Advertise on podcast: The OJSM Hot Corner

Sleep disruption is a hallmark symptom of rotator cuff pathology. Poor sleep can result in profound detriment to one's health and wellbeing. One of the greatest rewards of rotator cuff surgery is the ability to correct this. However, recovery from rotator cuff repair surgery can be long, upwards of 6+ months, with each individual's recovery pathway unique to him/herself. So when should a patient expect, on average, to see improvement in sleep after shoulder surgery? Drs. Mohammad Daher, MD and Joseph Abboud, MD from the famed Rothman Institute in Philadelphia, PA join us to share their findings on this topic.

Does cannabis use have any effect, good or bad, on Orthopaedic Surgery? It's a question we, as a Sports Medicine community, hear increasingly frequently from our patients but so far don't have great data to provide sound advice. We welcome Dr. Grant Hogue who has studied this extensively across several disciplines of Orthopaedic Surgery. He presents his work with his colleagues at Boston Children's Hospital looking specifically at adverse effects of marijuana use on ACL reconstruction recovery.

Whether to close the capsule at the conclusion of hip arthroscopy remains a matter of great debate.  Prior data has been mixed. Dr. Bjarne Mygind-Klavsen from Aarhus University Hospital in Denmark joints us to discuss the results of his team's randomized controlled study comparing interportal capsulotomy closure versus no closure at 1 year following hip arthroscopy.

Tommy John is a name associated with the game of baseball not just because of the pitcher's Hall of Fame career, but because it has become synonymous with a devastating injury to the Ulnar Collateral Ligament of the elbow that continues to plague baseball pitchers often resulting in reconstructive surgery colloquially known as the Tommy John Surgery. Multiple risk factors have been postulated to put the UCL at risk of rupture including increased velocity, torque across the elbow, baseline stiffness in the shoulder and/or elbow, pitch volume, and pitch type. Well known for their extensive work in baseball science, Dr. Glenn Fleisig, PhD from the famed American Sports Medicine Institute in Birmingham, AL and Dr. Peter Chalmers, MD from the University of Utah in Salt Lake City join us to discuss their study that looks at these risk factors in professional baseball pitchers.    

Multimodal analgesia refers to a pain medication strategy that targets multiple chemical pathways to achieve adequate pain relief. This concept has grown in popularity over the years particularly in light of the recognition that opioids have major downsides including dependence. We welcome Dr. J. Preston Van Buren, DO from the Naval Medical Center in San Diego to discuss his team's findings after implementing a focused multimodal analgesia strategy with a reduced number of prescribed opioid tablets following Sports Medicine surgery compared to a more traditional, opioid-heavy regimen that has been classically employed. 

Meniscus tears can be confusing. They can occur with trauma or not, they come in a variety of shapes and locations which can influence treatment options and outcomes profoundly, and the right treatment remains a matter of great debate. The literature is likewise confusing, and historically has been heterogeneous. Dr. Benjamin MA, MD, PhD from the famed UCSF joins us to discuss an international multi-society expert panel he took part in to generate consensus statements regarding meniscus tear treatment. The consensus statements give all of us in the Sports Medicine world some guidance and reassurance for our approach to this seemingly simple structure, the meniscus, that, when torn, is full of complexities. 

Once the most popular graft choice for ACL reconstruction surgery, hamstring autograft has recently fallen out of favor for a variety of concerns including a higher graft rupture rate in younger athletes and concerns over graft diameters that tend to run smaller. However, what does the best level evidence actually say about hamstring autograft's long-term performance versus the current gold-standard, patellar tendon autograft? Dr. Derrick Knapick, MD joins us from Washington University School of Medicine in St. Louis to discuss his study looking at this question.    

ACL surgery has come a long way since the early days of acute open repair to modern-day ACL reconstruction. Still, in spite of our advancements in knowledge, technique, and technology, graft rupture as well as contralateral ACL injury remain a concern for patients and their Sports Medicine providers. Well-renowned for her body of work in ACL research, Dr. Kate Webster, PhD from La Trobe University joins us to discuss her team's recent study on the long-term survival of ACL autografts and contralateral ACL ruptures over a 10-year follow up period. These ACL re-injury rates illustrate that, while we have made great strides over the decades, there is still room for improvement.

