Explore every episode of the podcast The Sports Docs Podcast

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!

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!

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.

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. 

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. 

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.

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.

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.

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.

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.

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.

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.

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. 

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?

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.

We are joined today by two special guests. The first is Dr. Giselle Aerni. Dr. Aerni is nonoperative sports medicine physician and founder of Madam Athlete, a organization that is devoted to helping women thrive in careers in sports and athletics. Dr. Aerni received her medical degree from The University of Pittsburgh and completed her family medicine residency at UPMC. She then went on to complete a sports medicine fellowship at UConn, where she remained as the primary care sports medicine fellowship director and team physician for many years. Through her career, she has covered everything from the WNBA to NCAA DI and DIII national championship-winning teams, minor league baseball, high-school sports, marathons, and more. Dr. Aerni has published and presented research at the national level and was part of the writing team behind AMSSM’s position statement on mental health in athletes. In May of 2020 she created Madam Athlete as a space where women in sports and athletics can share their accomplishments, advice, and challenges. Dr. Aerni hosts the Madam Athlete podcast where she shares inspiring stories of professional women in the field of sports medicine and athletics. You should definitely check it out!

Our second guest is Dr. Mary Mulcahey. Dr. Mulcahey was actually our first guest on The Sports Docs Podcast way back in March of 2021. We’re very excited to have her back with us today. Dr. Mulcahey received her Bachelor of Arts in Biochemistry from Dartmouth College and her MD from the University of Rochester School of Medicine. She completed her orthopaedic residency at Brown University, followed by a fellowship in Orthopaedic Trauma at the same institution. Dr. Mulcahey then went on to do a fellowship in sports medicine at San Diego Ar

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.

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. 

On today’s episode, we’re going to chat about the treatment of distal biceps tendon ruptures. We’ve seen this injury across many sports and in some 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 sports and return to work 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. 

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.

We’re going to continue our discussion with Dr. Clayton Nuelle and focus on an overall treatment algorithm to approach different types of cartilage lesions and select the optimal surgical treatment for various cases.

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.

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 level I and II studies investigating osteochondral transplant techniques. 

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. 

We are joined today by Dr. Clayton Nuelle, a board-certified fellowship-trained orthopedic sports medicine surgeon and Assistant Clinical Professor at the University of Missouri. Dr. Nuelle obtained his medical degree from Loyola University and completed his orthopedic residency at the University of Missouri, where he received numerous awards. He then stayed at the University of Missouri to complete a fellowship in sports medicine. Dr. Nuelle is very active in research and has authored numerous peer reviewed publications, journal articles and textbook chapters. He is an Associate Editor for the Arthroscopy Journal and is a member of multiple Orthopaedic society committees and boards.

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.

We’re going to continue our discussion with Dr. Melissa Christino and dive deeper into the mental side of athletes recovering from ACL injury.

First up is Dr. Hewett’s study Factors Associated With Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery, published in AJSM in 2018. The authors conducted a level 3 cross-sectional study to identify factors that contribute to an athlete’s psychological readiness to return to sport after ACLR. A cohort of 635 athletes who underwent ACLR and had been cleared to RTS completed the Anterior Cruciate Ligament–Return to Sport After Injury scale at an average 12 months after surgery. Demographics (age, sex), sporting outcomes (preinjury frequency), surgical timing, clinical factors, such as laxity, functional measures (such as single-limb hop symmetry), and symptoms of pain and function were also taken.

Univariate analysis for the entire group showed that the following had a positive effect on psychological readiness: male sex, younger age, a shorter interval between injury and surgery, a higher frequency of preinjury sport participation, greater limb symmetry and higher subjective knee scores. In the multivariate model, subjective knee scores and age significantly accounted for 37% of the variance in psychological readiness. The only difference between the groups who had and had not returned to sport was that female sex was a significant contributor for the nonreturn group.

Next up is an additional Hewett and team study. This one is tilted Psychological Readiness to Return to Sport Is Associated With Second Anterior Cruciate Ligament Injuries, published in 2019 in AJSM. The authors set out to determine whether psychological readiness to return to sport is associated with second ACL injury. Patients who had a primary ACLR procedure completed the ACL–Return to Sport after Injury scale before their ACLR and repeated the scale at 12 months after surgery to assess psychological readiness to return to sport. In 329 patients who returned to sport after ACLR, 52 (16%) sustained a second ACL injury. No difference in psychological readiness was observed at the preoperative time point, but patients who sustained a second injury trended toward lower psychological readiness at 12 months compared with noninjured patients. Younger patients with lower psychological readiness are at higher risk for a second ACL injury after return to sport.

