The Sports Docs Podcast

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.** 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.

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/

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?"

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?”

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!

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!

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.

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.

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.

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

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.

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.

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.comWe'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.

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?  

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.”

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.

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.

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.

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.” 

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.”

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 fibroblastsInjectable Therapeutic Peptides-An Adjunct to Regenerative Medicine and Sports Performance?The role of vitamin D in shoulder health: a comprehensivereview of its impact on rotator cuff tears and surgical results

Happy New Year from The Sports Docs Podcast!

Happy New Year from The Sports Docs Podcast!

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.

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.comWe'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.

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. 

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. 

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.

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

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?

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. 

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.

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.--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. 

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.--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.

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.

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!

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.pdfhttps://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/bmac-augmentation-may-produce-structurally-superior-rotator-cuff-repair-2023.pdfhttps://pubmed.ncbi.nlm.nih.gov/32169466/CuffMend: https://www.arthrex.com/shoulder/cuffmend-augmentation-system

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!

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!

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!

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!

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!

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!

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!

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!

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.

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.comWe 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.

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!

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.

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!

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.