BackTable Bone & Sports

Are you truly understanding PRP and orthobiologics, or just following the latest trends in musculoskeletal medicine? In this episode of BackTable Bone and Sports, host Dr. Larry Balle and guest Dr. Jason Epstein explore the realities of platelet-rich plasma (PRP) and orthobiologics in non-operative musculoskeletal medicine. They highlight why successful outcomes start with honest patient counseling, clear definitions of the procedure, and addressing common misconceptions such as PRP being “stem cells.”

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps
00:00 - Introduction
09:02 - Exploring the Patient Definition of PRP
14:31 - Addressing Inconsistenties in the Literature for PRP
20:01 - Avoiding Stem Cell Terminology
26:24 - Encouraging Shared Decision Making
41:46 - Patient Selection, Dosing, and Post-Treatment Expectations
54:34 - Talking Cost of Treatment
58:07 - Choosing the Right Tool and Blood Draw Technique
01:01:31 - Personal Experience with PRP
01:05:35 - Discussing FDA Regulations and Marketing Myths
01:13:18 - Closing Remarks

---

More about this episode
The discussion covers the lack of standardization in PRP studies, reasons for variable patient responses, and how to guide patients through shared decision-making and realistic expectations. Drs. Balle and Epstein emphasize building trust, avoiding marketing hype, and discussing FDA regulations, legality, and off-label use. Practical advice includes tracking outcomes and cell counts, clarifying costs, and choosing the right kits and techniques to integrate PRP responsibly into practice.

---

Resources
Dr. Jason Epstein
https://www.linkedin.com/in/jason-epstein-27804a1a/

---

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

It’s comeback season! What’s bringing lateral extra-articular tenodesis (LET) back to the landscape of ACL surgery? In this episode of BackTable Bone & Sports, Dr. Larry Balle joins sports orthopedic surgeon and knee specialist Dr. Kyle Borque to discuss the resurgence of lateral extra-articular tenodesis (LET) as an adjunct to ACL repair and reconstruction. They explore LET’s origins as a solution for rotation instability in the era of open ACL surgery, and examine how modern arthroscopic techniques, patient selection, and surgical evidence have driven LET’s renewed relevance in today's practice.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
02:36 - LET Origin Story
14:16 - Modern LET Technique Updates
23:13 - A Run-Down of the Procedure in the OR
26:54 - Patient Selection for LET
34:18 - Supporting LET with Published Evidence
38:43 - Rehab After LET
44:33 - Dismissing OA Concerns
50:10 - Case Example: ACL Revision
53:02 - Wrap Up

---

More about this episode

The Drs. highlight the anatomy considerations, technical modifications, and the evidence that supports LET’s role in reducing graft failure, without changing rehab or increasing lateral OA risk. They compare LET with anterolateral ligament (ALL) reconstruction, emphasizing anatomy and technical approach. Dr. Borque details his modified technique using an iliotibial (IT) band strip fixed proximal and posterior to the lateral epicondyle of the femur. Furthermore, the doctors discuss selection factors for high-risk and revision patients, tactics to avoid overconstraint, and tips for patient counseling. They review the latest evidence, outline perioperative protocols, and address persistent myths about LET’s impact on recovery and osteoarthritis. The doctors highlight a real-world case example and the actionable insights for orthopedic surgeons to optimize ACL outcomes.

---

Resources

Dr. Larry Balle
https://www.linkedin.com/in/larry-balle-ii/

Dr. Kyle Borque
https://www.drborque.com/

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial
https://pubmed.ncbi.nlm.nih.gov/31940222/

---

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

“The athlete’s job is to stay consistent with rehab and to be hungry to get back on the field. I think our job as a sports medicine team is to make sure that they’re safe and that they can perform.” In this episode of BackTable MSK, guest host and sports medicine physician Dr. Larry Balle joins physical therapist/athletic trainer Andy Glidewell to discuss how “return to play” is defined and why it is often misunderstood among athletes, coaches, physicians, and rehab teams.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
04:25 - Return to Play from the Lens of Physical Therapy vs. Sports Medicine
12:11 - Evidence-based vs. Anecdotal-based Practice for Return to Play
21:18 - Is there an Appropriate Team Approach?
24:25 - Continuing Conservative Management vs. Surgical Intervention
34:01 - Notes on a High-Profile Sports Medicine Case
40:20 - The Influence of NIL on College Athletics
42:51 - Obtaining Objective Metrics for Clearance
52:38 - Influence of AI on Return to Play Algorithms
57:11 - Final Takeaways

---

More about this episode

They emphasize that return to play is a milestone-based rehabilitation phase requiring clear communication, collaboration, and risk management, rather than rigid timelines or just “vibes.”

The conversation covers how evidence and objectivity have shaped protocols (notably ACL timelines), the role of prognostic indicators in operative vs. non-operative decisions, and practical use of functional strength and agility reassessment. They also address pressures of working with elite sport and NIL (Name, Image, Likeness) considerations. Furthermore, they expand on how AI may inform, but not replace, the humanistic and team-based components of decision making.

