Ep. 120 Understanding Shoulder Embolization: Techniques & Patient Outcomes with Dr. Anuj Malhotra and Dr. Ahmed Farag

Why is MSK embolization taking off so fast? For patients with knee osteoarthritis who have tried everything short of surgery, genicular artery embolization (GAE) fills a gap few other treatments can, backed by a growing body of evidence from around the world that it is safe and reproducible. On this episode of the BackTable 2026 MSK Creator Weekend™, Dr. Osman Ahmed of Joint and Vascular Institute moderates a conversation with Dr. Anuj Malhotra of NYU Langone Hospital Long Island and Dr. Ally Baheti of Sound Vascular & Vein about the work that happens outside the procedure room. They review the evidence they rely on, what a recent sham-controlled trial means for the field, how they quote success to patients, why the minimal clinically important difference in pain medicine reframes GAE outcomes, and what the new SIR position statement means for physicians offering the procedure. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Guerbet. --- Timestamps 00:00 - Introduction01:33 - The GAE Evidence Base and Quoting Success Rates04:50 - MCID, Placebo, and the van Zadelhoff Sham Trial10:13 - The SIR Position Statement on GAE13:52 - Training, Adoption, and Standardizing Technique21:21 - Regulatory and Legal Considerations26:33 - Standard of Care and Medicolegal Risk30:26 - Rheumatology Referrals and Society Guidelines32:49 - Orthopedic Partnerships, Post-TKA Pain, and Hemarthrosis38:33 - Documentation and Practice Operations Pearls41:15 - Bilateral Knees and Patient Expectations43:44 - Closing Remarks --- More about this episode The group then explores where that growth is happening, from office-based labs to academic centers, how standardized endpoints and temporary embolics could make the procedure more reproducible, and when an innovative procedure can be considered standard of care. They also discuss referrals from rheumatology and orthopedics, the path toward ACR and AAOS guidelines, and pain after knee replacement and hemarthrosis as a bridge to orthopedic partners. Dr. Ahmed Farag of Advanced Vascular Institute drops in with documentation pearls, and the episode closes on timing treatment of the second knee and setting patient expectations. --- Resources Ahmed O, et al. Society of Interventional Radiology Position Statement on Genicular Artery Embolization for Symptomatic Knee Osteoarthritis. J Vasc Interv Radiol. 2026https://doi.org/10.1016/j.jvir.2026.108803 van Zadelhoff TA, et al. Long-term outcomes of genicular artery embolization for knee osteoarthritis: 12-month efficacy and secondary outcomes from a randomized sham-controlled clinical trial. Eur Radiol. 2026https://doi.org/10.1007/s00330-026-12505-8 Bagla S, et al. Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis. J Vasc Interv Radiol. 2022https://doi.org/10.1016/j.jvir.2021.09.019 Little MW, et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS) Using Permanent Microspheres: Long-Term Results. Cardiovasc Intervent Radiol. 2024https://doi.org/10.1007/s00270-024-03752-7 Dr. Anuj Malhotra, NYU Langone Healthhttps://nyulangone.org/doctors/1629369657/anuj-malhotra Dr. Ally Baheti, BackTable contributor pagehttps://backtable.com/shows/vi/contributors/dr-aparna-baheti Dr. Osman Ahmed, BackTable contributor pagehttps://www.backtable.com/shows/vi/contributors/dr-osmad-ahmed Dr. Ahmed Farag, BackTable contributor pagehttps://www.backtable.com/shows/msk/contributors/dr-ahmed-farag --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Heel pain that has outlasted stretching, orthotics, and physical therapy may come down to a few small abnormal vessels, and a growing number of interventional radiologists are now treating them with embolization. On this episode of the BackTable 2026 MSK Creator Weekend™, Dr. Osman Ahmed and Dr. Anuj Malhotra join host Dr. Ally Baheti to discuss embolization for plantar fasciitis and insertional Achilles tendinopathy. They describe the classic patient, the windlass test, point-of-care ultrasound to track fascia thickness, and how they counsel patients when the evidence is early and a second session is common. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Guerbet. --- Timestamps 00:00 - Introduction01:09 - Plantar Fasciitis: Patient Profile, Exam, and Ultrasound04:56 - Antegrade Femoral Access and Embolic Preparation07:45 - Sheathless Microcatheters Versus Posterior Tibial Access11:13 - Success Rates and Counseling Patients14:53 - Follow-Up, Repeat Treatment, and Chronic Symptoms16:46 - Achilles Tendinopathy: Indications and Workup19:58 - Achilles Arterial Supply and Case Review24:22 - Contrast Choice for Ethiodized Oil Emulsions27:12 - Permanent, Temporary, and Resorbable Embolics31:38 - Plantar Fasciitis Case and a Fluoroscopy-Free Technique36:03 - Patients with PAD and Closing Remarks --- More about this episode The conversation then turns to technique: antegrade femoral access with a base catheter versus a sheathless 1.7 French microcatheter, why a posterior tibial puncture can take five minutes or 45, how they mix imipenem-cilastatin, and an Achilles case treated with an ethiodized oil emulsion taken to stasis under live visualization. Drop-in appearances from Dr. Kavi Krishnasamy and Dr. Ahmed Farag spark a lively exchange on contrast choice, permanent versus temporary embolics, and what resorbable agents may change. The episode closes with a plantar fasciitis case, a fluoroscopy-free needle technique from a physician in Japan, and why the group holds back in patients with peripheral artery disease. --- Resources Sasaki T, et al. Clinical results of ultrasound-guided intra-arterial embolization targeting abnormal neovessels for plantar fasciitis: 66 cases with up to 4 years of follow-up. Foot Ankle Surg. 2025https://doi.org/10.1016/j.fas.2024.07.009 Madkhali R, et al. Sheathless microcatheter: a new approach for musculoskeletal arterial embolization. CVIR Endovasc. 2026https://doi.org/10.1186/s42155-026-00657-z Sapoval M, et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial. Diagn Interv Imaging. 2024https://doi.org/10.1016/j.diii.2023.12.003 Dr. Anuj Malhotra, NYU Langone Healthhttps://nyulangone.org/doctors/1629369657/anuj-malhotra Dr. Ally Baheti, BackTable contributor pagehttps://backtable.com/shows/vi/contributors/dr-aparna-baheti Dr. Osman Ahmed, BackTable contributor pagehttps://www.backtable.com/shows/vi/contributors/dr-osmad-ahmedDr. Venkatesh (Kavi) Krishnasamy, BackTable contributor page https://backtable.com/shows/vi/contributors/dr-venkatesh-krishnasamyDr. Ahmed Farag, BackTable contributor page https://www.backtable.com/shows/msk/contributors/dr-ahmed-farag --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

For patients with frozen shoulder who have failed injections and months of physical therapy, can embolization offer relief when there are no good surgical options left? On this episode of the BackTable 2026 MSK Creator Weekend™, Dr. Anuj Malhotra of NYU Langone Hospital Long Island and Dr. Ahmed Farag of Advanced Vascular Institute in Panama City, Florida, join host Dr. Kavi Krishnasamy to examine shoulder embolization for adhesive capsulitis, osteoarthritis, and chronic rotator cuff tendinopathy. They cover the workup, how long to persist with conservative care, who makes the ideal candidate, and why the evidence outside adhesive capsulitis is still thin. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Guerbet. --- Timestamps 00:00 - Introduction01:42 - Conditions Treated and Patient Workup06:17 - Conservative Therapy Before Embolization09:22 - Patient Selection and the Ideal Candidate12:25 - The Data Gap Beyond Adhesive Capsulitis15:23 - Radial Access and Device Setup17:27 - Target Vessels and Embolic Choice21:36 - Collaterals, Cone Beam CT, and Endpoints26:58 - Post-Procedure Care and Follow-Up30:49 - Shoulder Embolization and the Rotator Interval32:52 - Complications, Efficacy, and Durability36:39 - Case Review43:09 - Future Directions and Closing Remarks --- More about this episode The conversation then moves into technique: ipsilateral radial access, shapeable microcatheters for a high radial takeoff, which circumflex