6-8 Weeks: Perspectives on Sports Medicine

Shoulder Instability: Who Needs Surgery, and Why Remplissage Is Now StandardOn an academic Friday, Dr. Brian Feeley and Dr. Drew Lansdown talk about shoulder instability. It comes up a lot in the fall, when football and high school sports start, and again in winter with snowboarding and skiing. They cover which first-time dislocators should think about surgery, how stabilization surgery has changed over the past decade, and when athletes can realistically return to play.In this episode:What "academic days" are. Why protected time for research, education and department work matters for surgeons whose operating schedules are unpredictable.Dislocation vs. separation. A glenohumeral dislocation (the ball comes out of the socket) compared with an AC joint "shoulder separation" (where the collarbone meets the shoulder blade).Who gets surgery. The main factors are how many times it has happened, age (under 21 carries a high risk of it happening again) and activity. Surfers and rock climbers may be offered surgery even after a first dislocation.Instability, not pain. Patients often feel fine between episodes, which makes the decision to operate less obvious.Physical therapy vs. surgery. PT strengthens the rotator cuff, which holds the ball in place. Surgery repairs the labrum and tightens the capsule.Remplissage explained. It means "to fill in" in French. The surgeon fills the Hill-Sachs lesion with the posterior capsule and infraspinatus tendon so the dent in the ball can't catch on the socket.Outcomes over time. In older series, about 1 in 5 young patients dislocated again after repair. UCSF's recurrence rate with modern technique is now about 3–5%. The biggest improvement is fewer subluxations, the feeling that the shoulder is about to slip out.Measuring the Hill-Sachs lesion. Width vs. craniocaudal (north-south) length vs. location, and why the threshold for adding remplissage keeps dropping.The billing problem. Remplissage has become close to standard of care, but there's no billing code for it.Return to sport. Plan on about 6 months, and base the decision on function (range of motion, strength, confidence), not just the calendar.Coming up: Latarjet and patellar instability.Hosts: Brian Feeley, MD, and Drew Lansdown, MD (UCSF)References discussed:MacDonald P, et al. Arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with a Hill-Sachs defect: a randomized controlled trial. J Shoulder Elbow Surg. 2021.Woodmass JM, et al. Arthroscopic Bankart repair with remplissage in anterior shoulder instability results in fewer redislocations than Bankart repair alone at medium-term follow-up of a randomized controlled trial. Am J Sports Med. 2024.Arthroscopic Bankart repair with and without remplissage in longer inferior craniocaudal Hill-Sachs extensions: secondary analysis of a randomized clinical trial. (PubMed 40744323)Cong T, …, Lin A. Defining critical humeral bone loss: inferior craniocaudal Hill-Sachs extension as predictor of recurrent instability after primary arthroscopic Bankart repair. Am J Sports Med. 2024.Subscribe to 6 to 8 Weeks: Perspectives in Sports Medicine on YouTube, Spotify, Apple Podcasts or wherever you listen.This podcast is for educational purposes and is not medical advice. Please subscribe to our podcast at Apple PodcastsCheck out our website on Simplecast

6 to 8 Weeks: Perspectives in Sports MedicineEpisode Notes — 49ers Week 1 Injury RoundupHosts: Dr. Nirav Pandya & Dr. Brian FeeleyThe WR Deltoid Ligament ScareInitial fear on the field was an Achilles rupture (non-contact mechanism, inability to bear weight), then reports shifted to a calf strain, then finally landed on a deltoid ligament injury.Brian breaks down why the mechanism didn't fit a classic Achilles rupture (most Achilles tears happen off a "rock back" push-off step) and walks through the deltoid ligament anatomy — the ligament complex on the inside of the ankle.Isolated deltoid ligament sprains are rare. The hosts note the last notable isolated case they can recall locally was Steph Curry's deltoid sprain roughly 14 years ago. Deltoid injuries are far more commonly seen alongside fibular fractures.Return-to-play timelines vary enormously by severity — anywhere from a few weeks to season-ending surgery. The data on isolated deltoid repairs in NFL players is thin; most existing literature covers deltoid repair in the setting of ankle fractures.Bonus injury update: Myles Garrett found out in Australia that his knee needs surgery — offered half-jokingly as his excuse for a quiet stat line in Week 1.George Kittle's 8-Month Achilles ReturnKittle returned roughly 8 months after his Achilles rupture, faster than some expected (9–12 months).Discussion of the broader trend: Achilles recovery timelines are trending faster, while ACL recovery timelines are trending slower (more conservative).Cross-sport comparison: Jayson Tatum returned from his Achilles at ~10 months; Tyrese Haliburton sat out the full season. The hosts note that landing/jumping demands (basketball) are a very different ask than football's demands on the Achilles.Kittle was managed on a snap count to ease back in, aided by extra recovery time before the next game.Key teaching point: by 8 months the tendon itself is typically healed — the real variable is performance readiness and avoiding a secondary injury, which varies athlete to athlete and position to position.Tight End Depth Chart Trouble — MCL GradingWith Kittle on a snap count, the second tight end going down with an MCL sprain complicates things.Quick primer on MCL grading (Grade 1–3, based on clinical exam and MRI) and why some MCL sprains are treated as more serious than the "garden variety" 2-week sprain the public assumes.Nick Bosa's Revision ACL ReturnDeep dive into why bone injuries heal faster than ACL grafts: a plated fracture is often well-healed and ready to load within about 6 weeks, whereas an ACL graft has to achieve tendon-to-bone healing, develop its own blood supply, lay down new collagen, and regrow nerve endings for proprioception — a much longer biological process.Reference to Timothy Hewett's research suggesting a 2-year window for full ACL cellular/neuromuscular recovery — far longer than athletes actually wait to return to play.Notes that Bosa's prior injury/return wasn't a rehab failure; his more recent setback was a separate, unrelated contact injury.Discussion of graft-site donor pain/"tendonitis" as a very normal part of the return timeline, and how public-facing labels like "tendonitis" tend to simplify what's really happening.McCaffrey's Achilles Tendinopathy — A Different AnimalContrast drawn between post-surgical graft-site soreness (expected, manageable) and McCaffrey's Achilles tendinopathy without prior surgery, which the hosts note tends to feel worse and is harder to rehab through.Parallel drawn to Steph Curry's patellar tendonitis last season, reinforcing that these issues need individualized, athlete-by-athlete management based on position, load, and schedule.The Australia Trip DebateShould teams fly in the day of the game or a week ahead to acclimate? The hosts land on the trip being a net positive for team morale and experience regardless of the football outcome.On the science: travel-related performance effects are driven mainly by the air travel itself, not by when you take it — so arguments that early arrival gives a competitive edge don't hold up well.Light jab at the "the flight hurt the Rams" narrative — the hosts chalk the loss up to Week 1 randomness (and Myles Garrett's knee) rather than travel logistics.Closing ThoughtSeason-long theme: playoff success tracks with a healthy roster in December/January far more than with early-season form. A nod to the Brock Purdy era 49ers, where untimely injuries — not lack of talent — have been the difference in deep playoff runs.Listen to "6 to 8 Weeks: Perspectives in Sports Medicine" on Simplecast, Apple Podcasts, YouTube, and wherever you get your podcasts. Please subscribe to our podcast at Apple PodcastsCheck out our website on Simplecast

Overview: A tribute episode responding to news that Tommy John passed away, using his life and eponymous surgery as a jumping-off point to discuss the history and evolution of UCL reconstruction ("Tommy John surgery"). Topics covered: Tommy John's career recap — pitched in MLB from roughly age 18 to his mid-40s, playing for multiple teams multiple All-Star selections and a long career, especially notable for the number of wins after his surgery The original UCL injury mechanism — repetitive valgus stress on the elbow from the pitching motion, and how the ligament breaks down over time Dr. Frank Jobe's original 1974 surgery — described as highly experimental at the time, using a tendon graft (palmaris longus) to reconstruct the ligament, with tunnels drilled through bone Tommy John's original recovery — described as a lengthy immobilization period (cast for several weeks) followed by roughly a year off before returning, contrasted with much more aggressive early-motion protocols used today Evolution of surgical technique — from the original figure-eight graft technique to modern approaches (docking technique mentioned), plus newer options like internal brace augmentation and repair-vs-reconstruction decision-making Role of MRI in modern diagnosis — better visualization of partial vs. full UCL tears, which changes surgical decision-making Return-to-play and re-injury discussion — primary vs. revision surgery outcomes, and how performance/velocity can change post-surgery A comparison drawn to the early history of hip replacement surgery as another example of a once-experimental procedure that took decades of iteration to become standard Reflection on how faster information-sharing and higher surgical volume today make refining new techniques faster than it was in the 1970s Closing thoughts and sign-off Please subscribe to our podcast at Apple PodcastsCheck out our website on Simplecast

