Robert G. Marx, M.D, knee surgeon at HSS and Todd McGrath, M.D. sports medicine physician at HSS, will serve as UFC’s Head Consulting Orthopedic Surgeon and Head Consulting Orthopedic Physician, respectively. Together, they will be on call during UFC events for orthopedic consultation.

Said Dr. Duncan French, Senior Vice President, UFC Performance Institute, “HSS has been a trusted partner for nearly a decade. Their expertise has been instrumental in UFC providing industry leading services for injury prevention, treatment, and recovery for the athletes who compete in the Octagon. Together, we’ll continue to ensure UFC athletes have access to the highest level of medical care and support in combat sports.” 

“Our partnership with UFC reflects a longstanding commitment to delivering the highest standard of athlete care,” said Dr. Marx. “Our focus remains on elevating performance, accelerating recovery, and ensuring fighters have the comprehensive support they need to succeed in and out of the Octagon.”

“Success inside the Octagon starts with a strong foundation of health, and we are committed to helping fighters stay strong, recover fully, and prepare with confidence.” said Dr. McGrath. “We’re proud to work alongside UFC in advancing a unified approach to athlete health, safety, and competitive readiness. Through close collaboration with performance and medical teams, we’re ensuring fighters have the consistent, high-quality care required to meet the demands of this sport at every stage of training and competition.”

“We’re proud to extend our partnership with Hospital for Special Surgery, a world-class leader in orthopedic care and athlete health,” said Sana Shuaib, Senior Vice President, Partnership Marketing & Digital of TKO. “The continuation of our partnership reflects the strength of our collaboration and our shared commitment to supporting the performance and long-term well-being of UFC athletes.” 

The renewed partnership builds on a proven track record of supporting UFC athletes in maximizing performance and recovery. As part of the expanded agreement, HSS will maintain a significant presence across the UFC Performance Institute, including an enhanced role at the Mexico City facility, which reflects a meaningful extension of HSS’s international footprint. HSS also remains integrated into the state-of-the-art HSS Sports Rehabilitation Center within UFC’s flagship Performance Institute headquartered in Las Vegas. 

As an Official Partner of UFC, HSS will continue to receive highly visible brand placement inside the world-famous Octagon® at selected UFC Numbered Events. In addition, HSS will be prominently featured at UFC’s annual marquee event at Madison Square Garden in New York City, where HSS is headquartered.

UFC and HSS will also collaborate on a custom content series featuring UFC athletes and HSS doctors, underscoring a shared commitment to peak performance and long-term athlete health. This series will be amplified across UFC’s massive digital ecosystem that includes   Facebook, Instagram, X, and YouTube, collectively  reaching  more than 353 million social media followers worldwide. 

In addition to serving as UFC’s first-ever official hospital, HSS also provides care to the highest-performing professional, collegiate, and amateur athletes and organizations around the world, including the New York Giants, New York Rangers, New York Knicks, New York Liberty, New York Mets and Brooklyn Nets, among others and is recognized by FIFA as one of only 3 FIFA Medical Centres of Excellence in the United States. 

Psychological impairment following ACL reconstruction has long been recognized as a factor influencing an athlete’s ability to safely resume sport. Roughly one in three patients who undergo ACL reconstruction sustain a second ACL injury. While tools such as the ACL Return to Sports After Injury (ACL‑RSI) questionnaire are commonly used to gauge psychological readiness—including emotion, confidence, and risk appraisal—their relationship to actual re‑injury risk has not been well understood.

“We know that ACL injuries are not just physical—they have a profound psychological component,” said Riley J. Williams, MD, sports medicine surgeon and Chief of the Sports Medicine Institute at HSS. “What this research shows is that confidence can sometimes outpace true physical readiness. Athletes may feel mentally prepared to return before their bodies are fully capable of withstanding the demands of sport. That disconnect can increase their risk for re‑injury.”

The study compared ACL‑RSI scores between patients who sustained a second ACL injury and those who returned to sport without further injury.

