The Sports Docs Podcast

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 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?

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!

Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and I chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data ranging from operative indications, surgical approaches, post-op protocols and most importantly – patient outcomes.Today we’re talking about SLAP tears – tears of the superior labrum from anterior to posterior. We have two great articles for you today that focus on the surgical management of SLAP tears – specifically whether we should be repairing SLAP tears or proceeding directly to biceps tenodesis. We will also discuss the different types of biceps tenodesis procedures – mainly arthroscopic suprapectoral versus open subpectoral.Our first paper looks specifically at this patient population – young overhead athletes – and investigates the functional and athletic outcomes after primary subpectoral biceps tenodesis for type II SLAP tears. Brian Waterman and Tony Romeo published a case series in the January 2023 issue of Arthroscopy titled “High Rate of Return to Sporting Activity Among Overhead Athletes with Subpectoral Biceps Tenodesis for Type II SLAP Tear”. The authors reported that 81% of patients returned to their previous level of play at an average of 4 months post-op. There were also significant improvements in VAS and SANE scores post-op.But how do repairs do in this population? The answer is… not great. Return to preinjury level of play after SLAP repair has been reported in the range of 54% to 63% of elite throwers. In one cohort study by Boileau, 60% of patients reported persistent shoulder pain after SLAP repair and 50% elected to undergo secondary surgery. Provencher published on his outcomes of SLAP repair in an active military population and reported a 37% failure rate and 28% revision rate at short to mid-term follow up.Our second article focuses on this and is titled “No Difference in Clinical Outcomes for Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis at Midterm Follow-up.” Nikhil Verma – who will be joining us at AOSSM – and colleagues at Rush compared arthroscopic suprapectoral tenodesis versus open subpectoral tenodesis for long head of biceps tendon disease, so not SLAP tears. They reported no significant differences in patient reported outcomes or complications at any time point.

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.