Could platelet poor plasma be the missing link in muscle injury recovery? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Ryan Kruse, a sports medicine physician at the University of Iowa and team physician for the Iowa Hawkeyes and US Soccer, to explain what platelet poor plasma actually contains and why it has become his primary treatment for acute muscle injury.

They discuss how PPP differs from PRP, the challenges of defining the optimal dose, and the growing interest in exploring the bioactive components that make PPP worth keeping.

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Timestamps

00:00 - Introduction
05:01 - Defining Platelet Poor Plasma
11:22 - Volume, Dosing, and Fibrosis vs Regeneration
19:00 - Choosing PPP by Injury Grade and Treating Chronic Scar
25:30 - Blood Draw Volume, Kit Selection and Spin Speed
32:12 - Filters and Protein Concentrate
38:19 - Building a PRP Lab and Concentration Questions
43:26 - Keeping PRP Away from Muscle Injury
53:05 - Ultrasound and Return-to-Play
58:46 - Recovery Timelines and Recurrence
01:06:18 - The Evidence Gap in Orthobiologics
01:11:37 - Osteoarthritis, Intra-Articular Use and Replacing Cortisone
01:21:26 - Closing Thoughts

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More about this episode

The episode dives deeper into which injuries are best suited for PPP, when surgery is still necessary, and why PRP may actually increase fibrosis in primary muscle tears. Drs. Kruse and Balle compare kit selection, spin speed, filter pore size, and blood draw volumes, and discuss how to use ultrasound to guide both injury assessment and safe return to play. They also tackle the logistics of building a PRP lab, the use of PPP in osteoarthritis as a cortisone alternative, return-to-play timelines, recurrence risk, and the need for higher-level randomized data to move the field forward.

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Resources

Platelet-Poor Plasma for the Treatment of Acute Hamstring Muscle Injuries in Collegiate Football Athletes: A Cohort Study
https://pubmed.ncbi.nlm.nih.gov/39576137/

Platelet-Poor Plasma: A Novel Treatment for Acute Quadriceps Muscle Injuries
https://pubmed.ncbi.nlm.nih.gov/42037020/

Platelet-Poor Versus Platelet-Rich Plasma for the Treatment of Acute Thigh Muscle Injuries
https://pubmed.ncbi.nlm.nih.gov/38958567/

Platelet-Poor Plasma for the Treatment of a Quadriceps Muscle Tear in a Division I Football Athlete
https://pubmed.ncbi.nlm.nih.gov/39888358/

BackTable MSK Ep. 102: Understanding PRP and Orthobiologics for Musculoskeletal Medicine
https://www.backtable.com/shows/msk/podcasts/102/understanding-prp-orthobiologics-for-musculoskeletal-medicine

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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When does a knee cartilage defect need more than a clean-up, and how do you decide on the best repair? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes orthopedic sports surgeon Dr. Sachin Allahabadi for a practical tour of cartilage restoration. Together they explain what articular cartilage is, why it rarely heals on its own, and how to distinguish focal chondral defects from diffuse arthritis. The discussion covers the full spectrum of treatment, from chondroplasty and microfracture to cell-based restoration, osteochondral autograft, and allograft transplantation.

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Timestamps

00:00 - Introduction
04:39 - Cartilage Structure and Focal Defects
13:37 - Cartilage Healing Biology
16:51 - Evolution of Cartilage Repair Techniques
24:04 - Candidate Selection and Defect Characteristics
29:06 - Bone Marrow Edema and Offloading
33:46 - Osteochondral Autograft and Donor Sites
39:18 - Alignment, Meniscus, and Ligament Correction
45:31 - Cell Based Repair Indications and Procedure Durability
51:11 - Defect Sizing and Allograft Matching
59:29 - Rehabilitation and Orthobiologic Graft Integration
01:09:59 - Takeaways and Misconceptions
01:14:21 - Closing Remarks

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More about this episode

Dr. Allahabadi discusses how to select the right patients for different cartilage procedures, including how defect size, alignment, meniscus status, and ligament stability all factor into the decision. They review advances in cartilage repair techniques, the process of storing and matching fresh donor tissue, and the use of bone marrow aspirate concentrate to promote graft integration. The conversation also addresses the durability of allografts in real-world practice, setting realistic expectations with patients, the importance of referral to high-volume surgeons, and why thoughtful clinical decision-making is often more challenging than the procedure itself.