A total of 58 athletes participated in the study (24 males, 34 females; mean age 23.5 ± 9.6). Of these, 21 athletes experienced a second ACL injury following their return to sport. All subjects completed return‑to‑sport testing at nine months post‑operation (±1 month) and filled out the ACL‑RSI questionnaire prior to physical testing.

Researchers tracked re‑injuries on both the operative (n=4) and non‑operative (n=17) sides. A matched control group was created based on age, sex, and graft type. Independent samples t‑tests were conducted to evaluate differences in ACL‑RSI scores between the groups.

“Our findings challenge the assumption that higher psychological readiness is always a positive indicator for return to sport,” said Letty Krueger, PT, DPT, lead researcher and rehabilitation clinical manager at HSS Westchester. “In this study, athletes who reported the greatest confidence were actually the ones at higher risk for re‑injury. This underscores the need to evaluate readiness through a combined lens of physical performance, psychological state, and clinical data—rather than relying on self‑report scores alone.”

Athletes who sustained a second ACL injury had significantly higher psychological readiness scores compared to those who did not:

• Re‑injury group: 86.8 ± 11.2
• Uninjured group: 75.5 ± 17.3
• p = .02

At nine months post‑operation, athletes who later experienced ACL re‑injury reported significantly greater psychological readiness than those who returned to play without further injury. These findings suggest that elevated confidence—while often viewed as a positive marker—may not reflect true readiness for the physical demands of sport and may be associated with increased re‑injury risk.

The study underscores the importance of a biopsychosocial approach, integrating psychological factors with objective physical and clinical measures when determining an athlete’s readiness to return to sport. Researchers note that while higher ACL‑RSI scores are associated with higher return‑to‑sport rates, this increased exposure may also contribute to elevated re‑injury risk.

“Contrary to expectations, athletes who felt more confident and emotionally ready to return to sport were more likely to suffer re‑injury,” said Answorth Allen, MD, sports medicine surgeon and associate surgeon‑in‑chief at HSS. “This research reinforces the importance of evidence‑based, multidimensional return‑to‑sport protocols. By integrating psychological screening with strength, functional, and biomechanical testing, we can make smarter, safer decisions that protect athletes and enhance long‑term outcomes.”

The findings indicate that psychological readiness scores—even when favorable—should not be used as a standalone metric for return‑to‑sport clearance. Elevated self‑reported confidence may mask underlying physical or functional deficits, potentially placing athletes at greater risk. Clinicians and sports medicine professionals should interpret psychological measures within the broader context of recovery, emphasizing functional testing and physical preparedness.

Further research is needed to explore how psychological factors interact with physical recovery in influencing return‑to‑sport outcomes and susceptibility to future ACL injuries.

For more information about the study visit: Psychological Readiness after Aclr in Subjects with Subsequent Re-Injury Compared to Matched Controls

Letty Krueger, PT, DPT, Michelle Cilenti, PT, DPT, Debi Lynn Jones, PT, Robert G Marx, MD, MSc, Answorth A Allen and Riley J Willams  

HSS will also continue to assist UFC in the recruitment and placement of physical therapists who will be onsite at the HSS Sports Rehabilitation Center at the UFC Performance Institute® in Las Vegas, Nevada.

“We’re proud to extend our partnership with HSS,” said UFC Chief Operating Officer Ike Lawrence Epstein. “The care and service they provide our athletes is second to none. HSS has enhanced UFC’s industry leading health and safety protocols for our live events and for the UFC Performance Institute, and we’re thrilled that they will continue to help provide our athletes with best-in-care medical services.”

"Health and safety are of the greatest importance, especially during these unprecedented times," said HSS President and CEO Louis A. Shapiro. "HSS is proud to continue delivering the highest-quality, most responsible musculoskeletal care to UFC athletes, and to thousands of others who want to get back to doing what they enjoy most."

Daphne A. Scott, MD, and Robert G. Marx, MD, will serve as UFC’s Head Consulting Orthopedic Physician and Head Consulting Orthopedic Surgeon, respectively. Together, they will be on-call during UFC events for orthopedic consultation.

