Newsroom Hospital for Special Surgery

The Doctor Who Holds Elite Athletes' Careers in His Hands

Tue, 01 Sep 2026 11:17:11 -0400

Riley J. Williams III, MD, Chief of the Sports Medicine Institute at HSS and Medical Director for the Brooklyn Nets, New York Liberty, and New York Red Bulls, joined Confessions of an Elite Athlete with host and professional soccer player Midge Purce to discuss some of the most important topics in sports injury prevention and recovery.

Dr. Williams, who performed Purce's ACL reconstruction surgery, explains why ACL tears are increasingly common among female athletes, the biggest mistakes athletes make after ACL surgery, and what it takes to return safely to sport.

The conversation also explores the debate over playing on turf versus grass, the risks associated with early youth sports specialization, strategies for preventing lower extremity injuries, and Dr. Williams' ranking of the most challenging lower-limb injuries athletes can face.

Listen to the full podcast here: Confessions of an Elite Athlete with Midge Purce.

Michael Porter Jr. ‘Couldn’t Believe’ Kyrie Irving’s Recovery After ACL Surgery by HSS’s Dr. Riley Williams

Tue, 25 Aug 2026 10:23:00 -0400

Riley J. Williams III, MD, Chief of the Sports Medicine Institute at HSS, performed Kyrie Irving’s ACL reconstruction after the NBA star tore his ACL in March 2025. More than a year later, fellow NBA player Michael Porter Jr. says he was amazed by Irving’s progress during a recent pickup basketball game.

“I couldn’t believe how he was moving out there,” Porter said, praising Irving’s ability to get to the basket and finish plays despite the significant knee injury.

Read the full article at Yardbarker.com.

The article was also published in Yahoo! Sports, The Sporting News, and Heavy.com.

Washington Wizards Forward Jamir Watkins Undergoes ACL Surgery at HSS

Thu, 30 Jul 2026 09:16:00 -0400

Reuters reporters that Washington Wizards forward Jamir Watkins had successful reconstruction surgery to repair a torn ‌anterior cruciate ligament in his left knee, the team announced.

Watkins, 25, was injured during the NBA ⁠Summer League in Las Vegas. The procedure on his knee was performed by Riley J. Williams III, MD, Chief of the Sports Medicine Institute at HSS.

Read the full article at reuters.com.

Additional coverage:

nytimes.com. A subscription is required to access.
miamiherald.com.
yardbarker.com.

Jayden Quaintance undergoes successful clean-up surgery on his knee

Fri, 17 Jul 2026 16:50:00 -0400

On3.com reported on Jayden Quaintance, former Kentucky Wildcat, undergoing successful clean-up surgery on his meniscus following his 2025 ACL surgery.

This follow up procedure was recommended by Riley J. Williams III, MD, Chief of the Sports Medicine Institute at HSS, to put his ACL injury behind him for good.

Read the full article at on3.com.

Hailey Baptiste's Knee Surgery a Success: 'Recovery Has Begun'

Fri, 05 Jun 2026 16:07:29 -0400

Tennis Temple reported on Hailey Baptiste undergoing successful knee surgery, performed by Riley J. Williams III, MD, Chief of the Sports Medicine Institute at HSS, after suffering ACL and meniscus injuries at the French Open.

Baptiste shared the following message on her social media accounts: “It was scary, but I did it. The surgery went well and the recovery has begun. Thank you to the entire team at HSS (Hospital for Special Surgery) for making this process so smooth and pleasant. A big thank you to Riley Williams (the surgeon) for repairing the disaster I had caused to my knee.”

Read the full article at tennistemple.com.

ACL reconstruction in pediatric patients yielded small changes in coronal plane alignment

Thu, 04 Jun 2026 15:41:00 -0400

Healio/Orthopedics Today reported on an HSS study that found ACL reconstruction in pediatric patients yielded small changes in coronal plane alignment, featuring insight from Peter D. Fabricant, MD, MPH, pediatric orthopedic surgeon at HSS.

“We have to respect the growing skeleton, and these ACL reconstruction techniques do a good job, but there is still a small percentage of patients who will have changes in their leg alignment after surgery,” Dr. Fabricant told Healio about results presented at the Pediatric Orthopaedic Society of North America Annual Meeting. “It is important to know that for informed consent, for monitoring and, potentially, for intervention.”

Dr. Fabricant shared that these results may provide evidence for consideration of the use of guided growth — a procedure that allows correction of alignment of the knee.

“Although we did not look directly at guided growth, there is awareness for surgeons to, in addition to monitoring patients closely, potentially intervene at the time of surgery to correct the underlying coronal plane alignment, as it may get slightly worse in a subset of patients,” he shared. But he said more research is needed on when guided growth might come into play and the impact it may have on these patients.

Read the full article at healio.com.

HSS Research Supports Routine Imaging Before and After ACL Surgery in Growing Children

Fri, 08 May 2026 10:30:00 -0400

At this year’s Pediatric Orthopedic Society of North America (POSNA) annual meeting, researchers at Hospital for Special Surgery (HSS) presented two studies evaluating outcomes for three of the most common anterior cruciate ligament (ACL) reconstruction techniques designed to protect open growth plates in young patients who are still growing. The findings highlight the importance of using imaging before and after surgery to accurately identify and monitor alignment issues and capitalize on opportunities for early intervention.

What follows are highlights from these studies:

Use of Imaging to Identify Alignment Issues in Pre-Pubertal Children After ACL Reconstruction

A new multi-center prospective study from researchers at HSS evaluated two specialized surgical reconstruction techniques commonly used to treat ACL injuries by restoring knee stability while minimizing risks of growth disturbances in children with open growth plates (skeletally immature) and more than two years of growth remaining.

Researchers compared changes in lower extremity alignment among 112 pre-pubescent patients (girls younger than 12 and boys younger than 14) who had either a physeal-sparing combined intra/extra-articular reconstruction with iliotibial band (ITB) autograft (77 patients) or an all-epiphyseal reconstruction (35 patients). All patients had x-rays taken before surgery and again one year after surgery to measure and compare growth changes in both legs.

They found that approximately 25% of children in the study developed subtle postoperative changes such as differences in leg length and angular deformity that could raise their risk of reinjury in the future. However, there were fewer growth disturbances among older patients who had less than two years of growth remaining.

“It’s important to make people aware that even though these procedures are safe overall and designed to respect the growth plates, there is still a risk of kids experiencing alignment issues afterward,” says Peter D. Fabricant, MD, MPH, pediatric orthopedic surgeon at HSS and senior author of the study.

An ACL injury is a painful tear or sprain of the ligament connecting the femur (thighbone) to the tibia (shinbone). These injuries have become common among physically active children, especially with year-round participation in sports and an increased level of competition.

In adult patients, the standard ACL reconstruction technique involves drilling tunnels in the femur and tibia to secure a new ligament. For children who are still growing, the growth plates—where the bones grow and gain length—are exactly where the surgeon would need to drill those tunnels. That is why alternative surgical techniques have been developed that reconstruct the ACL and minimize damage to the growth plate in young patients.

“If you injure the growth plate in a younger child who has many years to grow, there’s a lot of time during which that growth plate can grow abnormally,” explains Dr. Fabricant. “Prepubertal patients are the most vulnerable population for growth plate injury, so this study focused on that subset of patients to determine the incidence of developing deformity after surgery.”

This is the first multicenter study to rigorously assess leg alignment before and after surgery and compare the surgical leg to the uninjured leg to identify and monitor postoperative growth disturbances. Such changes may not be reliably measured with clinical examination alone.

“This study gives evidence to support the use of imaging to routinely check a patient’s alignment before surgery, check it after surgery, and monitor these kids for growth disturbances so that we can intervene in minimally invasive ways while they are still growing,” explains Dr. Fabricant. “This is important because only checking alignment when there is a concern is very subjective and there may be missed opportunities for early intervention.”

One minimally invasive surgical technique used to correct alignment issues is called implant-mediated guided growth. This involves placing implants around the growth plate that guide it to grow in a way that encourages realignment. The technique avoids the need for a much bigger operation (osteotomy) to realign the bone and a lengthy recovery, as would be the case for an adult.

“You can only do guided growth surgery when the growth plate is still actively growing, which for some of these kids is only a year or two after their surgery,” explains Dr. Fabricant. “If you aren’t routinely imaging to monitor alignment and you don’t realize it in time, then you’re beyond that window of being able to do that minimally invasive surgery.”

Use of Imaging to Identify Alignment Issues in Adolescent Children With Open Growth Plates After ACL Reconstruction

A second study led by researchers at HSS found that 15% to 30% of adolescent patients who had ACL reconstruction with soft-tissue autograft developed changes in leg alignment, but no patients developed growth-related complications requiring intervention.

For adolescent patients who still have open growth plates and less than two years of growth remaining, ACL reconstruction with soft-tissue autograft is often the technique of choice. This procedure involves drilling tunnels in the bone that would be similar to an adult ACL reconstruction, but the surgeon uses a graft and implants that don’t typically affect the growth plate.

“Even though this procedure is largely safe for adolescents, there is still a possibility of alignment changes after surgery,” notes Peter D. Fabricant, MD, MPH, pediatric orthopedic surgeon at HSS and senior author of the study. “This study adds more evidence to support the need to take x-rays before and after surgery and monitor this population until they reach skeletal maturity.”

The prospective multicenter study included 99 patients (50 boys and 49 girls with a median age of about 14 years) who had less than two years of growth remaining and underwent a primary transphyseal ACL reconstruction with soft-tissue autograft. Researchers used x-ray imaging before surgery and one year after surgery to measure and compare differences in leg alignment.