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Resources

Allahabadi S, Quigley R, Frazier L, Joyce K, Cole BJ. Outcomes and Return to Sport After Knee Osteochondral Allograft Transplant in Professional Athletes. Orthop J Sports Med. 2024.
https://pubmed.ncbi.nlm.nih.gov/38410170/

Elias TJ, Allahabadi S, Haneberg EC, et al. Osteochondral Allograft Reaming Significantly Affects Chondrocyte Viability. Am J Sports Med. 2024.
https://pubmed.ncbi.nlm.nih.gov/39186448/

Allahabadi S, Haneberg EC, Elias TJ, McMorrow KJ, et al. Osteochondral Allografts: Pearls to Maximize Biologic Healing and Clinical Success. Arthrosc Tech. 2023.
https://pubmed.ncbi.nlm.nih.gov/38196872/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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Why do overuse injuries keep coming back even after the pain settles down? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Grant Ralston to define overuse injury as a load-related disorder, and to work through its causes, diagnosis, and management in both pediatric and adult athletes. They review common conditions like bone stress injuries, chronic tendinopathy, plantar fasciitis, and apophysitis, and discuss why year-round play, early sport specialization, social media, and name, image, and likeness (NIL) pressures are making these cases more frequent in clinic.

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Timestamps

00:00 - Introduction
06:22 - Defining Overuse Injuries
08:31 - Why Overuse Injuries Are Increasing
15:33 - Corticosteroid Injections in Chronic Tendinopathy
22:05 - Relative Rest and Cross-Training
26:28 - Lower Extremity Overuse Injuries
34:40 - Gluteal Tendinopathy and Greater Trochanteric Pain
39:17 - Hydrodissection and Prolotherapy
51:37 - Upper Extremity Overuse Injuries
56:05 - Early Sport Specialization and Time Off
01:00:39 - Training Load, Sleep, and Nutrition
01:08:20 - Imaging, Physical Therapy, and Treatment Options
01:15:40 - Final Takeaways and Wrap Up

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More about this episode

The conversation moves through the lower and upper extremities, addressing Achilles tendinopathy, medial tibial stress syndrome, gluteal tendinopathy, patellofemoral pain, and rotator cuff tendinopathy, all with a focus on underlying biomechanical deficits. Drs. Ralston and Balle dissect the pros and cons of repeated corticosteroid injections, explore alternatives like ketorolac, prolotherapy, PRP, hydrodissection, and shockwave, and clarify when imaging should and shouldn’t drive decisions. They close with tips on relative rest, scheduling breaks from sport, optimizing sleep and nutrition, and building strong referral networks to support patient recovery.

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Resources

Fredericson M, et al. Tibial Stress Reaction in Runners: Correlation of Clinical Symptoms and Scintigraphy with a New Magnetic Resonance Imaging Grading System. Am J Sports Med. 1995
https://journals.sagepub.com/doi/10.1177/036354659502300418

Taheri P, et al. Comparison of Subacromial Ketorolac Injection versus Corticosteroid Injection in the Treatment of Shoulder Impingement Syndrome. J Res Pharm Pract. 2017
https://pubmed.ncbi.nlm.nih.gov/29417082/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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What characteristics make bone biopsies unique in both presentation and procedure? In this episode of the BackTable Podcast, Drs. Junjian Huang and Majid Khan join host Dr. Neil Jain to break down the complexities of bone biopsy technique. They discuss key strategies for tackling difficult cases, from understanding referral patterns and pre-procedure planning to selecting the best guidance modality and anticipating complications.

---

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---

This podcast is supported by

Varian OmniBone
https://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone

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Timestamps

00:00 - Introduction
08:06 - Referrals And Pre-Procedure Planning
12:35 - Triaging and Managing Difficult Cases
17:06 - Measuring and Improving Diagnostic Yield
18:58 - Knowing Boundaries Behind Difficult Cases
22:37 - Choosing the Best Guidance Modality
26:16 - The Future with Augmented Reality
28:11 - Tough Case Scenarios and Setup
41:27 - Preventing and Managing Complications
47:49 - Technical Tips for Future IRs
51:40 - Wrap-up and Credits

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More about this episode

The conversation covers how to triage complex cases, adjust technique for smaller or hard-to-reach lesions, and benchmark diagnostic success. Drs. Huang and Khan share their preferred imaging guidance, from CT to fluoroscopy, and explore new frontiers like augmented reality. Case scenarios highlight practical problem-solving, and the episode wraps up with technical pearls and complication-prevention tips gained from years of experience in targeted bone biopsy.

---

BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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How do you navigate the evolving science and controversy of concussion care in athletes and beyond? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Ryan Stempniak to break down the fundamentals and emerging advances in concussion management. They define concussion pathophysiology, highlight why most injuries occur without loss of consciousness, and discuss delayed symptom onset that can complicate diagnosis and treatment.

