Advanced Sports Medicine: New Solutions for Athlete Injuries w/ Dr. Seth Sherman (Ep. 52)

From Sidelines to Solutions: Orthobiologic Innovations in Athletic Injury Recovery

Advances in orthopedic surgery are transforming treatment and recovery for athletes and aging adults alike, fueled by innovations in biologic therapies like platelet-rich plasma (PRP) and cartilage transplants. Dr. Seth Sherman, a third-generation orthopedic surgeon and specialist in sports medicine, sheds light on these developments, emphasizing that biologic enhancements could redefine patient outcomes in joint preservation and ACL, meniscus, and cartilage repair.

Orthobiologics in ACL and Meniscus Surgery

ACL injuries, one of the most common knee injuries in athletes, traditionally require surgical reconstruction using grafts. While ACL reconstructions have good outcomes, orthobiologics—therapies derived from natural biologic materials like cells and growth factors—are revolutionizing the field. PRP, for example, is derived from a patient's blood and is rich in healing growth factors. Dr. Sherman emphasizes that when PRP is injected at the injury site, it could potentially improve healing rates in procedures like meniscus repairs, which currently have an 80% success rate.

Moreover, as Dr. Sherman explains, “If we can give it a biologic boost, then that’s really where the future lies.” Orthobiologics promise to increase healing consistency by optimizing the body’s natural repair mechanisms. Success in this area could reduce re-injury rates, offering athletes a faster and potentially safer return to high performance.

Cartilage Transplantation: Restoring Joint Surfaces

Cartilage preservation and restoration are particularly challenging but essential in treating both athletes and aging patients. Cartilage acts as a shock absorber in joints, but injuries or wear can lead to pain, swelling, and long-term disability. Two main approaches have shown promising results in restoring cartilage:

• Osteochondral Allografts: This method involves transplanting bone and cartilage tissue from donors. By matching tissue contours and implanting it into the patient’s joint, surgeons can restore smooth joint surfaces and function. These transplants are a significant advancement, allowing for immediate joint movement post-surgery and eliminating the need for the patient's body to generate new cartilage.

• Autologous Chondrocyte Implantation (ACI): This technique involves harvesting a patient’s cartilage cells, growing them in a lab, and re-implanting them as a cartilage sheet. The cells then produce new cartilage in the joint, mimicking natural cartilage. While not perfect, this approach is effective in restoring joint surfaces and providing a better alternative to joint replacements.

These innovative options could give patients more time with functional, pain-free joints, possibly delaying or eliminating the need for full joint replacements. In cases like cartilage transplants, the surgery timeline is more extended, often geared toward preserving joint function rather than immediate performance in sports. This approach reflects a shift towards preservation and quality of life for older patients or retired athletes facing joint issues from years of intense physical activity.

Non-Surgical Biologics for Joint Health

PRP has emerged as a go-to orthobiologic because of its ease of use and potential benefits across joint, tendon, and ligament injuries. However, Dr. Sherman underscores that “not all PRP is the same,” as platelet concentration and other variables significantly affect outcomes. To address this, Stanford’s orthopedic team and the Biologic Association track every PRP injection they perform, studying outcomes to refine indications and techniques for different conditions.

Bone marrow aspirate concentrate (BMAC) is another promising biologic treatment that can be applied in orthopedic surgery to support bone and joint healing. BMAC therapy utilizes stem-like cells and growth factors from bone marrow to help modulate inflammation and support tissue repair. While not a “stem cell cure” in the traditional sense, BMAC can help attract the body’s natural repair cells to injury sites, aiding healing.

Dr. Sherman highlights that much of the impact of these biologic therapies lies in understanding their precise effects and tailoring them to individual patients. “With the right patient-specific data, these treatments can evolve from trial-and-error options to evidence-based choices,” he explains. Tracking and studying biologic samples will pave the way for more personalized and effective sports medicine.

Preventative Medicine for Athletes

Dr. Sherman points out the critical role of preventative care, especially in youth and young athletes. Overuse injuries are often caused by single-sport specialization, which can overburden specific muscle groups and joints, leading to chronic injuries. Encouraging multi-sport participation and cross-training not only reduces injury risk but also promotes well-rounded physical development.

Additionally, sports-specific injury prevention programs like the FIFA 11+ warm-up routine have been shown to reduce ACL injury rates in soccer players. When athletes consistently incorporate these injury prevention programs, they reduce non-contact injuries, a common issue in high-impact sports. Adapting these programs for young athletes across various sports could improve performance and lower injury rates. New approaches, such as gamifying these routines or using wearable technology to make them more engaging, are also under exploration.

The Promise of Future Technologies and Collaborations

Orthopedic and sports medicine teams across academic and clinical settings are collaborating to study and refine orthobiologic treatments. Stanford and other centers are studying PRP, BMAC, and cartilage restoration methods with a keen focus on integrating emerging technologies, such as 3D-printed implants and custom-fit cartilage transplants.

Looking ahead, Dr. Sherman foresees a future where orthopedic surgery is augmented by biologics at every stage—from surgery to rehabilitation. By understanding the nuances of each patient’s injury, treatment could become more precise and efficient, resulting in shorter recovery times and a better overall quality of life. The next five years hold exciting possibilities for orthopedic surgery and sports medicine as biologics continue to mature, offering new hope for athletes and aging patients alike.