“We know that leg alignment is a vital factor in predicting injury, reinjury, and surgical failure, so measuring alignment preoperatively is extremely important because you gain the opportunity to address alignment issues at the same time as the ACL surgery with no additional risk,” explains Dr. Fabricant.

For example, if a patient is found to have a borderline alignment issue before surgery, some surgeons may be encouraged to perform an implant-mediated guided growth surgery at the same time as the ACL reconstruction because they know that there is a risk of potentially worsening post-operative alignment if they don’t.

“The logical next step is to strongly consider intervening on alignment problems when necessary in order to prevent reinjury,” says Dr. Fabricant.

Everything changed in an instant for Michigan guard playing his best basketball

Wed, 25 Mar 2026 11:11:30 -0400

MLive.com reported on Michigan Wolverines guard L.J. Cason’s torn ACL featuring insight from Andrew Pearle, MD, sports medicine surgeon at HSS.

After suffering from the injury back in February during Michigan's Big Ten champion-clinching win at Illinois, Cason’s surgery is set for April 9, a few days after the national championship. Dr. Pearle told MLive that delaying the surgery can often be advantageous. The first season back, he said, is always difficult as the patient is usually tentative on the injured knee.

Read the full article at mlive.com.

What is the Difference Between an ACL and Meniscus Tear?

Fri, 20 Mar 2026 13:26:05 -0400

Hilary Topper on Air spoke with Sabrina M. Strickland, MD, sports medicine surgeon at HSS, about ACL and meniscus tears.

Dr. Strickland broke down the anatomy of these common injuries, explaining how they occur and their impact on mobility. She also discussed diagnosis and treatment, as well as insights on the mental and physical challenges of recovery. Finally, she shared how to reduce your risk of these injuries through proper training, stretching, and strengthening exercises.

Read the full article at atriathletesdiary.com.

Athletes with “Never Quit” Mentality Face Increased Risk of ACL Re Injury

Thu, 12 Feb 2026 15:00:00 -0500

Researchers at Hospital for Special Surgery (HSS) found in a new study that athletes who report higher levels of psychological readiness to return to sport following anterior cruciate ligament (ACL) reconstruction may actually face an increased risk of re‑injury. The findings challenge long‑held assumptions about the role of psychological confidence in return‑to‑sport decisions and highlight the need for more comprehensive evaluation methods. The study was presented on today at the American Physical Therapy Association (APTA) Combined Sections Meeting in Anaheim, CA.

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

Lindsey Vonn is skiing on a completely torn ACL. Could she still win Olympic gold?

Sat, 07 Feb 2026 12:54:39 -0500

ABC News reports that Lindsey Vonn, one of the most decorated skiers in Olympic history, skied cautiously during an official women’s downhill training session at the 2026 Winter Olympics in Cortina d’Ampezzo, Italy. The U.S. skier's time currently puts the 41-year-old in ninth place, outside the top ranks.

Her performance is remarkable considering that just one week ago she tore the anterior cruciate ligament (ACL) in her left knee, an injury that would typically sideline most athletes.

"Women injure their ACL 2.2 times more than men," Riley J. Williams III, MD, chief of sports medicine at the HSS told ABC News.

But Vonn is at an Olympic level of conditioning, Williams said.

"Her tolerance for speed and demand is greater than a normal person," Dr. Williams explained.

Though Vonn said in a news conference last week that she has the "help of a knee brace," Dr. Williams pointed out a brace may not prevent further damage.

"The brace is very helpful for side to side, but what it does not do is protect you from rotation," Dr. Williams explained. "As she's going from one direction to the other, doing those fast turns down the hill, there's a rotational component that even the tightest braces are not going to protect you from."

But if anyone can power through an ACL tear to compete at the highest level, Dr. Williams said, it’s the three-time Olympic medalist.

"Who would you pick to try to ski Olympic downhill without an ACL? It would be Lindsey Vonn," Dr. Williams said.

Read the full article at abcnews.com.

Surgeon discusses what Falcons’ Michael Penix Jr. faces after surgery

Wed, 26 Nov 2025 14:52:00 -0500

In an interview with The Atlanta Journal-Constitution, Danyal H. Nawabi, MD, FRCS, sports medicine surgeon at HSS, discusses Atlanta Falcons Michael Penix Jr.’s torn ACL and what his recovery will look like.

Falcons quarterback Michael Penix Jr. has a long road to recovery from reconstructive surgery to his left knee.

“The recovery can take anywhere from nine months up to 12 months,” Dr. Nawabi, explained. “Many players have had that surgery. As an elite quarterback, he would definitely need that surgery to return back at the highest level.”

The Falcons declined several requests to interview team physician Dr. Kyle Hammond of Emory Healthcare.

“He had his surgery,” Falcons coach Raheem Morris said Wednesday. “It went well. Obviously, he got a chance to do that yesterday. I’m really fired up about that. I’m really fired up about when he comes back and is playing.”

If Penix can complete his rehab in nine months, he could return in time to start the 2026 regular season. If it takes longer, he could miss the first month of the season — or more.

Either way, the Falcons will be in the quarterback market looking for a possible backup good enough to be a starter for a three or four games. Kirk Cousins is the starter for the rest of this season, but isn’t expected to be with the team next season with a $57.5 million salary-cap hit.

Penix had a bone bruise to his left knee early this season that caused him to miss the Miami game Oct. 26. He was hit in that general area in the Panthers game Nov. 16. He tried to get up and walk, but couldn’t.

The ACL might have been injured as part of the bone bruise and made the knee unstable. After an MRI, the team said Penix would undergo season-ending surgery for a partially torn ACL.

“An ACL reconstruction involves replacing the torn ACL with a graft,” Nawabi said. “The one thing that is interesting about his injury is when you are sacked or have a collision with the knee bent or flexed, the PCL can get injured. An isolated PCL tear typically doesn’t need surgery. But if the PCL gets injured in a knee which may have been compensating for a partially torn ACL from a prior bone bruise early on this season, then you can unmask an ACL tear resulting in knee instability.”

The Falcons have talked with Penix about his approach and how he’ll be off his feet for 10 to 12 weeks.

“Once you get back into it, and you’ve got the ability that you’re mobile and do some of those things, you want to keep your mind fresh,” Morris said.

The Falcons will want him to take part in the classroom portion of organized team activities and minicamps.

“The same thing with Mike, being able to get back in, doing some things on offense just to make sure his mind is fresh,” Morris said. “Then, once you get back to being able to do some things, obviously on the grass, that’s what he’ll be doing with our guys and our people that are getting him right. But, you definitely want to keep those guys fresh.”

Working out as much as he can with the team will be key. Also, nickel back Billy Bowman Jr. has Achilles surgery coming up.

“You definitely want to keep those guys within the game plans,” Morris said. “You definitely want to keep those guys knowing exactly what’s going on. They’re pretty much both the quarterbacks of our defense, talking about the nickel and our quarterback. Getting those guys to stay involved with the daily game plans and the daily rhythm and routine, that won’t happen for a little bit, up until they can get back and be mobile enough to do those things. You obviously want to get those guys back as quickly as possible.”

How much offseason work Penix, who has started 12 NFL games, gets will be key.

“No, it’s not out of the question to do some off season,” said Dr. David Chao, a former NFL team doctor. “But it will impact him. That’s what they’re working through. How much of the offseason we have … he still needs offseason development.”

In 2011, Vikings running back Adrian Peterson returned from ACL and medial collateral ligament surgery in eight months and rushed for 2,097 yards the following season. Akers, then with the Rams, returned after 5½ months in December 2021.

Penix has had two ACL surgeries on his right knee, one in 2018 and the other in 2020.

“He was always at a higher risk of tearing the ACL in the other knee,” Dr. Nawabi said. “The risk of tearing the ACL in the other knee goes up once you’ve torn the ACL in one knee. The risk increases three to fourfold in the other knee. … So, this was, unfortunately, an injury that he was at increased risk for.”

The previous rehabs might help Penix this time around.

“That nine-to-12 months number is for the general population,” Dr. Nawabi said. “A high-performing athlete, who has access to the best facilities for rehab, the best physical therapists at their disposal working on them everyday after the surgery, I don’t think it would be unusual at all for Michael to return in nine months or maybe even sooner.”

Read the full article at ajc.com. A subscription is required to access.

Sports medicine surgeon breaks down ACL surgeries, recovery for Michael Penix Jr.

Sun, 23 Nov 2025 13:20:00 -0500

WXIA-TV/WATL (NBC) interviewed Mark Amirtharaj, MD, sports medicine surgeon at HSS, who discussed ACL surgeries and the recovery timeline for Atlanta Falcons quarterback, Michael Penix Jr. following his recent injury.

Watch the full interview at 11alive.com.

Inside Lindsey Vonn’s Unprecedented Attempt at an Olympic Comeback

Mon, 27 Oct 2025 09:39:00 -0400

TIME Magazine reports on Lindsey Vonn’s attempt at an Olympic comeback after two ACL tears, an MCL tear, shinbone fractures, and nine knee surgeries.

Vonn connected with Martin M. Roche, knee surgeon at HSS Florida, who recommended a robotic-assisted partial replacement for Vonn’s right knee. Vonn’s major pathology was cartilage loss on her lateral, or outer, side. A minimally invasive procedure would keep her ACL, her medial meniscus and the cartilage on the inner part of her knee intact. This would aid her post surgery proprioception, or “sixth sense” ability to be aware of the movement and location of her knee joint for improved stability and balance.