---

Resources

Dr. Larry Balle
https://www.linkedin.com/in/larry-balle-ii/

Dr. Andy Glidewell
https://uamshealth.com/provider/michael-a-glidewell/

The Journal of Orthopedic and Sports Physical Therapy
https://www.jospt.org/

---

BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.

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

Beyond the basics: anatomy, technique, and clinical pearls for the evolving world of hip embolization. In this episode of BackTable MSK, we dive into the fine details of hip embolization. In Part II of this two-part series, Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, return with host Dr. Kavi Krishnasamy, to explore the nuances of hip embolization and reviewing real-world case studies.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
01:17 - Explanation of Hip Physical Exam Maneuvers
04:30 - Overview of Hip Embolization Technique with Anatomy
10:10 - Case 1: Awake Superselective Angiography and Procedure Technique for GTPS Patient
12:43 - Case 2: Patient Presents with Hip Pain, Increased Since L3 Compression Fracture
18:15 - Mixing Imipenem
20:40 - Overview of Hip Embolization Scientific Data
32:52 - Closure Techniques and Final Thoughts

---

More about this episode

Together, they apply the foundational skills of physical exam and procedure technique, including detailed anatomy, procedural technique, and hip physical exam maneuvers.The discussion also covers the latest research on the use of temporary embolization agents. Looking for a way to mix your Imipenem? Tune in for a “how to” and other intricate insights.

---

Resources

Dr. Mateus Correa
https://www.researchgate.net/profile/Mateus-Correa-4

Dr. Joaquim Filho
https://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho

---

BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.
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

Ready to shake up hip pain management? In this episode of BackTable MSK, we unpack how embolization is opening a new frontier for patients caught between conservative care and surgery. Interventional radiologist Dr. Kavi Krishnasamy hosts Brazilian interventionalists, Dr. Mateus Correa and Dr. Joaquim Filho, to discuss hip embolization for Greater Trochanteric Pain Syndrome (GTPS) and early hip Osteoarthritis (OA). The doctors highlight building multidisciplinary referrals, reimbursement, and the availability of embolic agents. They also address pre-procedure workup, including imaging and physical exam findings.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
02:37 - Guest Background in MSK Embolization
08:14 - Availability of Embolics and Preferences in Brazil
10:31 - Reimbursement and Access Hurdles
13:55 - Hip Etiologies Treated by Embolization
16:54 - Imaging Workup and the Role of MRI
24:23 - Offering Conservative Treatment Options Prior to Embolization
26:52 - Scoring Systems and Physical Exam
34:44 - Procedure Access Strategy
39:16 - When to Utilize Temporary vs. Permanent Embolics
46:34 - Post-Procedure and Follow-Up Guidelines
58:05 - Discussion of Current Evidence

---

More about this episode

At the time of the procedure, Drs. Correa and Filho explain why they prefer certain vascular access points and specify arterial targets, favoring temporary embolic agents due to potential risk of Avascular Necrosis (AVN) of the femoral head. Furthermore, the doctors detail awake procedures with intraprocedural palpation and blush/pain-based endpoints, post-embolization pain flare management, follow-up schedules, and re-treatment criteria; all with consideration for current published evidence.

---
Resources

Dr. Mateus Correa
https://www.researchgate.net/profile/Mateus-Correa-4

Dr. Joaquim Filho
https://www.researchgate.net/profile/Joaquim-Da-Motta-Leal-Filho

---

BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.
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

Caught between conservative care and a large spine surgery, the MILD procedure offers potential as the in-between. On this episode of the BackTable MSK Podcast, Interventional Radiologist Dr. Dana Dunleavy welcomes pain specialist Dr. Denis Patterson to explore the evidence, technique, and evolving role of Minimally Invasive Lumbar Decompression (MILD) procedure for lumbar spinal stenosis with neurogenic claudication.

---

Get the BackTable app
https://www.backtable.com/app

---

This podcast is supported by

Stryker
https://www.stryker.com/us/en/interventional-spine/products/mild-procedure.html

---

Timestamps

00:00 - Introduction
04:22 - What is the MILD procedure?
09:55 - Comparing Discogenic Pain to Neurogenic Claudication
19:20 - MILD Procedure Technique
22:54 - Toolbox and Workflow
36:59 - MILD Makes a Difference in the Pain Management Field
41:53 - Objectifying Pain Measurements and Setting Patient Expectations
46:26 - Driving Mutual Understanding in Surgical Cohorts
01:00:53 - Collaboration Over Competition
01:05:32 - Final Takeaways

---

More about this episode

Dr. Patterson explains the pathophysiology and diagnostic process, highlighting key insights from patient history and MRI findings. The physicians review technique evolution from multiple paramedian incisions and epidurograms to streamlined single midline incision access, and cross lateral oblique (CLO) fluoroscopic safety landmarks.

The discussion also references the MiDAS and Cleveland Clinic studies showing pain and functional improvement with a complication rate similar to epidural steroid injections, along with promising long-term outcomes and reduced need for surgical re-intervention. This episode also tackles practical considerations, including the impact of Category I CPT codes on reimbursement, challenges in radiology reporting, privileging politics, and pathways for physician training and proctoring.