6 to 8 Weeks: Perspectives in Sports Medicine Episode: Getting Into Med School — GPA, MCAT, Shadowing, Gap Years & Research Episode Overview In this episode, the hosts step away from injury talk to answer one of their most common inbox questions: how do you actually get into medical school? They break down what really moves the needle in an application — GPA and MCAT, choice of major and undergrad school, how to approach shadowing, whether a gap year helps, and what admissions committees are actually looking for in research experience. Disclaimer As always, this discussion is for informational purposes only and isn't professional medical (or admissions) advice — please consult your own advisor for guidance specific to your situation. Key Topics GPA & MCAT — the two numbers that still matter most Despite everything else on an application, GPA and MCAT remain the primary screening tools admissions committees use. Grade inflation is real and varies significantly by school — a 3.6–3.8 GPA range is roughly where competitive applicants land, but the same GPA means different things depending on the school and major. A tougher major at a rigorous school isn't automatically valued over an "easier" major elsewhere — committees weigh context, but it's not a simple apples-to-apples comparison. Does your major or college choice matter? There's no official "pre-med major" — the actual requirement is a specific run of prerequisite coursework (calculus, bio, chemistry, etc.), and the rest of your major is up to you. Study what you're genuinely interested in; passion for the subject matters more than picking a major purely for strategy. MCAT prep: courses vs. self-study, and when to take it Prep courses can help people who need external structure and a set schedule, but self-motivated students often do just as well studying independently. Timing matters — many students benefit from a dedicated, uninterrupted block of study time (e.g., over a school break) rather than squeezing prep into a busy semester. Retaking the test once is reasonable if there's a clear explanation for an underperforming score; diminishing returns set in after that unless there's a specific circumstance (e.g., testing in a non-native language). MCAT scoring context Competitive applicants generally cluster in a fairly narrow score band, with average matriculant scores in the low 510s and top-tier scores in the high teens (out of the 472–528 scale). Small point differences can matter less than people assume — the scale rewards consistency more than chasing a marginal few extra points once you're already in a strong range. Shadowing: what it's actually for The hosts are candid that shadowing's educational value is debatable, but it remains an expected, near-universal part of applications (most students log somewhere in the 60–100 hour range). Its real purpose may be less about clinical knowledge and more about exposure — understanding what a doctor's day actually looks like, including the less glamorous parts (documentation, charting) that TV medical dramas skip over. How to find a shadowing opportunity Cold-emailing physicians is common — and volume is high on the receiving end, so personalized, well-written outreach stands out. Small details matter: get the doctor's name right, be specific about why you're reaching out, and keep it concise. A personal connection (a family doctor, a referral) significantly increases response rates compared to a cold email. Gap years Increasingly common and not a red flag — the key is what you do with the time. Strong gap years tend to involve meaningful international work, high-level athletics, or substantive clinical/research experience — not just "time off." What matters is being able to articulate what you learned and how it shaped your decision to pursue medicine. Research: it's not about the publication count Admissions committees care less about how many papers you've published and more about whether you can demonstrate scientific thinking — forming a hypothesis and working through ways to prove or disprove it. This is explicitly contrasted with clinical reasoning, which tends to follow a more structured, rule-based diagnostic process. Research quantity matters more later on, at the residency/fellowship stage — for med school applications, quality of experience and what you took from it matters more. Does the prestige of your undergrad school matter? Less than people think. What matters more is how well you did there and whether you took advantage of the opportunities available to you. A student at a smaller or less "name brand" school who fully used the resources available (research, clinical opportunities, leadership) can stand out just as much as someone at an elite feeder school who coasted. The personal statement Life context matters — family obligations, financial circumstances, or nontraditional paths (e.g., pursuing elite athletics before switching focus to medicine) can meaningfully shape and strengthen an applicant's story when explained well. Where to Listen Available on Apple Podcasts, Spotify, and YouTube — search "6 to 8 Weeks: Perspectives in Sports Medicine." Please subscribe to our podcast at Apple PodcastsCheck out our website on Simplecast