Through a CAT scan, Dr. Roche built a virtual 3D model of Vonn’s damaged knee. Before the April 2024 surgery, he used it to size the titanium implant. In the operating room, Roche guided the robotic arm that removes damaged bone and cartilage. “It’s almost coloring within the lines,” he says. “I can get down to millimeter precision.” He didn’t touch any muscle, ligaments, or tendons. “Recovery is much faster because we haven’t traumatized or damaged any soft tissue,” he said.

As the world’s best winter athletes gather in February for a celebration of speed, acrobatics, and artistry on snow and ice, Vonn’s attempt to earn another Olympic medal will likely be the buzziest story of the Games.

Read the full article at TIME.com.

3 science-backed ways to avoid a knee replacement

Thu, 09 Oct 2025 23:05:27 -0400

The Washington Post reports that every year, more than 700,000 Americans undergo knee replacement surgery. And researchers expect the procedure will only become more common as people strive for an active, pain-free life as they age.

People usually get a total knee replacement when they’re no longer able to move through their daily life without constant pain. But, how can you build healthy, strong knees today that power you through walks and workouts for decades?

“Motion is lotion,” said Andrew D. Pearle, MD, sports medicine surgeon at HSS. The best way to keep the joints healthy as you age is by bending your knees. The movement helps to circulate fluid around the joints, Dr. Pearle said. “The more you move it, the better,” he said.

Read the full article at washingtonpost.com.

Meet The People Behind Your PRs: Dr. Ayoosh Pareek

Mon, 18 Aug 2025 15:43:49 -0400

In an interview with Muscle and Fitness, Ayoosh Pareek, MD, sports medicine surgeon at HSS, discusses the evolution of football training across different seasons, emphasizing the importance of recovery and rebuilding during the off-season, sport-specific conditioning in the pre-season, and injury prevention during the in-season. He also highlights common football injuries such as ACL tears, shoulder labral tears, and hamstring strains, and offers strategies for effective training and recovery to enhance performance and minimize downtime.

Read the full article at muscleandfitness.com.

Why Are So Many Women Athletes Tearing Their ACLs Now?

Thu, 31 Jul 2025 21:26:43 -0400

SELF.com reports on the rising number of women athletes experiencing ACL tears.

Researchers have long known that women are far more likely to tear their ACLs. While precise estimates vary depending on the age group and population, they likely have about three to four times the risk as men,

Gabriella Ode, MD, sports medicine surgeon at HSS, member of the Women’s Sports Medicine Center, and team physician for the New York Liberty, explained that the ACL’s role is to stabilize the knee’s front and back motion, preventing your tibia from sliding out ahead of your femur. It also gives you control over rotation—“the ability to step with your foot and then turn and feel like, ‘Hey, I have good support below me in order to move explosively,'

There's another effect of ACL tears that can’t be understated: The mental impact can be huge. “This is an injury that typically occurs in athletic people who are participating in a sport or doing some sort of high-level activity, and it really derails their mobility and their desires for sport and activity, whether short- or long-term,” Dr. Ode says. “It’s totally okay to have an emotional response.”

Read the full article at self.com.

NBA Fans Send Love To Dallas Mavericks Star Kyrie Irving

Wed, 18 Jun 2025 12:38:00 -0400

Sports Illustrated reports that NBA fans are showing support for Dallas Mavericks star Kyrie Irving after he underwent successful surgery to repair a torn left ACL at HSS by Riley J. Williams III, MD, Chief of the Sports Medicine Institute at HSS.

Read the full article at si.com.

Preclinical Study Finds Earlier ACL Reconstruction is Associated with Lower Risk of Knee Osteoarthritis

Wed, 12 Mar 2025 10:00:00 -0400

A preclinical study by HSS investigators found that earlier anterior cruciate ligament (ACL) reconstruction led to lower immune cell activity, less inflammation and fewer joint changes associated with knee osteoarthritis compared to delayed surgery. The research team shared their study results today in a poster presentation at the American Academy of Orthopaedic Surgeons 2025 Annual Meeting.

After a knee injury, such as an ACL tear or rupture, immune cells travel to lymph nodes, where they interact with other cells that support and regulate inflammatory responses in the joint. This activity plays a critical role in healing, but prolonged immune cell activity and inflammation can promote osteoarthritis.

“Orthopedic surgeons actively debate the optimal timing of ACL reconstruction after an ACL injury,” says senior study author Scott Rodeo, MD, Vice Chair of Orthopaedic Research, co-director of the Orthopaedic Soft Tissue Research Program, and director of the Center for Regenerative Medicine at HSS. “The original thought for delaying surgery was to let inflammation resolve since operating on a highly inflamed knee can lead to postoperative stiffness, but how long to wait has been unclear.”

Dr. Rodeo and the HSS research team, including Theresa T. Lu, MD, PhD, St. Giles Chair for Research in the HSS Research Institute and pediatric rheumatologist, investigated the timing question in preclinical models of ACL reconstruction. In total, 16 models underwent immediate reconstruction after ACL rupture, 16 underwent surgery a week after injury, and 16 had no surgery. After four weeks, the researchers used advanced techniques to identify and measure the number of immune cells present in the spleen and iliac lymph nodes that drain from the knee.

The researchers observed an increase in several immune cell populations in the two surgical groups compared to the no-surgery group. Immune cell counts were significantly higher in the group that had delayed surgery compared to the group that underwent immediate surgery.

The investigators also assessed cartilage changes associated with osteoarthritis in the preclinical models. The group that had delayed surgery showed more severe and extensive signs of cartilage destruction than the group that had immediate surgery.

“Overall, our preclinical study suggests that immediate ACL reconstruction may lower the risk of developing knee arthritis, tying in with existing studies showing that chronic, unresolved inflammation leads to progressive arthritis after knee injury,” Dr. Rodeo says. “These results inform ongoing human studies at HSS in which we are evaluating the optimal timing of surgery and other factors that affect the role of immune cells and inflammatory responses in ligament healing. In these studies, we are evaluating changes in immune cells and inflammation in lymph nodes using magnetic resonance imaging, joint fluids and blood.”

Authors: Thomas M. Li, MD, Julia Retzky, MD, Camila Carballo, PhD, PT, Jihyun Sim, Lauren E. Simonian, BS, Mohammed Hammad, MD, Yuki Okazaki, MD, PhD, Claire Eliasberg, MD, Theresa T. Lu, MD, PhD, Scott A. Rodeo, MD, FAAOS.

Reference:
1 Li TM, Retzky J, Carballo C, Sim J, Simonian LE, Hammad M, Okazaki Y, Eliasberg C, Lu TT, Rodeo SA. Early anterior cruciate ligament reconstruction in a murine model is associated with reduced local lymph node responses. Accessed February 10, 2025 at
https://submissions.mirasmart.com/AAOS2025/Itinerary/PresentationDetail.aspx?evdid=428

HSS Presents New Research at the AAOS Conference 2025

Tue, 11 Mar 2025 11:27:00 -0400

At this year’s American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting, HSS physicians and scientists presented exciting new research related to clinical advancements for care and patient outcomes in orthopedics.

Research highlights include advancements in accelerating recovery after knee surgery, a preclinical study which found earlier anterior cruciate ligament (ACL) reconstruction is associated with lower risk of knee osteoarthritis, and a 40-year study demonstrating active patients who had total knee replacement are unlikely to require revision surgery in their lifetime.

HSS Presents Innovative Research Aimed at Faster Recovery After Knee Surgery at AAOS Annual Meeting

HSS investigators presented several significant studies, three of which focused on new ways to help patients recover faster after total knee arthroplasty (TKA), also known as knee replacement surgery.

Preclinical Study Finds Earlier ACL Reconstruction is Associated with Lower Risk of Knee Osteoarthritis

A preclinical study by HSS investigators led by sports medicine surgeon Scott Rodeo, MD, found that earlier ACL reconstruction led to lower immune cell activity, less inflammation and fewer joint changes associated with knee osteoarthritis compared to delayed surgery.

New Study Reveals Young, Active Patients Who Have Total Knee Replacements are Unlikely to Need Revision Surgery in their Lifetime

A 40-year study by HSS researchers led by hip and knee surgeon William J. Long, MD, FRCSC, has found that active young adults who underwent total knee replacement were unlikely to require knee replacement revision in their lifetime.

Guest Opinion: Can teen athletes stay a step ahead of torn ACLs?

Mon, 02 Dec 2024 17:55:00 -0500

Andrew D. Pearle, MD, chief of sports medicine at HSS, shares strategies to help teen athletes prevent ACL injuries.

According to Dr. Pearle, most ACL ruptures occur when an athlete moves in a way that involves a change of direction, like dodging another player or landing after a jump. Agility-based sports — like soccer, football, and basketball — have higher rates. Girls experience ACL tears up to eight times more frequently than boys. High school girls playing year-round soccer have the highest risk of all — an alarming 16% to 18% chance of rupturing an ACL.

Knee injuries are not an inevitable part of playing sports. Decades of research have shown that targeted exercises to improve agility-based body control can reduce the risk of ACL tears and other knee injuries by 50% to 80% explained Dr. Pearle.

Read the full article at grandforksherald.com.

“Militao will face a unique set of challenges after his second ACL tear,” says medical expert

Fri, 22 Nov 2024 12:54:48 -0500

Ayoosh Pareek, MD, sports medicine surgeon at HSS, discusses the challenges Real Madrid defender Eder Militao may face after his second ACL tear in an interview with SB Nation.