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Timestamps

00:00 - Introduction
07:16 - Who Manages Concussions?
12:21 - Defining and Understanding Concussions
23:31 - Injury Mechanisms and Pathophysiology
26:56 - Recognizing and Grading Symptoms
35:00 - Assessment Tools: SCAT6 vs. SCOAT
38:34 - Return-to-Play and Return-to-Learn
50:42 - Medications, Supplements, and Treatment Advances
57:10 - Concussion Subtypes and Individualized Care
01:02:01 - Helmets, Wearables, and Emerging Technology
01:10:11 - AI, Imaging, and Research Directions
01:13:01 - Myths, Facts, and Protocol Updates
01:16:57 - Closing Thoughts

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More about this episode

The conversation covers mechanisms of injury, symptom assessment, sideline and office evaluation, and the critical role of return-to-learn before return-to-play. Drs. Balle and Stempniak discuss concussion subtypes, medication and supplement limitations, and the latest on helmets, wearables, and AI-driven research. They also emphasize individualized care plans, the importance of school and work accommodations, and practical strategies for clinicians managing this complex and ever-changing condition.

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Resources
Dr. Ryan Stempniak
https://www.linkedin.com/in/ryan-stempniak-843545295/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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How have modern surgical techniques, pain management algorithms, and focus on rehabilitation transformed joint replacement outcomes? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. William Bryan of Houston Methodist to share his insights from decades of experience in orthopedic surgery and sports medicine. Dr. Bryan reflects on his journey from mentorship under Dr. George Lane and Dr. Michael DeBakey to serving as team physician for the Houston Astros, emphasizing the importance of restoring normal function and keeping patients active.

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Timestamps

00:00 - Introduction
04:55 - Praising Mentorship
11:59 - Evolution of Total Joint Care
18:44 - Optimizing Pain Control Post-TKA
30:42 - Discussing Operative Approach, Implants, and Emergence of Robotics
38:21 - Longevity of TKAs in More vs. Less Active Patients
41:58 - Knee Pain Eliciting Surgical Intervention
50:13 - The Balancing Act of Orthobiologics as a Conservative Modality
55:44 - Imaging Myths in Total Joint Surgery
58:02 - Sharing Surgical Pearls
01:03:42 - Advice for Non-Operative Colleagues
01:07:38 - Final Takeaways and Wrap Up

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More about this episode

The physicians explore the progression of arthritis, conservative treatment options, and the evolution of joint replacement, from early complications to advances that have improved implant longevity. They also discuss anesthesia advancements including periarticular nerve blocks, emerging calcium channel-blocker analgesics, and the use of the ROMTech home rehabilitation device. Curious about common misconceptions surrounding total joint replacement? Dr. Bryan and Dr. Balle address the role of orthobiologics, imaging myths, and other frequently misunderstood aspects of arthroplasty. Throughout the conversation, they emphasize the importance of ligament balancing, the unique challenges of treating ligamentously lax patients, and practical strategies for maintaining joint health through low-impact exercise and diet-driven weight loss.

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Resources

Dr. William Bryan
https://doctor-bryan.com/

ROMTech
https://romtech.com/

---

BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

What’s your game plan when heat illness strikes on the field? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes sports medicine physician Dr. Irvin Sulapas to discuss how clinicians and athletic trainers can use wet bulb globe temperature (WBGT) and other tools to improve athlete safety. They highlight best practices for communication with coaches, modifying training protocols, and recognizing the full spectrum of heat-related illness from heat rash to syncope and exertional heat stroke.

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---

Timestamps

00:00 - Introduction
04:12 - Defining Heat Stress and Its Risks
08:26 - Cooling Strategies in Sports and Mitigating Risk
17:11 - Wet Bulb Globe Temperature Explained
22:37 - Collaborating with Coaches and Trainers
26:02 - Identifying High Risk Athletes
30:57 - Heat Acclimatization Protocols
33:17 - Physical Exam for Heat Illness
39:12 - When to Activate EAPs and Call EMS
47:02 - Return-to-Play Guidelines
49:45 - Debunking Heat Illness Myths
54:11 - The Future of Heat Safety
57:13 - Key Takeaways and Wrap-Up

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More about this episode

The discussion covers risk stratification, early interventions like cold-water immersion and tarp-assisted cooling oscillators, and practical protocols for emergency response. Dr. Sulapas and Dr. Balle also address key physical exam findings, when to activate emergency action plans, and guidelines for returning to play after heat illness. They debunk common heat myths and look at future directions for improving heat safety in sports medicine.

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Resources

Dr. Irvin Sulapas
https://www.houstonmethodist.org/doctor/irvin-sulapas/

---

BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Time is money, but when it comes to ACL rehabilitation, the calendar alone does not determine readiness for return to play. On this episode of BackTable Bone & Sport, host Dr. Larry Balle is joined by returning guest Dr. Andy Glidewell to discuss modern protocols for anterior cruciate ligament (ACL) rehabilitation. They cover the ACL’s role in knee stability, common injury mechanisms, and why moving beyond timeline-based milestones is crucial for optimal recovery. Glidewell emphasizes that while surgery reconstructs the ligament, rehabilitation is what restores true knee function.

