Our next poster is titled Sleep in Orthopaedic Surgeons: A Prospective Longitudinal Study of the Effect of Home Call on Orthopedic Attending and Resident Sleep. Recurrent episodes of partial sleep deprivation resulting from call schedules are commonly seen in physicians. This has been shown to cause decreased mental effectiveness while at work, which corresponds with a blood alcohol level of 0.08%. 

Sleep deprivation has been associated with adverse personal health events, with an increased risk of diabetes, heart disease, stroke and risk of death. Additionally, sleep deprivation has been demonstrated to have a negative clinical impact, including decreased surgical performance, increased errors, and greater risks of accidents.

Despite the known negative impacts of poor sleep, the effect of home orthopedic call on surgeon sleep has not been well quantified.  The purpose of the study was to quantify the impact of resident and attending physician home call on sleep performance – specifically total sleep, slow-wave sleep and rapid eye movement sleep – as well as heart rate variability. 

Sixteen orthopedic residents and 14 attendings at a level 1 academic trauma hospital wore WHOOP 3.0 straps for a period of 1 year. The WHOOP strap is wearable device that tracks all 4 stages of sleep and monitors wake events, efficiency and respiratory rate. The authors recorded total sleep, slow-wave sleep and REM sleep.  Slow-wave sleep is considered to be the most restorative sleep stage and plays an important role in growth, memory and immune function.

This study showed that overall, attendings slept significantly less than residents, at 6 hours compared to 6.7 hours.  When on home call, resident total sleep decreased by 20%, REM sleep decreased by 12%, and slow-wave sleep decreased by 12%.  For attendings, total sleep on-call decreased by 10%, REM sleep decreased by 7% and slow-wave sleep decreased by 4%.

The authors concluded that orthopedic surgery residents and attendings exhibit low baseline sleep, and taking home call reduces this even further.  On home call nights, Residents and Attendings experienced a significant decrease in total sleep, REM sleep and short wake sleep.  The authors suggested that further research is required in order to determine how to ensure excellent patient care, maximize educational environments and develop strategies for resilience.

Our next poster is titled Characterization of Concussions in the National Basketball Association and the 90-day Period Following Return to Play: Analysis of Musculoskeletal Injury Risk and Player Performance. This study was performed at the Mayo Clinic in Arizona and sought to determine the incidence of musculoskeletal injury in the immediate 90-day period following return to play from concussion.  The secondary outcomes were to evaluate player performance within the 90-day.  As well as time lost after musculoskeletal injury.

Concussions have steadily garnered increased attention over recent years. We actually did an episode with Dr. Rachel Frank focused on concussions and sideline evaluation.  This is episode 98 if you want to go check it out.  That episode focused primarily on identifying and appropriately managing concussions.  This study aims to evaluate the impact of a concussion on risk of musculoskeletal injury. 

Concussions have previously been shown to have persistent neurological effects that may lead to slower reaction times and may compromise postural stability in high-level athletes. Therefore, it stands to reason that a player may be at greater risk for musculoskeletal injury and may exhibit poorer performance upon return from a concussion.

The authors identified NBA players who sustained a concussion between 2015-20 22 using a publicly available database.  The database was also queried to identify any musculoskeletal injury in the 90-day period following return to play after the concussion, as well as time lost after the subsequent injury. 

Performance statistics were obtained from each players preinjury season and post-injury season.  Each concussed player was matched with a non-concussed control player using position, win shares, player efficiency rating and points per game as metrics.

So, what did this study find?  A total of 70 concussions were identified during this time period. 70% of concussed players sustained a musculoskeletal injury in the 90-day period following return to play.  Compared with controls, the odds of sustaining a musculoskeletal injury in the concussed cohort were 11.3 times greater.  There was no significant difference between the type and location of injury, with ankle injuries being the most common in both groups.

Now let’s talk about performance.  Interestingly, there were no significant changes in points per game, minutes played per game or true shooting percentage between the concussed and control groups.  When compared with the controls, no changes in performance statistics were significantly different. Games missed after subsequent musculoskeletal injury were similar between the concussed and control groups.

Our next AAOS 2025 Annual Meeting poster is titled Mid-term Follow-up of Patellofemoral Osteochondral Allograft Transplantation. This study was performed by Dr. Bill Bugbee and his team at the Scripps Clinic. Dr. Bugbee was a guest on our show back in November 2023.  That is episode 59 and 60, if you want to go check it out.  In that episode, we discussed osteochondral allograft transplantation for various cartilage defects of the knee, including medial and lateral tibiofemoral, which are the more common locations for OCA transplantation.  This study focuses specifically on outcomes of OCA transplantation for patellofemoral cartilage defects.