According to Dr. Pareek, the biggest concern for any athlete recovering from an ACL tear is always the risk of re-injury. Returning too quickly or not addressing critical aspects of rehabilitation can significantly increase the chance of another injury, either to the same knee or the opposite one. Beyond that, regaining explosiveness and neuromuscular control is a primary challenge, especially for athletes like Militao, who rely heavily on their ability to accelerate, decelerate, and change direction rapidly. We know that athletes who are highly explosive sometimes take up to two full years to regain their pre-injury level of explosiveness, even if they return to competition earlier. Balancing this timeline with the need to get an athlete back to play—where inactivity is also not helpful to the athlete or the team—is a delicate process. Neuromuscular control for sport-specific tasks, like cutting and pivoting, is critical and must be trained rigorously in a progressive manner. Mental factors also play a significant role. Confidence in the repaired leg is key, as hesitancy or fear of re-injury can limit an athlete’s ability to fully trust their body. Rehabilitation must address both the physical and psychological aspects to optimize performance and reduce the risk of setbacks.

Read the full article at managingmadrid.com.

A Surgeon Sheds Light on 49ers WR Brandon Aiyuk's Recovery Timeline

Mon, 04 Nov 2024 15:33:00 -0500

Ayoosh Pareek, MD, sports medicine surgeon at HSS sheds light on San Francisco 49ers wide receiver Brandon Aiyuk's recovery timeline after tearing his ACL and MCL.

According to Dr. Pareek, for ACL injuries, pro athletes typically aim to return within 9-12 months. MCL injuries, especially minor ones like sprains or partial tears, often show up with ACL tears but usually don't change the return-to-play timeline. Most of the time, MCL injuries heal with rehab alone, and players can stay on track for recovery. However, in cases where the MCL tear is more severe and needs surgery, the process can take longer—adding 1-3 months to the return to sport timeline. That timeline can shift depending on factors like the player’s position, surgical variability, and individual rehab progress. If both the ACL and MCL need surgery, it makes recovery more complex, and some of the usual milestones, like running or cutting drills, might get delayed. Fortunately, surgery for the MCL is less common, which helps keep most players on the standard recovery path.

Read the full article at si.com.

Inside Tyrone Mings’ 445-day road to recovery: Severe ACL injury, global rehab and muscle atrophy

Thu, 31 Oct 2024 15:54:53 -0400

The Athletic reports on Tyrone Mings' road to recovery after his second significant career knee injury.

Mings’ second injury forced him into a rigorous recovery, recalling the challenges of his first ACL injury years before. Following an awkward fall, Mings pursued a tailored rehab, splitting time between Villa’s facilities and specialists in the U.S. and Qatar. He focused on both physical and mental resilience, even stepping away from social media to maintain focus.

“There is a very close correlation between mental health and the physical ability to return to play,” says Tony Wanich, MD, sports medicine surgeon at HSS . “Especially after an injury like an ACL injury that requires a prolonged course of rehab.”

“Fifteen to 30 percent of ACL injuries have associated cartilage injuries,” said Dr Wanich. “All patients following knee surgery develop some degree of atrophy of their muscles. Specifically, we like to see a 90 per cent return of strength on the injured leg compared to the uninjured side.”

Read the full article at the nytimes.com/athletic. A subscription is required to access.

ACL Injuries

Tue, 20 Aug 2024 16:58:00 -0400

Newsday reports on the rise of ACL injuries in young athletes according to Stephen Fealy, MD, sports medicine surgeon at HSS.

“Young athletes gain enormous health benefits from participation in team sports, and as sports medicine physicians, we strongly encourage athletic activity. However, we have seen a concerning increase in knee injuries involving the anterior cruciate ligament, commonly called the ACL. Adolescents playing team sports that require cutting maneuvers or a sudden change of direction, such as soccer, basketball, football and lacrosse, are most vulnerable. Research suggests that the risk of non-contact ACL injury can be dramatically reduced through neuromuscular training — the adoption of various exercise and conditioning strategies that improve movement and allow athletes to change speed and direction with greater strength and body control," explained Dr. Fealy.

The article appeared in the print issue on August 21, 2024.

Lateral augmentation relies on individualized care

Thu, 15 Aug 2024 14:03:19 -0400

Healio reports that recent research as ignited a resurgence in the application of lateral sided extra articular procedures, such as a lateral extra-articular tenodesis and anterolateral ligament reconstruction.

“Conceptually, lateral extra-articular reconstructions are not new operations, rather they have been reintroduced in North America recently, while our European colleagues have continued to employ them as a component of the treatment offered to ACL-injured patients since they were first described,” Frank A. Cordasco, MD, MS, sports medicine surgeon at HSS. “Historically, these reconstructions were performed decades before intra-articular ACL reconstruction became the standard of care for ACL injury in North America.”

Read the full article at healio.com.

Why do women suffer more ACL injuries? Research offers possible explanations

Wed, 14 Aug 2024 20:11:57 -0400

TODAY.com highlights why women suffer more ACL injuries than men according to research.

People often injure their ACL while playing sports, especially agility-based sports which involve quick changes in direction or jumping and landing, according to Andrew D. Pearle, MD, chief of sports medicine at HSS. These include soccer, basketball, lacrosse, football, field hockey and volleyball, Dr. Pearle added.

“It has been known for some time that women have higher rates of ACL injuries ... anywhere from a three to six or four to eight times higher risk of ACL injury as compared to men with the same exposure rate (playing the same level of a sport),” said Dr. Pearle.

Females have wider hips and pelvises which can affect how their lower bodies move.

"There are theories about alignment ... women tend to have more of what's called a valgus alignment of the hips, knees and ankles, where their knees cave in a little bit more," said Dr. Pearle.

This "knock-knee" alignment can impact the way women jump or land, Dr. Pearle added, which may increase the risk of ACL injury compared to men, who often have a more bow-legged alignment.

“Women may be a bit more more ligamentously lax than men,” said Dr. Pearle, adding that this causes looser ligaments and more flexible joints, which may contribute to knee instability.

Read the full article at today.com.

Change the game: Injury challenges in female athletes

Tue, 18 Jun 2024 21:06:00 -0400

Orthopedics Today interviews Gabriella E. Ode, MD, sports medicine surgeon at HSS, about injuries among female athletes.

According to a 2022 report from the Women’s Sports Foundation, the percentage of girls participating on high school varsity teams increased from 7% in 1972 to 43% in 2018 to 2019, the most recent reporting year. The report also noted the percentage of women competing on college teams increased from 15% in 1972 to 44% during the 2020 to 2021 academic year.

Despite an increasing number of women in sports, inequalities still exist not only in participation opportunities but in research of injuries and care of female athletes, as well.

According to Dr. Ode, “Non-modifiable risk factors, such as the width of the pelvis, angle of the knees and muscle balance, can put women at a higher risk of ACL tears.”

She continued, “There are some studies that say there might be a predisposition during certain times during their menstrual cycle that they are more prone to injury that can contribute to ACL tears. There is a complex interplay as to why but, certainly, the highest risk category for an ACL tear is going to be a female athlete who participates in a cutting-and-pivoting sport, like soccer, basketball, etc.”

Read the full article at healio.com.

Atlanta Hawks Starter Will Be A Free Agent This Summer

Sat, 18 May 2024 13:43:00 -0400

Saddiq Bey is coming off a strong season where he averaged 13.7 points, 6.5 rebounds and 1.5 assists per contest while shooting 41.6% from the field and 31.6% from the three-point range in 63 games (51 starts).

However, the former Villanova star got injured at the end of the season.

Bey underwent successful surgery to repair the torn left anterior cruciate ligament (ACL) in his left knee. The surgery was performed by Riley J. Williams III, MD, sports medicine surgeon at HSS. Bey sustained the injury during the 3/10 game vs. New Orleans.

Read the full article at si.com.

RONNY MAURICIO MEDICAL UPDATE

Wed, 03 Jan 2024 10:17:00 -0500

MLB reports that Ronny Mauricio underwent right knee ACL reconstruction surgery performed by David W. Altchek, MD, co-chief emeritus of the HSS Sports Medicine Institute. A typical return-to-play timeline from this procedure is 8-12 months.

Read the full article at MLB.com.

Analysis: Serious knee injury among teen athletes grows 26%

Mon, 27 Nov 2023 12:10:00 -0500

Project Play reports on the growing number of ACL injuries in high school athletes. Among the most dreaded injuries in sports, the rate of anterior cruciate ligament (ACL) injuries among high school athletes has grown significantly over the past 15 years, according to a new data analysis by organizations collaborating to assess and address the problem of serious knee injuries.

The National ACL Injury Coalition reviewed injury data for 12 major girls and boys sports over five three-year periods from 2007 to 2022, as supplied by certified athletic trainers in the High School RIO surveillance program. From period one to five, the average annual ACL injury rate grew 25.9% to 7.3 injuries per 100,000 athlete exposures. ACL injuries now represent more than 14% of all injuries involving the knee.

The analysis offers a major update of national ACL injury figures for high school sports participants. Drawing on medical reporting from more than 100 U.S. public high schools, it is the first study since 2013 to explore the prevalence of the injury in high school sports. The analysis captured annual athletic trainer-reported knee injuries, regardless of the participant’s age or level of play in the school, and then created average annual rates for each three-year period. A 12% increase in annual ACL injury rates was also found when comparing strictly by individual year, as highlighted in the State of Play 2023 Report.

“The negative health impacts of ACL injuries are significant, both in the short-term and the long-term,” said Joseph Janosky, DrPH, MSc, PT, ATC, lead researcher for the coalition’s analysis and director of athlete health at HSS, a founding partner of the coalition.

“Among the most concerning long-term health issues is the development of osteoarthritis after ACL injury. It's important for high school athletes and their parents and coaches to understand that the health issues related to ACL injury can last a lifetime," Janosky explained.

Read the full article at projectplay.org.