humeral, thoracoacromial, and suprascapular branches to interrogate, and why both guests use imipenem-cilastatin and prune rather than push to stasis. They discuss caution near the suprascapular origin, collateral supply, cone beam CT, physical therapy, follow-up, and repeat treatment, along with a recent study showing less rotator interval inflammation on MRI after embolization. The episode closes with case images, including a firefighter who could raise his arm right after treatment for the first time in five years, and a look at where shoulder embolization may stand in five years. --- Resources Liang KW, et al. Clinical and Radiological Outcomes of Transarterial Embolization for Adhesive Capsulitis. Korean J Radiol. 2025https://doi.org/10.3348/kjr.2024.0883 Allaw S, Khabaz K, Yu Q, Ahmed O. Transarterial Embolization for Refractory Adhesive Capsulitis and Related Tendinopathies: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol. 2026https://doi.org/10.1016/j.jvir.2025.10.027 Dr. Anuj Malhotra, NYU Langone Healthhttps://nyulangone.org/doctors/1629369657/anuj-malhotra Dr. Ahmed Farag, BackTable contributor pagehttps://www.backtable.com/shows/msk/contributors/dr-ahmed-farag Dr. Kavi Krishnasamy, BackTable contributor pagehttps://backtable.com/shows/vi/contributors/dr-venkatesh-krishnasamy --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Today’s fifty-year-old deadlifts, plays pickleball, and does yoga. When pain starts at the base of her thumb and the X-ray looks normal, it is easy to call it tendinitis and miss early arthritis. On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Jamie Alexander and Dr. Daniel Torres, orthopedic hand surgeons at Houston Methodist, to discuss how they diagnose and manage thumb carpometacarpal (CMC) osteoarthritis in active and younger patients. They explore why early disease often gets missed, which metabolic and inflammatory workups matter, and how a multidisciplinary team helps patients get the right care. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction07:02 - Prevalence and Underdiagnosis of Thumb CMC Arthritis13:56 - Instability in Younger Active Patients15:34 - Metabolic and Inflammatory Workup21:27 - Multidisciplinary Care27:22 - Limits of Trapeziectomy and the Move to Implant Arthroplasty36:43 - Conservative Management45:54 - Injections and Bracing50:21 - Candidate Selection and Bone Health55:18 - Surgical Pearls and Revision Options57:58 - Closing Remarks --- More about this episode The conversation moves from conservative management, such as splints, hand therapy, grip changes, and injections, to surgical options. Dr. Torres and Dr. Alexander explain when to consider dual mobility thumb CMC arthroplasty for patients with good bone stock, how trapeziectomy compares, and why setting realistic expectations about function and recovery is so important. They share pearls for picking candidates, protecting bone health, and keeping surgical options open for future revisions, closing with advice for sports medicine physicians and therapists about recognizing instability and early arthritis before it progresses. --- Resources American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020https://doi.org/10.1002/acr.24131 Own the Bone, the American Orthopaedic Association bone health and fragility fracture prevention programhttps://www.ownthebone.org/ Dr. Daniel Torres, Houston Methodist physician profilehttps://www.houstonmethodist.org/doctor/daniel-torres/ Dr. Jamie Alexander, Houston Methodist physician profilehttps://www.houstonmethodist.org/doctor/jamie-j-alexander/ Houston Methodist Orthopedics & Sports Medicine at Clear Lakehttps://www.houstonmethodist.org/orthopedics/locations/clearlake/ Dr. Larry Balle, BackTable contributor pagehttps://www.backtable.com/shows/msk/contributors/dr-larry-balle --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

