Podcast Transcripts

[00:00:00] Will Sanchez: Welcome to Sports Doc Talk. As you can see, we have Dr. Grant Garcia. I'm Will Sanchez. Uh, Dr. Garcia, unbelievable. It's the end of the year. We're wrapping things up. And before the year was over, we wanted to make a mention, um, of some key injuries, looking at 2025, even though 2024 Major League Baseball season just ended.

[00:00:39] Will Sanchez: But with the winter meetings concluding, So many players out there. If you are Juan Soto, you just got paid, baby. So for life, he's not going

[00:00:50] Dr. Grant Garcia: to be playing anywhere else.

[00:00:52] Will Sanchez: Oh my God. That, that is, that is absolutely amazing. Gary, listen for there's over 3000 division one [00:01:00] players in the transfer portal in college.

[00:01:02] Will Sanchez: Forget football, go learn how to throw a curve ball, hit some blind drives, hit some home runs, go get paid, go get that baseball money is guaranteed. I think, I think I'm gonna start having babies again. You, you have some young ones, maybe, maybe your wife needs to hear this episode and let's, let's get some babies back on, let's get some baseball players.

[00:01:24] Will Sanchez: You're an athlete. Am I starting trouble? I don't know, but there's money out there. I'm really excited. It's a lot

[00:01:30] Dr. Grant Garcia: of money. That's a lot of money. Holy cow.

[00:01:34] Will Sanchez: Before we get to, um, these key injuries, as we look forward to 2025. Uh, for the baseball season holidays, maybe I should whisper us, maybe we should keep it quiet.

[00:01:46] Will Sanchez: Did, did you do your shopping? It's the end of the year. Did, did you take care of the shopping? The kids taking care of wife, taking care of what's going on. This is a safe place. You could tell us, you could tell us.

[00:01:58] Dr. Grant Garcia: Everybody knows that, you know, I'm too [00:02:00] busy to do that. There's no way I'd be capable of physically doing that.

[00:02:03] Dr. Grant Garcia: You know, there's a, my friend sent, my wife sent me an little Instagram ma'am, and it shows this little squirrel. That's like very excited and looking around. It says, that's what dad looks like on Christmas. Cause he's never seen the presents either

[00:02:15] Will Sanchez: messed up. Well, so I do, I do get all those companies.

[00:02:20] Dr. Grant Garcia: I do my best when I can, but unfortunately the, you know, the boss of the house is in charge and there's no way my gift would be good enough anyway, so I might as well just let the boss deal with it.

[00:02:32] Will Sanchez: A smart man. That's exactly what you should do. It's like you pick out what you want, and then I'll go, we'll all be surprised on Christmas morning.

[00:02:40] Dr. Grant Garcia: Yes, precisely. I like it because it's like for me, it's the Christmas as well. I get everything surprised. So it's very nice.

[00:02:46] Will Sanchez: Yeah. And for those that have listened to the show, if you need some travel plans, Dr.

[00:02:50] Will Sanchez: Garcia is the travel master. So you, you will coordinate all the vacations, all the travel, and the wife will take care of all the presents and make [00:03:00] sure that everyone's having a wonderful holiday as we wrap up the year. I think that's a good, uh, that's a good plan right there.

[00:03:07] Dr. Grant Garcia: Absolutely.

[00:03:08] Will Sanchez: All right, let's move on because if not, we're just going to keep going.

[00:03:10] Will Sanchez: I do this all the time. I apologize to everyone. Uh, the Dodgers have wrapped up the world series. Uh, they defeated my Yankees, which was just tough, tough, tough, tough, but you know, they've got a squad. They've deferred over a billion dollars and God knows what's going to happen going forward. But one of the star players on their team got injured and one of the star players, you know, most recognized.

[00:03:35] Will Sanchez: Players in the world. Uh, Shohei Ohtani, he had orthoscopic surgery to repair a labrum tear in his left shoulder, right now his right that he sustained during the world series, uh, while he was sliding into second base. Um, and you can explain this, right? The surgery known as was a Bankart shoulder repair involves reattaching damaged ligaments, the [00:04:00] proper position in the shoulder joint.

[00:04:02] Will Sanchez: So I hear. A very specific shoulder repair. So you got to tell me why it's called that, but also you're using ligaments to put the shoulder back in the proper position. So what happened with this injury and what does this all mean?

[00:04:18] Dr. Grant Garcia: Okay. So, uh, we talked about shoulder dislocations before, but when he slid into the, uh, the base and dislocated his shoulder, basically when you dislocate your shoulder, you're pulling the shoulder out of the joint.

[00:04:30] Dr. Grant Garcia: And there's a suction seal on it called the labrum and I draw this for so many of my patients, but imagine my hand like this. I'll try my best if I can do it. And it's probably gonna be best like this. So there's a suction seal around there called the labrum. He tore the labrum. Generally, when you dislocate your shoulder, it's out the front.

[00:04:45] Dr. Grant Garcia: So front, An inferior, so an anterior inferior tear. That front anterior tear is called a bankart tear from, you'll never guess. Dr. Banhart, he described it first. Genius. [00:05:00] So it's called a bankart repair, but basically repairing that anterior labrum. And there's various versions of this. Trevor Lawrence had a tear like this, but it was much bigger.

[00:05:11] Dr. Grant Garcia: It went all the way around. Remember them bragging, he had a seven or eight anchor repair, you know, there's been, there's been a few of these types of injuries, um, before, but this dislocation pretty much people always ask, how do you know it's torn? You don't even need an MRI to really confirm this. Cause when you have a dislocation, almost always is labrums torn.

[00:05:32] Dr. Grant Garcia: The question is whether he's had it before. Probably not. Yeah, and they did it in the first try. It's probably because now this is interesting. So this is actually the bigger point here. If he's never had dislocation before, it's his first one, right? So fixing it's almost a little bit controversial. Now, there's more.

[00:05:49] Dr. Grant Garcia: We used to tell people and I just had a patient, two patients today that I talked about this with, we used to say you can dislocate your shoulder a bunch of times, who cares? just deal with it. We've talked about this before in the season. You know, the in season [00:06:00] athlete, what do you do with them? Just look at your shoulder.

[00:06:02] Dr. Grant Garcia: But to be honest with you, we're getting more and more data to show that we should really be fixing these patients right away because the longer you wait, you get glenoid fractures like Deshaun

[00:06:11] Will Sanchez: wants and

[00:06:13] Dr. Grant Garcia: lose bone. And then this simple Bankart repair that was done is no longer an option. Um, and so I think they also what happened is it was probably as a result of the timing.

[00:06:25] Dr. Grant Garcia: I think if he dislocated his shoulder in the middle of the season or in the beginning of the season, he would not have gotten surgery, but it's that set classic like NFL thing to, you know, as you hear about the players, you're like that player wasn't injured. And then all of a sudden got surgery at the end of the season.

[00:06:38] Will Sanchez: Yeah. Yep.

[00:06:39] Dr. Grant Garcia: They probably said it wasn't worth the risk. There may have been more to the damage than we thought because it's, it's still fairly aggressive to do it, especially on the non throwing shoulder. Um, the swing in the back by February, I think is reasonable. He injured this in November. Right. Or October, end of October.

[00:06:57] Dr. Grant Garcia: Yeah. Yeah.

[00:06:57] Will Sanchez: It would, uh, yeah, it would end of [00:07:00] October. Yeah. Middle. Yeah. So

[00:07:01] Dr. Grant Garcia: we got surgery. He probably got surgery with a couple of days because he just calls his buddy Alitrosh. Yeah. You know, the one guy, the same guy did his elbow. So he's, he's going to be one, two, three, four months. I mean, usually full return for one of these, you're full return four and a half, five months.

[00:07:16] Dr. Grant Garcia: six, five and a half months. That's back to everything. So his swinging, they said February, probably March, and he'll probably be ready for the season for pitching again. It's his non pitching shoulder pitching shoulder. It will be

[00:07:29] Will Sanchez: his lead swinging shoulder. If as a left handed hitter, right. So, I mean, that is your pull.

[00:07:37] Will Sanchez: Yeah, but that doesn't. There's no concern when it comes to that.

[00:07:42] Dr. Grant Garcia: I mean, his power is going to be from the drive, right? The follow through is important. Yeah. But he's not going to dislocate his shoulder following through with the bat. Especially after one of these. This is a very bad thing for a pitcher.

[00:07:54] Dr. Grant Garcia: But thankfully it wasn't his pitching side. So,

[00:07:56] Will Sanchez: okay. So if it was, yeah, that would

[00:07:58] Dr. Grant Garcia: be, that would be kind of not, [00:08:00] that would not be good. This is coming off an

[00:08:02] Will Sanchez: injury already from pitching as well.

[00:08:05] Dr. Grant Garcia: I mean, the question you have obviously played amazing, but what is the longevity now? This is the third, this is the second surgery on his body in the last few years.

[00:08:14] Dr. Grant Garcia: Granted, obviously this is, You know, unfortunately the part of the game for some of these players, but you know, this is, this is another, another procedure you underwent, you know, it'd be back. It's not, this is not something that's, it's not a small procedure to do.

[00:08:28] Will Sanchez: So, so this type of procedure, if it was whatever the dog days of summer, right?

[00:08:34] Will Sanchez: June or July, if this would have happened and this surgery probably wouldn't have happened, they would have treated something, uh, very differently. Or Because maybe there was a, if there would have been something more severe, then you go, well, we have to go in and fix it and not just be as dismissive as, uh, we're just kind of fixing that labrum.

[00:08:55] Dr. Grant Garcia: Yeah. Like Deshaun wants a type of thing. Um, or there's something called a [00:09:00] Hillsacks legion. So he has a big one of those, or this wasn't his first one. You know, we don't know that probably his first one. I feel like we would have heard about this before. Um, And the, the mechanism was so traumatically generally when people have multiple dislocations, they don't dislocate it traumatically.

[00:09:14] Dr. Grant Garcia: It's like, Oh, I dislocated my sleep. I dislocated like putting my arm over my head. So it was probably his first one. And there was probably a little more damage than we're hearing about. And it's him. He's worth a lot of money. The Dodgers. Oh yeah. They have no interest in him being out next season.

[00:09:30] Will Sanchez: Yep.

[00:09:31] Will Sanchez: They probably made

[00:09:32] Dr. Grant Garcia: a game time decision.

[00:09:33] Will Sanchez: All right. So hopefully he'll get back. Um, unless there's some complications, if they are, we'll be back on here talking about it. So that, that, that's a plus for us then, but I don't know if that sounds a little selfish. It's a pretty

[00:09:44] Dr. Grant Garcia: low risk. It's a pretty low risk surgery and Ella trust does a good job.

[00:09:47] Dr. Grant Garcia: I, he'll be a very low chance of him not getting back.

[00:09:51] Will Sanchez: You have your Atlanta Braves logo behind you and I apologize to any Braves fans, but it seems like there you're some of your best players got hurt this past [00:10:00] season. And if you're a fan of the team, you know that firsthand. You don't need me to tell that because, uh, there were so many key injuries and, uh, that's going to be some NL East race now with Lindor and Soto and with the Mets.

[00:10:13] Will Sanchez: And then hopefully they get guys back. Like Joe humanists, uh, the land of Braves key reliever. He has surgery to repair the cartilage damage in his left knee. And he was, the surgery was performed by, you know, your buddy, Dr. Brian Cole on October 29th, 2024. He's expected to miss roughly a calendar 12 months, um, which is a big blow to, uh, the bullpen.

[00:10:41] Will Sanchez: You know, he had a fantastic ERA at two 62. So. A couple of things. October 29, 2024 is really, I mean, the season's over. So is this something, you know, when, when you hear about an injury like this and when it happened, when you're having [00:11:00] surgery, how the length of it, what do you think that process was? And we're dealing with hypotheticals here, but what do you think happened there with this picture where they realized that he had to go get this repair, the repair, the cartilage on this knee?

[00:11:15] Dr. Grant Garcia: So, I mean, this wasn't, this wasn't a spur of the moment decision. This was probably planned. Right. It's the same thing as what we talked about before is at the end of the season, you have a string of players, you know, you take care of the professional teams that Latin and that week after is like open season, right?

[00:11:32] Dr. Grant Garcia: You got to fix everybody up, get the team ready to go because it's the maximum amount of time for recovery. Uh, so this was a planned surgery, likely, um, you know, nothing we heard about and obviously he wouldn't have played so well if he had been, you know, it had been something had to get done acutely.

[00:11:48] Dr. Grant Garcia: Right. Right. So, it clearly was bothering him enough to get this done. Eight to twelve months is a long time. It's a long time. So, you're, you're looking at probably a more advanced cartilage surgery. Okay. [00:12:00] So, so yeah, break

[00:12:00] Will Sanchez: that down. What do you mean advanced?

[00:12:02] Dr. Grant Garcia: So again, the problem you have with some of these layman terms they put in here is they try to dumb it down so much, um, that unfortunately it's hard for someone like me to really diagnose it.

[00:12:11] Dr. Grant Garcia: Like, you know, the Lonzo Ball thing, we had to hear multiple rounds of injuries. Yeah, this is a bad enough that Brian Cole had to get involved. Yeah, there's some minor more minor procedures that he can do. We've talked about like bio cartilage where you can kind of micro fracture that area and you put some Yeah, some juvenile cartilage.

[00:12:29] Dr. Grant Garcia: There's some newer procedures out there that he may have done for him. Eight to 12 months in my opinion is like a cartilage transplant, which is we talked about with Lonzo ball. So, you know, maybe Dr. Cole is getting more brazen with the cartilage transplants because he now has done a few of them. He did the professional hockey player recently.

[00:12:46] Dr. Grant Garcia: Um, he just did, uh, he did Lonzo ball. And now all of a sudden, maybe this is like, I told you, what did I say in the last, Podcast. I said this could open the floodgates for more and more of these surgeries. So I wouldn't be surprised if he did something like [00:13:00] that, like a cartilage surgery. They may not announce it anymore 'cause it may not be considered hot news.

[00:13:04] Dr. Grant Garcia: Right. You know, I've had a few of 'em in the Yeah, that's in the, the NLB that's, so it's like, oh yeah, he just had a cartilage transplant. No big deal.

[00:13:11] Will Sanchez: Yeah, that's really concerning. Um, Ronald Kuia Jr. He tore his left ACL in May. Uh, he's expected to be out. You know, a couple months of the 2025 season, so that's pretty much almost a full calendar year.

[00:13:25] Will Sanchez: Second major knee surgery in three years. I mean, so what are we concerned about with his knee, with his health, um, and, and maybe what's left in that knee.

[00:13:36] Dr. Grant Garcia: That's perfect. That's a lot. Your last comment was very good. You know, you're gonna, you're gonna get your MD soon at this show. You keep going. So the, uh, So anyhow, so the, the second surgery is to me is always the word meniscus, right?

[00:13:50] Will Sanchez: Yeah,

[00:13:51] Dr. Grant Garcia: probably not cartilage damage. Generally, he gets bad enough cartilage damage. It's less common in these ACLs. When you get it, you're starting to address it or they're having a lot of pain and [00:14:00] swelling and just the cleanups don't work anymore. The ACL tear obviously needed the surgery, but my assumption is he probably had some sort of meniscus tear that they either fixed the first time or they cleaned up.

[00:14:11] Dr. Grant Garcia: So now he's had two major knee surgeries. And we're worrying, is this going to be a situation like you had with Lonzo Ball where by the time you're done with him, he's got minimum meniscus left. That being said, when you have minimum meniscus, it doesn't mean you need to be completely out of the, uh, out of the season or you're done for the, you're done for your next five years.

[00:14:32] Dr. Grant Garcia: Uh, so it's important, um, to understand that, uh, this. this meniscus injury just could be a blip. Obviously, if it goes into cartilage stuff, that's a problem. But from the meniscus standpoint, you know, we'll just have to see and hopefully we all know that when people have these A. C. L. Tears and they're reconstructed, um, the return to sport is good, but the overall longevity of the knee Is, uh, is not as good on when the [00:15:00] meniscus is gone

[00:15:03] Will Sanchez: for those who are wondering what the hell happened.

[00:15:06] Will Sanchez: I had to get my charger as I'm trying to listen to you and I disappear. So it's all, it's all very interesting. Dr. Garcia. Well, you know, the good [00:15:17] Dr. Grant Garcia: news is that I tried to keep talking until you came back.

[00:15:21] Will Sanchez: He's probably like,

[00:15:23] Dr. Grant Garcia: where did he go? I was thinking, I was like, I'm pretty sure I'm done with this. This thing, the podcast is over right now.

[00:15:30] Dr. Grant Garcia: Will's just told me it's time to leave. He just slowly exits the screen.

[00:15:35] Will Sanchez: Just see it. That's how you know, at the end of your episode here, uh, Ronald, we, we really do care about, we're really concerned about your knee. Um, as, as you can tell. So basically what

[00:15:48] Dr. Grant Garcia: we had said, Will was. Meniscus damage with an ACL, not as good of result, definitely a concern.

[00:15:55] Dr. Grant Garcia: There's been lots of data that the time that people go back, this increases the chance of [00:16:00] ACL. We want to save the meniscus at all costs. Not sure his meniscus was saved based off hearing all this stuff. And we don't want to turn into Alonzo ball situation where this turns into cartilage damage. You know, you have a really good young player here.

[00:16:11] Dr. Grant Garcia: Um, so. But again, you know, the age, the age issue with these, uh, ACLs is there's always a little secret stuff in there and you got to figure out if there's anything else wrong and how they're going to do. But generally these guys do well for a while.

[00:16:25] Will Sanchez: What would be your red flag for you? If he gets out on the field next year, starts playing, starts running or swinging.

[00:16:41] Will Sanchez: And he complains of, you know, certain pain, especially if it's not obvious if it's something that, okay, he just, you know, running the outfield or, um, you know, taking a swing and that torque in that lower body area and all of a sudden he walks up, [00:17:00] feels like, yeah, I'm, I'm, I'm kind of feeling something, you know, what's, what's, I guess, what's the next big concern for you now that he's had multiple injuries and surgeries?

[00:17:09] Dr. Grant Garcia: Yeah. I mean, I'm always thinking about his meniscus, right? If it's been trimmed or removed, you know, the ACL, you can get retears. It's just not that common, especially in baseball players. Right. We don't hear about it that frequently that you have someone. reconstruction and then retear. That's more like NFL, rugby,

[00:17:26] Will Sanchez: you

[00:17:26] Dr. Grant Garcia: know, occasionally basketball, but, um, and baseball players, I'm sure can get it, but it's just not as common.

[00:17:32] Dr. Grant Garcia: So, you know, I worry about like he starts to run and he says swelling, you know, all of a sudden you see him going on the DH more frequently, right? Like those are the things that worry me. The deficiency syndrome where basically you get some of your meniscus removed and you get into Alonzo ball situation.

[00:17:46] Dr. Grant Garcia: It's not that common. So I, I don't think he's going to have that issue, but if they fix his meniscus, well, if it's the second attempt to fix his meniscus or save any part of it, that can retear. That's a higher chance that he's going to have a retear of his meniscus. [00:18:00] If he got it fixed, then if he has part of his meniscus removed and he has a problem, it's just a much, it's just a higher percentage, 20 percent or something.

[00:18:07] Dr. Grant Garcia: So we'll see. Um, I think he's probably going to do well, but if there is issues, you know, you worry about his knee long term. I mean, the good news is obviously it depends on, he may be able to change positions if he, you know, up to that, but I think he's going to do well, uh, with just this surgery alone.

[00:18:24] Will Sanchez: Staying with the Braves. Once again, apologize. Braves, uh, Spencer Strider, you had to

[00:18:27] Dr. Grant Garcia: have him up.

[00:18:29] Will Sanchez: Yeah, no, it was just one of those things. And, and it's, it's a thing that we're just, you know, keen on certain injuries and it just kind of happens to be a lot of those players. Uh, Spencer Strider, and I'm going to kind of go back a little bit here, right?

[00:18:42] Will Sanchez: So he had Tommy John surgery in 2019. Okay. In 2024, he had elbow discomfort. Right. It began, he began to start feeling it in spring. He tried to pitch through the pain. So I want to ask you about pitching through pain, [00:19:00] especially when it comes to the elbow area. And then the MRI, uh, showed that there was damage to the UCL.

[00:19:08] Will Sanchez: And then he had surgery in April 13, 2024. He had the UCL surgery with Internal brace, you know how we like that stuff. So with all of the concerns, right, 2019 Tommy John surgery, elbow discomfort, you have the UCL surgery now with the internal brace, which is different than your traditional, uh, Tommy John surgery.

[00:19:34] Will Sanchez: And I want you to explain the difference with that. Uh, by the way, we'll always shout out the, uh, procedure by Dr. Keith Meister. That's a pretty cool name, right? Meister. Um, so let's just kind of talk about. the differences between the UCL surgery with internal brace compared to the regular Tommy John surgery.

[00:19:53] Will Sanchez: And what are some of your concerns and thoughts on it?

[00:19:57] Dr. Grant Garcia: So, um, the first part I'll make, I think for any of the doctors [00:20:00] listening is obviously I'm not sure he actually had a full reconstruction. We'll, um, we have to look at it. Cause if you have a reconstruction, you have no more UCL left there or Tommy John ligament left there.

[00:20:09] Dr. Grant Garcia: So you can't repair it. So I'd, I'd be interested to hear if that was, if maybe he had like some PRP done to it and they thought it was a procedure, um, on his UCL. So we'd have to look, we have to look into that. That's the only thing I'll say from that data that they give that you were given. Um, but, but let's go through the surgery procedures.

[00:20:26] Dr. Grant Garcia: So Tommy John obviously is the first picture that had it done. We've said this before. Yeah. We've talked about Brock Purdy. This is a really big deal and I'll explain to you why. It's not just because of the surgery is because of his status and then what had was done. So this is again, This is doctors breaking surgeons breaking in to the cutting edge material and I'm this is why I told you guys before about new tech we said does do athletes get the new tech right with Dr.

[00:20:50] Dr. Grant Garcia: Liu?

[00:20:50] Will Sanchez: Yeah, yeah, yeah.

[00:20:51] Dr. Grant Garcia: They are much slower to get the new tech because people don't want to test it out, right? Like, yeah. Carlos transplant. I told the. Guys before has been around for [00:21:00] years and we've gotten it better and better and better. And I've done hundreds of them, pro athletes, very few.

[00:21:07] Will Sanchez: And that's why you made a mention about Lonzo ball and how him having that surgery, you know, this new tech opens up the floodgates.

[00:21:15] Will Sanchez: Go ahead.

[00:21:16] Dr. Grant Garcia: So that's where we're going to go with this. So Tom John reconstruction is where you take a ligament from either the wrist, someone with the palmaris, or you take it from the hamstring, whether or not, cause some people don't have this ligament in the palmaris. It's like old cat claw. You can see it right there.

[00:21:28] Dr. Grant Garcia: Yeah. Okay. Some people don't have that. So they use the, uh, ligament in the, in the knee and then you can reconstruction. Now, we've got some newer techniques we're working on, but generally you're talking about a 12 to 18 month recovery. Okay. This newer procedure, which is maybe not even new anymore. It's almost five years old or more.

[00:21:47] Dr. Grant Garcia: Um, we repair the UCL, this tear. And again, certain tears can get this, not all of them. And then we do an internal brace, which is this, this, uh, synthetic suture. We've talked ad nauseum on this and one of Will's favorite, uh, [00:22:00] slogans, um, the internal brace as well. So the, it's a faster recovery. If it can be done, the results are the same as a UCL reconstruction, but you're back in six, seven months, kind of depends on the picture, but it's a much faster recovery.

[00:22:14] Dr. Grant Garcia: Ideally, everyone would do this. When this came out. My number of reconstructions dropped my repairs went up.

[00:22:22] Will Sanchez: Yeah,

[00:22:22] Dr. Grant Garcia: I do more repairs now that I do reconstructions and that's a good stat You should be doing that because there are so many more you can rip There's so many of these you can repair and get the patients back.

[00:22:31] Dr. Grant Garcia: So reconstruction is still has a place but it's not as high But what's really interesting for the audience to hear is that this was done on a pitcher So you hear the word pitcher all the time, but generally before the last few years They reserved this surgery for College pitchers, high school pitchers, little league, not as common pitchers and outfielders and infielders in professional baseball, but not for the pitchers.

[00:22:59] Dr. Grant Garcia: The [00:23:00] pitchers in professional baseball are the highest standard and as a

[00:23:04] Will Sanchez: result,

[00:23:05] Dr. Grant Garcia: the moneymaker. But the same point, do you want to test a surgery on a professional pitcher? Do you want to be the first guy to do a UCL internal brace on a professional pitcher and have it stretch out and tear in the first year?

[00:23:17] Dr. Grant Garcia: Right. It's just devastating. And so for, for, for years, these pitchers were the pitchers, even though other players were getting, I remember when we were taking care of the white socks, you know, six, seven, seven, eight years ago, the outfielder we did it on was like one of the few, our catcher was one of the first ones that got the UCL repair with internal brace, and that was a big deal, but they did not, they had a pitcher tear their UCL and they were like, no way.

[00:23:40] Dr. Grant Garcia: We're doing a reconstruction right now. Professional pitchers are starting to get this surgery because. The surgery works really well. There's been so much data to show that why were we doing reconstruction just because they're pitchers. If it works just as well on other players, there's no reason why a professional pitcher wouldn't work well for.

[00:23:57] Dr. Grant Garcia: So the fact that he's getting that shows that one, the [00:24:00] doctor is willing to push the envelope, which is great. And two, it's not really pushing the envelope because there's so much data out there for it. But this is what the audience should hear. This is a pretty unique thing that, right. That's the first thing I picked up when I heard this.

[00:24:11] Will Sanchez: Yeah. And, and we talked about it before. It's not just. One part of it at that level, right? It's a player, it's agent, it's ownership. It's it's, it's, there's so many factors to where everybody has to, you know, get on board and, and approve it. Um, and then obviously, you know, it'll fall under the player and who knows if there's something in the contract, you know, when they do something like that and say, well, we're, we're recommending reconstruction over repair.

[00:24:43] Will Sanchez: You know, if something happens. So I. Well, and you

[00:24:47] Dr. Grant Garcia: know, no, we're not. I mean, yeah, I know, but it's good. We couldn't, we don't want to go too crazy on this, but you know, like when they go to Ella Trosh, Ella Trosh does what he wants.

[00:24:54] Will Sanchez: Yeah. Yeah.

[00:24:55] Dr. Grant Garcia: I don't, no one tells Ella Trosh what to do, but that's not, [00:25:00] that's not who did his surgery.

[00:25:01] Dr. Grant Garcia: And that's who not to, that's not who does all these surgeries.

[00:25:03] Will Sanchez: Meister.

[00:25:04] Dr. Grant Garcia: And good. I think I, I, I, I think I know him. He's actually a good guy, but the, the point being is that if you're doing a handful of pro athletes and handful of college athletes, and you're the big name in your area, You obviously don't want to push the envelope too much, but also if an agent calls you and they want, when you take care of one of their players, they're going to be like, you should really do this, right?

[00:25:24] Dr. Grant Garcia: Like in the end, the surgeon makes the decisions, but let's be on the pros. This is the whole combination. I mean, frequently we would do the players in HSS, there would be a trainer in the room watching you do the surgery. Like, this is like how, this is how intense the situations are. It's not like, you know, you just get to do whatever you want on these professional athletes, right?

[00:25:41] Dr. Grant Garcia: You, everything's this, this discussion of doing the UCL repair was probably like six opinions in.

[00:25:48] Will Sanchez: It's, it's fascinating, but you know, with someone like Stryer and you know, some of these other pitchers and the Lonzo balls of the world, and we're starting to see, you know, people saying, okay, [00:26:00] let's, let's kind of go this route with some of this, you know, It's not new tech, but it's newer for the, for the, uh, players that's being done on, um, it'd be really interesting because when, once you start to do more, more things like that, and you open up the floodgates to, you know, do other things and present new, you know, new opportunities.

[00:26:20] Will Sanchez: So, um, it'd be really interesting to follow along that case, uh, this summer, and if everything goes well, you know, that bodes well, not for people, two, three years down the road. The season, right? I mean, if they see that this works for, for the pitcher in the season, obviously we know in, you know, people get hurt, there's gonna be a lot of injuries.

[00:26:42] Will Sanchez: And if they can say, Hey, we could get back sooner and not have that major reconstruction and it worked for this player. And we have the same agents or, you know, we're in the same major league baseball, because that's a, that's a small club. We think, you know, major league baseball, a lot of players, that's very few people that are [00:27:00] in that.

[00:27:00] Will Sanchez: So once

[00:27:02] Dr. Grant Garcia: they're all similar. Right. They know they're going to call this one. Who's your guy have, who did yours, right? Like this is, there's so much, I mean, when you have over 700 million invested in a contract for a player, you're going to make a lot of decisions to make sure that the contract keeps going.

[00:27:17] Dr. Grant Garcia: Yeah. All

[00:27:18] Will Sanchez: right. We got, I got two more players here. We're going to wrap up, uh, Walker Bueller, uh, well known pitcher, just kind of go back a little bit. 2022 Tommy John's then he had a flexor tendon repair that, uh, along with. the surgery. Um, so that was done at the same time, but it added to the recovery time.

[00:27:40] Will Sanchez: So I want you to explain why that added to recovery time. And then last year, this past season, he had hip inflammation. Right, right hip inflammation that complicated his return and then he was put on IL and he's kind of had struggles right including the reduced velocity and [00:28:00] They running out of gas getting fatigued So what are some of the things that you're hearing there as I'm explaining this this?

[00:28:10] Will Sanchez: History pattern of injuries with Walker Buehler.

[00:28:13] Dr. Grant Garcia: I mean Unfortunately, we always talk about the players that make it back, but there are players that do not make it back from these surgeries. So this could be just one of those issues. But when I hear the word flexor, that's weird. Now, was it included in the surgery?

[00:28:27] Dr. Grant Garcia: Because in order to do this surgery, you have to attach the flexors at the elbow or do you actually have a rupture of Or I don't think this, I don't want to say this, but did he have some complication during the surgery, right? When you harvest the Palmaris, did you damage another part of the wrist when you did the procedure? [00:28:44] Dr. Grant Garcia: Probably unlikely. Um, but it's very weird to have a flexor tendon tear on top of the Tommy John at the same time. So, or, or did he get it fixed and then it pulled off or when they got in there was a

[00:28:57] Will Sanchez: pair, right? But we don't know what that means between [00:29:00] repairing.

[00:29:01] Dr. Grant Garcia: Did, did he have, did he, when he tore it, did he tear his elbow?

[00:29:04] Dr. Grant Garcia: And then also his flexors. So we had to have that repaired and that took longer to come back. It just, the problem is the Tommy John takes so long to come back from that. I just don't understand how it took that much longer, or I bet he might have complications. Like if you had a flexor tendon repaired in his hand, um, they can get some stiffness in that and then it can not glide as well.

[00:29:21] Dr. Grant Garcia: So that could be another issue too. Anyhow, we won't know, but those are some, those things doesn't bug me. But that's interesting because, [00:29:29] Will Sanchez: because I was thinking about the, the, how even rehab could play a part in that, right. You know, whether if, you know, we have an elbow and we having the hand, the strength and what's not working and, you know, dealing with those things.

[00:29:43] Will Sanchez: So that, that's kind of interesting. Um, the big one for me is, uh, the phenom, the Japanese pitcher phenom, that's going to wind up going to one of these teams, an off season.[00:30:00]

[00:30:05] Dr. Grant Garcia: Will, you're muted.

[00:30:12] Will Sanchez: I don't know how that happened. There's going to be a lot of editing.

[00:30:16] Dr. Grant Garcia: No, don't edit it. Show them that we're normal. I

[00:30:19] Will Sanchez: don't know what happened. I didn't even touch anything. Anyway, so, uh, Roki Sasaki, Japanese phenom pitcher, uh, 2023. oblique injury, right? So that's always interesting. He was limited to 91 innings because of that injury.

[00:30:38] Will Sanchez: Um, that obviously affects the power and rotation and things like that. You could describe it better than me. And then 2024 right arm discomfort. I love these sayings. The discomfort and, you know, these key keywords that, you know, go, ah, there's nothing there, but, you know, right on discomfort, the issue has been a reoccurring problem and the [00:31:00] team had been cautious about the workload.

[00:31:02] Will Sanchez: So when you're having a young pitcher, right, that's about to make so much money in major league baseball, right? They're going to, he's already been posted. Uh, one of these teams are going to throw millions and millions of dollars. He's only 23 years old. But he's had an oblique injury. Now he's had this arm, uh, right arm discomfort and they've had to manage his innings pitch.

[00:31:27] Will Sanchez: What are some of the concerns there, especially for me is, uh, discomfort and the oblique, which is interesting.

[00:31:35] Dr. Grant Garcia: Yeah. I mean, oblique to me, doesn't bug me too much, but you know, the problem with those oblique injuries. It's not that it's not. They can reoccur, but also they're just hard to treat. Right. We just, there are very few people treat them.

[00:31:46] Dr. Grant Garcia: If you tear the oblique, you can get it fixed, but it's just not that common. So generally it's just something you kind of deal with. Maybe he had treatment, maybe rested it. And eventually I'm assuming,

[00:31:55] Will Sanchez: but they can linger, right? I mean, like a mid has had, um, like we've seen [00:32:00] players that they've had.

[00:32:02] Dr. Grant Garcia: Remember LeBron James is growing for like an entire season. I mean, these, these injuries let linger for months until you stop playing. Right. So he had to take a break probably to get the thing down and eventually it probably calmed down, but it's a recurrent, just strain. Right. And they're, they're torturous, but.

[00:32:20] Dr. Grant Garcia: At the same point, it's not something you need surgery most of the time. So he got over that. I'm not as worried

[00:32:24] Will Sanchez: discomfort for a 23 year old

[00:32:27] Dr. Grant Garcia: that, that could be again, is it the words or is it real? Right? We all talked about this. You've seen these amazing ways. They write up like partial sprain of the Tommy John, right?

[00:32:39] Dr. Grant Garcia: So generally arm discomfort is pretty common in baseball players, right? From even a young age, you know, I see them frequently. They come in, they think they tore the Tommy John. They didn't, you know, it's a flexor strain. So this is a recurrent flexor strain. That's fine. The problem is You know, the MRIs are only so good for seeing the UCLs or the Tommy John [00:33:00] ligament.

[00:33:00] Dr. Grant Garcia: So is he having attritional partial tearing of this and not able to see it on the MRI? I'm sure he's getting the highest quality. I'm sure they're watching him like a hound. Every team that's going to, uh, recruit him is probably going to get a new MRI on him.

[00:33:14] Will Sanchez: Oh, the medicals.

[00:33:18] Dr. Grant Garcia: Yeah. You don't want to be, he's going to have more MRIs than any of any of us have had in like a month.

[00:33:23] Dr. Grant Garcia: As he starts getting his final contract stuff because every team is going to want their own, right? So to be honest with you, he's probably going to be fine if a team signs him. They've done a lot of diligence on this, but it does bother me that, you know, now he's got two injuries. We've seen it. It's just, unfortunately it's the nature of the beast.

[00:33:42] Dr. Grant Garcia: And this is a, maybe this would be another podcast would be great. What makes a player resilient and what makes them not. It's just bad luck. Sometimes, you know, you have these players that are phenomenal and all of a sudden they just get injured. They get injured, they get injured, they get injured, and then they're just done.

[00:33:58] Will Sanchez: Yeah.

[00:33:58] Dr. Grant Garcia: I'm not saying it's the case, [00:34:00] but you have some of these players that are just like, never, they never get hurt or they just keep bouncing back. I mean, how many injuries did Tom Brady have? And he just kept popping back and he had a couple of bad ones, right? Like you just, that'd be a great topic to be like, what's the difference.

[00:34:14] Dr. Grant Garcia: And Answer is sometimes it's not. Sometimes it's surgery. They had a surgeon go as well, but sometimes it's just bad luck. I mean, you talked about Walker Bueller and his issues, right? He's had three injuries in a very short span, still not back. And the problem is the longer you're out. The harder it's to get back no matter how good you are.

[00:34:34] Will Sanchez: Yeah, that makes, that makes sense. And then you could be, uh, someone maniacal, like a Ronnie lot where you don't wanna miss a game, so you're gonna cut off your finger because it's, uh, you know, dislocated and broken and you, you're supposed to miss the rest. I just, Hey doc, Dr. Garcia. Just, just, just cut it off.

[00:34:50] Will Sanchez: I gotta, I gotta play in the Super Bowl. I just, just cut it off. I don't, it's, I, I got nine other fingers. These, they're built different. These people built different. So we talk about all [00:35:00] the time. Anyway, we'll wrap it up. I hope you get a great presence. I know we're going to do one more end of the year kind of recap on 2024, which should be a lot of fun, but for the holidays for you and your family and the little ones running around, not destroying the Christmas tree or anything like that.

[00:35:21] Will Sanchez: Or if they are just like, leave them. It's okay. Whatever you buy another one next year, just take it out. But, uh, I wish you guys the very best. Um, and, uh, I hope you enjoy the holiday. I hope you get some time off. Which I know this time of year where everybody's trying to get, get in their surgeries before they deductible start to, uh,

[00:35:40] Dr. Grant Garcia: I'm going to be operating until, uh, until January one.

[00:35:43] Dr. Grant Garcia: I've decided I'm not going to leave. I should, I'm doing this podcast for my OR.

[00:35:47] Will Sanchez: Yeah. Yeah. Yeah. You're doing that. So am I, I'm just, I'm, I'm in the next room. I'm scrubbing up. I'm getting my internal brace ready. I get all set up. [00:35:57] Dr. Grant Garcia: Well, happy holidays to your family and happy holidays to [00:36:00] all the listeners.

[00:36:01] Dr. Grant Garcia: We're going to have another end of the year episode, so it's not our final one. Um, but this was a good one just for the, for everyone to hear about it. And there's brought up a couple of good topics. I think that, you know, what are these injuries about and why do some people bounce back from injuries better than others?

[00:36:16] Dr. Grant Garcia: You know, there's a psyche thing. We've always wanted to have a psychologist on this show. And at some point we will, uh, when we can find the time to find somebody. Um, but. You know, happy holidays, everybody. Thanks again for listening again, follow us on all of our different ones. You've seen, we've had some shout outs on LinkedIn recently, um, with some topics.

[00:36:33] Dr. Grant Garcia: So this is exciting. There's a lot of momentum building. So thank you

[00:36:36] Will Sanchez: all check us out. Sports doc, talk. com for more content, uh, great information, transcripts, and, uh, we'll appreciate you. And I don't know about that. Bringing in a psychologist or something like that. I'm going to be in tears and the episode is going to get messy, but whatever.

[00:36:52] Will Sanchez: Thank you everyone. Bye guys. Audio Transcript

[00:00:00] Will Sanchez: Welcome to Sports Doc Talk. I'm Will Sanchez, along with our orthopedic surgeon, sports medicine specialist, say that a bunch of times, Dr. Grant Garcia. Dr. Garcia, look, man, I don't know if you can see, man, I got my, I'm hanging with my gnomies because it's the holiday season. I know we're going to talk about our injury spotlight, um, but you know, we're just, we're just, we're I can't believe it's the end of the year and it's, uh, it's been a great year.

[00:00:45] Will Sanchez: I want to throw that out there. It's a, it's always a pleasure working with you and, uh, and doing these shows. So, um, how are you?

[00:00:53] Dr. Grant Garcia: I'm good. No, it's end of the year. End of the year for some people is like, Oh, Christmas is coming. End of the year for me means that. [00:01:00] I work as many days of the week as possible because the deductible season is not done until December 31st.

[00:01:06] Dr. Grant Garcia: January though is great. January is usually a lot chiller. Yeah,

[00:01:10] Will Sanchez: that's a lot chiller. So, so can you get a t shirt that says, you know, Mr. Deductible or something like that? Like just wear it in December? I don't want to

[00:01:19] Dr. Grant Garcia: make it about the deductible, but patients come in just absolutely begging to get it done.

[00:01:23] Dr. Grant Garcia: They're like, I've had my, my Farris surgeries, my family's other surgeries. Now it's. free. So I want to do it now. Nice. In January, it's not. And I'm like, okay, well, you know, unfortunately we waited all year to decide on this, but nonetheless, we got to get them done. So we're going to stay busy, but we still have time for the podcast because we have way too much fun on the show.

[00:01:45] Will Sanchez: Too much fun. Listen, I see you have your Miami Dolphins background. And wait, and before that, let's give a little love to our peeps out here. Because you know, when we're trying to recovery, where do you need to go? The recovery shop. [00:02:00] Dr. Garcia, tell us about the recovery shop.

[00:02:03] Dr. Grant Garcia: Big thanks to our sponsors.

[00:02:05] Dr. Grant Garcia: We've had this, you know, repeatedly on here. They've been great sponsors of the show and I love talking about them. I mean, it keeps coming up my patients, right? So your patients, they get high quality surgery. They want, they expect the best. And they, after surgery, they're like, what else can I do? Right?

[00:02:19] Dr. Grant Garcia: Like I got this surgery. You talked about all these fancy things. You've talked on this show, internal bracing, you name it, but I want to make sure that I have the best recovery. So yeah. On there we have, uh, nutrition supplementation, which is all over the internet and one of the hottest topics. We have the Nice Machine.

[00:02:36] Dr. Grant Garcia: We have new braces. We have the ReBliss for some of the patients who are having a more complicated knee surgery. That's pretty

[00:02:41] Will Sanchez: cool.

[00:02:42] Dr. Grant Garcia: Yeah, and the patients can get this and it's a, it's easy. The patients have been thrilled with it. I mean, we have patients that had issues with snowstorm deliveries and they made sure that they overnighted these products for them.

[00:02:52] Dr. Grant Garcia: Um, and my patients love it. Again, there's no cut from me for you signing up for this. The key here is just to give information for [00:03:00] surgeons or patients. If you did a surgery done and you want something like this, talk to your surgeon about using this opportunity because it's a really nice opportunity.

[00:03:07] Dr. Grant Garcia: It's beneficial for all parties. Um, And again, the goal is for the patients to get the best. And sometimes it's hard to get the best just insurance alone. So this opportunity is great. Reach out to Mike at recovery shop. com. He's all over the website. A fantastic group to work with a strongly recommended for any surgeon who wants to, to offer patients a little bit extra.

[00:03:28] Dr. Grant Garcia: So thanks guys.

[00:03:29] Will Sanchez: Yeah. Once again, Mike B at shop dash recovery. com for more information. And uh, that's what we're doing here today, right? We're providing everyone with a little bit more information. We were watching, um, you know, NFL Sunday, right? NFL football. There's only so many weeks left. It's a sport that we love.

[00:03:48] Will Sanchez: that we're into, but we also know it's a sport that is dangerous, that we have severe injuries in there. And, uh, unfortunately, once again, a Miami [00:04:00] Dolphin has sustained a concussion. Mike DuBose, um, you know, catching the pass across the middle, getting hit and pretty much laying there. Obviously, um, There was a lot of concern.

[00:04:14] Will Sanchez: And as the doctors that go out there and we think about these head injuries, right? And you're like, okay, well, he got hurt. There's a head injury. Um, unless it's super, super serious. We usually don't see the cart or stretcher being, you know, called out, you know, they go into the blue tents. then eventually maybe get, you know, back into the locker room, things like that.

[00:04:37] Will Sanchez: But for this situation, that wasn't the case. So they came out and they brought out the spine, uh, the boarding. So while we, we wanted to talk about the importance of spine boarding in these situations. Um, so while we start with there and Dr. Garcia, just explain a little bit, like what's that procedure, right?

[00:04:56] Will Sanchez: You, you have to play it there. You have concern [00:05:00] and. we don't really think about spine boarding when we think of concussions. So tell us a little bit about what happened and how did they get there?

[00:05:09] Dr. Grant Garcia: Yeah. So, I mean, you can watch the videos. It was, uh, it was pretty atrocious looking in terms of the hit. You see the head cock back and then you see him go down and you see a posture position and then you see very limited movement of the arms.

[00:05:21] Dr. Grant Garcia: Now, again, this is just what they showing, right? They pull away from the athlete once they're injured. Yeah, and then the medical team comes in. So we're not really getting to see that much from someone who's recently had to spine board a patient on the field. I can tell you that you don't just start pulling the spine board out just for fun.

[00:05:39] Dr. Grant Garcia: It's a pretty serious situation you're concerned about. I will tell you this is like, it's When in doubt, spineboard. Okay, so that's the number one thing I'm going to tell you. It's just like when you learn in lifeguarding, right? I was a lifeguard when I was a kid. You know, if you're concerned about, again, they were probably, they were not initially concerned about a head injury.

[00:05:57] Dr. Grant Garcia: I'm sure they were, but that's not why they [00:06:00] spineboarded him. They spineboard him because they're worried about a neck injury. And they worry about a spine injury. So the board is for the spine to keep it straight. So really what the key is, is if you think there's damage to the spine, either the bones or the spinal cord, which we've all talked about, those are the worst possible football injuries we can think of.

[00:06:19] Dr. Grant Garcia: Um, you don't want any movement of that spine. So you need this board to be on there and then you need to be able to find a way to strap them on there. Now, this sounds really simple. Right. You slide the board on, move them. It's not so simple to move a 240, 250 pound human being who has completely gone limp or is not moving, whether or not they have a real injury and actually get them on the board.

[00:06:42] Dr. Grant Garcia: So there's actually a procedure and you've seen, I will give you examples. So I take care of a high school team, right? Mercer on high school. I've been there now for six years. We've had injuries on the field. And in one game, I had a spine board, two players. No joke. [00:07:00] It's a traumatic thing for the players.

[00:07:01] Dr. Grant Garcia: It's very traumatic for the, for the field. Obviously the worst is for the player. The

[00:07:06] Will Sanchez: parents also, right? The parents. For

[00:07:08] Dr. Grant Garcia: the parents, for the other players and for the stands. I mean, as soon as I spine bore these patients, there was concern to the players that died. There was concerns of the players, you know, they paralyzed and So, but you have to do it, right?

[00:07:22] Dr. Grant Garcia: Because you're concerned about it. So in both those cases, the players were not moving their legs or said they had severe back pain and they couldn't move. So you have to spineboard them. So that's the same thing that happened here. Thankfully in mine, both players were okay. And I will tell you that probably a majority of time that we spineboard the player, the player, a person is okay.

[00:07:41] Dr. Grant Garcia: Um, but there are definitely instances where it's not. We've seen this on the news. You've, we've talked about this before with players getting paralyzed, but here, They thought there was something wrong with the cervical spine and so they got a spine board. The key is you don't, you imagine when you're rolling somebody, their whole thing is they're going to hold collapse, right?

[00:07:58] Dr. Grant Garcia: So you got to keep them on. [00:08:00] But now there's the catches here. He's also got a helmet on. So how do you get the helmet on without bending the neck? Or extending the neck. Okay. That's the first part. So they have to take off the face shield, which they did, right? That's they can see, make sure he's breathing.

[00:08:14] Dr. Grant Garcia: Sometimes it would take off the guard and the actual helmet. And sometimes you have to sneak in there. The other thing is you want to keep the airway open. So if they're worried, he can't breathe. They're going to have to elevate the chin so that he can breathe and put a mask on him. And I know they brought out the oxygen for this as well.

[00:08:29] Dr. Grant Garcia: So this is not a joke with there. This is not an exercise. Yeah. Yeah. And,

[00:08:32] Will Sanchez: and they also hooked them up to EKG. So he was hooked up to EKG and, um, I, I'm obviously do not have the experience you do. Um, I do have my certification WFR and the wilderness, uh, certification and talking about how, um. You're stabilizing.

[00:08:51] Will Sanchez: You have that person right behind the head behind them and stabilizing the neck. And they're like, do not let go [00:09:00] of that head. You're and you are

[00:09:01] Dr. Grant Garcia: like in charge.

[00:09:02] Will Sanchez: Yeah.

[00:09:03] Dr. Grant Garcia: Like you are the most important person. So our average number of people for a spine boarding is five. So when I did it, we had five EMTs and two surgeons there.

[00:09:11] Dr. Grant Garcia: It turns out my buddy, Dr. Wayne, while I was also on the field, we had to do it together. Um, but you know, You get in there, players either not conscious and or players can't speak right and or players as they have numbness and tingling or back pain. The first thing you do is check it out. The second thing you do is if you're really worried, you're going to put them on the spine board and you're going to take them away to the hospital.

[00:09:34] Dr. Grant Garcia: And the reason is you want to get that CT scan, the cat scan of their neck and spine to double check for any breaks. If they have to do an urgent MRI, they will many times on the way to the hospital, the decrease in anxiety for the player, the calm situation of being on the spine board and or the amount of time from the injury.

[00:09:54] Dr. Grant Garcia: Most of the time, the real symptoms will either subside or still be there, right? So that's the biggest [00:10:00] concern. There were some other things that you mentioned when you initially texted me yesterday about this injury that were, that's pretty alarming for the people watching. It's cutting off all the pads.

[00:10:10] Dr. Grant Garcia: Right? You don't get to see that that often either. Like, how often do you see a player leave with no shirt on? Right. I thought it

[00:10:16] Will Sanchez: was something else. I was like, Oh my God, are we, you know, we dealing with something, a Demar Hamlin situation, right? And you know, and you know, I'm going to tease an episode that's going to be out in about another month.

[00:10:28] Will Sanchez: So with us and Dr. Dave and Dr. Dave was concerned not only about the heart, but maybe this was more of a traumatic injury to the brain. Anyway, I digress a little bit.

[00:10:39] Dr. Grant Garcia: You don't digress though, because you're right, this is some, this is a similar situation. He had an EKG tested, maybe for arrhythmia issues when he got hit.

[00:10:48] Dr. Grant Garcia: Similar thing to tomorrow. He had, he had the spot. So the reason they cut off the pads is so we can check the back of the neck and it can check the back of the player because you want it. [00:11:00] The first thing you do is you, the back of the spine has a lot of points on it and you want to feel those points because if any of those are tender, there's a concern that something called a burst fracture, which is not good, but basically it means That the spine is like a hole in it, right?

[00:11:13] Dr. Grant Garcia: So your cord can go through there and then surrounds by bone. When you have a burst fracture or crack, you can have a crack and it can go into the spinal cord or it can be unstable and that can cause a shift, which would cause spinal cord damage. So that's how we're checking for that. And so all those things are important.

[00:11:29] Dr. Grant Garcia: So when I did one of these players, he kept complaining that I was hurting his back when I was touching him and I'm not touching the muscles. I'm touching right on the bones. That to me is spine board. Don't, you know, get them over there. Do all this stuff like so they probably checked his hands. They probably checked himself and he's like, I can't feel my fingers, right?

[00:11:44] Dr. Grant Garcia: Cause he had just gotten hit. So he's just totally out of it. Yeah, he may not even been conscious. He may have not been able to say anything. He may have been limp and completely knocked out. That's what, that's what

[00:11:54] Will Sanchez: it looks like. He did not look, there was that slight movement, but it looked like, you know, [00:12:00] that could be also from the falling and he [00:12:03] Dr. Grant Garcia: basically got, he basically got KO'd boxing style and that's essentially what happened.

[00:12:08] Dr. Grant Garcia: Um, and so, you know, they don't know what to do with this right now. So this is split second decision. And I think that the, the, the part that I really like about this is that this was the safest bet to do. And when in doubt, you do that. So you've done your, so let's say you've taken your helmet off. Now you're starting to get off the head.

[00:12:23] Dr. Grant Garcia: Now you do, again, the hardest part is the roll, right? You have five people, you need to roll a 250 pound monster. I mean, the kid I did was about the same size as him. So I don't understand. It's, it's not easy. You roll them off, you slide the pads out, you're getting the back feeling, and then you're putting them back on the board.

[00:12:38] Dr. Grant Garcia: And then you got to slide them onto the board. Now, again, none of this, you want any movement of the spine. So it's a lot harder than it sounds, and it's good to have a concerted effort, but it's amazing when you get a team that, you know, we had four EMTs, so they were just like, boom, boom, boom, boom, boom, and they took over in terms of how to move, like these guys just do this all the time, and they're really good at it, and [00:13:00] that's essentially what they're, I mean, the team position wasn't leading the spine boarding.

[00:13:04] Dr. Grant Garcia: That was the ATCs on the field and the EMPs that were there, uh, to do that. So,

[00:13:09] Will Sanchez: yeah, the team physician would go with them. Is that something, you know, when he gets in the ambulance or is his responsibility to stay with the team and somebody else from the team goes with them and reports back of what's happening?

[00:13:24] Will Sanchez: What's normally that's,

[00:13:25] Dr. Grant Garcia: that's an excellent question because that is brought up a lot. And that's really hard when you start to be a team physician, you don't really understand like where your place is, right? Like as a doctor, if I'm on, if I'm like doing surgery, I would never like leave my patient, right?

[00:13:38] Dr. Grant Garcia: And go somewhere else. But at the same point, You have to because your job is to come after that plays done. He's got 52 other guys,

[00:13:46] Will Sanchez: right?

[00:13:48] Dr. Grant Garcia: Yeah. Or you, and you have all the entire field you have to take care of. So as a team physician, what you do is you pass it off. So you're basically the EMTs go there.

[00:13:56] Dr. Grant Garcia: And I, and like the same thing happened to me when I'm in the high school game. [00:14:00] Right? Like I'm like, okay, send the player to the hospital. And then I will, if there's an update, they'll have my number. They can call me. Usually the trainers will update me as to what's going on. But once they're kind of at the hospital, they've got the appropriate emergency room care.

[00:14:12] Dr. Grant Garcia: So the same thing happened there. They probably called, had the hospital get ready. Then he went straight to the emergency room. He probably had all the testing done. And it sounds like he's doing really well. So this is really good news. Obviously wheel brought up at the beginning, head injury. But if we had had this discussion last night, that's not what we've been talking about because this is new information, um, from the last 24 hours.

[00:14:33] Dr. Grant Garcia: But it's important for you guys to the, the listeners to hear this. Cause this is not just. Orthopedics is his team position. Um, at any surgeon or person, resident ATC that takes care of the team position, you need to know how to spine board and you need to know the threshold to do it. Um, like I said, I've been covering these games for six years plus fellowship plus residency, and I've only had a spine board a couple of times, [00:15:00] but when it happens, it's, You gotta make the decision, you gotta be becoming more,

[00:15:04] Will Sanchez: it's becoming more of the norm because you know, we, we see it more now.

[00:15:10] Will Sanchez: So I wonder what's the standard? What are those conversations? We know, especially at the high levels, I'm pretty sure in NFL College High School, you're involved with high school, have these conversations, especially in the off season of going into a new season saying, hey. When we have these type of injuries, we're always going to caution on the safer side because we're seeing, you know, players treated in this manner.

[00:15:34] Will Sanchez: You know, it's not going back to like the Dennis Bird days where they're just laying there and it seems like people are not sure what to do. And, you know, now it seems like there's a plan, you know, what's that checkpoint system, right? You mentioned, do you have feel in your hands? Do you know what, what's that process when you go in there and you're saying, Oh, wait a minute.

[00:15:54] Will Sanchez: I see one sign. And let's, let's do this.

[00:15:58] Dr. Grant Garcia: Yeah. So obviously there's [00:16:00] the big red flags, which we talked about. There's the consciousness, things like that. So obviously those have not changed, right? Like what you look for has not changed in the last 20 years. But what has changed is technology, information, social media, right?

[00:16:13] Dr. Grant Garcia: Like, yeah. If there's a delayed response on the field, that doesn't look good for anybody, right? It's just, it's just serious there. We don't know. I don't think of, and again, I, I hope obviously this is just my opinion or what I've seen. So this is definitely not 100. This definitely hasn't been fact checked,

[00:16:28] Will Sanchez: but

[00:16:28] Dr. Grant Garcia: I haven't seen an increase in.