Dr. Marci Goolsby joins Doctor Podcast

Fri, 22 Sep 2023 15:40:05 -0400

Doctor Podcast sits down with Marci A. Goolsby, MD, primary care sports medicine physician and medical director of the Women Sports Medicine Center (WSMC) at HSS to discuss women's sports and ways for female athletes to stay healthy and protect themselves from injury.

Dr. Goolsby specializes in the non surgical treatment of bone stress fractures and overuse injuries. “I think the most important thing for stress fractures is figuring out why it happened so trying to address any of those risk factors. I ask my patients about their training and what changes there have been, what kind of shoes they wear, do they have low vitamin D, are they a vegetarian, do they have history of an eating disorder or menstrual issues? A lot of it is activity modification. If it hurts, don't do it,” explained Dr. Goolsby.

Dr. Goolsby discussed the importance of proper nutrition and creating the right culture and messaging about the importance of appropriately refueling for their sport. I use my sports nutritionists and sports psychologists a lot. It's really a team.

“A lot of it is education and making sure people understand not getting your period might be common, but it isn't normal. The implications of that on various systems, but usually the bones are the ones that are front and center because they are at increased risk of getting stress fractures and early osteoporosis.”

Dr. Goolsby discussed the prevalence of ACL injuries especially in female athletes. “ACL injury prevention is very important for females in particular. We have a lot of injury prevention programs set up at HSS and even have an app to keep people engaged in ACL injury prevention,” said Dr. Goolsby.

Watch the full interview at youtube.com.

Why ACL injuries are on the rise

Mon, 14 Aug 2023 11:04:00 -0400

Good Morning America reports on why ACL injuries are on the rise in an interview with Andrew D. Pearle, MD, Chief of Sports Medicine at HSS.

Dr. Pearle explained the ACL is commonly injured in people who play cutting sports. When an athlete goes to cut or to pivot, they plant and their foot goes one way and their knee goes the other. That puts the ACL at risk.

Dr. Pearle continued. “Classically people feel a pop. They can feel it or hear it. People usually go down immediately afterwards. If they try and get up, the knee feels loose or unstable. Usually people can't continue playing. That day or that night, the knee will often swell. If you have a swollen knee, that usually means you've damaged the internal structure of the knee. If you can't bear weight, it's certainly time to see a doctor. ”

It's not just professional athletes that are at risk. “A lot of the spotlight has been on elite athletes, but the population that's most vulnerable is high school athletes, particularly girls. They have a 2 to 8 times higher risk of ACL injury than boys. If you tear your ACL in high school, there's about a 50 to 70 percent chance that you're going to get arthritis in your thirties,” said Dr. Pearle.

“We have solutions for this. Neuromuscular training can help. This refers to exercises that build muscle memory to optimize athletic movement,” advised Dr. Pearle.

Watch the segment here on Goodmorningamerica.com. This segment also aired on broadcast on August 14, 2023.

HSS Orthopedic Surgeon Dr. Charlton Stucken Helps Introduce an Exciting App for Injury Prevention

Thu, 10 Aug 2023 17:52:00 -0400

ESPN West Palm interviewed Charlton Stucken, MD, orthopedic surgeon at HSS about the HSS developed app called RIIP Reps that enables schools, clubs and leagues to easily implement neuromuscular training programs to reduce injuries and improve performance. The app is for ages 13 and up and the program builds athletic strength, agility and control when accelerating, stopping, cutting, jumping and landing.

“Neuromuscular training is a series of specific training activities that you can do that help out with strength, agility and control when you're trying to accelerate, cut, pivot and land. The goal is to try to avoid these types of injuries before you get them,” said Dr. Stucken.

“In general, ACL injuries are what we are trying to prevent. It's that non-contact type of injury. We are seeing it more and more in our young athletes. We have seen an over 300 percent increase in ACL injuries over the past 20 years. That is significant. All of these sports that require cutting, pivoting and twisting are the ones we worry about. Research has shown we can drastically reduce the rate of ACL injury by about 50 percent if we can preventively work on this neuromuscular training,” explained Dr. Stucken.

Listen to the podcast at podcasts.apple.com.

ACL injuries plague women's soccer

Sat, 05 Aug 2023 19:07:00 -0400

CNN reports on why female soccer players suffer more ACL injuries than male counterparts and what can be done about it.

After seeing the headlines of how many of the world’s top players are missing out on this year’s Women’s World Cup — including two from the US team — it’s hard not to think of this injury as an inevitable part of the sport, especially as a woman.

Different studies have found female athletes are two to eight times more likely than their male counterparts to tear their ACLs.

“This issue has been around for a long time, it’s gotten worse and worse,” said Andrew D. Pearle, MD, chief of sports medicine at HSS.

Over a 10-year period, Dr. Pearle says he saw a 300% increase in ACL injuries in adolescents.

So while the injuries among top professional players have brought this issue into the spotlight, Dr. Pearle said the highest incidences are still in high school athletes — and he is seeing increasing numbers in middle school-age athletes.

Dr. Pearle said this is why parents need to be aware that these injury prevention programs exist.

“If you got a girl’s soccer team, you’d say to the coach or the sports organization, OK, what’s your neuromuscular training plan? What are you guys doing for it? You know, that should be a question that everybody asks,” Dr. Pearle explained.

Read the full article at CNN.com.

Team ACL: The growing women’s soccer club that no player wants to join

Tue, 18 Jul 2023 17:50:00 -0400

In an interview with Andrew D. Pearle, MD, Chief of Sports Medicine at HSS, The Washington Post reports that female athletes are two to eight times as likely as male athletes to tear an ACL. Since 2021, at least 87 players from eight of the world’s top women’s soccer leagues have torn their ACLs. Some of the sport’s biggest stars will miss the World Cup because of this injury.

In women, the intercondylar notch, the area in the femur where the ACL sits, is narrower; additionally, women’s pelvises are wider, creating a higher angle between the hips and knees that can put greater stress on the quadriceps and the ACL. Female athletes tend to land flat-footed with knees inward on jumps and have more strength in the quads rather than the hamstrings. Those circumstances put female athletes at risk before even taking the field. In movement-heavy sports, a sudden change of direction or an improper landing could spell a tear.

“The quintessential ACL-busting cohort is in female soccer players,” said Dr. Pearle. “The numbers are really kind of tragic.”

Across soccer, pushes have been made to make injury prevention programs accessible. HSS developed an app called RIIP Reps that condenses essential exercises into seven-minute sessions.

Read the full article at washingtonpost.com.

Let's Start Treating Knee Injuries Like Brain Injuries

Mon, 17 Jul 2023 17:58:00 -0400

TIME reports on the increase in ACL injuries among female athletes according to experts including Andrew D. Pearle, MD, chief of sports medicine at HSS.

So, how to attack this complex problem? In May, The Aspen Institute Sports & Society Program and HSS created the National ACL Injury Coalition, a group of experts and leaders that will work together through 2026 to identify and implement practices, partnerships, and resources that can reduce injuries in the high school population.

Step one: Get coaches to build better injury-prevention exercises into team activities. That includes neuro-muscular training, which develops muscle memory that optimizes athletic movement and leads to more control, agility, and strength during sudden changes of direction. Such exercises include squats and side lunges and can eliminate 50% to 80% of non-contact ACL injuries. As a side benefit, they improve athletic performance and reduce the risk of other injuries like ankle sprains and even concussions.

Team warm-ups should include the FIFA-developed protocol 11+. Or coaches could ask players to do these exercises at home and track their participation through an app called RIIP Reps.

“It’s there, it’s free,” said Dr. Pearle. “It’s seven minutes a day, four days a week. We just need coaches to implement it."

Read the full article at time.com.

ACL Injuries Cast a Shadow Over the Women’s World Cup—and Girls Soccer

Fri, 07 Jul 2023 16:58:00 -0400

The Wall Street Journal reports that female athletes are at greater risk of ACL injuries in an interview with Andrew D. Pearle, MD, Chief of Sports Medicine at HSS.

“We did a study showing a 300% increase in ACL injuries in adolescents and teenagers,” said Dr. Pearle of a study that ended in 2009. “So this is an incredible epidemic.”

The problem is especially acute at the youth level. ACL injuries are as much as six times more common among female high school soccer players than among male players. A girl who plays soccer year-round has a 16% chance of injuring her ACL during her high school years, explained Dr. Pearle.

The good news for amateur players is that half or more ACL injuries are preventable with regularly performed exercises called neuromuscular training, Dr. Pearle said. HSS and the Aspen Institute recently formed the National ACL Injury Coalition to encourage their adoption.

In general, several factors are thought to put female athletes at higher risk of ACL injuries, explained Dr. Pearle. Female athletes tend to move their knees inward when landing from a jump rather than keeping them in line with their toes. They’re more knee-dominant in their change-of-direction movements rather than engaging the muscles around their knees and hips. Their joints are generally looser than those of male athletes. And women and girls have less muscle mass around the knee to reduce force on the joint.

Read the full article at WSJ.com.

Discussing ACL Injuries & the National ACL Injury Coalition with Dr. Carr of HSS

Sat, 01 Jul 2023 14:49:00 -0400

ESPN West Palm interviewed James B. Carr II, MD, sports medicine surgeon at HSS Florida, on air to discuss ACL injuries and the National ACL Injury Coalition.

“ACL injuries are very common. They happen more frequently in female athletes, but also very frequently in male athletes. Mostly athletes that do a lot of cutting and pivoting. So, soccer, lacrosse, field hockey, basketball, football. These athletes are the most at risk for these injuries. They happen the most in our younger athletes from age about 15-20. But they happen in our older professional athletes and weekend warriors as well,” explained Dr. Carr.

