148: The Injury Report: Turf Toe / Cincinnati Bengals QB Joe Burrow

Today we’re breaking down a common but sometimes career-altering knee injury in professional football – the meniscus tear. We’ll cover how often these happen in the NFL, how players present, what treatment choices look like, timelines for returning to play, and critically – how meniscal injury affects performance and career lengthBut first, a quick refresher: The menisci are two C-shaped fibrocartilage discs in each knee (medial and lateral) that help distribute load, absorb shock, and stabilize the joint. Losing meniscal tissue – through a tear and subsequent meniscectomy – changes knee biomechanics and increases contact stresses on articular cartilage, which can lead to earlier degenerative change. This biomechanical role is why meniscal management matters so much for athletes.So how common are meniscus tears in the NFL or NFL prospects? Well, that depends on what study you read and how that study chose to measure the prevalence of meniscus tears. Listen to this episode to get the full scoop on how these athletes perform in the setting of meniscus injury.Reference:Dr. Jorge Chahla (friend of the show) in 2018 in AJSM used MR imaging data to determine the prevalence of prior meniscal injury.  This study of approximately 2,000 NFL Scouting Combine participants from 2009–2015 found that 20% of players had a prior meniscus injury. So, this is the more frequently sided statistic.This study also went on to discuss the impact of partial meniscectomy on player performance and career length 

On each of these mini episodes, Catherine and I 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 discussing a brand-new paper hot off the press titled: “Predictors of Tunnel Widening After Anterior Cruciate Ligament Reconstruction” published in the November 2025 issue of AJSM. This study digs into why femoral and tibial tunnels enlarge after ACL reconstruction with hamstring grafts – and what anatomic and surgical factors might be driving it.Tunnel widening matters: it impacts revision surgery, graft stability, and in some cases early failures. So, this is a clinically meaningful topic. We will start with some background. Tunnel widening after ACL reconstruction is not new…but why it happens is debated. There are a few proposed mechanisms:·       Biologic factors: synovial fluid ingress, cytokines, graft necrosis, remodeling.·       Mechanical factors: graft motion (“windshield wiper” / “bungee effect”), repetitive shear.·       Anatomic factors: posterior tibial slope increasing anterior tibial translation forces.·       Surgical factors: fixation method, tunnel position, graft choice (hamstring vs BTB or Quad). This study asked three key questions:1.     Does posterior tibial slope (PTS) predict tunnel widening?2.     Do meniscus root tears contribute?3.     Does adding a lateral extra-articular tenodesis (LET) influence tunnel change? ·       This is the first large cohort looking at all these together over 2 years, with both tibial and femoral tunnel measurements. ·       The study included 307 patients who underwent primary ACL reconstruction using hamstring autograft. The femoral and tibial tunnels were measured immediately postop and again at 2 years.  Medial and lateral posterior tibial slope was measured on long-leg lateral radiographs.  The authors also looked at the incidence of additional LET, meniscus root injury and BMI.·       They used univariate and multivariate regression to determine independent predictors.So, what did they find? Tune in and enjoy the episode!

Our conversation picks back up with an article titled “Patient Outcomes and Return to Play After Arthroscopic Rotator Cuff Repair in Overhead Athletes.”  This systematic review, published in the January 2023 issue of JOT, analyzed 20 studies comprising 692 patients with an average follow-up of 40 months.  The authors found that arthroscopic cuff repair led to significant improvements in patient reported outcomes as well as improved shoulder elevation. Overall, 75% of athletes returned to play at a mean of 6.4 months post-op, and 63% returned to their preinjury level of sport. Complication and reoperation rates were relatively low at 7% and 10%, respectively. Then, from the December 2019 issue of AJSM, we review an article titled “Partial-Thickness Rotator Cuff Tear by Itself Does Not Cause Shoulder Pain or Muscle Weakness in Baseball Players.”  This cross-sectional study investigated whether articular-sided partial-thickness rotator cuff tears alone produce symptoms in overhead athletes. Of the 87 collegiate baseball players that were analyzed, 47% had ultrasound-confirmed partial-thickness tears, yet rates of shoulder pain and muscle weakness were not significantly different from those without tears. Most of these tears were small (approximately 5 mm in depth) and were asymptomatic in 83%. Pain correlated instead with scapular malposition, dyskinesis, and poor total shoulder condition – not the presence of a tear. We finish up our discussion today with an article titled “Internal impingement of the shoulder in overhead athletes: Retrospective multicenter study in 135 arthroscopically-treated patients.” Patients underwent a variety of procedures, including cuff debridement or repair, posterior glenoidplasty, labral debridement, posterior capsular release, and anterior capsulorrhaphy. Overall, 90% returned to sports, with 52% returning to their prior level at an average of 9 months. Better return-to-sport outcomes were associated with male sex, presence of a cuff lesion, and simple cuff debridement. Greater tuberosity cysts and anterior capsulorrhaphy correlated with poorer outcomes and higher post-op pain. We hope you enjoy this episode!

