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

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

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

Key Discussion Points

Understanding ACL Injuries in Soccer

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

ACL Reconstruction Graft Options

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

Modern Return-to-Play Decision Making

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

Study Review: Secondary Muscle Injuries After ACL Reconstruction

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

Key findings included:

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

Most Common Secondary Injuries

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

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

The Highest-Risk Window

One of the most important findings:

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

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

The Importance of the 9-Month Rule

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

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

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

Performance and Career Impact

Players who sustained secondary muscle injuries experienced:

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

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

Strengths and Limitations of the Study

Strengths

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

Limitations

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

Clinical Takeaways

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

Article Discussed

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

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

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Our Hosts:

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

www.cloganmd.com

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

🎧 Episode Summary

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

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

Highlights

Platelet-Rich Plasma (PRP) for Plantar Fasciitis

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

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

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

PRP vs Corticosteroid Injections

Corticosteroid Injections

Advantages:

• Rapid short-term pain relief
• Widely available
• Low cost

Limitations:

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

PRP

Advantages:

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

Challenges:

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

The Role of Biologics

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

Important considerations include:

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

When Is Surgery Appropriate?

Fortunately, most patients improve without surgery.

Surgical intervention may be considered when:

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

Before surgery, patients should typically complete:

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

Nano-Arthroscopic Plantar Fascia Release

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

Potential advantages include:

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

Surgical Pearls

When performing plantar fascia release:

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

Key Takeaways

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

Featured Guest

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

🎤 Stay Connected

🎧 Listen & Subscribe

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

Follow us on Instagram

Our Hosts:

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

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

Live from the Arthrex Team Physician Controversies Conference

🎧 Episode Summary

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

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

Diagnostic Imaging - MRI is critical for:

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

Surgical Decision-Making

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

Autocart (Autologous Minced Cartilage)

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

•  Preserves native chondrocytes & extracellular matrix 
•  Avoids staged procedures 

Ideal for small-to-medium contained lesions

Outcomes:

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

BioCartilage

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

Best for:

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

Outcomes:

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

Cartiform

Cryopreserved osteochondral allograft with viable chondrocytes
 Maintains native cartilage architecture

Indicated for:

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

Advantages:

•  Single-stage procedure 
•  Conforms to irregular defects 

Key Takeaways

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

Featured Guest

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

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

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

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

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

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

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

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

Our next poster is titled Arthroscopic Rotator Cuff Repair with Bioinductive Patch Achieves Equivalent Patient-Reported Outcomes At 1 Year and was performed by Dr. Stephanie Muh and team at Wayne State University and Henry Ford Medical Center.
 
The purpose of this study was to compare patient-reported outcomes, range of motion and complications of patients undergoing arthroscopic rotator cuff repair augmented with a bovine bioinductive patch compared to standard repair.

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

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

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

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

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

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

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

Modern Surgical Management of Elbow UCL Tears

Live from the Arthrex Team Physician Controversies  

🎧 Episode Summary

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

Highlights

Changing UCL Injury Landscape

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

Nonoperative Management & Role of PRP

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

Indications for Surgery

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

UCL Repair with Internal Brace

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

UCL Reconstruction (Tommy John Surgery)

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

Internal Brace Technology

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

Key Takeaways

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

Featured Guests

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Happy New Year from The Sports Docs Podcast! 🎆

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

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

Happy New Year from The Sports Docs Podcast! 🎆

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

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

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

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

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

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

thesportsdocspod@gmail.com

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

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

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

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

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

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

Live from the 10th Annual Arthrex Team Physician Controversies Conference 

🎧 Episode Overview

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

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

What You’ll Learn

1. The Evolution of Nano Arthroscopy

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

2. Seeing What Imaging Can Miss

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

3. The Power of Panoramic Visualization (Panoscope)

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

4. Workflow & Efficiency in the OR

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

5. Adoption & Learning Curve

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

Featured Guest

Dr. James Voos

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 Links to discussed papers:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So, let's dive in!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In this episode, we discuss:
What are the benefits of using biceps autograft SMASH rather than many of the other scaffold options that are available, such as acellular dermal allograft, xenografts or other autograft tissue?

How is the biceps graft harvested, prepared and then secured to the rotator cuff repair? (Check out our Instagram - @thesportsdocspod - for images of the graft preparation.)

