Shoulder and elbow injuries in pitchers are as old as baseball itself. Measures to lower the risk of these injuries have been evolving for decades, with a nationalized though heterogenous effort from state to state implemented in the mid-2010s. Adherence to pitch counts and mandatory days of rest in between outings, for example, are common restrictions placed upon pitchers to try and keep them safe. Dr. Peter Kriz, MD and his team from Boston Children's Hospital look back to see if these policies made any impact. Have the pitching restriction regulations designed to keep pitchers safe actually worked?

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.

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.