ashley chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the indications, various surgical approaches and overview of the outcomes. We’re excited to bring this new styles to our listeners and would love to hear your feedback about it!

On this Overtime episode, we’re going to chat about extra articular augmentation of ACL reconstruction, specifically focusing on lateral extra articular tenodesis. The need for this procedure arose due to the concern that even our best “anatomic” ACL reconstructions often fail restore rotational control, resulting in a persistently positive pivot shift test, which has been strongly associated with worse clinical outcomes, increased functional instability, possibly even increased arthritic changes.

Enjoy these brief, research updates in a casual discussion setting!

The history of Lateral Extraarticular Tenodesis (LET)

In the 1960s ACL reconstructions were limited to open techniques as this was before key hole surgery (arthroscopy) and they involved rerouting the patella tendon to provide stability
However, this resulted in such poor outcomes that alternative techniques were sought
In 1967 Dr Marcel Lemaire was the first to describe an isolated LET to help reduce rotational instability
This involved an 18 x 1cm wide strip of iliotibial band and rerouting it around the outside part of the knee
With the advent of arthroscopic ACL reconstruction techniques, the benefit of smaller scars and less pain, LET was thought to be unnecessary
Increasing medical evidence though has shown that whilst isolated ACL reconstruction may be adequate for lower demand athletes, new modified LET procedures help to significantly improve rotational stability to an arthroscopic ACL reconstruction

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Welcome to The Sports Docs Podcast with Dr. Ashley Bassett and Dr. Catherine Logan. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.

Most of the literature about BFR focuses on the effects distal to the site of occlusion, but what about proximally? Our next paper explores that question a bit further. From the August 2021 issue of AJSM, the article is titled Blood Flow Restriction Training for the Shoulder – A Case for Proximal Benefit. This randomized controlled study compared the proximal muscle changes after 8 weeks of combined upper extremity BFR and low-intensity exercise versus low-intensity exercise alone.
(https://pubmed.ncbi.nlm.nih.gov/34110960/)

Patrick McCulloch and colleagues at Houston Methodist concluded that the addition of BFR to the proximal arm resulted in greater muscle mass in both the upper extremity and the shoulder region, as well as increased internal rotation strength and endurance. Acute occlusion was associated with increased proximal muscle activation as measured by EMG. The authors suggest that occlusion-induced distal fatigue may contribute to enhanced activation of proximal muscles to compensate for fatigue of the distal muscles.

We’ll then shift our discussion to the use of BFR for lower extremity conditions, specifically after ACL reconstruction. Jorge Chala and his team published a systematic review titled Perioperative Blood Flow Restriction Rehabilitation in Patients undergoing ACL Reconstruction. This review concluded that data on the use of BFR after ACL surgery is very limited and heterogenous, but that most studies found significant benefits in muscle hypertrophy, strength and pain scores.
(https://www.researchgate.net/publication/340169823_Perioperative_Blood_Flow_Restriction_Rehabilitation_in_Patients_Undergoing_ACL_Reconstruction_A_Systematic_Review)

Then, from the March 2020 issue of AJSM, we wrap up with a randomized controlled trial titled Blood Flow Restriction Training Applied With High-Intensity Exercise Does Not Improve Quadriceps Muscle Function After ACL Reconstruction. Curran et al randomized patients to one of four exercise groups: concentric, eccentric, concentric with BFR and eccentric with BFR. The exercise program was initiated 10 weeks post-op and continued for 8 weeks. The authors reported no difference in muscle volume, strength or activation at any time point across all groups.
(https://pubmed.ncbi.nlm.nih.gov/32167837/)

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Welcome to The Sports Docs Podcast with Dr. Ashley Bassett and Dr. Catherine Logan. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.

On today’s episode we’re focusing on blood flow restriction therapy or “BFR”. Blood flow restriction is one type of ischemic therapy that is thought to increase muscle mass, strength and performance at a lower level of resistance training. And that last part really is the key, because training at high loads is often not possible for our patients undergoing rehab for an injury or postoperatively.