We are are particularly excited to also include an article hot off the OJSM press. The senior author is our guest this evening, Dr. Melissa Christino. The study, Psychological Readiness to Return to Sport at 6 Months Is Higher After Bridge-Enhanced ACL Restoration Than Autograft ACL Reconstruction, hypothesized that patients who underwent bridge-enhanced ACL restoration (BEAR) would have higher levels of psychological readiness to return to sport compared with patients who underwent ACLR. It is a level 1 study, randomized controlled trial.

A total of 100 patients with complete midsubstance ACL injuries were randomized to either the BEAR procedure or autograft ACLR and underwent surgery within 45 days of injury. Objective, functional, and patient-reported outcomes, including the ACL--Return to Sport after Injury (ACL-RSI) scale, were assessed at 6, 12, and 24 months postoperatively. The authors found that patients who underwent the BEAR procedure had significantly higher ACL-RSI scores at 6 months compared with those who underwent ACLR (71.1 vs 58.2; P = .008); scores were similar at 12 and 24 months. Baseline factors independently predictive of higher ACL-RSI scores at 6 months were having a BEAR procedure and participating in level 1 sports prior to injury.

Regression analysis of baseline and 6-month outcomes as predictors indicated that the International Knee Documentation Committee (IKDC) score at 6 months explained 45% of the 6-mo

On today’s episode we’re focusing the mental side of the injured athlete: what factors influence the psychological aspects of return to play, what criteria are used to determine readiness and how this all differs between sports, injury types and gender.

We’re joined today by Dr. Melissa Christino! Dr. Christino is a board-certified orthopaedic surgeon who is dual-fellowship trained in orthopaedic trauma and sports medicine. Dr. Christino has a long history of involvement with athletics. She is a Hall of Fame Athlete at Hingham High School as well as a Division 1 athlete and coach for the Harvard University Women’s Lacrosse team. Following her medical training, Dr. Christino has provided medical care to athletes from the youth to professional levels and enjoys working with athletes of all ages.

We have some great articles for you today that contribute well to our conversation on returning to sport after musculoskeletal injury.  The first paper is a review article authored by today’s guest entitled The Mental Side of the Injured Athlete, published in the June 2021 issue of JAAOS. This article details the circumstances athletes are often faced with, such as injury in sport, that make them susceptible to psychological challenges unique to the athletic population. The authors note that these circumstances can be a source of notable distress and may precipitate the emergence of new psychological disorders or exacerbate underlying psychological disorders that are already present. The aim of this review was to highlight the impact of psychological factors on measurable outcomes after orthopedic surgery and to explore interventions that can be implemented to improve surgical outcomes and the overall care of injured athletes.

The next article we will discuss is titled Mental Health Services in NCAA Division I Athletics: A Survey of Head ATCs published in Athletic Training. This observational study surveyed 127 head athletic trainers at Division I NCAA colleges. Questions assessed several aspects of mental health clinicians, perception of care coordination, and screening. 72% of respondents noted that counseling took place in a counseling center while 20% indicated that they had a mental health provider who worked in the athletic training room. Mental health clinician credentials varied widely and included marriage and family therapists, psychologists, clinical social workers, and psychiatrists. Fewer than half of the ATCs surveyed indicated that they use screening instruments to assess for mental health disorders.

Finally, for Part I of this episode, we will discuss the AJSM article Sports-Specialized Intensive Training and the Risk of Injury in Young Athletes published by Dugas and colleagues. The authors set out to determine whether sports specialization, weekly training volumes, and growth rates are associated with increased risk for acute injury and serious overuse injury in young athletes. This level 3 case control study assessed injured athletes aged 7 to18 years old from 2 hospital-based sports medicine clinics and compared with healthy controls from affiliated primary care clinics undergoing sports physicals. The authors found that injured athletes were older than uninjured athletes and reported more total hours of physical activity and more organized sports activity. Sports specialized training, defined as engaging in intensive training and/or competition in a sport for at least 8 months per year at the exclusion of other sports, was an independent risk for injury and serious overuse injury. The authors also found that growth rate was not related to injury risk.

We are honored to have Dr. Christino join us for the discussion today. Dr. Christino is a pediatric othopaedic surgeon at Boston Children’s Hospital and is very involved with clinical research and national orthopedic organizations. She currently serves as a member of the ACL Performance

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.