Hamstring autograft has been a widely used graft option for ACL reconstruction surgery for years. Data over the last decade, however, has called into question its performance versus other autograft options particularly when it comes to the rate of re-tear. One potential reason for a higher rate of re-tear may be that hamstring grafts tend to be smaller in diameter compared to patellar tendon autografts, for example. Historically, a hamstring graft diameter of 8 mm has been considered a critical value that could determine long-term success versus failure, however an exact graft diameter has not been identified. Dr. Raffy Mirzayan, MD from Kaiser Permanente Baldwin Park joins us to discuss his study aiming to find that threshold diameter for hamstring autograft. We discuss how the fear of a smaller diameter graft may influence surgeons to look at other options such as quadriceps tendon autograft. 

Chronic tendinopathies whether it be at the shoulder, elbow, knee, or ankle continue to perplex the Sports Medicine community. These nagging conditions have no easy fix to them which can be frustrating for both the patient and treatment team. Data in most cases does not support surgery as the answer. Thus, we continue to search for non-surgical treatments that can solve tendinopathies as quickly and effectively as possible. Unfortunately, the best answer for these conditions remains elusive. Coming to us from Stony Brook University Hospital, Drs. Salvatore Capotosto, MD & Alireza Nazemi, MD, MS present their findings on Prolotherapy, a promising option in the treatment of chronic tendinopathies.

The evolution of all-inside meniscal repair technology has given sports medicine surgeons an efficient, less invasive, yet more costly option to address meniscus tears. How does it compare in the long-run against the classic inside-out technique? Dr. Aaron Krych, MD and his team at Mayo Clinic examine this question specifically for bucket-handle tears, a situation that can typically be addressed with either an all-inside or an inside-out approach. He joins us to discuss the results of their study and if there is an advantage of one technique over the other.

Meniscus tears have historically been treated with arthroscopy. However, compelling data has shown that this surgery does not work for degenerative meniscus tears. Physical therapy, conversely, has been shown to be a more effective measure for the degenerative meniscus tear, and is a more reasonable first-line measure compared to arthroscopic menisectomy. Still, the public's perception, guided by decades of advice from Sports Medicine Specialists that arthroscopy is the answer for all meniscus tears regardless of the chondral condition in the knee, has not changed with current evidence. This can create uncomfortable conversations with patients who have a degenerative meniscus tear and expect arthroscopy. Coming to us from the University of Buffalo, Drs. Nomi Weiss-Laxer and Leslie Bisson discuss their study examining patient perceptions and expectations of nonoperative treatment for degenerative meniscus tears.

The Medial Meniscus is a known secondary stabilizer to the ACL in terms of anterior tibial translation in the knee. So what happens after ACL reconstruction if the medial meniscus is deficient? Dr. Andrew Fithian, MD joins us to discuss his study addressing this very question. Coming to us from Kaiser Permanente San Diego, Dr. Fithian and his team investigated postoperative anterior tibial translation in autograft ACL patients with an intact medial meniscus, a repaired medial meniscus, or a partially resected medial meniscus. The results may guide decision making when facing a situation with an irreparable medial meniscus tear in the setting of an ACL tear, particularly with graft choice.

As another exciting NFL season kicks off, Sports Medicine community members and fans alike continue to ponder whether the risk of lower extremity injury is higher on artificial turf versus grass. We welcome UCSF's Chief of Sports Medicine & Shoulder Surgery and host of the podcast 6-8 Weeks: Perspectives on Sports Medicine, Dr. Brian Feeley, MD to discuss his team's recent publication in OJSM examining this very question. 

Historically, ACL repair resulted in poor outcomes and this procedure fell out of favor while ACL reconstruction became the gold-standard surgical approach for a torn ACL. Recently, thanks in part to the advent of more modern techniques, ACL repair has regained interest in the Sports Medicine community as a potentially viable option in certain situations that may provide advantages in comparison to ACL reconstruction. To this point, the literature comparing these two surgeries with modern techniques has been heterogenous in terms of quality and design, and results have been mixed. Drs. Kyle Kunze, MD and Benedict Nwachukwu, MD, MBA and their team from Hospital of Special Surgery (HSS) bring us this systematic review and meta-analysis to cull the best literature available. Their findings indicate that, while ACL repair may have an evolving role in our toolbox, its failure rate remains higher than that of ACL reconstruction and thus should be approached with caution.