The Sports Docs Podcast

Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and I chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data ranging from operative indications, surgical approaches, post-op protocols and most importantly – patient outcomes.

Today we’re talking about SLAP tears – tears of the superior labrum from anterior to posterior. We have two great articles for you today that focus on the surgical management of SLAP tears – specifically whether we should be repairing SLAP tears or proceeding directly to biceps tenodesis. We will also discuss the different types of biceps tenodesis procedures – mainly arthroscopic suprapectoral versus open subpectoral.

Our first paper looks specifically at this patient population – young overhead athletes – and investigates the functional and athletic outcomes after primary subpectoral biceps tenodesis for type II SLAP tears. 

Brian Waterman and Tony Romeo published a case series in the January 2023 issue of Arthroscopy titled “High Rate of Return to Sporting Activity Among Overhead Athletes with Subpectoral Biceps Tenodesis for Type II SLAP Tear”. The authors reported that 81% of patients returned to their previous level of play at an average of 4 months post-op. There were also significant improvements in VAS and SANE scores post-op.

But how do repairs do in this population? The answer is… not great. Return to preinjury level of play after SLAP repair has been reported in the range of 54% to 63% of elite throwers. In one cohort study by Boileau, 60% of patients reported persistent shoulder pain after SLAP repair and 50% elected to undergo secondary surgery. Provencher published on his outcomes of SLAP repair in an active military population and reported a 37% failure rate and 28% revision rate at short to mid-term follow up.

Our second article focuses on this and is titled “No Difference in Clinical Outcomes for Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis at Midterm Follow-up.” Nikhil Verma – who will be joining us at AOSSM – and colleagues at Rush compared arthroscopic suprapectoral tenodesis versus open subpectoral tenodesis for long head of biceps tendon disease, so not SLAP tears. They reported no significant differences in patient reported outcomes or complications at any time point.

Welcome to Overtime with the Sports Docs. 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 be impacting our practice.

Today, we’re talking about hamstring injuries in the NFL. And if your fantasy team is anything like my fantasy team, it currently looks like an infirmary. So, you’ll probably want to listen in to this episode.

Now, we’ve covered hamstring injuries in the NFL before.  Last year we did an entire Game Plan episode dedicated to this topic.  That is episode #52 if you want to check it out. Today, we are actually reviewing a new study just published this month in AJSM that focused on how player characteristics, injury severity and imaging findings can impact the amount of time missed as well as risk of recurrent injury. 

The article is titled “Correlation of Player and Imaging Characteristics with Severity and Missed Time in the National Football League Professional Athletes with Hamstring Strain Injury.” Molly Day, Scott Rodeo and team at HSS published this retrospective cross-sectional study that aimed to identify certain player characteristics, clinical examination findings and MRI  results that were associated with injury severity and missed playing time. 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 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 one specific question that we get asked a lot from patients, and review a recent article that came out about this topic.

We both use cryotherapy and cryo-compression therapy postoperatively after our knee and shoulder surgeries.  Many of these devices are unfortunately not covered by insurance, and therefore require patients to pay out-of-pocket.  A question we get asked all the time from our surgical patients is: “Is this worth it?” Basically, do cryo-compression devices offer a significant benefit compared to a bag of peas? Is the cost worth it?

Welcome to another episode of Game Plan! These Game Plan episodes are specifically designed for patients – to hopefully answer some of the questions you have about the most common sports medicine conditions and surgical treatments. But today’s episode is a little different and we’re excited about it! Today, we’re focusing on common injuries in the NFL and how these injuries impact time missed and player performance once athletes ultimately return to play.

This is something that each NFL team looks at carefully when evaluating rookie prospects before draft day. Teams look at the number of previous injuries, the types and severity of the injuries and treatment rendered when trying to decide on the ranking of a draft candidate. Now, this is just one facet of the evaluation – a physical examination is performed at the NFL Combine and performance metrics post-injury are obviously taken into account. 

But as the literature continues to grow in this area, it is becoming more feasible to project a player’s injury risk, career length and even performance in the NFL. This is useful information for NFL teams but also fantasy football enthusiasts who want to make sure they draft the best players for their team. So, our discussion today is going to focus on common injuries in the NFL and how that injury history may impact player reliability (games played), longevity for the season and performance. 

Welcome to another episode of Game Plan! 

As you might remember from our episode on ACL graft choices, these Game Plan episodes are specifically designed for patients – to hopefully answer some of the questions you have about the most common sports medicine conditions and surgical treatments. 

We’re continuing with our favorite topic today – ACL tears – but today’s episode is going to focus on risk factors for ACL tears. Specifically, which of these risk factors can we modify to lessen the chance of sustaining ACL tear and how do we decrease that risk.