BFR involves the use of a cuff or tourniquet system positioned at the upper part of the limb to restrict venous blood return while maintaining arterial inflow. While the exact mechanism of BFR remains unclear, restriction of venous outflow leads to an anaerobic – or oxygen depleted – environment similar to that of higher-intensity training. This anaerobic environment is hypothesized to promote muscle hypertrophy through a combination of cell signaling and hormonal changes.

BFR is not for every patient and there are relative contraindications to its use. These include conditions that may increase the risk of blood clotting, such as vascular disease, obesity, sickle cell trait or disease, cancer and a history of DVT.

Article 1:

Blood Flow Restriction Training for Athletes: A Systematic Reviewhttps://journals.sagepub.com/doi/abs/10.1177/0363546520964454

Article 2:

Local and Systemic Effects of Blood Flow Restriction Therapy in an Animal Model https://pubmed.ncbi.nlm.nih.gov/33136456/

Article 3:

Blood Flow Restriction Training for the Shoulder: A Case for Proximal Benefithttps://pubmed.ncbi.nlm.nih.gov/34110960/

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On today’s episode we’re focusing on return to play after various orthopedic injuries: what factors influence the timing of return, what criteria are used to determine clearance and how this all differs between sports.

We’re joined today by Dr. Robin West, Chairman of Inova Sports Medicine and head team physician for the Washington Nationals. Dr. West also has 18 years of experience in the National Football League, serving as a physician for both the Pittsburgh Steelers followed by the Washington Football Team. So we’re excited to hear her take on this topic of return to play, especially given her experience across a multitude of elite sports.

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Welcome to The Sports Docs Podcast with Dr. Ashley Bassett and Dr. Catherine Logan. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.

On today’s episode we’re focusing on return to play after various orthopedic injuries: what factors influence the timing of return, what criteria are used to determine clearance and how this all differs between sports. We’re joined today by Dr. Robin West, Chairman of Inova Sports Medicine and head team physician for the Washington Nationals. Dr. West also has 18 years of experience in the National Football League, serving as a physician for both the Pittsburgh Steelers followed by the Washington Football Team. So we’re excited to hear her take on this topic of return to play, especially given her experience across a multitude of elite sports.

We have some great articles for you today that contribute well to our conversation on returning to sport after musculoskeletal injury. As always, links to all the articles we discuss on this show can be found on our podcast website.

The first paper is a systematic review from the May 2019 issue of OJSM titled How Much Do Psychological Factors Affect Lack of Return to Play After ACL Reconstruction? Riley Williams and his team at HSS reported that 65% of athletes who did not return to play after ACL surgery cited a psychological reason for not returning, with fear of reinjury being the most common. Lack of confidence in the knee, depression and lack of interest or motivation were other reasons given. The authors also found that when psychological factors were present there was a prolonged time to return to play, at an average of 17.2 months across the included studies.

The next article we’ll be discussing also focuses on psychological factors that impact return to sport. From the July issue of AJSM this year, the paper is titled Factor Structure of the Shoulder Instability Return to Sport After Injury Scale. This scale was adapted from the ACL Return to Sport After Injury scale and is designed to measure the psychologic readiness to return to play after a shoulder dislocation. Authors Margie Olds and Kate Webster found that athletes return to sports after a shoulder dislocation relatively quickly, despite reporting high levels of fear and anxiety about reinjury. This may contribute to the high rate of recurrent shoulder instability in this population. Athletes who underwent surgical stabilization had significantly lower fear of reinjury.

