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.

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.