163: Ask The Sports Docs: What is the Optimal Timing of ACL Surgery

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 impact our practice. Today, we’re chatting about recurrent patellar instability, and specifically the risk of progressive cartilage damage in the setting of repeat patella dislocation events. We’re going to review an article from the August 2024 issue of AJSM titled: “The Number of Patellar Dislocation Events Is Associated With Increased Chondral Damage of the Trochlea.”This study uses data from the JUPITER cohort — which stands for: Justifying Patellar Instability Treatment by Early Results. The authors ask a clinically critical question: Does the number of dislocations matter when it comes to cartilage damage?

Welcome to another episode of Ask The Sports Docs. We get a lot questions from 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 focuses on a question that we get asked a lot on the sideline, in locker rooms and by parents of our young contact sport athletes: Do you recommend the use of Guardian Caps to decrease the risk of concussion? If you have watched NFL training camp over the last few years, you’ve seen them – Those padded shells over the helmets. They’re everywhere now in preseason practices. But are they actually preventing concussions? Or are we just seeing a visible symbol of safety without meaningful impact? That is what we are going to tackle today. And to do that, we’re going to review a recent article published in the August 2025 issue of AJSM titled “An Analysis of Guardian Cap Use and Changes in the Concussion Rate in NFL Preseason Practices From 2018 to 2023.”Find us:www.thesportsdocspod.com / www.cloganmd.comhttps://orthopedicnj.com/physicians/ashley-bassett

Today, we’re diving into a paper that reviews the long-term outcomes following arthroscopic Bankart repair and challenges some of the historical narratives around this procedure.The study that we are reviewing today is titled “Long-term Outcomes of a Contemporary Arthroscopic Bankart Repair Technique in Patients With Traumatic Anterior Shoulder Instability: A Minimum 10-Year Follow-up.” This is a minimum 10-year follow-up study looking at modern arthroscopic Bankart techniques using at least three anchors — and it asks: Are recurrence rates still as high as we’ve been taught?

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.

We get a lot questions from 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 focuses on timing of ACL reconstruction surgery. Our patients, and their families, frequently ask… how long can I wait tohave the surgery? To answer that question, we’re going to review an article, hot off the press in this month’s issue of AJSM titled “Early ACL Reconstruction Mitigates the Development of Posttraumatic Osteoarthritis in a Murine ACL Rupture Model.” Dr. Julia Retzky and colleagues at HSS sought to answer the question:Does the timing of ACL reconstruction actually matter for long-term joint health?This is a timely paper because posttraumatic osteoarthritis or “PTOA” after ACL injury remains a massive unsolved problem. Even with modern reconstruction techniques, we’re still seeing 23 to 60% rates of PTOA at 10 to 25 years post-op. Historically, the literature on timing is all over the place. Some studies suggest early ACLR may reduce PTOA risk, others show no difference. The problem isheterogeneity—different grafts, definitions of “early,” imaging versus radiographic OA, meniscal status, you name it.And that’s where this paper is interesting. It strips away a lot of clinical confounders by using a controlled murine model (or mouse model) with a noninvasive closed ACL rupture, followed by either immediate reconstruction, delayed reconstruction, or no reconstruction. And importantly, this is the first murine study using a true intra-articular ACL reconstruction model, rather than extra-articular stabilization. So this mirrors what we do clinically, with a true anatomic ACL reconstruction.So, let's dive in...

Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and I chat about a new technique or treatment option 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 tackling a topic that’s coming up more and more in clinic, locker rooms, and social media—injectable peptide therapy. Specifically, we’re going to walk through a recent AJSM narrative review by Mayfield and colleagues that serves as a primer for orthopaedic and sports medicine physicians.This is a great paper because it separates biologic plausibility from clinical reality. Patients are asking about BPC-157, TB-500, growth hormone–releasing peptides — often convinced these are regenerative breakthroughs — while the evidence base is still extremely limited. So, let's get started!Links:https://pubmed.ncbi.nlm.nih.gov/41476424/www.cloganmd.com https://orthopedicnj.com/physicians/ashley-bassett

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 howthis data will impact our practice.Today, we’re talking about one of the hottest topics in sports medicine — platelet rich plasma for lateral epicondylitis. If you’ve ever wondered why PRP seems to work great for some patients… and not at all for others — this paper gives us a compelling answer.We’re reviewing an article from the January 2025 issue of AJSM titled “Platelet Concentration Explains Variability in Outcomes of Platelet-Rich Plasma for Lateral Epicondylitis.” The key takeaway from the systematic review and meta-analysis is that PRP isn’t one standard treatment. The dose matters and platelet concentration may explain most of the conflicting data we’ve seen over the years.