The Sports Docs Podcast Year in Review.

Hear all the highlights from the first season of the Sports Docs Podcast!

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.

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.

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.  The first article is retrospective cohort study published this past 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 “A 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. 

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.

We’re going to continue our discussion with Dr. Jo Hannafin and focus on building teams within clinical research as well as within the OR.

We start off this episode with an article from the April 2021 edition of General Orthopaedics entitled Orthopaedic Clinical Research: Building a Team that Lasts by Laura Stiegel and her team. The authors discuss the importance of having a diverse team, paying attention to time management and flexibility, as well as the need to establish a culture that promotes team member longevity and commitment to productivity. Dr. Hannafin was the first Clinician-Scientist at the Hospital for Special Surgery and maintained an active research program in the area of ligament physiology for over 20 years. We are grateful to hear her perspective on building programs with sustainability. 

Finally, we dive into the topic of surgical teams. The Annals of Thoracic Surgery published the article Effective Leadership of Surgical Teams: A Mixed Methods Study of Surgeon Behaviors and Functions. Dr. Sara Singer, of the Harvard School of Public Health, and her colleagues observed, surveyed, and interviewed cardiac surgical teams including 7 surgeons and 116 team members. Among survey responses, surgical staff evaluated the performance of surgeons as team leaders as 5.4 of 7, ranging from 4.2 for the lowest rated surgeon to 6.2 for the highest rated surgeon. The authors provide concrete behavioral strategies that surgeons can use to improve team performance, in particular increasing engagement of team members in perioperative tasks.

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 is 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 on how to build high functioning teams in the field of sports medicine.. The first article hails from the Harvard Business Review and is titled, The Kinds of Teams Health Care Needs by Amy Edmondson. Ms Edmondson, a professor of Leadership and Management at HBS, opens this article by 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.

Our second article is from MIT Sloan Management Review, entitled Establishing High-Performance Teams: Lessons from Health Care. The authors pondered the question: 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.

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

We’re going to continue our discussion with Dr. Edward Chang and focus on the use of blood flow restriction therapy for both upper and lower extremity conditions.

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. 

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.

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. 

Hi everyone. Before we kick off our episode today, we must start with some sad news. The orthopedic community suffered a tremendous loss this past Friday with the passing of Dr. Freddie Fu. Dr. Fu was a giant in the field of sports medicine and touched the lives of countless patients and athletes around the world. He mentored generations of orthopedic surgeons, many of whom went on to also become leaders in the field of sports medicine and carry his legacy onward. Thank you, Dr. Fu. You will be profoundly missed.

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.

We’re joined today by Dr. Edward Chang, orthopedic surgeon and director of research at Inova Sports Medicine. Dr. Chang recently won the O’Donoghue Sports Injury research award for his work on the use of BFR after ACL reconstruction, so we are very excited to have him join our discussion today.

We have some great articles for you today that contribute well to our conversation on the use of blood flow restriction therapy for both routine training and after musculoskeletal injury or surgery. 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 recently published by Mary Mulcahey and colleagues in the June issue of AJSM this year, titled Blood Flow Restriction Training in Athletes. This paper analyzed the effects of BFR training compared to traditional resistance training in healthy athletes. 78% of the included studies reported a significant increase in muscle strength after BFR compared to traditional training. 3 of the 4 studies that evaluated sports specific performance reported significant improvement across various running, jumping, endurance and agility tests compared to controls. The effect of BFR on muscle mass, however, was less clear. Of the 8 studies, 50% found a significant increase in muscle size while 50% reported no difference between the groups. 

Though there was no difference found in 50% of those studies, an argument can be made that achieving equivalent muscle mass at lower loads is still a win. Another take-away from this paper was the incredible variability across the BFR protocols that were used in these studies. They varied widely in terms of duration of training, frequency of sessions, intensity of exercise, number of repetitions performed, length of occlusion and rest periods, body part and cuff pressure measurements, with some studies simply using an elastic band applied to perceived resistance, known as “practical BFR”. Moving forward, future studies should aim to clarify the optimal BFR protocol for different body parts and different patient populations. The BFR protocol for someone who is training is likely to be different than the protocol for an athlete recovering from injury.

Our second article is a laboratory study from

We’re going to continue our discussion with Dr. Robin West and dive deeper into return to play decision making, including criteria for clearance and novel treatments to expedite return.