Dr. Carr explained that HSS has partnered with the Aspen Institute and a number of sports organizations to form the National ACL Injury Coalition that seeks to reduce the injury to young athletes.

“There is really good data showing that high risk athletes can drastically reduce their risk of injuring their ACL by doing certain training programs that focus on neuromuscular control. At HSS we are really passionate about injury prevention, especially in our young athletes, so we partnered with a couple different organizations to try to get a more national program that can bring these programs to high school athletes to train the coaches, athletes and parents on what they can do to reduce risk of these career altering injuries,” said Dr. Carr.

Listen to the podcast at podcasts.apple.com.

Coalition against ACL injuries formed, promoting high school neuromuscular training

Thu, 25 May 2023 19:00:00 -0400

Healio reports that the Aspen Institute and HSS have joined efforts with nine other organizations to form the first national coalition to reduce ACL injuries.

The National ACL Injury Coalition aims to promote the adoption of neuromuscular training in high school sports programs, helping "participants learn to move better and face fewer threats to serious injury, so they can remain active for life.

Two decades of research and data have allowed us to develop simple training programs that mitigate ACL injury risk. The problem we face now is the implementation of these programs," said Andrew D. Pearle, MD, Chief of Sports Medicine at HSS.

Read the full article at healio.com.

Hospital for Special Surgery awarded a 2-year research grant from Arthritis Foundation to support a Center of Excellence in Osteoarthritis

Thu, 26 Jan 2023 15:42:43 -0500

Patients undergoing anterior cruciate ligament (ACL) reconstruction surgery are at higher risk of developing post-traumatic osteoarthritis (PTOA), and evidence from large multicenter studies testing the efficacy of non-surgical preventive therapies is lacking.

Scott Rodeo, MD, sports medicine surgeon, vice chair of Orthopaedic Research and co-director of the Orthopaedic Soft Tissue Research Program at HSS, and Miguel Otero, PhD, associate scientist in the Orthopedic Soft Tissue Research Program at HSS, have received a 2-year research grant for $200,000 from the Arthritis Foundation to support a Center of Excellence in Osteoarthritis. As a Clinical Trial Unit of the Arthritis Foundation Osteoarthritis Clinical Trial Network (OACTN), HSS will bring its unparalleled clinical volume, including over 1,300 ACL reconstructions annually, and world-class expertise in orthopedic surgery, clinical research, molecular biology, biostatistics, and imaging, to support and strengthen the OACTN goal to test innovative interventions in multicenter randomized clinical trials (RCTs). The RCTs will integrate the use of non-surgical preventive therapies in patients at high-risk of developing PTOA, with state-of-the-art analyses of quantitative MRI, patient-reported-outcomes and biospecimens. This unique and paradigm-shifting approach has the potential to identify novel treatment approaches that could revolutionize current clinical protocols and beneficially impact patient care, both increasing quality of life and reducing financial burden.

Arthrex's ACL implant cleared for pediatric use

Tue, 10 Jan 2023 15:35:00 -0500

Becker's Spine Review reports the FDA cleared an anterior cruciate ligament (ACL) reconstruction implant for pediatric use, which has pediatric-specific instrumentation and is now the only ACL fixation device cleared for young patients.

HSS sports medicine surgeon Frank A. Cordasco, MD, MS, and pediatric orthopedic surgeon Daniel W. Green, MD, MS, FAAP, FACS, helped develop the implant.

Read the full article at beckersspine.com.

Additional coverage: healio.com.

FDA Provides Clearance of First-Ever Device for ACL Reconstruction in Children

Tue, 10 Jan 2023 10:00:00 -0500

The U.S. Food and Drug Administration (FDA) has provided clearance for use of the ACL TightRope^® II implant as the first-ever device for reconstructing torn knee ligaments in children and adolescents. The technology is based on a related device commonly used in adults undergoing anterior cruciate ligament (ACL) reconstruction, but with features specifically designed to accommodate the growing skeletons of young athletes. The key advantage of the new technique is that it allows surgeons to tension the graft sequentially to ensure proper fixation and strength and to utilize minimally invasive techniques to diminish damage to the growth plates while performing a successful reconstruction.

“Surgery to utilize the implant for graft fixation is more efficient and effective than previous methods and has been shown to result in more successful outcomes,” said Frank A. Cordasco, MD, MS, a sports medicine surgeon at Hospital for Special Surgery (HSS) in New York City. Dr. Cordasco and an HSS colleague, pediatric orthopedic surgeon Daniel W. Green, MD, MS, FAAP, FACS, have partnered in this effort and are among the nation’s leaders in using the approach in the operating room. These physicians, who are dedicated to improving outcomes for pediatric and young adolescent athletes with ACL tears both clinically and through research and education, helped evaluate the clinical effectiveness of the device through a collaboration with Arthrex that started approximately 15 years ago. Drs. Cordasco and Green also developed pediatric- and young-adolescent-specific instrumentation guides to address an increasing population of injured high-risk young athletes. Previously, only adult instrumentation guides were available for use and are inadequate in the surgical management of this cohort of pediatric and young adolescent athletes.

Tears of the ACL, a structure that is essential for knee stability during lateral movement, have become increasingly common in children and young adolescents over the past two decades, largely as a result of greater participation of both boys and girls in competitive team sports.

Until relatively recently, however, surgeons were reluctant to operate on children whose growth plates in the legs had not fused. Doing so carries the risk of permanent deformities to the long bones (femur and tibia) that meet at the knee, explained Dr. Green. Historically, the solution for most of these patients was to treat them with a brace and hope for the best until their bones had matured. But in the majority of cases, the non-operative approach led to serious problems, including further damage to the joint, as well as psychosocial effects by limiting the young athletes’ participation in sports until they reached skeletal maturity a few years later.¹

The Cordasco-Green technique of all-epiphyseal ACL reconstruction was developed in collaboration with Arthrex for use in the youngest athletes with more than three years of remaining growth.² This approach involves the use of pediatric-specific instrumentation guides to drill sockets for the ACL graft and avoid the growth plate and thereby diminish the potential for growth disturbance.^2,3,4

The complete transphyseal technique is indicated in young adolescent athletes who are approaching skeletal maturity. This approach drills across the growth plates with a small socket to perform an ACL reconstruction using a quadriceps autograft (taken from a piece of the athlete’s quadriceps tendon). Based upon their research, Drs. Cordasco and Green have found that of the two all-soft tissue autografts available for ACL reconstruction, quadriceps autografts have superior outcomes compared to hamstring autografts in this high-risk young adolescent athletic population.^5,6,7

Unlike previous iterations of the approach, the newly cleared technique uses Adjustable- rather than Fixed-Loop buttons. This feature improves surgeons’ ability to adequately tension the quadriceps autograft tendon while the patient is on the operating table and to reduce “creep,” slack in the tissue that leads to residual instability in the knee. “The stronger and greater the fixation at the time of surgery, the better the outcome for the athletes,” said Dr. Cordasco. In addition, the implant eliminates the need for ligament interference screw fixation, which may increase the potential for growth plate injury and growth disturbance.

These techniques have also provided superior outcomes in terms of the need for revision surgery and return to sports. “Our research has demonstrated that more than 90 percent of children who have undergone the surgery with this implant at HSS have returned successfully to sports without the need for additional surgery,” said Dr. Cordasco.^5,6,7

“The ideal patient for the procedure is, in general, a child between the ages of 12 and 15 to 16, depending upon the athletes’ skeletal maturity, at which point the growth plates are effectively closed,” said Dr. Green. This group has seen an “epidemic” of ACL tears over the last 20 years, he added.

Dr. Green concluded that the youngest children may not good candidates for this approach, because their bones are not large enough to hold the sockets. The youngest children benefit from a different physeal-sparing approach using a combined intra- and extra-articular surgery utilizing the iliotibial band as a graft.

References:

1. James EW, Dawkins BJ, Schachne JM, Ganley TJ, Kocher MS; PLUTO Study Group; Early Operative Versus Delayed Operative Versus Nonoperative Treatment of Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis. Am J Sports Med. 2021 Dec;49(14):4008-4017. doi: 10.1177/0363546521990817. Epub 2021 Mar 15.PMID: 33720764

2. Fabricant PD, Jones KJ, Delos D, Cordasco FA, et al: Reconstruction of the Anterior Cruciate Ligament in the Skeletally Immature Athlete: A Review of Current Concepts: AAOS Exhibit Selection. J Bone Joint Surg 2013, 95:e28(1-13). PMID: 23467876.

3. McCarthy MM, Graziano J, Green DW, Cordasco FA: All-Epiphyseal, All-Inside Anterior Cruciate Ligament Reconstruction Technique for Skeletally Immature Patients. Arthrosc Tech 2012, 1(2):e231-e239. PMID: 23767001

4. Cordasco FA, Mayer SW, Green DW: All-Inside, All-Epiphyseal ACL Reconstruction in Skeletally Immature Athletes: Return to Sport, Incidence of Second Surgery and Two-Year Clinical Outcomes. Am J Sports Med. 2016 Dec 1:363546516677723. doi: 10.1177/0363546516677723. [Epub ahead of print] PMID: 28027452

5. Cordasco FA, Black SR, Price M, Wixted C, Asaro L, Heller M, Nguyen J, Green DW: Return to Sport and Re-Operation Rates in Athletes Under the Age of 20 Following Primary Anterior Cruciate Ligament Reconstruction: Risk Profile Comparing Three Patient Groups Predicated Upon Skeletal Age. Am J Sports Med. 2019 Jan 15:363546518819217. Doi:10.1177/036354651882917. [Epub ahead of print] PMID: 20645948

6. Aitchison AH, Schlichte LM, Green DW, Cordasco FA. Open Full-Thickness Quadriceps Tendon Autograft Harvest With Repair for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2020 Sep 15;9(10):e1459-e1465. doi: 10.1016/j.eats.2020.06.006. eCollection 2020 Oct.PMID: 33134047

7. Aitchison AH, Alcoloumbre D, Mintz DN, Hidalgo Perea S, Nguyen JT, Cordasco FA, Green DW. MRI Signal Intensity of Quadriceps Tendon Autograft and Hamstring Tendon Autograft 1 Year After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes. Am J Sports Med. 2021 Nov;49(13):3502-3507. doi: 10.1177/03635465211040472. Epub 2021 Oct 6.PMID: 34612708

Repair or Reconstruction: What's Best for ACL Tears?