We are honored to have Dr. Robin West join us for the discussion today. Dr. West is an orthopedic surgeon specializing in sports medicine and is the Chairman of Inova Sports Medicine and President of Inova’s Musculoskeletal Service Line. She is an associate professor at VCU School of Medicine and Georgetown University, and currently serves as the head team physician for the Washington Nationals baseball team. Dr. West earned her medical degree from George Washington University, where she also completed her orthopedic residency. She then went on to complete a fellowship in sports medicine at the University of Pittsburgh. Dr. West has extensive experience in the NFL, first as a team physician for the Pittsburgh Steelers and then head team physician for the Washington Football team. She currently serves on the board of directors of the NFL Physicians Society and NFL Scouting Medical Committee.

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Welcome back to The Sports Docs Podcast with Dr. Catherine Logan and Dr. Ashley Bassett, where we chat about the most recent developments in sports medicine with experts in the field. In episode 8, we’re going to continue our discussion with Dr. Michael Ciccotti and dive deeper into UCL surgery, including surgical techniques and outcomes for both primary and revision UCL reconstruction.

We’ll start with the systematic review and meta-analysis titled Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction. Chang and his colleagues found no significant difference in clinical outcomes and return to sport between the docking or figure-of-8 technique once controlled for surgical approach. It appears that inferior outcomes attributed to the original figure-of-8 technique may be more related to detachment of the flexor pronator mass during the approach and submuscular ulnar nerve transposition.

Then from the November 2020 issue of AJSM, we review the publication Ulnar Collateral Ligament Tear Location May Affect Return-to-Sports Rate but Not Performance Upon Return to Sports After Ulnar Collateral Ligament Reconstruction Surgery in Professional Baseball Players. Dave Altchek and team at HSS reported that professional baseball players who sustained a distal UCL tear were more likely to return to sport after UCL reconstruction compared to players that had a proximal UCL tear.

Lastly, Andrews and his team published a study on Outcomes After Ulnar Collateral Ligament Revision Reconstruction in Baseball Players. The authors found that outcomes after revision UCL reconstruction are not as favorable as those after primary reconstruction, with only half of all baseball players returning to their previous level of play after revision reconstruction.

**We are honored to have Dr. Michael Ciccotti join us for the discussion today. Dr. Ciccotti is an internationally recognized orthopedic surgeon specializing in sports medicine, shoulder, elbow and knee surgery at the Rothman Orthopedic Institute and Thomas Jefferson University, where he is the Chief of the Sports Medicine Division as well as the Director of the Sports Medicine Fellowship Program. Dr. Ciccotti earned his MD from Georgetown Medical School. He completed his orthopedic residency at Thomas Jefferson University and then went on to complete a fellowship in sports medicine at Kerlan Jobe.

Dr. Ciccotti is the current President of the American Orthopedic Society for Sports Medicine. He also serves as the Chairman of the Major League Baseball Medical Advisory Committee and has been the Head Team Physician and Medical Director for the Philadelphia Phillies as well as Saint Joseph’s University athletics for over 25 years. Dr. Ciccotti has received numerous awards and recognitions for his outstanding contributions to sports medicine, including the George D. Rovere Award for Lifetime Contribution to Sports Medicine Education by AOSSM and The Twenty Year Service Award from the Professional Baseball Athletic Trainers Society. He has published hundreds of articles, book chapters and given countless presentations on many topics in sports medicine, with a particular focus on elbow UCL injuries – which is why we are so fortunate to have him joining us for this discussion today.**

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On today’s episode we’re focusing on ulnar collateral ligament injuries of the elbow with Dr. Michael Ciccotti, Chief of Sports Medicine at the Rothman Orthopedic Institute and current president of the American Orthopedic Society for Sports Medicine.

We have some great articles for you today that really contribute well this conversation on how to best manage elbow UCL injuries in throwing athletes. As always, links to all the articles we discuss on this show can be found on our podcast website.