When a college basketball player asks when he can go back in the game, the person making the call is rarely wearing a white coat. On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Matt Townsend, ATC, head athletic trainer for Arkansas men’s basketball, for an inside look at basketball medicine from the training room. They walk through the basketball calendar, common injuries, and the return-to-play decisions that happen in real time, including movement screening, tendinopathy rehab, vitamin D supplementation, and the impact of name image and likeness (NIL) on athlete advocacy. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:21 - A Day in the Life of a Basketball Athletic Trainer12:47 - Common Basketball Injuries16:20 - Training Load and Recovery Education19:44 - Return to Play Philosophy25:45 - Name Image and Likeness and the People Around the Athlete28:59 - Taping and Bracing Decisions35:11 - Anterior Knee Pain and Tendinopathy Management39:08 - Vitamin D and Bone Health45:50 - Agents, Pressure and Athlete Advocacy51:14 - Communication With Coaching Staff55:20 - Advice for Future Athletic Trainers1:00:36 - Closing Remarks --- More about this episode They walk through the basketball year from pre-participation physicals and movement screening to the injuries that define the sport, like lateral and high ankle sprains, MCL injuries, anterior knee pain, and stress fractures. Townsend shares how return-to-play decisions are made in real time, balancing objective force plate data, player feedback, and the demands of coaches and agents in the NIL era. The conversation covers the shift away from rest and ice toward progressive tendon loading, how quad weakness explained a player’s chronic knee pain, and how vitamin D protocols are managed for indoor athletes. They discuss bracing and taping as negotiations, the realities of injury prevention and load management, and why pre-participation screens can reveal more than a clinic visit. The episode closes with insights on athlete advocacy, team communication, and the reminders that even elite athletes are often just eighteen years old. --- Resources Matt Townsend, ATC, Head Athletic Trainer, Men's Basketball, University of Arkansashttps://arkansasrazorbacks.com/support-staff/matt-townsend/ University of Arkansas Sports Medicine staffhttps://arkansasrazorbacks.com/sports-medicine/ Dr. Larry Balle, BackTable contributor pagehttps://www.backtable.com/shows/msk/contributors/dr-larry-balle Dr. Larry Balle, Houston Methodist physician profilehttps://www.houstonmethodist.org/doctor/larry-balle BackTable Bone and Sports Ep. 100, Return to Play Post-Injury: Balancing Risk and Recovery, with Dr. Andy Glidewellhttps://www.backtable.com/shows/msk/podcasts/100/return-to-play-post-injury-balancing-risk-recover BackTable Bone and Sports Ep. 103, Sports Medicine and Lifestyle Medicine Intersections, with Dr. Megan Ferderberhttps://www.backtable.com/shows/msk/podcasts/103/sports-medicine-lifestyle-medicine-intersections Andrew M. Schween, DPT, physical therapist, UAMS Healthhttps://uamshealth.com/provider/andrew-m-schween Barrie Steele, athletic training, University of Idahohttps://govandals.com/sports/general/roster/barrie-steele/1205 National Athletic Trainers' Associationhttps://www.nata.org/ Kaminski TW, et al. National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. J Athl Train. 2013https://doi.org/10.4085/1062-6050-48.4.02 --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Why is rehab for the overhead athlete so nuanced—and how much of the answer is hidden below the shoulder? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Corbin Hedt, PT, DPT, SCS, CSCS, to explore upper extremity rehabilitation, fellowship training in sports physical therapy, and the evidence behind advanced throwing programs. Hedt breaks down the kinetic chain from the ground up, explains why only a few accredited fellowships exist for upper extremity athletes, and shares why modern rehab is all about proximal stability leading to distal performance. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction07:43 - Nuances of Upper Extremity Rehab14:22 - Upper Extremity Fellowship Overview21:12 - Barriers to Fellowship Expansion28:15 - Kinetic Chain in Throwing33:03 - Core Control and Movement Quality37:27 - Evaluating the Softball Pitcher44:24 - Blood Flow Restriction Training49:42 - BFR Protocols and Study Findings56:06 - Injury Risk and Workload Research1:03:37 - Imaging Findings in Asymptomatic Throwers1:07:36 - Curveballs, Velocity and Volume1:11:01 - Final Takeaways and Closing Remarks --- More about this episode The discussion covers clinical decision-making for common injuries like rotator cuff tendinopathy and UCL injury, the use of blood flow restriction therapy, and how evaluation and rehab protocols are evolving with new research. They dive into the mechanics of throwing, movement quality, imaging findings in asymptomatic athletes, and what really drives youth arm injuries. The episode closes with practical pearls for trainers and clinicians, including the dynamometer trick for patient buy-in, and why looking at the whole athlete, not just the pain, matters most. --- Resources Lambert BS, Hedt C, Ankersen JP, et al. Rotator cuff training with upper extremity blood flow restriction produces favorable adaptations in Division IA collegiate pitchers: a randomized trial. J Shoulder Elbow Surg. 2023;32(6):e279-e292.https://doi.org/10.1016/j.jse.2023.02.116 Intelangelo L, Lassaga I, Gonzalo E, et al. Is Strength the Main Risk Factor of Overuse Shoulder Injuries? A Cohort Study of 296 Amateur Overhead Athletes. Sports Health. 2025.https://doi.org/10.1177/19417381241298287 Bowen L, Gross AS, Gimpel M, Bruce-Low S, Li FX. Spikes in acute:chronic workload ratio (ACWR) associated with a 5-7 times greater injury rate in English Premier League football players: a comprehensive 3-year study. Br J Sports Med. 2020;54(12):731-738.https://pmc.ncbi.nlm.nih.gov/articles/PMC7285788/ Erickson BJ, Camp CL, D'Angelo J, et al. Musculoskeletal Findings of the Major League Baseball Combine: A Description of the "Normal" Prospective Professional Baseball Player. Am J Sports Med. 2025.https://doi.org/10.1177/03635465251339773 Fleisig GS, Andrews JR, Cutter GR, et al. Risk of Serious Injury for Young Baseball Pitchers: A 10-Year Prospective Study. Am J Sports Med. 2011;39(2):253-257.https://doi.org/10.1177/0363546510384224 Ready To Throw, the free throwing program, rehab protocol and pitching mechanics repository https://www.readytothrow.com/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Which athletes actually carry the highest cardiac risk, and is the sideline ready to act? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Nick Larson, emergency medicine physician, to discuss cardiac risk, screening, and sideline response for athletes of all ages. They discuss which athletes are at highest risk, what preparticipation screening does (and does not) catch, and how a working relationship with cardiology and a strong emergency action plan can change outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction05:39 - Emergency Department Arrival Priorities10:13 - AED Access and Arrest Incidence15:33 - Cardiac Risk Patterns by Age and Sport25:12 - Preparticipation Physical Limitations29:14 - Commotio Cordis and Blunt Chest Injury39:37 - Hypertrophic Cardiomyopathy in Athletes45:56 - Exertional Syncope Workup53:00 - Myocarditis and Viral Risks01:03:44 - Ischemic Events in Older Athletes01:09:39 - AED Use and Emergency Action Plans01:17:16 - Rapid Fire Takeaways01:21:15 - Closing Remarks --- More about this episode The conversation covers the diagnosis and management of commotio cordis, hypertrophic cardiomyopathy, myocarditis, and ischemic events in both young and older athletes. Dr. Larson shares his approach to exertional syncope, red flags for on-field collapse, the practical realities of AED use, and why follow-up is critical after the initial event. The episode closes with advice on team drills, the importance of rapid decision-making, and why “time is tissue” when cardiac emergencies strike on the field or sideline. --- Resources Petek BJ, Churchill TW, Moulson N, et al. Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study. Circulation. 2024. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.0659082024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy. Circulation. 2024. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001250 Revisiting Commotio Cordis: Novel Insight Into Clinical Variability, Diagnosis, Epidemiology, and Prevention. Journal of the American Heart Association. 2025. https://www.ahajournals.org/doi/10.1161/JAHA.125.045115 National Athletic Trainers' Association Position Statement: Emergency Action Plan Development and Implementation in Sport. Journal of Athletic Training. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11220767/ Life in the Fast Lane (LITFL), recommended on air by Dr. Larson https://litfl.com/ EMCrit Project, recommended on air by Dr. Larson https://emcrit.org/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Could platelet poor plasma be the missing link in muscle injury recovery? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Ryan Kruse, a sports medicine physician at the University of Iowa and team physician for the Iowa Hawkeyes and US Soccer, to explain what platelet poor plasma actually contains and why it has become his primary treatment for acute muscle injury. They discuss how PPP differs from PRP, the challenges of defining the optimal dose, and the growing interest in exploring the bioactive components that make PPP worth keeping. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction05:01 - Defining Platelet Poor Plasma11:22 - Volume, Dosing, and Fibrosis vs Regeneration19:00 - Choosing PPP by Injury Grade and Treating Chronic Scar25:30 - Blood Draw Volume, Kit Selection and Spin Speed32:12 - Filters and Protein Concentrate38:19 - Building a PRP Lab and Concentration Questions43:26 - Keeping PRP Away from Muscle Injury53:05 - Ultrasound and Return-to-Play58:46 - Recovery Timelines and Recurrence01:06:18 - The Evidence Gap in Orthobiologics01:11:37 - Osteoarthritis, Intra-Articular Use and Replacing Cortisone01:21:26 - Closing Thoughts --- More about this episode The episode dives deeper into which injuries are best suited for PPP, when surgery is still necessary, and why PRP may actually increase fibrosis in primary muscle tears. Drs. Kruse and Balle compare kit selection, spin speed, filter pore size, and blood draw volumes, and discuss how to use ultrasound to guide both injury assessment and safe return to play. They also tackle the logistics of building a PRP lab, the use of PPP in osteoarthritis as a cortisone alternative, return-to-play timelines, recurrence risk, and the need for higher-level randomized data to move the field forward. --- Resources Platelet-Poor Plasma for the Treatment of Acute Hamstring Muscle Injuries in Collegiate Football Athletes: A Cohort Studyhttps://pubmed.ncbi.nlm.nih.gov/39576137/ Platelet-Poor Plasma: A Novel Treatment for Acute Quadriceps Muscle Injurieshttps://pubmed.ncbi.nlm.nih.gov/42037020/ Platelet-Poor Versus Platelet-Rich Plasma for the Treatment of Acute Thigh Muscle Injurieshttps://pubmed.ncbi.nlm.nih.gov/38958567/ Platelet-Poor Plasma for the Treatment of a Quadriceps Muscle Tear in a Division I Football Athletehttps://pubmed.ncbi.nlm.nih.gov/39888358/ BackTable MSK Ep. 102: Understanding PRP and Orthobiologics for Musculoskeletal Medicinehttps://www.backtable.com/shows/msk/podcasts/102/understanding-prp-orthobiologics-for-musculoskeletal-medicine --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

When does a knee cartilage defect need more than a clean-up, and how do you decide on the best repair? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes orthopedic sports surgeon Dr. Sachin Allahabadi for a practical tour of cartilage restoration. Together they explain what articular cartilage is, why it rarely heals on its own, and how to distinguish focal chondral defects from diffuse arthritis. The discussion covers the full spectrum of treatment, from chondroplasty and microfracture to cell-based restoration, osteochondral autograft, and allograft transplantation. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:39 - Cartilage Structure and Focal Defects13:37 - Cartilage Healing Biology16:51 - Evolution of Cartilage Repair Techniques24:04 - Candidate Selection and Defect Characteristics29:06 - Bone Marrow Edema and Offloading33:46 - Osteochondral Autograft and Donor Sites39:18 - Alignment, Meniscus, and Ligament Correction45:31 - Cell Based Repair Indications and Procedure Durability51:11 - Defect Sizing and Allograft Matching59:29 - Rehabilitation and Orthobiologic Graft Integration01:09:59 - Takeaways and Misconceptions01:14:21 - Closing Remarks --- More about this episode Dr. Allahabadi discusses how to select the right patients for different cartilage procedures, including how defect size, alignment, meniscus status, and ligament stability all factor into the decision. They review advances in cartilage repair techniques, the process of storing and matching fresh donor tissue, and the use of bone marrow aspirate concentrate to promote graft integration. The conversation also addresses the durability of allografts in real-world practice, setting realistic expectations with patients, the importance of referral to high-volume surgeons, and why thoughtful clinical decision-making is often more challenging than the procedure itself. --- Resources Allahabadi S, Quigley R, Frazier L, Joyce K, Cole BJ. Outcomes and Return to Sport After Knee Osteochondral Allograft Transplant in Professional Athletes. Orthop J Sports Med. 2024.https://pubmed.ncbi.nlm.nih.gov/38410170/ Elias TJ, Allahabadi S, Haneberg EC, et al. Osteochondral Allograft Reaming Significantly Affects Chondrocyte Viability. Am J Sports Med. 2024. https://pubmed.ncbi.nlm.nih.gov/39186448/ Allahabadi S, Haneberg EC, Elias TJ, McMorrow KJ, et al. Osteochondral Allografts: Pearls to Maximize Biologic Healing and Clinical Success. Arthrosc Tech. 2023. https://pubmed.ncbi.nlm.nih.gov/38196872/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Why do overuse injuries keep coming back even after the pain settles down? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Grant Ralston to define overuse injury as a load-related disorder, and to work through its causes, diagnosis, and management in both pediatric and adult athletes. They review common conditions like bone stress injuries, chronic tendinopathy, plantar fasciitis, and apophysitis, and discuss why year-round play, early sport specialization, social media, and name, image, and likeness (NIL) pressures are making these cases more frequent in clinic. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction06:22 - Defining Overuse Injuries08:31 - Why Overuse Injuries Are Increasing15:33 - Corticosteroid Injections in Chronic Tendinopathy22:05 - Relative Rest and Cross-Training26:28 - Lower Extremity Overuse Injuries34:40 - Gluteal Tendinopathy and Greater Trochanteric Pain39:17 - Hydrodissection and Prolotherapy51:37 - Upper Extremity Overuse Injuries56:05 - Early Sport Specialization and Time Off01:00:39 - Training Load, Sleep, and Nutrition01:08:20 - Imaging, Physical Therapy, and Treatment Options01:15:40 - Final Takeaways and Wrap Up --- More about this episode The conversation moves through the lower and upper extremities, addressing Achilles tendinopathy, medial tibial stress syndrome, gluteal tendinopathy, patellofemoral pain, and rotator cuff tendinopathy, all with a focus on underlying biomechanical deficits. Drs. Ralston and Balle dissect the pros and cons of repeated corticosteroid injections, explore alternatives like ketorolac, prolotherapy, PRP, hydrodissection, and shockwave, and clarify when imaging should and shouldn’t drive decisions. They close with tips on relative rest, scheduling breaks from sport, optimizing sleep and nutrition, and building strong referral networks to support patient recovery. --- Resources Fredericson M, et al. Tibial Stress Reaction in Runners: Correlation of Clinical Symptoms and Scintigraphy with a New Magnetic Resonance Imaging Grading System. Am J Sports Med. 1995 https://journals.sagepub.com/doi/10.1177/036354659502300418 Taheri P, et al. Comparison of Subacromial Ketorolac Injection versus Corticosteroid Injection in the Treatment of Shoulder Impingement Syndrome. J Res Pharm Pract. 2017 https://pubmed.ncbi.nlm.nih.gov/29417082/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app