[00:16:30] Dr. Grant Garcia: Issues with delayed responses from the NFL, right? We haven't seen a part of players that have had like that have died. They weren't taken care of. I mean, if anything, we talked about to Mary Hamlin is like a stroke of a stroke of pure amazement that they were able to get on the field that fast and take care of that.

[00:16:45] Dr. Grant Garcia: So, and nothing but accolades for all the, the secondary, uh, you know, uh, the EMTs and everything else in the ATCs on the field. So what I have seen is probably an increased response time, like you said. So there's just more speed to get there. Yeah. And probably [00:17:00] from Damir Hamlin and other, we talked about this with Dr.

[00:17:02] Dr. Grant Garcia: Joe Liu, you know, the entire team probably has extra checks. And I would imagine from some of these more serious injuries, Bronny, Damar Hamlin, and other players that we've seen, that there are probably an increase in what they're going to start doing stuff. And they're, you know. We've seen really bad injuries and note and everybody knows that like sometimes response time is really important with any of these things So we've just probably seen and we're also now looking for it more will but I would say that I do I do think that they have that the checklist for these injuries has probably increased and there is with Litigation increasing with NFL lawsuits, which we saw talked about with dr.

[00:17:40] Dr. Grant Garcia: Liu.

[00:17:41] Yeah,

[00:17:41] Dr. Grant Garcia: you know But there is no doubt in my mind that all of that has helped persuade people to do things a little bit more aggressively

[00:17:49] Will Sanchez: caution, caution, caution, caution, right? I mean, it's, uh, you know, just making sure that, you know, if you're going to side anyway, in any [00:18:00] direction, you're siding in an area that's just being extra cautious, right?

[00:18:03] Dr. Grant Garcia: Well, if there's ever a doubt. You spying board, there's just no, there's, there's no one, I mean, I had, I had to, I had to send, I had a patient. I thought I had broken their neck on one of my teams and tons of pain in the back of the neck. The dad was an orthopedic surgeon. I don't think he was very happy to me that I sent his son to the emergency room to get a CT scan, but I didn't really care.

[00:18:27] Dr. Grant Garcia: Right. Because I'm like, I don't really care what the dad thinks. I don't care what anybody else thinks. It's going to be a nuisance. They're going to get called at two in the morning because they have their CT scan of their son back. But to me, all I care about is that I'm making sure that the person has that the player is fine.

[00:18:40] Dr. Grant Garcia: And they ended up being fine, which was great. Um, what is the number? We don't one miss over a hundred non misses is well worth it still. So again, I'm not spying, boarding everyone on the field. Like I told you before, it's very rare that I have to do it, but there was enough that you had these. You had these team physicians calling for it.[00:19:00]

[00:19:00] Dr. Grant Garcia: And yeah, I mean, we could, we could go at nauseam with this, but again, it's the importance here is understanding that this was clearly more serious. They expected it to be more serious and thank goodness it's not. And hopefully he has a full recovery and this goes into concussion protocol. And in a few weeks, he's back to playing.

[00:19:17] Will Sanchez: Yeah. And for me, it's, it's the evolution. That's what stands out for me because I was like, wait a minute, this was head trauma, right? It wasn't, I can't feel my legs. Or anything like that. So just seeing the evolution of, of how, uh, players are being treated and taken care of, and you, you know, illustrate it perfectly, especially what has happened since DeMar Hamlin.

[00:19:42] Will Sanchez: And I can imagine those conversations you're starting the day after. With every team physician, you know, with those types of scenarios, it's just being overly cautious and just being careful and making sure that, um, because that's the scariest thing that anything could happen to the NFL, right? Is having a [00:20:00] player, God forbid, die on the field.

[00:20:03] Will Sanchez: And, uh, and all of a sudden now, Oh, you know, Moms and dads all over the place is saying, well, go make one Soto money and go play baseball and get off the football field. Um, and just real quick, you know, you mentioned that, you know, you do work with Mercer Island. Um, at one point I was, uh, one of the coaches with Franklin high school, and we had a player that got absolutely demolished kickoff.

[00:20:28] Will Sanchez: Return. Um, and we had to call the ambulance. They had to get spine boarded. And they wound up going to Harborview. All of us. I can't imagine the parents and everyone else in the stands, as you mentioned, but from the coaching staff, we were playing against hail from the coaching staff. I just wanted the game to be over.

[00:20:51] Dr. Grant Garcia: Well, they canceled our game. The game got forfeited when we did it.

[00:20:54] Will Sanchez: Yeah. It was so

[00:20:55] Dr. Grant Garcia: traumatic for people that the entire game was forfeited.

[00:20:58] Will Sanchez: Yeah. And [00:21:00] I kind of wish that we would have done the same thing, right? I'm not, I wasn't a head coach, but it's one of those things like, all I want to do is get out of there, get in my car, And then myself and the head coach, we went to the hospital, checked in on them, got the update, the parents were there, you know, like, and by the, and then once we were all done, we were like, I was looking at the coach.

[00:21:20] Will Sanchez: I was like, let's, let's go get a slice of pizza and a beer. I need a, I need to say, I can't go home right now. I need a second. So it's just, it is just so scary to see anyone so vulnerable. Um, so, you know, one of the reasons also that we were kind of talking about this as well.

[00:21:39] Dr. Grant Garcia: No, and it's good. I mean, it's just important for people to understand that I'm glad I was taken seriously.

[00:21:44] Dr. Grant Garcia: This is an, this is important people understand when you see the spine board come out, it's again, the, the, the goal of this episode I think is, and again, we're not going to run on too much longer, but the goal of the episode is to show people that people are, it's when you see a spine board, it doesn't mean there's a, some catastrophic thing.

[00:21:59] Dr. Grant Garcia: You know, I don't, [00:22:00] we want to, we don't want to cause more trauma to people when they see this spine board come out, but I want you also to hear that it's. It's expected that you should feel trauma like to see the spine board is very traumatic like the traumatic response I got when I got home. My wife is telling me I saw the Instagram posts about what happened at your game.

[00:22:17] Dr. Grant Garcia: What happened? And I hadn't even been home yet. It was like one hour, right? And it was a lot of traumatic and they canceled the game and everything else. So that's totally expected response. But at the same point is it's also doctors and, and EMTs just doing their job because we want to be safe. So a lot of times it isn't as big a deal.

[00:22:34] Dr. Grant Garcia: Um, but to understand that, you know, you, the number one thing you should think about is obviously the safety of the player and to, you know, Just making sure that it's good to know that people are on the field that want to make sure the player gets the safest, most lowest risk potential, um, scenario. Yeah.

[00:22:51] Will Sanchez: Look at this picture over here. Look at that. Sports Do talk.com. All sports, all orthopedics all the time. [00:23:00] Check out our website. You got the Look at this guy right here. Look at that picture. I mean, what a hand. I'm gonna change

[00:23:05] that to your picture. I got that. The greatest picture ever in the, in the logo one.

[00:23:10] Will Sanchez: Check out our past episodes, our transcripts. Um, we'll always want to hear from you. So if you have some suggestions for shows, we've had a couple of people request certain shows and we make sure that we give our listeners, uh, what they want, especially, you know, being informative. So we, uh, we want to hear from you, but please check out the website.

[00:23:31] Will Sanchez: Check out our podcast. We have audio podcasts, video podcasts on YouTube. We're on every stream and platform, Spotify, iHeart. Apple, you name it. We're there. You're probably sick of us at that point, but we really appreciate you because you know what? I'm hanging with my Nomi's right here and this is my Nomi right here with me. [00:23:51] Will Sanchez: Dr. Grant Garcia. Uh, happy holidays. Uh, you're all squared away for the holidays and ready to go. Except for the 18 surgeries you're doing [00:24:00] in the next two days. Is that, that, that, uh,

[00:24:02] Dr. Grant Garcia: yeah, we're, we're good. I, I, listen, I ha that's why I have a great wife because I can do my job and she's going to. Take care of all the stuff. [00:24:10] Dr. Grant Garcia: She's going to take over everything that's actually important and I'm just going to focus on my doing my stuff. So, and you know, I appreciate all your listeners, uh, happy holidays. This is going to be the last episode of the, of the new year, but we've got a lot more to come and I'm really looking forward to next year.

[00:24:26] Dr. Grant Garcia: Um, and we've sound, we've seen a lot of changes in this. This podcast, you know, we've got these injury updates, we've got guest appearances. It's been awesome. And I think the viewers like all of it. So, I mean, I just heard about his tongue. Well, I heard a couple of patients even this week asking about the podcast and things that they had seen about it.

[00:24:41] Dr. Grant Garcia: So we keep doing this so you guys can be informed. This is fun for us. This is not our full time job. Uh, so this is just something we, this is something we just record late at night.

[00:24:51] Will Sanchez: Yeah. It's spooky. Anyway, happy holidays, everyone. We want to wish everyone a, uh, Merry Christmas, uh, Hanukkah, [00:25:00] however you celebrate with your loved ones, happy new year and, uh, be merry and be safe.

[00:25:05] Will Sanchez: Uh, Dr. Garcia, I appreciate our relationship, our friendship and our, uh, partnership. So let's keep it going.

[00:25:13] Dr. Grant Garcia: My Nomi.

[00:25:14] Will Sanchez: My no me. Bye peoples. Audio Transcript

[00:00:00] Will Sanchez: Welcome to sports doc talk. I don't know. I got this vertical thing going on. Hold on. Let's go. Here we go. That's our look. Will Sanchez along with Dr. Grant Garcia, our orthopedic surgeon, sports specialist. How are you Dr. Garcia?

[00:00:33] Dr. Grant Garcia: I'm good. I'm good. It's a good day. And, uh, you guys have, we got a new logo in the back.

[00:00:38] Dr. Grant Garcia: So we're going to learn a little bit about this. You never know what's going to be up there.

[00:00:42] Will Sanchez: Dr. Garcia is constantly changing his background. We started out with a promise in early September rooting for the Giants, having the Giants background. And apparently Dr. Garcia has put the kibosh on the Giants with the background.

[00:00:56] Will Sanchez: So now he's going with different backgrounds for all our shows. [00:01:00] It's still not working. I'm not sure what we need to do next. Maybe I need to change the blue light to a red light or yellow light or green light. Oh, you know what? I should have done green light for today's show because we have a phenomenal guest.

[00:01:15] Will Sanchez: But before we get to our guests, this kind of, uh, give a little housekeeping here and give a little shout out to our sponsors, the recovery shop. Garcia, this is your bread and butter. Take it away.

[00:01:26] Dr. Grant Garcia: All right. Well, again, this is, it's awesome. I've I talked to Mike and those guys and they said that they've had some people contact from the show interested.

[00:01:33] Dr. Grant Garcia: I had a surgeon that sent me a patient that asked to use this because the patients love it. So the idea behind recovery shop is any of your performance things that you want after surgery. People kept asking, I want more. You're doing all the cutting edge tools, but what else can I have? What else can you get me to get me better?

[00:01:50] Dr. Grant Garcia: Um, and we've seen some of these different products on the show with the Nice Machine, the Nutrition Supplementation, the Rebliss, you name it. So now my patients can go to this sort [00:02:00] of page that's mine and get whatever they need in terms of that for the recovery. So if you are a surgeon, you're interested in this or you're a surgeon, you're about to get surgery and you want your surgeon to offer this, I'll reach out to them and Mike likes and be contacted directly.

[00:02:13] Dr. Grant Garcia: So it's easier for you again I got no say in this other than the sponsorship. So just use this direct line Um, and hopefully you enjoy it for your patients and i've been super happy. So

[00:02:23] Will Sanchez: yeah, that's it's great for everyone and We're going to tease our own website at sports. talk. com. You can find transcripts.

[00:02:32] Will Sanchez: You can find previous shows. You could go to YouTube, check us out your favorite, uh, listening podcast platform, whether it's Spotify, Apple, you name it. So I am doing a shameless plug, maybe not so shameless plug of our show and all the great guests that we've had on, uh, Are you tired of listening to me talk at this point?

[00:02:51] Will Sanchez: Should we tease who's about to come on our segment and what they do?

[00:02:56] Dr. Grant Garcia: Yeah, I think we mix it up each time. So let's do a little quick intro for the, [00:03:00] uh, the viewers, uh, and also the listeners to hear what's up next.

[00:03:04] Will Sanchez: All right, here we go. The future of sports medicine is a biologic based. We owe

[00:03:10] it to our patients to bring the most up to date technology that'll make their recovery easier and also allow for them to heal faster.

[00:03:19] It's forming a new bone within 24 months. It integrates so there's no trace left behind. We've gotten away from using truly artificial means and restoring the body to its native structures. Osseofiber is going to revolutionize sports medicine.

[00:03:36] Will Sanchez: Dr. Garcia, we're really excited to have our guests. We have Brennan Marilla and I know the last name.

[00:03:43] Will Sanchez: I know how to say it. Let's go. Brendan Marella. Thank you so much. He's our chief commercial and operating officer at Osseo. Thank you for taking some time and to join us tonight. We appreciate it.

[00:03:56] Brennan Marilla: Thanks guys. Appreciate it. Thanks for playing that video. That video always gets [00:04:00] me pumped up every time I see it.

[00:04:01] Brennan Marilla: So, uh, hope you enjoyed it.

[00:04:03] Will Sanchez: It's a great video. Um, before we get into all the, all the toys that Dr. Garcia likes to use and obviously, uh, what you're providing, um, just for our listeners and viewers, we reached out to you a couple of weeks ago. We were trying to plan an earlier show and unfortunately, like so many others affected by The hurricane season, you were affected with the hurricane that came through hitting the Tampa and Orlando region.

[00:04:32] Will Sanchez: Uh, first and foremost, before we get to the show, how are you, how's your family doing, , what's going on? Because that was some scary, scary stuff.

[00:04:41] Brennan Marilla: Yeah. Well, hey, thanks for asking. Uh, this is, this is a rental home. We're in and I'm grateful to be in this house and I've got my, I've got my two adult children with me too.

[00:04:51] Brennan Marilla: So it's, we're back to a family of four because my kids also had their places flooded. Uh, but we had a, we have a house on a barrier Island here

[00:05:00] in the, uh, kind of the Sarasota area. And, uh, unfortunately, Helene, um, uh, Helene, uh, flooded our house. So we had about two feet of water throughout the entire house.

[00:05:10] Brennan Marilla: So, uh, while we were in the process of removing, you know, all of our furniture and all of our things, and ripping out the drywall and the insulation, you know, kind of there's a race against time for. You want to get it out before the mold sets, uh, in the middle of all that we had to evacuate because Milton was coming and, uh, unbelievable, you know, so it was kind of a one, two punch.

[00:05:32] Brennan Marilla: It's been kind of a wild, uh, wild month for us. Uh, but I think we're starting to kind of get our feet out, feet under us now. And, uh, you know, life is starting to get back to normal, but we're starting the long rebuild process now, but everybody's safe and, uh, you know, the area, the community has been great.

[00:05:49] Brennan Marilla: And I think, uh, We'll be back soon.

[00:05:52] Will Sanchez: Do you have them do, do, do you have the kids now doing chores? Are, are they raking leaves, throwing out the garbage, loading up the [00:06:00] dishwasher? Like are you, are you taking advantage of the full labor that maybe is, uh, happening in the house or now they're too grown and they can't be told what to do?

[00:06:08] Will Sanchez: What's going on there?

[00:06:09] Brennan Marilla: Yeah. No, I'm cracking the whip, just like the good old days.

[00:06:12] Dr. Grant Garcia: smart man.

[00:06:14] Brennan Marilla: Yeah, they're living rent free right now, so. Uh, you know, now I have to just kind of negotiate things, you know, like I need you to do this. I need you to do that. I, I'll, you won't have to pay utilities if you take the trash out.

[00:06:25] Brennan Marilla: So when they get, when they become adults, you have to do a little bit more negotiating cutting deals versus just telling them to go to their room.

[00:06:33] Dr. Grant Garcia: So we're learning, I'm learning so much from this. Well, anyhow, I'm glad you're safe. Everything's good. Uh, we're really excited to have you on her. I know it's been a lot going on in your life, but this product you guys have heard about it before on our show, right?

[00:06:46] Dr. Grant Garcia: This idea of harder than, you know, some of the other competitors on the market turns into bone faster, uh, and replacing metal. And honestly, this is just what patients have been asking for. I mean, I know that the couple of shows I put out with I put out before had [00:07:00] questions about this. We finally have someone who's an expert on it.

[00:07:03] Dr. Grant Garcia: I've used the product. I use it a lot. I'm really pleased with it. But obviously, you know, we have experience here with one of the man himself. So, Can you, we can talk about a little bit about your background and kind of why you got an Osseo before we go after the product, because it's going to be really awesome.

[00:07:17] Dr. Grant Garcia: We start talking about it, but as well knows we're gone once we start going after it, because it's going to be so much stuff we're going to have questions on.

[00:07:24] Brennan Marilla: All right. What do we, what are we talking about first? I'm ready to go. Well, I love

[00:07:30] Will Sanchez: the title on the website. If you go to Osseo. io. It's great. It says don't settle for metal.

[00:07:37] Will Sanchez: It's the first thing that you see on the website. And right there, it is so simple. It is so catchy. And all of a sudden, if you don't know what's happening or what it's about, just those three words alone already kind of puts you on the path saying, Oh, wait a minute, this is something different. So tell us a little bit about, uh, how you got involved with the company first, before [00:08:00] you get into the product itself.

[00:08:01] Brennan Marilla: Yeah, sure. So I've been in med tech about 30 years. Most of my career has actually been in cardiovascular, actually peripheral vascular and aortic disease. Spent a lot of most of my career at big companies. I've done some small companies, some big companies. I was at Medtronic for many years at Covidian.

[00:08:16] Brennan Marilla: Um, you know, one thing I learned from coming from the peripheral vascular space is that the mantra in that space is in terms of opening arteries, things like that, instead of leaving Instead of putting stents in like they used to, the market is moving towards, uh, like shockwave ultrasound or drug coated balloons.

[00:08:34] Brennan Marilla: The mantra is leave nothing behind. And the body leave nothing permanent behind. So, uh, when, uh, when Brian Verrier, who's our CEO, who I've worked with, uh, for many years at a few other companies told me he was thinking about taking this job as the CEO and, uh, I was at a different company. We had just sold that company.

[00:08:57] Brennan Marilla: Uh, and he called me and said, you know, I'm thinking [00:09:00] about doing some different things. There's this company Osseo. Um, would you take a look at it? I just want some advice on whether I should take this job or a different job. And I said, sure, I'd love to see it. And he sat down with me and showed me kind of the management presentation and some early animal studies and the idea of osteofiber.

[00:09:17] Brennan Marilla: And I said, God, I think that sounds like one of the most compelling things I've ever heard. I, the value proposition is, is obvious. I mean, you could explain to your next door neighbor, Hey, wouldn't you love to have orthopedic surgery? And instead of. a metal implant, you have an implant that turns into your own bone.

[00:09:34] Brennan Marilla: Uh, you know, immediately they're like, of course I would want that. You know, so we, I thought, geez, there's a huge, uh, unmet need here. It's very compelling to patients, to surgeons, even payers. Um, and, uh, you know, it's a five, 10 K path. It's very disruptive versus being something that's incremental. And I said, you know, you ought to take that job.

[00:09:56] Brennan Marilla: And by the way, if you take that job and you raise some money, why don't you bring me on? [00:10:00] Uh, and let's do this together because I think this sounds really, really interesting. The other thing that caught my attention was that, um, again, I was new to orthopedics seven years ago when we, when we kind of got Osseo off the ground, the United States.

[00:10:13] Brennan Marilla: Um, but, uh, I just thought it was interesting that all of, you know, most of the large companies, uh, have tried this over the years. They've tried to come up with non permanent implants because it's, it's, the need is obvious. Uh, the benefits are fairly obvious. But no one's really been able to quite crack the code on a non permanent implant that's weight bearing that is really strong and also is very biocompatible.

[00:10:40] Brennan Marilla: Um, and so that's why I thought Osseo could really be very disruptive. across multiple sectors of orthopedics.

[00:10:50] Dr. Grant Garcia: I want to chime in there. So we'll to you have, and obviously I wanted you guys on the show. I've been pretty excited about the product since I first saw it myself. [00:11:00] I would say, well, you have now have two people on this show and I'm assuming Will's going to be that way in a minute that when I heard about this idea, I said, that's, I've never heard of anything like that.

[00:11:09] Dr. Grant Garcia: And then when I used it, I felt the same way. So the disruption you have here to the listeners or to will is metal is very strong, right? Like we think of metal is like kind of what, almost, I hate to say the gold standard, right? Like when you're putting something in, you would never put in a plastic, you know, you put in plastic screws and drywall, but you wouldn't put a plastic screw into wood, right?

[00:11:32] Dr. Grant Garcia: I mean, it just not, now we can talk about this thing, but you wouldn't do that originally. You think it's break, it's not strong enough. And there's no products that we see out here for drywall stuff that we see that is often. In the bone, in the, in the body, it's the same way. And so people are just like this idea that every time we use a product, that's sort of supposed to dissolve or turn into bone before I've seen this.

[00:11:52] Dr. Grant Garcia: They would crack

[00:11:53] Brennan Marilla: right? Hard,

[00:11:54] Dr. Grant Garcia: hard bone. It cracks. Sure. So the first time I put this into something that was hard, I was [00:12:00] expecting it to crack. And instead it worked just as well in terms of strength as the metal, which we're going to go to in a second. There are various different types of screws that are not metal.

[00:12:11] Dr. Grant Garcia: And I have not seen one yet that turns into bone as well, but it's also as hard, which is just an extremely unique pattern. And I think that Brendan's going to go into this, but for the people to see this, it's like, there's so many different products out there, but there's, this one seemed to figure it out.

[00:12:28] Dr. Grant Garcia: And so that I think is what the uniqueness of the product is. And that's why I want people to hear about it. And I'll, we'll explain more of this in a minute as to why this is so important. Sorry, keep going, Brendan.

[00:12:37] Brennan Marilla: No. So what we tried to do is we, we wanted to create a new category. Uh, called bio integrative implants.

[00:12:44] Brennan Marilla: Um, we didn't, we especially didn't want to call this a bio resorbable or a biocomposite. That's not what it is. We, these are made differently. And Brendan,

[00:12:53] Dr. Grant Garcia: will you explain everybody why you didn't want to call that?

[00:12:56] Brennan Marilla: There's just a lot of baggage and a lot of negative baggage with bioresorbables [00:13:00] for a couple of reasons.

[00:13:00] Brennan Marilla: One is they're primarily just. Polymer based implants. Um, biocomposites introduced a little bit of minerals, some resin to kind of give it a little bit more, um, uh, structure, but they're still, it's still kind of powder. So basically traditional bioresorbables, uh, that have not been widely adopted, uh, in, in orthopedics.

[00:13:22] Brennan Marilla: And that's why metal is still still around 150 years later. Everybody's tried this and haven't really, haven't really been able to succeed is because polymer is very, it's not strong enough. If you drill it in, if you, if you nail it in, if you screw it in, um, you know, the, sometimes the, they'll, they're very brittle and they'll break or after you, uh, after you fixate bone, they might not be weight bearing, uh, they might break.

[00:13:47] Brennan Marilla: And, but if you get them in successfully, What happens is, um, these big polymer, these polymer implants can have these acidic breakdowns two, three, four years down the road. And when that happens, [00:14:00] patient feels inflammation, pain, uh, you guys see cystic formation, bone void, things like that. Uh, also the other issue is that if you want to do a revision surgery, whether it's metal or even peak, it's in your way.

[00:14:14] Brennan Marilla: Uh, and so we thought that, you know, if you. Um, if you have a technology that turns into bone, there's, there's nothing in your way if you need to go back in for any reason. Um, so we make these differently than the non permanent implants of the past. And that's why we call these bio integrators because that's really kind of the nature of how it works.

[00:14:35] Dr. Grant Garcia: We'll put that slide back up. I think that was important. The one we just had. So to chime in on this, he, what he hit on his thing, the cysts and the cracking for the biocomposite is a big concern. And. And the idea behind plastic, you're still leaving behind something that you've got to take out. And some of the plastics you can drill through, but some you can't.

[00:14:56] Dr. Grant Garcia: And this is a big problem. Alright, Will, so here's an example. Nick Chubb, we just had the [00:15:00] discussion. He had a revision surgery, right? There's a low chance that the surgeon used a biocomposite screw for him. So they probably used either a metal screw. Or a plastic screw, a peak screw. So when they did the second ACL for him, they had to either take them out.

[00:15:17] Dr. Grant Garcia: And by the way, everybody knows no one looks good taking out hardware. And so you're talking about stripping a screw pulling out. I do a ton of revision ACLs. I do a ton of revision surgeries. I mean, I just had a patient today. She's doing awesome. You could see she's got, I took out all these metal from the ones you had before.

[00:15:33] Dr. Grant Garcia: They just got track marks all over the inside of her bone. And I had to worry about those when I'm doing the surgery. Is it going to get in my way? Is my going to get by fixation? So there's still these things. And if they have a biocomposite, the CIS formation is actually worse. Taking out a screw and having a hole is a, is frustrating and certain surgeons can figure out different ways of doing it, but the cyst is a nightmare.

[00:15:53] Dr. Grant Garcia: And so you, the fact is you leave no trace doing a second surgery or doing a third surgery, which we [00:16:00] never want to do, but it's like probably something I do twice a week or three times a week. Yeah. It makes my life so much easier. And so that's another point of it as well. So else, sorry. Can you describe the, the strength prat, the strength graph and the regeneration graph you have here?

[00:16:15] Brennan Marilla: Yeah. So the, um, the graph on the right is just kind of, uh, an illustration of kind of what we set out to do was, you know, the kind of the Holy grail of, of, uh, materials, fixation materials and orthopedics should be that they're natural. Um, they, they leave nothing behind, leave no trace, but they're also strong.

[00:16:36] Brennan Marilla: So if you kind of look at that chart, you've got strength on one axis and you've got kind of natural bone regeneration on the other axis. Um, you can see where we're twice as strong as peak or about five times as strong as a traditional bioresorbable. Uh, and, um, and we also have that natural bone regeneration happening.

[00:16:53] Brennan Marilla: So that upper right hand corner is kind of where you want to be in terms of orthopedic fixation materials in the future.

[00:17:00] Dr. Grant Garcia: All right, well, let's go to that next slide. By

[00:17:01] Brennan Marilla: the way, Um, you mentioned Harbor Removal Surgery, uh, obviously there's a huge cost benefit here too. Um, obviously patients don't want a second surgery, especially, uh, children, which is why we have a pediatric label for most of our products now.

[00:17:16] Brennan Marilla: Um, but Harbor Removal Surgery is one of the most common surgeries in the United States. Of any surgery and that's and you also started foot

[00:17:24] Dr. Grant Garcia: and ankle, which is the most common, right? So as a knee surgeon, I take out plates. I take out I I don't do many metal in you're talking about surgeons Still love this product not being a metal guy.

[00:17:34] Dr. Grant Garcia: I'm an anti metal surgeon if I could do it I mean I have to do metal occasionally But i'm anti metal and I tell my patients I try not to do metal But even that that type of surgeon that does anti metal this product is very very unique still Right, so, you know you're comparing to metal and that's actually the most common thing we see You Um, but even people that don't always use metal, there's still a huge benefit of this, right?

[00:17:54] Dr. Grant Garcia: It's just that you're, you, we're always, metal is the gold standard for hardness. Um, but taking out [00:18:00] removal of hardware is very common. And in foot and ankle, I have a bunch of really good partners. I would tell you that 30 percent of their surgeries are removing the hardware they put in the foot.

[00:18:08] Brennan Marilla: Exactly.

[00:18:09] Brennan Marilla: It was really important to us that we bring you guys, the surgeon community, um, a technology that would not have, would not have trade offs so that you could get the benefit, the patient benefit. You could get the benefit of leaving nothing behind and preserving your landscape without feeling like you're trading off strength.

[00:18:29] Brennan Marilla: Or ease of use. And we've worked very, very hard at that. So the way we get our strength is, is this, this chart here, this, this, um, kind of illustration here. Um, we take basically minerals found in bones, silica, calcium, magnesium, et cetera. Um, Iran, our founder, uh, figured out how to take, uh, these minerals and how to, um, engineer them into these long, continuous fibers.

[00:18:55] Brennan Marilla: like fiber optic cable and then he layers them in different directions. You layer [00:19:00] them in different directions, uh, and you create like this matrix infrastructure and that gives you unbelievable strength. Um, it gives you a lot of body, a lot of structure and a lot of strength. And as a matter of fact, we make our, our implant, if you know, if we make a screw different differently than we make a staple or an anchor, we can just take these fibers and we orient them in different ways.

[00:19:21] Brennan Marilla: to dial in different mechanical properties. But each time we do that, we definitely continue to overlap and weave them. So they're really, really strong. Um, what that does is it gives you really, it gives you. Uh, strength higher than cortical bone at time, zero through six months and beyond. And then, and then over time, what happens is bone attaches to this immediately.

[00:19:42] Brennan Marilla: We saw in our animal studies at two weeks tra trabecular bone formation on the implant. Bone thinks this is bone and then it starts to infiltrate the implant. It's a little porous bone cells infiltrate the implant and then over time it just mineralizes and just regenerates and just becomes bone. [00:20:00] So at about in all of our animal studies and in our human studies as well, but in the animal studies where you can look at histology.

[00:20:06] Brennan Marilla: At two years, there's no evidence there was ever an implant.

[00:20:10] Dr. Grant Garcia: And well, this is a really, I want to explain to you what you said for the listeners. Cause obviously the surgeons get it. Med device company, people might hear this and understand some of it, but we'll cortical bones, the outside of the bone. Okay.

[00:20:22] Dr. Grant Garcia: And I think, can you go to the next slide? Is that the one with the bones? So I can show them. Yes. Right here, guys. Okay. So cortical bone is the surrounding bone. You guys see the bottom, that sheep study that's cortical bone. That's the hard stuff. So like, and I don't want to gross too many viewers out when you're drilling, you're hit cortical bone.

[00:20:39] Dr. Grant Garcia: You're like, that's hard. It's like really solid. And then you go through the counsellors bones, like where the bone marrow is. That's like, well, if you ever eat bone marrow, it's super soft and gushy. And can sell us bone is like very soft. So there's really not much there. And then you go to cortical bone.

[00:20:53] Dr. Grant Garcia: So the idea is that this is the hardest bone you want is cortical. Like we always are looking for cortical purchase. It's like in a [00:21:00] wall, right? You have, you're looking for the stud. That's absolutely right. But what's cool about this product is that it basically, what we're finding and you're going to see us in a second is that that's the screws are essentially turning the entire tract into cortical bone.

[00:21:15] Dr. Grant Garcia: So you're actually getting, you're actually making the bone harder in certain spaces. Which is pretty crazy to think about. So the idea is that in some of these cases, they're actually able to heal bone. You're going to see that from the knee bar study. And the idea is like helping with union, right? So if you've got two, you split that bone in half right there.

[00:21:32] Dr. Grant Garcia: Imagine you've got two, the shell casings are good, but when you, when you put it back together, you still have the soft stuff in the middle. And that can take a little while to heal. So the idea that we're still working on is if we put that screw through the middle in a metal one, there's nothing's going to grow, right?

[00:21:45] Dr. Grant Garcia: It's just going to grow around it, but not in the middle. So you're going to have a part that's not actually healed. If this turns into solid bone, are you actually going to turn this? This bone into like a three part thing. So now you're going to have a piece of cortical going through the middle, which is kind of a crazy concept.

[00:21:59] Dr. Grant Garcia: You're [00:22:00] essentially get, you essentially could make people's bones harder, which is really fricking wild. I don't know, Brennan, if you were going to talk about that, but that idea to me was, that's one of the things we're working on is the future. Right.

[00:22:11] Brennan Marilla: Yeah. That's interesting. You know, the, uh, over time it'll end up, it'll end up like it was never there.

[00:22:18] Brennan Marilla: Uh, and so, um, you know, you don't have to worry about any of these kind of like, uh, uh, extra articular structures and like that on the, on the, on the bottom there, that's a, that's a plate study that we did, um, years ago. Uh, a little feasibility study, the sheep tibia, and what's interesting about the study is you look, we put a plate on top, you can see in the kind of the 13 week on the far left, and then over time, it looked like bone kind of tense up to the side of it, and then it all remodels back down to the cortical surface.

[00:22:48] Brennan Marilla: So for us, for, for us, you know, we are working towards a plate technology. Um, but the staple that we launched, we launched a staple a year ago. We just launched a small staple that has a lot [00:23:00] of foot and ankle applications, a little hand and wrist. They do a lot of Aikens with these little nines and 11s.

[00:23:04] Brennan Marilla: But, um, but this was, uh, this, this helped us with the FDA in terms of getting this, the first non permanent staple in the world to market, because people wondered, we knew what happened in bone. We wanted to know what happens on bone. And this is what happens on bone. It completely remodels down to the cortical surface

[00:23:21] Dr. Grant Garcia: and that's incredible to create

[00:23:22] Brennan Marilla: a speed bump.

[00:23:23] Brennan Marilla: You don't have to worry about, uh,

[00:23:25] Dr. Grant Garcia: uh, overgrowth

[00:23:26] Will Sanchez: looking out. Yeah. Brendan. Um, what was this seems, you know, we we've had so many shows, um, With different technology, um, you know, different, you know, medical advances from the beginning, right? You got the phone call, the company, things like that. But what was the process to talk to the doctors to see what worked?

[00:23:52] Will Sanchez: What didn't work? What did that look like? What was the studies? How many people did you guys talk to? Um, was it just, you know, [00:24:00] United States was expansive. Did you, you know, what, what was the research? I'm just curious to. To come up with the concept and just hear from the different, um, whether it's orthopedic surgeons or anyone else saying we need something else besides metal.

[00:24:16] Will Sanchez: And what did that look like as far as trying to figure that out and get, and get into the point where you're at now, because obviously like all the, all this technology is start somewhere. Yeah.

[00:24:25] Brennan Marilla: You're talking about developing the technology or developing the go to market plan. Well, no, just, just, yeah, no,

[00:24:32] Will Sanchez: just really just kind of just having the conversations, you know, how did those conversations start with other doctors and realizing that, you know, there was a market for something like this and how do we get to the point where we can get away from metal?

[00:24:45] Brennan Marilla: Yeah. I mean, look, I, I think like I said earlier, the, uh, um, the market had already been kind of validated. The need had been validated. Everybody's been trying to bring, you know, uh, non permanent implants, the market that can be mainstream. I mean, we wanted this to be. the [00:25:00] first credible replacement to metal implants and other permanent implants like peak.

[00:25:05] Brennan Marilla: Um, Iran price bloom is our founder. He deserves all the credit for this. Uh, I call him the Elon Musk of orthopedic fixation materials. He's a very talented biomedical engineer, uh, studied at Columbia university, uh, orthopedic research department. His thesis was the interaction of metal and bone. He became very obsessed with the fact that, uh, there's so much innovation in orthopedics.

[00:25:27] Brennan Marilla: I mean, there's a lot of innovation in this part of med tech, but fixation materials is not one of them. And, uh, and they're, and they're problematic for all the reasons that we know, of course it works and, you know, and using it for a hundred plus years. But you know, why, why are we going to put somebody.

[00:25:44] Brennan Marilla: On mars in the next 10 15 years and we're still using metal implants. It's kind of ridiculous. So he was obsessed with it and and uh, and was able to Uh bring this concept to life and uh You know, we got some smart, you [00:26:00] know early, um advisors around us. Uh, we were able to raise money Um, we were able to get some seed money from the israeli government because the technology center is based in israel Okay, and um, and we were able to get it off the ground Get it off the ground and, and get it into some successful animal studies.

[00:26:18] Brennan Marilla: Um, when we just, when we started, um, our, when we kind of got our plans together to go to market United States, when we, you know, in about 2017 is when we, uh, opened up the Boston headquarters and started hiring people in United States. And, um, and at that point we began to go out and try to understand the perceptions of the market around non permanent implants.

[00:26:43] Brennan Marilla: And what we found was what we, what we thought we would find, which is everybody loves the idea. There's not a single surgeon that just says, yeah, that's not a good idea. Like, why are you even thinking about this? That's, that's not even the, you know, kind of validating the need we don't need to do. We have to prove that this is [00:27:00] different from prior attempts.

[00:27:01] Hmm.

[00:27:02] Brennan Marilla: And so we had to get out and we had to understand what were, you know, what did they like and dislike about, you know, the, the other, um, the other non permanent implants that had been on the market are still in the market, including the biocomposite market, which is still very, that that's been a successful part of non permanent implants is shoulder biocomposite acres.

[00:27:21] Brennan Marilla: Um, but otherwise anything weight bearing has not been typically. Um, so we went, we had to go out and try to understand, you know, uh, how would the market view this, how would, how do we need to explain it? And we just decided to go out and just be as transparent as we possibly could with how we make it all the animal studies.

[00:27:39] Brennan Marilla: Um, we wanted to be a very scientific company. Uh, we wanted that to be part of our brand personalities to be, to be very scientific and innovative. And, um, and we also decided to brand the category differently with, which is biointegrative. And that has been a term that I think has been very sticky for us because once you have a chance to explain this, um, [00:28:00] to a surgeon or even to a patient.

[00:28:03] Brennan Marilla: Uh, it just makes a lot of sense and people want to evaluate it and try it. So

[00:28:09] Dr. Grant Garcia: the, uh, I think we'll also, you're trying to get at the way these surgeons think again, I'm obviously just one of them. There's many of them. Um, all the stuff that Brennan saying is really good. Right. And we listened to that, but obviously the same thing is it's got to perform.

[00:28:24] Dr. Grant Garcia: When you actually do it, so when I did my first trial, so we can hear this, I picked the hardest scenario because I was like, if it doesn't mess up on this, then we're good. Right? So I eat the tibia, which is the tibial bone. And so I do certain surgeries that require the fixation of the tibia. And I have tried a lot of anchors.

[00:28:42] Dr. Grant Garcia: And I've had a lot of reps upset when they crack when I'm doing them. And I remember the first time I put one of these in, I put it in and it just kept squeaking, which means, as you know, squeaking in the wall means like, there's only two ways this is going. It's going to snap in half

[00:28:57] Will Sanchez: and I'm not

[00:28:57] Dr. Grant Garcia: going to be done using it or it's going to go all the way [00:29:00] down and it's going to work.

[00:29:01] Dr. Grant Garcia: So I remember doing it and went all the way down. I look over at the rep and I said, how did you guys do that? I was sure this thing was going to crack because I heard it squeaking the entire time. And then the next time I did it, I was like, let me make this even harder. So, you know, you're supposed to tap up screw.

[00:29:15] Dr. Grant Garcia: He's like, just the reps, like do only a little bit. And I was like, dude, that's going to break for sure. And I did the exact same thing, but I'm like, if this breaks, it's no big deal. Right. The cool part about these implants is, you know, again, doesn't happen, but if they crack, you can just drill it out and do it again.

[00:29:30] Dr. Grant Garcia: It's not like when you have a wall, you have a whole hole, you can't use it again. So I tried it again and it squeaked even more. And I'm like, this is definitely going to break. And sure enough, it didn't. And I looked at him, I was like, where can I get more of these? This is awesome. So that's all honestly, will, I hate to tell you that you can, Brendan can talk all day about all the data he says.

[00:29:48] Dr. Grant Garcia: And that's really great. And that helps me feel good to tell my patients about it. But in the end, it's got to perform. It's just like these athletes, right? Like all day you can train, but if you can't shoot the hoops, there's no point in even being on the court. So [00:30:00] anyhow, go to the next slide. This is, this is really good.

[00:30:06] Dr. Grant Garcia: So you can see where they're at. I mean, Brennan, you can see where we're going to ask about what are your, what are the service lines you're looking at? And we want to make sure we get to all this stuff cause we could go all day with this. We,

[00:30:17] Brennan Marilla: we see this as a platform technology, uh, and you could make, you can make endless number of implants across all the, all the sectors of orthopedics.

[00:30:26] Brennan Marilla: Um, I mean, you know, uh, you know, Iran, our founder, he wanted to go into spine first. Okay. We were like, well, maybe let's, let's pick a different space. Uh, first that's, that's a little bit of the wild, wild West right now. He is,

[00:30:38] Dr. Grant Garcia: but he is the Elon Musk. So he's just,

[00:30:41] Brennan Marilla: listen, we think there are many great applications of spine, but we said, you know, why don't we start with a foot and ankle and we started in foot and ankle for a few reasons.

[00:30:49] Brennan Marilla: One is we thought that was maybe where the biggest unmet need existed because you're walking on these implants, people feel them in their feet, even when you have a successful union, a

[00:30:59] Dr. Grant Garcia: lot of removal of [00:31:00] hardwares is probably the

[00:31:01] Brennan Marilla: very high hardware removal rate. Um, and there just wasn't a lot of, uh, non permanent implants available for that market.

[00:31:11] Brennan Marilla: So we went to that market first and we've had a lot of success in that market. We've, you know, we're over 40, 000 implantations now. Um, And, and that just in a few years. And so this is our current portfolio. Um, thanks for pulling this up. You know, we started off with, we started off with something really easy.

[00:31:29] Brennan Marilla: We thought, geez, a hammer toe implant would be really a easy place to start. Uh, it's also an interesting study because we did our first in human study was, it was in hammer toe. And not because we wanted to really, we were super interested in hammer toe. It's just that we wanted to show biointegration and safety and efficacy.

[00:31:48] Brennan Marilla: And, um, that implant fills up a lot of that, uh, intramedullary space. So it's actually a really good test. But anyway, so we start off with a hammer toe. Uh, we introduced these nails, these nails, think about rebar, [00:32:00] uh, anywhere where you need stability or strength, uh, if you need to add fixation. Um, these nails, these trimmable nails are super interesting to use really strong.

[00:32:09] Brennan Marilla: You can hang 350 off the end of one of these nails and you can trim them. You can customize them. Um, and then we introduced screws. Uh, we then followed with, uh, the suture anchors that you've, you, that you've used Dr Garcia, uh, then this, then the, uh, different staples. And then we have a new product that we literally launched a few weeks ago, which is the fully threaded trimmable nail, or it's kind of like a fully threaded screw, but we have a really interesting way to, uh, to trim them and then to, um, resharpen the tip.

[00:32:45] Brennan Marilla: So it's a, it's, it solves the scourge of the end of the industry that one of the biggest problems in the industry is. Inventory management. Imagine one length screw, essentially it's a nail and you trim it. And then, um, [00:33:00] you've got a little pencil sharpener there and you, you basically have a driver that's adjustable and you would just adjust the driver to the length of the, of the nail after you cut it.

[00:33:10] Brennan Marilla: And then you just resharpen the tip. And then you, you put it in, you can drive it in really easily. You don't even have to tell you

[00:33:17] Dr. Grant Garcia: don't have to tell you is you can use, you can have one long nail and put in three small screws with it. Is that what you're saying?

[00:33:22] Brennan Marilla: No, you can have one long nail. Oh, so on the, on the trimmable now, just the normal, just the typical nails, the ones we've had for a while.

[00:33:29] Brennan Marilla: You can cut those in half or in three pieces and you can get two or three implants out of those nails. The, the fully threaded nail. Uh, I think that may be difficult to do. I think you're going to get one implant out of that nail. You're just going to be able to trim it to length.

[00:33:44] Dr. Grant Garcia: Yes. So you're only having one side of the table.

[00:33:47] Dr. Grant Garcia: So you're not having to have like 10. So, well, the other issue you have with these implants is obviously stock, right? Like I'm lucky I've got a pretty good stock area, but like I can't carry every single size. So what he's saying is it comes in and you have one size fits [00:34:00] all, and then you can adjust it and customize it.

[00:34:02] Dr. Grant Garcia: So it means everything's a lot easier.

[00:34:04] Will Sanchez: I love that wording. The pencil sharpener is like, okay, you know, it's a three inches long. We need to get it down to two and a half. Well, we're just going to, you know, just, uh, Use the, the trimable nail and get it down to two and a half where I need it. And there you go.

[00:34:18] Will Sanchez: There's the exact size that you need for whatever the size of the bone or the area that you're going in. Because as we know, every person is built differently. Everyone is a little bit longer or shorter or things like that. So, uh, that's a, that's a great concept. Uh, what, what was the mindset behind that was to just realizing that there was a need and finding a tool would.

[00:34:42] Will Sanchez: You know, satisfy that?

[00:34:45] Brennan Marilla: Well, yeah. I mean, uh, our, our, our compression screws are, are, uh, partially thread at compression screws. They're really strong, but they're, um, not as sharp as metal. So you, you do have to tap them in hard bone, especially. Um. With the [00:35:00] fully threaded nail, you don't have to tap because the driver extends through the, uh, along the nail.

[00:35:07] Brennan Marilla: So you don't have all the torque in the head. And also it gives you better visibility when you're placing the implant because the driver, you can see the tip of the driver at the very end of the implant.

[00:35:15] Dr. Grant Garcia: Yes. Well, that's a good point you brought up. You can't see them on x ray either. So after you're done, you have to be able to find it.

[00:35:20] Dr. Grant Garcia: So this is why they did the beat, beat the trick on there. Yeah.

[00:35:23] Brennan Marilla: Yeah. So we actually used instrumentation to solve a few of the, uh, maybe some of the minor objections we had with our original screw. And we think this is the platform moving forward and the compression you get is amazing. And the squeaking, the surgeons love the squeak.

[00:35:37] Brennan Marilla: Uh, and I actually, I think this is a great TTO product for, uh, for, for sports medicine. Surgeons a great product for. using for TTOs and some of the other applications. But, um, we're going to have four and a half. We have five and a half. So we're going to launch next month. And we also have a hand and wrist.

[00:35:54] Brennan Marilla: So we have a kit for foot and ankle and sports medicine. Other, you know, kind of, kind of a universal kit. [00:36:00] Uh, and then we have one that's specific to hand and wrist for, so they can use these as metacarpal nails. So you asked like in terms of what sectors we're in, we're in foot and ankle. Um, we've been in foot and ankle for five years.

[00:36:11] Brennan Marilla: We've been in sports medicine for about a year. We're having great success in sports medicine right now. And then we're just, we're kind of entering hand and wrist. We've done, been doing hand and wrist cases, but this is our first like specific hand and wrist product. Is the, trimmable nail with the hand and wrist kit.

[00:36:26] Brennan Marilla: Go For metacarpal surgery, um, which obviously you don't, you hate to, you hate to revise those with metal on the way, uh, and patients don't want metal in their hands. So, you know, we think this is a winner for that application to really excited about this product and we'll continue to make all, we'll make smaller diameters and we'll make larger diameters.

[00:36:45] Brennan Marilla: We want to make big seven O's for big hind foot surgeries, hip, things like that.

[00:36:50] Dr. Grant Garcia: Yeah. Will, I want to tell you one more thing. So this product, again, I had the older trim old nail. I remember they showed me and they brought it in. They were like, okay. So they gave it to me. And this is all part of the intro [00:37:00] cock with the surgeon.

[00:37:00] Dr. Grant Garcia: And they said, and I've had this before where it hasn't gone well, not with you guys, but other companies. And they said, break it. And I was like, Okay. So he goes, break it, bend it. You're strong. You think you're strong, break it. And you're talking about, you know, it's this, I don't even know. It's as long as this chapstick.

[00:37:15] Dr. Grant Garcia: Right. But if it's thin, it's, this is only 4. 5 millimeters. That's not very thin. That's not very thick. And they were like, break it with your hands. So I'm like squeezing and it's, it's literally not moving. And I'm trying, I'm put on the table and I'm trying to break it. You can't break it on the table. So right then and there, you're like, okay, what's going on here with this?

[00:37:32] Dr. Grant Garcia: Not only is it not breaking, the threads are not shaving off. So that's a pretty impressive product. I remember specifically doing that cause I was 99 percent sure it was going to crack in half.

[00:37:44] Brennan Marilla: I'm glad it didn't. I wouldn't expect it. But

[00:37:48] Dr. Grant Garcia: you know what though, that's how you guys, that's how you guys get people to believe it because I remember, well the thing about this product is it's budding what we're [00:38:00] so used to.

[00:38:00] Dr. Grant Garcia: We're reached a really integrative, uh, Materials being soft and really strong materials not being integrative. So it's just, it's, it's so different that it just takes a lot of people to figure it out and a lot of time with people and it takes us for someone like me, it just takes me, I got to see this to believe it, right?

[00:38:22] Dr. Grant Garcia: I got to try this. I got to test how strong it is. Then I got to see how the patients do. And again, I've seen plenty of studies on this. I know the product works well. I'm not concerned about this in terms of. Recovery from the patients or cystic changes. I feel really good about it. But the, the hardness to me was the hardest part for me to, to bear.

[00:38:39] Dr. Grant Garcia: And I needed to test it out on the hardest stuff. And I've been pretty impressed. I

[00:38:44] Will Sanchez: just wanted to ask you, you've been with the company now for a while. What was that? Wow. Moment for you when you were like, obviously the, you know, you were all in, you believed in the product, but from seeing the products, you know, we saw the timeline right up till [00:39:00] now.

[00:39:01] Will Sanchez: What was that wow moment for you saying, okay, we got, we got something incredible on our hands and the future is just sky's the limit.

[00:39:10] Brennan Marilla: Gosh, that's a tough question. There's been a lot of wow moments. Um, uh, I'll give you a recent one and I'll maybe try to back up and give you some of the early ones. I think a recent one is getting the pediatric label from the FDA, uh, being able to treat children down to two years old.

[00:39:26] Brennan Marilla: Um, that was a big vote of confidence by the agency, um, in our, in our technology. Um, and, uh, and, and having surgeons across different specialties that have treated, um, pediatric, uh, pediatric patients tell us success stories, show us x rays. Um, we've been able to interview some of the parents and some of the children.

[00:39:51] Brennan Marilla: That's a major wow factor because when I first thought, when we all first thought about this opportunity, you know, should we, should we do Osseo or not? Um, we always thought [00:40:00] that pediatric avoiding a second surgery for a child that falls off a bike or breaks their ankle. Uh, is, is, uh, that's kind of the Holy grail.

[00:40:12] Brennan Marilla: That's why you get out of bed in the morning. It's not just the money. It's not the resume. It's not all the other benefits that, you know, all the other motivators that are kind of exist in jobs. It was. Gosh, that's just a really, that's just a really cool thing to be able to do is to put these and put these in children, have them just turn into their own bone and they have to, they don't have to go back for a second surgery and go through all that pain and, and you know, all the, all the hassle of having to do that.

[00:40:40] Brennan Marilla: So, so that's been very exciting for us as of late early on. I think it was just having surgeons use the product, um, having them, um, be so impressed with the strength of it. But, but more importantly, having them tell us three months, six months, a year, two years later, they're like, God, my patients are doing so well.

[00:40:58] Brennan Marilla: And no one's complaining. [00:41:00] Like no one comes back and says, Oh, I, you know, I've got this, you know, my, I've got all the swelling now, a year out. I mean, we just didn't hear that. And so that was, And then that's a foot and ankle

[00:41:09] Dr. Grant Garcia: thing too, what you brought up, Brendan. I mean, they picked. And they all say they pick foot and ankle because the market was underserved, but they also pick foot and ankle because like I said, I tried it on the tibia, the foot and ankle stuff.

[00:41:20] Dr. Grant Garcia: If the hardware is not going to work with foot and ankle, it's not going to work anywhere else. It's the hardest place to heal. It's the smallest place. It's the place that can patients complain by far the most of hardware, right? You guys, the easiest thing for you guys would have been to start with sports.

[00:41:36] Dr. Grant Garcia: Right. The sports has a lot of innovative, but there's not as much stuff. You pick the hardest one. I mean, spine would have been, spine would have been a hard one, but it wouldn't be the same because the patients have a lot of other stuff going on. Right? Like you pick the one where like, my mom's had multiple foot surgeries before.

[00:41:50] Dr. Grant Garcia: I know how hard it is to recover. Right. Then done plenty of foot surgeries at HSS. And you picked a very difficult one. And the fact is that that market was so successful that you moved on to [00:42:00] other ones should tell people how this product's doing.

[00:42:02] Brennan Marilla: You know, one thing that, one thing that kind of, I was thinking about as we were thinking about entering foot and ankle was seeing all the competitors in foot and ankle, or they were like, I don't know, they were like 25 or more companies that make.

[00:42:14] Brennan Marilla: Make hardware, uh, for foot and ankle. And I thought, geez, that's a really red ocean. Um, but in some ways it told you that first of all, these are all great competitors. There's a lot of phenomenal startups and big companies that are, that, that compete in foot and ankle. But when it, when you have that many companies making hardware, you wonder how does the market support that many companies?

[00:42:35] Brennan Marilla: Uh, and I've thought, you know, maybe it's because they're just not very differentiated and there's nothing that's really come in. That's replaced all of it. And that would take many years to really knock out all these, all these other, uh, uh, products. But, but when the, when a market's that noisy, you just say to yourself, geez, maybe if there was one great product, you wouldn't have to have 30 different companies with hardware.

[00:42:57] Brennan Marilla: Maybe that's not the right way to think about it, but why just, we thought that [00:43:00] that was both a, uh, a sign that's very competitive. So it's going to be difficult, which, you know, which it is. But it's also, um, because there's little differentiation, that's an opportunity. It's not also

[00:43:13] Dr. Grant Garcia: not someone dominating, right?

[00:43:15] Dr. Grant Garcia: It's like you're saying, like, when there's 200 answers for something, clearly, maybe you don't have the answer yet. Right? Like if there was, if it was, if someone had the right thing that worked every time, The other companies wouldn't be able to compete.

[00:43:27] Brennan Marilla: Exactly.

[00:43:27] Dr. Grant Garcia: Right. They'd be out right now. All my screws a little different than this screw.

[00:43:31] Dr. Grant Garcia: My plate's a little different than this plate. You know, it's all the repetitive same stuff so they can take their market shares and spread them out. So we'll, it's, it's, as a matter of fact, the more competitors you have, the better it's a, it's a kind of a backwards thing to think about. But I, what you're saying is perfect.

[00:43:44] Will Sanchez: Well the competitors are starting to, you know, spread thin because top 10 innovations. Best Technology Award, Best Practices Award, Global Excellence Award, Best Orthopedic Medical Device Company. Your [00:44:00] award winning technology is on display and is getting recognized. Uh, so competitors, I know it's very competitive field, but you guys are definitely leading the way.

[00:44:10] Will Sanchez: And, uh, I'll let you get back on topic as we always tend to steer in different directions there. Um, let me get back that, uh, That beautiful slide there, but congratulations. I mean, the, the, the awards, the recognition, um, it's gotta be exciting when, when you get that, you know, notification when the company, uh, when the founder gets recognized like that.

[00:44:36] Will Sanchez: So, uh, it's gotta be, it's gotta be a special thing just to validate all the work that you guys are doing.

[00:44:41] Dr. Grant Garcia: Will, let's show that foot and ankle side for the sake of time. I want to keep going. There we go. Show them that. And Brendan, you tell this. Why is it such a big deal?

[00:44:48] Brennan Marilla: Yeah. Again, um, not, not that anybody's watching your show to, to, to look at hammer toe studies.

[00:44:54] Brennan Marilla: Uh, there's more, I'm sure there's more. You never

[00:44:57] Dr. Grant Garcia: know. You never know.

[00:44:58] Brennan Marilla: There's might be more [00:45:00] exciting things to talk about, although it's a, it's, it's a, it's a highly prevalent issue and it's important issue for people. Um, so we did that, we, you know, that was our first product. So we did our first in human study.

[00:45:10] Brennan Marilla: Using a hammer toe implant and not because we were not not because we the market needed another hammer to implant or another hammer hammer to implant paper, but it was a great first study for us because we were looking really at safety biointegration and A hammer toe implant actually fills up quite a bit of an intramedullary canal.

[00:45:31] Brennan Marilla: So it's actually a really good test You really put it to the test and you can see here on x ray. You can see it two years You can't see it on x ray You It's in that second toe there. There's no joint

[00:45:43] Dr. Grant Garcia: left, guys. You can see there's no joint left. It just looks like a big long bone.