---

Resources

Dr. Denis Patterson
https://www.linkedin.com/in/denis-patterson-50ba0485/

MiDAS I (Mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical study
https://pubmed.ncbi.nlm.nih.gov/20648206/

The durability of Minimally Invasive Lumbar Decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up
https://pubmed.ncbi.nlm.nih.gov/33942964/

Pacific Spine and Pain Society
https://pacificspineandpainsociety.com/

---

BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.

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

The embolization playbook is expanding. The question is: are you ready to use it? In this episode of the BackTable MSK Podcast, host Dr. Ally Bahehi joins Dr. Mikin Patel and Dr. Osmad Ahmed from Joint and Vascular Institute in the greater Chicago area to discuss plantar fasciitis embolization; a newer MSK embolization technique, building from concepts and clinical pearls for genicular artery embolization (GAE).

---

Get the BackTable app

https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
01:18 - Ideal Patient for Plantar Fasciitis Embolization
02:14 - Workup, Imaging Needs, and the Reality of Insurance Coverage
03:53 - Benefits And Expectations
06:05 - Step By Step Procedure Walkthrough
11:29 - Pain Relief and Follow-Up Timeline
13:46 - GAE Case Setup
14:54 - Debating Access Strategy
15:54 - Crash Course in Genicular Artery Anatomy
19:08 - Minimalist GAE Toolkit Set-Up
22:32 - Time to Inject! The Wrap Up

---

Resources

Dr. Mikin Patel
https://jointvascular.com/team/mikin-v-patel-md-mba/

Dr. Osman Ahmed
https://jointvascular.com/team/osman-ahmed-m-d-fcirse/

Every new device and technique comes with a learning curve, ​​and in this BackTable MSK Brief we’re navigating pelvic curves. Host Dr. Kavi Krishnasamy joins Dr. Brandon Key to dissect pelvic and sacral fixation techniques. They discuss patient positioning and prep to needle-guidance software, with procedural pearls scattered throughout the conversation.

Episode Outline

00:00 - Introduction

00:26 - Pelvic Positioning Strategy

04:00 - Need to Know: Needle Guidance 

09:20 - Thermoablation in Pathologic Fracture Fixation

13:29 - The Photodynamic Nail by IlluminOss: An Overview

20:00 - Finding The Way with a Curved Trajectory

22:52 - Wrap Up

Resources

Dr. Brandon Key, MD

https://www.linkedin.com/in/brandon-key-md-367a01310/ 

IlluminOss

https://illuminoss.com/us

For patients who have exhausted conservative management but aren’t ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization.

---

SYNPOSIS

The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno’s early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women’s Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization.

---

TIMESTAMPS

00:00 - Introduction
01:42 - Dr. Yan Epelboym’s Origin Story in MSK
03:02 - Building Referral Networks
06:50 - Details on Clinic Workflow
10:08 - The Run Down on Shoulder Embolization Treatment Targets
22:09 - Current Insights on Shoulder OA Embolization
27:56 - Shoulder Embolization Setup and Access Choice
34:28 - Shoulder Embolization Strategy and Endpoints
36:38 - Post-Procedure Pain Control and Activity Limitations
42:26 - Shoulder Surgery Status-Post Embolization
44:17 - Discussing Existing Research Data on Shoulder Embolization
01:00:32 - Key Shoulder Arterial Anatomy and Variants
01:04:27 - Shoulder OA Case Discussion
01:09:08 - Final Thoughts

---

RESOURCES

Dr. Yan Epelboym, MD, MPH
https://www.linkedin.com/in/yan-epelboym-4a84991b/

Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)
https://clinicaltrials.gov/study/NCT06095050

In orthopedic IR, confidence comes from exposure. It’s all about getting those reps in. In this BackTable MSK Brief, host Kavi Krishnasamy interviews Dr. Brandon Key from the Medical College of Wisconsin about implementing bone stabilization and fixation in interventional radiology for pathologic and non-pathologic fractures.

The doctors discuss key barriers which include limited training exposure and operational inefficiencies that discourage adoption. However, they highlight the evolving technology, vendor toolsets, and growing multidisciplinary collaboration that are mitigating these barriers. The discussion expands to cover trauma-related consults from orthopedic surgery, indications and evolving applications of the IlluminOss device, screw types and preferences, and the capabilities of the Flow-FX cement-delivery device. 

Episode Outline

00:00 - Introduction

00:57 - The Delay in Take-Off of Bony Fixation and Stabilization at the Trainee Level 

03:10 - Meaningful Multidisciplinary Momentum

05:35 - Treatment of Pathologic Fractures in the Orthopedic IR Space

09:17 - Considerations for Trauma and Fragility Cases

16:09 - Patient Prep and Approach

18:05 - Final Thoughts

Resources

Dr. Brandon Key, MD

https://www.linkedin.com/in/brandon-key-md-367a01310/ 

IlluminOss

https://illuminoss.com/us 

Flow-FX
https://flow-fx.net/products/