Live from the Arthrex Team Physician Controversies Conference

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with two leading ACL experts—Dr. Pat Smith and Dr. Aaron Krych—to discuss strategies to reduce failure after ACL reconstruction.

The conversation highlights the evolution of ACL surgery, focusing on graft selection, fixation, biologic augmentation, and mechanical protection, with an emphasis on optimizing outcomes in young, high-risk athletes.

Graft: Autograft vs Allograft

Strong evidence shows higher failure rates with allograft in young athletes
MOON data: ~4–6x increased risk of failure in patients <25 years

Allograft best for:

• Older, lower-demand patients
• Revision or multi-ligament cases

Autograft Selection

Graft choice depends on:

• Age, sex, sport, and anatomy

BTB:

• Preferred for high-level pivoting athletes
• Strong fixation, less graft elongation

Quadriceps tendon:

• Increasingly utilized
• Larger graft diameter
• Less donor-site morbidity vs BTB
• Particularly useful in younger and female athletes

Key insight:
Grafts <8 mm are associated with higher failure risk

Internal Brace (IB)

Indications:

• Young athletes
• Hyperlax patients
• Revision ACL

Benefits:

• Decreased graft elongation and cyclic displacement
• Reduced postoperative laxity
• Lower rerupture rates (~1% at 5 years in some studies)
• Faster return to sport and improved rehab confidence

Lateral Extra-Articular Tenodesis (LET)

Strong evidence supports reduced failure rates:

• Primary ACLR: ~11% → 4% (high-risk patients)
• Revision ACLR: ~21% → 5%

Benefits:

• Decreased pivot shift
• Improved return to pre-injury sport
• Cost-effective in high-risk populations

Indications for LET

• Age ≤25 years
• High-grade pivot shift
• Knee hyperextension
• Return to cutting/pivoting sports
• Revision ACL reconstruction

LET Surgical Technique Pearls

IT band graft (7–8 cm x 1 cm)
Passed under or near LCL depending on technique
Fixation near lateral epicondyle

Pearls:

• Fix in neutral rotation and ~30–60° flexion
• Avoid overconstraint
• Close IT band defect

Featured Guests

Dr. Pat Smith – Hospital for Special Surgery Naples

Dr. Aaron Krych – Mayo Clinic, Team Physician for the Minnesota Timberwolves

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Catherine Logan, MD, MBA

https://www.cloganmd.com/

Ashley Bassett, MD

https://orthopedicnj.com/physicians/ashley-bassett

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Live from the Arthrex Team Physician Controversies Conference

🎧 Episode Summary

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with cartilage restoration expert Dr. Travis Maak to discuss the modern surgical management of knee cartilage defects.

The conversation focuses on diagnostic workup, surgical decision-making, and cutting-edge cartilage restoration techniques, including Autocart, BioCartilage, and Cartiform.

Diagnostic Imaging - MRI is critical for:

• Defect size and depth
• Subchondral bone integrity and edema
• Concomitant meniscal and ligament pathology

Surgical Decision-Making

• Patient age & activity level
• Lesion size, location, & containment
• Subchondral bone involvement
• Prior surgical history

Autocart (Autologous Minced Cartilage)

Single-stage autograft cartilage restoration technique
Uses patient’s own cartilage with PRP or BMAC
Key advantages:

• Preserves native chondrocytes & extracellular matrix
• Avoids staged procedures

Ideal for small-to-medium contained lesions

Outcomes:

• Significant improvements in pain & function at ~5 years
• ~75% achieve clinically meaningful outcomes
• Low reoperation rates

BioCartilage

Micronized cartilage extracellular matrix allograft scaffold
Used in combination with microfracture and biologics (PRP/BMAC)
Functions as a biologic bridge to enhance cartilage repair

Best for:

• Small-to-medium, contained, full-thickness defects
• Well-aligned, stable knees

Outcomes:

• Improved pain and function at 2 years
• Better repair tissue quality compared to microfracture alone

Cartiform

Cryopreserved osteochondral allograft with viable chondrocytes
Maintains native cartilage architecture

Indicated for:

• Larger lesions (>2 cm²)
• Defects with subchondral bone involvement

Advantages:

• Single-stage procedure
• Conforms to irregular defects

Key Takeaways

• Cartilage restoration success depends on correcting biomechanics first
• Procedure selection should be lesion-specific and patient-specific
• Autocart offers a promising autograft solution with strong midterm data
• BioCartilage fills the gap between microfracture and larger restoration procedures
• Cartiform is a valuable option for larger defects and requires careful patient selection

Featured Guest

Dr. Travis Maak – University of Utah, Head Team Physician for the Utah Jazz, cartilage restoration and joint preservation specialist

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Modern Surgical Management of Elbow UCL Tears

Live from the Arthrex Team Physician Controversies

🎧 Episode Summary

In this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with two leaders in sports medicine—Dr. Neal ElAttrache and Dr. Jeffrey Dugas—to discuss the modern management of ulnar collateral ligament (UCL) injuries in throwing athletes.

Highlights

Changing UCL Injury Landscape

• Increasing incidence of UCL injuries and surgeries across all levels of play
• Notable rise in adolescent and collegiate pitchers
• Contributing factors include year-round play and high pitch velocity

Nonoperative Management & Role of PRP

• Nonoperative treatment remains appropriate for select partial tears
• Success varies based on tear grade and location
• PRP discussed as an adjunct to rehab

Indications for Surgery

• Complete tears—especially in competitive throwers—often require surgical intervention
• Tear characteristics (location, tissue quality, chronicity) are critical in decision-making

UCL Repair with Internal Brace

• Increasingly utilized in appropriately selected patients
• Ideal candidates:
  • Acute injuries
  • Proximal or distal avulsion tears
  • Good tissue quality
• Advantages:
  • High return-to-play (~90%+)
  • Accelerated recovery timelines (often several months faster)

UCL Reconstruction (Tommy John Surgery)

• Remains the gold standard for:
  • Chronic degeneration
  • Midsubstance tears
  • Revision cases
• Techniques have evolved over time:
  • Docking technique
  • Figure-of-eight
  • Newer fixation methods (e.g., cortical button techniques)
• Autograft (commonly palmaris longus) remains preferred in elite throwers

Internal Brace Technology

• Provides added stability and resistance to valgus stress
• Supports early rehabilitation while protecting healing tissue
• Increasing use in both repair and, selectively, reconstruction

Key Takeaways

• UCL injuries are increasing, particularly in younger athletes
• Treatment decisions are increasingly personalized based on tear type and athlete profile
• UCL repair with Internal Brace is shifting the paradigm for select patients
• Reconstruction remains essential for more complex or chronic injuries

Featured Guests

• Dr. Neal ElAttrache – Kerlan-Jobe Orthopaedic Clinic, Head Team Physician for the LA Dodgers & LA Rams
• Dr. Jeffrey Dugas – Andrews Sports Medicine & Orthopaedic Center, leading expert in UCL repair and reconstruction

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If you enjoyed this episode, be sure to subscribe, rate, and review on:
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