[00:45:47] Brennan Marilla: Yeah, it's a big fusion.

[00:45:48] Brennan Marilla: Nice fusion there. That's what you want to see when you get your hammer toe, uh, uh, fixed. And then on the right side is an, is, is a MRI. And you can see there's no fluid accumulation. And the implant is gone at two years. Um, [00:46:00] so that was the basis for, you know, our, some of our first publications. That came out first human publications.

[00:46:05] Brennan Marilla: And, uh, these were really important. And by the way, we got great, we got great fusion rates for, uh, for hammer toe implant.

[00:46:12] Dr. Grant Garcia: 96%. Well, if I did anything in my life, 96 percent would be good. So let's go to the next study. Let's go to the next study for him to show 100 [00:46:19] Brennan Marilla: percent patient satisfaction. That was, that was one of the most important metric we actually did.

[00:46:22] Brennan Marilla: That was an end point in the study was patient, uh, uh, satisfaction. We had a hundred percent patient satisfaction and, and usually patients aren't too happy with hammer toes. It's just a tough procedure. We thought that was a, we thought that was really, really good.

[00:46:35] Dr. Grant Garcia: All this is really good. I know you want to go this.

[00:46:37] Dr. Grant Garcia: I want you to touch on that last one. The biocomposite comparison. And I want to show people the difference because you, people say when I have a biocomposite anchor, I've got an anchor that's turns into bone. It turns in right away, right? I want you to show this 24 month thing.

[00:46:53] Brennan Marilla: Yeah. So, um, I believe one of your mentors, Brian Cole, uh, Brian Cole did this study with us [00:47:00] and, uh, we did this at the vet school at Colorado state and, um, we compared osteofiber to, um, A couple of the leading biocomposite anchors in the market and, uh, we were looking at a couple of things, uh, strength on strength at implantation.

[00:47:16] Brennan Marilla: Uh, we did really well there. And then on biointegration and, um, what we saw at two years, we're essentially completely biointegrated that point. Um, and what we saw with the biocomposite anchors is they really haven't broken down very much at that point. There really is not a lot of degradation that's happened.

[00:47:34] Brennan Marilla: Um, there's a lot of anchor left. And, uh, so at two years we didn't see much of a, uh,

[00:47:40] Dr. Grant Garcia: yeah. So when we, when people are selling some of these things, they're telling you. My biocomposite anchor, you want to use it because it turns into bone. And the idea is that more surgeons are, know this, and we all know this, that like, yeah, it might turn into more bone than a plastic one, right?

[00:47:55] Dr. Grant Garcia: Cause that's not going to go anywhere. That's inert, but it's not going to turn into bone as fast as you [00:48:00] think. And they can leave behind reactions, which is why he keeps saying it did not react because the common thought process is reaction happens with these. It's cystic changes. I mean, look at that.

[00:48:10] Dr. Grant Garcia: That's still not integrated. It. You see them too, Will? I mean, you don't have, you have an MD from the show, but outside of that, that's, but you know what I mean, Will, can you see the differences in that?

[00:48:19] Will Sanchez: Oh yeah, 100%. You can definitely see it. You can tell the difference, tell the graph.

[00:48:24] Brennan Marilla: One of the other things that's really cool about this study, um, we looked at graph cellularity.

[00:48:29] Brennan Marilla: So we wanted to see, you know, the biologics around the kind of the anchor graph interface. And we had a statistically significant Significantly better, uh, higher graft cellularity versus the, uh, control. Um, so we thought that was really interesting. So it heals really, really nicely. In addition to the strength, um, this, this heals really, really well.

[00:48:51] Dr. Grant Garcia: All right, let's go to the next one and see if there's anything on there. That's the, so this is, this is pretty cool. This knee bar thing is what I talked to you guys about [00:49:00] when I said, if you put it through something, it can kind of like heal it because actually it might promote healing because of the way it's structured.

[00:49:07] Dr. Grant Garcia: Right. Is that part of the thought process?

[00:49:08] Brennan Marilla: Yeah, yeah. Again, this is, we're, we're evaluating this in a clinical study right now. Um, looking at our trimmable nails that are already on the market, indicated for fracture fixation. Uh, looking at, um, uh, looking at, looking in the knee at, uh, at treating insufficiency fractures.

[00:49:28] Brennan Marilla: And is the, is the raftering, you know, basically is the kind of the scaffolding from this, um, from these nails. Is that having an effect and is the kind of the bone regeneration around that implant having an effect to reduce edema and pain? Um, again, this is, this is, uh, we're, we're doing a study. Um, uh, we're seeing very, very promising results.

[00:49:52] Brennan Marilla: Uh, uh, I know, uh, Dr. Cole's a manuscript that's, uh, you know, hopefully we'll get a publication soon. There's something that's, uh, [00:50:00] you know, in process right now on the, on the feasibility. Yeah. The, the, the initial feasibility. And, uh, this looks very promising. Uh, we're still learning, we're still trying to perfect the technique.

[00:50:09] Brennan Marilla: Um, but, um, but we're very excited about the, the potential for. this application, um, and it's interesting

[00:50:19] Dr. Grant Garcia: for them. It's interesting to see this stuff. I mean, this stuff is pretty impressive because we've all tried this. Well, so in this, this stuff you're seeing here, this edema, this is what pain it comes from.

[00:50:29] Dr. Grant Garcia: And so I'll do, you know, if they have this, it's either, you know, you either have to do eventually it's bad enough. You do an knee replacement. So if you can turn the, you see there, the one on the right, you see all of them, you see the white stuff going to no white. That's a really good thing. That's a really, really good.

[00:50:44] Dr. Grant Garcia: That means that person doesn't have pain anymore. Generally. Speaking. So this is the idea that you can do this without having to do a lot of other stuff. Cause some of the stuff on the market now is, you know, you blow it up with calcium and that actually really hurts, right? Versus something that's a screw that they're not going to feel.

[00:50:59] Dr. Grant Garcia: I mean, people don't [00:51:00] generally feel screws when you put them in after the first few months, they have achiness from the screw later on, sometimes with the change in weather. But the idea that you're putting this screw in, it's not a very painful process after the first few weeks. Uh, but the idea is that it heals in, which is pretty cool.

[00:51:15] Brennan Marilla: And will you asked about the wow factor? This has been a big wow factor for us. Um, um, and, uh, you know, we've been, uh, uh, a little stealthy with this because we wanted to make sure we had good scientific evidence before we really went out and, uh, and, and, you know, pursued this. Um, but, uh, the wow factor is definitely there.

[00:51:36] Brennan Marilla: The patients are really happy about their result and the surgeons are really happy. Really excited about what they're seeing so far. Um, more to come on this.

[00:51:46] Will Sanchez: Yeah. And, uh,

[00:51:48] Dr. Grant Garcia: maybe another episode.

[00:51:49] Will Sanchez: The, the, the wow factor is really the next slide that's coming up. Right. And even if you're not sure exactly all the things you talked about.

[00:51:58] Will Sanchez: It's clear as day when you [00:52:00] look at the results from the examples of metal to what Asio, the comparison, I mean, the pictures speak a thousand words. Uh, I have a buddy that broke his fibula and tibula jogging, a nasty accident. He has a rod and he had metal screws put in. And they didn't get taken out. So he still has them and he has a bunch of complications at times he could feel them.

[00:52:25] Will Sanchez: So having metal in his body at, you know, 53 years old and getting older in New York city with the heat, humidity, cold, we didn't, we didn't even talk about how the weather makes the body feel right. We, you know, just dealing with all of those elements, especially on the East coast where you have the extreme temperatures.

[00:52:45] Will Sanchez: I mean, he talks about it. So. Seeing this right here and seeing this slide and example, uh, metal compared to Osseo, the picture says a thousand words.

[00:52:55] Brennan Marilla: We treated a, uh, we actually have a video on our website. You can look at it. There's a, it [00:53:00] was a Kentucky Derby jockey, uh, out of Louisville, Kentucky. Really great guy.

[00:53:03] Brennan Marilla: And he had metal, he had a lot of metal from a lot, you know, a lot of accidents, these jockeys get. You know, throwing off his horses a lot and he had a lot of metal in his foot and his ankle. And, uh, in, in the, in the winter that gets so cold, he would go back down to Louisiana and train down there because he couldn't stand, uh, how his foot felt.

[00:53:20] Brennan Marilla: So he actually had the hardware removed and, and, and they replaced it with osteofiber and he's, it's, it's been a game changer for him. So we made a video with him. It's, it's, it was really inspirational. Um, you know, what's the other thing that, that, uh, that that's been really fun is to, um, we've been advertising on meta, the different meta platforms.

[00:53:38] Brennan Marilla: Um, around elective proce bunions, hammer toe proce patients research and sho say on the sidelines beca of surgery. And so we've awareness to the patient reception we've gotten ha We have about 350 surgeons Um, [00:54:00] and, uh, and we, this, so far this year, we've had over a hundred thousand patients click our ads and then go to our locator, a hundred thousand.

[00:54:10] Brennan Marilla: Uh, and we're not even spending that much money on advertising. I mean, we're a small company. We're not, we're not spending like millions of dollars on this. So, uh, we're getting a really strong interest, a really strong patient demand, and they're asking for it. They're going to their surgeon and saying, I want osteofiber.

[00:54:25] Brennan Marilla: And, and I've seen them, by the way, I'm seeing patients now in chat rooms and they're like resource groups that are online, these Facebook bunion groups and things like that, and they're in there and they're talking about osteofiber. And it's really, really, uh, really great to see that because the more patients are educated about this, the more they can go in as an informed consumer and say, Hey, is this right for me?

[00:54:48] Brennan Marilla: And if it is, you know, I want it. And, and they rave about it. So that's been a strategy of ours to educate, educate patients about this and certain sports medicine applications might be tough. [00:55:00] to advertise because I don't, people really shop for, okay, what kind of an anchor am I going to get when I have rotator cuff surgery and things like that.

[00:55:06] Brennan Marilla: But there are definitely, there are definitely opportunities there that we're also exploring in terms of some of those applications that are more relevant to your practice. Um, Dr. Garcia.

[00:55:16] Dr. Grant Garcia: Well, you know, I would, I would, I would counter you, Brennan, and tell you that patients come in asking for everything that I do.

[00:55:22] Dr. Grant Garcia: They asked for the every possible thing you could think of. They're like, I want this type of surgery. And we'll, we've talked about this before with a lot of the other companies, you know, they come in asking for specific things. I mean, today in the office, I had three or four specific requests for specific surgeries, specific implants.

[00:55:39] Dr. Grant Garcia: So they're really educated. We're in Seattle. They're like doing, you know, I bet you half my patients are already on your chat blog and they're going to be going on there now to figure out what this thing is and ask for it. So I would say that this is, this happens everywhere and any surgeon that does a practice where they require, where they're reliant on patients to look them up and find things and come to their website and things like that.

[00:55:59] Dr. Grant Garcia: This is a [00:56:00] great opportunity from a marketing standpoint for a good product that differentiates itself and to be able to offer this for your patients because they're going to ask for it. And these surgeons say they don't ever ask for it. I don't know you're talking about. You know, I just do my surgery the way you do it.

[00:56:12] Dr. Grant Garcia: Well, that's okay. You can be left in the dust if you want. Uh, but it's important that you understand that this is, this is coming, whether you like it or not, this is an excellent product and patients are going to ask for it, Brennan, even with your small amount of marketing.

[00:56:25] Will Sanchez: And if you're going to ask for it, you know what to say already, right?

[00:56:29] Will Sanchez: Don't settle for metal. Don't

[00:56:30] Brennan Marilla: settle for metal.

[00:56:31] Will Sanchez: Don't say

[00:56:32] Brennan Marilla: nature remains, baby. Leave nothing behind.

[00:56:34] Will Sanchez: Leave nothing behind. It's right on the website. It's amazing. I love it. I'm all for it. Whoever, whoever put that up there, the problem is now, well, it's going

[00:56:44] Dr. Grant Garcia: to repeat it like over the next five

[00:56:46] Will Sanchez: podcasts, every show, it's going to be like a little Easter egg.

[00:56:51] Will Sanchez: Yeah, that's great, man. Don't settle for metal.

[00:56:53] Brennan Marilla: There's a great foot and ankle surgeon in Baltimore, Stuart Miller, all the foot and ankle surgeon knows Stuart Miller. And he used to say when we first [00:57:00] introduced Osco to him, he used to say, I just want to set it and forget it. You set it and forget it. I just want to, I just want to treat that pain.

[00:57:07] Brennan Marilla: I want to just put that implant in there and not have to worry about it again. Set it and forget it. So I always, always remember that one.

[00:57:12] Will Sanchez: It's like an infomercial.

[00:57:13] Brennan Marilla: I

[00:57:13] Will Sanchez: love

[00:57:14] Brennan Marilla: it.

[00:57:16] Dr. Grant Garcia: So we'll we're at, we're now out of time.

[00:57:19] Will Sanchez: We are out of time. Let's say goodbye to Brennan. Brennan, thank you so much for your time.

[00:57:24] Will Sanchez: Um, I mean, we've talked about it. Check out asio. io. I mean, the webpage is amazing. I mean, it's good. We don't need to say anything. I mean, the awards say, speak for themselves. Um, we wish you and your family, uh, you know, just speedy recovery for the house, for the home, getting back, kicking the kids out, or if not putting them to work, whatever it is.

[00:57:46] Will Sanchez: Um, we just wish the best for you and your family and I'm hoping that this is a positive, right? To get the, get the family back under the roof and, you know, spend some quality time. And I know you kicked them out of the room because you were doing this show, so we really [00:58:00] appreciate it. That was, that was really fun.

[00:58:01] Brennan Marilla: I keep telling myself that, well, that's good. That's a good, it's a good positive outlook. So no, we're happy to be together. And, um, listen guys, if you, if you buy a house in a flood zone, just make sure it's really, really high. Okay. Just that's my, that's my lesson. Let me serve as a warning to others. Okay.

[00:58:19] Will Sanchez: All right. Or have some kayaks or something. All right.

[00:58:26] Brennan Marilla: All right. so much. Appreciate it. Talking to you. Enjoy the opportunity. And uh, Dr. Garcia, I'm so, so happy. Your patients are doing so well with this technology. So thanks again, guys. Great to meet you. Well,

[00:58:38] Will Sanchez: thank you. Likewise. Dr. Garcia. That was Brennan Marilla.

[00:58:42] Will Sanchez: I mean, providing information, right. And talking about tech and we emphasize a lot on the tech. And I mean, Osseo speaks for itself. Uh, the don't settle for metal. I'm going to say it all the time. Don't settle for metal. I'm gonna drive you [00:59:00] crazy. All right. Enough of that. Will Sanchez, Dr. Grant Garcia. Do you want to, anything to, before you wrap it up, Dr.

[00:59:05] Will Sanchez: Garcia?

[00:59:06] Dr. Grant Garcia: I don't know. Check it out. This book. Product's awesome. Check out the stuff they're doing. I hope that people are informed again. It's all orthopedics, all sports, all the time. Obviously we talked about it with some other specialties, but it was good. Follow us. We're almost running out of time. Cause they're not going to like it.

[00:59:19] Dr. Grant Garcia: If we go over an hour. Thank you.

[00:59:22] Will Sanchez: All right, people don't settle for metal.

Audio Transcript

[00:00:00] Will Sanchez:Welcome to Sports Doc Talk. I'm Will Sanchez, along with our orthopedic surgeon in sports medicine specialist, Dr. Grant Garcia, uh, Dr. Garcia, before we get started and before we welcome our guests today, um, what's going on with your background? The last couple of weeks we've had the New York Giants, we're already hyped up, you know, for the season and Danny Dimes.

[00:00:38] Will Sanchez: And this is our year. We're going to make it.

[00:00:43] Dr. Grant Garcia: Not a good showing last week and we had to change it. I still cheer for them, but I can't represent right now. Got to represent what's doing well. The podcast. That's much better. That's a great picture, by the way, of Will. I got to work on mine, but that's an excellent picture. [00:01:00] That's the best rendition I've seen.

[00:01:01] Will Sanchez: I got, yeah, I got my little haircut kind of going on. Surprisingly,

[00:01:05] Dr. Grant Garcia: surprisingly, he looks even better in real life than the picture.

[00:01:09] Will Sanchez: Anyway, um, You know, it's perfect, right? Because our guests has been working with sports, works right in your field, you know, you know him really well.

But before we get to him, let's kind of give a shout out to our sponsors, the recovery shop, Dr.

[00:01:26] Will Sanchez: Garcia. You know, we talked about them before we even started working with them, but Tell us a little bit about why the recovery shop just works so well.

[00:01:35] Dr. Grant Garcia: Yeah. So we, you know, we've said this on all the episodes, but really the recovery shop for me has been awesome for my patients, right? There's certain things they can't get and I can get them to the recovery shop.

[00:01:45] Dr. Grant Garcia: And so instead of going online and having to look up, you know, which products they want, braces, more advanced ice things, the re bliss, other scar creams. It's now all available for my patients on their recovery shop. And each one of us surgeons has their own landing page. So my [00:02:00] patients feel comfortable with the stuff that I've pre approved.

[00:02:02] Dr. Grant Garcia: And I review all those things and do it. It's been rave reviews from the patients just because of the ease of it. And then they can, you know, they're always coming to me like, I want nutrition supplements. We have those from the show on there. Uh, I want to have the Reblesses on there. I want the Nice Machine.

[00:02:16] Dr. Grant Garcia: It's on there. All those things are all together and they can order them whatever they want. And a lot of times with the complicated surgeries we do, they want to be going to the next level. And it's not just the surgery. It's not just the rehab. They want the extras. And so this provides it for them. So, again, I get no cut from this, you know, go on there, go to, go to the recovery shop, uh, talk to them, uh, see if they're interested for surgeons is an awesome outlet to offer your patients the next level and stuff, especially there when they're asking for more.

[00:02:44] Dr. Grant Garcia: So without further ado, we got to get to the, to our awesome guests tonight. All right.

[00:02:50] Will Sanchez: Bring in our orthopedic surgeon, uh, Dr. Lu, Joseph Lu, uh, thank you for taking some time to be with us. And it's funny. Dr. Garcia mentioned something about the [00:03:00] Rebless and we'll get to that later on because I saw a really cool video of you checking out the Rebless.

[00:03:06] Will Sanchez: Well, we'll get back to that first and foremost, you know, it's, it's all about the company you keep. And obviously you're friends with Dr. Garcia. How in the hell do you guys have a relationship? Tell us a little bit how this relationship started. And, uh, and we'll take it from there.

[00:03:22] Dr. Joseph Liu: Well, Will and Grant, thank you so much for having me on the show.

[00:03:26] Dr. Joseph Liu: Um, just like you said, I've known Grant for Basically forever. Um, he and I were co residents, meaning we were the same year. We entered at the same time, uh, in residency at New York, in New York City at the Hospital for Special Surgery, which is basically the number one orthopedic hospital in the nation.

[00:03:42] Dr. Joseph Liu: And if that wasn't enough, we spent five years together there. Uh, we actually spent an additional year of subspecialty training when we traveled to Rush, uh, in Chicago together and did our one year sports medicine fellowship at the Midwest Orthopedics at Rush. So, you know, it's been a long time and we've been friends ever since.

[00:03:58] Will Sanchez: Dr. Garcia, before you [00:04:00] jump in, this is an important question here. You spent all this time in New York, uh, I'm originally from New York. In fact, I, my broken wrist was treated at the hospital for special surgery, but. Where was the hangout spot? All right. We're in the city. You guys are working together and spend all this time.

[00:04:18] Will Sanchez: Where's the watering hole? What was the spot? Are we hanging out on Second Avenue? We're going to fifth. We're going to Madison and we're going midtown uptown. Where was that? What was that

[00:04:27] Dr. Grant Garcia: Mexican restaurant that we always went to? It was so good.

[00:04:31] Dr. Joseph Liu: It was on second and 70th. I just remember the sangria. Okay.

[00:04:34] Dr. Joseph Liu: Okay. Okay. So this

[00:04:36] Dr. Grant Garcia: place, this place, this place will, we, the HSS, if you don't know, they try to track the best residents. And so by doing that, they subsidize housing. So we basically have our own building. And so we get like insane rent, uh, to go there. So it's like a, it's a no brainer when you want to go to New York and plus working at this place.

[00:04:53] Dr. Grant Garcia: So Joe and I all live in the same building for five years. So he like, we got, you know, not only do you work with the person, but you live in the same building as them. [00:05:00] And they see all your outside stuff, all your personal stuff. So there's no, there's all the dirty, the dirty things are released at that point.

[00:05:07] Dr. Grant Garcia: But on the way, literally we only have to walk two blocks and this is dangerous cantina between the two that has like the best sangria ever. And literally every time you walk home, you see some sort of one of the residents or fellows or whatever at the place. So, and I remember we would go there way too frequently.

[00:05:25] Dr. Grant Garcia: Uh, but it was an awesome hangout spot. Good. I think it was, it was Mexican. I'm almost positive. There's so many ones in New York, but that one was like dangerous cause you literally could smell it as you walk by or like your friends are like trying to hand you a margarita on your way home from the residency.

[00:05:40] Dr. Grant Garcia: Not the way in, obviously would never do that on call. Well, the

[00:05:43] Dr. Joseph Liu: worst is when you're covering the night shift and everyone's coming home and they're meeting up at this, uh, you know, corner tapas or sangria bar and you have to go in for the night shift and you can't, you know, take anything with you. And you're the only one in the hospital that evening.

[00:05:58] Dr. Joseph Liu: And so then you're just jealous for the rest of the [00:06:00] night, missing out. I don't think the audience wants to know about the night

[00:06:03] Dr. Grant Garcia: shift. The night shift, I don't wish the night shift upon anybody. Up is down, down is up. The only person that can handle the night shift was Dr. Joe Lu here. He's a master of that.

[00:06:14] Dr. Grant Garcia: He could do no sleep. You run around the hospital on fire is amazing. Well, that's hanging

[00:06:19] Will Sanchez: out at the cantina, right? I know. Grant was hanging out at the cantina. That's after six months. I was

[00:06:23] Dr. Grant Garcia: smart. I was smart. I was at the cantina. He was working. That's the way it rolls. Well,

[00:06:28] Will Sanchez: I'm glad the patients heard that.

[00:06:29] Will Sanchez: So they, they know that they were always safe, but they were in good hands with Dr. Liu. So that's good.

[00:06:35] Dr. Grant Garcia: So I wanted to introduce Dr. Liu, because obviously. You know, he had amazing training, HSS rush. He went to UCSF and then Stanford for undergrad. So he's clearly a slacker, uh, on the show. Um, but on top of that, you know, he's currently works with, uh, USC.

[00:06:52] Dr. Grant Garcia: He's done the USC athletes been on the field team physician. Um, and also works with the Sacramento, right? Sacramento Kings LA [00:07:00] LA Kings, LA Kings. And does the hockey team, but the hockey team is unique because we haven't talked about hockey, professional hockey coverage. It's a totally different animal than the football players.

[00:07:11] Dr. Grant Garcia: And we're going to go into this later, but there's also the side of the business, which is taking care of the players, the grit, the glitzy part. But then there's the other side. We talked about the last episode or two episodes with Tua and what happens with the clearance of him. So Dr. Liu is going to kind of, kind of refer to us as on that as well.

[00:07:28] Dr. Grant Garcia: But Joe, kind of talk about your practice, you know, what you do, uh, and then, you know, go from there and we'll keep jumping around.

[00:07:37] Dr. Joseph Liu: Yeah, so, you know, I'm an academic sports medicine surgeon at Keck Medicine of USC. Uh, I work with residents. I have sports medicine fellows that we train on a yearly basis as well.

[00:07:48] Dr. Joseph Liu: Um, I also do some, um, work at L. A. General Hospital as well, where you take care of, like, level one trauma or trauma associated sports medicine care. Lots of knee dislocations and multi ligament, you know, knee dislocations and things [00:08:00] like that. Um, and then I'll, you know, as an adjunct, because we're part of the USC faculty, we take care of the sports team.

[00:08:05] Dr. Joseph Liu: So USC Athletics, the USC football's almost like a professional team. Their yearly budget is You know, basically the same as a professional sports team, except for the salaries and with NIL, that's also a changing story as well. And then we also work with the Los Angeles Kings. And I think it's a great mix of taking care of, um, you know, patients from all walks of life.

[00:08:26] Dr. Joseph Liu: You have. You know, patients who are in, you know, kind of lower socioeconomic status at the LA General, where you get to take care of people that are very in need of care, and sometimes don't have great access to care. And then you have the flip side of things, where you take care of professional athletes, uh, collegiate athletes, where, You know, they're getting the, um, they're getting immediate care, you know, day zero care, and they're trying to, you're trying to get them back to sport immediately, you know, a lost day on a lost hour is, is too much for them.

[00:08:52] Dr. Joseph Liu: So they're trying to get back immediately. And I think that's the dichotomy between taking care of professional sports versus taking care of patients in [00:09:00] our office who come in and see us on a kind of outpatient basis.

[00:09:03] Dr. Grant Garcia: Uh, Joe, two questions that came from that, obviously questions from you introducing yourself, the NIL, right?

[00:09:09] Dr. Grant Garcia: We talked, we've heard about this. Have you noticed a difference in the USC team since the NIL was instituted? Is there any difference in the players, the way they're acting or the way you have to treat them differently? Right? Because before you take care of players, something happens. They don't really have a contract yet.

[00:09:24] Dr. Grant Garcia: Now they're worth millions of dollars. They're essentially pro athletes, right? So it's a different, it's a different, did you notice anything different when that happened? I mean, it's kind of been three or 10 years.

[00:09:33] Dr. Joseph Liu: I think the first thing that I noticed number one is that I think it came with the transfer portal.

[00:09:38] Dr. Joseph Liu: So the transfer portal changes as well as the NIL kind of occurred, not simultaneously, but around the same time period. And I think the combination of the two really changed the way we view. Um, or not necessarily the medical staff still treats them the same, but the way the players kind of try to, uh, kind of see their career.

[00:09:57] Dr. Joseph Liu: And that's part of it is their tenure at any [00:10:00] one university, USC included may not be that long, right? So you, what happened is when I started in most of the time, when you recruit someone, you're recruiting someone in the past for their entire collegiate career. They might have one transfer and it used to be where you had to wait a year before you were eligible.

[00:10:14] Dr. Joseph Liu: So transfers were a lot more, taken a lot more. Um, they just gave it a lot more thought. Nowadays, if you're not doing well or performing well, you might get injured. You might register early because you can transfer immediately and get asked either to another school or get a better contract through the NIL and you don't lose a year of eligibility.

[00:10:33] Dr. Joseph Liu: So I think the combination of the NIL money as well as the transfer policies have now made it so that players are, um, Are more apt to not be free agents. It college seems like a more of a little bit more like a free agency these days than it has in the past. I think that's probably the biggest change.

[00:10:52] Will Sanchez: Yeah, 100%. And, um, there's been articles coming out, especially lately, as far as. [00:11:00] What's going to be the next step. And so I want to ask you that question. And it's a really, it's a little bit of a vague question because we're alluding to the fact that these kids are now becoming professionals, right? And as we know, college sports and, and amateur sports, we are getting so far away from that at this point that we can, I can see the landscape changing all together where it, whether it's going to be a.

[00:11:27] Will Sanchez: Professional minor league or whatever it is. Um, are you starting to see that on your level in even as month to month, day to day, as we get closer and closer and seeing these changes that you're noticing that you're having a lot more influence, whether it's the coach or staff. Player player agent, you know, things like that, where there's a higher level of concern, especially when it comes to someone being injured.

[00:11:58] Will Sanchez: And, and I know it's a weird question [00:12:00] because as you mentioned earlier, you're going to treat each individual, give them the same care, but it doesn't mean that you had the same amount of stress. So I'm wondering if you're starting to see that or your staff or just across the board, maybe not yourself directly, but indirectly with your peers as well.

[00:12:17] Dr. Joseph Liu: I think that's a great question. And I think what you're alluding to is the fact that there is just more at stake here for these athletes, even at the collegiate level, right? Whereas before, um, maybe that transition was more at the professional level or CoachingBadminton. com because there wasn't as money as much money at stake.

[00:12:36] Dr. Joseph Liu: Um, there may have been a little bit more leeway to get these athletes back into, you know, back to playing status or you just had a little bit more time because there was kind of a little bit less at stake because you weren't trying to get them back for that season. So otherwise they would have transferred out or something like that.

[00:12:51] Dr. Joseph Liu: You had kind of more time to develop them. Um, but I do think that in this day and age, whether it's Just the competitive of collegiate [00:13:00] sports at every level has become greater. There's more money involved. There are just more, um, minds kind of in, in, uh, started behind every athlete. And so whether it's the parents that are more involved or there's an agent, or there is the, the kind of the posse behind these players that all have to be, you know, all want to be involved in, in their care and all have, there are people that they want to give their opinion.

[00:13:25] Dr. Joseph Liu: Um, I think that's part of it. Um, I think it's the second thing is we're probably more apt to, if someone's not doing well, to have second, you know, earlier opinions from other experts, whether it's from our partners or, or either from partners within USC or even partners within the town or even partners across the United States, where we send them to a specialist that is just known to treat all of the, you know, these athletes with this specific problem.

[00:13:50] Dr. Joseph Liu: Um, there's no expense spared because, you know, probably Neil

[00:13:53] Dr. Grant Garcia: Alatrosh. Right. We talked about this way too many times. Well, yeah.

[00:13:58] Will Sanchez: Yeah. That's interesting [00:14:00] to hear about that collaboration. So, you know, are you seeing your, uh, you know, to use an old term, your Rolodex kind of opening up and saying, well, we know how to treat this, but we're going to, you know, collaborate with a different group where they specific hand injury or Thumb injury for quarterback.

[00:14:16] Will Sanchez: That's just not healing. Right. And you know that, you know, someone across the country has a little bit more experience. So are you starting to see a wider pool of, or an openness to collaborate with your peers, uh, across the board? Because there's so much at stake.

[00:14:32] Dr. Joseph Liu: I think that's absolutely the case. And I don't think that's necessarily, I think, uh, USC athletics is very much like that, where we're very open to collaboration with the experts across the nation.

[00:14:45] Dr. Joseph Liu: Um, and it's always a case by case basis. Right? I think if it's something that's very, um, uh, you know, standard in terms of an injury, such as an ACL tear, uh, you know, shoulder dislocation very commonly treated, then, you know, certainly [00:15:00] keeping, keeping it within, sorry, keeping it in house is very reasonable.

[00:15:04] Dr. Joseph Liu: And if it's a very esoteric injury, so for example, we had, there was a foot injury that we recently sent out. Um, or, you know, there've been a couple of foot injuries that we've sent out to Dr. Anderson, who's one of the premier foot and ankle specialists across the nation. Um, you know, he's known to get these athletes back in a timely fashion.

[00:15:20] Dr. Joseph Liu: You know, there, there was, there are certain circumstances that require us to basically collaborate with these experts across the nation.

[00:15:27] Dr. Grant Garcia: Well, and do you ever, I mean, when we taking care of the pro teams as well, you know, you had a lot of these players, did they ever ask to go outside? Or whether, because they, they have agents now, right?

[00:15:36] Dr. Grant Garcia: With NIL, are they doing agents? And so a lot of times the agents will just float them. There'll be like, we're going to get another opinion, right? Whether or not you choose to, because now there's so much more money at stake. I mean, that's the one people don't realize. Like you could be a team doc. I mean, many of these team doctors don't operate on the players, right?

[00:15:52] Dr. Grant Garcia: The big players, they go wherever they want. They just pick and choose and they fly around the country. I remember seeing a few of the. Seahawks in my office. And it was just like, I [00:16:00] was opinion number six, right. And they'd already seen like they'd already, but they'd already had like the entire United States they'd seen and they were asking other opinions.

[00:16:07] Dr. Grant Garcia: And it was all the agent, the team was not, was not validating that, but that's not their, you know, the team doesn't make that decision. Unfortunately, in the end maybe a different for the college stuff. No, I think

[00:16:17] Dr. Joseph Liu: as a result of, you know, the NIL Monday, NIL money, I think these athletes have more people in their circle, whether it's their agent or.

[00:16:26] Dr. Joseph Liu: Um, family, friends or whoever, and they have all have their own connections. That's kind of how they get into the circle. Right. And they may have their opinions or you need to see X, Y, you know, this person to get their opinion because they know best and, you know, it kind of depends on who's talking in the athlete's ear.

[00:16:41] Dr. Joseph Liu: I'm not, I don't think an 18 year old who comes into college definitely knows, you know, the nuance ins and out of them, but if they get connected with an agent, there's enough money on the line, there's going to be someone who's talking in their ear that. Basically may recommend someone who they would see.

[00:16:55] Dr. Joseph Liu: And I think that's okay in sports, you know, and I think in medicine, it's, it's okay to get several [00:17:00] opinions. And I think when there's more consensus, then I think these athletes often, uh, have more confidence in their care as well.

[00:17:07] Dr. Grant Garcia: And I think the thing that people need to understand when they're hearing this is that As much as everyone thinks it's so great to operate a professional athlete, right?

[00:17:14] Dr. Grant Garcia: It sounds so cool Right. Like everybody always asks me that they're like, who do you operate? And obviously you don't tell them you can't say anything, but like, who do you put professionals? Do you operate? Have you operated on her? Who you fixed? They don't realize like, that's like, that's absolutely torture.

[00:17:26] Dr. Grant Garcia: Right. That's like calling the agent. They have to perform well, they don't perform well. And you're not one of the bigger top five sports guys in the country. You know, you're, it's your fault. Right. And there's the med legal, which we'll get into in a second as well. So like I, you know, we all welcome multiple opinions and there are certain guys that can just take on the risk.

[00:17:43] Dr. Grant Garcia: Neil Elitrosh somehow is the golden hands, right? He can operate all these players. He, I'm sure he's got issues with legal stuff dealing with it. No matter who you are, you have the James Andrews, you have Anderson. Um, you know, you have all check at HSS. Uh, you have all these guys that basically they, they're [00:18:00] basically, their practice and their whole setup is tuned to take care of these athletes and they can handle that volume, right?

[00:18:05] Dr. Grant Garcia: Cause if, if Neil Elitrosh does surgery on a professional athlete, right? And he doesn't get back, They're not going to blame Neil Altraz. They might, but he'll be like, I've done other, I've done 50 other guys like you and they all got back. So it's not my fault. If one, no offense to one of us, but if we do, we do one of the top players, they don't get back.

[00:18:22] Dr. Grant Garcia: They might be like, well, their Garcia hasn't done that many pro athletes. Maybe we didn't do a good job.

[00:18:27] Dr. Joseph Liu: Yeah. I think in the, uh, in the professional world, in terms of surgery, there are a select number of trusted surgeons that are the standard in terms of getting athletes back to sport, even if it's the same surgery that any of us would offer them, right?

[00:18:41] Dr. Joseph Liu: Um, that being said, it's, you know, that's their reputation. It's their history. Um, it's their, um, relationships with the agents and the players themselves kind of through the leagues that they've worked with. And I think that's confidence and trust that's built through You know, several decades of experience.

[00:18:57] Dr. Joseph Liu: And, you know, I think that's why there are a few, you know, [00:19:00] just a few surgeons that are out there that are, you know, in the echelon.

[00:19:04] Dr. Grant Garcia: It's a, this is this topic we could keep talking about all day. I mean, it's the, the thing people interesting that they don't understand is you're right. It's it 99, 95 percent of the time.

[00:19:15] Dr. Grant Garcia: Cause I mean, you and I both worked at rush HSS. We got bulls, white socks, U. S. Open giants, you name it. And we can talk about that experience, but you know, these are really good surgeons, but the surgeries that we do or the surgeries that I've seen by other doctors, Are just as good in many respects. And sometimes they use newer nuances.

[00:19:35] Dr. Grant Garcia: 'cause sometimes we've talked this in the pros, but they don't always get the like most up-to-date stuff 'cause people aren't willing to mess around with them. Right. Well like there's newer ACL techniques and if, like, I just saw an article that they pulled all these professional athletes and all, all these professional, uh, NFL doctors and they all would do the same ACL that we've done for the last 20 years.

[00:19:54] Dr. Grant Garcia: They wouldn't add anything extra to it. They would just do the exact same basic ACL. Now it's worked. It's time [00:20:00] tested. But the fact is that there was no innovation added to that. Meanwhile, I'm out there and Joe's out there doing things that are like 10 steps ahead because we don't have to be worried about the norm.

[00:20:11] Dr. Grant Garcia: Right. We want the best for the patients with best for the newest data. We've read 15 papers over the last two years showing how much better it is to add this stuff. But in that professional athletes, they can't, you can't start experimenting. I mean, that's why the Lonzo ball meniscus Carlos transplant is so crazy if he gets back, but there's only one person that could do it.

[00:20:27] Dr. Grant Garcia: And get away with it. And we all know that's Brian Cole, uh, outside of that is not possible. So hopefully it gets back. That'd be a whole nother topic to talk about. But Joe, on that topic, can you talk about your experience? I mean, everyone's heard me talk about HSS and rush, obviously awesome experience, you do the same stuff.

[00:20:47] Dr. Grant Garcia: And then like how that helped you or what you felt like going into the USC and then taking care of the hockey team. And like, kind of get the ins and outs of that briefly, you know, I think people love hearing that stuff because behind the scenes, they just see us running around on the field [00:21:00] and they don't really know what goes on, right?

[00:21:01] Dr. Grant Garcia: They don't understand the behind the scenes stuff.

[00:21:04] Dr. Joseph Liu: Uh, yeah. So are you talking about, you know, just my experience training at HSS and Russian? Yeah. And

[00:21:10] Dr. Grant Garcia: you know what, taking care of the pro athletes, what you, what you saw, what you, You know what, briefly what you did, you know, those kinds of things. And then how did it translate into your sort of taking care of the hockey teams, the USC, because we'll kind of jump in basically trying to talk about being a team doctor and all the stuff that you had to go through and like how you got prepared for it.

[00:21:27] Dr. Grant Garcia: Right. Cause not everybody gets the experience that we get in those first six years is vital. There's a reason there's a high HSS in Russia, some of the highest amount of professional team doctors in the country because they, they breed that, right. They want that.

[00:21:41] Dr. Joseph Liu: Yeah. I mean, I think. Number one is just HSS is just the mecca of orthopedics and sports medicine, right?

[00:21:48] Dr. Joseph Liu: We have, you know, some of the godfathers of sports medicine there that have, you know, so Dr. Warren is taking care of the, or previously taking care of the, uh, the giants for the last 40 or 50, you know, 40 years. And, you know, now [00:22:00] he's passed it on to Dr. Scott Rodeo, uh, who's, you know, been the head team physician for a number of years recently, and just watching them, uh, you know, getting, um, you know, watching them take care of patients on and off the field in the office.

[00:22:13] Dr. Joseph Liu: Uh, in the training room. I think that is a very unique experience. It's not necessarily available to all of the residents across the nation, right? You basically can only get that in very special, you know, specialized training facilities. Uh, I think also just the volume and the complexity of care that was taken, you know, done at special surgery, which is an orthopedic only hospital.

[00:22:33] Dr. Joseph Liu: Uh, working with, uh, basically every subspecialty, there's a giant in that field and, you know, probably not just one of them or a couple of them are, you know, at special surgery. That's kind of how unique it was. Uh, and then going to, you know, rush in Chicago, I think, you know, being involved in the White Sox and the Bulls and watching Dr.

[00:22:50] Dr. Joseph Liu: Brian Cole take care of the Bulls and see, you know, seeing how he managed those, you know, both in season and out of season players. I think that's the critical thing, right? I think the difference in taking care of professional [00:23:00] athletes is depending on where they are, the type of injury. Where they are in the season that you're it's going to be managed differently And I think there's only one way to see that you can't see that in the office Unless you're taking care of that style of patient If you just take care of, you know, someone like myself walking into the office, they're going to just give me physical therapy and see you in six weeks, right?

[00:23:19] Dr. Joseph Liu: But when you're taking care of professional athletes, you're trying to timeline and try to get them back to, you know, tomorrow, the next week, you're going to get, you're going to see them on a daily or, you know, uh, on a daily basis, occasionally to try to get them back to kind of see how they are. They might be day to day in terms of their status.

[00:23:34] Dr. Joseph Liu: And I think that's not something you can experience unless you're in the training room in the dugout. Uh, at the games, you know, seeing these injuries real time, uh, assessing them right at the time of injury, seeing them in the office the next day, seeing, you know, seeing the combination of their imaging, as well as their symptoms basically evolve over the next couple of days.

[00:23:53] Dr. Joseph Liu: I think that's the difference in terms of professional athletes. It's the speed at which you have to treat these injuries and trying to get [00:24:00] them back in the quickest way possible because days off are considered. Um, You know, they're, they're taboo, right? You, they're, they're playing for their next contract.

[00:24:09] Dr. Joseph Liu: They're playing in a contract year. Those are so, those considerations are so different. And so as a result, those are the things that aren't taught in normal orthopedic residency or education. They're not taught in normal medical education. You know, we're just, you know, in normal medical education, just taught to take care of the patient, try to get them back.

[00:24:26] Dr. Joseph Liu: But there's not really, um, that urgency. Um, that changes the way, you know, things are done in professional sports. I will say the other thing that I learned, and I don't know if you guys talked about it previously, is there is, uh, probably a little bit more reticence to, or sorry, more, um, incentive to do surgery on an earlier basis sometimes, so there's some things that potentially in the lay person you might treat nonoperatively.

[00:24:49] Dr. Joseph Liu: Because there's probably a more variable outcome or sorry timeline for healing. So for example a fracture that we might treat, you know A broken bone that we might treat non operatively in in the professional [00:25:00] athlete You're more likely to operate on them because once their wounds healed you have a much faster more reliable healing Uh timeline and you can get them back faster.

[00:25:08] Dr. Joseph Liu: And so as a result, uh Those indications are slightly different than what we would indicate for potentially someone who's just a community, uh, you know, someone coming into our office, basically.

[00:25:20] Dr. Grant Garcia: I think that's like literally the best points ever. I mean, Will, you should hear this because this is from like a layman standpoint.

[00:25:25] Dr. Grant Garcia: This kind of like blows people's minds. It's like we don't treat them differently, but you have to, right? You just have to like we try not to, but like sometimes I mean, Joe, what Joe's saying is right. Like certain things you treat them more aggressively. Right. Like a clavicle fracture, they go straight to ORIF, right?

[00:25:41] Dr. Grant Garcia: Because they want to get them back. And that means fix plating it. You know, there's a lot of things. But there's also some surgeries where we treat them less aggressively. Like cartilage, right? We wouldn't do a cartilage transplant on a professional athlete, obviously, until Alonzo Ball. But generally, we're going to do, they're going to do microfracture and things that like, would be considered like a huge no no now in my [00:26:00] practice.

[00:26:01] Dr. Grant Garcia: Right. But we change our methods for each doctor. I remember seeing one of the players and he had a terrible cartilage lesion with me from a condyle. And that will would be like, I'd be like, yeah, this needs like a pretty big cartilage procedure. And I, and I basically, the player was in a contract year and I had to tell him, you know, we're just going to do some stem cells or we're going to do some PRP and try to get you through the season, but like a lame person will walk in, I've been like, don't run.

[00:26:27] Dr. Grant Garcia: Don't walk. We're going to go to surgery in like six months. Like this is not good for you. So you just have like, everything's just different perspective and you don't, and then you can't be taught that you need to see other guys that other guys and gals that do this to learn how to do it that way. I mean, the in season out of season thing you mentioned.

[00:26:46] Dr. Grant Garcia: Joe was, is so vital. And there was no textbook for that. And even just even now treating just like high school and college athletes, they come in. I'm like, when's your season over with? I mean, even the martial arts high school kids, it's like, do you treat the dislocation in the [00:27:00] middle of the season? Do you treat at the end of the season?

[00:27:02] Dr. Grant Garcia: What surgery do you, you can tell them, okay, maybe you're gonna get a basic surgery now, but if you wait till the season, it's going to be bigger. Like everything you said was just on par. I don't know if Will has any questions about that, but it's like, I don't think we've talked about this on the show.

[00:27:13] Dr. Grant Garcia: We've had like over 40 episodes. But this is, this is amazing. This is exactly what we were hoping to get out of Dr. Liu today.

[00:27:20] Will Sanchez: This is more of a curiosity question just because, um, just from watching games and kind of seeing the speed and the movement of the reaction of the doctors on the field. We just saw Aiden Hutchison have a, you know, just pretty much breaking his leg.

[00:27:37] Will Sanchez: Instantaneously people are coming out, you know, getting his leg in a cast. Um, and in less than 24 hours, he already has surgery. So when you're working with the LA Kings, what's the protocol for someone like yourself or a team of physicians on game day? Like how many people need to be there, be ready just in case something happens.

[00:27:59] Will Sanchez: [00:28:00] What's the protocol of an injury of that magnitude happens that Yeah, we're hitting the ice. We've got four of us on standby. We have automatically this hospital ready to go. The aim, like just to kind of get a behind the scenes because when you watch it and if you're paying attention, it happens really, really fast and we've seen it with, you know, especially in the NFL where it, every second matters, right?

[00:28:27] Will Sanchez: Whether it's a DeMar Hamlin or anything else. So what's your protocol for game day? What does that look like behind the scenes? Yeah.

[00:28:34] Dr. Joseph Liu: Uh, that's a great question and um, I think the most important thing is there are more doctors than you can imagine that are That starts with that it starts with who your personnel is I think that's a character preparation so Uh at in in the nhl you're required to have an orthopedic surgeon who is the kind of head team physician there then you need to have um An er doctor typically our er doctor is in a general surgeon as well as er [00:29:00] trained.

[00:29:00] Dr. Joseph Liu: They're kind of combined, you know They have there are um, you know They're kind of code co trained. They, we have a dentist there for, you know, cause we get a lot of, uh, facial or, or mouth injuries. Oh, yeah, yeah, yeah. E and T doctor or a plastic surgeon who takes care of a lot of facial lacks or, uh, we have an ophthalmologist for eye injuries.

[00:29:17] Dr. Joseph Liu: Uh, we obviously have a general medicine doctor there for concussions. Um, uh, those are probably the, uh, those are the most common ones that we have in hockey. Uh, for football, we also have on staff neurosurgery that's involved as well. Uh, I know the NHL ha oh, sorry, NFL has their own kind of independent neurologist, uh, that's available to deal with depression, but that's not required at the collegiate level.

[00:29:39] Dr. Joseph Liu: Um, and then, um, So in terms of what's available on game day, we have paramedics are basically right off the ice, right? So you in, in USC football, they're just kind of right in the, in the tunnel that leads to the stadium. And then on the, uh, in for, um, for the NHL, they're just right off the ice. And we basically have, you know, uh, hospitals that we [00:30:00] know that, you know, we go to for certain problems.

[00:30:03] Dr. Joseph Liu: So if it's a cardiac event, they're going to go to a certain hospital. They're going to, if there is a traumatic injury, they're Uh, whether it's, uh, like a broken bone or something like that, we have another, it's a separate hospital for that. And so we know the contact and we go over the contact with, uh, the opposing team before game.

[00:30:19] Dr. Joseph Liu: So there's this pre game kind of huddle to make sure that everyone's on the same page. Uh, if there's like a cervical spine, a neck injury, we know how they like to basically position and get the patient uh, athlete off the, uh, off the rink to make sure they're transported safely. I see. I think these are, you know, it's all in the preparation more than so that when something like this happens, we can react on a moment's notice.

[00:30:38] Dr. Joseph Liu: And we're not, we're just following protocol at that point. We're just going to say, okay, this happened. We're going to do X, Y, and Z, and we're going to get them to the right location.

[00:30:45] Dr. Grant Garcia: And I want to bring up a point because I actually was, my friend was asking me this lot two weeks ago. He said, what's the craziest thing you had in your residency or fellowship?

[00:30:54] Dr. Grant Garcia: And you remember the White Sox player that had the aneurysm? And, and will [00:31:00] the, He's, I can't remember the guy's name. I just looked it up. He'll survived. White Sox player had an aneurysm on the mound. So he ruptured a blood vessel in his brain.

[00:31:09] Will Sanchez: Do you hit by a ball or was it just something that was building up

[00:31:12] Dr. Grant Garcia: sporadic?

[00:31:13] Dr. Grant Garcia: I mean, I don't know if there's a history of him. What he had is, but he probably had something brewing at some point, but he's just passed out and normally you'd like die from that and they somehow got him actually one of our co fellows with the doctors there, got him to the hospital. They got him taken care of and he survived.

[00:31:30] Dr. Grant Garcia: And he wasn't brain damaged. I mean, throw out a first pitch a few years. And that was on when dark, that's when Joe Lou and I were both at rush. We actually were not on that game, but we could have been. Um, and it was, I heard it was quite a traumatic experience for everybody there in the field. I mean, there's also the side of this is like, I mean, you're at the NHL and you get that carotid artery injury.

[00:31:49] Dr. Grant Garcia: That's no joke, man. So it's like most of the time, a lot of these games you deal with small things, but I mean, how many times Joe, we've had a couple and I will, we haven't even talked about this, but like we've [00:32:00] had a couple where we're like, we, the residents are called in. Because we're at HSS and we had to fix one of the Giants that broke his leg at like Saturday night, right?

[00:32:08] Dr. Grant Garcia: They're like, you're not even working and they're like, you get like a ring on your phone. It's like, we need you in the OR. You know, thankfully you're sober, so you run to the OR to help them out because you're not on call. And you need to go see, you know, whatever. I'm not at the cantina

[00:32:20] Will Sanchez: on 2nd Avenue and 70th.

[00:32:21] Will Sanchez: No,

[00:32:22] Dr. Grant Garcia: you're not in the cantina when you get the call to go fix the Giants. But, um, it happens. I mean, probably most, I think the most traumatic stuff is generally football, but there, we can pick a story from any one of those, but it's a, there's a lot of stuff that goes on behind the scenes. I think that's an excellent question.

[00:32:38] Dr. Grant Garcia: And it's really interesting for the, cause you just see that on the field. And all of a sudden you get a news report, right? You don't see the like hours of work behind the scenes. And I mean, how many times you prepare for this stuff and nothing happens. Right. So you got to be on alert. It's yeah.

[00:32:53] Dr. Joseph Liu: I mean, it, it can happen.

[00:32:55] Dr. Joseph Liu: Obviously the games are the most high profile, but it can happen anytime. Right. There's some players, [00:33:00] you know, who basically had a cardiac issue, you know, in practice and how to get them to the hospital, you know, And so those are things that, you know, at the most high profile situations are the games where other stuff is going on, and that's why protocol is really important.

[00:33:17] Dr. Joseph Liu: This can happen not just to the professional athlete, this can happen to anyone. And I say, so I think, you know, having these protocols at these locations that we, um, Uh, take care of. I think it's really critical and knowing who your resources are. I think that's another part of it. No one can ever do this alone, right?

[00:33:32] Dr. Joseph Liu: No, you know, there's, we're, we're all sub specialists in our own field. We know how to take care of what we know how to do very well. And we're going to rely on. Um, partners to take care of the, you know, things that they're specialized about. And so having a team that's in place beforehand, like I said, the preparation and having the right team available and having those protocols in place is going to keep our athletes safe.

[00:33:55] Dr. Grant Garcia: So I want to, I want to Change pace a little bit. This is always going to be, this is [00:34:00] always the hardest part of our jobs, but it's important for the viewers to hear this because we brought it up with the two, a conversation, but the med legality of team coverage, it is no joke. And the sexy thing of saying you're the team doc for this or the team doc for this, that's all great, right?

[00:34:19] Dr. Grant Garcia: Patients want to see you. You've got clout. You're solid. You know, that's, that's, that's, that is the highest level of marketing you can have as be a professional athlete, team physician, right? Like any, any, any sports guy coming out, that's the first thing they're thinking about doing, especially when you come from places like we did, right.

[00:34:34] Dr. Grant Garcia: They're just like, when are you gonna take care of the professional team? The problem is it doesn't always go the way you like. And sometimes you get issues. And we talked about the most recent one. And I want to know your opinion, but this is, this is for the viewers. This is the largest lawsuit in the history of the NFL, right?

[00:34:52] Dr. Grant Garcia: And one doctor, Dr. James Bradley, who's a great guy, great surgeon, Pittsburgh Steelers, but took care of this player. [00:35:00] And they sued him for, what, 29 million dollars, which is insane. And Rothman, who took care of the Eagles, which no longer does, got sued for, I don't know, I can't remember, 12 or 19. And they didn't even actually take care of him, they just did the rehab.

[00:35:13] Dr. Grant Garcia: So the fact that the lawsuit was dropped on them as well is absolutely insane. And this is going to change the market for teams. I mean, the teams can't even get coverage now because they're workers comp injuries. They can't even get coverage for some of these teams. Have you noticed, did you guys talk about that when it came out?

[00:35:29] Dr. Grant Garcia: Like I remember every surgeon, all my partners were talking about it. When it came out and they're like, did you hear about this? Did you hear about this? Like it's a big deal

[00:35:38] Dr. Joseph Liu: Yeah, so i'm not sure it's trickled down to the collegiate level yet Um, but we did have a specific meeting about it at the nhl team physician society And so what happened was?

[00:35:50] Dr. Joseph Liu: Um, this was, you know, like Grant said, the largest settlement that's ever been, um, you know, kind of doled out for a malpractice suit. And not [00:36:00] only was it the size, it was not, it was about future earnings, right? So there, in, in very, in certain states, there are short reform for painting suffering that's limited to a certain number.

[00:36:09] Dr. Joseph Liu: Uh, but there is no limit on future event, future earnings. And so that's basically why the number became so high, right? Um, and they just,

[00:36:18] Dr. Grant Garcia: and one second for the listeners, that's why professional athletes are the hardest, the hardest issue for malpractice because the word future earnings is killer because most insurance is like, no offense, but like if a standard person got injured, their future earnings are not going to be a hundred million dollars.

[00:36:33] Dr. Grant Garcia: Right. So, and most policies won't go that high. So that's the, sorry, keep going, but that's the reason why the future earnings is a huge deal.

[00:36:40] Dr. Joseph Liu: And so just like Grant was saying, our typical policies for just taking care of patients, right, is usually like a 1 policy. That's for just taking care of normal patients.

[00:36:51] Dr. Joseph Liu: And that, you know, that includes pain and suffering and, you know, any sort of negligence, that type of thing, malpractice associated payouts, you know, bodily harm, [00:37:00] um, that type of thing. But that's you, like Grant was saying, that takes into account what, you know, normal people are going to make in their lifetime.

[00:37:07] Dr. Joseph Liu: And so that's usually why that policy won't be maxed out. But in the professional level, there's typically not a secondary coverage that you're taking just because you're a professional, you know, a team physician. And so what, because this settlement was so high, there's never been in the history of a policy that's been that high for one individual surgeon.

[00:37:26] Dr. Joseph Liu: And so the fact that they personally had Dr. Bradley, um, uh, liable for, you know, 29 million himself was, you know, astronomical. That's crazy, right? There's no policy that's going to cover him. And then the secondarily, when the health system, you know, from Rothman was, you know, Uh, you know, on the hook for another 1 3rd, you know, basically another 1 3rd of that settlement, you know, that's how they got in trouble as well because I don't think I think the apartments themselves had to, um, they didn't, I don't think they had necessarily had secondary insurance that was that high that could cover that.

[00:37:56] Dr. Grant Garcia: Well, that's not a good day when you asked to write a check of that size and you didn't [00:38:00] even have to take care of the person.

[00:38:01] Will Sanchez: Yeah, 14. 3, right? So, um, that was their stake in what they owed. What does that do to a doctor? It, when you get sued at that level at 29. 2 million or whatever it is personally, What does that do to you?

[00:38:19] Will Sanchez: How does that affect not only obviously your wallet, but as far as you working with an institution, another hospital, like what are the ramifications at that level is it's, well, this doctor's legit. So it's just bad luck and we can move forward or do people hesitate saying. Hey, we cannot afford bringing, you know, to bring him in and have a lawsuit on our hands at that size.