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Timestamps
00:00 - Introduction
05:55 - Collaborative ACL Protocols
09:56 - Anatomy Review: The Role of the ACL
14:41 - ACL Rehab Misconceptions
19:04 - Rehab Goal Metrics: Time vs. Subjective Measures
28:55 - Early Post-Op Priorities
36:26 - Tweaking ACL Protocols Based on ACL Reconstruction Graft
42:30 - Use of Orthobiologics in Surgery
47:15 - Progressing BFR to ARPE to Hypertrophy in Rehab
56:38 - Incorporating Plymometrics and Agility Training in ACL Rehab
1:00:19 - The Mental Hurdles in ACL Rehab and Return to Sport
01:08:00 - Clinical Pearls in ACL Rehab
01:10:20 - Wrap Up

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More about this episode
The conversation explores early post-operative priorities, the importance of progressive strength and functional testing, and the need for closer collaboration between surgeons and physical therapists. Additional topics discussed include shifting from time-based to subjective and objective criteria for return to sport, and evolving approaches to open-chain knee extension to address persistent quadriceps deficits and reduce anterior knee pain.

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Resources
Dr. Andy Glidewell
https://www.trainrecovermove.com/andyglidewellpt
https://uamshealth.com/provider/michael-a-glidewell/

---

BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app

Ergogenics: supplements NOT substitutes. On this episode of BackTable Bone & Sports, host Larry Balle joins Dr. Ryan Rhodes, a sports medicine physician and Army National Guard flight surgeon, in a discussion about ergogenic aids and supplements in athletic and military populations. They distinguish supplements from substitutes and define ergogenics broadly, noting limited evidence for popular peptides and the “bro science” culture. The doctors review historical and modern pharmacologic performance enhancers including anabolic steroids, selective androgen receptor modulators (SARMs), growth hormone and hormone replacement therapy (HRT).

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---

Timestamps

00:00 - Introduction
04:03 - Ergogenics Overview
07:17 - A Brief History Lesson in Performance Hacks
14:54 - SARMs Explained
18:00 - Supplement Industry Economics
24:28 - Growth Hormone and HRT Nuance
34:50 - Stimulant Use in Sports
37:30 - The Hype Around Creatine
44:03 - Addressing the Renal Safety Myth with Creatine Use
46:02 - The Rundown on Protein Intake Basics
49:47 - Future Discussions on Ergogenic Aids
52:02 - Closing Key Point: Five Point Supplement Test
57:14 - Wrap Up

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More about this episode

This episode also features case discussion surrounding injury risks from exogenous testosterone use and nuances associated with hormone-replacement. Dr. Rhodes shares his appreciation for creatine, highlighting its strong evidence and safety profile. Key takeaways include the five-point framework for evaluating supplements: safety, claims, meaningful impact, correcting deficiency, and cost.

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Resources

Dr. Ryan Rhodes
https://www.ochsner.org/doctors/ryan-rhodes/

---

BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

A bone biopsy can reach the target and still miss the diagnosis. In this episode of the BackTable Podcast, host Dr. Neil Jain is joined by Dr. Peter Thurlow to discuss how lesion selection, imaging review, trajectory planning, and device choice determine whether a targeted bone biopsy produces a useful sample without compromising future treatment.

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This podcast is supported by
Varian OmniBone
https://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone

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Timestamps
00:00 - Introduction
04:17 - Approaching Focal Bone Lesions
06:17 - Differentiating Lesions and Pain Management
13:13 - Settling on Bone Biopsy Imaging
16:55 - Understanding Pre-Op Imaging from Lesion Characteristics
21:50 - Maintaining Communication Across Specialties
24:21 - Which Devices To Select and Navigating Challenges
32:28 - Trajectory Paths and Surgical Considerations
35:30 - How to Avoid and Mitigate Biopsy Complications
41:30 - Wrap Up

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More about this episode
The conversation begins with a systematic approach to evaluating focal bone lesions, including the likelihood of malignancy, lesion location, number of lesions, and selection of an appropriately sized sampling device. Dr. Thurlow reviews anesthesia and pain-management strategies for both superficial and deeper osseous targets, as well as the respective roles of MRI and CT in procedural planning. For challenging lesions, he explains why needle-guidance technology may be preferable to adjusting gantry tilt and outlines how imaging findings and biopsy strategy should be tailored to lesion type, with particular attention to the difficulties associated with blastic lesions.

The doctors also discuss the importance of communication with pathology, surgery, oncology, and other collaborating specialties before proceeding. Dr. Thurlow shares his preferred biopsy devices, considerations for selecting a safe trajectory, and ways to account for potential future surgical approaches. The episode concludes with practical strategies for avoiding complications, minimizing tissue injury, and obtaining an adequate diagnostic sample.

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app