Today, we’re diving into a paper that reviews the long-term outcomes following arthroscopic Bankart repair and challenges some of the historical narratives around this procedure.

The study that we are reviewing today is titled “Long-term Outcomes of a Contemporary Arthroscopic Bankart Repair Technique in Patients With Traumatic Anterior Shoulder Instability: A Minimum 10-Year Follow-up.”

This is a minimum 10-year follow-up study looking at modern arthroscopic Bankart techniques using at least three anchors — and it asks:

Are recurrence rates still as high as we’ve been taught?

Welcome to another episode of Game Plan! It has been a while since we have done one of these Game Plan episodes so to quickly review: These episodes are specifically designed for patients. They are designed to hopefully answer some of the questions you have about the most common sports medicine conditions, injury prevention and treatment options.

Today we’re talking about pickleball – the fastest growing sport in the United States. From 2019- 2021, the number of pickleball players increased from 3.3 to 4.8 million. The reason for the growth of the sport is likely multifactorial, including that it encompasses a wide variety of age ranges, it is easy to understand and it is inexpensive to play. However, with this steady growth has come a corresponding linear rise in pickleball injuries. And these injuries are not inexpensive, costing between 250 to 500 million dollars in 2023 alone.

Pickleball is a paddle sport that takes aspects from tennis, badminton, and ping-pong. Now, we were going to try to explain the pickleball rules here, and how it differs from other racquet sports. But, USA Pickleball has a really nice 5-minute video on their website (usapickleball.org) that quickly summarizes the basic rules. If you are interested in learning more about this game, definitely check out their website. It should be noted that the rules and scoring system are currently variable. But as more competitions arise, more standardization to the game will likely follow, as is the trend with most sports.

Today, we’re reviewing an article published in the November 2024 issue of the yellow journal titled “Pickleball: A Standard Review of Injury Prevalence and Prevention in a Rapidly Growing Sport.” This study compiled data from retrospective studies containing emergency department data and case reports of specific injuries sustained while playing pickleball. The authors also utilized a customized survey to capture outpatient data of current pickleball players seen in outpatient orthopedic facilities and at local pickleball events.

We get a lot questions from our listeners each week and they’re great questions,
so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started! Today’s Ask The Sports Docs focuses on timing of ACL reconstruction surgery.

Our patients, and their families, frequently ask… how long can I wait to
have the surgery? To answer that question, we’re going to review an article, hot off the press in this month’s issue of AJSM titled “Early ACL Reconstruction Mitigates the Development of Posttraumatic Osteoarthritis in a Murine ACL Rupture Model.” Dr. Julia Retzky and colleagues at HSS sought to answer the question:
Does the timing of ACL reconstruction actually matter for long-term joint health?

This is a timely paper because posttraumatic osteoarthritis or “PTOA” after ACL injury remains a massive unsolved problem. Even with modern reconstruction techniques, we’re still seeing 23 to 60% rates of PTOA at 10 to 25 years post-op. Historically, the literature on timing is all over the place. Some studies suggest early ACLR may reduce PTOA risk, others show no difference. The problem is
heterogeneity—different grafts, definitions of “early,” imaging versus radiographic OA, meniscal status, you name it.

And that’s where this paper is interesting. It strips away a lot of clinical confounders by using a controlled murine model (or mouse model) with a noninvasive closed ACL rupture, followed by either immediate reconstruction, delayed reconstruction, or no reconstruction. And importantly, this is the first murine study using a true intra-articular ACL reconstruction model, rather than extra-articular stabilization. So this mirrors what we do clinically, with a true anatomic ACL reconstruction.

So, let's dive in...