[00:38:45] Will Sanchez: Can you, can you even answer that?

[00:38:48] Dr. Joseph Liu: I mean, I obviously I don't have personal experience with that number, but this is what I would imagine. There's two parts about it. Number one is. Are you insurable? [00:39:00] Right? Will insurances be with that type of settlement against you continue to cover your malpractice? Or are they willing to cover your malpractice insurance going forward?

[00:39:11] Dr. Joseph Liu: Because you have a suit of this type. size. You

[00:39:14] Will Sanchez: set the standard already, right? I mean, if you have, somebody has the same injury and something goes wrong, well, they already paid out at this. So that's where I'm starting my,

[00:39:24] Dr. Grant Garcia: well, that's a whole nother topic. Well, that's the, that's the worst part of this whole situation, which we haven't talked about.

[00:39:30] Dr. Joseph Liu: You know, just going forward, as you keep taking care of patients, you're in theory, in the eyes of the, in these insurance companies, you're much higher risk because you have this, Against your record whether you're at fault or not, right? And so this is just a statistic that you can no longer get rid of it's like kind of like getting uh, you know, a Something on your record tattoo or something like that Like that exactly that's exactly correct Um, I think the second thing is the mental aspect of it, right?

[00:40:00] Dr. Joseph Liu: Are you willing to take on you have the confidence? To take on that stress of getting someone back it at that level. That's a good It's not necessarily that you're not confident in your own surgical skills, right? But are you confident to treat them because they're going to potentially come back and bite you in the butt again, right?

[00:40:20] Dr. Joseph Liu: Meaning that are will they? If they have a bad outcome, are you always going to think what if they have a bad outcome? You treat them differently because of that. I think that is the thing that I can't answer because obviously I've never been in that mental space, but I would certainly think about that.

[00:40:36] Dr. Joseph Liu: And that's what I, I think that's what team physicians have to start thinking about. At the professional level, at the NIA level, when that much money is involved, right? Do, are these athletes going to suddenly turn around and start saying, because did you, whatever you did stopped me from these future earnings, therefore I'm going to sue you now, right?

[00:40:54] Dr. Joseph Liu: And I think that's really critical to think about. That maybe in the past we didn't think about because we were so focused on [00:41:00] the other side, the glamorous side. This is the, the very, You know, kind of the, the dirt of the, the, uh, team position side for sure.

[00:41:07] Dr. Grant Garcia: This is so important for the listeners to hear and to hear Dr.

[00:41:11] Dr. Grant Garcia: Liu's thing, because when you're a team, when you're a sports surgeon and you have some sort of clout in your community, the number one thing people ask is, are you taking care of a professional sports team? It's not how are you doing? You busy in practice? It's how are you taking care of your professional sports team?

[00:41:26] Dr. Grant Garcia: So there's a lot of motivation to do it. But the downside is there are too many surgeons I know who did sports teams who got so burnt out from the medical legal stuff or so scared that they were going to get sued by a player and lose all of their earnings for one thing. And by the way, The lawsuit, the lawsuit against this guy was not a mistake.

[00:41:50] Dr. Grant Garcia: It was actually a legitimate reason. It just somehow was able to find a way to win this lawsuit with a trauma surgeon that I went against an orthopedic surgeon. It's actually like absolutely some of these lawsuits, facial [00:42:00] professional athletes, they were on, you know, the problem you have, this guy's on, you know, guys on a contract year, he gets hurt, will can't 20 million contract if it hadn't been for you.

[00:42:10] Dr. Grant Garcia: Right. And you have a

[00:42:13] Will Sanchez: champion that goes to validate him, right? You know, I mean,

[00:42:18] Dr. Grant Garcia: because they're the because they know all about

[00:42:20] Will Sanchez: it and said he was a great player that can't get back on the field. So you have this Philadelphia Eagles Super Bowl champion that has a statue in front of the stadium saying, if it wasn't for you, He would be earning money and be back on the field.

[00:42:35] Will Sanchez: So there's a whole other aspect of it because now, now you're getting into public opinion, you're getting into fandom. I mean, we just talked to him. We started the show talking about the giants, right? So you're, you're, you're pulling on all of these emotional strings. And then you're having a decision made by a judge and now you have these ramifications.

[00:42:58] Will Sanchez: So I think going back to what you were [00:43:00] originally talking about, what happens to the Eagles? What happens to, uh, will we see a norm where eventually teams kind of take a step back because of something like this? Is there anything that you can foresee or guess that could sway a certain way?

[00:43:17] Dr. Grant Garcia: I don't think this is going to go over very well, this comment, but I'm going to say it anyways, because that's what we do here.

[00:43:22] Dr. Grant Garcia: Unfortunately, there are way too many of us young surgeons that turn into little lemmings. And we want to have the team coverage because you want to be busy when you come out and you're in private practice. I've had this experience and you open up your doors and you're, you're six months in and all of a sudden nobody's there.

[00:43:39] Dr. Grant Garcia: You got to pay the bills and you're stressed.

[00:43:42] right?

[00:43:42] Dr. Grant Garcia: Or you're two years in or three years in. And thankfully I was able to build my practice very quickly in Seattle. So for fewer years in that stress reduced. But to be honest with you, I had the same stress and I had this opportunity for potential professional athletics and I'm so glad I did not do it.

[00:43:58] Dr. Grant Garcia: But it was there and it would have [00:44:00] been very glorious to have opportunity. And Joe knows this, but you know, everyone we ever talked to, whenever we talk about how things are going, if they got onto a professional sports team, that's the number one thing they tell us. Guess what? I'm doing the trailblazers.

[00:44:11] Dr. Grant Garcia: Guess what? This team does this so that I think that's never going to go away. And unfortunately it means that young. Physicians and surgeons are going to be put up as lemmings and then eventually have some sort of burnout from something else. I don't know if Joe feels the same way, but, um, it's sad, but you know what?

[00:44:28] Dr. Grant Garcia: For some people, they really need that to boost their practice. And so I'm not faulting them for it. I just think it's, I wish there was a safer method and I wish there was more tort reform, but you know, we could go on and on about this. I don't know what you think, Joe.

[00:44:40] Dr. Joseph Liu: Yeah. So that's definitely the case.

[00:44:42] Dr. Joseph Liu: So, um, as long as they're surgeons that are willing to become team physicians, this problem is solved. We're all we don't have the leverage basically if that's what you're I think that's what you're pointing to is At this level from the team position level that you don't have leverage against this type of possibility, right?

[00:44:59] Dr. Joseph Liu: You certainly want [00:45:00] um You know our surgeons society is to kind of police themselves to make sure that surgeons are At an appropriate level to take care of these athletes and you're doing the right thing And I think that's also you know, just to point out that you had talked about previously who is kind of testifying on this athlete's behalf and drawing, you know, tugging on their heartstrings and things like that.

[00:45:20] Dr. Joseph Liu: The biggest issue is that, you know, in these medical legal cases, as you're trying to, you know, Basically, you're trying to basically convince these, the jury who are, you know, typically lay people, not medical people on purpose, right. Kind of the nuances of these surgeries. Right. And I think this is a very nuanced situation in terms of what Dr.

[00:45:39] Dr. Joseph Liu: Bradley decided to do in the, at the time of surgery that, you know, the lay person doesn't necessarily understand. And I think that's the complexity of surgery and sports medicine, especially at the highest level is that it's not just. One or the other there's not one right answer and often it's a judgment call of what you see at the time of surgery in the context of the what you see [00:46:00] in the rest of you know the athlete's you know body or the joint or whatever we're operating on it's not just the one thing that they're talking about right and so I think that's very hard to describe to the lay person and so a trial by peers is You know, not perfect because of the fact that the people that are actually sitting on the jury don't have the education to make such a, um, you know, the call to say someone's truly liable or negligent in this situation.

[00:46:26] Dr. Joseph Liu: And I think that's what's required in malpractice, right? These, you know, is the, is the negligence portion.

[00:46:31] Dr. Grant Garcia: And the problem you have too, is the experts. that they find they have trouble getting the good experts, right? Nobody's going to go against James Bradley if they think what he did was legitimate, right?

[00:46:41] Dr. Grant Garcia: Like you've gotten calls with Joe. I've gotten calls to be an expert witness against a sports surgeon that did something legitimate. I mean, I got a call six months ago. The surgeon did very little, definitely not enough to get sued. And I was like, I'm not testifying against them. That was completely legitimate.

[00:46:58] Dr. Grant Garcia: But of course, you know, [00:47:00] like they're going to find somebody eventually, right? And that's the problem. So it's a whole nother ballgame. I, we could keep going on this. I got a few more minutes. I got what I do, but I want you do your follow up question. Then we're going to go to NHL. I want to NHL's decision.

[00:47:13] Dr. Grant Garcia: So you do your follow up question. And then cause we're going to go all night. Will we do this all the time?

[00:47:17] Will Sanchez: I definitely go all night. So can you see a world where the contracts change? Between player and team, where, where the team is protective when it comes to, uh, the medical treatment and also maybe combining that with insurance policies, which we've seen, but I don't know if every player has them.

[00:47:42] Will Sanchez: So with the insurance policies covering the player and also the contracts that the player signed with the team, as long as you know, if you're going using our. Physicians or facilities or something like that, where maybe something is put in place where everyone is getting [00:48:00] something out of it, if something goes wrong, where someone's not getting smeared, if something happens, players are insured, can you envision something like that?

[00:48:08] Will Sanchez: I know there's certain things in place and some players have it, but I don't know if that's across the board.

[00:48:14] Dr. Joseph Liu: Um, so I think this might get at Grant's point that we're going to talk about very shortly, but I think. You obviously want players to earn their money, right? And so as all of these sports become more and more popular, they're just more and more money involved.

[00:48:27] Dr. Joseph Liu: And that's why these numbers are just going up and up, right? Our contracts nowadays for. You know, all of these sports are two, three times 10 X, what they were 10, 20 years ago. But it's also

[00:48:39] Dr. Grant Garcia: 10 X compared to the average population, right? They've gone up exponentially higher than all of us. Normal earners, right?

[00:48:46] Dr. Grant Garcia: We just, there's no way that we can't match the exponential growth of them. So that's a problem too, but keep going.

[00:48:51] Dr. Joseph Liu: So basically, and I'll bring this up a little early, um, is that, you know, when the NHL team positions were started to talk about this dilemma and, you know, [00:49:00] who should be coverage covering it, you know, they, they started to talk to the players association as well as the league.

[00:49:05] Dr. Joseph Liu: And I think what they came up with is that in, um, that probably the, the person that makes them, or the entity that makes the most sense to cover or provide kind of the secondary coverage is the league itself, right? Because that's where all the money's funneled through. Uh, and so if the league, you know, and that allows team positions to do what they are supposed to do, which is take care of players in the best way possible, not think about these consequences.

[00:49:28] Dr. Joseph Liu: And so if you have this larger entity that kind of obviously wants the best for their, you know, wants the players to do well and be healthy because that's their, you know, that's their product. Right. And wants their team positions to be available to keep taking care of. Um, players and not be afraid of kind of the possibility of these lawsuits occurring, then all of these leagues that have, have all this revenue that's then ultimately divided amongst the teams and the players, if they are the entity that covers them, then that's going to be the one, the entity that has the most amount of money that can cover them, right?

[00:49:58] Dr. Joseph Liu: So whether the, you know, I [00:50:00] think ultimately if they're, we're able to, they're able to come up with an agreement with all of the, you know, team positions, the team position society, as well as the players association and say, okay, well, you know, the league is going to head, you know, kind of. lead this kind of secondary insurance policies above and beyond what they carry normally, right?

[00:50:16] Dr. Joseph Liu: You don't need it for, you know, normal malpractice. You need the secondary insurance for basically, you know, out of this world settlements like, you know, the most, right, exactly.

[00:50:25] Dr. Grant Garcia: So this is amazing. What Joe just brought up as many point and the people, when they listen to this, These NFL teams literally have dead money and every year because they trade a player that's atrociously playing and they paid them so much money.

[00:50:40] Dr. Grant Garcia: 29 million dollars is like a rounding error for some of these teams. But meanwhile, you have James Bradley and Rothman that literally are like, sunken because of this lawsuit. And if the NFL literally could do this, it would be a game changer for all team positions and they could really take care of their players.

[00:50:58] Dr. Grant Garcia: And it would be no, this would be very little [00:51:00] burden, to be honest with you. I mean, the largest lawsuit ever is that big. I mean, that's like one year salary for one of these players. I mean, it's not like

[00:51:07] Will Sanchez: it's less than a year salary for Daniel Jones. Enough said, and

[00:51:12] Dr. Grant Garcia: that's, that's, that's saying a lot. So my point being is that what Joe is getting at is that is the future.

[00:51:20] Dr. Grant Garcia: And the only way you're going to get the best surgeons and the best people to take care of the players and they can do their best. And it's not going to incentivize us to do a poor job. It's going to send us to do a better job because when my number one concern, when I was offered to do more professional teams and I wasn't going to be fully employed and it was going to be a contractual relationship is that if I touch the player, I'm going to get sued.

[00:51:40] Dr. Grant Garcia: If there's a problem and I'm not protected in Washington state, we have employment laws that actually protect this situation. So if you're a team physician, but you're in fully employed with the sports team, supposedly you cannot be. sued by the sports team. So this would not happen in Washington state, which is interesting.

[00:51:55] Dr. Grant Garcia: And so we have very strict employment laws. Now, again, it may have changed recently. [00:52:00] That's something that's not in most of these states. It's clearly not in Philadelphia. Philadelphia is the largest Joe knows. This is the largest per capita of lawyers in the country, right? You just, you just, you run into a lawyer when you walked on the street.

[00:52:12] Dr. Grant Garcia: I mean, that's just, this is just the way it goes when I trained it, uh, in Penn. But this isn't, this is just really important. People understand there is a solution for this. Um, I just think the greed of the NFL needs to be fixed and uh, you can see this right now. I mean, it just protect your players, let them get the best possible treatment.

[00:52:31] Dr. Grant Garcia: And every team physician's thinking this when they're thinking of the player, they're worried about this. It doesn't matter who they are. I've, we've talked to, we've had seen so many amazing surgeons we've worked with and this is one of their concerns. I mean, it's right, Joe. It's medical legal. Everyone's concerned.

[00:52:45] Dr. Grant Garcia: No one wants to talk about it.

[00:52:47] Dr. Joseph Liu: Yeah. I mean, I think you're just, you're covering your eyes and you're covering your ears and hoping for the best, right? When you're taking care of these players, obviously, I think, you know, ultimately all of these leagues that, you [00:53:00] know, have all the revenue. They're the ones that have the deepest pockets to be able to cover these.

[00:53:04] Dr. Joseph Liu: And it's going to be up to, you know, the negotiating power of these teams. physician societies, as well as, you know, and as long as the players, I think associations are also on the same page. I think there will be enough leverage to hopefully get these kind of, um, entities to cover, cover the, uh, cover the physicians.

[00:53:20] Dr. Grant Garcia: Well, I think maybe the hope of this NHL thing is that it shows the other teams that they could do it. Um, and. I hate to say you keep saying the word deep pockets, but this isn't very deep. I mean, it's like I said, this is the rounding errors for NFL. Like there, how, how often will, and Joe, are there's, is there money that's like these teams when they, they get rid of a quarterback mid season, right.

[00:53:41] Dr. Grant Garcia: Who's done terrible. And it's got like 29 to 30 million of dead money. And we're talking about like a lawsuit here against the, one of their team physicians. For a, for a one single instance, that was likely not even negligence, right? It was, there's, from what I've understood about it, this is, this is, again, we know this is [00:54:00] extreme situation, but many of these are like player just can't play and they didn't get back to what they wanted to do.

[00:54:05] Dr. Grant Garcia: And so it's really important for people to understand that this is not a huge financial burden for these teams. And it's just, it destroys physicians who are doing teams and you don't get the best people, in my opinion, don't get people that you don't, you don't get the cream and you don't get your full pick, right?

[00:54:21] Dr. Grant Garcia: It's just, it's just the way it is, or you get people and they're scared. So it's just, it's a, it's a sad state. But again, we're not here to depress the viewers. We're just here to give them information.

[00:54:32] Will Sanchez: I see. You got five minutes because you just, you don't let Dr. Lou talk and you're jumping in all over the place.

[00:54:38] Will Sanchez: I'm so excited. I'm so

[00:54:39] Dr. Grant Garcia: excited to talk about this.

[00:54:42] Will Sanchez: It's all right. I stole a lot of your time, man. It was my bad. Listen, uh, how do you work your, uh, work life balance, uh, Dr. Liu? Just, uh, you know, you're busy, USC, and Kings, and, you know, dealing with Dr. Garcia. That's taking up all your time. What are you doing for, uh, for fun?

[00:54:59] Will Sanchez: And what's your work [00:55:00] life balance like? Just so, uh, just so we know here.

[00:55:02] Dr. Joseph Liu: Yeah, I think that's really critical for our longevity in any career. Uh, and, uh, I think now that I've come, uh, uh, Grant is gonna make fun of me because I used to be the most, uh, frugal person that he knows, and he might still be the most frugal person he's ever known in his life.

[00:55:17] Dr. Grant Garcia: He definitely is. This kid, this guy could retire. He's so frugal.

[00:55:21] Dr. Joseph Liu: But, I think, uh, you know, just finding, uh, Time on a daily basis to keep yourself, to keep my body healthy, as well as my mind healthy, working out, going to the gym, I think travel, you know, broadening your horizons, I think, you know, spending all your time working, I think that's, if it's, obviously, I think it does give someone purpose, but I think, um, going outside, learning about new things, I think learning about new cultures, uh, diversity, that kind of thing.

[00:55:47] Dr. Joseph Liu: I think that's the way to stay grounded in the fact that, you know, there's more than to life than just work. There's more to life than just taking care of sports. There's more to life than just doing surgery. Um, I think getting to know [00:56:00] new people, I think that's always exciting. I think that's, you know, but in a, in a situation that's not medicine, right?

[00:56:04] Dr. Joseph Liu: I think that's the interesting part, right? Um, that's what gives me joy. I think travel does that because you're, Uh, instantaneously going to go to a different place, uh, a walk of life that you may not have, um, You know, been able, been exposed to in the past. And I think, uh, you know, my girlfriend is loves to travel.

[00:56:21] Dr. Joseph Liu: She, you know, she's hit more countries and she she's gone through more passport books. As you're

[00:56:26] Dr. Grant Garcia: hearing the girlfriend changed him. Thank you.

[00:56:30] Will Sanchez: Have you gotten the, gotten the travel itinerary from Dr. Garcia? Right. And you know about this.

[00:56:38] Dr. Grant Garcia: Thankfully we're running out of time. So Joe can't tell me.

[00:56:41] Dr. Joseph Liu: I should be a separate podcast.

[00:56:43] Dr. Joseph Liu: If it hasn't already been featured.

[00:56:45] Dr. Grant Garcia: It's a, well, first off, I just want to tell everybody the, one of the best parts of my job as orthopedic surgeon is also the colleagues that I met and my friends and Joe's one of my best friends [00:57:00] and it's awesome. To be able to talk about random stuff, work stuff, anything.

[00:57:05] Dr. Grant Garcia: And honestly, I have a lot of work life balance, but the decompression, when I have a tough case or when stresses like not hopefully this level come up, I have someone like Joe that I can call and I would tell you, I've bounced, he's heard me talk way too many times and I've, he's bounced stuff off me. Um, and that's really the key to longevity.

[00:57:24] Dr. Grant Garcia: In practice and taking care of people, uh, because as much as we want to be perfectionists, nothing's perfect in life and we can bounce things off. And I am better because of friends like Joe and I hope that Joe's better because they're friends like me. And so that's what this really is important for the podcast too.

[00:57:40] Dr. Grant Garcia: Obviously we talked a lot about medical legal, but we both fricking love our jobs, right? But I like my job too, because I have people like Joe that I can talk to and I feel really good about my decision to do this thing. So thank you, Joe.

[00:57:53] Dr. Joseph Liu: No, thanks, Grant. I, I definitely want to echo Grant's sentiments about, you know, even though we're, a lot of us are [00:58:00] taking care of patients one on one, I think number one, it's, you know, our collaborative experiences from our training, you know, training, training with the best of the best and the greatest in orthopedics and sports medicine.

[00:58:11] Dr. Joseph Liu: And then it's not a community. You know, once you're in, so, you know, practice on your own, you don't finish learning, right? I think it's a lifelong learning experience. You continue to talk to friends and colleagues, uh, about difficult cases. Um, and you know, I I'm still learning every day with every patient.

[00:58:30] Dr. Joseph Liu: Um, I think that's the most, the best thing about orthopedic surgery, about sports medicine, is that not everyone is exactly the same, and everyone has their own story, and you can treat them, you know, you just need to treat them with kindness, and, uh, you know, understand that Okay to have a team behind you to give them the best possible care.

[00:58:51] Dr. Grant Garcia: Thank you so much, Dr. Liu. We really, really appreciate you coming on and normally we could keep talking, but we're going to go past an hour and Instagram does not like an [00:59:00] hour.

[00:59:02] Will Sanchez: Hey, we just want to, we want to thank everybody. We want to thank your time. Check us out at sports. talk. com. We have episodes, transcripts, you name it.

[00:59:10] Will Sanchez: Uh, we're going to get, uh, Dr. Grant Garcia's, uh, travel itinerary. It will be bigger than war and peace. Uh, so just be prepared. We'll see if we could do a cliff note version and we have to get a Dr. Lou talking about, you know, all of the travel shared here and, uh, everything that Dr. Garcia has done. Thank you, Dr.

[00:59:32] Will Sanchez: Lou. Thank you. Thank you, Dr. Garcia. our favorite orthopedic sports medicine specialist. And we, as always, we want to thank the listeners. Say goodbye, everyone. Thank you. Bye.

Audio Transcript

[00:00:00] Will Sanchez: Welcome to Sports Doc Talk. I've got our orthopedic surgeon, sports medicine specialist, Dr. Grant Garcia, Will Sanchez, Dr. Garcia. I mean, your background says it all. It's incredible. MBA time. I got to be honest with you. I'm a Knicks fan. I'm a little triggered from all the Jordan and Pippen beatings, but I'm going to, I'm going to excuse.

[00:00:39] Will Sanchez: I know you've worked with them in the past and I know you have some affiliations, so I'm gonna let it go. But before I ramble on and get excited about our show, how are you? And are you a bulls fan?

[00:00:51] Dr. Grant Garcia: I'm not a bulls fan. So first off, I don't want to throw off the viewers. We're going to, we're starting to do some stuff.

[00:00:56] Dr. Grant Garcia: You never know what's going to be on my background. So today we're going to talk about. [00:01:00] Obviously took care of the bulls. You know, working with them was awesome. Um, but the player we're gonna talk about today, which we'll go after in a minute is Lonzo ball, who is currently going to be starting with the bulls.

[00:01:11] Dr. Grant Garcia: Let's say three days, right? Thursday, I think is the start of the season.

[00:01:15] Will Sanchez: Yeah. So, um, that'll show will be the morning of, uh, the start of the season for them. So we're really excited about this 20, 24, uh, 2025, like I said, I'm a Knicks fan, so I'm hoping for good things this upcoming season, but for the business that you're in and what we like to talk about, um, This is right up your alley.

[00:01:35] Will Sanchez: We talked about it in the show previously, but before we get into that, because we're going to talk about recovery and this is kind of what we do. Let's talk about the recovery shop. Take it away.

[00:01:47] Dr. Grant Garcia: So again, thanks for our sponsors. Uh, we've heard this before, but this is what's essential for these big surgeries.

[00:01:53] Dr. Grant Garcia: You get these big surgeries, patients like professional athletes, regular athletes, college athletes. They were like, what do I, can I do? I need [00:02:00] what you're doing is good. But I need more. Yeah. Right? So what can we offer? So as a surgeon, we can have a place like this as a landing page and the surgeons can offer their patients that they go there or they get a call from the recovery shop offering these services and they can buy a bunch of these different things that they want.

[00:02:16] Dr. Grant Garcia: Different advanced ice machines, advanced recovery machines. You know, we got scar creams, uh, we got special bending machines. I mean, pretty much anything you want, you can put on there. I mean, that's the nice thing about this. It's not like you have to stick with something and it's something you value. So if it's something different that you want, you can talk to them.

[00:02:33] Dr. Grant Garcia: They can do it again. Obviously there are sponsors, but I get no affiliation if you sign up. Um, so just, you know, check it out, contact them as a surgeon. It's always good to have this. armamentarium because the patients are going to ask for it. Don't pretend like they don't, you know, you unfortunately have way too many visits where the patients come in, they go, what else can I do?

[00:02:49] Dr. Grant Garcia: And you'll say, well, you got this or this, you know, we can offer nutrition. So it's been an awesome outlets for my, for my patients.

[00:02:57] Will Sanchez: Yeah. And let's get kind of get started about, uh, [00:03:00] today's show. You know, we, uh, we talked about it last year. just the concern, right? And you know, when we're talking about Lonzo ball, you know, when we heard about his injury, um, he's had, I believe three arthro arthroscopic surgeries since the 2021 2022 season, which would be 2022.

[00:03:18] Will Sanchez: I believe the last time he stepped on the court was January, 2022. So he's finally been cleared after the torn meniscus, which has happened twice the surgeries. You know, we talked about it. Very concerning. This is something that most likely this player, even at such a young age in his twenties, may never play again.

[00:03:45] Will Sanchez: But now there's the chance he stepped on the court for the first time during preseason. He got a chance to play. Um, why don't you tell our listeners and viewers more about the injury that leading up to it and the procedure that he had, because, [00:04:00] um, like I said, we both discussed it and we didn't think that this was something that he may come back from.

[00:04:05] Dr. Grant Garcia: So first off this episode, I'm really excited about, uh, many reasons. First reason was when we did this initial show, you can go back and listen to it. We did not know that he had his meniscus replaced because it was never announced. We said we had an entire show, one of our hottest shows on the internet about cartilage transplants.

[00:04:26] Dr. Grant Garcia: Yeah. And we talked all about cartilage transplants, the recovery and everything else. And then all of a sudden, like six months ago, it came out that he had a meniscus transplant and a cartilage transplant. Which is a humongous surgery and that's near and dear to my heart. And there's a couple of reasons.

[00:04:42] Dr. Grant Garcia: One, this is my, this is my absolute favorite surgery to do. This is my absolute favorite surgery to take care of patients. This is a highly niche practice. There are a few very few people in each state that do this. So this is a very cool that I can talk about this in an NBA player. And [00:05:00] finally, The most cool part of this is the person that taught me how to do meniscus and cartilage transplants, who did this on Lonzo Ball, is the person that did it to it.

[00:05:10] Dr. Grant Garcia: Dr. Brian Cole, the godfather of cartilage and meniscus transplants. So, and, happens to also be the Bulls team doctor. So this is a, Awesome conglomeration of everything that I've worked for, for since I've been here to talk about this and to be able to show off this, this really cool procedure, you know, patients know about this, they come in asking about it, but, and we tell them it's for recreational athletes, professionals have never gotten it before.

[00:05:35] Dr. Grant Garcia: A cartilage transplant, but the meniscus transplant is even the next level. And so now we're about to see an NBA player who's already played preseason play in his first professional NBA game. The first player in history to have this type of procedure. I think he's the first player with a cartilage transplant and the first player with a meniscus.

[00:05:51] Dr. Grant Garcia: And they decided to go after both at the same time. And we can explain that in a minute why they did that. But this is a humongous deal. It's a technical surgery. [00:06:00] And it has obviously its own risks, just like any other surgery, but let's roll through the slides for the, for the viewers. They can understand what he did.

[00:06:09] Dr. Grant Garcia: Now I have inside information. Not only do I do this procedure, but I've done this procedure with the person that did the surgery on him. So I can tell you, this is exactly how he did it. So this is really cool. So on the left hand side, you see the black and we'll please chime in because for the viewers, I I'm going to, I'm geeking out right now.

[00:06:27] Will Sanchez: Yeah, I know. I'm just giving you a little room to breathe and stuff. Cause I've got some follow up questions, but go ahead, man. You're like a little kid in a candy store. I know.

[00:06:36] Dr. Grant Garcia: Okay. Thank you so much for the opportunity. So the. So the meniscus transplant you see here on the left. So what we do is this is called a If you're not

[00:06:44] Will Sanchez: watching this, and it's a great way to promote our YouTube page.

[00:06:48] Will Sanchez: Uh, Dr. Garcia has got a smile ear to ear. I mean, he may hurt his cheeks from smiling so much. I'm sorry to interrupt. A mental

[00:06:56] Dr. Grant Garcia: break. I got a mental break after this. I'm too excited. So, and we [00:07:00] got to keep this short because it's supposed to be a blast episode. As you know, we do a good job of that.

[00:07:03] Will Sanchez: Yeah.

[00:07:03] Dr. Grant Garcia: Okay. So, so first off, this is the meniscus transplant. So you can see here, now this is a lateral one. I'm pretty sure he had a medial one. That's more common with the issue he had, but nonetheless, gets his meniscus removed a few times. All of a sudden gets a hole in the meniscus or a hole in the cartilage, as we talked about.

[00:07:19] Dr. Grant Garcia: And then all of a sudden has no meniscus left either. The problem you have and what some surgeons do is they say, Hey, the meniscus is really hard. The meniscus is the hardest part of this whole surgery. So let's say the surgeon skips that, right? That's not good because now you've lost the cushion. You need to get all three things fixed.

[00:07:34] Dr. Grant Garcia: The cushion, you need the tibial plateau and you need the cartilage to be good. The tibial plateau is usually not the issue, which is the bottom part of the tibia right here below where the transplant is. Then you have the meniscus transplant and then you have the cartilage portion. So if you fix the hole, you fix the meniscus and the plateau is good.

[00:07:49] Dr. Grant Garcia: Then you have a good knee again. And right. And that's where the pain goes away and allows you to get back to activities. So the way he did this, as you see here, this is like a keyhole. It's actually crazy. It's just like woodworking. So [00:08:00] you cut that hole in, um, And then you slide the meniscus in like that, but you don't see here.

[00:08:04] Dr. Grant Garcia: And I didn't want, I couldn't find any images that were not gross for the viewers. So I apologize, but you attach it with stitches. Now that looks like it's really simple, but this is one of the most technically challenging surgeries that we do in orthopedic sports medicine because of all the nuances and little complications that can occur when you do this.

[00:08:21] Dr. Grant Garcia: So you do all that. And then on the same time, On the right hand side and this surgeries happen at the same time. This is not something you do separately and you come back. So you, I mean, Dr. Brian Cole is amazingly skilled at this and he's very efficient in the operating room. You take a piece of cartilage from someone else that has passed away.

[00:08:38] Dr. Grant Garcia: Generally someone younger. It's unfortunate to talk about it like that, but you that's the way it is. They just recently passed away three to four weeks. So it has to be fresh. And when you get it, you do some things, prepare it, and you actually core it out just like a bone dowel. So, so you see here, it's a bone plug, and you push that thing right back in.

[00:08:55] Dr. Grant Garcia: You generally don't need any screws or anything else. It literally just press fits. It's designed in the system to do [00:09:00] that. And those two things together are going to instantaneously give the patient a better joint surface. And then you're talking about a long recovery. I mean, Lonzo Ball's recovery was more extended than I would do for a regular athlete.

[00:09:12] Dr. Grant Garcia: I think they

[00:09:12] Will Sanchez: said it was 18 months or something like that. I mean, that sounds unreal to have a recovery that long for the surgeon. Go ahead.

[00:09:21] Dr. Grant Garcia: But you know what? He had bone edema. He had other issues going on. What's bone edema

[00:09:25] Will Sanchez: for those? I don't know.

[00:09:27] Dr. Grant Garcia: Obviously, he's starting to get like basically that means the bone is not happy, right?

[00:09:30] Dr. Grant Garcia: He has no meniscus. He has no cartilage and he's on that pre arthritis stage So if they don't do something soon, this is going to go really poorly, which is why he had so much pain, right? There are athletes i've taken care of nfl athletes Nba athletes that have had early arthritis or arthritis in their knees and they're fine, right?

[00:09:46] Dr. Grant Garcia: It hurts but they can push through it Lonzo ball clearly had something else going on the swelling the constant pain that he had but His knee didn't react very well to losing that meniscus and it doesn't happen to everybody. Um, he's just lucky that everything else [00:10:00] was in his favor. Good ACL, good everything else.

[00:10:02] Dr. Grant Garcia: So he basically had this special surgery, which again is incredibly unique. It's not unique in general, probably do. I mean, I think Dr. Brian Cole probably does 60 of these a year. He probably does a hundred cartilage transplants a year. You know, I do 20 of these a year with cartilage about 45. So it's not uncommon that we do them.

[00:10:23] Dr. Grant Garcia: I do one every couple of weeks, uh, but to do it in a professional athlete is, uh, is the next level. So this 18,

[00:10:30] Will Sanchez: I'm going to interrupt you as we go along. Why is that something that becomes a risk and why you normally wouldn't do it on an athlete like this?

[00:10:40] Dr. Grant Garcia: So first off, very few people have the. Have the cojones to go after the, be the first one, right?

[00:10:45] Dr. Grant Garcia: No one wants to be the first one with a surgery like this. If it fails, right? Like let's say Alonzo ball goes out in two weeks. And again, I hope not. I don't think it's going to happen. He's obviously been checked a million times. I'm sure he's had way too many MRIs to make sure everything's looking good.[00:11:00]

[00:11:00] Dr. Grant Garcia: Uh, and I'm sure Cole's seen him. I'm sure other people have seen him and make sure that he's cleared and ready to go. Right. There's no way the Bulls are letting him put in an experimental NBA thing and then go after it. Right. The surgeon experimental, but it's the first time done on an NBA player. Yeah.

[00:11:13] Dr. Grant Garcia: So the idea is that like that's, that's the big problem here, right? That's what we have to worry about. Like, what else, what else is going to happen? So what can happen is you can tear your meniscus again, right? The meniscus, even though, so that meniscus transplant is from somebody else. It's a cadaver as well.

[00:11:30] Dr. Grant Garcia: Now, those are frozen. And the cartilage is fresh. So the cartilage sustains itself better. Those less likely damage themselves. So other professional athletes have gotten cartilage transplants. There was a hockey player that just recently got it from Brian Cole. There's a few other athletes that have had the cartilage transplant.

[00:11:45] Dr. Grant Garcia: Those are way more durable. Those are way more solid. Like I do those and I kind of set and forget. I mean, people can have issues with them, but it's just not as often. The meniscus, the meniscus has three zones. There's the zone with the blood supply. That's the very far back [00:12:00] zone. Then there's the middle zone and there's the white zone, which is the edge.

[00:12:03] Dr. Grant Garcia: And you can see that here when the meniscus transplant heals. And it's pretty crazy. I just scoped someone last week that had a meniscus transplant. You can't tell all the sutures have dissolved. Everything looks like it's a regular meniscus. I grab, sometimes I grab a nurse in the room and I say, Hey, what is this real or not real meniscus?

[00:12:18] Dr. Grant Garcia: And they can't tell. So they look the same, which is amazing because it's been from somebody else. The, that little layer, the layer without the blood supply never gets integrated into the rest of the body. And so there's a risk of tearing again. It's a little more brittle. It's a little more fragile than maybe the one you were born with.

[00:12:35] Dr. Grant Garcia: You know, obviously nothing's as good as what we were born with.

[00:12:38] Will Sanchez: Yeah. But.

[00:12:39] Dr. Grant Garcia: And it depends on you. Well,

[00:12:40] Will Sanchez: can I assume that depending on the age of, of where you're getting this transplant from can also be a factor as far as let's say, you know, like Lonzo balls is 26 years old, you know, and if you got a replacement from someone that was in their twenties, you know, maybe that is a little bit more stable and stronger compared to [00:13:00] someone that's older.

[00:13:00] Will Sanchez: Can that be a part of making the decision making when you're selecting a transplant? That specific, um, you know, part of the body for the transplant.

[00:13:10] Dr. Grant Garcia: That's an excellent point. So the answer is we rarely would put something older than 30 to 30 years old in a knee like his. I'm sure he got something younger than him.

[00:13:21] Dr. Grant Garcia: He got a patient younger than him. It's just, that's unfortunate. Unfortunately, there's way too many, Bad things that happen out there. And we have a lot of these transplants to do. And again, I don't want to go into the ethics and, you know, stressfulness of the situation of getting donors. Um, but yeah, it's real.

[00:13:37] Dr. Grant Garcia: I mean, it's, we all know what happens. Listen, I

[00:13:40] Will Sanchez: I'm a donor. Gaffa bits. You know, when my time comes, if there's anything still working, please take it. And it's really

[00:13:48] Dr. Grant Garcia: nice too. Like what you can do and you do these, my patients will write letters to the family. that donated. And so you can actually, I've done my, I mean, I did one of my best friend's wives and she got [00:14:00] a cadaver ligament for her ACL and she wrote a really nice note to the family.

[00:14:03] Dr. Grant Garcia: And actually they, that's really cool. I get it frequently. My patients do it cause I do a lot of these. Um, and it's a really cool thing you can do. Uh, and again, I'm sure it makes the family feel better that they went to, went to a good cause and made a patient feel better and made someone feel better. So.

[00:14:17] Dr. Grant Garcia: Anyhow, on that, on, on back to the topic, the recovery 18 months is pretty long, but not for, uh, athlete of his level, you know, these, the average return to sport on these is about 10 months to a year. Um, and I have my patients, you know, the thing is, what's crazy about these is he probably felt pretty fricking good by about 8, 10 weeks, you know, there don't usually feel, they feel a difference in their knee very quickly.

[00:14:41] Dr. Grant Garcia: Despite how big of a surgery this is, but he probably had to reduce that bone inflammation. He probably had to reduce all that stuff and he had to strengthen his knee. And also because he's an NBA athlete, I'm sure they were just going super slow with him. I mean, one of the things that

[00:14:57] Will Sanchez: they mentioned was, Oh, one of the articles I read was [00:15:00] that he had to relearn to walk.

[00:15:03] Will Sanchez: Now, why would that be something that happens? Is it the procedure? It is it the way you want it to heal a certain way. So even though you're saying you're going to feel a certain way, eight to 10 weeks that you want to make sure that you're not advancing. So why is that?

[00:15:20] Dr. Grant Garcia: I'm so glad you're on here. Well, this is great.

[00:15:22] Dr. Grant Garcia: These are the questions that I don't, I just assume people know. So this is excellent. So when you get a meniscus transplant, you cannot put weight on it. For up to six weeks or so. So the first four, again, it depends on the surgeon. It depends on the procedure you do. It depends on your comfort level, but generally four weeks of no weight on this.

[00:15:41] Dr. Grant Garcia: So, and then two weeks of sort of partial weight, I think Cole's very similar. So by six weeks, you're walking pretty normally, maybe more aggressive walking by seven, eight weeks. Right. So that's the, that's the thing here is he had to relearn to walk. One, he probably was limping or having pain frequently.

[00:15:58] Will Sanchez: Yeah.

[00:15:58] Dr. Grant Garcia: And two, and generally his pain [00:16:00] pins are not doing very well when they start beforehand. And then he had to learn to walk again. And then he probably was walking abnormally. Because he was probably hurting right enough. They shut down so many times. Um, I mean, he basically, I don't think he was probably normal with his knee for two to three years before this.

[00:16:18] Will Sanchez: And, and who knows if he was normal or what we, you know, quote unquote normal because he had already had an injury prior to the one that set them back to where he's at right now, uh, with that meniscus injury or the meniscus tear, uh, prior. So, um, and also we've talked about it, right? You're laid up, you're losing strength, you're losing muscle.

[00:16:41] Will Sanchez: Um, just everything that kind of goes into it, right. We've had different discussions now to saying that this is something that they use, but you know, we've talked about peptides. We've had different conversations with different people, amino acids. How do we, you know, get certain things. So, you know, it'd be great to know what was the goodie bag, right.

[00:16:59] Will Sanchez: If we're [00:17:00] going into Halloween, right. to look into our bag of goodies and what did the doctors put in there to try to help him even though it's such a long process to get them going as fast as they can.

[00:17:11] Dr. Grant Garcia: A hundred percent. I'm sure there was more than you could possibly imagine. I mean, I've, I've had to take care of some of these bulls players and the screening tests we do for them, you would, they're not normal, you know, you're getting like checked for literally everything, right?

[00:17:24] Dr. Grant Garcia: They're getting, they're getting way more information. They've got, Cutting edge technology above what we have. Like we've shown before, you know, guardian caps, uh, Q collar, plenty of other technology that makes it to the NBA much faster than we would make. Right. They don't, there's no insurance costs. They don't care about that.

[00:17:41] Dr. Grant Garcia: They've unlimited supply of money and they're like, whatever it takes, let's do it. It's cutting edge. It's not going to hurt. The player and it's going to give him a leg up. Let's do it. So you, yeah, no, they're, I mean, they're, they look like, unfortunately, the NBA training rooms look like a science experiment because they've got all these different little potions and things there that you, that we [00:18:00] don't even have, we don't even access to yet.

[00:18:02] Will Sanchez: We've talked about recovery plenty of times, right? H robotics, rebel list, things like that. What would be something that they would use for Lonzo in this healing procedure?

[00:18:14] Dr. Grant Garcia: So this is what I use as the rebus for. This exact surgery. So this procedure. So basically he gets this surgery and I'm not sure if Cole used just our standard bending machine or he used, I mean, he didn't use the rebless, but another machine of some similar thing, we start using that right away.

[00:18:30] Dr. Grant Garcia: And that we used to use those bending machines for everything, ACL, you name it, but that's also a little more old school. But now with these machines, you want the patient to get bending because as he bends, he, he, he, he, He puts fluid through his knee. It's like lubrication and it gets the things moving and he wants to put a little bit of Bend on it because it actually pushes that meniscus out To the capsule where you want it to heal to and with the transplant it keeps it flush, right?

[00:18:55] Dr. Grant Garcia: So he's checking up before he finished the surgery He's gonna re scope at the knee be like that all [00:19:00] looks perfect Everything nothing's moved since I've bent the knee and then he's gonna let him bend his knee to try to get him back because you Want him in like week one or two to have very little pain and to be really moving that knee really well You Like by week six, you want them to let them loose.

[00:19:12] Dr. Grant Garcia: And you're going to say, go to full motion and you want them walking smooth, glide, no issues.

[00:19:18] Will Sanchez: All right, so it's not Lonzo's leg, right? So I'm gonna take Lonzo's leg out of it. Dr. Garcia has just had this operation done. What's the normal, and I know everyone is different, so just for our listeners to take it with a grain of salt, what's the normal progress for the bend?

[00:19:34] Will Sanchez: So if the, if the leg is straight, completely horizontal, you know, That week, first week, two weeks, whatever it is, what's the degrees that you start to implement? And if everything is on on par and going the way you want it as a doctor, when do we get to that 90 degrees, uh, in that timeframe?

[00:19:54] Dr. Grant Garcia: So it's actually fairly quickly with these, which is pretty impressive.

[00:19:58] Dr. Grant Garcia: I mean, I would say [00:20:00] I start them. I let them go all the way to 90. If they can in the first, Week now most people can't the first week if they get swelling everyone's different like you said But I let them go to 90 and I want them to keep going to 90 Repetitively because as you know after a surgery, especially a big surgery your swelling is going to keep coming back So you can't you gotta if you set it and forget it and then you stop doing it.

[00:20:20] Dr. Grant Garcia: It's going to lose motion again So you have the motion? Of the knee and the motion of the shoulder, but really mainly the knee for these surgeries is so important It's so important that that's why we give people these machines You So they can do bending. I mean, my patients talk about falling asleep in the machine.

[00:20:35] Dr. Grant Garcia: So they're just falling asleep and they get six to eight hours of just bending their knee while they're sleeping. And that's a really, really good thing for the knee. There's no damage caused by this. If you're worried about damage, then you did the, the surgery was not, uh, up to par. Um, so it's, uh, it's really important to have that aspect.

[00:20:53] Dr. Grant Garcia: So it's a good question. So then progress for me outside of the bending, you know, walking [00:21:00] fairly normally at six weeks, seven weeks. That's when you start to be like, Hey, how are you feeling really? That like up to three months is when you start to really notice a difference in your knee. Um, three months doing some elliptical ish stuff.

[00:21:12] Dr. Grant Garcia: Running, it's going to be like five, six months. Now again, this is, this could have been delayed more with Lonzo ball and then you have sort of the high impact stuff, seven, eight months, full return, 10 months to a year, but eight to 18 months is not considered abnormal. I mean, I've had patients that have taken 14, 16 months, even just from the transplant to get back.

[00:21:33] Dr. Grant Garcia: So that's what I tell people. The return to sport data is 10 months, but not everybody's the same and a high level cutting basketball player is different than my. patients who want to hike Mount Rainier or one of the

[00:21:46] Will Sanchez: biggest concern with this surgery for the basketball player, right? We're talking about one explosion to the basket or that quick cut, quick shift.

[00:21:56] Will Sanchez: You know, he's a point guard. I'm not sure how much they're gonna play him to the point [00:22:00] guard, which means you're you're stopping, starting, accelerating, coming off the pick and roll, things like that. So what are your concerns when you're thinking about uh, you know, your lateral to horizontal movements. If you're looking at this player, your patient, you're going, okay, this is what I want to see when he's doing, you know, X movement.

[00:22:19] Dr. Grant Garcia: Yeah. So, I mean, that is by far the most, I mean, you have a, you have a young 20 year old NBA level basketball player. Who's going to be playing all out. I mean, he's going to be scared that first six months. I don't think you're going to see him at his number one. There's just no way because he's going to be too concerned about damaging this.

[00:22:35] Dr. Grant Garcia: It's been two years. We've talked to us before. There's a massive mental aspect to this. And I mean, this is a guy that his, his livelihood is required, you know, him, him to be able to continue on and do in the NBA and do stuff he loves, but also get paid. He's got to be able to play well. And now he also has to worry about his knee because he's now the first one ever in the NBA to have this.

[00:22:57] Dr. Grant Garcia: That being said, this isn't a, this is not a [00:23:00] surgery that is experimental. This has been around. I mean, um, Brian, Dr. Brian Cole has done this for like 15 or more years. Right. He's done over 800 to a thousand, right? This is not a, he, no offense to Lonzo ball, but he probably did this as like he had his morning coffee and then he walked and he did lots of well, that's type of guy that Brian Cole is.

[00:23:19] Dr. Grant Garcia: So this is not something that we should be stressed about the quality of the surgery, just that it's unknown. And um, I mean there's plenty of athletes I've done this on that had done really well, but never professional obviously, or you know, but that cutting maneuver is, is a concern. And that's what I'm watching out for.

[00:23:37] Dr. Grant Garcia: You may get into this, but the two biggest things we worry about with this, the number one, and I hate to say it, retear of the meniscus transplant because, and it can happen. It's like 10, 15 percent in the first year, it can be up to it. So 75 percent of these transplants are still intact at 10 years. The problem you have is you have some, that's in general, right?

[00:23:58] Dr. Grant Garcia: So my, my 40 year old patients, I [00:24:00] do this on, And they're not going back to cut high level cutting sports. Yeah. So he may not last as long with this new meniscus, but again, if we get him three or four more years in the NBA, that'd be amazing.

[00:24:13] Will Sanchez: That's a, that's, that'd be interesting. I I'm, I'm looking forward to, obviously I'm, I'm, I'm a sports fan, basketball fan.

[00:24:20] Will Sanchez: I want to. see what his minutes restriction will look like, you know, especially in the beginning. Um, you know, obviously the league is always talked about, especially the players nowadays with the back to back games. I would be shocked to see him in any back to back games. Um, but it'll be, it'll be interesting to see what the progress is from when, you know, and maybe at the end of the season, you know, we're talking about the NBA finals, maybe some key injuries or NBA playoffs.

[00:24:48] Will Sanchez: You know, we could kind of look back at the, this injury and, you know, whether the bulls are in the playoffs or not, uh, they have a young team and we'll see kind of what happens with them, but kind of say, Hey, got through the [00:25:00] season. Hopefully we're saying got through the season, went from, you know, six minutes of game, no back to backs by the season, he was up to 22 minutes a game or something like that, able to contribute.

[00:25:11] Will Sanchez: Looks like things like that. And I know we're, we're starting to go along here, but, um, where are you feeling as a doctor? What's that over the hump, right? Because you already said there's always a chance of tear, right? And it almost seems like you you'll be surprised if there wasn't, especially with this high impact.

[00:25:33] Will Sanchez: But I mean, if I did this,

[00:25:34] Dr. Grant Garcia: I'd be nervous all season, right? If I was, if I was, if, Brian Cole, I know, is able to, he's a cool, calm guy. I love him. He's awesome. But, and there's, I don't think he's nearly as stressed as I am watching Lonzo Ball play. Just because I know the level of the surgery and the level of two years of recovery and obviously being the first one.

[00:25:52] Dr. Grant Garcia: Yeah. Um,

[00:25:54] Will Sanchez: but there's not a point there where you go, well, he's up to 20 minutes. He's, he's, he's reacted. Well, obviously I [00:26:00] can't imagine how many times he's being checked in, right? You know, at this level that you're, you know, you know, dr cole's checking in on him. How you feeling? What's going on? Okay, let's, let's get your ice and You know, this is what I want you to do when you come off the court and, and after the game and before the game, like this whole process, I can't even imagine, uh, what goes into it.

[00:26:20] Will Sanchez: So there, there's no point of it where you go, all right, anything can happen. But overall, I'm kind of feeling pretty good where we're at. And, you know, everything else is just kind of, you know, we'll, we'll see.

[00:26:30] Dr. Grant Garcia: Well, so I think to me is he's had a long discussion with the agent. I'm sure family, uh, Alonzo Cole had discussion with many other different surgeons too, to make sure this call was the right call.

[00:26:41] Dr. Grant Garcia: And I think it is because this has not been done before and it's needs to be done. I mean, you have players, you have, this is, this is a, this is a humongous first start. And I think that there is not, I think, I think that as the games go along, there's gonna be less and less stress. And you're going to see that if this works, Lonzo is going to be playing better than he's [00:27:00] probably played in a while because

[00:27:02] Will Sanchez: when

[00:27:02] Dr. Grant Garcia: patients get this, like my, my, this is one of my highest.

[00:27:06] Dr. Grant Garcia: The reason I like the surgery, I already told you it's extremely challenging. It's a really niche thing that very few people do, but when you do it right and well, the results are mind boggling. I mean, you get patients that are miserable with pain, swelling, frustration, and you can make them feel stable.

[00:27:24] Dr. Grant Garcia: They have this thing they call stability, which is very weird because they're not actually unstable, right? They have normal ACLs. And you can make their pain go away and they feel like the fullness of their knee feels better, right? It's like a car and they're like you're driving you feel like something's missing like the belt's not working, right?

[00:27:38] Dr. Grant Garcia: You can just feel it clutching you feel something weird going on. Yeah, when they get this they go My kneel my knee feels different. It feels strong. It feels stable. It feels not swelling. It's not painful These are weird comments that you don't hear when you do other surgeries. Like I do lots of other procedures I Thank you.

[00:27:56] Dr. Grant Garcia: I feel better. My pain's better, but they'd like they'd like they can like put their mouth on it. They can put their [00:28:00] words to it and they can say this is what this is.

[00:28:02] Will Sanchez: Yeah.

[00:28:02] Dr. Grant Garcia: And if he gets that if he gets that and again, it happens more frequently than then it doesn't happen Um, that'll be so cool. I think we're gonna see some impressive things and I think that You know, we're talking about 10, 12 games of the season.

[00:28:15] Dr. Grant Garcia: He's following the restrictions slowly improving. We're going to see some pretty impressive things. And I'm confident in this procedure. I hope he does really well. And even worst case, I'll let the viewers live this even worst case. If he does get a small tear at the end of the season or something that gets cleaned up, it doesn't mean that it's a failure.

[00:28:29] Dr. Grant Garcia: Right. Because he's still going to have a lot of his meniscus left. He's still gonna have that cartilage transplant, hopefully. So even a small hiccup, it doesn't mean that you're failed, right? Most of these cleanup procedures, you still keep going. So I know we go all day with this, but I'm really excited about this.

[00:28:42] Dr. Grant Garcia: Obviously, I think that it's really cool for the listeners to understand this. The last piece I'm going to tell the listeners, be prepared. This is not going to be the last person that gets this surgery. If this works in the next year, Because there are so many other athletes that need this done that no doctor wants to do this surgery on them because they're terrified.

[00:28:59] Dr. Grant Garcia: So because [00:29:00] they don't want to be, have this fail, right? This is a higher complication rate than an ACL. This has a higher complication rate than a meniscus cleanup, right? It's got all of the things. But if this works and gets back a player that has, there's, this is, this is career ending. You're going to see, uh, not a flood, but this is, this is going to be something you're going to see every year in the news after this.

[00:29:19] Dr. Grant Garcia: I, again, I could be wrong, but we'll see.

[00:29:23] Will Sanchez: It'll be, uh, it'll be great to watch. Um, you know, just as we wrap it up, we think about injuries and what's happening on the court and, you know, you've had injuries, I've had injuries and probably every, you know, everyone that's listened is not. Just the injury of what you're doing.

[00:29:40] Will Sanchez: It's laying in bed. It's trying to sleep. It's trying to be comfortable. It's just being uncomfortable and having this, this issue with whatever it is, whether it's your knee or elbow or neck or whatever. So just having some, something there that can be Kind of will make him feel better and even sleeping, right?[00:30:00]

[00:30:00] Will Sanchez: Maybe getting your full eight, nine hours to sleep and everything else. It's got to be beneficial, uh, for, you know, physically and mentally. So we, we hope that everything goes well and we know what it is to just be in pain, right? And that's one of the reasons that we talk about the show, you know, being in pain is not fun, not just walking, but even doing nothing, you can be in constant pain.

[00:30:23] Dr. Grant Garcia: Well, and again, for this one, It's not, he probably wasn't in pain constantly. The people, these, most of my patients are athletes, right? They're like, it hurts when I run, it hurts when I do sports. And that's what we're here for a sport surgeon. I want to fix you so you can do sports again.

[00:30:35] Will Sanchez: Yeah.

[00:30:36] Dr. Grant Garcia: Um, but you know, also wanted to let them know the lesson, let the listeners know, thanks again for all the requests I had.

[00:30:41] Dr. Grant Garcia: I've had three patients in the last three weeks asked me when the show was going to happen. And I didn't tell them I was going to do it. So people are waiting for this Lonzo ball show to hear about it. So I've been excited. The start of

[00:30:52] Will Sanchez: the

[00:30:52] Dr. Grant Garcia: NBA season. Right.

[00:30:54] Will Sanchez: Well, opening night, we had to, we had to come back to this.

[00:30:59] Dr. Grant Garcia: Thank [00:31:00] you to the listeners for. Continuing to encourage us to do stuff like this, because this is what this what's all about. Want to teach people about this surgery. You know, people come to me like this is so new. I'm like, it's not new, but you just haven't heard about it. So we're going to inform you and learn.

[00:31:14] Dr. Grant Garcia: So thanks again.

[00:31:16] Will Sanchez: Yep. And please check us out at sports. talk. com because that's where you can put in your requests for other shows and anything else you want to listen to. You could check out our previous shows transcripts. You get tired of listening to us babble, but you love the information. Check out the transcripts of the show.

[00:31:33] Will Sanchez: We have everything there. So, uh, we appreciate you guys and, uh, let's go next. Let's see if we could finally win one. It's been damn too long. It's been since 73 and I don't want to have to talk about John Starks anymore, missing all those shots. I'm not going

[00:31:50] Dr. Grant Garcia: to, I can't root for the bulls, but I'm going to say go Lonzo.

[00:31:52] Dr. Grant Garcia: No,

[00:31:54] Will Sanchez: no, we, we always root for our guys recovering, uh, things like that. So Dr. Garcia, this is

[00:32:00] great, man. Thank you so much. You have a good one. Bye.