On today’s episode we’re focusing on the thrower’s shoulder with Dr. Sara Edwards, an orthopedic sports medicine and shoulder surgeon at UCSF. We have some great articles for you that contribute well to our conversation on different shoulder pathology in the overhead throwing athlete.  We start off our discussion today with a review article from the April 2023 issue of the yellow journal titled “Surgical Treatment of Superior Labral / Biceps Pathology in the Overhead Thrower.” The authors concluded that type II SLAP tears are the most common and are often difficult to diagnose due to frequent false positives on MRI. Therefore, history and physical exam correlation are critical. Nonop management – including rest, physical therapy targeting internal rotation deficits, and correction of scapular dyskinesis – can help, but return-to-play rates among pitchers remain low, around ~22%.When surgery is indicated, options include labral repair, biceps tenodesis, and rarely tenotomy. SLAP repair yields variable outcomes, with elite throwers showing the poorest return to prior performance – often less than 40%. Biceps tenodesis was once a salvage procedure but is now increasingly favored for selected athletes due to higher satisfaction, improved function, and return-to-sport rates of 70–80%. However, its impact on elite throwing mechanics remains uncertain. Then, from the June 2022 issue of JSES, we discuss a systematic review article titled “Return to play following nonsurgical management of SLAP tears.” This study evaluated outcomes of conservative treatment in 244 athletes (162 of which were elite). Across five studies, the overall return-to-play rate was 54%, rising to 78% among those who completed rehab. Return to prior performance was 43% overall and 72% for rehab completers. Successful programs emphasized restoring internal rotation, correcting scapular dyskinesis, and strengthening the rotator cuff and kinetic chain, with most athletes returning within six months. Risk factors for failure of conservative treatment were: older age, overhead sports participation (particularly baseball pitchers), traumatic injury, positive compression-rotation tests, rotator cuff pathology, longer careers or symptom duration, and Bennett spurs. Patient-reported outcomes improved significantly with nonoperative care. The authors conclude that nonsurgical management can be effective – especially for athletes who adhere to structured rehabilitation – but success is less predictable in older or high-demand overhead throwers.We are joined today by Dr. Sara Edwards, an orthopedic sports medicine and shoulder specialist at the University of California in San Francisco, and an Associate Professor at UCSF School of Medicine. She received her medical degree from Northwestern University and remained at Northwestern to complete her orthopedic surgery residency.  Thereafter, she completed a fellowship in sports medicine and shoulder surgery at Columbia University.  Dr. Edwards is currently the team physician for the City College of San Francisco, the University of San Francisco and the Oakland Ballet. 

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 Overtime with the Sports Docs. Today, we’re talking about Cyclops Syndrome after ACL reconstruction surgery. We review an article published in this month’s issue of AJSM titled “Risk Profile for Cyclops Syndrome Necessitating Reoperation After Anterior Cruciate Ligament Reconstruction.” But first, let’s back up a bit and discuss the basics, starting with what Cyclops Syndrome is.Cyclops syndrome is when a fibrous nodule — the so-called “cyclops lesion” — forms in front of the ACL graft, usually leading to a loss of terminal extension – or reaching full straightening of the knee. Clinically, athletes can’t fully straighten the knee; you may feel a mechanical block or audible clunk; and also feel their gait or running pattern is disrupted.So, Dr. Ting Cong and colleagues at UPMC analyzed 1,163 primary ACL reconstructions performed between 2014 and 2021. Average patient age: about 25 years. They looked at surgical, anatomic, and patient-specific variables — everything from graft type and diameter to notch width, posterior tibial slope (PTS), tunnel position, remnant preservation, and even contralateral knee hyperextension.They wanted to define a risk profile — who’s more likely to need that second surgery for a symptomatic cyclops lesion. Listen to learn all about their findings!

Welcome to GamePlan 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

Today, we’re heading back to the NFL to discuss a surprisingly serious injury – turf toe. In Week 2 of the 2025 NFL season, Cincinnati Bengals quarterback Joe Burrow was sacked and sustained left great toe injury.  This was ultimately diagnosed as a grade 3 turf toe injury requiring surgery.  Burrow was placed on injured reserved and elected to undergo surgical repair. While the surgery reportedly went well, timing for return is uncertain, though initial estimates are around 3 months. 

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, with some literature to back it up.Today we will be tackling: “What are the most studied and most effective supplements currently for sports medicine patients — both for performance and for injury recovery?”“What’s the current evidence and your view on the NICE ROCC palm cooling device? Does it really enhance recovery or performance?”“What’s the latest on bracing for shoulder dislocations when returning to sport? Are functional braces advisable, and in what role do they play?”

Today, we’re diving into one of the most serious injuries in American football, and that is a knee dislocation. Dolphins star wide receiver Tyreek Hill recently suffered a devastating knee injury in the Monday Night Football game versus the Jets. He dislocated his knee resulting in multiple torn ligaments, including his ACL. Tyreek was taken to the hospital directly from the game for further evaluation and ended up undergoing urgent surgery for ligament reconstruction and repair. The team has obviously declared that this is a season-ending injury, and we wish him the best in his recovery.