Episode Summary Dr. Brian Feeley interviews Dr. Nirav Pandya about the recently published study he co-authored on short-term workload patterns preceding Achilles tendon ruptures in NBA players — how the paper came together, what it did (and didn't) find, and why it caught national media attention. The discussion also digs into the difference between correlation and causation, the study's limitations, and what the finding might mean for how teams monitor player workload going forward. Timestamps & Topics 0:00 – Introduction & study overview Dr. Feeley sets up the paper's title and premise — a descriptive study looking at NBA Achilles tendon ruptures over roughly a ten-year period, prompted by a recent cluster of high-profile tears. Dr. Pandya walks through what triggered the research question and the study's basic design (no control group; retrospective look at workload leading into injury). 2:00 – The pattern in the data Dr. Pandya lays out the central finding: an increase in minutes played in the 10–15 games immediately before an Achilles rupture, even when season-long workload looked unremarkable. Early caveat that this is an observed trend, not a proven cause. 4:00 – Correlation vs. causation, sanity-checking the finding Dr. Feeley raises a lighter aside about spurious correlations (jokingly noting you could "find" a correlation with almost anything), which Dr. Pandya uses to frame why the workload spike is a plausible signal but not confirmed as causal. Comparison of modern soft-tissue injury patterns to blunt-force injuries seen decades ago. 6:00 – How big is the difference, really? Dr. Feeley presses on the actual magnitude of the workload increase (on the order of ~1–2 additional minutes per game); Dr. Pandya explains why that's clinically meaningful at the NBA level, given how much cumulative high-intensity activity is packed into that time. 8:00 – What are players actually doing with that extra time? Dr. Pandya speculates on mechanism — intensity, deceleration/jumping load, and fatigue accumulation over a 10–15 game stretch rather than any single game. He notes that back-to-back games did not show a correlation with Achilles injury risk in the data, which Dr. Feeley flags as somewhat surprising given how much back-to-backs are discussed in load-management conversations. Consistency of minutes over time floated as possibly more relevant than any single spike. 10:00 – Original hypothesis vs. what was found Dr. Pandya discusses going in expecting more of a cumulative, season-long load story and being surprised the signal clustered in that shorter pre-injury window instead. Discussion of confounders — hamstring injuries and other soft-tissue injuries as comparison points, and acknowledgment that the cohort skews toward star/veteran players logging heavy minutes. 12:00 – Limitations, and the media's reaction Dr. Pandya directly acknowledges the study's limitations (small cohort, no control group, correlation not causation) and voices frustration that some media coverage ran with the headline finding without engaging the full paper. He calls for the NBA and other leagues to be more open to collaborating with outside researchers so questions like this can be studied with better data access. 14:00 – What would you change? / closing thoughts Dr. Feeley asks what Dr. Pandya would do differently if responsible for NBA player health and safety — Dr. Pandya answers with more consistent, science-based load monitoring (tracking, muscle/movement monitoring) rather than ad hoc minute restrictions, and better use of player-reported feel/symptoms alongside objective data. Episode closes with the standard subscribe/follow call-to-action (Spotify, Apple, YouTube). Key Takeaways The study found a workload spike in the 10–15 games before Achilles rupture — not a season-long overuse pattern. No correlation was found between back-to-back games and Achilles injury risk in this cohort. The paper is explicitly descriptive/observational — the hosts are careful to frame it as hypothesis-generating, not proof of cause and effect. Media coverage tended to oversimplify the finding; the hosts encourage listeners to read the full paper rather than headlines. Consistency of workload over time may matter more than any single game or back-to-back stretch. Please subscribe to our podcast at Apple PodcastsCheck out our website on Simplecast