Audio Transcript

Dr. Grant Garcia:Oh, and you can see my, my logos changed. Unfortunately, the Giants are, uh, So we're Cleveland, but, uh, we're going to be starting. I can't represent right now. So we decided to put this up in [00:01:00] honor of So this is, this is the new sports stock talk for the next year. We're going to keep trying to do logos.

[00:01:07] Dr. Grant Garcia: You're going to guess my logo is coming up for each show.

[00:01:09] Will Sanchez: Oh, maybe we should do that. Right. What's the, what's the logo of the next show? Um, you know, geez, we had this, this show last year, right. And we mentioned the, the Nick chop injury. I believe it was Sunday night. football. I think it was Sunday night football.

[00:01:25] Will Sanchez: I forget why we were watching them and it was just a nasty, nasty leg injury with the helmet to the knee and the leg moving in places that you just don't want to, you know, see it move. Uh, for those that didn't see the injury, I'm pretty sure you could find it on YouTube and anywhere else going back to that run.

[00:01:47] Will Sanchez: And we talked about it right away. You were like, this is, this is a tough one, right? With the damage to the medial collateral ligament, the medial capsule and the meniscus. Um, before we update where he's at today, [00:02:00] let's go back to that, you know, that injury and kind of recap what that injury entails.

[00:02:08] Dr. Grant Garcia: Yeah, so I remember when we were talking about the, when the first show happened, it was just so nasty and actually I would tell, I would tell you that this is lucky compared to what I thought it was just because it looked like a full knee dislocation.

[00:02:19] Dr. Grant Garcia: So he tore the MCL, which commonly happens with these ACLs, but as we remember, he had an ACL done already. This is now a second surgery. Go back to college. Yes, exactly. And so it's never the same, right? It's not like a fresh situation we're going into. So this is not a guy that tore his ACL for the first time.

[00:02:37] Dr. Grant Garcia: This is a second ACL tear. This is an MCL tear. And what was not mentioned is the bone grafting, right? So he supposedly had some bone grafting done because the tunnels were not perfect. Like we had talked about this. He might need that. And then it turns out he ended up needing that. So he got his September surgery.

[00:02:53] Dr. Grant Garcia: He got his MCL fixed. He got his meniscus fixed and that's what they did to obviously help out with some of the trauma, [00:03:00] right? Cause all the surgery at once might be traumatic. He got some bone grafting and then basically September, October, November, three months. As soon as they could do it, they did the second surgery.

[00:03:10] Dr. Grant Garcia: They talked about using some smaller scopes to try to help with inflammation and they gave him a new ACL. Uh, and they use some special screw options to try to help integrate the bone. And we can talk about the future of those at some point. And maybe in a future show, who knows, we don't want to hint too much on upcoming guests.

[00:03:28] Dr. Grant Garcia: Um, but. They use some biocomposite screws. So these are screws that turn into bone. And so the idea is that just leave no trace, right? Everything will be natural when he's done and hopefully give him the best, uh, option to recover. And also it fills any of those old tunnels of graft. Um, so pretty bad injury, revision ACL, new MCL or new MCL repair and meniscus repair.

[00:03:51] Dr. Grant Garcia: I mean, this is, this is not ideal. But we have seen players come back from this, but you know, 390 something days after [00:04:00] the injury. We can pull that up. Um, that's the impressive. Uh, and I mean, 11 carries a touchdown in 22 yards. Not too shabby for an NFL player, especially coming back from injury. This level.

[00:04:12] Dr. Grant Garcia: We're going to see this. We've talked about this well with our other players that have gotten injured the first day, the first week, the first month. It's not the same. Right. They, it takes them a while to get back and we've seen the return to sport data for different players and running backs are not ideal, right?

[00:04:28] Dr. Grant Garcia: Quarterbacks different, which is Dan Jones, which we, we can't really talk about too much anymore now. Uh, but, uh, you know, for him. This is, uh, this is impressive that he's back out there doing what he loves to do. Um, and big shout out to Dr. James Vu's, who is the team doctor for Cleveland. And one of my friends also, uh, Jacob Kelsey, who, who probably was assisting or some part of that surgery as well.

[00:04:53] Dr. Grant Garcia: So, uh, you know, I know these guys, they're really good surgeons and, um, just to be able to get a guy back like this is [00:05:00] awesome. And again, it's a team. Right. We've talked about this way too many times. We'll have something coming up soon. Maybe about Lonzo ball, something about the recovery for other athletes.

[00:05:10] Dr. Grant Garcia: It's everything, right? Everything matters. It's not, you know, the surgery is incredibly important. The techniques you use are incredibly important, but it's the entire, it's setting expectations is telling Nick Chubb 150 times. You're not going to go out there and run 200 yards and plow through everybody.

[00:05:27] Dr. Grant Garcia: Your first game. It's just not going to happen.

[00:05:30] Will Sanchez: Yeah, I, I'm curious, right? So obviously the injury was just, you know, as you mentioned, it was really nasty, right? When we first saw it and, you know, we decided to do the show and we, in fact, we touched upon a couple of other injuries. I'll bring up an injury, um, you know, going forward that we talked about, but, um, Were they, are there any benefits with going back in and having that type of injury and fixing kind of what was [00:06:00] done, whatever it was five or six years prior, right?

[00:06:03] Will Sanchez: We have new technology, right? We're always talking about new tech and new toys and, and things like that. And maybe it was something that whether the knee was going to eventually go or whatever case, maybe But is there any benefit to going back in, kind of redoing what was done, taking out the old, putting in the new, getting the knee, maybe even stronger.

[00:06:25] Will Sanchez: Right. We think about re injuring. And when I hear re injure, I go, you're weakening, you're re weakening something. Is there any positive that could come out of that?

[00:06:36] Dr. Grant Garcia: So a lot, I mean, if you're in a concern that there's going to be, remember the tunnels that we had before are no longer bone, right? They're tendon.

[00:06:44] Dr. Grant Garcia: So they don't, they never fill with bone again. So they can be windshield wiper. And so the tunnels are too big. or not perfect spots or they've, they've changed over time. You want to have that ACL at the exact spots, right? So it stops the knee from going forward. And so I do a lot of these [00:07:00] revision situations.

[00:07:00] Dr. Grant Garcia: If it's not a situation where you're exactly happy with it, you want to redo the whole thing

[00:07:05] Will Sanchez: because

[00:07:05] Dr. Grant Garcia: it's not very hard to redo. And with a guy like Nick Chubb. So like a standard athlete, three to four months is what I'd wait between the two surgeries. But understanding that like he has, he can wear a special brace, they'll protect him from not injuring his ACL, but still let him work.

[00:07:19] Dr. Grant Garcia: Some of my patients, they kind of, they don't always listen as well as someone like Nick Chubb would because they don't have all the resources, right? So I worry, the only thing you worry about between those two times is does he injure himself because now he doesn't have an ACL, right? He had no ACL for almost three months.

[00:07:34] Will Sanchez: That's what that

[00:07:35] Dr. Grant Garcia: is. And he doesn't, you don't need it for walking. You don't even really need it for running. Um, and a guy like him, I bet you that his exam would be hard to tell if you actually tore his ACL at the beginning. Cause look at his legs. He can overpower you. Like some of these guys, you can't even tell you need them to be sort of like almost paralyzed for a second before you can get the exam.

[00:07:53] Dr. Grant Garcia: Um, we've talked about players like Heinz Ward, right? For the Steelers, there's been players that have had no ACL and still been able to get away with [00:08:00] it. So these guys are really strong and they can, they can beat the system in certain respects. Uh, so like it is, it is definitely an advantage to what they did.

[00:08:07] Dr. Grant Garcia: And they added new technology. I'm sure they added internal brace. I know who's just talking about the nanoscope that they use, the special mini scope, that's an Arthrex product. Um, they, they used, they use the most cutting edge technology for him and they probably use some things we haven't even heard of, uh, because they have everything there.

[00:08:23] Dr. Grant Garcia: Like I said, this is, they're going to, they're going to pull out all expenses for the Cleveland Browns. Um, and the, uh, the, the. With the hospital system that he got done at. So

[00:08:31] Will Sanchez: I was going to ask you about that when you talked about the holes, if they would go internal brace or fertilize ACL or any of the other things that we've talked about before to maybe fill in some of those gaps to make it stronger and for it to operate.

[00:08:44] Will Sanchez: I bet they did

[00:08:45] Dr. Grant Garcia: everything. I bet they did everything. I mean, you're talking about, they're talking about the smaller scope they used. They probably use some sort of stem cell PRP option to help the ACL integrate. We talked about this with revision ACLs on our, you guys look back. If you want to go see how this [00:09:00] happens.

[00:09:00] Dr. Grant Garcia: We talked about this on our bio biologics and ACL surgeries. One of our, one of our more popular episodes, they did a lot of things to try to get him back faster. Now, again, 398 days is not faster, but for the type of injury had, that isn't faster. I thought,

[00:09:14] Will Sanchez: I thought it could be his career, let alone, you know, being back.

[00:09:18] Will Sanchez: Yeah. This is,

[00:09:18] Dr. Grant Garcia: this is, this is a, this is a, I mean, 3 98 days is an average for some of these NFL players. Yeah, yeah, right. Who just getting race regularly.

[00:09:25] Will Sanchez: He got, he got hurt, I believe it was week two of the 2023 season, and now we're in week seven of the 2024 season and he's out on the field. I mean, that is.

[00:09:35] Will Sanchez: mind boggling when you look at the type of injury that he had the violent nature of the collision. This is not a knee that just kind of, you know, buckled on his own. This was a man running into your knee and making it go in a direction that is not supposed to go right. Just to kind of give context to it.

[00:09:54] Will Sanchez: So, uh, fast forwarding, what are your concerns, um, going forward? [00:10:00] He had, he went out on the field, he got contact, you know, he, he huddled, he, you know, he gotta take it to the ground. So, you know, what is this week looking like for him that you would, if you had to guess? You know, as far as his recovery.

[00:10:16] Will Sanchez: afterwards and then just kind of getting ready, um, for each game as he goes forward for each season. If you're treating him as a doctor, knowing the type of injury and the type of sport, what are some of the key things that you're looking out for, uh, for this upcoming season for Nick chuck? [00:10:33] Dr. Grant Garcia: I mean, the first thing I'm doing is just symmetrical strength and activity.

[00:10:36] Dr. Grant Garcia: I'm just making sure that after the game, he still looks like he's walking normally, he's active normally, right? Like making sure that he still stays symmetrical, right? His goal is like, you got to work both sides. You're going to try to shut down any inflammation. He's going to, he's going to swell like heck.

[00:10:49] Dr. Grant Garcia: I'm sure his knees swollen more than average right now, because you just, he just put it through a ringer that he's hasn't, you know, as much as you practice what you do, do in the game. The game's totally different animal. Right. He's going to, [00:11:00] his adrenaline is going to kick in. Um, and then finally, you just want to make sure he recovers down.

[00:11:04] Dr. Grant Garcia: You get that swelling down as soon as possible. Um, and then I think the last part, which I'm sure they're doing at the Browns is a mental health coach. Like he's got to get in with the mental health coach, but like, how did that feel? Right. Like you had a devastating career, any injury and you just play it again.

[00:11:19] Dr. Grant Garcia: Like, how are you feeling? Like, do you feel good about this? Are you ready to go back for the next game? Did you have any hesitancy, like going through a play by play virtual in his head, like how it went, that's what I would do. Yeah. Um,

[00:11:31] Will Sanchez: Yeah. And he, he was emotional leading up to the week. The, the fan base, you know, cheered for him.

[00:11:38] Will Sanchez: Um, you know, his teammates came up to him afterwards when he scored and, you know, gave him that, you know, the pat on the butt and everything else. So, uh, I'm pretty sure, and I love that you brought that up, right? The mental aspect, because it looked like the teammates rallying around wasn't rallying around because of the injury was rallying around with the person saying, okay, you did it.

[00:11:58] Will Sanchez: Yeah. And him having kind of [00:12:00] that expression of gratitude and maybe some relief. So it's really, uh, I'm really glad that you brought that up his teammate. Unfortunately, Deshaun Watson, and this is why I kind of go back to the original show, because we've talked about his shoulder displaced fracture in the glenoid and I don't know, I'm, I'm out of my depths over here with some of these wording, you're doing

[00:12:21] Dr. Grant Garcia: great.

[00:12:21] Dr. Grant Garcia: You're doing great.

[00:12:23] Will Sanchez: You know, we talked about the severity of that injury. Um, I looked at the replay today and we're doing a show on Sunday night. Um, and it looked like his Achilles popped. It's exactly what you want. You have the closeup on the, on the Achilles. He steps to go forward and you see the muscle go like, you know, and he hits the ground.

[00:12:44] Will Sanchez: So, uh, it looks like back to back seasons, uh, for Deshaun Watson, for him being out. So. It's just, uh, Cleveland Browns, not good for the quarterback and, uh, of their team, but great news for Nick Chubb being [00:13:00] back on the field and, you know, resuming a career where last year I wouldn't have been surprised if you said, yeah, he's done that.

[00:13:08] Will Sanchez: That knee is just not going to cooperate on the level of being an NFL player. He can walk again, he'll do this, but to perform at that level and squat 600 pounds and. Run over 300 pound lineman them days are over. So it's a, it's a great story. Any last thoughts before we wrap it up?

[00:13:29] Dr. Grant Garcia: Yeah, I mean, thanks to listeners.

[00:13:30] Dr. Grant Garcia: Uh, this obviously is kind of an important injury to talk about, uh, just cause it was so devastating. We had the previous episode and do some followup on this. So hopefully they enjoyed this, learned a little bit more and, uh, awesome job. Congratulations, Nick Chubb for getting back and we may have some more update injuries coming up soon.

[00:13:47] Dr. Grant Garcia: So thanks for listening. Take care guys. Bye bye. Audio Transcript

Dr. Grant Garcia: So I was honored to get Castle Connelly, which is actually one of the ones when I first started, I really was excited to get, you don't really know you're going to get it until they email [00:01:00] you.

And then Castle Connelly does a Latino and Hispanic section. They have different sections for different diverse backgrounds. So they selected me for top doctor for Latinos as well. So it was cool. I think my dad was pumped about that. I think my post, but Yes, my dad was born in Brazil. He came over here when he was nine.

He was, he learned how to learn English. He ended up doing really well. And now I'm here. So my mom's from Jersey, so she didn't have to do the same type of stuff nonetheless, and grew up a Giants fan. So this is why. We still root for them.

Will Sanchez: Yeah. Congratulations, man. It's you're achieving a lot and just to get recognized like that and see what you're doing.

It's important. It's great for Latinos to see the possibilities. And being rep, having representation in every field is important, so it matters. And not only is a great honor for you, but it's a great honor for someone else that recognizes that. Anyway, enough. [00:02:00] No more compliments.

I'm completely done with it. I'm blushing. We got to move on. Let's go. I'm blushed. Let's make it

Dr. Grant Garcia: cut.

Will Sanchez: Yeah, your cheeks are a little red, man. It might be all that little sun. The sun's going away. We're about to get the clouds and rain, so no more sun for us. I

Dr. Grant Garcia: know. I know.

Will Sanchez: We were talking about it.

And once again another scary site, right? And this time it was less traumatic. We're talking about to a tongue of Iola suffering another concussion just to give you a recap. Last year he didn't have a concussion that we were aware of, but the year prior against Miami.

I'm sorry against Buffalo. He sustained an injury in Miami where he was hit. He got up. He stumbled. We all clearly saw that this injury he sustained had everything that you would deem to be a concussion. The doctors approved him to play the following week against the Bengals. Since then, After the Bengal injury, which was a nasty [00:03:00] injury when he was sacked and flung to the turf, laid out there.

For those that don't know, he suffered what's called fencing, and I'm going to tee you up in a second for you to explain what fencing is. And now once again, he has suffered another concussion, three concussions on the biggest stages, one on the Sunday afternoon game, Another one on a Monday night game and then again on another prime time event where the world kind of watches since NFL rules our universe here in the United States.

First off, describe what fencing is and to what was the first thought you had when you saw that to a sustained another concussion, a third concussion that we're aware of in this short time frame.

Dr. Grant Garcia: So Yeah, first off fencing you whenever you get traumatic injuries or traumatic brain injuries, it goes back to your prenatal state.

And so when you're getting hit, this idea of fencing is you flinging back the arms, everything's just like abnormal motion. Actually, like the fencing position, [00:04:00] like when you fence in the Olympics, it's the idea of what it looks like. It's not good. And we had this. Entire podcast a year and a half ago.

You guys can listen to our episode about this exact same injury. And so when does it happen again? And all of a sudden now the articles are coming out about concussions. It just has to come up again. We have to have the conversation because this is not just a hot topic because it's a hot topic because it's a good player.

It's a hot topic because we're just, we're seeing a bad injury and a difficult situation for someone like to as to what to do. You have the media spoken people that are saying retire, retire, but you also, you have no idea what's going on behind closed doors, right? We're just seeing a bit.

We're seeing just the tip of the iceberg. And we've seen the shows, movies, concussion. We've talked about this. We've seen We've had Dr. David Smith on here talking about ways to reduce traumatic brain injury in these sort of events. And now we're having another thing come up, and it was on the stage, and it's not like he got up and he was dizzy.

He went into [00:05:00] fencing position again. Which is just, this is just not a good thing.

Will Sanchez: Yeah. For me, it was really scary because if you look at the hit and for those that haven't seen it, just go back to playing against Buffalo he's rushing for a first down. He's trying to get close to the end zone.

He runs into, of all people, DeMar Hamlin, which we've talked about, this sustained a life threatening injury on the field in Cincinnati. Also just a little over a year ago and the contact was not extreme. And that's really what kind of made me go. This is not good. This wasn't a defensive player coming at him and coming with the crown of his head, banging his head or anything like that to actually ran into the Mars chest, which, that's scary itself because that's how he sustained this injury just was running, ducked into it, ran into his chest and collapse.

Demar, it was the most, the [00:06:00] softest tackle pretty much is almost like he's just. cradling him as he's running into him to tackle him. And the fact that he had this concussion and his body had that reaction, went into this fencing state. And that for me was scary because I'm saying if he got hurt like this on a tackle play, that when you look at the NFL, it is a non violent type of tackle play.

Where do we go from here when it comes to this man and this injury?

Dr. Grant Garcia: The problem you're going to have too is who's going to clear him, right? They'll find somebody but like you've been seeing I was just bringing up my partners You've been seeing these massive lawsuits in the nfl, right?

There was the one for the philadelphia eagles so bad The lawsuit was so bad that the philadelphia eagles got dropped by rothman institute. Like that just doesn't happen Like on the news, they say we are no longer going to cover the Philadelphia Eagles and they had to find the scrambled and found an old doctor that did them.

I'm sure doctors great, but it's not Rothman Institute. [00:07:00] And so for those that

Will Sanchez: don't know, I'm sorry to interrupt for those that don't know, can you explain that Rothman Institute, Rothman

Dr. Grant Garcia: Institute, Rothman Institute is one of the biggest orthopedic places. I train eight spousal special surgery.

You have Rothman down there in the Philadelphia area, but now they basically run the whole West East coast. And they are, their main hub is in Philadelphia, actually across the street from where I went to the med school in Penn. And they're known for just being really big powerhouse orthopedics.

And they've got A number of teams. I think they did the flyers they used to do the Eagles, and they have really good surgeons. They're really good guys and they got a massive lawsuit. We're not here to talk about medical legal of football, but they got a massive lawsuit and they dropped the Eagles and they announced it on NF on the ESPN and all these other shows that they're dropping because of that lawsuit, because it was the largest lawsuit in the history of the NFL.

And so now if you see this situation where you have a player that got two injuries, another concussion. You clear him. He goes back out there and gets another one. All of a [00:08:00] sudden he can't, he has no cognitive ability. Some of the things have happened, again, I don't want to predict this, but the brain is scary.

We have no idea which way it goes. You see these, you boxers get hit repeated times. They're going to hit more than obviously this. Clear him to go back and then he has another instance, another week or two, and now he's like out for another season. The, they find some way to let him go, get him pushed off.

The dolphins are screwed in this situation. Anyways, we saw well, they played last week. Yeah,

Will Sanchez: they look

Dr. Grant Garcia: terrible. This is a really difficult situation. And if he doesn't, and if he doesn't retire himself, if he hasn't, he has to get medically retired for him to have all that money. And it's a lot of money, like 120 million I think is on the table.

So this is a really difficult situation because you have, Medical legal side from the doctors. You have that dolphins, which I know they care about him. So I'm not going to hear to talk about NFL being a bad person, but at the same point, they want to win. So they want to maximize stuff. And this is just difficult.

This is a business. [00:09:00] It's as if this is just a difficult situation. And now you have players. We used to see Steve Young just get smashed every single game, right? And just right. Concussion after concussion, bread, barb, concussion. It's no longer that way. We know the risks. We've seen it way too many times.

We've got, we've seen shows about this. There's, we're not going to bring up too much today, you've got the league of the Niles article, the PBS special that we just watched. This is a, this isn't ending. This is not going away. We are looking for new things. And as we've seen, there is so much technology out there and we still can't stop it.

You, we brought this up to a did, I think I had showed you, he was practicing jujitsu classes to learn how to fall and hit the turf better. That's a really great thing that they talked about, fricking way that's going to stop him from getting, if he's got baseline. This wasn't a hit. Like you said, this wasn't a traumatic thing.

He didn't smash his brick. I don't care how well you learn how to fall. If you get hit blindside, it doesn't matter who you're the best athlete in the world. You're not [00:10:00] going to see it coming. It's all about, when you do jiu jitsu, right? I have a lot of take care of jitsu people.

They're, they see their opponent. They know what their opponent's gonna do. It's MMA too. You see what they're doing to do. They may be fast, they may do something, but they're coming at you. They're not blindsiding you in the ring. Yeah. It's a totally different thing. I think we can do whatever, we'll talk about some preventative measures, but again, we keep seeing upgraded helmets, upgraded protocols, and there's a reason for that because we still haven't gotten the answer.

Will Sanchez: Yeah. I'm going to be selfish here and I want to be clear and let our listeners know, right? I'm going to give you a selfish point, right? And this is my selfish take on this, his injury and the way he's. the way he has suffered this injury in front of everyone has almost become not fair. It's not fair to his teammates.

It's not fair to his opponents, and it's [00:11:00] not fair to the fans that every time This man draws back to pass or starts running that you are going to think about his safety. And that is what has happened when I've watched him play. When he started taking off running, I felt like the announcers were almost saying slide, the fact that Demar Hamlin did not take a shot on him.

That you're running, you got a quarterback and usually is Hey, the game, let's take them up. You didn't see that if we're his teammates. So now whether it's blocking Lyman blocking or him getting sack the coaching staff, whatever it is, his teammates have to look at this player back there saying, I hope today is not the day his opponents that are trained to be violent.

In this sport are saying, I hope I'm not the one and for fans saying, I hope I'm not going to witness anything [00:12:00] on the field that is going to be lasting. And we've seen different injuries. We've seen bad injuries. We've seen Derek Dennis bird, Corey stinger. We've seen men paralyzed on the field and what that does.

We saw what happened with the more Hamlin and everyone just being emotional, but. Almost to the point now, if two is back under center, there is no way as a football fan that you're not watching that game saying, I hope that we don't see something today. But

Dr. Grant Garcia: It's true. I think he's going to be back.

I think someone's going to clear them. They'll find a neurologist to clear them. That's the NFL. But, and I don't think he's going to retire. Yeah, I just don't see it. They just it's just not a good situation. Know we, I think we, I think I brought it up to you, but, there have been players that have retired.

Before we had the original one, that's the Luke Cooke [00:13:00] Cooke's league or whatever you he's the one that just

Will Sanchez: recently retired.

Dr. Grant Garcia: Yep.

Will Sanchez: Linebacker, same thing, but a lot of injuries had concussions, probably borderline hall of famer. If you're a Panthers fan you're saying definitely hall of famer.

A guy that made it to the league out of, I believe it was Boston college and became the captain of the team and went to a Superbowl with Cam Newton. Yeah. And. Same thing, had to leave the game due to those injuries. And we saw some bad ones. You mentioned the Eagles, Lane Johnson, starting left tackle for the Eagles concussion, right?

Devante Smith and nasty concussion where he was hit from behind and his helmet came flying off. And he experienced some of that fencing as well. Scary stuff. So the fact that you mentioned the Philadelphia Eagles, now they've got two major injuries right now. The Devante Smith, that was really serious.

He's not a big guy. I'm, he's lucky if he's buck 90. He is a skinny Y receiver and [00:14:00] you wish him the best. I wanted to put up there for those that are watching and not just listening. I'm putting up the five phases for the NFL concussion protocol and I'll just go through them real quick.

And then I want to ask you about this protocol and also whether you have a similar protocol since you are a team doctor as well. And maybe some of the symptoms that you see and what you expect from before you clear player. So phase one symptom limited activities, light aerobic exercise phase 20 minutes of running stationary bike under supervision.

Phase three football specific exercise like non contact drills, strength training, cone drills, phase four club based non contact training. So that's participation, running, throwing, catching, still non contact. And then phase five is pretty much full participation in practice without, with [00:15:00] any restrictions.

If any of the player's symptoms return at any point during any of the phases, they will return to the previous phase of the protocol. Can you talk about that a little bit?

Dr. Grant Garcia: Yeah. So this is important. And I think we brought this up. We've had a few concussion episodes just cause it's such a hot topic, even though it's not,

It's an orthopedic thing, but it's not really we don't see these every day as an orthopedic surgeon, especially sports surgeon. But if you take care of teams and players, you're going to have to know how to deal with this, right? Cause it's it's just the nature of the beast. There's an neurologist on the field during the high school games.

Sometimes the college games, there's no neurologist NFL. Yes, but different animal. Yeah. So the, those phases, those one through five, it used to be, I think actually seven. So it was always hard. And it may not have been NFL level that had the seven, but you can see that each one of those steps is really important.

And they're monitoring for symptoms. You always say I don't know if they're gonna clear the protocol, right? So they go phase one, phase two, phase three. All of a sudden, player get some symptoms, lose a day, go backwards. And that's [00:16:00] why you have Injury on Sunday really starts on Monday, right?

They may not be cleared, right? But if they have five days, they can be like Friday, you hear Friday, Saturday, oh, they cleared the protocol. And I don't know, I would, I want to say they're strict, but I don't know how it works. If the guy had very minimal symptoms, they call them out of the game.

They go phase one, two and two days in one day. I don't, it's just this, the problem is this is a really fancy little page, but how does it, this is not always the case. It's not exact science. The other thing is, what about like training in hot facilities versus cold facilities and how are you going to have symptoms, ready to get a concussion, but you also have to have a little bit of heat, and do stuff, but you gotta be careful about like when you're skipping these phases.

This is a guideline, it's important to have it, we're much more stringent on it in high school and college because, there's just less to lose by missing a game. Like I just, my players get hurt, they're out. And they're not out. They're not back until I feel really strongly. They're going to be safe, right?

It just doesn't matter. It just, I know they all play for the [00:17:00] championship. They're all, I want all the kids to do well, but I sure as heck don't want another kid to, if I saw a kid fence, I would never let him, I would never, that would be done for the season. So this is just not worth it. And the NFL is a different animal.

Yeah. He's got millions of dollars on the line. He's an adult. He's got an agent, right? Like they, this is, there's not just, this is not right. It's, we always talk about this. We treat everybody the same, but unfortunately the pros, it's just a different ball game. Yeah. It's just way too much money, way too much on the line and they're adults, right? My kids on the field, they're my kind of got a kid got hurt. He's got 15 years old. They got to ask the parents for permission to do something, right? Like It's just different different strokes, but anyhow,

Will Sanchez: and we talk about all the time they're built different, right? I cannot do what they do. I cannot get into that mindset.

And for them to always have that winning mindset of, I can do this at the highest level where 99. 9 percent of the people [00:18:00] that play the sport can't reach. I they cannot reach that level. So you have to be built different, so that's another part of it where they're, that's one of the things it's, who is the ultimate competitor?

I'm going to get out there. I, my team, imagine him sitting on the couch, watching that game against the Seahawks going. I can't help my teammate. They look like a bunch of scrubs out there. If I was out there, we could probably win this game. I could get the ball to Tyreek Hill. I can do these things.

I could go in there and support my brotherhood, and we've seen them compete at every level. And you talk about it all the time. These professional athletes are built different. And in all of the elements that you're talking about, what makes it so hard between the business, the mindset getting cleared, being an adult.

I can't imagine, being that team doctor or multi at this point, I'm assuming he's going to go to multiple specialists and doctors for them [00:19:00] to say. You passed my face. I'm clearing you. What about the next guy?

Dr. Grant Garcia: Exactly. For the sake of our short segment, we're trying to do is do a good job of, sorry, we should talk about this next thing because this is cool.

Cause I actually did not know much about this. We'll bring it up. So you guys have all been seeing, if you watch, I just watched the Giants game replays on highlights and you see a couple of the Cleveland Browns, which we beat, which is very exciting. The, these coffee caps and you're like, what the heck are these things?

So these are guardian helmet caps. And Guardian is the company. And these are actually, so they're now mandated in the NFL for practices. They're not actually that expensive. At least I looked them up. It didn't seem like they're that expensive. Now what's interesting is I hadn't seen these in the high school level.

No one talked about them and maybe they're using it in practice, but you've seen the practice. They had all those weird helmets and things like that. These are the new thing.

Will Sanchez: Yeah.

Dr. Grant Garcia: And if you can pull the timeline up, it's interesting to show this. So in 2017, they won this sort of NFL tech award.[00:20:00] They had validated and it turned out that they found that it was a 50 percent reduction in concussions. Now the problem here, obviously, and I don't want to be knocking this because I think this is like anything, anything that can help is always good, right? There's nothing. I'm not going to, I'm not going to pooh any technology.

That's great. But obviously what's the definition of concussion. We saw this with Dr. David Smith, right? It's very broad. There's not like a diagnosis. If someone has an ACL tear, there's very few people that are going to have a, like surgery, they can't figure that out, right? It's an ACL tear, you examine it and you get an MRI and it says ACL tear, right? Simple concussion. You do a testing system. We've gone over so many different testing systems, right? Those are pretty good, but these are still like, check boxes and try to do your best. There's no brain MRI. It's going to tell you there's a brain MRI for traumatic brain injury, but you don't want to get to that level.

You can start seeing it as I think Dr. David Smith said, if you can start seeing an MRI, you're beyond a problem.

Will Sanchez: So

Dr. Grant Garcia: we have to be aware of that. And then, so now they found this is so [00:21:00] in 2018 is validated the increase of use and all of a sudden, boom, 2022 mandated by the NFL for certain players.

So it was the offensive lineman, defensive lineman, tight ends and linebackers. Okay, but listen to this, listen to what we're going to say about the positions. 2023 expanded it to include preseason, regular season, postseason contact practices. So then they added running backs and fullbacks and then 2024 and this is where it's crazy.

They expanded it again. O line, D line, linebacker, defensive back. We'll go down the list. The only one, one of the only ones not on there. quarterback. So that's interesting. We'll talk that, that jumps segues right into our thing. And now you're seeing they're allowed as of this year. That's why you're starting to see them.

They're allowed to wear the guardian caps on their head, on their helmet, as long as the team logo is on there. So this is just super interesting because you're just seeing a piece of, again, we talk about this, we talk about orthopedic sports all the time, but we love technology. And so this is just something else and it's [00:22:00] simple, right?

It's a really simple thing. But if we can reduce these concussive symptoms. Anything helps now again, there was something else about maybe if they have a new helmet option, they don't need that, players are into this, they're trying to use it. You seen this, you see a player maybe has this on and the cue collar, which you guys can look at our old episodes, but this piece of tech is pretty interesting.

Will Sanchez: Yeah, it definitely is. And and I think you're bringing up a really good point as far as the technology, because, and I apologize, I don't know his name, but one of the head guys at the NFL, their doctor, their head doctor that kind of, does the rounds. He said that they've looked at 12 new helmets, six of them are being approved going forward.

And then one of the questions brought up was. This guardian cap and they're saying you're just putting the helmet on top of a helmet, and they go, yeah, we understand that, but this is what we have right now. We don't have [00:23:00] the amount of testing time, which then leads back to the conversations we have prior when it comes to technology yeah, they're utilizing it, but there's still, it's still not, approved and we're starting to see the groundwork.

And that was some of the things that they were simulated We, we are looking at stuff, but we have not had enough time from testing for it to finally get approved. So this is where we're at right now, but they realize that there's a huge emphasis on trying to figure this out. And we've talked about it before, right?

Do you have something new? And we've had guests talking about new tech. How long, right? We talk when winter was on, right? Winter innovations. How long does it take? From concept and testing to finally getting approval and going out there. What are we looking at? 10 years less, what's the normal.

Dr. Grant Garcia: Yeah, 10 years.

But that's the crazy part is this is the 2017 to 2024 use in the [00:24:00] NFL is actually fast, but they don't need like FDA, right? They don't need to make sure it's safe, right? Because it's padding, right? It's not it's a different thing. And it's not approved for patients. It's a different to pay for proof for NFL players in sports, right? So they just want to show, but they just want to show that efficacy for the NFL to approve it. But it doesn't need to be like mainstream. It's not going through insurance. It's not a medical device. Yeah. So it's just different. But yes, 10 years is from start to finish. Obviously there's different things.

We've talked about this before. We're not going to go into here. There's faster pathways, but from very basic idea, brand new idea to that 10 years is a pretty good timeline and that's a long ways to wait. It's a long way for anybody to wait for anything. Yeah, no, this is but this is, they're just trying to, this is a damn that is.

This is a dam and they're plugging the holes in the dam and this plus the two, a thing, it just. Just not good for them, [00:25:00] right? They're trying everything they can in the guardian caps. No offense. They look a little ridiculous, but nonetheless, if they work, that's awesome, but it just shows then makes you question why are we what's one of the helmets?

Like, why do they need this? If they have the helmets?

Will Sanchez: Yeah. And that's exactly what it is that they eventually need to figure out. It's almost like the NHL, they used to play without helmets and then it took forever for them to approve it. And then not only that for the players to buy in, as we see, you can wear it, but only a few players are wearing it. We showed a picture of Jonathan Taylor or Julius peppers or something like that. Not everyone is wearing it. And then based on some of the conversations we've had, Four prior with our doctors, they're going, yeah, the helmet's never going to treat it because your brain is going to squish around.

Anyway, it's still going to move. The helmet is not keeping the brain in place, so you're still going to have some issues. So it's fascinating. I think that's why we wanted to talk about, because it brings up conversation. It's not just what's happening with [00:26:00] two, but what's happening with all these players and with the sport and their biggest concern, and if you're concerned with your business.

You're going, Oh my God, this is happening. Everyone's seeing it and little, and mommy's not gonna let little Johnny play football and we're going to have a crisis of football players on our hands. 20 years from now.

Dr. Grant Garcia: Yeah. But the other thing you want to say is I think as orthopedic surgeons, we were so hyper focused on everything except for this.

And you can't, if you guys are not watching, it's I'm talking about my face or my head. Yeah. So you basically, we don't focus on it. Meanwhile, this is one of the things we've seen the most tech, right? We had the Bluetooth. Conversation stuff. We talked about the helmets. We've talked about multiple renditions of different helmets.

You've talked about areas, the Q collar to reduce, to increase the pressure inside the brain so that you're less sloshing of the brain when you get hit. We're still scrounging for options and this is, and there's no surgery to fix these problems. There's no pill, there's no medicine. [00:27:00] We are literally just using the same device, the helmet and modifying it.

Helmets. They look cool, but they don't look that much different than the helmets from 10 years ago, right? Did they? I don't really see much. I know there's a lot of technology, so I'm not belittling anything in the technology. But the fact is, now that we have to add these caps. That are like basically just like mittens on top of there to try to hopefully help prevent this situation It just shows the situation that we're in right but at the same point, I think it's awesome The side thing this to be I don't want to be a debbie downer because we're talking about concussions and you know all this stuff

Will Sanchez: Love also, let's be clear right?

This is what makes it hard right? These are tough conversations And this is a sport that we like to watch. You have a New York giants background, right? I've got, like we, we talk sports, right? That's our show, right? It's orthopedics and sports, and this is what we do. And this is what we love.

But at the same time, we can have real conversations and this is exactly what that is. And it's a little maddening [00:28:00] at the same time. Dr. Grant Garcia: And also I want the listeners when they're watching the games to be like, oh, that's the guardian Catholic. That makes sense, right? Like, why are they doing that?

Like, why is that guy wearing that thing on his head? That's what I said when I saw it the first time and you've seen him at practice and now when all of a sudden we're doing research on Tua and I watch an article on my feed, I see something about the guardian caps and it makes sense now and you read about it, but it's actually pretty interesting because I didn't realize his route for that long and the history is really interesting, but you know what I'm going to wonder?

Do you think they're going to be adding the QB to the mandated practice thing?

Will Sanchez: Yeah. Yeah. Let's see. Yeah. Yeah. Yeah. I know. I'm going to get a text from you and be like, Hey, guess what? Same, the same way we look for the, I look for the Q collar, right? We've had, we've talked about the Q collar. I recognize it.

The second I see somebody wearing it in the NFL game or college, I go, oh, he's wearing a cu collar. So just recognize that still. My, my favorite tech is the urinal with the player. I know it's you,

Dr. Grant Garcia: you want, you're upset because you missed out on the [00:29:00] patent on that one. I know you're upset about That was a good stuff.

Podcast is people learn. Every aspect of sports technology right now, they're seeing, you watch a show and you go, Oh, like they talked about Aaron Rogers speed bridge. You know what that is? You talked about, now you see the guardian caps. Now you see the Q collar. Now you see the new helmets. Maybe someone miked up, all those things.

Heads up displays, things like that, like where we're going. And so now we can give you what's the latest tech and how it relates to the medical field. And so anyhow, we did our, we did a good job of staying under 30 minutes, like we always do.

Will Sanchez: But yeah,

Dr. Grant Garcia: it's good.

Will Sanchez: By the way, that heads up helmet that we did a show on for deaf football players has finally been approved.

So they had approved it for one game when we first had this discussion. They just recently, maybe a week, two weeks ago, somewhere along that timeline approved it for full time use. So that's another thing with technology and it got more to come and good for those players now [00:30:00] to level the field a little bit.

When it comes to them enjoying the game, they love to play. So anyway, enough of that. Congratulations once again on your award. It's always great talking with you is always great.

Having these. Real discussions and we've got more shows, headed our way. Thank you Everyone

Dr. Grant Garcia: always good. All right. Peace out. Bye

Audio Transcript

[00:00:26] Will Sanchez: Regular fans, but I think hopefully they'll, uh, they'll excuse it. Dr. Garcia, man. Uh, first welcome. And then how excited you to finally have some football coming around.

[00:00:41] Dr. Grant Garcia: So excited. It's a, I'm not, I watch some sports, but my wife will say, you know, I do a lot of other stuff too busy in my life, but when it comes to football season, especially for the Giants, I find time.

[00:00:51] Dr. Grant Garcia: So I'm super excited. Uh, and plus, you know, Being a sports surgeon, this is where all the crazy stuff happens. You get to see crazy comebacks, [00:01:00] which we'll talk about today. Um, you learn about all the innovative stuff. I mean, really, when you talk about the cutting edge sports medicine, it's all to get players like these NFL players back in the game.

[00:01:12] Dr. Grant Garcia: And so, you know, it's really exciting. I love, I love football. It's my favorite sport.

[00:01:18] Will Sanchez: Yeah, listen, we're excited. And just to kind of let the, our listeners or viewers, um, know, you know, this is our 2024 NFL season. We're thinking about key injuries from last year coming into this year. Uh, comeback players, eventually I'm going to ask you, who's your comeback player of the year if you had to guess, uh, so we'll kind of get into all of that, uh, later on.

[00:01:40] Will Sanchez: September 5th, we kick off the season. I mean, Two teams, right? Possibly two MVP candidates in Patrick Mahomes and Lamar Jackson, Ravens chiefs, the defending super bowl champion. I mean, Derek Henry is now with the Ravens. He's left the [00:02:00] Titans. There's so many storylines, so many reasons to get excited. But for us, we're going to talk about the players getting ready for this year, but.

[00:02:09] Will Sanchez: I am super excited to kick off the NFL season, especially with that doozy on Thursday night. And as always, we like to give a shout out to our sponsor, the recovery shop. We know it's our favorite, not even our favorite, the patient's favorite, Dr. Garcia's favorite. When it comes to all the stuff that you need from the recovery shop, and I'll kick it over to Dr.

[00:02:31] Will Sanchez: Garcia because he uses them all the time for his patients.

[00:02:38] Dr. Grant Garcia: You know, I love this place. And again, you know, obviously they're sponsors, so we bring them up every episode, but it's great that people can hear about this. And I was just talking to my friend in the car who's works in California. He's going to plan on start using this.

[00:02:49] Dr. Grant Garcia: Cause he's like, Hey, how do I get this innovative stuff? Right? Like my normal products, I can't cover it. They're not covered. I can't get them into my patient. My patients want the newest stuff. And so the recovery shop allows you. [00:03:00] And what's really cool about it too, is if, you know, we have someone on this episode and they talk about something new I can offer at the recovery shop for patients.

[00:03:06] Dr. Grant Garcia: So it's all built into that one section. So it's really nice for surgeons to be able to offer patients. The newest stuff that may not be from the, the medical realm, but sort of the tech realm. Yeah. Um, on top of that, it's all, it's all together vetted for you. It makes it really easy. And the patients have raved.

[00:03:24] Dr. Grant Garcia: I mean, we're not gonna go again on this episode about how much we love the Nice machine, but you know, the ability to offer all those products like that, or the res or something else. The res, yeah, that's a good one in one place. And really I do, I do feel like. It improves the recovery for my patients. So check it out if you're a surgeon you can offer this to Uh contact myself, uh the website check out the website here Um at shop recovery.

[00:03:50] Dr. Grant Garcia: net and you'll see it on our links also. So thanks again guys

[00:03:54] Will Sanchez: Yeah. And that's a great one. And before we move on from that, you know, we started talking about this way [00:04:00] beforehand. So check out our previous shows. We talk about the next machine. We talk about the rebless. We talk about this, you know, these futuristic, you know, get better, heal better, something's better for your nutrition.

[00:04:14] Will Sanchez: We've gone in depth about these machines. So now we finally have a platform that we can also make a reference to. But if you want to hear more about that. Go back, check our shows. We always have great write ups. We have trans, uh, uh, transcripts. So check us out at sports doc dot, uh, talk. com. It's a mouthful right there, as you can tell, but I'm really excited, uh, about all of that, but we're excited about.

[00:04:37] Will Sanchez: This season, before we get into that, I just have a question. I know you do work with the high school kids. Are you picking up, uh, once again, working with the football team and working with the high school kids, give us a little update, uh, for the 2024 season for Dr. Garcia, uh, this upcoming football season.

[00:04:56] Dr. Grant Garcia: Yeah, so I, uh, you know, previously we took care of pro [00:05:00] teams and we've had opportunities for those things, but, and those are fun. We've talked about them before, but, uh, I have a special connection with Mercer Island High School, uh, and that's where I currently live on Mercer Island and I went to high school there too.

[00:05:13] Dr. Grant Garcia: So when I came back, that was, I wanted to take care of the team that used to be, I used to be with my, my wife also went to high school there. Wow. We went, yeah, no, listen, I'm told you I'm going to drop a little bit each time. So we went to high school there and I remember she was in the band and we used to go to the games and hang out and I had my Letterman jacket on and now I get to be the team doc for them.

[00:05:36] Dr. Grant Garcia: And I take care of the players. Now, of course, when they come into the office, they're like, you didn't go to Mercer on your way to old. I'm like, dude, I'm not that old yet. And so, you know, but it's so much fun. And so, yeah, I'm super excited, you know, myself, and actually, uh, you've had Dr. Wayne while in here.

[00:05:52] Dr. Grant Garcia: He's also going to be helping out, uh, because he does the, we all basically help. Like I do most of the sports. I did the triage and [00:06:00] then, you know, foot and ankle. We had one of the coaches tears Achilles. You never, you know, who fixed them. Yeah. Yep. Dr. Anthony. Yeah. Dr. Wayne. Wow. When they have the hand injury.

[00:06:10] Dr. Grant Garcia: So, you know, we have a whole list of docs that can help out the team. It's really awesome. And I'm on the field with them and I have a lot of fun and I get to see everybody went to high school with sometimes, uh, in the stands with their kids. So it's a super awesome experience. It's so fun to get back. So, yeah, I mean, I'm, I'm so excited.

[00:06:26] Will Sanchez: It's so amazing to think about that. Right. And it's just kind of a reminder for all of us as we do our part within our communities that, you know, you leave school, you go off to college, you, you live a life and then all of a sudden you're, you know, you're coming back, uh, um, you know, three 60 and, you know, back where you started, but now you're giving back, uh, to the community.

[00:06:46] Will Sanchez: Um, you mentioned Dr. Yee and, you know, it's, it's one of those things when it comes to Dr. If you see in them. And you're not there to see him as a doctor. It's great to see him, but if not, it usually means that something has gone [00:07:00] wrong. And, uh, if we look back to September 11th, 2023, uh, four plays in as the jets.

[00:07:09] Will Sanchez: Came out to kick off the season and they were taking on the Buffalo Bills and they were at MetLife Stadium and the stadium was going crazy. It was jam packed and they had the, the, the light show, the fireworks and their brand new toy comes running out of the tunnel with the American flag in his right hand, leading out the cheer and the crowd and the fans are going.

[00:07:37] Will Sanchez: Absolutely bonkers. And you're saying, oh my Lord, what a way to kick off the 2023 season. And for all my friends back in New York that are Jets fans, not so much my Giants fans, they are as excited as can be going back to maybe last time with Vinny Testaverde was with Bill Parcells and Curtis Martin saying, we have a [00:08:00] chance four plays into the season.

[00:08:04] Will Sanchez: runs out of the pocket and Dr. Garcia, what happens next?

[00:08:10] Dr. Grant Garcia: Achilles tear. Emilia calls his buddy, Dr. Elitraj, which we've heard all those things about and is on the opera room table in a few days. And unfortunately the rest of this history, except for the Recurrent news articles talking about speed bridge and how quick he was going to get back.

[00:08:27] Dr. Grant Garcia: So, you know, I think, uh, we'll see how the season goes. You know, we've, uh, this is obviously not, we've had this talk a few times. We had the Olympic talk recently. We had a whole separate section when he injured it. We talked about this. You've gone over your recovery too, with Dr. Yee. So we've had all these discussions on Achilles, but this is now again, quarterbacks are different, right?

[00:08:49] Dr. Grant Garcia: This isn't, uh, Simone Biles having to go jump around and do back flips. Or front flips or her own new tricks, you know This is a guy that can sit in the pocket and do his throwing, you know He's never [00:09:00] been known for his high level mobility. Um, But what's important I think for this episode which you can bring up and we're not going to go again We try to talk about orthopedic sports all the time yeah, but I do want to bring up a little data because this is really interesting because like Even as orthopedic surgeon I can fire off my opinion, right?

[00:09:16] Dr. Grant Garcia: My opinion is this is not a good injury My opinion he's not going to recover and patients, you know, that stuff that you know, they understand I got experience I see these things But the data doesn't lie. And so it's really interesting to see the data because we're so used to seeing like the one or two athletes that get back.

[00:09:31] Dr. Grant Garcia: But what about the guys in the practice squad? What about the guys on the, you know, that are not the starters? How do they get back from these injuries? Because really, they're the ones that, you know, we talked about before, like, an injured LeBron James is better than most of the players on the court, right?

[00:09:46] Dr. Grant Garcia: But an injured professional player is no longer a good player. Right. So how long does it take them to get back and can they get back? And this may segue into our discussion of our controversial quarterback, [00:10:00] Daniel Jones and his ACL tear. Um, but you know, there's two articles we'll talk about. So the first article is really easy to kind of go over, but basically it looks at return to play.

[00:10:11] Dr. Grant Garcia: So return to football in the NFL for wide receivers. Now it's not Dan Jones, a quarterback, but I looked these up because for this show, I was like, well, I want to know, cause I know Will and I are going to talk about what do we think Dan Jones is going to get back? What's his performance going to be like?

[00:10:23] Dr. Grant Garcia: And I was like, well, the other, I'm sure someone's looked at this, right? Like you want to know this data. So the wide receivers was interesting. A wide receiver. Achilles, patella, and ACL are, are the greatest effect on the career. And actually they do have a decrease in success after one year of surgery.

[00:10:42] Dr. Grant Garcia: And what's interesting, so we always talk about the one year mark, but I always tell patients, remember we talked about this, Will, other than the Adrian Peterson absurdity, which we saw. Yeah. Most players are not better the first year they're back and they're not at their full level. And it takes, I mean, Saquon Barkley, right?

[00:10:57] Dr. Grant Garcia: Obviously we, you know, it's kind of a dirty word now for New York. [00:11:00] Um, but, but, uh, you know, they found that, you know, this, it takes a section year and sometimes they don't get back. And of the four major sports, NFL players, so the hockey, football, basketball and baseball, the NFL, the shortest injury, the shortest careers afterwards in the highest decrease in performance after ACL injuries.

[00:11:22] Dr. Grant Garcia: So it's just something for people to be aware of. But if you're a New York Giants fan, you'll like the second article, second article, same guy, Burgess et al. And he, they found that there is no significant decrease in performance for AC reconstruction for quarterbacks. So that is a good thing for us to hear.

[00:11:41] Dr. Grant Garcia: And maybe the mental side of things, but not for the physical. So running backs, wide receivers, we added running backs, decreased performance, but for some reason, quarterbacks do not have a decrease in performance afterwards. And it's probably because. What's their main use of their bodies is their arms, right?

[00:11:56] Dr. Grant Garcia: I mean, they have to aim, they have to have core, but they're not doing the same [00:12:00] thing. A running back wide receiver, you want that explosive speed. You know, we've seen Odell Beckham Jr. Two ACLs, you know, it's, it's, uh, they're not as good the second time. And it takes longer. And you know, these guys are freak athletes.

[00:12:12] Dr. Grant Garcia: So

[00:12:13] Will Sanchez: yeah. And just to let, you know, let our listeners know, these are studies going back, uh, they reviewed it from 88 to 2017. So it's a, uh, large chunk of data, uh, that they were able to make a reference to for, for the numbers that Dr. Garcia just, um, explain. Go ahead, Dr. Garcia, you're going to say something.

[00:12:35] Dr. Grant Garcia: Well, we're going to make this even more complicated because you know, I like to do this. But if you think about this, we didn't have the new ACL techniques we do. I just read an article yesterday and Will's going to get too excited when I tell him that. So I'm going to say it quickly and hopefully we can move on from the topic.

[00:12:50] Will Sanchez: We're going to move on.

[00:12:51] Dr. Grant Garcia: Adding internal brace, any of your, any of your ACL constructions or hamstring, which is they have here, private teleten, [00:13:00] which they got in quad. So all three of the graphs from, and these are pro players are getting, they're getting Grafts from their own body, decreased tear rate, decreased, uh, increased speed, uh, sort of recovery and decreased the stretching of the graft.

[00:13:13] Dr. Grant Garcia: And so, you know, probably one of the reasons these people don't get back as much is part of it is also, is there some natural laxity? Do they re tear it? And those type of things. So maybe the data we might see in the next, you know, 10 years is actually, there isn't a decrease. So we have technology. So you gotta be careful.

[00:13:30] Dr. Grant Garcia: It's just like when you look at anything, I just told you all this data, but now we're not in 2017, are we? We're in 2024

[00:13:37] Will Sanchez: with new, with new technology, new concepts. Uh, our previous show, we were talking, um, with, um, with the gentleman from Arthrex and about how fast the technology is moving. Advancing. So it was like, okay, this works.

[00:13:54] Will Sanchez: Yes. But how can we make it better? Right. Just so yeah, 2024 [00:14:00] and 2028 and 2030, you know, we're probably looking at a whole slew of other things because as we know, we can see it in our regular, you know, day to day technology is moving so fast right now that the numbers are changing, um, at extreme rate, probably like we've never seen before.

[00:14:19] Dr. Grant Garcia: Well, and look at the, look at the, uh, look at the people now. I mean, we used to have Ember, Tommy John, you could never throw again. Now I'm talking about designing a new technique and how it's going to make people get better and how we're going to add the internal brace and how we're going to add different techniques and we're developing new things so that we can do the technique faster and more efficiently reduce revisions.

[00:14:38] Dr. Grant Garcia: You get us, if you get a first time, Tommy John reconstruction, you fail it. We now have better techniques for a second one. You've heard of people, you've heard of baseball players coming back after a second Tommy John. And so we, that was unheard of, right? None of this is, I mean, we could do a whole show.

[00:14:52] Dr. Grant Garcia: This might be a good one. We'll later on what we, what we do now that we like what players can get back. Now they never were able to come back. [00:15:00] I mean, a patella tendon rupture like Victor Cruz had or other players. Yeah. We've had that show a long time ago that was done. I mean, you were done, you were never coming back.

[00:15:10] Dr. Grant Garcia: Yeah. We have all this fancy gear, biologics. Awesome recovery stuff. You know, we've talked about nice machine talk about blood flow restriction. Uh, There are ways that we can do things now Now the human body is still the human body and we have to be there and you have to have the right surgeons Which nowadays, you know, if you're an athlete, you can go anywhere in the world, right?

[00:15:31] Dr. Grant Garcia: Like it's not like you got to like ride a horse and buggy to go find the next guy. Like you hop on your private jet and you go and get, you hope you go and get fixed up by the person you think is going to do the best job. So, you know, it's a, it's a different game than it used to be, but it's a, it's pretty cool too, because as at a sports fans or as a surgeon that likes to watch sports as well, it's exciting to see at, it's terrible to see an athlete get injured and never come back because.

[00:15:56] Dr. Grant Garcia: You know, the ones we're watching out for are the stars, right? It's really sad when [00:16:00] you lose that level. Of athleticism, obviously there's retirement from injuries and everything else, but it's pretty cool. Like, I mean, the, where we're going is hopefully we can see these players play longer, um, and play better, which is, which is awesome

[00:16:13] Will Sanchez: before we move on from Aaron Rogers, I kind of want to bring it up, right?

[00:16:16] Will Sanchez: So there's, there's two things I want to bring up his injury happened week one, September, right? Right now we have, uh, Kirk cousins that had the same injury week eight. Now. We'll find out if Kirk, he's not on the P, uh, the pup list and we'll kind of get into that later on, you know, but what are your concerns as a surgeon week one to week eight?

[00:16:43] Will Sanchez: So now we're talking two months later. Right. Coming back at the same time. Right. So you're starting off at the same time with week one in 2024. And then you're also comparing. So one of them is a time assisted and another one is age assisted since he's [00:17:00] younger than Aaron Rogers. So. Trying to see what's the way I want to kind of word this.

[00:17:05] Will Sanchez: If you had to pick one or the other, when it comes to healing fast and being ready for the start of the season, are you more concerned about the age? Or are you more concerned that one of them had recovery two months earlier?

[00:17:19] Dr. Grant Garcia: So no offense, Dr. Eltrod, he's amazing. So I'm sure his surgery was bomb proof, but I would choose the younger age to be more likely to, I'd be more motivated by the younger age.

[00:17:30] Dr. Grant Garcia: I just hate to say it, you know, Even a few years is a big difference. And Aaron Rogers looks old, Kirk Cousins still looks young and you know, people, people's bodies are different, right? Like I get in, I get into people's bodies and I do a lot of ACLs and ligament surgeries on these patients that between 20 to 40.

[00:17:48] Dr. Grant Garcia: And sometimes I get into a 35 year old knee and I say, this is not a 35 year old. This is a 40, 45 year old knee. And sometimes I get in and go, holy cow, this 35 year old's got bone of a 20 year old. Right? [00:18:00] And you can kind of, you know, you don't always tell, but you can kind of tell, you know, that the age is a little bit, is more showing on there.