Mon, 18 Jul 2022 15:42:00 -0400

HealthDay reports on preliminary research presented at the American Orthopaedic Society for Sports Medicine (AOSSM) 2022 annual meeting comparing repair and reconstruction procedures of anterior cruciate ligament (ACL) tears and includes commentary from Andrew D. Pearle, MD, chief of sports medicine at HSS, who was not involved in the study.

Dr. Pearle said ACL repair is “an important tool to have in our armamentarium,” but advised that the risk of re-injury in young patients should be taken seriously.

According to Dr. Pearle, “For young athletes, repair has what I consider an unacceptable revision rate.”

A repeat rupture, he noted, can damage other tissue in the knee — including cartilage cushioning the joint.

Dr. Pearle added that for adults who are not heavily into “cutting” sports, like soccer and basketball, ACL repair can be an option.

Additionally, another choice for the relatively older, non-athletic crowd: Physical therapy, without surgery.

Dr. Pearle explained that some people are “copers.” That is, their knee joint is stable enough for their usual activities, even without an ACL. Other, not-so-lucky people are “non-copers,” and without an ACL they end up with a “trick knee” that routinely buckles. (Unfortunately, Pearle noted, there's no way to predict which patients will be copers.)

One question the new findings do not address, Dr. Pearle said, is how ACL repair compares against physical therapy alone for relatively older patients. That would be a valuable study, he noted.

Read the full article at Healthday.com.

Competitive cheer leads to rise in ACL tears, fractures, concussions

Wed, 11 May 2022 17:58:00 -0400

The New York Post reports on a rise in competitive cheerleading injuries and includes insight from HSS pediatric orthopedic surgeon Daniel W. Green, MD, MS, FAAP, FACS, and highlights the experience of HSS patient Aleena, who tore her anterior cruciate ligament (ACL) due to an overuse injury.

Dr. Green repaired Aleena’s ACL with a pediatric procedure that used her IT band. During Aleena’s recover and rehabilitation, she became serious about injury prevention and adopted a weight-lifting routine.

According to Dr. Green, “A common injury in cheer is an ACL tear. If we look at the data 10 years ago, close to 90% of the kids [with an ACL tear] played soccer, lacrosse, basketball, football and skiing. And we’re definitely seeing more cheerleading ACL injuries than we have a decade ago.”

“Part of it is the athleticism of these young folks. They are so strong, powerful and jumping so high [that] when they land wrong it can result in an injury,” he added.

Aleena underscored, “If I hadn’t gone through this, I wouldn’t know how to lift weights and become stronger,” said Abrahamsen, who is now on her school’s team and competition squad and hopes to cheer at Duke after high school.

“You have to listen to your coach, you have to have a good work ethic and mesh well with your stunt group. If you don’t mesh with your stunt group, it can be dangerous,” she noted.

Read the full article at NYpost.com.

New HSS Study Finds Safe and Effective Outcomes After Innovative ACL Reconstruction Technique in Children and Adolescents at High Risk for Re-Tears

Fri, 25 Mar 2022 17:30:00 -0400

A new study by researchers at Hospital for Special Surgery (HSS) in New York City presented today at the American Academy of Orthopaedic Surgeons (AAOS) 2022 Annual Meeting found that a novel surgical technique performed during anterior cruciate ligament (ACL) reconstruction in certain younger patients garnered positive results two years post-surgery.

The study evaluated the safety and efficacy of performing a lateral extra-articular tenodesis (LET) using a modified Lemaire technique (MLT) in conjunction with an ACL reconstruction in children and adolescents who are at an increased risk for a failed ACL reconstruction. Findings revealed the technique was associated with favorable patient-reported outcomes, high return to sports participation and low ACL re-tear rate.

Research has long demonstrated that young adolescents (typically in eighth and ninth grades) who return to a pivoting or high-risk high school sport have the highest re-tear rate after an ACL reconstruction.

In the New York City metro area alone, over 80 percent of ACL injuries in adolescents stem from participation in sports such as basketball, soccer, lacrosse, skiing and football.

The ACL, one of four major ligaments in the knee joint, helps maintain the knee’s rotational stability and prevent the shinbone (tibia) from slipping in front of the thighbone (femur). It is especially vulnerable to injury from impact or athletic activities.

Currently, the standard-of-care surgical treatment for ACL tears is reconstruction. This involves placing a graft in the knee using a minimally invasive incision. Approximately 300,000 ACL reconstructions are performed annually in the United States. If the surgery fails, a revision procedure is necessary, which may result in higher rates of failure and lower rates of return to sport.

“Reconstruction alone has not been sufficient for kids who haven’t finished growing yet and want to stay active in sports,” said Daniel W. Green, MD, MS, FAAP, FACS, senior author and pediatric orthopedic surgeon at HSS.

“The risk of re-injury has been too high, leading to devastating consequences for a young athlete,” added Frank A. Cordasco, MD, MS, lead author and sports medicine surgeon at HSS, who noted that this continues to be an important area of clinical research for sports medicine surgeons worldwide.

About a decade ago, surgeons in France innovated on the standard ACL reconstruction procedure after identifying elite soccer players as high risk for re-tear. They added the LET to the reconstruction and successfully demonstrated that this combination decreased the re-tear rate in adult soccer players by nearly 50 percent.

Drs. Cordasco and Green are two of the first physicians to apply this European technique to teenage athletes in North America. The physicians are dedicated to improving outcomes for adolescent athletes with ACL tears both clinically and through research.

“We are proud to have published one of the first surgical-technique papers describing how this procedure can be safely performed in young patients who still have open growth plates,” said Dr. Green, who explained that this study is also unique in that it reports on two-year clinical outcomes in children who underwent this particular procedure.

“Not only does this technique not disturb children’s growth plates or cause post-operative stiffness, but we also found that this demonstrates a remarkably low re-tear rate in this high-risk group,” said Dr. Cordasco.

The study followed 61 patients between 11 and 19 years old who underwent simultaneous ACL reconstruction and LET with a minimum two-year follow-up; 97 percent of the patients participated in organized sports, with soccer being the most popular. These patients were identified as high risk when one or more of the following factors occurred: the patient participated in high-risk competitive sports such as football, lacrosse, soccer or basketball or that involved grade 3 pivot shift; had hyperlaxity; recurvatum; revision ACL reconstruction; contralateral ACL reconstruction; or chronic ACL insufficiency.

Depending on the patient’s skeletal maturity, the ACL reconstruction was performed either by using full-thickness quadriceps tendon, bone-patellar tendon-bone autograft, all-epiphyseal or complete transphyseal techniques.

At a minimum two-year follow-up, the researchers looked at patient-reported outcome measures as well as data on returning to sports and any potential additional surgeries. The results were overwhelmingly positive, with a median Single Assessment Numeric Evaluation (SANE) score of 95%, where 100% represents normal function. The mean Pediatric International Knee Documentation Committee (Pedi-IKDC) score was 91, where 100 is interpreted to mean no limitations on daily living or sports activities. Patients also reported a median score of 27/30 on the HSS Functional Activity Brief Scale (HSS Pedi-FABS), which is a validated eight-item instrument to quantify the activity of children.

Nearly 92 percent of patients were able to return to sport. One patient had a revision ACL surgery and three had subsequent contralateral ACL reconstructions.

This study expanded upon work that Drs. Cordasco and Green published in 2020 that showed LET can be performed safely in skeletally immature athletes who underwent a quadriceps autograft ACL reconstruction.

HSS Presents New Research at the AAOS 2022 Annual Meeting

Tue, 22 Mar 2022 10:00:00 -0400

Highlights include gender and health disparities research in treating severe carpal tunnel syndrome and patient satisfaction related to hospital experience after knee or hip replacement; innovations in rotator cuff repair and the role of cell therapy; timelines for a patient’s return to activity after surgery to correct progressive collapsing foot deformity (PCFD); the use of biomechanics to improve joint replacement outcomes; new imaging technology to help guide the management of adolescents with scoliosis; a novel anterior cruciate ligament (ACL) reconstruction technique performed in children and adolescents at high risk for re-tears, and more.

HSS Study Offers Timelines for Return to Activity After Major Foot Surgery

An HSS study led by Scott J. Ellis, MD, foot and ankle surgeon, and colleagues, provides attainable goals for return to sports and related physical activities for patients who have undergone procedures to correct progressive collapsing foot deformity (PCFD), a severe musculoskeletal pathology that can drastically inhibit a patient’s daily function. Study data will be used to provide patients with realistic expectations and timelines to resume activities post-surgery and as a resource at the time when surgery is being discussed.

Searching for New Cell-Therapy Innovations in Rotator Cuff Repair

A thought leadership piece by Scott A. Rodeo, MD, sports medicine surgeon, discusses innovations in rotator cuff repair, specifically the role of cell therapy, and how the HSS Center for Regenerative Medicine has a robust research program that is investigating the basic cellular and molecular mechanisms of healing damaged tissue.