The first paper is March issue of AJSM this year, titled Return-to-Play Outcomes in Professional Baseball Players After Nonoperative Treatment of Incomplete Medial UCL Injuries. Thomas Noonan and his team at the University of Colorado found that professional baseball players with incomplete UCL injuries treated nonoperatively had a high rate of return to play and similar performance metrics compared to players with no history of UCL injury. Then, from the December 2020 issue of OJSM, we review the publication Effect of UCL Reconstruction on Pitch Accuracy, Velocity and Movement in MLB Pitchers. McKnight and colleagues reported that MLB pitchers who underwent UCL reconstruction had decreased fastball accuracy that persisted up to 3 years post-op. Fastball velocity and curveball moment were unchanged.

We are honored to have Dr. Michael Ciccotti join us for the discussion today. Dr. Ciccotti is an internationally recognized orthopedic surgeon specializing in sports medicine, shoulder, elbow and knee surgery at the Rothman Orthopedic Institute and Thomas Jefferson University, where he is the Chief of the Sports Medicine Division as well as the Director of the Sports Medicine Fellowship Program. Dr. Ciccotti earned his MD from Georgetown Medical School. He completed his orthopedic residency at Thomas Jefferson University and then went on to complete a fellowship in sports medicine at Kerlan Jobe. Dr. Ciccotti is the current President of the American Orthopedic Society for Sports Medicine. He also serves as the Chairman of the Major League Baseball Medical Advisory Committee and has been the Head Team Physician and Medical Director for the Philadelphia Phillies as well as Saint Joseph’s University athletics for over 25 years. Dr. Ciccotti has received numerous awards and recognitions for his outstanding contributions to sports medicine, including the George D. Rovere Award for Lifetime Contribution to Sports Medicine Education by AOSSM and The Twenty Year Service Award from the Professional Baseball Athletic Trainers Society. He has published hundreds of articles, book chapters and given countless presentations on many topics in sports medicine, with a particular focus on elbow UCL injuries – which is why we are so fortunate to have him joining us for this discussion today.

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Dr. Matzkin specializes in sports medicine, knee and shoulder surgery. She is an attending surgeon and Chief of Women’s Sports Medicine at Brigham and Women’s Hospital . Dr. Matzkin earned her MD from Tulane Medical School. She completed her orthopedic residency at the University of Hawaii and then went on to complete a fellowship in sports medicine at Duke.

Dr. Matzkin currently serves as a team physician for the U.S. Women’s National Soccer Team, U.S. Paralympics Soccer Team, U.S. Women’s National Hockey Team, and is the head team physician of Stonehill College. She is passionate about the care of female athletes and has dedicated much of her research to focusing on sex differences in musculoskeletal medicine.

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Dr. Matzkin specializes in sports medicine, knee and shoulder surgery. She is an attending surgeon and Chief of Women’s Sports Medicine at Brigham and Women’s Hospital . Dr. Matzkin earned her MD from Tulane Medical School. She completed her orthopedic residency at the University of Hawaii and then went on to complete a fellowship in sports medicine at Duke.

Dr. Matzkin currently serves as a team physician for the U.S. Women’s National Soccer Team, U.S. Paralympics Soccer Team, U.S. Women’s National Hockey Team, and is the head team physician of Stonehill College. She is passionate about the care of female athletes and has dedicated much of her research to focusing on sex differences in musculoskeletal medicine.

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On today’s episode we’re continuing our discussion on shoulder instability with Dr. Mark Price, Orthopaedic Surgeon at Massachusetts General Hospital and Head Team Physician for the New England Patriots. We have 5 great articles which we discuss over two episodes that really contribute well this conversation on how to best manage shoulder instability in athletes both in-season and post-season.

We’re very honored to have Dr. Mark Price join our discussion today. Dr. Price specializes in sports medicine, knee and shoulder surgery. He is an attending surgeon at Massachusetts General Hospital and Assistant Professor of Orthopaedic Surgery at Harvard Medical School. Dr. Price earned his MD from Harvard Medical School and PhD in Medical Physics from MIT. He completed the Harvard Combined Orthopaedic Residency Program, where Catherine and I both attended as well, and then went on to complete a fellowship in sports medicine and shoulder reconstructive surgery at Mass General. Dr. Price is Head Team Physician and Medical Director for the New England Patriots and a Team Physician for the Boston Red Sox. He is a Captain in the US Navy Reserves and has served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal for meritorious service.