[00:18:07] Dr. Grant Garcia: And so it does concern me that, you know, is, and also, I don't know, maybe is, is there other things at play too? Are they taking weird supplements? Are they weird dieting things they're doing? You know, I don't know all the background to that. Yeah. Um, but you know, I know that, I know that both of them probably got amazing surgeries.

[00:18:25] Dr. Grant Garcia: Yeah. Yeah. Um, but if I had to choose one, even with a little bit of a difference in the timeline, uh, I would choose, uh, Kirk Cousins.

[00:18:33] Will Sanchez: Got you. Got you. And then, you know, we always, we always want to remind our listeners that, you know, this is, we're always talking about what, what we think, but without dr Garcia actually going into the knee and you made a reference to that and being there to see the ins and outs.

[00:18:49] Will Sanchez: It's, you know, it's never a verbatim 100 percent but it's kind of like the guest because I was curious, right? Because those are two factors, right? Time versus age. I [00:19:00] know my injury later on, right? Was way different than when I've been injured earlier on. And, um, we know that we, we say it all the time, athletes are freaks, especially the way they, uh, they heal and perform.

[00:19:12] Will Sanchez: And we know that Aaron Rogers will not lose his fastball. But it will be really interesting to see a 40-year-old body start to take hits. From the season, so I don't wanna scare any of the Jets fans. We're gonna kind of move on because they've had enough suffering over the years. We might [00:19:29] Dr. Grant Garcia: get some, we might get some nasty comments on our podcast.

[00:19:31] Dr. Grant Garcia: Yeah, yeah, yeah. Some Angry Jets fans,

[00:19:33] Will Sanchez: um, you know, and the quarterback and the team that we're rooting for. We expecting a, a, a, probably a, a rough year, um, as far as wins and losses. So we're just kind of brace ourselves for that. But Daniel Jones is coming back, uh, from his injury. Why don't you talk about that injury a little bit and then we will, uh, we'll take it from there.

[00:19:52] Dr. Grant Garcia: So he suffered an ACL tear. We've talked about ACL tear ad nauseum on this show. It's obviously a very hot topic ever. It's so [00:20:00] common. I mean, we could go through the, we went through the, in this preparation for this player's, uh, injury list. You know, we basically, I kind of had to say, let's not talk about any more ACLs on here.

[00:20:08] Dr. Grant Garcia: Right. Cause we've done it so many times, but it's a big topic. So I don't know what else he had done. I'm assuming just ACL, they didn't say anything else on meniscus or anything else related, but we don't know. Um, but obviously he's out for the season now. He's back. Uh, you know, the question is Dan Jones, you know, you may, you like him or you hate him, right?

[00:20:25] Dr. Grant Garcia: There's nobody, there's no in between. There isn't. Yeah. Um, but he was known for his speed, right? He was fast. Like that's, I mean, give him that. He's one of the fastest. He was like one of the, he had the fifth and most in rushing and he was, he's one of the fastest quarterbacks, uh, in the NFL. Um, and he's tall and he is big.

[00:20:44] Dr. Grant Garcia: So, and he's bulked up, which is nice.

[00:20:46] Will Sanchez: He's a big guy. Yeah, but can you

[00:20:48] Dr. Grant Garcia: take, but can you take those same hits, right? Like,

[00:20:51] Will Sanchez: or should

[00:20:52] Dr. Grant Garcia: he, he's not a pocket player. Don't get me started on a pocket player. No, no, but he's not a pocket player, right? He's not, he [00:21:00] relied last year, the last few years on his ability to get out of the pocket and run and avoid tackles because he had such a bad offensive line.

[00:21:07] Dr. Grant Garcia: Right. So it's just, I don't know. I hope he can, but you know, there's that rust too of getting, you know, your ACL torn, right? He's got to come back from that. Oh, the one thing that he has dealt with is he's dealt with so much adversity and so much negative publicity and negative comments about him that I don't really know if this is going to make a difference for him.

[00:21:26] Dr. Grant Garcia: I think some of the players that have been the best themselves, the whole five years of their 10 years of their career, and then they injured their knees and they're worried they're gonna really get back, I think there's more of a mental aspect. I just don't. I honestly think he's too tough to even be stressed about it.

[00:21:39] Dr. Grant Garcia: To be honest with you, he's put up with so much stuff, more than most quarterbacks would ever have to do in their position,

[00:21:44] Will Sanchez: especially in New York. One of the reasons I brought up, um, Daniel Jones, besides, you know, the whole jets giants thing and, and everything else, but it's, my concern is The neck injuries and we talked about it briefly before we, uh, hit record on [00:22:00] the show.

[00:22:00] Will Sanchez: Um, he's had a few neck injuries he's had at different times. You know, I think going back to 2019, he suffered an injury and then, uh, last year before he got hurt, he had a neck injury. This, and then he hurt it again. They said it was unrelated. Um, so I am concerned. Not so much from the knee aspect and maybe you as a surgeon going, I'm concerned about the knee, but I'm also concerned about the neck, uh, injury.

[00:22:26] Will Sanchez: And, you know, I'm showing here for those that are listening and not watching us on YouTube Packers running back, AJ Dillon, which is their star running back. He's on the season ending IR he's done for the 2024, uh, seizing with a. Stinger injury and stinger is always kind of like, it's always a funny thing because I go, well, that doesn't sound like a big deal.

[00:22:49] Will Sanchez: It sounds like you got like a little pitch, something or other, and you're going to be fine in a week or two, but apparently it is. Can you talk about, you know, what kind of injury that is? And it sounds like. That's serious [00:23:00] enough that without taking a snap in the 2024 season, getting hurt in at a joint practice that you are already done for the year.

[00:23:11] Dr. Grant Garcia: So let's go through this. So first of, I'll talk about the Dan Jones thing. So anytime the word is repetitive neck injury, I get worried. And what the heck puts you out for a couple months? It's probably something cervical, which is in neck and it's probably in the disc and he could be getting some bulges and they're concerned about it.

[00:23:29] Dr. Grant Garcia: And maybe it's pinching a nerve. I don't really know. And they were super cryptic about it. I mean, he said he had a neck injury, but he's had this repeatedly three or four times. Yeah, that's not, that's not a neck spasm. That's something where they're worried about the health of his, him. And if he gets another hit, could he like get paralyzed type of thing?

[00:23:45] Dr. Grant Garcia: In my opinion. Okay. Yeah, I don't think it's that bad, but I think that there's something else going on. They're not telling us and that's that's okay That's what that's the nature of football and the nature of the show is we get to do a little guessing Um with the stinger, so usually a stinger is when [00:24:00] you get hit on one side It's unilateral.

[00:24:02] Dr. Grant Garcia: So one side you get hit on the side and it goes into your brachial plexus So you imagine i'm not going to get too much in anatomy But imagine you can try to show here imagine you have your neck and all the nerves come off and they go into like your upper chest Area down to the shoulder and they, they branch off like this.

[00:24:17] Dr. Grant Garcia: And when you stretch them, you get your whole arm. Just like, like you feel like a sting, like that's why I call it a stinger. Yeah. Okay. And that's like, remember you guys ever hit your funny bone? Yeah. Imagine the whole arm. The whole arm is where it happens. It happens and it goes away, right? And it's usually a single, like unilateral.

[00:24:34] Dr. Grant Garcia: We say you get a unilateral stinger. You're good. Like 10 minutes rest, make sure they're all normal and then they go. So that's why I don't understand about this. I think that they're trying to dumb down the injury. You get a bilateral stinger. That's when you basically likely had some real bad neck injury.

[00:24:48] Dr. Grant Garcia: Like you're like a disc in your cervical spine, which we've talked about with Dr. Schaefer before on this up on the show. And that does concern me because I don't even know if that's considered a real stinger, right? Like I think they're just doing, you know, they say like [00:25:00] knee contusion or knee sprain or meniscus meniscus contusion, because they're trying to dumb it down.

[00:25:06] Dr. Grant Garcia: Yeah. And what they're trying to do is try to play it off as not that big a deal. But the fact is, if you're out for the season with this, that is not good. So I think, you know, I don't know what he had. I'm surprised he's not getting surgery when he goes out like that. Um, but there are some notable neck injuries that have happened in the NFL.

[00:25:21] Dr. Grant Garcia: Obviously, the most prominent one is Peyton Manning. He had multiple neck surgeries. Uh, he had a spinal fusion, so they actually fused. We talked about disc arthroplasty, a replacement with Dr. Schaefer. Yeah, that's where they actually, and that's, that probably would have been, he probably would have had that now, but this was, this was a while ago, 2011.

[00:25:41] Dr. Grant Garcia: So now the new stuff, which we talked about again, remember if you look at all the performance of these surgeries and 10 years later, it's probably a different surgery, right?

[00:25:50] Will Sanchez: Yep.

[00:25:51] Dr. Grant Garcia: So

[00:25:52] Will Sanchez: yeah, we had a great discussion with dr Andre Schaefer. Um, you know, with, and he was showing us all the cool little gadgets and you know, everything else [00:26:00] that they're using, uh, in that cervical area.

[00:26:02] Will Sanchez: So, and we go back to 2011, that's a long time. We just started off the show saying it, things are moving fast, let alone going back to 2011. You know, what, what kind of recovery with Peyton Manning and he was getting a little bit older at that point too, but what kind of recovery would he have had because we know his super bowl season I mean, he could barely move and barely throw the ball because he was just so jacked up.

[00:26:25] Dr. Grant Garcia: Yeah, I mean, we think we talked about this a while ago, but at some point, he couldn't even feel his arm. He was just throwing with no triceps. Cause one of his nerves was out. So, I mean, it's just, just craziness, but you know what I said, LeBron James, Peyton Manning, when they're missing something, they're still really good.

[00:26:42] Dr. Grant Garcia: Yeah. Also helps have a good team with you. And then David Wilson's one of our, the favorite guys used to see him do backflips on the field. And I remember he was kind of a freak and they talked about the next big thing. And unfortunately after like a year or two, It's something called spinal stenosis. So it's where you're, I'll go into [00:27:00] basically briefly, but you basically have like your, your whole spine.

[00:27:02] Dr. Grant Garcia: This is like really straight and it's like not made to bend well. And if you get hit, it can be like instant paralysis. So if you have that, it's automatic retirement, which is what he had. And it actually can be happening commonly in football players. Uh, so it's a pretty scary thing. So when they diagnosed that with him, he was out.

[00:27:18] Will Sanchez: Yep. He was, uh, he was a promising, uh, running back also kick returner. Uh, we thought he was going to be another compliment along with Ahmad Bradshaw and, and, you know, some of the other guys that were on that Giants team. And I believe he was a either first or second round draft pick, maybe out of Virginia.

[00:27:35] Will Sanchez: Anyway, at this point, I'm probably just guessing here. Uh, no, I remember he used to do

[00:27:39] Dr. Grant Garcia: the best show. Is that, remember that little. Intro. They had him. He was catching rabbits in the field or something crazy. They showed how I got so fast. That's what you do. Well, you and I can do that. We should do rabbit catching.

[00:27:49] Dr. Grant Garcia: We'll get ourselves.

[00:27:50] Will Sanchez: I can't catch a spider right now. I ain't going nowhere. That's it. I'm going to see how fast I can catch the remote out of, out of somebody's hand on the couch. [00:28:00] That that's, that's the speed that we're at right now. But, uh, you know, stick, you know, listen, we're talking about catastrophic injuries to the running back.

[00:28:07] Will Sanchez: Um, there was. I don't recall last year and obviously the year before that we had the scariness that happened in Cincinnati on the field. But as far as devastating injuries, um, what happened to Nick Chubb on that game and we, we reached out immediately. You know, uh, when we were texting each other saying, Oh my God, did, did you just see what happened?

[00:28:35] Will Sanchez: Um, to, uh, Nick Chubb on, um, when he was playing against the Steelers where that leg bent in ways that, you know, You, you just, you just didn't want to see, you know, we, and I have a picture not of the injury. 'cause I just didn't even, I saw it and I just didn't wanna put it up there. But, you know, he, and, and I want you to break this down because it said damage to the medial to, to the MCL, the medial [00:29:00] capsule and meniscus.

[00:29:01] Will Sanchez: And then he had a second surgery on November 14th to repair a torn ACL. And I know some of this and, and this is why I'm gonna have you kind of break down this. Knee, what happened to the knee, what they did, and also the fact that they went back and fixed a previous ACL surgery, going back to Georgia, where he had a really nasty injury.

[00:29:23] Will Sanchez: I believe it was on the sideline where his knee bent in a way that it wasn't supposed to. And when they went back in, they said, well, we're going to fix, we're going to fix that also, and redo the entire thing, not just kind of leave it the way it was. When you hear about all of this and going in and doing first off multiple surgeries, it's not just one area of the knee and and how you're fixing certain things to connecting to others and whatever peptides or whatever else he's taken in order to recover.

[00:29:55] Will Sanchez: Just I don't even have a question. What's your initial thoughts when you hear [00:30:00] about all this?

[00:30:01] Dr. Grant Garcia: So I remember, I remember this show and we saw the knee dislocate. Right. And when you told me he was going to get a small surgery or he got a small surgery, I was like, there's no fricking way. Like, and, and the problem you have is I know Dr.

[00:30:16] Dr. Grant Garcia: Vose is awesome. I think he went to same place, HSS. And then I know the other team doctor, uh, who's a friend of mine went to residency with me. Um, They're both great surgeons, great guys. But I think this press release was a little, the press release they talked about his knee was a little soft and they tried not to dumb it down what he had.

[00:30:34] Dr. Grant Garcia: I mean, this is a nasty injury and you know, they did it in two parts. And one of the reasons they didn't two parts, which not everybody does it that way, but they didn't do parts to reduce the stiffness, right? Cause it's, you hit up, imagine like. If you repair only part of it, the knee, then it got to have time to calm down.

[00:30:50] Dr. Grant Garcia: They use the smaller scope and nanoscope is actually an Arthrex products. A big like thing is like, can we make this incision smaller? I'll be honest with you. It's a great product, but [00:31:00] I'm not sure that this made a difference in his swelling, but I know that it's kind of a fancy thing they like to talk about.

[00:31:05] Dr. Grant Garcia: The most minimally invasive opt and we can talk about this at some point. Yeah. And then they went back and they did, you know, they use special screws. for healing of the ACL. And somehow his PCL didn't get torn. So I'm I think this I think there was more to the story. but obviously this guy is a freak, right?

[00:31:23] Dr. Grant Garcia: So they obviously had to redo it. I think we had talked originally did some bone tunnel grafting because you know, the problem you have is once you have an ACL, if you, if it's not in a good spot or weakens out, you might need to get bone graft done, which we had talked about. Remember you and I were talking about this cause we were like, how are they not bone graft?

[00:31:40] Dr. Grant Garcia: And then all of a sudden you found it. They went in there and they didn't realize how bad it was. And then they ended up doing a bone grafting or something crazy. So Unfortunately, guys, with this one, I don't think that the article is correct. And I think there's missing some things. It's just way too simple sounding for what we saw on the TV.

[00:31:57] Dr. Grant Garcia: It was absolutely nasty. But [00:32:00] what's more important, I think, is if they finished the second surgery and they felt that they had a solid repair of everything and reconstruction, then. I think that, you know, hopefully a guy like that can come back, but I think his career is limited. Um, I don't think we're going to see the same Nick Chubb, but we will see, and that's the whole point of this show, right?

[00:32:18] Dr. Grant Garcia: To prove me wrong. Maybe there's, you know, the newer technology they used is going to get him back and things that we've never been able to see. But I mean, I just read an article on this, multiple ligament injuries. So ACL, MCL, multiple injuries actually get back the same amount as a regular ACL. Now, the problem is it's not a revision.

[00:32:36] Dr. Grant Garcia: Which is a different animal, right? A second time. And we all know second time for anything's not good. So, you know, we'll see. I think my hat off to Dr. Booz, if this, if Nick Chubbs comes back and does it just a similar season to what he had before, I will be, I will eat my words and I will be very impressed.

[00:32:53] Dr. Grant Garcia: So good luck.

[00:32:55] Will Sanchez: Yeah, I mean, listen, we don't need him to be the way he was because you, you know, [00:33:00] you, uh, we're very clear, you know, you usually don't come back to the way you were at least initially right away. But if he could get back on the field, take a couple of hits, the leg responds. Well, that fear because I'm, I'm assuming.

[00:33:15] Will Sanchez: That there, I know for myself, there will be that fear factor, right? Because this was a tackle. This was Minka Fitzpatrick coming in to tackle him. He didn't want to deal with the big man, went low, right. And then the leg didn't give out, stayed right where it was. And the knee went right. One way the leg went the other, and you know, the rest is, uh, a nasty, nasty, uh, history there.

[00:33:39] Will Sanchez: So if he can get back on, on the field and, you know, and big picture is yeah, you're, you're able to walk around as, as you get older. Right. And we're hoping that we have advances in arthritis and things like that. Right. Because we always try to think about not just today, but tomorrow, uh, like all the normal folks like us, you know, that just having some [00:34:00] quality of life there, but, uh, it's, it's absolutely amazing.

[00:34:05] Will Sanchez: And, and I, I remember when we were talking about this, I said, what happens if something's pinching something else and they have to go in right away? You know, did, did they, Put things back in place and let it calm down. Or is that something that was instantaneously that they had to go in? But perfect scenario is to let it calm down first, right?

[00:34:26] Will Sanchez: Stabilize it and then go in.

[00:34:29] Dr. Grant Garcia: So it depends on the way it is. I mean, if it was torn artery or something like we've seen those crazy ones in some of these, there was that one player for the Browns that had to have the artery. he dislocated his knee an emergency, right? Like yo lose his leg. I don't thin case.

[00:34:43] Dr. Grant Garcia: Obviously they chec as soon as they can. So, idea to let the body calm discussion we can have at kind of like the idea of So as a sports surgeon, someone comes in and they tear their knee like this, like multiple ligaments, there is some [00:35:00] discussion. This is a debate on all these. I mean, I was just talking at one of the meetings for Arthrex and I showed a case and they're like, wow, you did all four of those things at once.

[00:35:06] Dr. Grant Garcia: And I'm like, yeah, my team can do it. I did it. But some of the guys were like, I would have done in two parts like they did here. Yeah, and I did one part, let it calm down, do the second part, um, and come back and there is that, you know, there's, but then you always have to talk to the patient, like, are you okay with two surgeries?

[00:35:20] Dr. Grant Garcia: Right? Like Nick Chubb trusted his surgeon and he's a, you know, he's the professional player and they did whatever they thought was the best plan for him. Yeah. But the key is, yeah, I mean, there is some thoughts to, should you do these things in part? And when you have an urgent surgery, you can do whatever you want, right?

[00:35:35] Dr. Grant Garcia: Like the person's not going to go find some other surgeon that says, I'm going to do it together, right? It's not, it's not like there's, there's a little different factor when it's something that's, that you can go walk around and find different people for it. Um, but what's important to know is, yeah, I mean, their thought process here is less stiffness.

[00:35:50] Dr. Grant Garcia: So you do the first surgery. Sooner. Fix the ligaments on the outside, not inside the knee, and then do a little check to see what everything else is gone. And then the second surgery come [00:36:00] back and do the inside part when it's not as stiff. And that's exactly what probably was done here. That way you Is that stiffness?

[00:36:05] Will Sanchez: Is that better? You would think that you work inside out, but you're saying it is better to work outside in with something you decide to do two surgeries.

[00:36:14] Dr. Grant Garcia: This is a great question. So assuming you're not grafting anything, like you're not, you don't need to do this in two parts 'cause you're waiting for something to heal.

[00:36:20] Dr. Grant Garcia: Right. Like when you're grafting the bone, it means the tunnels in the ACL were not good. And if you put a new ACL and imagine like, imagine if like I put a hole out of the ground and there's a massive hole right there. Right. And then you want to put like something smaller in like a stake, but it's going to wiggle around.

[00:36:34] Dr. Grant Garcia: Right. Yep. So the only way to fix that is to fill the hole with good grass again, let it grow back and then stick it back in. Does that make sense? Yep. So that would be the, a reason that you do two parts and you'd want to wait. That's not related to stiffness, but when you want someone to not get stiff, you want their knee to get moving.

[00:36:50] Dr. Grant Garcia: Like what we tell people is you want your pre motion to be what your post motion is. So if he's stuck, I get to, he gets injured and I can't bend his knee past 20 degrees. [00:37:00] Then you don't want to go in there and do surgery. Cause they'll get stuck like that. But you can do the outside ligament spine, which are the MCL and the LCL.

[00:37:06] Dr. Grant Garcia: And then you can still be able to give his motion back. Cause you're not messing with the inside of the knee. It's like, it's kind of like a bomb went off in there and you don't want to get in there. So

[00:37:13] Will Sanchez: he started rehab after the first surgery, maybe using a rebless, a shout out to our sponsor there.

[00:37:19] Will Sanchez: Maybe that would be awesome. I don't know. Maybe, maybe grabbing a rebless and getting the, getting it. The nice machine probably. Get some stuff going on, starting to PT, uh, you know, as soon as possible before getting ready for the next surgery. Right. Now, something that we've discussed in the past with some of our other guests, right, starting that physical therapy, uh, prior, you know, obviously he did not know that he was going to sustain this.

[00:37:44] Will Sanchez: So you're not rehabbing prior to the surgery, but as soon as that first surgery is done and, you know, we're just, you know, we're just kind of guessing here as far as what may have happened. Um, I just kind of want to go back and I'm, I'm trying not to get stuck here [00:38:00] with these conversations and move on.

[00:38:03] Will Sanchez: But how do you determine the severity of the knee and knowing that you got to go in that maybe it's impinging on something? Is that, are you sending this to the MRI to get an MRI right away to see if it's on a nerve or, or on something? That can cause permanent damage or what, what's the process? Or can you tell right away?

[00:38:24] Will Sanchez: What's the, what, what are the steps there for you to go? Oh, this is, we, we cannot let this calm down. We have to go in ASAP.

[00:38:31] Dr. Grant Garcia: Great. So let's, we'll, we'll change around the knowledge base there. So that's perfect. So. Impinging on nerves pretty uncommon with these. The one you can do when you dislocate your knees, you can stretch the nerve on the outside of your leg and that causes a foot drop.

[00:38:42] Dr. Grant Garcia: You may have seen people occasionally that have like their foot drops and they've got to wear a brace to keep their foot up. It's called a, uh, and that's the perineal nerve on the outside. So if you dislocate your knee, that can go out. Generally, we're not going in to fix that because once it's stretched, you just want it to come back, right?

[00:38:57] Dr. Grant Garcia: You're not, it's not like usually it's cut. And unfortunately [00:39:00] those are a lot more permanent. Like when that happens, there's not really much we can do to save it. Right. We can do grafting and everything else, but usually you give it like 10 months to a year before it CO goes, but the artery is a different animal, right?

[00:39:11] Dr. Grant Garcia: The artery is the bad one. So that's the one that they got Chicago bears player had basically that's in the knee dislocates. It comes out. And the thing in the back gets torn. It's the artery. So we don't get an MRI on those. You get a CT scan. That's a, that's a bunch of x rays and then you run dye in there called a CT angio and you run dye down the artery and with a CT scan, you can do it really fast.

[00:39:32] Dr. Grant Garcia: Like they can do it in like 20 minutes. And so that's what you would do on top of checking the blood pressures. It's kind of crazy. It's called ABIs to check the blood pressure in the foot and the blood pressure in their arm. And you tell there's a difference, right? Cause if there's not, if there's a tear in the artery, the blood pressure is going to be lower in the foot.

[00:39:49] Will Sanchez: Yeah, it makes sense. So that's

[00:39:50] Dr. Grant Garcia: how they do it. So you check that originally you check pulses and then you go straight to the CT angio and then you're in the operating room that night, uh, if that, if that happens with the artery, so if the dye is leaking, [00:40:00]

[00:40:00] Will Sanchez: right, if the dye is leaking, then you, you know that you've, you've got, we've got trouble buzz.

[00:40:05] Will Sanchez: Yeah.

[00:40:06] Dr. Grant Garcia: Yeah. And you'll just see, I mean, like the, and then do your giants, like how you do right here. It's like, goes like this. And then you just see, you just see the stop. And there's nothing below it. It just out. And that's, that's a medical emergency. And that's when you get a vascular surgeon in there, they bypass it.

[00:40:20] Dr. Grant Garcia: And usually, unfortunately, they're probably not coming back and you can lose your leg, uh, if you don't do that, but hopefully we don't see many of those. And that's not what happened here. So

[00:40:30] Will Sanchez: have you had to experience anything close to that or something like that?

[00:40:36] Dr. Grant Garcia: I have seen, I have seen one of each. Um, I have seen the one where it was not caught and the person lost their leg. [00:40:46] Dr. Grant Garcia: And I have seen one where it was caught and it was fixed. So, uh, you don't want to be on the second, the first one. That's not a good day. Unfortunately, the person was under the influence and didn't wake up for like [00:41:00] 24 hours. And so that was a problem when they dislocated it. So that's nasty. But I don't want to gross the viewers out too much.

[00:41:06] Dr. Grant Garcia: No, it's it's

[00:41:07] Will Sanchez: it's it's what we do here. You know? Yeah. So

[00:41:09] Dr. Grant Garcia: if that happens to you and you're worried about it, get someone to see you quickly. But thankfully, it's just not that common.

[00:41:15] Will Sanchez: It's very, very rare. Wow, that's, uh, that's scary stuff, but it's good to kind of understand what the process is because, you know, when you see an injury like that, you assume the worst, right?

[00:41:25] Will Sanchez: Anyone that saw that injury, any fan that saw that, you, you go, what did, it lost his leg. He's never going to play again. That, that's just, you know, when, when players on the field cringe. That's usually a sign for me going. Oh, that's not good. You know, just that's my sitting at home when I see the players going.

[00:41:45] Will Sanchez: Oh, my God. When Lawrence Taylor is jumping up and waving over the medical staff that because of what has happened to Joe Theismann or what has happened to Alex Smith, when we see players react a certain way, you know, whatever has happened because these guys [00:42:00] have seen probably the it. the nastiest of injuries on the field, but when they react a certain way, you go, okay, that whatever's, whatever's happening right now, that's, that's not good.

[00:42:11] Will Sanchez: Anyway. Well, the Cleveland Browns have had it, uh, had a, had a rough year last year. And we probably could say that, uh, going back to probably the, the Bernie Kosar days, those are probably the last good days, uh, for the Cleveland Browns fans. But their superstar quarterback to Sean Watson. Um, he had a rough season last year before he got hurt in his shoulder.

[00:42:33] Will Sanchez: Um, multiple injuries. Tough guy. In fact, he he displaced this fracture that he had. I'm gonna let you break it down and kept playing throughout that game. With that injury just to kind of display the toughness of these, uh, of these athletes, but talk about this, uh, this displaced, uh, shoulder that he has.

[00:42:54] Will Sanchez: And, you know, the rumors about possible additional procedures he may have [00:43:00] had and the rotator cuff, he, he injured his rotator cuff week three before the broken bone in the shoulders. And they, you know, once again, uh, James Voss and, uh, Uh, Ella Trash was also was, uh, a part of this, uh, these decisions. So if you could talk about this injury.

[00:43:18] Dr. Grant Garcia: So we had another, this is another one of our special episodes last summer, hit all three of them. Yeah. So Dr. Ella Trash is obviously involved in all of these, I think. Um, anyhow, so, uh, he broke off, well, we don't know the full story. We actually got a couple, we didn't end up working out, but we got a couple articles, we got a couple of reporters from, I remember the Browns that reached out to us and wanted to talk about this.

[00:43:41] Dr. Grant Garcia: Cause after our, after our podcast, they were a little bit surprised to hear that we had some other thoughts. Yeah. Yeah. And you know, that was interesting to me that people were interested that much in the topic that the actual people that cover the Browns were asking about it. What's really interesting to me is we talked about this.

[00:43:57] Dr. Grant Garcia: If he broke a piece of his shoulder off, usually within a couple of [00:44:00] weeks of the heels, right? These heels so fast because, and if you have to heal in the wrong spot, they heal fast. And the fact you played through it is very impressive. Again, this is the classic example. I just don't know the whole story because it doesn't make sense to me.

[00:44:12] Dr. Grant Garcia: And I do this surgery. I mean, I, I do some fancy techniques to fix things like this. You want to fix these within three weeks, four weeks of their stock. But I heard a rumor. And again, I don't know if it's true is that maybe it was not fixable and something else was done actually to reconstruct the bone in the front of his shoulder, which would be absolutely insane.

[00:44:30] Dr. Grant Garcia: If that was truly done in NFL player. You know, we've seen the first carlet transplant being done. We've seen the first meniscus transplant being done in high level athletes. So I had heard that there was some possibility there was a reconstruction with something called an ankle bone or a distal tibial allograft.

[00:44:45] Dr. Grant Garcia: And again, I have no confirming data. This is what happened to his shoulder. But it does seems weird to me that when you break off the golf tee and it heals in the wrong spot, you can't rebreak it and bring it back up. It's stuck there. Is

[00:44:58] Will Sanchez: that shoulder? Is that closer [00:45:00] to the clavicle? Like where, where is this for, for those that don't understand exactly what you're discussing?

[00:45:07] Will Sanchez: Can you get, can we get a visual, um, of where this injury may have occurred in his shoulder?

[00:45:15] Dr. Grant Garcia: All right, let me do my best. So the black box is the. Golf tee, and that's the socket, right? Okay, I got you. Sockets like this. I

[00:45:26] Will Sanchez: got you, I got you. So

[00:45:26] Dr. Grant Garcia: imagine, imagine if I took off 25 percent of this and broke this off.

[00:45:32] Will Sanchez: No, that's not good. Now when I do

[00:45:33] Dr. Grant Garcia: this, it slips out, right? It slips, it slips out faster. But when you break a piece of plastic like this. If you maybe, maybe right away, you can glue it, but maybe after a couple of weeks, it heals the wrong spot. You can't get that piece up again. It's done. Like if it's there, you're not going to re break it and shift it up.

[00:45:49] Dr. Grant Garcia: It's just not going to happen. What you have to do is replace it with something else. And so I had heard potentially that he had something replaced there. Um, but that was never told on the, uh, [00:46:00] on the information of that. And if he got something, Is his

[00:46:03] Will Sanchez: rotator cuff had played a part in maybe, you know, something, you know, I think the rotator

[00:46:08] Dr. Grant Garcia: cuff tore when he dislocated his shoulder because that's a, that's a, like now generally only happens in people over 40.

[00:46:15] Dr. Grant Garcia: So if you're over 40, you dislocate your shoulder. You have a very high chance of tearing the rotator cuff. And I've fixed patients like that before. Or a 350 pound

[00:46:22] Will Sanchez: man landing on you, on your shoulder. That is

[00:46:24] Dr. Grant Garcia: a new indicator. That might be a new reason to have a 350 pound man lands on you. Then you're more likely to tear your rotator cuff.

[00:46:31] Dr. Grant Garcia: Okay. Okay. So, so again, more of the story is here. Like the good news is that these patients, if it's stabilized, actually do really well. I mean, it sounds like a nasty injury, But like, if you can stabilize his shoulder, I actually think he'll get back pretty well. Like I'm not worried. I'm not as worried about the Sean Watson as about the other ones we've talked.

[00:46:50] Dr. Grant Garcia: Now we'll see again, it's my prediction. Yeah, poorly. And the Browns are screwed, but you know, I, I think that, I think that whatever you had done [00:47:00] is probably going to keep them stable. And if Ella Trash was doing anything, he'll work his magic. And, uh, I think we're going to see another, another miraculous recovery from Dr.

[00:47:09] Dr. Grant Garcia: Ella Josh's surgery skills.

[00:47:12] Will Sanchez: So they determined the injury will require immediate surgical repair to avoid further structural damage. You made a reference that if you, if it sits around for a few weeks, you could have that permanently damaged. Is there anything that kind of, you know, has the light bulb go off in your head where you're like, this was an immediate surgery, um, that they had to perform once they kind of found out what was going on that they determined the head physician along with, uh, Dr.

[00:47:40] Will Sanchez: Al Trash.

[00:47:42] Dr. Grant Garcia: Well, so, I mean, as soon as you see that glenoid fracture, I mean, I have one of these coming up and then you're just like, oh, that's not a good thing, right? Like, once the bone's broken on the shoulder socket and he feels like his shoulder's shifted out of place, he'll just destroy his shoulder.

[00:47:55] Dr. Grant Garcia: He won't be able to throw. So that's why they wanted to fix it. Right. Cause like in a [00:48:00] normal human, doing normal activities, they can't tolerate this, right? It's slipping out. He's obviously not a normal human. He's super athletic, but he's also putting his shoulder at I mean, having to throw the ball and throw it, the velocities of the accuracy he does.

[00:48:14] Dr. Grant Garcia: And already having a, just a not perfect socket or base for the arm is not a good thing. And so, you know, you could see that. This was a, I think this was actually more of a surgery to help longevity rather than just for the acute situation. Does that make sense? Like it could have, like, if he could, like, if they wanted, they were probably worried it's gonna do more damage and they just put a lot of money in their investment.

[00:48:35] Dr. Grant Garcia: This was to save their investment.

[00:48:39] Will Sanchez: Yeah. I mean, you, you think about the torque, you think about the speed, the accuracy, you think about people landing on it. Um, they said, you know, he is a mobile quarterback. Um, he does run around. It would be interesting to see if that, you know, if they had that conversation with the coaches saying, Hey, you've got to find a way to coach them out of this a little bit.

[00:48:58] Will Sanchez: You know, some of the things that we'd [00:49:00] like to see Daniel maybe do a little bit less. So it all around. I don't have the player's name. I know they looked into their backup quarterbacks, making sure that their backup quarterbacks are kind of legit and ready to go as well. If without knowing everything that's happening, if everything goes smoothly, what's the, what's the timeline here?

[00:49:25] Will Sanchez: You know, for having, this was week 10, so two and a half months, October, November, I guess right before December, I'm guessing I'm not looking at the calendar, just thinking about the timeline or close to December, um, that he suffered this injury. We're now kicking off the NFL season, uh, the first week of September.

[00:49:47] Will Sanchez: You know, is that timeline concerning for someone that works on shoulders and, and things like that, uh, and for your thought process, or you're like, well, once that's done, they done X, Y, Z, they've done the rehab. [00:50:00] It's just a matter of going out there, getting contact and seeing how it holds.

[00:50:05] Dr. Grant Garcia: So what's crazy is with the shoulder stuff.

[00:50:07] Dr. Grant Garcia: Minus the baseball players and maybe quarterback might be a little different. Generally, we're talking about five months. I mean, I've had linebackers with these injuries come back in four and a half months, so it's crazy if done well, uh, as long as the bone heals, if they had to do a bone healing procedure or whatever, you know, you're talking about five and a half months and you're letting them rip.

[00:50:25] Dr. Grant Garcia: So it's different than a knee. So I think he'll be back. Like I said, I mean, I wouldn't wish any of these injuries on anybody, but I think if he had his, if, if, again, I don't know what happened, this glenoid fracture thing is still super crazy to me that it was injured months, weeks before, and they found him and they had to think through an urgent surgery.

[00:50:44] Dr. Grant Garcia: So I have no idea exactly what they found, but I can suspect what they did. But, you know, based off whatever they did, I'm assuming that they feel pretty good about it and I'm assuming that he, you know, hopefully we'll get back.

[00:50:56] Will Sanchez: AFC North has been, uh, Been getting, taking their [00:51:00] lumps, obviously one of the MVP kind of, uh, you know, one of these, one of these guys probably going to win the MVPs between, you know, Joe Burrow and, uh, Lamar and Patrick Mahomes.

[00:51:15] Will Sanchez: But, you know, once again, uh, Burrow ending his season, torn ligament, wrist. I mean, he had a real rough season where he had an earlier injury, uh, to start off the year with a cap injury. And then, you know, he had this torn ligament, any concern with the wrist area, uh, for Joe Burrow going into this season, besides, you know, he hasn't played much football, you know, the last year, um, as far as taking hits, spinning the ball, gripping the ball.

[00:51:43] Will Sanchez: Right. I mean, I think gripping is one of the concerns. And I think if we had a Dr. Whale here, we'd be talking about that. What are your thoughts on that?

[00:51:52] Dr. Grant Garcia: Yeah, I mean, I'm worried about that. With ligament stuff like this where you're not doing a reconstruction, you're just basically repairing it. I think if he doesn't get [00:52:00] anything stuck, I think he'll actually be pretty good.

[00:52:02] Dr. Grant Garcia: I think it's more the But that's just me, again, I'm not a hand surgeon, so I do less of these. But, I tend to see, I tend to be less stressed about something like this. You know, I'm more worried about, I'm more worried about the knee stuff and the damage and the revision situations. You know, unfortunately the knees take the longest.

[00:52:19] Dr. Grant Garcia: This is a good one though. So we'll move on. I want, this is a good one.

[00:52:21] Will Sanchez: Yeah. Yeah. Anthony Richardson

[00:52:23] Dr. Grant Garcia: thing.

[00:52:23] Will Sanchez: Yeah. Anthony Richardson, you know, I wanted to get to that because we've been yip yapping away. And, uh, as time is ticking over here, let's get to Anthony Richardson's with his AC joint sprain. And once again, we hear sprain or I hear spray and I go, well, that doesn't sound like it's too concerning.

[00:52:39] Will Sanchez: But, uh, grade three, uh, what, what's your biggest concern with this? Also, once again, it's the throwing arm.

[00:52:46] Dr. Grant Garcia: Yes. So this is controversial topic. Good. You picked a good job. You always do a good job with this. Well, so AC joint injury, acromion clavicular. So acromion is this, it's a shoulder separation, right?

[00:52:56] Dr. Grant Garcia: You've heard the word shoulder separation. Yep. It's a really common in [00:53:00] bikers football, direct blow on the shoulder. The thing about this is for every grade, there's six grades, but we almost never see the fours. Those are like with some weird, you know, the cloud was stuck underneath. It's just almost, I've never, I think I've seen one of my whole life.

[00:53:15] Dr. Grant Garcia: Um, but the threes and the fives, the ones you worry about, because those are the ones that might need surgery. One, two is like a little bit. Three is where it comes up a little bit more than five is where it's like way up. If he had had a five he would have automatically gotten surgery. Uh, but because he's a three The three is where it's on the fence And so the data shows that if you have a three That half those patients don't need any surgery.

[00:53:39] Dr. Grant Garcia: They'll get back on their own And I have one of the Mercer on football players. I just did this with and I was able to treat him without surgery, but some people come back and I've had this at like two months, three months, four months, and they still feel bad. They can't throw. They have like popping and it's unstable.

[00:53:53] Dr. Grant Garcia: And what they've seen now is it's actually maybe more like a three a and a three B. The A's can get back and the B's don't because there's actually [00:54:00] a component that's, we think about AC joint injuries, the chromium goes up, right? That's how we measure it. But we don't think about it. Remember, Our body doesn't work in one plane.

[00:54:09] Dr. Grant Garcia: It works in two planes. So the concern is that some of these eight, these grade threes actually have this stability and this, and when you have both, then you might not get back. My assumption is he just had this one, right? Or they would have probably done surgery on him, but we've done studies on this.

[00:54:25] Dr. Grant Garcia: Looking at baseball players is a really common baseball injury. And you ask about the team doctors and it was crazy because only half of them said they would ever do surgery on this. The other half said never would do surgery on a grade three. I will do surgery on somebody, but again, the studies show that you want to try no surgery first.

[00:54:41] Dr. Grant Garcia: So the surgery timeline, the recovery timeline for this is about one to two weeks for every grade. It's like an MCL without surgery without surgery. So six weeks.

[00:54:50] Will Sanchez: So, so you, you should, you should have the needed information for you to think about your next step within the two week period.

[00:54:59] Dr. Grant Garcia: Usually I [00:55:00] tell them six to eight weeks, you know, now with him, he's going to give you monitored more closely.

[00:55:04] Dr. Grant Garcia: But like I tell, like I told the football player and the office is going back and play, I said, you know, go back and play for the season if you can, and if it starts feeling unstable, you can't do it. We got to pull you out. We're going to do surgery on you. And if you can tolerate it and it's bad at the end of the season, then we do it at the end.

[00:55:20] Dr. Grant Garcia: So what he may do is he may, but again, you can see these bikers, they come in cause we have all this biking around, we're surrounding around the area, you know, the bikers have both of them. They look like little horns, right? They got AC joint injuries on both sides and they've been no surgery on it. So it's really depends on the patient and how they feel.

[00:55:35] Dr. Grant Garcia: But it's that, it's that shucking anterior posterior. So front backwards. And that's why we're starting to see these, like that, the, that the grading system we have may be too old school, right? Like it's just, it doesn't give us cause we reason we make grades and I'm going, I know we're almost over. We make grading systems so we can, we can determine.

[00:55:53] Dr. Grant Garcia: We can say, okay, that grade twos need this something, this grade three needs this something. Does that make sense? That's what we grade these things. [00:56:00] And we, so we can describe them more easily. Right. So like, we know grade one takes this long grade two, and we can just like, by having that documentation, it makes it faster.

[00:56:07] Dr. Grant Garcia: It's like a, it's like a, it's a, um, conversion chart for surgeons. You think it's time to

[00:56:12] Will Sanchez: reassess these grades for these type of injuries? Possibly without starting trouble.

[00:56:18] Dr. Grant Garcia: I think, well, no, we're talking about it. Well, you're going to start some trouble. I love it. No, no, no. You're absolutely right. And there are people looking at it.

[00:56:24] Dr. Grant Garcia: There was a paper about this recently that wanted to regrade some of these because we don't have a good system and this, this grade three, like the number of ones that create these come my office and I go, listen, you might need surgery, you might not. The only ones I benefit from are the ones that come in at like two or three months.

[00:56:40] Dr. Grant Garcia: They have a grade three and they're not happy because those are the ones I know need surgery, right? Like they've already declared themselves, but these acute ones, a lot of times you don't need surgery, but it's tough because they get different opinions and some people say you need it. So this is one of those ones.

[00:56:52] Dr. Grant Garcia: It's a gray box. This is a great topic.

[00:56:55] Will Sanchez: Any concerns for him this season as we get ready to wrap up? [00:57:00] I could talk about this for another two hours. Anyway, go ahead.

[00:57:04] Dr. Grant Garcia: I know you could. I know you could. You open up Pandora's box every time he asks you about an injury. Um, concerns for him are, I hope he doesn't have the bee.

[00:57:13] Dr. Grant Garcia: I hope he got the A. I'm assuming he does. He wouldn't have got surgery already. So, so we might, they don't damage the inside. All right. So, so once he

[00:57:21] Will Sanchez: starts playing football, gets hit, we're going to find out if, if something needs to be done. So there is a question Mark about his 2024 season. Um, you know, until we see what happens, right.

[00:57:36] Will Sanchez: Is that comfortable enough to say there?

[00:57:38] Dr. Grant Garcia: Yeah, I have a good feeling about it. I feel like you, I feel like they would have pulled the trigger already. I have a good feeling about it. So,

[00:57:45] Will Sanchez: all right. We had a bunch of other stuff to talk about, but we're not, we're going to end on some trivia to kick off the season.

[00:57:51] Will Sanchez: All right. Three players have won the NFL comeback player of the year award and a super bowl. Can [00:58:00] you name one of those three players? JJ Watt.

[00:58:04] Will Sanchez: Nope. One more.

[00:58:06] Will Sanchez: Tom Brady. Tom Brady is one of three players. He won the comeback player of the year in 2009 and then won the Super Bowl that same year. Peyton Manning won it in 2012 and then, uh, won the Super Bowl. And Rob Gronkowski also was a part of that. So hip, hip, hooray. I'm excited about the G. I got my Tiki Barber jersey on.

[00:58:32] Will Sanchez: Can't see it there. Tiki bar right now. You got your giants. I'm really excited. I got to put my

[00:58:36] Dr. Grant Garcia: brand.

[00:58:38] Will Sanchez: Yeah. And hey, we're going to update our, our listeners throughout the year. We think it's important, these injuries and top players. So being the look lock lookout, we're going to do some short, quick hitters.

[00:58:51] Will Sanchez: I hope we'll keep it short, but probably not. And, uh, keep all of our fans, uh, Ready to go for this season, man. I [00:59:00] appreciate you. Dr. Garcia is always good to chat with you and we look forward to our upcoming shows. Check us out at sports doc talk. com where we have plenty of content and transcripts. Say goodbye.

[00:59:13] Will Sanchez: Dr. Garcia.

[00:59:15] Will Sanchez: Bye bye.

[00:59:17] Dr. Grant Garcia: Thank you guys. Audio Transcript

[00:00:40] Will Sanchez: Garcia, how are you doing today?

[00:00:43] Dr. Grant Garcia: I'm good. I'm really good. You know, I'm excited for the show. Something different. Put a little spin on it. Each time you never know who's going to be on here.

[00:00:49] Will Sanchez: That's right. And as always, we always like to give a shout out. Where's our little shout out here? Let's give a shout out to The Recovery Shop.

[00:00:59] Will Sanchez: This [00:01:00] episode is sponsored by The Recovery Shop. Orthopedic surgeons like Dr. Garcia and patients alike love the recovery shop for its curated selection of physician approved post operative recovery products from braces to nutrition. We've had the nice machine, you name it, you, you, we have it all for you on

[00:01:20] Dr. Grant Garcia: there.

[00:01:21] Dr. Grant Garcia: The Rebless is on there too. The

[00:01:23] Will Sanchez: Rebless, so many cool things. Um, and obviously we know why Dr. Garcia loves it because it's easy. He can. Pushes patients that way. And, uh, it's just great for everyone. So, uh, check us out at the recovery shop and Dr. Garcia. Um, you excited about today's guests?

[00:01:43] Dr. Grant Garcia: I am. I'm excited.

[00:01:44] Dr. Grant Garcia: One more thing on the recovery shop. Again, we've brought it up many times. You know, this is, this is awesome for the patients, right? Like we want, you want something new, you know, if we hear something new today or on rehab, I can call them and say, Hey, listen, put that on the website. So my patients can find it easily, right?

[00:01:59] Dr. Grant Garcia: You're [00:02:00] not going to Amazon. You're not going to other proprietary websites where you don't know the quality. These are all been pre vetted by myself and working with these top guys in the recovery shop. And it's great for surgeons kind of have your own little hub, right? It adds a little personalization to it.

[00:02:14] Dr. Grant Garcia: The patients really like it. And honestly, the products which Will's tried, I've tried, they really worked. Will didn't want to give

[00:02:21] Will Sanchez: it back. And we had a grant on from the nice recovery. And I told him, I said, The best part about having the nice recovery and it is the way it worked wonders. And especially for my wife that I was laid up and she didn't have to run around getting me ice packs all the time.

[00:02:41] Will Sanchez: And I was able to use machine. But when I actually had to send it back, I was very disappointed. Let's not go down this rabbit hole. We know I'm going to stop. We got to move on. We got such. No, we always do this. Listen, we've got a great show

[00:02:55] Dr. Grant Garcia: is gonna be short. As you know, our show is always short.

[00:02:57] Will Sanchez: Oh, shut up, man.

[00:02:58] Will Sanchez: We're not doing that. Come on. You know [00:03:00] how that works. Come on. Let's bring in, where is he? Where's where's Austin? Austin. Austin Robinson working with Arthrex in Seattle and before Austin, I apologize because I'm jumping the gun here and I'm yip yapping away, I just want to let. The viewers and listeners know, right?

[00:03:18] Will Sanchez: We have nothing to do with Arthrex, any kind of financial standpoint or anything like that. Okay. We're talking about Arthrex and we're bringing you on because the product is so good and it's not only just beneficial for. are surgeons, but I could care less about that because I'm not a surgeon. I'm a patient.

[00:03:39] Will Sanchez: And when you've got cool tools to play with, it makes my recovery a whole lot better than everyone else out there. That's a patient. And for someone that actually has some gear in my leg, I'm very thankful. So. Austin, welcome to the show. Oh, Garcia, interrupt me because I'm talking too much. No, you're doing great.

[00:03:59] Auston Robinson: [00:04:00] Thank you for having me. It's a pleasure to be here.

[00:04:02] Dr. Grant Garcia: So I can choose Austin again. I'll bring that up again. This is, there's no monetization from Arthrex on this. I'm a consultant for them. I work for them. I help with product development and other things and videos, but nothing to do with this. The reason I bring someone like Austin on is first off, Austin, how long have you known each other?

[00:04:16] Dr. Grant Garcia: I think five, six years.

[00:04:18] Auston Robinson: Yeah.

[00:04:18] Dr. Grant Garcia: And we talk about internal brace, Will, don't get started yet. Wait, wait. And we talk about a sale repair. We talk about all this innovative stuff. Can you hear me talk about, you know, I visited here, we went here, we did this and that all sounds great, but that doesn't, it doesn't happen like that.

[00:04:35] Dr. Grant Garcia: You don't just go to those places. You don't just get those new products. There has to be someone behind the scenes. And when you're doing the type of complex surgeries that I'm doing in my surgery center, or you're looking to constantly be on what they have, and we'll go to Arthrex as alpha beta launches.

[00:04:49] Dr. Grant Garcia: So we get, will the products before other surgeons get them? How does that happen? Well, it happens through someone like Austin, right? And you, you you pair up to get those, they get those things [00:05:00] earlier, so you can try them, you can use them in safe manner. And there's so many different things that Austin's team offers, As a subunit of Arthrex and then the major corporate will get into too.

[00:05:12] Dr. Grant Garcia: Like, what is the benefits of this? Um, and what can surgeons learn from it? And this is, you know, a lot of different industry does this, but you know, they have a specific way of doing it for sports. And I remember, I won't get too much more Austin. Sorry. I don't want to take up time, but I remember when I was in residency, I know, I know, but I was wondering like, how did they get in?

[00:05:32] Dr. Grant Garcia: How are they able to get involved in so many things? And it's the. It's not just the products. It's not just the glitz and the screen in the background, which we'll get into in a minute. It's the, it's the whole thing. It's the videos. It's a teaching. It's a focus on the entire, the entire unit and making sure that surgeons are integral part in helping out, uh, with this sort of company.

[00:05:53] Dr. Grant Garcia: And it's, it's pretty awesome. So anyhow, without further ado, Austin is the owner and agency [00:06:00] owner of the Seattle Pacific Northwest. And he has been, he has done way too many jobs in the past. And he is now, he is now, he's a good friend of mine. We talk way too much. My wife's jealous of Austin. I talked to him more, I think, unfortunately, as

[00:06:11] Auston Robinson: well.

[00:06:13] Dr. Grant Garcia: So anyhow, well, thank you for coming on and we'll, do you want to pop his little bio up there as little.

[00:06:18] Will Sanchez: Yeah, I'll throw it up there. And, uh, in Austin, just real quick, man, how, how did you get involved with, uh, Arthur X?

[00:06:26] Auston Robinson: That's a great question. Uh, and thank you for having me. It's a distinct, distinct privilege to be on the program.

[00:06:31] Auston Robinson: This is a prestigious show. to catch every episode. It's always fun to hear. So it's a unique experience to be featured with you all and be part of the conversation. Obviously, Dr. Garcia, thank you so much for your approach to patient care, because it really aligns with Reinhold's vision at Arthrex of helping surgeons treat their patients better and helping people get better.

[00:06:50] Auston Robinson: Um, and you, you do that at the cutting edge. You're the tip of the spear in so many different modalities, but I, I found my way to Arthrex. I was working for a competitor as, as often as the story [00:07:00] Uh, in the medical device world. And, uh, uh, my previous boss, Bobby Adams, who was very influential in my life and career, uh, gave me an opportunity to, to embrace Arthrex is, is a lesser known fact about Arthrex, but something that is, uh, some, you know, feature that we take great pride in is Arthrex is one of the largest medical education companies in the world, if not the largest.

[00:07:21] Auston Robinson: And, um, he hired me into a role that was a burgeoning new department called. our local medical education department and, uh, just kind of progressively made my way through the, uh, the different levels of the organization and have been privileged and honored to be given the opportunity to, uh, take the helm with Arthuric Seattle.

[00:07:40] Auston Robinson: Uh, we have a tremendous team as I just play a very small part, but it's a really, uh, fun opportunity to be a part of it.

[00:07:46] Dr. Grant Garcia: I'm laughing. He doesn't play a small part. He's the man. This is the man. He's takes, he's a strong leader. It's amazing. All the different people that talk about how good a leader you are, Austin, but I'm not going to, I'm not making, so you can at least walk out of the room, [00:08:00] not have your head explode.

[00:08:01] Dr. Grant Garcia: So, yeah, I'm

[00:08:02] Auston Robinson: going to get my wife and see if she can listen in just to, you know,

[00:08:07] Dr. Grant Garcia: so the, so I guess this is, this is a good way to start when people hear, I think. When some patients hear industry, they think that's awesome. Like they see arthritis, you know, patients come in all the time asking me for, I want the tight rope.

[00:08:20] Dr. Grant Garcia: I want the internal brace. I want, you know, a swivel lock. I want the thing Aaron Rodgers had. I want the thing that, you know, Neil Alatrosh did to that other guy, that other NFL player, right. They ask for those things. So they have a, they have a reasonable perspective. I think the idea of industry and surgeon type of thing is not really a negatively influenced at this standpoint, but from a surgeon standpoint is a different.

[00:08:41] Dr. Grant Garcia: Uh, thought process and especially early on, you know, some, I think some places think of like, Oh, if you talk to industry or industry talks to you, you know, this is like, you shouldn't get involved. You shouldn't help out. And even early on for me when I was in practice. It was surprising to me working with you guys and I worked with, you know, [00:09:00] Arthrex a lot because they do, I do sports and that's like one of your biggest things, right?

[00:09:03] Dr. Grant Garcia: Like you're, you guys are, it's mega. And what I realized pretty quickly was like, it's not just about the implants. It's about what do you want to get better at? What do I want to improve on? How do I want to help my patients get better? And it was, it's weird because it, for me, it felt more like. family situation and understanding, like, what is the whole that we want to improve on?

[00:09:24] Dr. Grant Garcia: Like, if I, I go to Austin all the time, I'm like, what's new? What can I, what can you show me that's new? And I don't have to, you know, stive the internet, right? He's going to help me give me the catalog of things that I can look at and also being fair with pricing, which is, which is awesome. And so I think, what, how do you navigate that with surgeons that are skeptical of the idea of, Industry, right?

[00:09:44] Dr. Grant Garcia: It's a, it's alarming, especially new surgeons. You know, you have older surgeons that are like, you know, I don't, I'm not involved. I don't really care. I'll just do whatever. Um, and we all know that situation. We've talked about that before, but these newer guys, social media, they're hitting that. They want to prove themselves.

[00:09:57] Dr. Grant Garcia: They're gunning. How do you deal with that situation [00:10:00] where they're nervous about industry involvement?

[00:10:03] Auston Robinson: Yeah, that's a great question. Uh, and it's a great opportunity to just live up to our mission statement of helping you all treat your patients better. We, we, uh, you know, obviously we're a business. We're, we're trying to do well in, in that regard, but ultimately I think what, what drew me to Arthrex and what makes it so unique is that the patient is still the center focus.

[00:10:23] Auston Robinson: Reinhold has done an incredible job. ever since he started in 81 to keep the company private. So there's no shareholders that he has to appeal to. There's no quarterly statements that have to be emphasized, uh, or profits that have to be justified or decisions that need to be justified. And there's a lot of decisions that he makes.

[00:10:42] Auston Robinson: that don't make good financial sense. Uh, I wouldn't say a lot. He's been very successful, but there are there are certain instances where he will invest a tremendous amount of money into building a device or a tool to make the job of the surgeon easier so that you're not having to worry about that. You can keep your [00:11:00] mind focused on that patient's outcome, and we try to live up to that through our commitment to medical education locally.

[00:11:07] Auston Robinson: Every agency in the country is as if not one, several, uh, local cadaver labs that allow their surgeons to practice and rehearse and bring their team in. And that's a, you know, no cost to them, uh, accessory to their practice that they can use to continue to leverage their training into advancing their skills.