HSS Study Reveals Why Men are More Likely to Be Offered Surgery for Carpal Tunnel Syndrome

HSS research led by Duretti Fufa, MD, hand and upper extremity surgeon, suggests males presented with more severe carpal tunnel syndrome and were offered surgery more often than females with the condition. The study adds to a growing body of research by HSS investigators examining gender, racial/ethnic and socioeconomic disparities in diagnoses, treatment approaches and outcomes in a range of musculoskeletal conditions, including hip and knee replacement, lupus and rheumatoid arthritis.

New Study Finds Black Patients Less Likely to be Completely Satisfied with Care After Knee or Hip Replacement

A collaborative HSS study that included Susan M. Goodman, MD, rheumatologist, and Mark P. Figgie, MD, chief emeritus of the Surgical Arthritis Service, found that Black patients were less likely than white patients to be completely satisfied with the process of care following knee or hip replacement. Socioeconomic status was not found to play a role in patient satisfaction. The researchers reviewed the Press Ganey survey responses of more than 4,600 patients who had surgery at HSS from July 2010 to February 2012. Individuals having a primary knee or hip replacement who resided in New York, New Jersey or Connecticut were included in the study. Although Black patients indicated they were less satisfied with the process of care right after surgery, there was no difference in satisfaction with their joint replacement outcome. More research is needed to investigate other factors, such as perceived staff courtesy and baseline pain and function, to understand why disparities exist to achieve a high level of patient satisfaction for everyone.

Study Finds Cementless Knee Replacement Outcomes Comparable to Standard Knee Implant, Less Time Needed in OR

In a study comparing outcomes of a modern cementless knee implant to the standard knee implant that requires bone cement for fixation, HSS hip and knee surgeons Geoffrey H. Westrich, MD, Brian P. Chalmers, MD, and colleagues found no difference in hospital length of stay, complications, hospital readmission within 90 days of surgery, or rates of revision surgery at two-year patient follow-up. With respect to time spent in the operating room (OR), researchers found that using the cementless implant reduced OR time by 25%, saving an average of 27 minutes.

HSS Presents New Biomechanics Research at 2022 AAOS Annual Meeting

HSS investigators present new research related to biomechanics and orthopedic surgery, highlighting the unique relationship surgeons have with the engineers to promote the highest quality in patient care and advancing joint replacement for the future. Three studies focus on how to optimize total knee arthroplasty (TKA) surgery using biomechanics and computer modeling, while another study discusses how three-dimensional (3-D) modeling can improve total hip arthroplasty (THA).

New Study Finds Surface Imaging Provides Highly Accurate Models of The Body for Scoliosis Surgeons

A collaborative study by Roger F. Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS and Howard J. Hillstrom, PhD, a biomechanical engineer at HSS, found that a technique called 3dMD, which uses an array of highly sensitive cameras and can image the entire body in a fraction of a second, generates extremely accurate and reliable models of the torso that can guide the management of adolescents with scoliosis.

New HSS Study Finds Safe and Effective Outcomes After Innovative ACL Reconstruction Technique in Children and Adolescents at High Risk for Re-Tears

HSS research by Daniel W. Green, MD, MS, FAAP, FACS, pediatric orthopedic surgeon and Frank A. Cordasco, MD, MS, sports medicine surgeon, evaluated the safety and efficacy of performing a lateral extra-articular tenodesis (LET) using a modified Lemaire technique (MLT) in conjunction with an ACL reconstruction in children and adolescents who are at an increased risk for a failed ACL reconstruction. Findings revealed the technique was associated with favorable patient-reported outcomes, high return to sports participation and low ACL re-tear rate.

Column: Knee Injuries: What to Know, How to Treat

Sat, 26 Feb 2022 16:57:00 -0500

Greenwich Sentinel features an article by HSS sports medicine surgeon Moira M. McCarthy, MD, about common treatments for knee injuries, including: anterior cruciate ligament (ACL) tears, meniscus tears, and chronic knee pain.

According to Dr. McCarthy, “When an ACL injury happens, the athlete may hear a popping noise after an awkward twist, collision or fall. Immediate symptoms are pain and swelling in the knee. In most cases, we recommend surgery as the best way to stabilize the knee joint and resume an active lifestyle.”

For meniscus tears, “There are two menisci inside each knee joint. They are soft cushions on the inside of the knees that protect the cartilage. Meniscus tears are very common with all types of activity. A torn meniscus can be categorized as traumatic (acute) or degenerative (associated with aging or wear and tear).”

On the topic of chronic knee pain, she explained, “Many of the patients we see at HSS with knee pain are suffering early arthritis, which we also call cartilage softening or thinning. Other conditions like patella tendonitis and quadriceps tendonitis can cause knee pain, hindering activities like climbing stairs, squatting, jumping, and running.”

Read the full article at Greenwichsentinel.com.

New Research into Preventing Post-Traumatic Arthritis After Knee Ligament Injury

Fri, 03 Sep 2021 12:00:00 -0400

The 20 laboratories and 300 personnel that comprise the HSS Research Institute are subspecialized in research that can improve outcomes and quality of life for people with orthopedic and rheumatic conditions. This week, I discussed new and exciting ways we are looking into the prevention of arthritis after knee ligament injury in several sessions at the American Academy of Orthopaedic Surgeons 2021 annual meeting.

Four bands of connective tissue called ligaments support the knee joint: the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. Ligament damage, such as a tear from a sports injury, makes the knee joint unstable. About half of patients who experience injury to the ACL develop degeneration of cartilage that can lead to knee arthritis over about 15 years. This late effect can be particularly life-altering for young athletes.

HSS research is driven by the fact that we are seeing an increasing number of patients with these problems. Surgery can fix the initial problem of a torn ACL or cartilage and stabilize an injured knee, but we are striving to develop new treatments to prevent post-traumatic arthritis that happens later.

Our researchers have unparalleled access to patient data and tissue samples, making HSS a living laboratory for translating basic research insights into cutting-edge treatments. We’re investigating ways to prevent the development of arthritis after knee ligament injury from three different angles. First, we are analyzing changes at the tissue and cellular level in basic laboratory studies and with use of state-of-the-art quantitative magnetic resonance imaging (MRI) techniques that provide unparalleled information on changes in the microscopic structure of cartilage, going far beyond the diagnostic capability of standard MRIs.

Second, we are conducting biomechanical studies using knees from human cadavers, simulating typical gait and loads on joint surfaces and seeing how injury to ligaments and cartilage damage affects movement of the joint. Simulator technology makes it possible to perform thousands of repetitive movements in a much shorter period than observing changes in patients. The biomechanical studies are being paired with 3D computer modeling, helping us to better understand and predict abnormal stresses on the cartilage that lead to arthritis. There are numerous factors that can lead to post-traumatic arthritis, and our hope is that these models will provide insights into why some patients develop arthritis while others do not.

Third, I am leading a new, multi-institutional clinical research study evaluating the use of platelet-rich plasma (PRP) injections as a potential treatment for reducing the risk of developing knee arthritis after an ACL injury. PRP injections contain platelets concentrated from the patient’s own blood. These platelets provide a rich source of anti-inflammatory chemicals and growth factors known to stimulate repair processes. We want to determine if it can combat the inflammation that is a big culprit behind progressive degeneration in the joint.

We plan to recruit patients with ACL injuries. Patients will be randomly assigned to receive one PRP injection at diagnosis and another during surgery to repair a torn ACL or to receive placebo injections instead and will be followed for two years.

Joint fluid samples will be analyzed over time to look for inflammatory markers by using state-of-the-art laboratory techniques and quantitative MRI techniques that will allow us to detect biochemical changes in cartilage tissue within a year or two, much faster than the development of changes on routine x-rays, which can take up to 15 years. We will combine this information with patients’ symptoms and measures of function, pain and strength.

PRP has great potential, but one of the biggest challenges to date is its variability. As a blood product, the components vary greatly between patients and even on different days from the same patient. To address this issue, we will analyze a small sample of each patient’s PRP in the lab to look for common characteristics that lead to a positive response in warding off the development of arthritis.

We are proud to be leading multiple avenues of research into new ways to prevent knee arthritis in patients with knee ligament injuries.

- Scott A. Rodeo, MD, sports medicine surgeon, Vice Chair of Orthopaedic Research and Co-director of the Orthopaedic Soft Tissue Research Program at HSS

Quadriceps Grafts May Be Superior to Repair ACL in Adolescents

Mon, 12 Jul 2021 08:51:00 -0400

Applied Radiology reports on a new HSS study that suggests a graft from the quadriceps may be superior to the standard hamstring graft for younger patients who required anterior cruciate ligament (ACL) reconstruction surgery by Daniel W. Green, MD, MS, FAAP, FACS, pediatric orthopedic surgeon, and Frank A. Cordasco, MD, MS, sports medicine surgeon.

The researchers evaluated graft maturity by comparing magnetic resonance imaging (MRI) signal intensity of quadriceps tendon autografts and hamstring tendon autografts used in primary ACL reconstruction, and presented findings at the American Orthopaedic Society for Sports Medicine - Arthroscopy Association of North America Combined 2021 Annual Meeting.

Dr. Green said, “The decrease in signal between six and 12 months post-operatively suggests quicker graft maturation and improved structural integrity of QTA [quadricep tendon autograft] as compared to HTA [hamstring tendon autograft]. This provides evidence that one year postoperatively, QTA may have a superior rate of incorporation and synovialization as compared to the HTA.”

Read the full article at Appliedradiology.com.