"The HSS Sports Medicine Institute has a long history of providing trustworthy and comprehensive care to elite and high-performance athletes," said Dr. Scott, primary care sports medicine physician at HSS and the UFC's Head Consulting Orthopedic Physician. "Our top priority is injury prevention, however when injuries do occur, we bring 157 years of specialization to ensuring athletes have a safe return to activity both in and out of the octagon."

“Mixed martial arts is a combat sport that demands extensive training and caring for these athletes requires the expertise of experienced sports medicine professionals,” said Dr. Marx, sports medicine surgeon at HSS and the UFC’s Head Consulting Orthopedic Surgeon. “This partnership provides seamless integration of care and we continue to look forward to positively impacting the health and well-being of these elite athletes.”

As the organization’s official hospital, HSS will also receive branding inside UFC’s world-famous Octagon® at select events, as well as digital and social advertising, and a new content series in 2021, along with participating in UFC-based corporate social responsibility programs. For more information, please visit UFC.com.

In addition to serving as UFC’s first-ever official hospital, HSS also provides care to the highest-performing professional, collegiate, and amateur athletes and organizations around the world, including USA Basketball, Fédération Internationale de Football Association (FIFA), the New York Giants, New York Knicks, New York Mets and Brooklyn Nets, among others.

About UFC®

UFC® is the world’s premier mixed martial arts organization (MMA), with more than 318 million fans and 126 million social media followers. The organization produces more than 40 live events annually in some of the most prestigious arenas around the world, while broadcasting to nearly one billion TV households across more than 171 countries. UFC’s athlete roster features the world’s best MMA athletes representing more than 72 countries. The organization’s digital offerings include UFC FIGHT PASS®, one of the world’s leading streaming services for combat sports. UFC was acquired in 2016 by global entertainment, sports and content company Endeavor, along with strategic investors Silver Lake Partners and KKR. UFC is headquartered in Las Vegas, Nevada. For more information, visit UFC.com and follow UFC at Facebook.com/UFC, Twitter, Snapchat and Instagram: @UFC.

Additional coverage: Beckersspine.com

Reconstruction is the current standard of care surgical treatment for tears of the anterior cruciate ligament (ACL). This procedure typically uses a graft, or a piece of tissue, placed in the knee minimally invasively, using small incisions. About 300,000 ACL reconstructions are performed annually in the United States with well documented rates of success.

ACL repair is an older technique that involved suturing (sewing) torn ACL tissue, not rebuilding it with a graft. ACL repair was performed in the 1970s at select institutions, including Hospital for Special Surgery, but was abandoned due to unacceptably high failure rates of up to 50%.

Today, ACL repair has been modernized and can be performed through a minimally invasive approach. Proponents suggest that modern ACL repair techniques may be performed safely and may lead to a quicker recovery than ACL reconstruction. However, the limited studies to date raise questions that must be discussed in detail with your surgeon.

1. It is critically important to get ACL surgery right the first time.

When ACL surgery fails, surgeons must do a revision procedure to correct or revise the problems that were not fully addressed the first time. Revision requires reconstructive ACL surgery with a graft. (ACL repairs cannot be done as revisions.) Redoing ACL surgery may result in higher rates of failure, lower rates of return to sports, and increased risk of osteoarthritis.

The importance of successful initial ACL surgery holds true for people of all ages, but it is particularly critical for young athletes, for whom a failed surgery can have devastating consequences, including years lost from sport in the short term as well as chronic pain and loss of function in the long term.

2. Failure rates for ACL repair appear to be significantly higher than those for ACL reconstruction in people of all ages.

Current studies suggest that modern ACL repair techniques have a failure rate that may be five to ten times higher than that of ACL reconstruction^1,2,3. One major recent study in a prominent sports medicine journal found that arthroscopic ACL repair has unacceptable outcomes in young athletes, with short-term failure rates of close to 50%².

It has been suggested that ACL repair may be appropriate for older adults who have a type of ACL tear called a proximal avulsion and who do not participate in “cutting and pivoting” sports such as basketball, volleyball, and soccer. For these patients, failure rates in the short term appear to be much higher than ACL reconstruction in this age group^1,2,3.