Today’s episode is going to focus on two common athletic shoulder injuries that we see in American football – traumatic anterior shoulder dislocations and acromioclavicular joint injuries. We’ll dive into the acute on-field management followed by treatment thereafter, including nonoperative and surgical treatment options. We are joined today by Dr. Kevin Farmer, a Professor of Orthopaedic Surgery at the University of Florida, a team physician for the University of Florida gators and the editor of the “In-Season Management of Football Injuries” textbook. He is also a past president of the Florida Orthopaedic Society and the Florida Alliance for Sports Medicine, and a board member for AAOS and the Southern Orthopaedic Association. So, without further ado, let’s get to the Field House!

Our conversation picks back up with an article titled “Mental toughness in surgeons: Is there room for improvement?” This paper was published in the December 2019 issue of the Canadian Journal of Surgery and evaluates mental toughness among general surgery residents and staff surgeons using the Mental Toughness Index. The authors found that staff surgeons score significantly higher across all domains—including self-belief, attention and emotion regulation, optimism, buoyancy, and adversity capacity—than residents. Survey data from three Canadian academic centers showed that although both groups use some techniques to manage stress, staff rely on these strategies more frequently, and both residents and staff express strong interest in further developing mental toughness skills. The study also identifies gender differences, with men scoring higher in attention and emotion regulation. The authors highlight the lack of formal mental toughness training in surgical education despite evidence from athletics and paramilitary fields supporting structured psychological skills training. Then, from this month’s issue of the Journal of the Association for Surgical Education, we review an article titled “Do expert surgeons use mental skills to improve their surgical performance?” This study explores whether expert pancreaticoduodenectomy (Whipple) surgeons use mental skills during complex operations and how these strategies map onto known performance psychology frameworks. Through structured interviews with 15 internationally recognized high-volume surgeons, the authors found that all participants consistently employ cognitive techniques—including preoperative mental rehearsal, deep task focus, emotional regulation, maintaining situational awareness, and reframing unexpected events—to optimize performance under pressure. Surgeons described entering a “flow-like” state during critical steps, relying on deliberate calmness, structured routines, and controlled breathing to manage stress and maintain precision. These mental skills closely parallel those used in elite athletes and high-stakes professions, suggesting that expert surgical performance is supported not only by technical mastery but also by refined psychological strategies. The authors argue that mental skills training could be formally integrated into surgical education to help trainees develop the cognitive tools that expert surgeons intuitively use.  

On today’s episode we’re focusing on mindset skills, emotional regulation and mental toughness and feel that orthopedic surgery with Dr. Winston Gwathmey, an orthopedic surgeon at UVA. We start off our discussion today with an article from the September 2022 issue of the Journal of Surgical Research titled “Emotional Regulation in Surgery: Fostering Well-Being, Performance, and Leadership.” This article reviews the critical role of emotional regulation as a trainable cognitive skill that enhances surgical well-being, technical performance, and career longevity. It highlights how burnout and stress are pervasive in surgery and argues that individual-level emotional regulation training—paired with necessary system-level changes—can help surgeons cope with the inherent stressors of operative practice, complications, and high-stakes decision-making. Through multiple institutional case studies, the paper illustrates practical strategies for implementing emotional regulation curricula within surgical training, including mindfulness-based programs, mental skills training, and broader well-being initiatives. Across all examples, successful adoption hinges on leadership support, stakeholder buy-in, iterative design, and embedding training into existing educational infrastructure. Ultimately, the authors advocate for an integrated national curriculum that combines cognitive skills training, application to technical performance, and preparation for independent practice to promote surgeon resilience and sustainable careers.Then, from the July 2021 issue of the Journal of Surgical Research, we review an article titled “Mastering Stress: Mental Skills and Emotional Regulation for Surgical Performance and Life.” This article reviews how mental skills training and emotional regulation can enhance surgeons’ technical performance, well-being, and career longevity by mitigating the negative effects of stress. It explains the physiological and cognitive mechanisms of stress and highlights how chronic stress impairs decision-making and increases burnout. The authors present evidence that mindfulness, cognitive training, and mental rehearsal improve surgical skill acquisition, stress resilience, executive function, and performance under pressure. The authors go on to outline common elements of successful programs. They also discuss barriers to implementation and propose a framework for integrating mental skills training across surgical education from basic instruction to independent practice. They ultimately advocate for the development of a national mental skills curriculum to promote surgeon well-being, reduce errors, strengthen leadership and teamwork, and improve patient and systems-level outcomes.We are joined today by Dr. Winston Gwathmey, a board-certified orthopedic surgeon and a Professor of orthopedic surgery at the University of Virginia.  He is the Medical Director for the Sports Medicine Clinic at UVA and is also one of the team physicians for both UVA and James Madison University. Dr. Gwathmey is the Program Director for the Orthopedic Surgery Residency Program at UVA and is very passionate about educating the next generation of orthopedic surgeons.  He has won numerous teaching awards including the Mulholland Teaching award, the Charles W. Miller Resident Teaching award, and the Dean’s Award for Excellence in Medical Student Teaching. So, we’re very excited to have him on today to talk about this important topic.