The OJSM Hot Corner

Calcific tendinitis is a common, painful condition that can cause intense pain and dysfunction of the shoulder. However, in spite of its commonality, there is much we do not understand about it including why it occurs. One thing we do know is that, in most cases, the calcium will just go away, however we do not have any way to predict how long that may take to occur. A variety of treatment options...

Lateral Extra-Articular Tenodesis (LET) has become an accepted adjunct to standard anterior cruciate ligament reconstruction to help provide additional rotational stability to the knee and lower the risk of re-tears. The classic situation to perform this surgery would be at the same time as an ACL reconstruction in a patient with a high degree of rotational instability or in a patient who has alre...

The importance of the mind-body connection in Sports Medicine is well-established and continues to be a hot topic of study and conversation. This connection between psychological and physical is especially noted with ACL injuries, surgery, and rehabilitation. Dr. Brian M. Devitt, MD, PhD from UPMC Sports Surgery Clinic in Dublin, Ireland joins us to discuss his team's work examining psychological...

The correct treatment for rotator cuff tears remains a matter of debate. The varying characteristics of cuff tears – symptomatic versus asymptomatic, tear size, tendon quality, the presence of fatty atrophy, etc. – makes generalizations about the best treatment approach difficult. One thing shoulder specialists agree on is that tear enlargement is problematic. A cuff tear that enlarges may turn a...

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 saf...

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 e...

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'...

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.

Tommy John is a name associated with the game of baseball not just because of the pitcher's Hall of Fame career, but because it has become synonymous with a devastating injury to the Ulnar Collateral Ligament of the elbow that continues to plague baseball pitchers often resulting in reconstructive surgery colloquially known as the Tommy John Surgery. Multiple risk factors have been postulated to p...

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...

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 mul...

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-standa...

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...

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 autog...

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 a...

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...

Meniscus tears have historically been treated with arthroscopy. However, compelling data has shown that this surgery does not work for degenerative meniscus tears. Physical therapy, conversely, has been shown to be a more effective measure for the degenerative meniscus tear, and is a more reasonable first-line measure compared to arthroscopic menisectomy. Still, the public's perception, guided by...

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 transl...

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 ex...

Historically, ACL repair resulted in poor outcomes and this procedure fell out of favor while ACL reconstruction became the gold-standard surgical approach for a torn ACL. Recently, thanks in part to the advent of more modern techniques, ACL repair has regained interest in the Sports Medicine community as a potentially viable option in certain situations that may provide advantages in comparison t...

One of the long-standing assumptions in Sports Medicine is that anterosuperior labral variants including the Buford Complex and Sublabral Foramen are non-pathologic, normal anatomic variants of the shoulder joint.   But is this true?  Dr. Eric Edmonds from Rady Children's Hospital in San Diego challenges this assumption and our accepted practice of ignoring these findings when observed arthroscopi...

Failure of shoulder stabilization surgery continues to plague contact athletes. Football players are thus at high risk of a repeat shoulder dislocation even after a well-done surgery to stabilize that joint. Such is the nature of a sport with violent and unpredictable collisions. Dr. Andrew Pennock, MD and his team at Rady Children's in San Diego investigated the outcomes for high school football...

Second ACL injuries, whether it be a tear of the ipsilateral ACL graft or the native contralateral ACL, continue to be of great concern to patients and sports medicine practitioners particularly during the first 1-2 years after surgery. Sending a patient back too early to play is widely considered a major risk factor for this 2 nd injury. As health care providers, we take pride in the joy and conf...

The right surgery for recurrent patellofemoral instability remains a topic of controversy.  While medial patellofemoral ligament reconstruction (MPFLr) is the standby surgical procedure for this condition, many adjuncts including tibial tubercle osteotomy (TTO) are performed concurrently with the hope of improving the chances of success.  Historically, a tibial tubercle-trochlear groove (TT-TG) di...

Despite our technological advances in ACL surgery, the rehabilitation period remains challenging, particularly when it comes to lingering quadriceps weakness. Blood Flow Restriction (BFR) Therapy has been introduced as a potential means to speed up the return of quad function. We welcome Dr. Kelechi Okoroha from the Mayo Clinic to discuss his high-level study, " Effects of Perioperative Blood Flow...