3. There is still much we don’t know about ACL repair.

There has been no scientific evidence that shows a difference in postoperative pain between ACL repair and reconstruction. Rehabilitation and return-to-play protocols for ACL repair have not yet been established. Proper guidelines for rehabilitation and return to sports are essential to keep people safe from re-injury.
 

Andrew D. Pearle, MD

Chief, HSS Sports Medicine Institute

Bryan T. Kelly, MD

HSS Surgeon-in-Chief and Medical Director

Answorth A. Allen, MD

David W. Altchek, MD

Struan H. Coleman, MD, PhD

Frank A. Cordasco, MD, MS

David M. Dines, MD

Joshua S. Dines, MD

Stephen Fealy, MD

Andreas H. Gomoll, MD

Lawrence V. Gulotta, MD

Jo A. Hannafin, MD, PhD

Anne M. Kelly, MD

John D. MacGillivray, MD

Robert G. Marx, MD, MSc, FRCSC

Michael J. Maynard, MD

Moira M. McCarthy, MD

Danyal H. Nawabi, MD, FRCS

Stephen J. O’Brien, MD, MBA

Anil S. Ranawat, MD

Scott A. Rodeo, MD

Howard Anthony Rose, MD

Beth E. Shubin Stein, MD

Sabrina M. Strickland, MD

Karen M. Sutton, MD

Samuel A. Taylor, MD

Russell F. Warren, MD

Thomas L. Wickiewicz, MD

Riley J. Williams III, MD

References

1. Jonkergouw A, van der List J, DiFelice G. Arthroscopic primary repair of proximal ACL tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):21-28.

2. Gagliardi AG, Carry PM, Parikh HB, Traver JL, Howell DR, Albright JC. ACL repair with suture ligament augmentation is associated with a high failure rate among adolescent patients. Am J Sports Med. 2019 Mar;47(3):560-566.

3. Wright RW et al. Risk of tearing the intact ACL in the contralateral knee and rupturing the ACL graft during the first 2 years after ACLR: A prospective MOON cohort study. Am J Sports Med. 2007 Jul;35(7):1131-4.

For more information visit https://www.hss.edu/condition-list_torn-acl.asp.

"Kids are playing more sports than they used to. There’s more organized sports, more practices, more games and more opportunities to get hurt," says Dr. Marx. "With advances in diagnostic imaging, we are identifying the injuries better, earlier and more frequently. And our surgical techniques have evolved so we are able to fix things more than we used to be able to do."

"Seasonality still remains an issue for many athletes. Certainly at the high school, varsity and collegiate levels, they generally do have a season… having said that, there’s often a place for rehabilitation for many injuries and giving them a chance to heal or get better without surgery, with surgery as the last resort if they don’t heal. There are also certain injuries where rehab is not appropriate and you know its not going to work or a patient needs surgery right away," adds Dr. Marx.

Listen to the full interview at LeagueApps.com.

"The quadriceps muscle attaches to the kneecap through this tendon he ruptured — the quadriceps tendon — and then the kneecap attaches to the tibia through the patellar tendon, which allows the quadriceps to pull the tibia forward," explains Robert G. Marx, MD, MSc, FRCSC, sports medicine surgeon at HSS, who has not treated Oladipo.

"In people under 40, the patellar tendon is typically ruptured and in people over 40, it's typically the quadriceps. So it's a little unusual to have a quad rupture in someone so young and you wonder if there was something else going on before the injury," says Dr. Marx.

Read the full article at TheAthletic.com.

Robert G. Marx, MD, MSc, FRCSC, sports medicine surgeon at HSS, notes that patients who are symptom-free after surgery should not be subjected to second-look arthroscopy as it may cause complications that could have been avoided.

The article explores when this procedure can be used in place of imaging, and also the benefits of in-office arthroscopy.

From a research perspective, second-look knee arthroscopies could be useful for surgeons.

"It may be part of the research protocol that the patient is subjected to a second-look largely for research purposes, so you can learn from that person's experience and perhaps even biopsy a small piece of the regenerative or new tissue or see otherwise what is happening," Dr. Marx says. "But, that would be something that is specified ahead of time and ethically the patient would have the right, of course, to opt out."

Read the full article at Healio.com. This also appeared in the April 2018 print edition.