We’ll start our discussion today with the systematic review and meta-analysis titled Return-to-Competition Criteria After Ulnar Collateral Ligament Reconstruction from the June issue of AJSM this year. Chris Ahmad and his team at Columbia University found that there is minimal literature describing the return to play process after UCL reconstruction. There are currently no validated or universally accepted guidelines for determining when an athlete is safe to return to play. The authors found only three specific criteria across all studies. Completion of a return to throwing program was the most frequently used criterion, followed by time from surgery and lastly completion of a return to mound program for pitchers. Nine months from surgery was the most common time point used. No study mentioned return to play criteria relating to pain, motion, strength, endurance, balance, coordination or fear of reinjury.

Then, from the April 2020 issue of OJSM, we wrap up with the publication Platelet-Rich Plasma Shortens Return to Play in NFL Players With Acute Hamstring Injuries. A quick overview of PRP for our listeners. PRP is a concentrated source of platelets and growth factors, prepared by centrifuging the patient’s whole blood. PRP can be leukocyte rich or leukocyte poor, referring to the concentration of white blood cells. Selection of PRP type depends on the pathology being treated, with leukocyte rich PRP thought to be beneficial for conditions like arthritis and leukocyte poor PRP being more advantageous for acute muscle injuries. 

Jim Bradley and colleagues at UPMC reported that leukocyte poor PRP injections allowed for faster return to play in athletes with grade 2 hamstring injuries, with a 1 game overall difference. There was no difference in total days missed or time to return to practice. The authors recommend using PRP with a low platelet count and low leukocyte count, as PRP preparations rich in platelets and leukocytes may lead to increased local reaction and subsequent scarring, increasing the risk of reinjury. 

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.  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. 

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.

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

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 from the 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!

On today’s episode, we’re going to continue our discussion with Dr. Elizabeth Matzkin and dive deeper into the surgical management of meniscus tears, specifically focusing on bucket handle meniscus tears and post-surgical rehab.

We’ll start with the article by Aaron Krych and his team at the Mayo Clinic titled Comparative Outcomes of All-Inside Versus Inside-Out Repair of Bucket Handle Meniscal Tears in OJSM. This study found no significant difference in clinical outcomes, retear rate and complications between the two repair techniques. Interestingly, increased age trended towards decreased repair failure rate, attributed to less demand placed on the repair compared to younger patients.

We follow that up with a more recent paper from the December 2020 issue of Arthroscopy, investigating The Biomechanical Performance of the Latest All-Inside Meniscal Repair Devices. This lab study found that hand-tied Orthocord suture repair was the strongest repair construct compared to newer all-inside devices including the AIR, FasT-Fix, and Meniscal Cinch.

We then finished up with a discussion on post-op rehab after meniscus repair with the systematic review article titled Weightbearing versus Nonweightbearing After Meniscus Repair from Sports Health.

On today’s episode we’re focusing on meniscus tears with Dr. Elizabeth Matzkin, Orthopedic Surgeon at Brigham and Women’s Hospital and Chief of Women’s Sports Medicine. We have some great articles for you today that really contribute well this conversation on how to best manage various types of meniscus tears across different age groups.

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.

The first paper is from the April issue of AJSM, titled Long-term National Trends of Arthroscopic Meniscal Repair and Debridement. It is a descriptive epidemiology study specifically looking at ABOS case collections. For our listeners that may not know what that means, orthopedic surgeons in their first year of practice are required to prospectively record their cases over a 6 month period and submit those to the American Board of Orthopedic Surgery for evaluation. So, this data is thought to be a good surrogate for the current state of orthopedic education, and can highlight the newest shifts in treatment. Wasserburger et al found that, over the past 10 years, the rate of meniscus debridement has steadily decreased while the rate of meniscus repair has increased. Younger patient age and treatment by a sports medicine surgeon were associated with a higher likelihood of repair.

We then focus specifically on meniscus root tears and review the publication Outcomes of Arthroscopic All-Inside Repair Versus Observation in Older Patients with Meniscus Root Tears from the April 2020 issue of AJSM. Dragoo and colleagues at Stanford described their technique for all-inside meniscus root repair using a side-to-side reduction suture between the posterior horn and remaining posterior root tissue, followed by a mattress suture to tether the meniscus to the posterior capsule, thereby reinforcing the repair. The authors showed improved functional outcomes and decreased rate of total knee replacement compared to non-op treatment of root tears in patients with moderate arthritis.

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. 

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. 

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.

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.

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.

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.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.

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.

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!