[00:11:27] Auston Robinson: So, uh,

[00:11:29] Dr. Grant Garcia: this is important for, I'm sorry, I'll send me interrupt you, but I want to hear this. I want the young surgeons. I want will to understand this because we'll always I went to the lab and I practiced it. And then I tried it and then I was able to take it to the patient and do a good job. And we had a Savito on, he was talking about that as well.

[00:11:44] Dr. Grant Garcia: Oh yeah. And a lot of the companies, and again, I'm not between any of the companies. I've worked with a lot of them. They're all, all of them have their different benefits of working with them. If I want to try something, I can call Austin. He's like, Hey, I'll get you a lab. We'll do it in the cadaver. We'll practice it.

[00:11:58] Dr. Grant Garcia: And I mean, awesome. We've come up with new [00:12:00] techniques. I mean, I would tell you, I would tell the patients that how many times I've been in the lab. It's way too many, right? I know that I grabbed my coffee. I know exactly where I'm supposed to go, right? But the thing is, that's how you get better, right? Like you don't want, we don't want to practice on a patient, right?

[00:12:13] Dr. Grant Garcia: Like we have like, We have nuances we can change in the operating room, but if it's something big, I mean, I remember starting practice. Well, like I called, uh, my rep who was, who's working with Austin at the time. And I was like, I want to try these two new surgeries. I'm about to bring to Seattle. Like, can we go and start before I started practice?

[00:12:29] Dr. Grant Garcia: That was. I'm now almost six years. It's crazy and basically was practicing in the lab to get ready for my patients and it makes me better Faster and more efficient and you know, it's crazy, too And again, you know, I don't know what the arthritis to think about this But like we've practiced that plus adding techniques right like new things not just the arthrix thing, right?

[00:12:48] Dr. Grant Garcia: So austin's all about What can you do to get better? Right? Like if I'm going to do five different things during a surgery and four are going to be arthrics and one is going to be non arthrics, that's okay with these guys because they want, they care about what the patient outcomes. And I think [00:13:00] that's, what's really hard for some of this newer surgeons to see is it's that like, you don't always have to be doing everything from one place.

[00:13:07] Dr. Grant Garcia: And what's the focus for them is like that you do good surgery, right? Because a good surgery you're like i'm gonna do that exact same technique and use the exact same instrumentation the same next time I don't know if you have any questions, but I will but it's just it's just

[00:13:18] Auston Robinson: yeah

[00:13:19] Dr. Grant Garcia: people don't understand It's so hard to get a cadaver lab at many of these companies.

[00:13:22] Dr. Grant Garcia: I've tried i've been like I want to do this in the lab And unfortunately, I'm spoiled because I have the access to Austin because we're friends and he's able to help me out. Um, and the Arthritics guys, I can get a lab whenever I want, you know, they're always available. It's such an incredible resource and it's so rare.

[00:13:36] Will Sanchez: Yeah, I wanted to ask you, like, how do you, how do you elaborate on the patient's Transcribed outcomes and satisfactions. Um, how do you measure that, you know, for making informed decisions for the product? So, you know, based on a reaction from the, from the patient, what, how do you give that feedback, um, that, you know, whatever that decision making is?[00:14:00]

[00:14:00] Auston Robinson: Uh, from my perspective, we rely heavily on people like dr Garcia. You know, um, he treats the patients and, you know, it's been very compelling. As you mentioned, ACL repair earlier, there's a variety of techniques out there. I am biased, but I feel like we have the best technique and the best product for that, you know, procedure.

[00:14:20] Auston Robinson: But we rely heavily on our on our surgeons to say, Hey, this needs to be improved. You know, this was a struggle. This was finicky. This was Uh, and Reinhold, he, that's how he started the company and that's how he's maintained the flow of information at the company is surgeons are in the, in the pilot seat where, you know, we're in the background trying to make sure that we can give the surgeons the tools that they can use to most optimally treat their patients.

[00:14:45] Auston Robinson: So when they say, you know, You know, this, it's, it's rare. I would say, Dr Garcia, you might, might agree with me. It's rare for Arthrex to produce something that is flawed. They do such a great job thinking it through because they have so many surgeons offering guidance and feedback. But in the [00:15:00] instance that there is a refinement that could be put in place, offered or interjected.

[00:15:04] Auston Robinson: Uh, we, the surgeons bring it and, and there's always, it's amazing. You go down to our headquarters in Naples, there's always people in the labs trying to refine the practice of surgical orthopedic surgery and spine surgery and laparoscopic surgery. Uh, it's incredible.

[00:15:20] Dr. Grant Garcia: Well, I don't want to have to there. I think you should, we shouldn't change the word from flawed, right?

[00:15:24] Dr. Grant Garcia: You have, when we had like, well, we've talked about this, there are these special anchors and they're so minuscule and they're so amazing for shoulder or labrum repairs. Right. Um, And then not less fiber attacks, right? And they've been changed four times in the last three years. And it's not because they're bad.

[00:15:38] Dr. Grant Garcia: It's not because they were flawed. It's like, Oh, some other person figured out how to make it even better. So I think what Austin is also trying to say is that there is a lot of change. I mean, you could have a product and you get like that swivel lock. You show there's been renditions. There's different changes of it.

[00:15:51] Dr. Grant Garcia: There's all these different things. And the reason being is not because the last product was flawed. They need to fix this, right? Occasionally there are products like that. [00:16:00] What's really interesting too, is that they have a lot of background input. There's alpha and beta, like I mentioned. And so before the product hits mainstream, they'll have surgeons and Austin's really big on this, have surgeons evaluate the products and they listen to it.

[00:16:14] Dr. Grant Garcia: I mean, every time I do a beta testing, I'm sending notes and the reps, you know, Rachel, we can talk about her at some point. She's amazing. Um, but you know, she's writing notes about what's going on the technique. Garcia didn't like this. He liked this part. This was good. And half the time you want to be, and obviously I'm, I have a lot of discussion where I say, Oh, maybe I did this wrong.

[00:16:32] Dr. Grant Garcia: And a lot of times it is the surgeon, the technique, we did it by holding the hands or something, but they're really good about making sure that they, they teach us the right way to do it. And if there's a, if there's something that we're concerned about, it's not, you know, most surgeons unfortunately will, and you may, may or may not know this.

[00:16:47] Dr. Grant Garcia: They like to blame others, which is not good. Um, for something that's not going right, and we all know that it's that we all have error in us, um, and it's never a bad thing if you have a little, you know, if you're putting the anchor and it didn't go exactly what you [00:17:00] wanted, it's not a catastrophic issue, but what we have, what we understand now is that, unfortunately, every surgeon's, surgeon's learning curve is different, and what arthritis really does is they don't want, they want to eliminate the learning curve, and that's really, really hard to do.

[00:17:16] Dr. Grant Garcia: And I found that out by working with Arthrex over the last five years that I'm like, well, I do this a lot, but like, maybe the surgeon next door doesn't do a lot of those. And so I'm like, I don't understand why you can't figure that. Or I do something. I'm like, I don't understand. I don't understand this thing.

[00:17:29] Dr. Grant Garcia: And they're like, you know, you tell them an idea and they're like, that's way too complicated. And you're like that. We're just talking about like an anchor, right? It's a little swivel. You pull it out, you pop the button, you know, this is straightforward. They're like, no, that might like, we're talking about a design right now.

[00:17:42] Dr. Grant Garcia: And I was told that they can't do two loops because sometimes they cut the wrong loop, right? Like you're like, that doesn't make any sense to me, but they're so keen on making sure that the surgeons. That the surgeons happy with the product and the product works flawlessly every single time. And that's really, really hard to [00:18:00] find the industry.

[00:18:01] Dr. Grant Garcia: Well, like, it's just amazing that they're like, I want someone that does one of these and does 10, 000 of these to be just as good every time to put it in. And that's extremely hard to do. That's way harder than you'd ever imagined.

[00:18:12] Auston Robinson: Uh, if I can interject, I know I'm just a passenger on this journey together, but that is, it seems like a perfect opportunity.

[00:18:19] Auston Robinson: If I can make a shameless plug for our people. Because I think a big part of that, too, is the technology is there. You're obviously a gifted surgeon, uh, and and surgeons are very well trained, but to have the support of, uh, you know, a competent rep in the background that knows the technology is prepared to do their job well, which, you know, You mentioned Rachel, Rachel Robinson.

[00:18:40] Auston Robinson: She's our rep that covers your, your, uh, surgery center. And she's super stellar. She's a rockstar and she wants to make sure that she doesn't let the patient on the table down or you down. And internally, I think that's another differentiator arthritis does really well is we have our own medical education director, a gentleman by the name of Bram Shamas, who's a brilliant [00:19:00] guy and devotes a lot of his time and energy to making sure that when we have a rep going to an OR, They know what they're doing and, you know, we all have room to improve.

[00:19:08] Auston Robinson: We're all continuing to grow on our journey. But, uh, you know, we, we invest heavily in those resources to make sure that we're not sending somebody into that procedure that can't assist, especially when, uh, something goes wrong. Right. And, and that's a, that's an

[00:19:24] Dr. Grant Garcia: incredible point. I don't think, Will, we do enough discussion of everybody else behind the scenes, right?

[00:19:30] Dr. Grant Garcia: Because it's impossible. Like, you've been productions. Like, you can't, you know, every camera person, every lighting person, you can't talk about it. I'm not trying to dumb down the reps or anybody else into like a, you know, a light or a camera or, um, but what's incredible about the reps on Arthrex, in my opinion, Is that there that you even get some people that are new and they're really, really intent on learning, right?

[00:19:51] Dr. Grant Garcia: I mean, we'll, I will tell you, and Austin may think we have some of the hardest surgeries we do in the state and our operating room, very complex, high volume, [00:20:00] really intense. Like I'm, I remember the best and we'll make me think this is funny, but inside information, I was always told that my OR is the most giggles.

[00:20:09] Dr. Grant Garcia: And the most stressful at the same time,

[00:20:12] Auston Robinson: because we're

[00:20:12] Dr. Grant Garcia: doing such complex procedures, but we're also having a good time. And so that to me is the key, but the fact that a rep can come into that situation, and they're prepared for it, and they have notes, I mean, Rachel, I, I don't want to make it about Rachel, because I know that she's going to blush when she hears this, but You know, I asked her about something I did and she's like, Oh, you did this like six months ago.

[00:20:30] Dr. Grant Garcia: You did this way. And I was like, how did you remember that? And right. Well, she's writing notes. So it's not like I am, I may steer the ship, but I have lots of people that help me out. Like my outcome in the end for the patient is because of Rachel, because of my scrub techs, because of my PAs, because of.

[00:20:47] Dr. Grant Garcia: My, my scheduler, like this is a combination. This is a team effort to get there. And if you don't, they are the final finish line, right? Like if you, when I'm doing something, if your rep's [00:21:00] not good and all of a sudden I do something that doesn't work, how do I decide? I've never seen it. Right. Like Rachel and I have been together most of the time, but she works with other surgeons or other reps do too.

[00:21:10] Dr. Grant Garcia: And if they, they actually have more experience than the surgeon does combined well, because they're going every day to the operating room. And so they know their product and they go, this doesn't work, do this. And early on, that was huge for me. I mean, I had Kyle, he's awesome. And he was like, he told me that something went wrong and he's like, this is how you fix it.

[00:21:25] Dr. Grant Garcia: I'm like, I had never even heard of that. And I'd been at HSS where these guys are using Arthrex products left and right, left and right. And you learn something new. And the cool part is they, if you keep an environment where you're like, Hey, just teach me because I want to learn too. And that's really, I think.

[00:21:40] Dr. Grant Garcia: The one thing you guys do a really good job of, you build a relationship. So the surgeons are willing to be taught, right? Like there's other companies and I will not name names where I don't want to be taught by anybody. Because to me, I don't feel like there's a lot of, there's the same caliber of what I'm getting, which is why to me, the relationship is so important, um, because of the consistency [00:22:00] and because of the personalities.

[00:22:02] Dr. Grant Garcia: I mean, Will and ROR, they're like our, The reps there for Arthur to come in. They're like best friends. Everyone's like, Hey, Rachel, thanks. Good morning. Let's get going. You ready for today? And she's like, Oh yeah. And they put so much effort in well, it's hustle all day long hustle. And that is a, that is a hard thing to do.

[00:22:16] Dr. Grant Garcia: And that's something that's built by the brand. Um, and You know, I think Austin, one thing I think that people would say is, and we'll might be able to test to this, but you know, one thing that one knock, I think people talk about arthritis, that the products are expensive, right? There, they maybe are more expensive than some of the other brands for the patients listening and for the surgeons is that unfortunately, when you have, you usually pay for what you get, right?

[00:22:41] Dr. Grant Garcia: So if you don't have the higher quality stuff or the higher quality thing, you don't get the rep in the room that knows what's going on. You don't get the medical videos to teach you how to do it. And we'll, I don't know what your thoughts are, but I think that if I offered you, and again, there's nothing wrong with a Honda or Toyota or a BMW or a, you know, [00:23:00] a Mercedes, I think, you know, which one you might choose.

[00:23:02] Dr. Grant Garcia: It's just, it's just the difference.

[00:23:05] Will Sanchez: It's funny. You're talking about this and, um, it reminded me, and this is, I'm really going off the beaten path here, uh, episode of the King of Queens, right. And, um, he wants to surprise his wife with a LASIK surgery. So he's like, all right, we, you know, for your birthday, we're going to get you the LASIK surgery, you're going to no more glasses.

[00:23:27] Will Sanchez: So, you know, he goes to take the surgery and she wakes up the next day. It's blurry. The day after that, it's blurry. Finally, she's at her birthday party. She can't see anything. And then, you know, one of the friends comes by and it's like, Hey, I heard you had the surgery is like, yeah, blah, blah, blah. Did, did you go to my guy?

[00:23:46] Will Sanchez: She was like, what are you talking about? Yeah, this guy is like, no, I went to this guy and she found out that her husband got cheap and kind of got like a Groupon 50 percent off of one eye or the other and wound up having to go back to the original guy to get it [00:24:00] fixed. So in a weird way, you know, like I said, I'm going off the beaten path.

[00:24:05] Will Sanchez: You're not off. You pay for what you get. In this case, he got cheap on it. Didn't get what the necessary tools. And the result was a very angry wife that did not celebrate a birthday. So

[00:24:19] Dr. Grant Garcia: it's one way to think about

[00:24:20] Will Sanchez: it.

[00:24:20] Dr. Grant Garcia: Thankfully, I mean, again, there are a lot of other product companies that have make good products, but I think what we're trying to get at here is that you have this consistent quality, which to me is really important.

[00:24:31] Dr. Grant Garcia: And I'm, my patients are looking for it. My patients are like, did you put metal in me? That's the one thing that's just put metal in me. What type of anchors did you use? Like I get the Boeing engineers, I get the Microsoft, I get the Facebook and they've done all the research, right? They've seen the Olympics and they saw the two players that got back after Arthrex and they're asking me, am I going to do it?

[00:24:50] Dr. Grant Garcia: We'll ask this, am I going to do a speed bridge? Right. So if you don't offer that option, what are you going to do? Right. You got to stay up with the times. And so to me, it's the patients [00:25:00] have gotten smart and that's what helped build, honestly, for surgeons listening. One of my, one of my biggest polling points is that I, is that I offer some of these products because the patients want it.

[00:25:09] Dr. Grant Garcia: I mean, it's just a no brainer patients want their ACL repaired, and if you can do a good job on it, you have an awesome product that you can support. It makes it easier. And it's a heck of a lot easier for me to. Offer the surgery for the patients when I feel like consistently I'm not giving up something right like if I knew something would save me money And it was inferior.

[00:25:27] Dr. Grant Garcia: I would absolutely never ever use it in a patient and I might and I talked about this with my partners and everybody else. It's like, why are you using this thing versus this? I'm like, I think it's better. And if I didn't think it's better, and that's the best part about Austin and why our relationship works out.

[00:25:41] Dr. Grant Garcia: If I don't think it's better, Austin's like, then don't use it like Austin's in sales. But I can tell you right now, if Austin sells me something that's expensive and crappy, sorry to put on the, on the call, he knows I'm done. I'm not going to ever trust him on that product. And so he, that's what's really good about them too.

[00:25:56] Dr. Grant Garcia: It's not overselling, right? We're in sales, [00:26:00] trust me, it's a business and that's the way it works. But at the same point, it's amazing to focus, you know, with corporate Arthrex, but also this relationship we have with Arthrex and Pacific Northwest. Austin's team is that it's, I mean, you can describe this better, but you guys really, you don't, that's not your goal.

[00:26:18] Dr. Grant Garcia: Like you're not, your primary goal is not, you know, we have to find a way to get involved in everything possible. It's more like, what do you, what do you need? What's going on here? What's the problem here? What's your issue here?

[00:26:29] Auston Robinson: Absolutely. I mean, you know, that's a another unique approach that I think Arthrex senior leadership has understood and done very well for a long time.

[00:26:37] Auston Robinson: They look at solutions for problems, right? You know, we're we're a partner and we're a symbiotic partnership between the two of us. You treat the patients. How can we make your job easier? How can we make sure that if that's my mother on the table, she has the best, most optimized outcome possible. And I, you know, I, I appreciate the fact that you, uh, recognize the value [00:27:00] there, because I think that's a really important part of what we do.

[00:27:03] Auston Robinson: Um, and you know, it's, it's not dissimilar to, uh, Surgeons reputations in the community, right? I mean, the value that you provide to a patient, the experience that you provide to the patient, uh, is not the only distinguishing factor that sets you apart, but it's certainly something that attracts patients to you from the word of mouth reputation that you've developed, uh, along with your, your exceptional skills.

[00:27:26] Auston Robinson: But we, you know, for us, it's very similar. We can come in and try to hammer you over the head with what we want you to use. But I'm not an orthopedic surgeon. Uh, you know, I understand it at a lower level, but I do know that we can offer solutions to problems and make the patient's outcomes better with the technology.

[00:27:44] Auston Robinson: So we want to introduce those things. We want to make sure people are aware and raise the awareness level. And Arthrex has done incredibly well at that as well with things like in terms of the living up to the You know, commitment to education with our orthopedia website, Reinholds invested immense amounts of [00:28:00] money into that resource that is not even branded Arthrex.

[00:28:03] Auston Robinson: It's just a resource for people to learn around the world on, uh, surgical techniques and biomechanics. Dr. Chris Adams, our global director of medical education, who's a Burkhart fellow orthopedic trained surgeon, very successful guy has committed a ton of hours with an impressive team to, Build out those resources where they, they go through the anatomy, then the biomechanics, then the clinical relevancy and, and so on and so forth.

[00:28:28] Auston Robinson: Uh, you know, you, you've seen that, that, uh, website, but it's an incredible commitment, you know, and, and they back it up with their actions, which is a really fun thing to be a part of.

[00:28:37] Dr. Grant Garcia: And I think before I talk about the thing behind me, um, I think we should tell people too, you know, people want to know they've seen posts of like, I fly to Naples, right?

[00:28:46] Dr. Grant Garcia: It's a far distance. And obviously there is some level of competition when I fly, but at the same point, it's still time away from work, time away from my family. So what's the reason for doing it? Well, the reason for doing it and the reason that, you know, any surgeon who's interested should [00:29:00] learn about it or see the headquarters or even go downtown to, uh, you know, Uh, you know, Kirkland to see it is the really the teaching and what's gone into the resources to allow us to do this.

[00:29:10] Dr. Grant Garcia: I mean, if you want to show the headquarters, I mean, it's just absolutely gorgeous. Well, it's, it's got, you know, pick a ball courts, its own hotel, its own restaurant. Like this is talking about, like, this is like, this is better than going to Vegas for an orthopedic surgeon. Trust me. And the, uh, and the labs.

[00:29:27] Dr. Grant Garcia: I mean, you, you might see eventually, well, a video where I'm in an operating room, it's not even the operating room. It's just like an operating. They've built up just for videos to show people like in an operating room. And they've got a studio, one of like seven in the country, and that's called studio X and that's behind me.

[00:29:42] Dr. Grant Garcia: And what it is, they can turn into anything they want, any environment, and they can film commercials there locally. It's pretty sick. But what they really do use it for is to teach. Other surgeons and to teach patients and I think they have you guys have you know You've we've talked about my videos on my website I've got so many 200 [00:30:00] 300 and part of that is honestly just mimicking stuff that arthrax has done Because it works so well for me to learn right like all of us want to learn and the surgical videos are so important But the, I mean, the amount of money that, that Reinholtz invested in it is, this is not like, there's no reason to have done that much money.

[00:30:17] Dr. Grant Garcia: He just did it because he's, he wants to show everybody and he wants to have the best video products, right? There's no reason to have 25 K videos for your products from us, from a monetary standpoint, right? It doesn't make a difference in my opinion to show that. And to make, you don't make more money off that.

[00:30:34] Dr. Grant Garcia: He's just doing it because he wants people to have the best and if he wants to, she wants to show his stuff in the best possible format, would you agree? And that's what you were talking about. You know, he doesn't always, it's not always about the dollar or it's not about the stockholder. It's about, it's about, well, how can I show that?

[00:30:49] Dr. Grant Garcia: How can I have the best? And how can I give everybody the best experience?

[00:30:52] Auston Robinson: Absolutely. Yeah. You know, not to sound cliche, but it's been described as a nexus of innovation. And, you know, as, uh, [00:31:00] as, uh, interesting as that may sound, it really lives up to its reputation. Reinholds designed it to be such so that, You know, people have a place in the country where they can go and inevitably you bump into another surgeon from, you know, another part of the country and they're talking about challenges or world, right?

[00:31:18] Auston Robinson: Yeah, we come across Europeans and South Americans and people from Asia Pacific region and they're experiencing the same challenges, same anatomy, same injuries. And you can rub elbows together and say, Hey, how can we make this better? And then Reinhold says, you know, to the to the degree of having rapid prototyping and, uh, you know, visually enabling technologies to improve the patient's experiences.

[00:31:42] Auston Robinson: And I can say without hesitation, He, you know, in, in even the personal conversations, he's so devoted and committed to the experience of improving the patient, uh, patient's experience, the patient's outcome and supporting the surgeon in a way that they have the resources and they see that as an extension [00:32:00] of their practice to be successful.

[00:32:02] Auston Robinson: It's, it's really a remarkable thing.

[00:32:05] Dr. Grant Garcia: So well, how many times, oh, sorry. One second. Ask a question. Well, how many times have you seen a company? As big as Arthrex and everybody knows the CEO by first and last name and where you go to a random event, let's say you have. Walmart and you go to a Walmart function and the Walmart CEO is hanging out there.

[00:32:25] Dr. Grant Garcia: Let's say you have like a McDonald's and the McDonald's CEO is out there. Again, not belittling anything that Arthrex does, but I don't want to get to the proprietary of other companies, but it's one of the few companies where the CEO is constantly there and involved. And that's what's, I think that's really what makes a difference, right?

[00:32:39] Dr. Grant Garcia: You know, I mean, I'm out there, Will, I'm out there for something. And all of a sudden he shows up at breakfast and he's like, Hey Grant. Hey Garcia. And I'm like, this is the CEO of Arthrex. And you know, he's just, he, he knows everybody. He just has that. And he asks, starts asking questions. What do you think about this?

[00:32:53] Dr. Grant Garcia: What do you think about this? I'm just like, holy cow. This is a lot of information. This is the guy who's the CEO of the company. So, I mean, it's just the [00:33:00] involvement and that makes you feel really good, right? Like, well, if you work for working for, if you're working for someplace, you never knew your boss, you never knew anybody else, and you just basically did your job and you kind of sat down and you kind of sat there, it's hard, right?

[00:33:12] Dr. Grant Garcia: But to see all those people involved and so committed is it's pretty. It's pretty impressive. It shows the mentality. [00:33:19] Will Sanchez: Yeah. And that shows that it's organizational culture, right? So obviously I've never met this individual, but what has been discussed and how his policy is, that is what he's promoting breeding and encouraging.

[00:33:34] Will Sanchez: Right. Is that culture. So he's setting the standard. So then. Everyone else could follow along. And that's why you have folks like Austin and some other people that will be a part of your community, because that's the culture that he's fostering. So on my culture there, anyway, so we talked about technology.

[00:33:54] Will Sanchez: We talked about innovation and it's 2024. And what is the hot [00:34:00] topic that's happening right now? That. Is the super advancement in technology, right? The, the industrial revolution of this, uh, decade in a century is going to be AI. So how is AI machine learning virtual reality? How are they starting to think about that?

[00:34:19] Will Sanchez: To apply that to not only the tech you have now. but future tech going down the road?

[00:34:27] Auston Robinson: That's a great question. Uh, and it's an exciting frontier to be a part of. Arthrex is always looking at ways to enhance, you know, the offerings that they provide the surgeons for the patients. And one of those areas that they can use machine learning is, uh, you know, we, we, in our shoulder arthroplasty, uh, portfolio, we have a tool that is, uh, uh, tool that is accessible to all surgeons.

[00:34:48] Auston Robinson: It's the, uh, we call it a VIP targeting system, but it's based off of the patient's native anatomy through CT, uh, examination, digitization. And so, uh, with machine learning, they [00:35:00] can look at this array of, uh, CT images of different shoulders and identify based on the patient's anatomy and the morphology of their scapula and the humerus and the chromium, there's an optimal position of the products and the implants.

[00:35:15] Auston Robinson: in, during the surgical intervention. And that is a game changer because you don't have to wonder, is this screw going to go through and hit a nerve? Is this a base plate going to be too far lateral? The machine learning, uh, based on the formulas and the weights and inputs that they include in the algorithms allow you to have a much more precise determination.

[00:35:32] Auston Robinson: And now they can start to, and we're, I think we're still exploring this, but can start to upload or include. other patient specific considerations like, uh, other other components of their health and their their genetic background, things like that to make more specific decision making that allows for the surgeon to not have to wonder as much.

[00:35:55] Auston Robinson: Not that they're I don't think the surgeons are necessarily wondering often, but [00:36:00] it reduces and eliminates some of that. uh, gray area in, in terms of implant position and implant sizing selections. That's just one unique way I think, uh, Arthrex is doing it. They're looking at, you know, different ways that they can, uh, visualize or the surgeon can visualize intraoperatively the anatomy, say for a spine and some of the revolutionary, uh, designs that Arthrex has partnered with some really, uh, exceptional surgeons in the spine world to better.

[00:36:28] Auston Robinson: visualize and identify patient's anatomy when they're suffering from extreme pain. Okay, just

[00:36:34] Will Sanchez: to follow up on that, uh, can you see a world where Arthrex is not only leading a technology with, um, what's, what you're doing now for surgical outcomes, but also in a preventive way with having this AI information about the anatomy and seeing where there may be certain situation because, you know, they've ruptured their Achilles twice and they know their tendons [00:37:00] a certain way where, where maybe, and maybe I'm going, you know, to keep

[00:37:04] Dr. Grant Garcia: going, keep going, we see

[00:37:07] Will Sanchez: this arthrax preventative, uh, innovation headed.

[00:37:12] Will Sanchez: down the road.

[00:37:14] Dr. Grant Garcia: So I'm going to help a little bit and then I'll let him jump in. Sorry, but this is amazing. Will. Arthrex's focus is not on putting a hundred implants into a patient and revision, revision, revision. Arthrex's, Arthrex's goal by adding such as the, and Will don't get too excited yet, internal brace, adding biologics, adding all these things is so that you don't have to come and do the surgery again.

[00:37:36] Dr. Grant Garcia: And whether it will be more cost effective, that's the key here is. No more second surgery. And that's why I use a lot of my Arthrex products. Because I don't want to do another surgery on a patient. I want to give them the internal brace. The regular ACL. If I need to add biologics, do what I will. With the ACL repair, we're working on more biologics, tissue engineering, biomaterials, you name it.

[00:37:58] Auston Robinson: Wound

[00:37:59] Dr. Grant Garcia: healing, [00:38:00] jumpstart, amniotic patches, well, we could go all day on this stuff. That is the number one thing they want they want to find ways to prevent the second surgery preventing original surgery There's biologics. There's all these different things too that they have again. I digress Awesome.

[00:38:18] Dr. Grant Garcia: Keep going. Sorry.

[00:38:19] Auston Robinson: No that no, that's great insight. Dr. Garcia. I appreciate it. But yes Will, your question, can I envision a world where Arthrex is leading the way in that space, uh, with the leadership that we have, uh, in the organization and the teams that we have abroad, I can envision, uh, leading in any space, but especially in the, the area of preventative medicine, uh, you know, we have among the companies that are in orthopedics and in, in the industry, the broadest portfolio of, uh, biologics.

[00:38:49] Auston Robinson: implements that are our customers are exposed to, uh, to consider the entire algorithm of care, if you will, in how they treat the patient prior to [00:39:00] degeneration of tissue or cartilage during the procedure and then also postoperatively. So biologics, I know, uh, internally, our leadership is So strongly supportive of that direction that they're implementing those things in their own bodies on a regular basis, you know, to prevent arthritis, prevent tendinopathies, different things like that, uh, in a way that is, it just shows the commitment to the development in the, into the space.

[00:39:29] Auston Robinson: And I think that that's something that Arthrex is going to, I can't speak for Arthrex, uh, in terms of, you know, organizational, uh, strategic initiatives. But from my perspective and from what I've heard, I would say that they're absolutely geared up to do whatever they can to make it so that the patient doesn't have to, uh, you know, have the problems that they're potentially going to have.

[00:39:49] Auston Robinson: And that's that's, you know, if the patient's at the forefront or in focus in a topic and there's a way to get better, Arthrex is going to at least from my perspective, continue to do [00:40:00] what they can and invest in developing ways to mitigate the risk for the patient.

[00:40:05] Will Sanchez: The key word that you said, you said a lot of important things.

[00:40:09] Will Sanchez: But when you said arthritis and there's so many people that suffer through that, um, and getting closer to, uh, relief. One of many different ways, uh, that, that should be excited for everyone along with, uh, all the other things that you talked about with, uh, you know, preventive medicine. So it's really exciting.

[00:40:28] Dr. Grant Garcia: Well, and one more thing, I think what Austin brought up, but that's really important. It's very rare in a company. Is the size of Arthrex is a little bit alarming to some surgeons and overall when you hear about it, but the size is what gives them their domination because they have crosstalk between the groups.

[00:40:43] Dr. Grant Garcia: Like I'm, when I work in on something with ACL repair and I'm like, Hey, I want to add biologics. I want my patients to even have a better healing rate. I'm not satisfied with. 90%. I'm not satisfied with 96 percent healing rates. I want 100. I want 99. They're looking at, and again, we can pull up the tight [00:41:00] rope, uh, which I love talking about, uh, in there, but they're like, let's get the biologics team involved.

[00:41:06] Dr. Grant Garcia: Or Austin's like, let me look at the portfolio. And because they have so much in their portfolio, um, this thing in three or four years, as amazing as it's going to hear. And obviously the whole knee team's going to hear me say this is probably going to be even obsolete for Arthrex soon. Cause it's just, it's so good, but we can make it even better, right?

[00:41:23] Dr. Grant Garcia: We can add biologics to it. Can we get the healing up? Right? Like maybe this technique is going to stay there, but there's going to be something added to it. Like we're, we're not even close. Uh, you know, we're not even, we're not even close to the end of this sort of rain of continuing to improve. Would you agree?

[00:41:39] Auston Robinson: Absolutely. I think, you know, as long as there's injuries, we're going to continue to pursue with vigor, better ways to treat them. Right. And in optimizing the patient's outcome, as long as there's a patient on the table, uh, we can get, we can continue to get better. And again, I can't speak to Arthrex corporate strategic initiatives as an agency representative in, in the [00:42:00] little, uh, state of Washington, but, uh, from what I know, from what I see, I would absolutely, uh, expect that if they're, uh, If there's an opportunity, they're thinking of a way to make it better.

[00:42:10] Auston Robinson: The thing in a way to make the patient get back to activity quicker, to get back to sport quicker, to get back to work quicker for the patients that, you know, a lot of these surgeries require a lot of downtime, you know, I think of, you know, somebody that's a single parent can't afford to take six weeks laying down because they have back pain.

[00:42:28] Auston Robinson: So, You, you know, the, we could go way off topic on that, that issue. But I, as an example, I was getting a haircut a couple of weeks ago. And, um, my barber is a female. She said, I'm really struggling with this pain in my leg and said, have you seen a spine surgeon? And she said, I have, they've done some injections.

[00:42:46] Auston Robinson: Now they want me to get surgery. They say I need a decompression. And I talked to her about, you know, our arthritis has recently made a foray into endoscopic spine surgery. And instead of doing a large two centimeter incision, you can do it through a scope, [00:43:00] eight millimeter incision. And she started. Dr.

[00:43:02] Auston Robinson: Schaefer, Dr. Schaefer. Well,

[00:43:04] Dr. Grant Garcia: that's what we have. We just had him on talking about arthritic stuff.

[00:43:07] Auston Robinson: Yep. Incredible surgeon. And, and, uh, similar to you cut from a similar cloth and in terms of, uh, you know, an affinity for innovation and how to optimize the patient's outcome. But she broke down. She said, I'm a single mom.

[00:43:19] Auston Robinson: And they told me I would have to take six weeks off of work. I can't afford to take six weeks off. And I said, talk to, yeah, I recommended Dr. Schaefer, gave her, uh, your practice's number and the website. And I said, people are getting, you know, endoscopic spine decompressions and they're walking out of the ASC.

[00:43:36] Auston Robinson: They're, they're back to work two days later. It's incredible what's going on. And, and, you know, that that's cool from a technology standpoint, but man, it's really impactful from a patient outcomes perspective.

[00:43:48] Dr. Grant Garcia: Well, and I think, I think what you brought up is really important. Some patients don't understand the technology sometimes, and that's why we have this show.

[00:43:55] Dr. Grant Garcia: Just tell people about the new technology. That's why I had as soon as Andre got in practice [00:44:00] with us to talk about endoscopic spine because I don't think and it's sad because what you said is calming. I mean, I literally just had Multiple patients I saw today in the clinic and the lady was like, I can't believe my ACL is going to be walking out of there and I'm gonna be moving this quickly and I'm gonna, you know, my, or my UCL, I can start throwing the baseball so soon.

[00:44:17] Dr. Grant Garcia: I thought that it would take longer. Like, my last one did not or the other surgeon told me this and I'm like, listen, the technology we have, I can let you rip. Right. We can, we can do it right. This, you have an internal brace in that ACL. You can go harder on it. Like, it doesn't mean that we're going to be too aggressive in room.

[00:44:33] Dr. Grant Garcia: I mean, we just had an ACL repair patient and she was worried cause she had seen other protocols and they were slow. And she's like, I don't, I'm worried about tearing this. And I'm like, listen, this new ACL repair is way stronger. I feel much better letting you go. And it just, you could just see her face just calm down.

[00:44:51] Dr. Grant Garcia: Oh my gosh. I'm not going to tear this right away. I know you're not, I trust it. That's why I do so many of these. And so I think we'll can attest to this, but [00:45:00] having that basic technology and we can bring it up, we can talk about internal brace for a few minutes. Well, if you'd like to bring it up, but it's just part of me.

[00:45:07] Dr. Grant Garcia: Yeah. Talk about that. Honestly, Austin, you, you, you, uh, you're, you're, you know, you're the master of all things. But how is the internal brace concept? changed your entire perception of things.

[00:45:24] Auston Robinson: It's incredible. I mean, you know, when you look at the incidents of of retail rates and a lot of these, we've, you know, Gordon McKay back in, uh, you know, the late early 20 teens, mid 20 teens really put some interesting work.

[00:45:39] Auston Robinson: A surgeon out of Scotland into the lateral ankle and Pat Smith and yourself and so many have really kind of been willing to give this a shot for their patients. And I think the data has shown that there is a tremendous value added to the procedure for the patient if it's incorporated. Um, you know, it started out as [00:46:00] a as a supplement for A.

[00:46:02] Auston Robinson: T. F. L. Ligament repair or, or, uh, you know, it's called a brochure procedure. Uh, and you have these patients that are, are frequently rolling their ankles. Cause I think Dr. Muffuli published, 10 year data that showed that they, the, the native tissue repair stretches out over time. So is there a way to strengthen this?

[00:46:20] Auston Robinson: So the patients don't, as you mentioned earlier, don't need a second surgery, don't need a revision to this. And it's, it worked so well. People started to think innovative surgeons started to think maybe this could be applied in other ligamentous. uh, areas of repair and reconstruction. And now we see, you know, people using these and we see second looks where a patient gets into a car accident and they hit their tibia on the dashboard and their femur slides way forward.

[00:46:46] Auston Robinson: And all of a sudden, uh, the tight rope or excuse me, the internal brace ruptures, but their ligaments intact. So we preserved them from needing an entire new reconstruction.

[00:46:57] Dr. Grant Garcia: I have personally had that. Where a patient I scoped [00:47:00] him and I saw the internal brace it, uh, had torn and the ligament was still intact or you go in there and you scope them for another reason.

[00:47:07] Dr. Grant Garcia: You see the internal braces grown into the A. C. L. It's just incredible.

[00:47:11] Auston Robinson: I mean, you know, the seventies people didn't work hard seatbelts, right? And then they were invented and somebody quickly realized we should put these in every vehicle. And it's very similar to the the advent of the internal brace where why you know Maybe it's not relevant to every procedure But why wouldn't you do it if you can give the patient a more optimal outcome with that backstop in the in the construct

[00:47:37] Dr. Grant Garcia: This is a good question I get this a lot from patients and will may have this question too since he has part internal brace in his body the uh, the I would say this question You Is it going to damage my ligaments?

[00:47:50] Dr. Grant Garcia: But I mean in your perspective I have I tell them I put in More I put in over that I've put in thousands of these and it actually grows into [00:48:00] ligaments Is that what you guys have seen like what is your experience with this? I mean that doesn't to me. It's very inert It's collagen impregnated, right?

[00:48:06] Auston Robinson: That's right. It's, it's synovializes with the ligamentous repair, uh, and healing process. And we've put millions of strands of fiber tape into human bodies since the early 2000s. And that reaction rate is, is, uh, insignificant. And so it's an incredibly safe, inert product that is there as a support for the construct that gives the patient the opportunity to prevent re tear of their ligament.

[00:48:31] Auston Robinson: Uh, you know, and it's a great adjunct to what's being done biologically there. Uh, because we all, I mean, you can speak to the science far better than I can, but as those graphs reincorporate, we know that they kind of turn into a jelly before they really reconstitute as a ligamentous tissue. So in that season of reconstitution, having something there that can offer a little bit of mechanical support.

[00:48:54] Auston Robinson: Makes a lot of sense. And, and I think the data shows that.

[00:48:58] Will Sanchez: Got a quick question here. Um, as [00:49:00] we get ready for, um, the NFL season that's coming up and just looking across the board, um, where around the world, football is the number one sport here. It's NFL. Can you see, um, a place where owners, and this is.

[00:49:19] Will Sanchez: Probably just personal thought, not trying to label the company's, uh, thought process behind us, but where these owners in these big industries could possibly start to incorporate some of these things in their, uh, players. For example, we see every offensive and defensive lineman pretty much wear knee braces, right?

[00:49:39] Will Sanchez: We know that between knees and ankle damages in the sport of football, um, It takes time away from the pitch and, you know, these billion dollars, you know, worth of revenue that come through. Um, especially if it's deemed safe, is it something that you can see, or is this kind of a [00:50:00] little farfetched as far as what, you know, we may see in the future of sport, protecting their investment and maybe not exactly the internal brace, but maybe there's some future tech alone.

[00:50:11] Will Sanchez: No,

[00:50:11] Dr. Grant Garcia: I think this is a great point. I think what. You're asking for is that's what they do. The arthritis teaches the team doctors. I mean, you have a team physician meeting. For all the team surgeons in the country that come to it and they learn about techniques that the other team positions are doing. And so it becomes a standard of care in the NFL, right?

[00:50:30] Dr. Grant Garcia: I mean, that's pretty much what that meeting is for. It's an incredible meeting. Um, and you can talk more about it briefly, but. Will, you're that's already happening. You just don't know about.

[00:50:41] Auston Robinson: Yeah, I think we, you know, we see more and more stories of high profile athletes that, you know, to your point of protecting the investment, uh, from the, the team's perspective, it makes sense, right?

[00:50:52] Auston Robinson: I mean, anecdotally, I've heard, uh, team doctors say that there's even been big linemen that, that have had a history of rolling their ankles, [00:51:00] asking for the internal brace prophylactically, uh, just as a preventative measure. Um, no, I don't think any surgeon in good conscious, uh, in good conscience to do that.

[00:51:09] Auston Robinson: Uh, you know, but the concept is there, uh, you know, be for the same reason you're asking the question. It makes a ton of sense to reinforce some of those, uh, injury prone anatomic location.

[00:51:22] Will Sanchez: And maybe this is the question that we're talking about leading into, you know, future tech, right? Because maybe it's not set up exactly the way it is now, but maybe as we go ahead and look five, 10 years from now and seeing a product that Is safe that can help, uh, players, you know, maybe this is something along the lines where there's Arthrex or anyone else that, you know, they're protecting this huge investment because we were seeing common injuries, injuries in certain sport, um, to protect.

[00:51:50] Will Sanchez: And, uh, it'll be interesting to see what happens. So as we always, I think you're on

[00:51:54] Dr. Grant Garcia: to a new show idea, by the way, this is phenomenal, this has been talked about in ACL [00:52:00] repair, there is, there was some theory. That if you didn't, if you didn't, uh, so an ACL repair, sometimes you do an extra ligament called the extra articular, um, tinnitus with called an IT band, or you can do an ALL reconstruction.

[00:52:13] Dr. Grant Garcia: There's some thoughts about doing that second ligament, but just doing internal brace, if someone hasn't told their ACL, but it's a high prone. And actually, I don't even know if there's a public study. I thought there was on this. It seemed like, I don't know how the IRB would approve it. Um, but some players have been considering doing that to prevent getting their ACL torn.

[00:52:31] Dr. Grant Garcia: Um, so you're onto this. And I. Don't know how it will ever ethically get approved or how anybody would ever undergo it, but there are some athletes that want the edge and an ACL tear is devastating or an ankle sprain. We've seen hundreds of those in the NFL, you know, Saquon, obviously not, no longer giants.

[00:52:47] Dr. Grant Garcia: We don't want to talk about it too much, but you know, roll, roll this ankle. Will and I are both giants fans, by the way. So, uh, I do think. [00:53:00] That it'll be prophylactic or though what we've seen now is surgery happens sooner. right? We have better instruments. So the old way of like, let's wait 20 times before you get surgery.

[00:53:10] Dr. Grant Garcia: Now it's like you're getting surgery right now. Like it's way better this new way, right? My homes are not homes. And there was other player that got an internal brace for his MPFL, his dislocating kneecap. And it was way earlier than he should have. And he ended up doing great because it's much faster recovery than standard reconstruction, right?

[00:53:26] Dr. Grant Garcia: Those are the type of things I will. So prophylactic before the injury happens or prophylactic before the standard would happen for surgery. Yeah. And therefore, you reduce the issues later on. So everything you're talking about is spot on. Well, you're, you should do it.

[00:53:40] Auston Robinson: Yeah, that's right.

[00:53:42] Will Sanchez: All right, Garcia, we, we need to wrap it up here.

[00:53:44] Will Sanchez: Um, but before we go, um, Austin, if you could control all of it, what would you like to see? Five years from now, 10 years from now, um, as far as a [00:54:00] revolutionary tool or something biometric to help the patient and surgeon collaborate to, uh, take this to a whole other level, you've got the power, you're the God of Arthrex and all this little toys, what would Austin do with this power?

[00:54:17] Auston Robinson: I'd love to come up with something unique, but I'm sure, uh, Reinhold's already thought of it. Uh, yeah, I, I, uh, I think that, you know, we would love to see things in from my perspective, you know, with the patient being the center of our focus, anything that we could do to anticipate the injury, like if there is a device that could be used to test the quality of of ligaments and tendons and look at their, their native tensile strength.

[00:54:42] Auston Robinson: Uh, before the sports injury occurs or, uh, if we could test the, uh, annular tissue of the, of the vertebral disc in, in determine whether or not their disc was going to rupture and go in and, uh, somehow with minimally or ultra minimally and basically, uh, Prevent that from [00:55:00] happening, I think would be remarkable technology, and I don't see why it's not gonna be something that we see in the in the near future, with all the development going on in the tech space and the merging of tech into into medicine.

[00:55:12] Auston Robinson: And, you know, you see different ads for a I being able to detect detect the breast tumor years before it actually develops those kinds of things that is going to Be a game changer for families around the world. Uh, and I think it would be a lot of fun to see Arthur X be a part of that because selfishly I'd love to be a part of it as well.

[00:55:31] Dr. Grant Garcia: I love that. And I think that's going to be the future. Right? You know, AI learning on MRIs. They're like, your disc is about to herniate. Go see the surgeon, 20 minute endoscopic procedure, little tiny patch, little internal brace on the disc will make him happy. And you know, the surgery takes 15 minutes.

[00:55:47] Dr. Grant Garcia: There's no recovery time because you never got hurt in the first place, right? You're almost got hurt, but didn't get fully hurt. And now you never going to tear that disc again. Right? Like that's, that's, that's what it's at. Well,

[00:55:58] Will Sanchez: Austin, thank [00:56:00] you so much for taking time. Uh, this was extremely informative and we really appreciate you, uh, being a part of the show.

[00:56:07] Will Sanchez: So, uh, thank you. I know Garcia talks to you all the time, but, uh, it was my pleasure to have you on. So thank you. Garcia. Thank you for the Austin.

[00:56:16] Auston Robinson: I really appreciate you having me. It's a real privilege. I'll talk to you

[00:56:18] Dr. Grant Garcia: tomorrow, Austin.

[00:56:19] Auston Robinson: I'll look forward to it.

[00:56:23] Will Sanchez: Dr. Garcia, man, Austin Robinson, that was awesome.

[00:56:26] Will Sanchez: Um, you talk too much. Look, we're almost at an hour. It's all your fault. We're just going to blame you for everything. I don't know. I know.

[00:56:33] Dr. Grant Garcia: It's because you give me too many layups, man. It's great. Unfortunately, I like all the guests too much. That's the problem. We need to pick some guests that are, I don't want nothing to do with.

[00:56:41] Dr. Grant Garcia: Then we won't chat. Yeah.

[00:56:42] Will Sanchez: Yeah, that won't be any fun. And we'll just be staring at each other and just comparing backgrounds. But listen, a lot of great information, right? You know, we, we talked about training, you know, a VIP targeting system, machine learning, preventative medicine, biomaterials, tissue, engineering, largest [00:57:00] portfolio,

[00:57:00] Auston Robinson: Austin

[00:57:02] Will Sanchez: has, I loved his answer on future tech.

[00:57:06] Will Sanchez: I mean, that is exactly, it is not a pie in the sky kind of answer. This is a legit answer where we all go. Yeah, that sounds great. Sign me up. I'll take one of those. And, um, you know, let me know when something's bad is going to happen in my body, right? Because that's what we want to get to. Right. And whether it's, I know, I know I'm going, here I go.

[00:57:28] Will Sanchez: I'm doing a one 80 here. Right. You go get a colonoscopy because you're trying to be prevented, right? You, you go through, you, you do certain things to make sure that you're going to be okay, and you're catching it early. That's exactly what we're talking about is having some tech besides the wonderful things that they do now is eventually, hopefully getting to that point as well.

[00:57:49] Will Sanchez: We can do better. Well,

[00:57:50] Dr. Grant Garcia: we can always do better, right? That's the one thing of the show. If you, I tell everyone this, if I'm doing the same thing I did five years ago, then I shouldn't be doing it because [00:58:00] you're not innovating. So preventative medicine is huge and preventive orthopedics is actually not talked about that often because I hate to say it.

[00:58:07] Dr. Grant Garcia: We like surgery. So, but if I could find a way to prevent people from having injuries and being fearful of injuring themselves and get to all the sports they love. I think that's honestly the best thing. And that is, I really appreciate Austin coming on and all the viewers listening. And I know we need to wrap it up cause we're on a minute and 40 seconds before we get kicked off.

[00:58:26] Will Sanchez: We're not going to kicked off, but we got to stay under the 60 minute. And I love the thing that you guys talked about in the beginning saying, yes, this works. But we can make it work better. And it's been changed two, three, four times, not because it didn't work or it failed is because you found a way to like, this works great, but if we do this, we can make it work better.

[00:58:47] Will Sanchez: So I, you know, that's something that I took out of it, that conversation as well, and that's something that. Everyone should be excited about. It's not, not only that this is, you know, we're doing something that's great and we utilize in the tool. That's great. But [00:59:00] how can we make it better? And I think that was the common theme throughout all this.

[00:59:04] Will Sanchez: How can we make it better? Dr. Garcia, we're going to wrap it up. We've got NFL and everybody's excited. I don't know how I'm feeling about the Giants. We'll talk about that the next show, but we're going to talk about key players coming back from injury, major injuries, how that affects the upcoming NFL season.

[00:59:21] Will Sanchez: And then somewhere along the lines, we'll probably take about two minutes and cry in our bowl about the upcoming Giants season. But as always, Dr. Garcia, our sports medicine orthopedic specialists, thank you for being with us. You rock as always. Um,

[00:59:42] Dr. Grant Garcia: Thank you, Will. Always good. Great episode. Thanks, guys. Audio Transcript

[00:00:38] Will Sanchez: He's got this cool, funky background going on, man. This is very like, wow, look at that. This is a Stanley Kubrick kind of thing going on, man. How

[00:00:46] Dr. Grant Garcia: are you? I'm good. This, this is a nice fun. I, you texted me this weekend. You said to this, you talked about this, uh, Mike trout injury. And I was like, you know what?

[00:00:53] Dr. Grant Garcia: It's time. This is our first. 15 minute segment. All the other ones have been [00:01:00] audio, so this is the first blast, um, and we're hoping for this season, uh, to do a few more of these, because I think that our listeners like these a lot, like, because it's more, it's more cutting edge, it's more, uh, recent, um, and this, this is the first time we've done this.

[00:01:15] Dr. Grant Garcia: meniscus stuff we're going to talk about is just keeps coming up. It's just nonstop with these. We just talked about an Olympic episode literally last week.

[00:01:24] Will Sanchez: Yeah. Yeah. And, and listen, it, when you have an injury to a first ballot hall of famer and Mike Trout, uh, someone that his career path was, you know, up there with some of the greatest players ever, except for the last five years now, where he's been pretty much robbed of a complete baseball season.

[00:01:45] Will Sanchez: And we'll show you the stats later on, uh, due to injuries. So just to recap on April 29th, Mike Trout, uh, was playing in a game. Uh, felt a little something in his knee, [00:02:00] went, ran the bases, played the outfield. Um, you know, came, came in, was like, yeah, I think I'm good. Didn't, no concerns. He goes home and, and I want you to kind of chime in on this.

[00:02:13] Will Sanchez: He goes home. goes to bed and it's like, Oh, something is not feeling right. I'm ha he's having pain. He, he's going through pain at night, wakes up in the morning, calls the doctors, like, Hey, I'm having some issues with, with my knee. Um, you know, maybe we should just go check it out just in case he wasn't thinking of anything because of the way that he was able to complete the game.

[00:02:38] Will Sanchez: Finds out when April 29th that he's, he tore his meniscus before we go further. What happened to Mike Trout? Is it just the adrenaline that kind of kept them going through or things didn't settle in? What happened when he got home at night, laid down, and when he was trying to sleep, all of a sudden this pain started coming off.

[00:02:59] Dr. Grant Garcia: So [00:03:00] one, you know, obviously you don't know the tear pattern. We didn't see the MRI. We talked about there's various tear patterns, right? You got these meniscus, it's C shaped.

[00:03:07] Will Sanchez: Yeah,

[00:03:07] Dr. Grant Garcia: you can have a radial tear. That's a big split. Probably not that usually that's a massive pop. And then you're like literally unable to walk, which is what we thought was happened to the Olympian.

[00:03:16] Dr. Grant Garcia: Right. Big crack. Yeah. This is a different thing. Uh, but again, we don't want to give away too much of it, but obviously it was repairable. So it was some tear pattern, maybe in the back of the meniscus where there's better blood supply. When you get a tear right there, uh, and usually it's a tear, it's a, it's a, he's probably from when he was batting or rounding the bases, right?

[00:03:36] Dr. Grant Garcia: Like it's a, it's a plant shift. And one thing that can increase the risk of this is probably the cleats, um, when he's batting, right? Cause you're, you're, you're plant the foot and then you're, you're cranking the knee. And if there's any pre, you know, they can have, you know, guys like this that are playing all the time, they can have these little small meniscus tears.

[00:03:54] Dr. Grant Garcia: We used to see, we took care of the giants, uh, and the mats and stuff. We'd have Monday morning kind of MRI [00:04:00] review and you get to see some crazy stuff in MRIs for players that are like still actively playing.

[00:04:04] Will Sanchez: Yeah.

[00:04:05] Dr. Grant Garcia: Right. So he may have had some small capsular tear that you couldn't really recognize, twisted, had some pain and maybe had a little tweak and he's like, Hey, I'm fine.

[00:04:12] Dr. Grant Garcia: I'm going to deal with it.

[00:04:13] Will Sanchez: Yeah. Yeah.

[00:04:13] Dr. Grant Garcia: Then he gets home. And what happens is these tend to ache and like my patients who have these special capsular tears or tears in the back where the blood supply, they say at night they have to put pillows between their legs and anytime they twist or move, it hurts a lot more and it probably started swelling up on it.

[00:04:30] Dr. Grant Garcia: So like, that's what he probably felt. And that's only me reading between the lines from experience from him at being in a fixable repair and just from the fact that the fact that it acted more at night and these, these tear patterns that he got these tend to be ones that people can kind of go up and down with, right?

[00:04:46] Dr. Grant Garcia: Like sometimes they know, but he's my trout. So he's getting MRI right away. Like some of these patients that come in, they're like, they've had it for two months. They've never really, they know they're just kind of like dealing with it.

[00:04:54] Will Sanchez: Yeah, so he has surgery on May 3rd, right? So we go back to April 29th.

[00:04:59] Will Sanchez: This is when he felt [00:05:00] that whatever happened to his knee, obviously we know that it was a torn meniscus, goes in May 3rd, uh, begins rehab assignment at AAA Salt Lake on July 24th. Before that, On the Thursday, they said that the MRI was clean and it was expected to start running shortly. And then he goes rehab assignment, plays two innings, leaves the game due to knee discomfort, right?

[00:05:27] Will Sanchez: And then they necessitated a follow up MRI, which revealed a new tear separate from the first one. And they're saying it's unclear. that how he tore his second or how he suffered a second tear. So I'm not going full, uh, conspiracy theory or what, but what is it? What, what, when you hear these things, what, what could have happened?

[00:05:54] Will Sanchez: Uh, because obviously this man is the franchise and the face of baseball. One of the faces [00:06:00] of baseball, the franchise for the angels, they wouldn't. I would assume that they're not going to risk his health based on them rushing him. So what happened? What do you think happened? The fact that he has an MRI, he has a meniscus tear and now suffers another one, uh, a month and a half later after surgery.

[00:06:20] Dr. Grant Garcia: Yeah, so again, obviously we don't hold me to this, right? We, or hold me to it, but you know how this works. We're predicting a surgery. Hold on. I'm writing down

[00:06:28] Will Sanchez: notes to hold you to it. Hold on a second. Write it

[00:06:30] Dr. Grant Garcia: down. Write it down. Maybe you'll find out in like six months. I had no idea what I was talking about.

[00:06:34] Dr. Grant Garcia: That's okay. That's how we do the show.

[00:06:36] Will Sanchez: So

[00:06:36] Dr. Grant Garcia: the uh, and again, thankfully my ego is not too soft. So I think I can handle it. So, you know, so the um, that's right. So basically he gets a fix. So you already know that the tear is a special type of tear, right? There's only certain tears we can fix. Some of these baseball players, school players, they get tears that are kind of just trashed meniscus, and you can't fix those, right?