Please note that this episode is going to focus strictly on ACL reconstruction. For more information on ACL rehab check out our recent two-part episode with Candace Townley Cox back in April of this year. We’ve covered the addition of “LET” or “lateral extra-articular tenodesis” to ACL reconstruction in an Overtime episode in November of 2021 and again with Dr. Brian Waterman live at the AAOS meeting back in March of this year. And, of course, our first Game Plan episode was on how to choose the best ACL graft for reconstruction, so definitely check that out.

Welcome to a very special episode of The Sports Docs Podcast. In celebration of our 101st episode, we are honoring Dr. Mark Price who passed away on August 16, 2024 following his battle with leiomyosarcoma. We wanted to pay tribute to Dr. Price, who mentored us both through our residency at Harvard. 

His death is an immeasurable loss to his family and the community. Dr. Price was the Head Team Physician and Medical Director of the New England Patriots since 2016 and a team physician for the Boston Red Sox since 2009. He was a Captain in the U.S. Navy Reserves and served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal. 

Most importantly, he was a bright example of a physician who cared deeply for his friends and family, including his wife Stephanie and their children, Henry, Julia and Sarah. The words shared by family and friends at his memorial service in Wellesley last month demonstrated a life rooted in purpose and accomplishments aligned with his values.

Mark was one of our first guests, coming onto the show for Episode #3 and #4 in March of 2021. Consistent with who he was, he was willing to take the time out of his busy schedule to help two of his mentees build something new. So, with that, we thank Mark Price for all that he taught us and the mentorship he provided to not only us, but our community.

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On today’s episode we’re continuing our discussion on shoulder instability with Dr. Mark Price, Orthopaedic Surgeon at Massachusetts General Hospital and Head Team Physician for the New England Patriots. We have 5 great articles which we discuss over two episodes that really contribute well this conversation on how to best manage shoulder instability in athletes both in-season and post-season. 

We’re very honored to have Dr. Mark Price join our discussion today. Dr. Price specializes in sports medicine, knee and shoulder surgery. He is an attending surgeon at Massachusetts General Hospital and Assistant Professor of Orthopaedic Surgery at Harvard Medical School. Dr. Price earned his MD from Harvard Medical School and PhD in Medical Physics from MIT. He completed the Harvard Combined Orthopaedic Residency Program, where Catherine and I both attended as well, and then went on to complete a fellowship in sports medicine and shoulder reconstructive surgery at Mass General. Dr. Price is Head Team Physician and Medical Director for the New England Patriots and a Team Physician for the Boston Red Sox. He is a Captain in the US Navy Reserves and has served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal for meritorious service. 

We begin with Dr. Hettrich of Brigham and Women’s Hospital who recently investigated the question “Are there racial differences between patients undergoing surgery for shoulder instability?” We’ll dive further into this topic and chat about how this impacts resident and fellow education. 

We will follow these articles up with a discussion on the surgical management of shoulder instability by reviewing two articles from the March issue of Arthroscopy. The first is a prospective randomized controlled trial titled Arthroscopic Bankart Repair With and Without Curettage of the Glenoid Edge. Desai and his team concluded that curettage of the glenoid edge reduced the incidence of postoperative recurrence of instability likely relating to improved healing of the capsulolabrum repair. Avramidis and colleagues contributed their cases on the management of recurrent anterior shoulder instability by All-Arthroscopic Modified Eden-Hybinette Procedure Using Iliac Crest Autograft and Double-Pair Button Fixation System. 

Welcome to a very special episode of The Sports Docs Podcast. In celebration of our 100th episode, we are honoring Dr. Mark Price who passed away on August 16, 2024 following his battle with leiomyosarcoma. We wanted to pay tribute to Dr. Price, who mentored us both through our residency at Harvard. 

His death is an immeasurable loss to his family and the community. Dr. Price was the Head Team Physician and Medical Director of the New England Patriots since 2016 and a team physician for the Boston Red Sox since 2009. He was a Captain in the U.S. Navy Reserves and served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal. 

Most importantly, he was a bright example of a physician who cared deeply for his friends and family, including his wife Stephanie and their children, Henry, Julia and Sarah. The words shared by family and friends at his memorial service in Wellesley last month demonstrated a life rooted in purpose and accomplishments aligned with his values.

Mark was one of our first guests, coming onto the show for Episode #3 and #4 in March of 2021. Consistent with who he was, he was willing to take the time out of his busy schedule to help two of his mentees build something new. So, with that, we thank Mark Price for all that he taught us and the mentorship he provided to not only us, but our community.

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We have 5 great articles which we discuss over two episodes that really contribute well this conversation on how to best manage shoulder instability in athletes both in-season and post-season. 