(Part II)
We begin with Dr. Hettrich of Brigham and Women’s Hospital who recently investigated the question “Are there racial differences between patients undergoing surgery for shoulder instability?” We’ll dive further into this topic and chat about how this impacts resident and fellow education.

We will follow these articles up with a discussion on the surgical management of shoulder instability by reviewing two articles from the March issue of Arthroscopy. The first is a prospective randomized controlled trial titled Arthroscopic Bankart Repair With and Without Curettage of the Glenoid Edge. Desai and his team concluded that curettage of the glenoid edge reduced the incidence of postoperative recurrence of instability likely relating to improved healing of the capsulolabrum repair. Avramidis and colleagues contributed their cases on the management of recurrent anterior shoulder instability by All-Arthroscopic Modified Eden-Hybinette Procedure Using Iliac Crest Autograft and Double-Pair Button Fixation System.

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On today’s episode we’re focusing on shoulder instability with Dr. Mark Price, Orthopaedic Surgeon at Massachusetts General Hospital and Head Team Physician for the New England Patriots. We have 5 great articles which we discuss over two episodes that really contribute well this conversation on how to best manage shoulder instability in athletes both in-season and post-season.

We’re very honored to have Dr. Mark Price join our discussion today. Dr. Price specializes in sports medicine, knee and shoulder surgery. He is an attending surgeon at Massachusetts General Hospital and Assistant Professor of Orthopaedic Surgery at Harvard Medical School. Dr. Price earned his MD from Harvard Medical School and PhD in Medical Physics from MIT. He completed the Harvard Combined Orthopaedic Residency Program, where Catherine and I both attended as well, and then went on to complete a fellowship in sports medicine and shoulder reconstructive surgery at Mass General. Dr. Price is Head Team Physician and Medical Director for the New England Patriots and a Team Physician for the Boston Red Sox. He is a Captain in the US Navy Reserves and has served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal for meritorious service.

(Part I)
The first paper is from the February issue of AJSM, titled Incidence of Posterior Shoulder Instability in the United States Military. It is a descriptive epidemiology study by Brett Owen and his team which found the incidence is higher than previously reported. Then, from the January issue of Sports Health, we feature the publication Does Functional Bracing of the Unstable Shoulder Improve Return to Play in Scholastic Athletes? Tokish and colleagues found functional bracing did not result in increased success rates when compared to no bracing in adolescent athletes.

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Episode 2 resumes our discussion with Dr. Mulcahey on all things ACL. On this episode, we chat about management of ACL injuries including graft choice, surgical technique and how we approach and rehab ACL revision surgeries. Dr. Mulcahey is an orthopedic sports medicine surgeon at Tulane University where she serves as the director of the Women’s Sports Medicine Program and is a team physician for numerous high school, collegiate and professional sports teams.

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Episode 1 starts off with a quick discussion on COVID-19 and its impact on sports before moving into our main topic of ACL injuries. We’ll chat about some of the COVID protocols that were put in place to ensure the safety of all our athletes during their seasons, as well as optimizing a safe return to sports after recovering from COVID-19 infection. After wrapping up our COVID discussion, we’ll then move on to the fun stuff: ACL injuries! We have three great articles for you that really contribute well the conversation on how to best prevent and manage ACL injuries. We’re excited to have Dr. Mary Mulcahey join us for this discussion. Dr. Mulcahey is an orthopedic sports medicine surgeon at Tulane University where she serves as the director of the Women’s Sports Medicine Program and is a team physician for numerous high school, collegiate and professional sports teams.

The Sports Docs Podcast: Recent Episodes

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