This study identified 127 patients undergoing OCA transplantation in the patellofemoral compartment – 51 to the patella, 47 to the trochlea and 29 bipolar patella and trochlea.  The most common indication was a degenerative cartilage lesion at 47%, followed by a traumatic cartilage injury at 25% and osteochondritis dissecans at 15%.  All patients had a minimum follow-up of 2 years.  OCA failure was defined as any reoperation that involved removal of the allograft.  Patient reported outcomes were also assessed pre-op and post-op, including the IKDC score and KOOS score.

So, what did this study find?  First, reoperations occurred in 39% of the knees.  Rate of reoperation was not statistically significant between patella, trochlea and bipolar grafts.  Second, OCA failures occurred in 16% of the knees at a median 4.4 years following the index surgery, and the most common revision procedure was arthroplasty.  Although it did not reach statistical significance, trochlear grafts had a lower failure rate of 9% compared to patellar grafts at 20% and bipolar grafts at 21%.

Overall, graft survivorship at 5 and 10 years was 91% and 82%, respectively.  Patients with patellar, trochlear and bipolar grafts all had significant improvement in IKDC scores and KOOS scores from preop to the latest follow-up and no statistically significant differences were observed between the groups.  Overall, 77% of patients reported being satisfied with the results of the OCA transplantation with no statistically significant differences in satisfaction between the groups.

Also check out:

Episode 91: Dr. Tom DeBerardino 0n Advances in Patellofemoral Cartilage Restoration

We are kicking off a special series of episodes to recap the new research presented at the American Academy of Orthopaedic Surgeons Annual Meeting, our largest orthopaedic conference. This year, over 20,000 orthopedic professionals gathered at the AAOS meeting in San Diego to take part. 

The educational program was comprised of instructional course lectures, video theater, live surgeries, podium presentations and research posters. Over the next several episodes we’re going to be reviewing seven sports medicine posters that were presented at the AAOS meeting. 

On this podcast we try to review the most updated literature on different sports medicine topics. So, reviewing some of the posters that were just presented at AAOS is particularly exciting for us because this is very new data. So new that most of this data has not even been published yet. 

So, let’s get started with our first poster, titled Return to Performance Following UCL Surgery in Major League Baseball Pitchers.  While return to play is very important for both players and teams, arguably even more important is return to performance.  With advancements in pitch tracking analysis and analytics, it is now possible to determine return to full performance, based on comparison of preop and postop metrics.

This retrospective analysis was performed by Dr. Christopher Ahmad and team at Columbia University. 119 MLB pictures who underwent primary UCL reconstruction or repair were evaluated. Return to play rates at 1- 2- and 3-years postop were reported. Additionally, the authors looked at performance data, including innings pitched as well as pitch-tracking data.

Overall, surgery remains an effective option for MLB pitchers to return to play and performance following a UCL injury.  However, athletes should be counseled that certain pitches may be negatively impacted postoperatively.

Welcome back to The Sports Docs Podcast!  In this episode, we’re going to continue our discussion with Dr. Andrea Spiker and focus on open surgical treatment for hip preservation, then wrap up with a discussion on post-op rehab and return to play.

Our conversation picks back up with an article from the September 2017 issue of AJSM titled “Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia.” Bryan Kelly and his team  at HSS investigated the effect of prior arthroscopic hip surgery on clinical outcomes after periacetabular osteotomy or “PAO”. They found that patients who previously underwent hip arthroscopy had inferior functional outcomes at 6 months and 12 months after PAO compared to patients with no prior hip surgery. The authors note that both groups significantly improved post-op and there was no difference in complications or reoperation between the groups.

We finish up today with a surgical technique article authored by our guest, Dr. Andrea Spiker, from the August 2022 issue of Arthroscopy Techniques. The article is titled “Treatment of Coxa Profunda with Open Surgical Hip Dislocation, Rim Resection, Cam Resection, and Labral Reconstruction” and describes an open surgical approach to address many of the challenges posed by coxa profunda. For our listeners, coxa profunda is essentially a deep acetabular socket. This differs from acetabular protrusio, in which the femoral head and socket displace into the pelvis. The global acetabular over-coverage associated with coxa profunda makes arthroscopic management very challenging in terms of obtaining adequate hip distraction and concerns for traction injury. For these reasons, an open approach has been proposed.

On today’s episode we’re focusing on hip preservation with Dr. Andrea Spiker. We have some great articles for you that contribute well to our conversation on femoroacetabular impingement or “FAI”, hip dysplasia and the arthroscopic and open surgical treatments for these conditions. As always, links to all of the papers that we discuss on this show can be found on our podcast website – www.thesportsdocspod.com

We’ll start off our discussion today with an article from the June 2018 issue of The Lancet titled “Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome.” This multicenter RCT included 348 patients across 28 hospitals in the UK and compared conservative treatment with physical therapy to surgical treatment with hip arthroscopy. The authors reported that while both groups improved after treatment, patients who underwent hip arthroscopy for treatment of FAI demonstrated significantly greater improvement in hip-related quality of life compared to patients who had nonsurgical treatment.