We’re very honored to have Dr. Mark Price join our discussion today. Dr. Price specializes in sports medicine, knee and shoulder surgery. He is an attending surgeon at Massachusetts General Hospital and Assistant Professor of Orthopaedic Surgery at Harvard Medical School. Dr. Price earned his MD from Harvard Medical School and PhD in Medical Physics from MIT. He completed the Harvard Combined Orthopaedic Residency Program, where Catherine and I both attended as well, and then went on to complete a fellowship in sports medicine and shoulder reconstructive surgery at Mass General. Dr. Price is Head Team Physician and Medical Director for the New England Patriots and a Team Physician for the Boston Red Sox. He is a Captain in the US Navy Reserves and has served in combat operations in Afghanistan, where he was awarded the Bronze Star Medal for meritorious service. 

The first paper is from the February issue of AJSM, titled Incidence of Posterior Shoulder Instability in the United States Military. It is a descriptive epidemiology study by Brett Owen and his team which found the incidence is higher than previously reported. Then, from the January issue of Sports Health, we feature the publication Does Functional Bracing of the Unstable Shoulder Improve Return to Play in Scholastic Athletes? Tokish and colleagues found functional bracing did not result in increased success rates when compared to no bracing in adolescent athletes.

In this episode, we’re going to continue our discussion with Dr. Rachel Frank and focus on emergency action plans as well as the sideline management of some common soccer-related orthopedic injuries.

Our conversation picks back up with a review article published in the July 2023 issue of Clinics in Sports Medicine titled “On-Field Sports Emergencies: Preparation and Readiness.” Authored by our guest today, this paper discusses the importance of an emergency action plan. The emergency action plan should include site-specific implementation, personnel who are involved, equipment, communication, transportation, and location of emergency care facilities. This paper notes that improvements should be made following self-evaluation after each on field emergency to ensure the EAP is optimal.

Then, from the upcoming issue of JAAOS next month, we review an article titled “Management of Sideline Medical Emergencies.” While most sports related injuries are benign, the potential for catastrophic injury is omnipresent and covering team physicians need to be prepared. This paper nicely highlights the acute management of a variety of medical emergencies, including cardiac arrest, respiratory failure, nervous system injury, significant bleeding, abdominal trauma and specific musculoskeletal injuries including hip and knee dislocations. The authors point out that physicians must be comfortable recognizing the signs and symptoms of life-threatening emergencies and not hesitate to rapidly escalate care and initiate an emergency response.

On today’s episode we’re focusing on concussions and emergency action plans with Dr. Rachel Frank, head team orthopaedic surgeons for the Colorado Rapids soccer team and USA Soccer Network Physician. We have some great articles for you that contribute well to our conversation on the recognition and management of concussions, as well as the importance of emergency action planning.

We’ll start off our discussion today with a review article published in the January 2019 issue of Orthopedics titled “Concussions in Sport”. Authored by our guest today, this paper dives into the current understanding of concussions, including the increasing incidence in youth sports as well as the role of orthopaedic surgeons in appropriately recognizing and managing concussions acutely.

Then, from the March 2022 issue of AJSM this, we review the publication titled “Association Between Symptom Burden at Initiation of a Graduated Return to Activity Protocol and Time to Return to Unrestricted Activity After Concussion in Service Academy Cadets.” This level 2 prospective cohort study found that cadets who endorsed greater than or equal to 2 concussion symptoms had a significant longer duration in the return to activity protocol that those who endorsed fewer symptoms. Other factors associated with a longer duration in the protocol included non varsity status, female gender, academic breaks and longer time to initiating the protocol.

We finish up our conversation today with the publication titled “Prevention of sports-related concussion in soccer: a comprehensive review of the literature” from the March 2023 issue of Annals of Medicine and Surgery. This systematic review identified several strategies that can be implemented to lower the rate of concussion in soccer. These include: Concussion education; rule and regulation changes to reduce player-to-player contact; and prevention training programs such as behavioral skills, vision training to improve sensory and anticipation, and cervical strengthening.

We are joined today by Dr. Rachel Frank, a board-certified orthopedic surgeon and sports medicine specialist. She is an Associate Professor of Orthopaedic Surgery and Director of the Joint Preservation Program at the University of Colorado School of Medicine. Dr. Frank is also a team physician for the University of Colorado Buffalos, head team orthopedic surgeon for the Colorado Rapids and a USA Soccer Network Physician. She is the editor and Chief of the Journal of Cartilage and Joint Preservation and has published over 300 peer-reviewed articles and 50 book chapters.

Welcome to the show, Dr. Frank!

On today’s episode we’re focusing on biologic augmentation of rotator cuff tears – including an algorithm for determining which patients require augmentation as well as different augmentation approaches such as extracellular matrix scaffolds and Orthobiologics.  

 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.

Research Links:
https://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/rotator-cuff-augmentation-with-dermal-allograft-improve-clinical-outcomes.pdf

https://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/bmac-augmentation-may-produce-structurally-superior-rotator-cuff-repair-2023.pdf

https://pubmed.ncbi.nlm.nih.gov/32169466/

CuffMend: https://www.arthrex.com/shoulder/cuffmend-augmentation-system