Which patients are ideal candidates for the InSpace subacromial balloon spacer? Should we be adding the balloon to rotator cuff repairs to protect the repair construct?

What are some pearls and pitfalls to optimize InSpace placement and avoid complications?

How do patients do after the InSpace procedure? How are the clinical outcomes compared to other treatments for MIRCTs?

Welcome to another episode of Game Plan! 

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

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

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

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

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

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

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

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

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

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

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

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

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

In this episode, we discuss:
What are genetically modified bone marrow derived stem cells? What have studies shown as it pertains to augmenting cuff repair?

Why use fully differentiated endothelial cells rather than pluripotent stem cells derived from bone marrow? What is so special about this cell population?

What were the main findings of the study investigating the use of genetically modified Human Umbilical Vein Endothelial Cells (HUVEC) to augment repair of full thickness rotator cuff tears?

Method of delivering stems cells to the area of pathology (and keeping them there!) is important. What are some tips/ tricks to ensure the cells stay put at the cuff repair?

Stem cells were injected around the tendon but also into the muscle itself - why? 

Is there any change in the rehab protocol after stem cell use? Any period of activity shut down when used in the non-op setting?

What other orthopaedic conditions would benefit from application of this genetically modified cell-based therapy?

There has been a growing movement to “Save the Meniscus”, which of course is ideal – but not always possible. Our discussion today will focus on surgical options to address meniscus deficiency when repair is not an option including meniscus allograft transplantation (MAT) and meniscus replacement (NUsurface).

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

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

In this episode, we discuss:
What patients are ideal candidates for meniscus allograft transplantation (MAT)?

What are the different meniscus allograft preservation techniques and which option is the best?

What role do biologics play in MAT? Can injecting the meniscus allograft with mesenchymal stem cells limit early graft degradation and shrinkage? 

What are the different surgical techniques for MAT? What are some tips to ensure anatomic reduction and minimize graft extrusion? (Check out our Instagram - @thesportsdocspod - to see surgical images of a lateral MAT using the bone plug technique.)

What is the NuSurface meniscus replacement prosthesis? What are the indications to use this device rather than MAT?

How do patients do after meniscus replacement? 

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

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

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

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

Over the years, there has been increasing focus on players’ health and safety in the NFL. Today, we are diving into that; specifically talking about the evolution of technology to reduce the risk of injury and optimize performance.

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

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

In this episode, we discuss:
The use of wearable trackers, including Radio Frequency Identification (RFID) tags to collect player data including position, speed and acceleration in real time.

Rule changes that have been made based on this data collected to eliminate potentially dangerous plays and reduce the risk of injury (i.e. the kick-off rule).

The process of helmet testing in the NFL. How is the NFL supporting the development of better-performing protective gear, including helmets?

The use of the “BEAST” system to biomechanically evaluate the interaction between players’ cleats and the playing field to ensure safe shoe wear. 

How does this data and advancing technology translate to improved safety for our high school and college athletes?

Today, we’re talking about Bridge-Enhanced ACL Repair or “BEAR”. The BEAR technique is a surgical alternative to ACL reconstruction, in which suture repair is combined with a specific extracellular matrix scaffold – termed the BEAR scaffold – which is placed in the space between the two torn ends of the ACL and activated with the patient’s blood. Our discussion today will focus on indications for use of the BEAR implant, the surgical technique, post-op recovery and clinical outcomes thus far.

We are joined today by Dr. Shawn Anthony, Associate Chief of Sports Medicine for the Mount Sinai Health System and Assistant Professor of Orthopedic Surgery at the renowned Icahn School of Medicine at Mount Sinai. Dr. Anthony is a orthopedic consultant for the US Tennis Association and provides side-line medical coverage at the US Open Tennis Championship each year. He has published extensively on the management of ACL injuries, so we’re excited to have him join for our discussion today on the Bridge-Enhanced ACL Repair or “BEAR” technique.

In this episode, we discuss:
The clinical benefits of repairing the native ACL rather than reconstructing it with a graft.

The science behind the BEAR scaffold. How does it work?

The indications to proceed with a BEAR ACL repair. Type of tear / age of patient / time from surgery?

The surgical technique as well as tips and tricks to make the procedure go smoothly.

The postoperative recovery. How does rehabilitation differ from that of a traditional ACL reconstruction?

The clinical outcomes of the BEAR thus far. How does it stack up to ACL reconstruction in different types of patients?

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

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

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