 Then, from the September issue of AJSM this year, we review an article titled “Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement with Hip Arthroscopy Compared with Nonsurgically Treated Patients.” Aaron Krych and team at the Mayo Clinic reported significantly less progression of arthritic changes in surgical patients compared to non-op. Seven percent of patients in the surgical group ultimately underwent a total hip replacement compared to 12% in the non-op group. Risk factors for failure of non-op treatment included male sex, presence of a CAM morphology, increased age and initial arthritic joint changes at diagnosis. 

 We are joined today by Dr. Andrea Spiker, a board-certified orthopedic surgeon at the University of Wisconsin-Madison who is dual fellowship trained in sports medicine and hip preservation. She is a team physician for UW Badger Athletics and provides head orthopedic coverage for the UW Men’s and Women’s Basketball teams. She is also the Program Director of the UW Orthopedic Surgery Sports Medicine Fellowship Program. Dr. Spiker is an active member in numerous orthopedic societies including AAOS, AOSSM and AANA, and has published extensively on the topic of hip preservation, so we’re very excited to hear all that she has to share on this topic today.

We get lots of questions from our patients and our listeners each week, and they’re great questions, so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started! 

Today’s Ask The Sports Docs is going to focus on an area of sports medicine that we get asked a lot, despite us being surgeons: “What nonsurgical treatments can I do to rehab my musculoskeletal injury as well as improve my performance and prevent reinjury?”

Specifically: 

Does Kinesiotaping actually improve recovery and performance?

Does sports massage therapy help with muscle recovery and injury prevention, or is it just a feel-good treatment?

What does the research say about acupuncture for pain relief and recovery in athletes?

On each of these mini episodes, we chat about a new article or new surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data and how this data will impact our practice. 

Today, we’re broaching a topic that we haven’t discussed before on this podcast.  And that is the medico-legal side of sports medicine.  Specifically, the malpractice liability exposure for team physicians.

In January of 2023, a professional football player for the Philadelphia Eagles sued a surgeon in Pittsburgh, that surgeon’s medical center, and the Philadelphia orthopaedic practice caring for the team.  After a 2-week trial, the jury found in favor of the plaintiff and awarded him $43.5 million dollars in damages.  This ruling has had a profound impact on our sports medicine community and ultimately led to the Philadelphia practice terminating its contract to care for this NFL team.

This case, and others that have come before it, has highlighted the liability that orthopedic surgeons assume when caring for elite professional athletes.  Despite this, many sports medicine physicians lack the legal expertise to understand their risk of exposure.  Today, we are reviewing an article published this month in AJSM titled “Malpractice Liability Exposure and the Sports Medicine Team Physician: Caring for Professional Athletes in the National Football League, Major League Baseball, and National Hockey League.”

It is a Reboot Special with one of our faves - Dr. Brian Cole!

Today’s episode is going to focus on osteochondral allograft transplantation, and specifically how basic science research can and should impact your clinical practice.

We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center.  He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox.

Welcome to another episode of Game Plan! It has been a while since we have done one of these Game Plan episodes so to quickly review: These episodes are specifically designed for patients. They are designed to hopefully answer some of the questions you have about the most common sports medicine conditions, injury prevention and treatment options.

Today we’re talking about pickleball – the fastest growing sport in the United States. From 2019- 2021, the number of pickleball players increased from 3.3 to 4.8 million. The reason for the growth of the sport is likely multifactorial, including that it encompasses a wide variety of age ranges, it is easy to understand and it is inexpensive to play. However, with this steady growth has come a corresponding linear rise in pickleball injuries. And these injuries are not inexpensive, costing between 250 to 500 million dollars in 2023 alone.

Pickleball is a paddle sport that takes aspects from tennis, badminton, and ping-pong. Now, we were going to try to explain the pickleball rules here, and how it differs from other racquet sports. But, USA Pickleball has a really nice 5-minute video on their website (usapickleball.org) that quickly summarizes the basic rules. If you are interested in learning more about this game, definitely check out their website. It should be noted that the rules and scoring system are currently variable. But as more competitions arise, more standardization to the game will likely follow, as is the trend with most sports.

Today, we’re reviewing an article published in the November 2024 issue of the yellow journal titled “Pickleball: A Standard Review of Injury Prevalence and Prevention in a Rapidly Growing Sport.” This study compiled data from retrospective studies containing emergency department data and case reports of specific injuries sustained while playing pickleball. The authors also utilized a customized survey to capture outpatient data of current pickleball players seen in outpatient orthopedic facilities and at local pickleball events.