[00:06:55] Dr. Grant Garcia: Probably not a root tear, probably not one of the more complex radial tears we talked about. He would have been out for a lot [00:07:00] longer, five, six months. So, I'm, I'm reading between the lines, right? He had a rate, he had a tear of the meniscus, and you guys see here, medial or lateral, generally they're medial, but I don't know which side his was.

[00:07:10] Dr. Grant Garcia: Medial means it's on the inside of the knee. You can see there. And then there's usually it's around the capsule. So the meniscus has blood supply in three zones, white, white, which means there's no blood supply. Those almost always get removed middle, which is red, white, occasionally fix those. And we're starting to push the envelope on fixing those, which you've talked about on previous episodes and younger patients.

[00:07:28] Dr. Grant Garcia: We fix them more. Um, and then red, red, which is right next to the blood supply. Those you want to fix as much as possible. Cause if you don't fix it. You remove a lot of meniscus and we've seen already we've talked about this a number of times on this on this show That removing that much meniscus is not good for people if you have to do it You know people ask like in their 50s like you're removing my meniscus.

[00:07:51] Dr. Grant Garcia: Why are you doing that? Well, I can't fix it then right it doesn't heal the same as it does in someone like mike trout who's still young uh active and healthy, um [00:08:00] And really the meniscus under, you know, 40, 30 years old. We just want to fix his man. He's

[00:08:04] Will Sanchez: 32 years old. Just to kind of give you the age group.

[00:08:07] Will Sanchez: He turned 32 years old. In fact, uh, it is, I think it's almost his birthday, August 7th. 33

[00:08:18] Dr. Grant Garcia: years old. Unfortunately, happy birthday to him. So anyhow, so the, um, so basically he gets this fixed and it's probably a capsular tear. He probably gets it fixed. There's different ways of doing this, right? There's stitches.

[00:08:29] Dr. Grant Garcia: You can do stitches from just two little poke holes. He can have a bunch of stitches in his knee and someone catches him out the back and he tie him in the back. And that's kind of like the more aggressive kind of gold standard method. So what happens is he gets that done and he gets his three month recovery.

[00:08:42] Dr. Grant Garcia: That's what makes me assume it was probably one of those, right? Cause it's only three months.

[00:08:46] Will Sanchez: Yeah.

[00:08:46] Dr. Grant Garcia: He starts running on it. He gets a clean MRI. The problem you have with the MRIs on these meniscus is you can't, I've been on my own meniscus and sometimes you think they MRIs are clean or you go in there for another reason, right?

[00:08:57] Dr. Grant Garcia: You rescope their knee cause they're having some other issue [00:09:00] or like a year or two later something else gets hurt, right? And you rescope them and then you go in there and you see like your meniscus repair is like mostly healed. There's still the stitches in there, but there's a line like where like imagine like your meniscus tear is like a full slit, right?

[00:09:13] Dr. Grant Garcia: It's the whole thickness of my fingers. Only like this much, only like this much healed, right? So you still have a layer that's a tear on the top, but on the MRI, it looks like it's a full connected tear repair. Cause what happens is scar tissue is really hard to pick up on these MRIs sometimes. So they always say like some of the reports, like I look at them as myself, but the reports say, Possible tear, but maybe due to surgery.

[00:09:38] Dr. Grant Garcia: So it may just be healing. Cause people always want to know, did it heal? So they think it healed, they let them go back out and he re tears it, or he ripped through the stitches. And that's what I think happened. He, the, the stitches we placed, you place that they're stress risers. And if it doesn't heal, those stretches are now holes in the meniscus and they can tug on them.

[00:09:58] Dr. Grant Garcia: And to be honest with you, I've had this happen to [00:10:00] me. You know, I do a lot of meniscus repairs and every once while you get in and the meniscus didn't heal. And now you've got this sort of rope. in the meniscus. And if it doesn't heal and scar in, it can act as like a knife and it can cut through. It's not anybody's fault.

[00:10:13] Dr. Grant Garcia: It's just the fact that didn't heal. And now he created a new tear.

[00:10:17] Will Sanchez: So that's why it was a

[00:10:18] Dr. Grant Garcia: separate area.

[00:10:19] Will Sanchez: I want to read a quote from him, right? Because to me, this is a warning sign or a concerning sign. And for you, it's probably nothing because you're like, yeah, I hear this all the time. He says, since my initial surgery on May 3rd to repair my meniscus, my rehabilitation proved longer and more.

[00:10:34] Will Sanchez: difficult than anticipated. But if you talk about the three month timeline, he came back right before the three month timeline. So if you're saying that you're, it was a difficult process and maybe it's just because these guys are super, super human. So it, you know, the fact that you don't recover as fast as you expect, you know, that all of a sudden there's a warning sign for the player, but when he says something like that, I don't know.

[00:10:59] Will Sanchez: Are [00:11:00] you concerned or is this something that it was just maybe bad luck for, you know, either didn't heal properly or he popped that, uh, that stitch and he suffered that tear?

[00:11:11] Dr. Grant Garcia: This is a classic sign that, again, first off, don't know the situation and he's also, you know, he's frustrated. You'll show a stat how many times he's been injured, right?

[00:11:23] Will Sanchez: Yeah. So to

[00:11:23] Dr. Grant Garcia: him, it's like any days down, he's like, this is so long, right? Like my, you know, I have this, I have, I'll see four patients, the same ACL surgery done within a few weeks of each other. Same surgeon, same technique. And one will be like, Oh, this process was terrible. It was so long. I'm like stressed.

[00:11:38] Dr. Grant Garcia: I don't want to do it again. Second one's like, thank you so much. You saved my knee. All of them look the same, but they all have different complaints, right? So you don't know the ones when I get these revision situations where something happens or I see someone that's had this and they'll say they go to get a second opinion, right?

[00:11:54] Dr. Grant Garcia: And they're like, my knee never felt right after the surgery. That's the ones you were kind of like, okay, that's a little bit [00:12:00] fishy. I don't think it's fishy with the angels. I think they probably did everything they're supposed to do. And also it's really easy for, I don't know when he quoted this, but it's really easy for Mike Trout to say My recovery wasn't as good as I wanted when he reto his meniscus.

[00:12:11] Dr. Grant Garcia: Oh, after

[00:12:12] Will Sanchez: the fact? Yeah, if it's after that, yeah. Like it's just

[00:12:14] Dr. Grant Garcia: total bias. So you know, you don't know. But, and also like we know Patience and Mike t Trout's no different. I mean, this is guy, this guy's smart, but he is not a rocket scientist. Like I'm sure the surgeon told him how long it was gonna be and he just was like.

[00:12:28] Dr. Grant Garcia: Whatever you want to do, doc, just fix me.

[00:12:31] Will Sanchez: Right.

[00:12:31] Dr. Grant Garcia: And sometimes they don't listen and they're sitting there like at two months. They're like, why is my knee still swollen? I'm like, I told you it's going to take a long time.

[00:12:37] Will Sanchez: So when it comes to the recovery process, right? Tear now retear 14 seasons in the major league baseball.

[00:12:49] Will Sanchez: He's going into his 15th season. just just turning 33 years old, so not old as far as age and even baseball. You kind of should be in your [00:13:00] prime, but he really started his career at an early age, which was really fast tracking him to this Hall of Fame resume. Uh, uh, What's the recovery process and then what are some of the concerns now?

[00:13:13] Will Sanchez: Obviously he's out for the whole season. So you'll have the rest of this year going into the winter and then coming back for spring. Are there any concerns at this point, uh, for as, as a doctor there, or is it something like, Hey, it's just. Shit happens, you know, go through the recovery process, you know, go through your PT, start over, get stronger and you know, we should see you back on the field or is it something where you go, all right, now we've got into that knee.

[00:13:44] Will Sanchez: What have we lost? Right? You're not looking at the knee. It's a process. What has been lost already from the surgeries to maybe impact not only his recovery process, but possibly continuing his career because he hasn't [00:14:00] played a full season in quite some time.

[00:14:04] Dr. Grant Garcia: And you can show the stats there. So basically, so to answer your question, this is really concerning.

[00:14:10] Dr. Grant Garcia: I mean, usually I tell them if, if, if someone good did a surgery, which I think it was, Um, the odds of it being fixable again are pretty low and going and trying it again on a guy like this might be a bad idea, right? Cause you're going to look pretty bad if he fails again in like three, in three months, right?

[00:14:28] Dr. Grant Garcia: We know about, it was a, one of the guys, uh, it was a guy that, you know, retore his triceps, sent him for the giants. And then he tore it again after, you know, playing it was out again for another six months. Right. Like he just doesn't, this is unfortunately get a little bit scary. I don't want to say this word, but it's sounding like Lonzo ball, right?

[00:14:45] Dr. Grant Garcia: They know like meniscus reminiscence. Now again, the first was a repair, but the second was likely a removal and we know where that went. And so that is the, that's obviously worst case scenario. But I, I, I don't think the amount of time that he [00:15:00] has to recover really matters to be honest with you.

[00:15:02] Will Sanchez: Yeah.

[00:15:02] Dr. Grant Garcia: It's what the health of the cartilage is and how much meniscus gets removed. If his cartilage is healthy, which we don't know. Probably is maybe hopefully. Um, cause he's still young, then he's going to be in a better situation. And if it's a medial meniscus, which what we showed on the board, medial meniscus, they do way better.

[00:15:23] Dr. Grant Garcia: If it's a lateral meniscus removed, they do a lot worse. And I mean, I've had a, I took care of an NFL guy that retired at 32. This guy was incredibly athletic. Had two lateral meniscus removals came to my office with a knee that was like knock me like this Terrible arthritis at 32, right? So that's what happens on the lateral side medials tend to last a lot longer So if he gets his medial meniscus removed At this point he may make it, you know He'll probably make it for the next few years of his rest of his career Um, and then obviously eventually may have issues in the long run But again, a lot of these athletes have that it doesn't it's not from this actual injury per se Um [00:16:00] But, but again, the problem is if he has all of a sudden he loses meniscus and he starts getting a cartilage hole, then we're looking at the same issue, you know, is he going to get a micro fracture, which we mentioned before, is he going to get a cartilage procedure?

[00:16:12] Dr. Grant Garcia: Is that even going to be possible for him? I hope not. We've got to see the worst case scenario with Lonzo Ball needing a really big surgery, like a Hail Mary surgery for a professional athlete. But those are the risks. If they do a repair, I'd be shocked. And then recovery wise, generally depends on the type of tear you repair.

[00:16:32] Dr. Grant Garcia: But usually, you know, two weeks of crutches, one week, no weight, one week, partial brace for six weeks with that sort of three to four month recovery. But everyone's different, right? Like Mike Trout's getting the best

[00:16:43] Will Sanchez: PT.

[00:16:45] Dr. Grant Garcia: Some patients takes five, six months. So it just depends on the level of what he's having.

[00:16:49] Dr. Grant Garcia: If he just gets a cleanup or, you know, that usual clean, you know, people go say they clean the knee, right. Did the little, the little cleanup of the knee, you know, that's probably six, six, eight weeks. So he doesn't [00:17:00] need all that time to get back. So we'll know how he's doing probably in the off season or towards the playoffs or pre.

[00:17:06] Dr. Grant Garcia: Um, but also depends like if he's out for the season, right. Cause you have August. I mean, September, October, they're out.

[00:17:12] Will Sanchez: Yeah, no, he's done. He's done for the year. And obviously it's a smart move. Um, let's wrap it up here because we've gone over our 15 minutes. So we got to change our 15 minute segment to 1723.

[00:17:26] Will Sanchez: But, um, I have to ask it any advancements right now when it comes to meniscus. Um, you know, recovery or surgery, things like that. We always like to talk about, you know, future stuff and all the cool toys that are out there. Is there anything that, um, that you can kind of throw out there that might be beneficial or depending on really kind of what's going on.

[00:17:49] Will Sanchez: And just to clarify with everyone that's listening or watching, it's hard to, we're talking about the injury itself. It's hard to know exactly what it is unless it Dr. Garcia was in [00:18:00] there looking at the knee. So I just want to kind of throw that out there as well.

[00:18:03] Dr. Grant Garcia: Well, and also for layman terms, right?

[00:18:05] Dr. Grant Garcia: Like everyone's here's the word meniscus tear. They all seem the same for me as a meniscus specialist. I go, if I go in like tomorrow, I'm doing three different types of meniscus tears repairs, right? They're all three different. Yeah, so for it's a very large gamut of that and I'm getting into the minutiae of it, but so advancements This is very similar to the ACL biologics.

[00:18:26] Dr. Grant Garcia: So the one advancement is we do the microfracture I told you about originally on the show poke holes where there's ACL PCL and with stem cells I'm assuming the surgeon did that there's been some studies on PRP So we take PRP injecting the knee after the meniscus repair hopefully help it One of the slick thing you can do is you can take blood turn into a vibrant clot and try to sneak that into the meniscus repair that you're doing it again.

[00:18:48] Dr. Grant Garcia: This is assuming that he's getting a meniscus repair. So you want to get that. Also, what matters is it kind of crazy, but you just have to do a good job of repairing it, right? Like you can't skimp. So this is getting the [00:19:00] details, but if you fix them, it's a meniscus. The meniscus fibers are radial. So they're circular.

[00:19:05] Dr. Grant Garcia: Does it make sense? Yep. Circular. So if you fix it horizontally, so I'm trying to do my best here to show you. If you fix it horizontally, you'll, you can go right through the meniscus. You see that if you fix it vertically, you cinch the meniscus and it won't tear out when you fix it. So when you do your repair, you wanna try to get your repair sutures like this rather than like this.

[00:19:26] Dr. Grant Garcia: I mean, you have to sometimes do that, but like this way stronger in the meniscus. So sutures, so all those things. Vertical,

[00:19:31] Will Sanchez: not horizontal, right? Because vertical. See, member, think about this vertical you got,

[00:19:36] Dr. Grant Garcia: I'm coming at you. Like this scissors vertical. You don't want vertical. There you go. I'm not, um. He might, that's gonna scare, that's gonna scare everybody now.

[00:19:44] Dr. Grant Garcia: Anyhow, so the, uh, so else, so the, uh, and then there's, and then there's Bone Mar Aspir. I'm sure he is getting everything. I'm sure he is doing that. I'm sure he is getting more stuff. And, and there's like collagen gels they're talking about. Again, this is the, when you figure out the solution on how you [00:20:00] can take an 80% success surgery.

[00:20:02] Dr. Grant Garcia: You know, without an ACL tear, this is a pretty, there is, there are people that do not do as well when you, if he tore his ACL at the same time, the success rate would go way up, right? So it's the, the issue is without the ACL, uh, is the problem here. And so we're looking at everything. I said, PRP, fibrin clot.

[00:20:20] Dr. Grant Garcia: I mean, I'm working on some of this stuff right now with other things and how we can make our ACL repairs better. So the biologics is a huge topic on this. We're just not there yet. But we're getting, we're going to be there hopefully soon in the next few years. So we'll see.

[00:20:33] Will Sanchez: Great job, Dr. Garcia. We hope that the three time AL MVP gets back on the field next season and, uh, is able to perform for all the fans out there that enjoy watching them.

[00:20:46] Will Sanchez: Because as you know, careers come and go pretty quickly. Uh, Dr. Garcia, say bye to the fans. Peace out guys. Remember vertical, vertical, not horizontal, and don't have Edward Scissorhands nightmares. [00:21:00] Peace.
Audio Transcript

[00:00:45] Will Sanchez: Dr. Grant Garcia. I know I'm blowing smoke right now, but listen, it's summertime. We have the Olympics before we get into all that. How are you doing? How are the kids doing? Does everyone having a good time this summer?

[00:00:57] Dr.Grant Garcia: Yeah. Summer's awesome. You know, usually [00:01:00] summer's not super busy, but this year for some reason, everyone's enjoying sports.

[00:01:03] Dr.Grant Garcia: I think it may be the pre Olympics chaos that happens. Um, and now we're gonna have that post Olympic chaos. You know, everyone's gonna start signing up for swimming. And track and field. That's right. You know, soccer. Uh, you know, we get, the swim team gets like triple the volume after they finish, see the Olympics and you see Michael Phelps and now you see all the new swimmers going on there.

[00:01:24] Dr.Grant Garcia: So it'll be cool. But yeah, summer has been good. We finally got some eighties now it's back down to 66. I don't know what's going on, but we'll figure it out. Somebody will figure it out.

[00:01:32] Will Sanchez: It's only a couple of days. The Seattle dude, we're such complainers.

[00:01:37] Dr.Grant Garcia: We waited months for this.

[00:01:39] Will Sanchez: Yes, we did. And listen, before we go on, let's give a quick shout out to the recovery shop.

[00:01:44] Will Sanchez: Uh, Dr. Garcia, I'll tee you up for that one there. Talk a little bit about the recovery shop.

[00:01:50] Dr.Grant Garcia: So these are our sponsors, uh, big thank you to them. Uh, I love this stuff. You guys, you know, reach out to me, reach out to the recovery shop link above. Um, this is really good [00:02:00] for the patients. Your patients are asking me, I had someone today came in asking me, what can they do after, after their surgery?

[00:02:05] Dr.Grant Garcia: What extras can we, do we offer? You know, they've been hearing about the standard stuff, but like, you know, the nice machine, uh, recovering nutrition, uh, you know, the reboost machine, all those things they off, you can, we can offer them that, you know, you normally can't get, uh, and this allows you as a surgeon to offer them to your patients kind of in a one big bundled, you know, option.

[00:02:24] Dr.Grant Garcia: They can see it all there. And what's really nice to is just got kind of tired of telling people, you know, go to Amazon, buy this brace, buy this aftermarket thing. Instead, I can vet it. We can put it up there and it can be really helpful for the patients. So for patients, you can reach out and find out who's dealing with the recovery shop.

[00:02:39] Dr.Grant Garcia: But really, for surgeons, it's really the key is because it allows your patients to get everything quick access and good quality items. Uh, so I strongly recommend, uh, feel free. You can reach out to me on my website, on the sports doc doc website, or reach out directly to recovery shop. Again, there's no, you know, benefit to us if you go from any of those links.

[00:02:56] Dr.Grant Garcia: Uh, so do whatever works for you. Uh, but hopefully, uh, it'll be work for you. [00:03:00] So. Thanks guys.

[00:03:01] Will Sanchez: Yeah. And for those that are listening to this, uh, shop recovery. net, or you can find it on our website at sports stock talk. And what's great about that. And we're going to let this go in a second, but you mentioned it, right?

[00:03:12] Will Sanchez: We've been talking about the nice machine. We've been talking about rebless for, I don't know, for the last year, probably longer. So this just kind of, you know, just validates all the things that we've been talking about. And, uh, the benefit is, um, the patients. So we just want to give a. Quick shout out to the recovery shop and thank 'em for, uh, being a partner with us.

[00:03:33] Will Sanchez: And more importantly, uh, they're there to assist the recovery of the patient. Listen, it's Olympic time, baby. The Olympics have started the, I I hope no one in my job is listening, right? So I bet I had a really busy week. I had a bunch of shows. We did all these shows, and then I've been working from home and I gotta say, I got the Peacock app going.

[00:03:55] Will Sanchez: I've got, it's called the gold, the gold channels, like the red zone, the gold [00:04:00] zone, and they had the red zone guys on there doing this, like the octo box. And we've got gymnastics and volleyball and I'm going bananas over here. And I'm trying not to spill the beans because of in the chat with the team, they're going to know that I'm watching the Olympics, but I've been so excited about the Olympics.

[00:04:19] Will Sanchez: Have you had a chance to watch any Olympics going on?

[00:04:22] Dr.Grant Garcia: I watched a little bit of them, but I need to do this. I clearly am working too hard. I need to get on your ring . You do. Even though I know you work so hard, I gotta get the gold box, whatever it is, with the, we're doing, do Peacock. It's a great idea. I watched

[00:04:34] Will Sanchez: the Peacock app, man.

[00:04:35] Will Sanchez: I, I got it last year for the football season. They, they tried to trick us into watching the playoff game and then I got a great deal and I was like, ah, whatever. I'll pick it up. And now, I mean. All of the games are on it. So totally worth it. And by the way, you know, you know how we do, right? We usually do some stats, especially when it's just you and I, right?

[00:04:53] Will Sanchez: When we have our gas, don't worry about it. We're not doing trivia yet. We're [00:05:00] not doing trivia yet, but we'll give you the stat, right? So, um, the 2024 summer Olympics in Paris, right? They have the surfing competition in Tahiti, which is 9, 750 miles away from the host city, which makes it the farthest distance between Olympic and event and the host city.

[00:05:23] Will Sanchez: So for those that don't know where Tahiti is, it's in the French Polynesia and it's super far. So you're watching the Olympic at night and then you've got surfing going on during the day. Uh, there's been some really cool photos out there. And I think I'm really jealous because I don't want to surf because I'm not messing with those waves, but I can get a chair and some sand and a cooler, uh, maybe a little sunblock and a sand castle somewhere.

[00:05:48] Will Sanchez: That's probably my speed right there. So when I look at everybody at the beach, that's kind of where I'm wishing I was. [00:05:53] Dr.Grant Garcia: I think you would enjoy it. We were just in, we went to that spot about a year and a half ago. Uh, but you know what [00:06:00] that way, you know, that area is called something of skulls. Not really sure that that what they didn't say.

[00:06:07] Dr.Grant Garcia: I just read an article on it is the, uh, I actually have a few stats today. I'm going to school you. So the last time they had an Olympics and there was an event that far away was equestrian in Australia because they can't have such a long quarantine. So they can't have the horses actively in Australia doing the competition.

[00:06:27] Dr.Grant Garcia: So they did it in. somewhere I think in Scotland or in Londoners or in England somewhere. Yeah. And so that was the last time this has happened. But what's super cool is, you know, just the ability that they're doing this so far away. Um, but the waves are so dangerous there that like people have died.

[00:06:44] Dr.Grant Garcia: There's multiple deaths on this wave that we're doing. So this is, this is just insanity. Um, but you know, they, it's a, that place is beautiful and I hope they get a little, we know we might be finding some of those athletes stuck in Bora Bora for a little while. Unfortunately.

[00:06:58] Will Sanchez: Yeah, yeah. Quote unquote, [00:07:00] unfortunate.

[00:07:00] Will Sanchez: And listen, here we go. We're going off the beaten path already. For those that don't know, Dr. Garcia is a maniac when it comes to planning his vacations. So we need to find a section at sports doc, talk. com where Dr. Garcia can share. He has an itinerary plan out my next vacation. I'm just going to tee Dr.

[00:07:23] Will Sanchez: Garcia up because he's going to tell me where to go. When to go, whatever we need to do. So I'm pretty sure you should at least post the Tahiti one because you probably have a 23 page document there for your travels. So can we get that on the website?

[00:07:39] Dr.Grant Garcia: Dude, seriously, you're rigged. That's my best kept secret.

[00:07:42] Dr.Grant Garcia: Nobody knows about this. I'm shouting it out. It's tremendous. Totally unlocked it. Yeah. My partners steal my spreadsheets for my trips. You know, my friends steal my spreadsheet for my trips. But listen, the audience needs to know, I vacation like I do my surgeries. I only go, I go all out [00:08:00] making sure I do the best possible job.

[00:08:02] Dr.Grant Garcia: And I don't, there's no chill mode. It's everything, everything we plan, plan to the T, make it perfect. Um, and it's fun. We like to do it wild. I like to not, I'm not, you've already seen, we've seen my surgeries. We like to do, you know, there's not a lot of repetition. So anyhow, so that'd be another show. You already got enough information out of me on that one.

[00:08:21] Will Sanchez: No, no, we're, we're, we're. That show will probably be a four hour show. We'll do four parts on all of the, the planning that goes into it real quick before we move on. See this, this we're off the tangent. Where are we? 10 minutes in eight minutes in a, does your wife love it? Or is she like, okay, this is your over planning.

[00:08:40] Will Sanchez: Like there's a delicate balance. What's, what's the deal? Because I know when we try to plan things out, there's a delicate balance. We're like, okay, we just, we overloaded. that the schedule or we under load it. What's that? What's that key balance? And how does your wife feel about the way you go about planning these trips?

[00:08:58] Dr.Grant Garcia: So I usually catch [00:09:00] her off guard. That's the key. So she's tired at night. She's had too much of the kids and I'm like, Hey honey, do you want to go to Vietnam? And she'll be like, yeah, yeah, sure, sure. And I'll be like, she said yes. And then she wakes up and the trip's fully booked for her. So that is a positive.

[00:09:16] Dr.Grant Garcia: We've started doing conversations before, like a few weeks before. So she knows where we're going. Cause a lot of times she's landed and she's like, I don't really know where this is. Like, you know, there's certain places that we have, what's the next step we're going. So. You know, most people, it's the, it's funny, you know, that's the, because of my job, they think that I'm like, not the vacation guy.

[00:09:33] Dr.Grant Garcia: So it's the, it's the exact opposite in our family. Like she likes it, but she's obviously stressed. She's be honest with you. Her job's harder than mine with the two little rascals. So, you know, it's the, it's fun, but yeah, we do, we have, it's a good time and she likes it, it's just, it becomes intense sometimes you're tired after the vacation, but then the memories are worth it.

[00:09:51] Dr.Grant Garcia: So.

[00:09:51] Will Sanchez: All right. Well, you're apparently you're the Olympic champion of planning. Speaking of another Olympic champion, that is, I mean, she's to [00:10:00] me and you know, I'm going to ask you who is your top Olympian? Uh, for me, I have Jesse Owens as one of the top Olympians ever because of not only him winning, but at the time that it happened, uh, where he did it, uh, the circumstances that like, to me, it just, I put it under a much bigger umbrella and I have a couple of others that fall under my, these are my goats.

[00:10:28] Will Sanchez: But before I continue with that, who, who is your goat when it comes to Olympic games and what you've experienced in your life?

[00:10:38] Dr.Grant Garcia: So again, um, Uh, there are a lot of ones that stand out, but I, I, I mean, I'm kind of biased, man. I'm a swimmer. So you know where I'm going with this.

[00:10:47] Will Sanchez: Yes, I do. You got

[00:10:48] Dr.Grant Garcia: Michael Phelps.

[00:10:49] Dr.Grant Garcia: I mean, to have a swimmer that's, I mean, I was literally watching, you know, in prep for this show, we were looking up different injuries and trying to see previous injuries and they show first pitches and it's [00:11:00] like Michael Phelps, like all talking about Michael Phelps, you know, he, how can you rock a ponytail and be so cool still?

[00:11:05] Dr.Grant Garcia: Yeah. It's just so impressive. It looks good. You saw him out there, right? But that's what, but that's what I'm saying. It's not that common that you can do that. And he pulls it off because he's Michael Phelps. I mean, he's the most famous swimmer and probably one of the most currently most famous athletes that's not professional, like professional swimmer, but he's not like LeBron James, right?

[00:11:24] Dr.Grant Garcia: He doesn't play in the NBA. Yeah, he's not still active. He's at every Olympics hosting. Uh, and he's, I mean, they said that, you know, there was a huge article on this insane, basically, like. The U S is, is, is thirsty for another Michael Phelps to make the Olympics cool again. I mean, he's good. There are a lot of good athletes out there, but he just was a different, it was a different animal, right?

[00:11:45] Dr.Grant Garcia: There's the, I can't remember the guys, the French guy's name, but they're like, yeah, we have a new Olympic, we have a new Michael Phelps and he doesn't swim for the U S I'm like, that was like the worst possible line you could do, you know?

[00:11:56] Will Sanchez: Swimmer. I mean, you know, the, it, it all goes [00:12:00] through waves of the dominance, but you know, um, another person that is.

[00:12:05] Will Sanchez: and by far she is the best know, when you look at th Mary Lou Renton's, I mean out of the water and that

[00:12:19] Will Sanchez: When you're doing tricks in the air that no one else has done and you have so many things named after you, uh, that alone puts you in a whole other category. Um, she's often running and by the time we air this show, she's going to be competing, I believe, in six different events. She did sustain a calf injury during her warm ups at the Paris Olympics.

[00:12:45] Will Sanchez: Um, what are some of the concerns? When it comes to an elite athlete that is loading that muscle, you know, what's something that's really concerning to you when you hear calf injury? Because when [00:13:00] I hear calf injury, I get worried about a whole bunch of other things, not just maybe I'm having some tightness or some soreness.

[00:13:07] Will Sanchez: What are some of your concerns?

[00:13:09] Dr.Grant Garcia: Well, I mean, you're going to see this a lot in this episode. We talk about All the spectrums, right? Um, calf injuries are nasty. I mean, they're one of the most annoying nagging injuries. I mean, we've talked about hamstrings before we talked about quad injuries, uh, and you don't get as much in upper extremity, you know, gymnast, maybe, but you know, they don't get nearly the same injuries you'd think.

[00:13:29] Dr.Grant Garcia: And they get a lot of these lower extremity because they're, because they're having to land at such high velocity, right? Like, I mean, if you look at the height they're going from and they're landing and then they land in an end point. Right. So that's like to drop that and not blow your, you know, blow out your Achilles as you land, which we'll talk about happens, uh, is pretty impressive.

[00:13:48] Dr.Grant Garcia: And so the patients that I take care of that have these calf injuries, they're usually not surgical. I mean, we've talked about many football players. This has come up a few times on here talking about these calf injuries, but they're just really, [00:14:00] really good. really nagging and they hurt. They hurt a lot.

[00:14:04] Dr.Grant Garcia: I mean the most of my patients are coming in with a calf injury. They're limping, they're walking weird. Now again, I'm assuming she wasn't had didn't have a really bad strain. I mean, I know she's tough, but probably a grade one. And again, for the audience, there's usually three grades of these tears. You know, again, there's grade one, which is just a little sprain grade two, probably hematoma, maybe.

[00:14:24] Dr.Grant Garcia: which is some blood, maybe a more of a split. And then you have like a full on rip tear, probably not a grade three, probably a grade one. Again, also depends on where it is, right? We could, you know, we're not going to show that other picture in a minute, but basically you have the muscle, then you have the muscle tendinous junction and you have the tendon.

[00:14:40] Dr.Grant Garcia: The tendon is the Achilles tendon. So you can see how this all links together. Yeah. But you can see when they wrapped her, You know, they wrap her so tight that basically she's not even contracting the muscle and what they're trying to do with that is to get it so the muscle stays in put so that when she's landing, it's basically not contracting, but she then loses her spring force.

[00:14:59] Dr.Grant Garcia: The crazy [00:15:00] thing

[00:15:00] Will Sanchez: she does not lose her spring force. And what it's wrapped up. And it doesn't affect her. Uh, it, she's absolutely amazing. I I'm sorry to cut you off there. I think

[00:15:11] Dr.Grant Garcia: that she's probably good enough to do it with one foot. That's why. Yeah. You know what I mean? Well, we've talked about this before, right?

[00:15:17] Dr.Grant Garcia: Like it's like. Um, some of my patients ask me about professional athletes and they're like, well, what, how did, what did they get? I'm like, well, just so you know, like I've seen some of these athletes surgeries and like a lot of the surgeons are great. We've talked about Neil Altrosh, amazing surgeon, right?

[00:15:30] Dr.Grant Garcia: Like it's insane article. We have to hold an episode just on that article. We just read in the New York or was it New York times or something incredible, but basically these elite athletes. Even if they don't get a great surgery, and I'm not saying they do always, I'm not saying that they don't, but if they don't get a great surgery or they don't get a great, uh, treatment, they still can perform better than average.

[00:15:50] Dr.Grant Garcia: I mean, when I take care of these high level athletes, and if let's say sometimes you come in and you know, these have percentage success, right? They're just don't [00:16:00] have that same issue. It's just not the same because they're able to overpower whatever they need and they're able to do it. There's a reason that they're elite.

[00:16:06] Dr.Grant Garcia: And you're talking about the most elite. person. Right. So what does it take to get that level? And then the problem is that she's not even what that take to get that level. She's significantly above the rest of the world, right? She has tricks named after her. She's going for another trick that we've never seen before, right?

[00:16:24] Dr.Grant Garcia: That's that she's going to rename, name another one of her tricks. Um, And so she doesn't even need to be at a hundred percent to win.

[00:16:33] Will Sanchez: Let me ask you about this. Right. And once again, we are recording this. If we were going to go live, we would need to get this out in the next three hours and 27 minutes because, uh, Paris is, it will start rocking and rolling at midnight, uh, Pacific time, uh, when they go.

[00:16:53] Will Sanchez: So this is going to be, you know, a little bit later and halfway through the Olympics when we released this, but Her [00:17:00] dates and the reason I'm bringing this up is what's your concern? If you're the personal trainer and you're like, I'm in charge of the most important calf at the Olympics for gymnastics, July 30th, women's teams final, August 1st, women's all around final, August 3rd, women's vault final.

[00:17:21] Will Sanchez: The fourth uneven bar, the fifth balance beam finals and the fifth floor exercise finals. That is six. Events within five days or six days and the last day she has two Major events with the balance beam and the floor exercise final What are you doing to keep that calf? not only when she's going to perform but before https: otter.

[00:17:53] Will Sanchez: ai[00:18:00]

[00:18:00] Will Sanchez: monumental beating within that time frame.

[00:18:03] Dr.Grant Garcia: I mean, you're doing everything right. They might even have to be thrown in PRP. They might have been throwing some stem cells in her during the time they may be doing something called shockwave. We've had a few of the players that come in. We had a couple high level soccer players.

[00:18:16] Dr.Grant Garcia: A couple of high level basketball players. We do the Seahawks and they come in and they get this thing called shockwave. And so they do it like when they get like, when they have injuries like this and it sort of breaks up the scar tissue and kind of relieve some tension there. So she may be doing something like that.

[00:18:29] Dr.Grant Garcia: There's probably things I've never even heard of that. She's getting treatment on there in Europe and remember she's in Europe, right? So they probably have some other things that they don't even have here in the U S that they can offer her. I mean, she's getting smashed with treatment right now. I mean, there's just no way that she's just sitting around doing nothing.

[00:18:44] Dr.Grant Garcia: And also you're, you're forgetting to mention, which again, you, you're bringing up the most important parts, but she's warming up also, right? Like she's just not going cold Turkey and doing those things. And she's going to keep herself warm every day. She's going to do routines every day. You know, she may be chilling out more than average because she's injured and she doesn't [00:19:00] want to get more injured and she wants to save it for the actual events.

[00:19:03] Dr.Grant Garcia: But I mean, those are not, those are still like a few days away. Right. Like we're not talking about like, this is going to be over in a day or two. Right. You're talking about six events over a period of time. So yeah, I mean, it's, they're doing everything possible and they're probably consulting, they're probably calling.

[00:19:19] Dr.Grant Garcia: They probably have all these people involved in this. This is not a single person. um, treatment option. Yeah. And there, and there has probably been so many people involved in this, which is always a really important to understand like these, even you have these team physicians, they're, they're top of their game.

[00:19:34] Dr.Grant Garcia: You know, I took, took care of a player that had seen Ella trash and then flew to see somebody else. And, you know, it's just amazing to hear their stories when they're like, Oh, well this guy operated me, but I flew to see three other people because he's like, I want you to get trekked by three people before I do your surgery.

[00:19:47] Dr.Grant Garcia: Like these are the best docs in the, world, if not country. Um, and they're still getting these extra opinions because all of us want to make sure we do the right thing for the player or for the patient.

[00:19:58] Will Sanchez: Um, last thing before I move [00:20:00] on, you know, we've heard a lot of different things right before it was, you know, um, the rest and the ice and things like that.

[00:20:08] Will Sanchez: And it seems like we're getting more information now about compression and maybe going away from some of the ice treatments when it comes to, let's say it's a grade one calf strain. What is that treatment? Is it focusing on compression or it's just besides everything else that you mentioned, but just, you know, what, what say maybe go to when she's at the hotel, she's already had her treatment, but they still want her to quote unquote treat it while she's.

[00:20:36] Will Sanchez: Relax at the hotel room at the end of the day. What is she doing there?

[00:20:40] Dr.Grant Garcia: I mean, there's, they're probably doing massage, they're probably doing graft and they're probably doing 24 seven

[00:20:46] Will Sanchez: everybody. It's, it's not a, you know, I don't think, I

[00:20:48] Dr.Grant Garcia: mean, I just don't think she's sitting there icing her leg. I mean, the problem is that ice is really good for like a sore knee, right?

[00:20:53] Dr.Grant Garcia: Like swelling, intraarticular swelling. Uh, I, I, as a, [00:21:00] a layman athlete, recreational athlete, you know, despite being an orthopedic surgeon, I would ice my leg, but that's just, cause I, you know, I don't have Even with all the stuff that I see and do, I don't have access to the treatments that she has, nor do I have the time to go get that stuff.

[00:21:15] Dr.Grant Garcia: And so as a result, I would just do the basic bread and butter, but that's not what she's getting. I mean, she's probably having, she probably has her own nice machine in the room. You know, she's probably getting something we haven't even heard about, you know, there's more than shout out to grant. I mean, I just think, uh, I, we can't fathom the type of stuff that she's probably having right now, but you know what?

[00:21:36] Dr.Grant Garcia: The best part is maybe we're completely wrong and maybe she's just so good. Yeah. That she's getting treatment and she's surprised

[00:21:43] Will Sanchez: by she's a, she's, she's a,

[00:21:45] Dr.Grant Garcia: maybe all this stuff. She's maybe she, maybe she watches the show and she says, these guys are such, we have, I've gotten no treatment and I'm just going to win regardless.

[00:21:55] Dr.Grant Garcia: I'm rocking my PlayStation. That's the fun part of the show where predictions are wrong. Yeah. Do our best. [00:22:00] We tell everyone, but it's, it's, uh, but you know, like LeBron James though, like he probably got like a hyperbaric chamber he brought with him. So I know he's getting treatment.

[00:22:08] Will Sanchez: And he likes his red wine as well.

[00:22:10] Will Sanchez: So maybe it's a little combination there between getting his treatment and a and a off day with a nice, uh, nice glass of red wine. We'll, we'll stick with the gymnastics. Uh, unfortunately these are serious injuries with Sky Blakely and Kayla, uh, Dello, uh, with their. Achilles injury, really rough. Um, I mean, Achilles injuries, right?

[00:22:33] Will Sanchez: That that's all we have to pretty much say, uh, during the U S Olympic uh, gymnastics trials for, uh, for Kayla, you know, I mean, you guys are seeing this,

[00:22:43] Dr.Grant Garcia: it's like the, when you think of Achilles injuries, you know, in no offense to the world, but we have, you know, it's usually. 30, 40, like we don't, the high level athlete injuries are a different animal, right?

[00:22:56] Dr.Grant Garcia: Yeah, they're just, you know, you've seen Aaron Rodgers, but Aaron [00:23:00] Rodgers wasn't 25 when he got his injury, right? There's NFL players that get it, but to see two 20

[00:23:05] Will Sanchez: years old. And we're talking about high level athlete.

[00:23:08] Dr.Grant Garcia: These are really young. Not that common to see this injury, um, in every day. I mean, we see people in their mid twenties to thirties tear there, but it's usually that like high twenties.

[00:23:22] Dr.Grant Garcia: We always call it the weekend warrior, right? Like the dad or it's more men. Actually, this is different. Obviously we're talking about two female athletes here, but it's usually higher precipitants of men because. They tend to do stupider things. That's me. Tend to wasn't directed at you. Will, but

[00:23:37] Will Sanchez: yes, it was 100%.

[00:23:39] Will Sanchez: Just because you're nice about it does not mean it wasn't directed weekend warriors doing dumb things and busting their, this is all

[00:23:47] Dr.Grant Garcia: about, I'm just trying to make fun of you the entire time without anybody knowing on the show. So I, uh, so, you know, so it's generally the population's generally I said, it's weekend warrior.

[00:23:57] Dr.Grant Garcia: Like I've had friends like that, you know, in the late thirties, early [00:24:00] forties, tear their Uh, Achilles and then talk about repair, which we will in a second. Um, but to have young, I mean, one of them was what, 16. Or something or like it, she's 20 years old and the other one, I can't remember how old she was, but these are not very old.

[00:24:15] Dr.Grant Garcia: Anyhow, so these are young, young athletes, but what, remember what we said before, this is like jumping off a building, right? Like they're going, look at the height that they go. Like we, we never get to experience that. Like you would never fall at that speed. And it's also a rotational component, right? And then they have to immediately stop on a dime.

[00:24:33] Dr.Grant Garcia: And that's usually what happens. It's that abrupt halt. That's what gets any of our things. Like if you think about. We see biceps tenon tears, you know, it's not like the guy is just lifting and obviously let's go. It's just all of a sudden goes into an isometric, which means that your muscle has to hold that same strength without moving and your tendon gives out because it's either your tendon or your bone snaps.

[00:24:55] Dr.Grant Garcia: Now, if they were younger and they were like in [00:25:00] 16, 14, they're 19 and 20

[00:25:03] Will Sanchez: just to let that's 19 and 20.

[00:25:05] Dr.Grant Garcia: That's we're talking about really young. This is a pretty devastating injury. And we've talked about this before on the show. We've seen examples of this. Um, and you know, you can see this is, this is a long road.

[00:25:17] Dr.Grant Garcia: I mean, they're out for a year and are they the same? I mean, they're going to have to rely on that power spike land. Uh, you know, maneuvers with this type of Achilles is just, it's a really devastating injury. And, but again, the nice cool thing we've seen now is it used to be, you know, we saw many baseball players that are earlier on, you know, 10, 15 years ago, get this and it would take them two years to come back and they never be the same.

[00:25:44] Dr.Grant Garcia: And now we've seen some players come back from it and they've done well, you know, and we'll see how Aaron Rodgers begin. Aaron Rodgers is not, he's a great player, but he's not the antithesis of like. A hurdler or a gymnast, right? Like he could sit in the pocket. He was never [00:26:00] known as a high, high impact player, right?

[00:26:03] Dr.Grant Garcia: Like going for big runs, doing dives, jumping and things like that. So like, he doesn't need to be, I mean, you saw him, he was at four, like six weeks, he's throwing the ball better than most quarterbacks can do. Right. He doesn't really need that Achilles to do the things that he does compared to these. He's gotta move in the pocket.

[00:26:19] Dr.Grant Garcia: Yeah, exactly. So Will's gonna show this. I know the audience. I don't want him to be too grossed out, but it's kind of interesting to see like kind of the old and the new way. Um, really briefly, just so the audience can see what it's, yeah. So I'm gonna show, show this.

[00:26:31] Will Sanchez: So give everybody heads up. I'm going to show an Achilles rupture.

[00:26:34] Will Sanchez: It's a little gross. If you're not used to it for Dr. Garcia, he has this with some peas in a salad. It's fine with him because he lives it every day. Uh, for those that are listening on our podcast, please is a great segue to check out our YouTube page. Cause if you want to see our faces and get grossed out by the next slide, then please, uh, check us out.

[00:26:54] Will Sanchez: So let's talk about this, uh, Achilles rupture here.

[00:26:58] Dr.Grant Garcia: All right. So again, [00:27:00] audience can see. So these are two the same. These are surgeries. So if someone tells you they got their Achilles repaired, this is actually the same surgery. You can obviously see there's a difference here. We've had Dr. Anthony on here.

[00:27:13] Dr.Grant Garcia: Will's undergone one of these. Thankfully, Will's undergone the one on the right. If you're looking at the screen, um, but so the one is an open repair. And again, that's a little more of an accentuated repair, but that's what the Achilles looks like when it snaps. And you can see that the white is the tendinous portion, and then it's sewed back together and you want to make sure you're sewing it.

[00:27:31] Dr.Grant Garcia: So you don't have a lot of knots on the outside or anything else, right? And the issue with this is obviously wound infections and things like that on the right. And now they don't have the little holes on the bottom for the speed bridge, but this is what Aaron Rogers got. And again, usually it kind of goes, this is a good one here.

[00:27:46] Dr.Grant Garcia: Usually you might go a little bit lower with your incision. You might go different orientations, but again, it's small, percutaneous, and then you just fix it down to that bone. That's kind of the newest hottest way of doing it. And that's the speed bridge you guys keep hearing about. Down into

[00:27:59] Will Sanchez: the [00:28:00] heel area, right?

[00:28:01] Will Sanchez: That's what, you know, As far as when you say the bone and the suture is connecting that

[00:28:05] Dr.Grant Garcia: like blue mark, as you can see, that's where the heel bone is going to be going roughly. And the reason is you can see here, 10 attendance, great. But what the Arthrex team and other people have figured out is that, you know, usually it actually tears a little bit lower and when it tears lower.

[00:28:21] Dr.Grant Garcia: The tendon that's connected to the heel bone, which is the lowest part. And again, I'm sorry, I can't show you because I can't point. Um, it, uh, it's really not good quality. And what we've seen is there are people that can be treated without surgery. There are people that are older or people that are really patient or okay with maybe not the high impact power plays.

[00:28:39] Dr.Grant Garcia: And so they keep their, they keep their ankle like this and then slowly over time. Now, again, for an athlete, if it was me, I'd get it fixed. Right. I want to get back faster. I want to, I don't, I can't sit in the OR for 10 weeks in a boot and be okay with it. And so you want to go a bit, you want to go back quicker.

[00:28:54] Dr.Grant Garcia: And so by having this sort of enhanced bridge and then being able to fix it to bone, it's stronger. Like if you can get bone to tendon [00:29:00] healing, it's always better than the tendon to tendon. Dr. Justin Marchegiani, M. D.: Less scarring. Evan Brand, M. D.: Faster recovery. Dr. Justin Marchegiani, the whole purpose of this is.

[00:29:06] Dr.Grant Garcia: So, you know, so they're probably undergoing that. I'm hoping they're undergoing the right one which is the percutaneous. I can sure bet that they'retheyone of them's probably gonna be seeing Dr. Elitrosh sometime soon. Dr. Justin Marchegiani, You know, we've already seen he's the master of everything. Iwe need to have an entire episode on him.

[00:29:20] Dr.Grant Garcia: Uh Dr. Marchegiani, M. D.: But anyhow, so thesethat's what's gonna be going to go in. It's gonna be a long recovery. And, you know, there's going to be their different ups and downs, but, you know, hopefully they're still young and hopefully we can see them again in four years and, uh, Los Angeles, right?

[00:29:34] Will Sanchez: Yeah. And, you know, before we move on, as we mentioned, right, 19 and 20, um, you know, one of them, uh, Kayla.

[00:29:44] Will Sanchez: Was part of the championship team last year and pretty sure was expecting to go and compete with her teammates and try to bring home a gold for the US gymnast uh, uh, gymnastics [00:30:00] team, you know, and. We talk about injuries. We talk about knees and Achilles and things like that. But what that mental preparation, some of the concerns are when you have these young athletes that this is possibly their career, even though they're young, we know that gymnastics is Obviously, Simone is 27.

[00:30:20] Will Sanchez: She's different. She's, you know, she's LeBron, you know, she's, she's, she's on a whole other out of our galaxy. But for a lot of these, you know, athletes, their careers, you know, end at an early age and, you know, if as a doctor, as someone that, you know, knows this, what are some of your concerns with the mental status?

[00:30:42] Will Sanchez: And what is something that you can do or encourage the patient to do when you know that They're going to be rough days. You are laid up, you're a mobile, you're watching on TV, your dreams, you know, you're not, you know, sitting there for a week or two, you're going, this is a [00:31:00] long recovery. What are some of your concerns as a doctor?

[00:31:04] Will Sanchez: And if you had to share with some of our listeners, what do you recommend if you're. Struggling mentally with something like this.

[00:31:13] Dr.Grant Garcia: I mean, we're going to need to have an entire episode on this. This is a great topic. I think the mental health of recovery is humongous and it's completely not talked about.

[00:31:23] Dr.Grant Garcia: If you watch our previous episodes, this probably comes up frequently and I made it. It wasn't a joke, but I made a point that I'm basically two thirds surgeon and one third therapist, even though my wife thinks that's funny because she would say you're not a very good therapist, but nonetheless, yeah, she's biased.

[00:31:40] Dr.Grant Garcia: She's biased. That's true. So anyhow, so there's a lot of therapy, right? I

[00:31:44] Will Sanchez: don't want to get in trouble here, but anyway, no,

[00:31:45] Dr.Grant Garcia: no, we're good. We're good. So she's, so basically, you know, there is, this is just, this is, I'm just dealing with everyday athletes, right? I mean, we had paid, we had some young kids today that came in that have, Meniscus tears we're gonna have to do surgery on and tell them, [00:32:00] you know, you're out five months, right?

[00:32:02] Dr.Grant Garcia: Like everything that you wanted to do done. You're stopping. Yeah baseball player Tommy John. You're done You're you know, that's a junior season you had it's out. You're not doing it It stinks, right? You're telling the parents, you're telling the kids and there's, and it's just, you know, the surgery, that's the easy part, right?

[00:32:20] Dr.Grant Garcia: Like you go to sleep, you wake up, let me do my job. And then you start the recovery and you have pain for a few weeks and then you get back. And that's, I'm not trying to belittle the pain and the recovery, but that's the, I mean, will, you know, you've gone to this, I've undergone surgery, like the surgery part sucks, but like, that's not the, that's not the hardest part.

[00:32:37] Dr.Grant Garcia: It's the mental part. Right. And so, and, and we're talking about like, Just being annoyed because we can't go play basketball or play with our friends. These are the people that have been training for this particular thing and they can no longer do it. And they're not pro athletes where they can be out for a year and still get paid.

[00:32:53] Dr.Grant Garcia: Right. Like, I mean, they're professionals, but they're not the same as these NFL players that don't have guarantees on their contracts and every, or these [00:33:00] MBA or whatever, and so they're going to need mental health coaches. I mean, we've seen it in shows. We've seen it in, um, you heard it on there. I mean, Simone Biles.

[00:33:09] Dr.Grant Garcia: Right? Mental health, the tipsies, all these other things, mental health is huge. And almost every athlete now has a psych, a sports psychologist that's available to them. And if you are doing athletics and you're having trouble with things, I would strongly, I mean, listen, this is not a athlete only issue.

[00:33:30] Dr.Grant Garcia: Right? Like there was a huge article on this for surgeons. I mean, we're put under in stream stresses sometimes in the, or you're dealing with athletes like this, you're trying to fix, you want to get them back. And if they don't get back, you feel sad. You're upset about it. Even though the success rate of some of these surgeries is 80%.

[00:33:46] Dr.Grant Garcia: That means 20 percent of the players that you operate on will not get back and there's absolutely nothing you can do about it, right? Nothing you can do about it. So it's the same thing with these, you know, they have to, and I think that this is important. I think that it's [00:34:00] completely underappreciated.

[00:34:02] Dr.Grant Garcia: And until recent with some of these athletes that have come out and said, you know, they have these mental illnesses use. No one wants to talk about it. It was considered sort of, which is sick to say is weak. If you came out and said you had the mental issues, if you said that you were having a tough time, but you know the worst part about this is it happens to everybody.

[00:34:19] Dr.Grant Garcia: It happens to, I mean it happens for the surgeons. It happens to everybody. You feeling feeling like you got to do better. You could do better on the next one, right? I don't remember. I don't remember like half my successes, right? Like I operate a lot of people. I take care of people. I'll don't, I can tell you right now, I remember every single one of the failures and you just, that's the same way they're going to be there.

[00:34:40] Dr.Grant Garcia: They're not going to remember the 15 competitions they won. They remember the time that they were sitting there on the couch with their Achilles recovery. And so I don't know, it's a long winded answer because obviously this is a little more personal clearly. Um, but the, uh, I think it's tough. Sports psychologist is important.

[00:34:56] Will Sanchez: Yeah. I think that's the big part because, um, [00:35:00] Right? Your surgery ends. You're like, all right, I'm going to rock this. I'm going to be gung ho about it. I'm going to get him. I can't write. And you, you just, especially if that you had that mindset, I'm just going to just go after it. Time is a mofo. You know, and you're like that for a couple of weeks, all of a sudden you start to feel it right.

[00:35:22] Will Sanchez: And you start to, you know, you're going through, even as you're doing things to try to benefit, eventually you're sitting there and you're like, man, this is, this is rough because sometimes not even yourself, but you, you see that it's affecting the people around you, right. If you know, if you have responsibilities, if you know, like for myself, when I got hurt, I see my wife doing all this stuff and, you know, and I can't do certain things and, and things like that.

[00:35:44] Will Sanchez: And all of this. Extra stress is falling on other people, and that's a whole other thing besides what you're personally going through. So, without going into, you know, so much as we already have, I think the point is that whether you're an [00:36:00] athlete or someone just getting surgery tomorrow morning, Be aware of that, you know, and, you know, reach out, get a support system, especially if it's a long term injury, because you're going to have some ups and downs and you want to have a support system there to kind of help you through that no matter how strong you are.

[00:36:19] Will Sanchez: I

[00:36:21] Dr.Grant Garcia: think, and I don't want to go any more because I think we're going to, I think, well, I've just added another topic for one of our podcasts. I wrote it right here. Look,

[00:36:27] Will Sanchez: people that are home, I wrote on my yellow pad. It says Mental health therapist as one of our next shows. So, so yeah, this will be a good show.

[00:36:36] Will Sanchez: I

[00:36:36] Dr.Grant Garcia: think the audience is going to love this one, but basically be honest with yourself. That's one to understand that everybody feels that way. You know, that's one thing I like to do in the office being like the girl before you was just upset. You know, the guy before you was upset that he had to go through this, like it, you're not alone, right?

[00:36:51] Dr.Grant Garcia: You're not even alone today. Right. Which is good. Um, and then I think the biggest thing you understand is that like, [00:37:00] is that you will get, you will get there if you persevere. And you have to be okay with different things. You've got to be able to have the options in your head, but it's hard. I mean, like you said, you're in isolation, despite, despite what you want to do.

[00:37:11] Dr.Grant Garcia: But, you know, we'll move on. This is going to be a great topic for another time. I think we could talk an entire hour on this, if not more. Um, and maybe you find a really good mental health sports psychologist to come on the show at some point, we will get,

[00:37:23] Will Sanchez: we will get one on. And, uh, anyone listening, I want to come join the show and be a part of our show.

[00:37:30] Will Sanchez: Check us out, sports. talk. com. We have on our website, not only all of our podcasts, but great information, Dr. Garcia provides, we have transcripts of the show. So if you get tired of listening to my voice, you can just read what we're talking about. And more importantly, if you want to be a part of the show, on our webpage.

[00:37:52] Will Sanchez: You can reach out to us and if it all works out, we would love to have you. We've been blessed with some great guests already. [00:38:00] We're going to move on. We're going to go to your fun spot, your warm spot. ACL injuries. It's like ACL and shoulder injuries are like Dr. Garcia's favorite. I don't know. Maybe they're all his favorite here, but let's talk about secretly.

[00:38:13] Dr.Grant Garcia: They're all my favorite secretly. I do not discriminate against injuries. Everybody's

[00:38:17] Will Sanchez: allowed. Cameron Brinks. ACL injury. Uh, she tore ACL just a month before the Paris Olympics. Um, really a blow to her, uh, team. And I mean, And maybe we'll get into this in a second here, having this ACL injury coming out of Stanford, graduating one of the best players in college rebounds points blocks.

[00:38:45] Will Sanchez: She was one by far, right? Everyone talks about Caitlin Clark and Angel Reese, Cameron Brink. Was a superb college athlete. It was going to have a tremendous rookie year for the Sparks. Um, let's talk about this ACL injury [00:39:00] and what this involves. We're talking about another young athlete here. What does this ACL injury involve?

[00:39:08] Will Sanchez: Just talk about that as, and then we'll get into the recovery process.

[00:39:11] Dr.Grant Garcia: Yeah. I mean, We've all heard about this with all these players. I mean, ACL keeps coming up on this thing. We talk about all the different surgery options she has and everything else. But again, she tears her ACL. You can see there. It's one of the most commonly torn ligaments.

[00:39:25] Dr.Grant Garcia: You it's the one you hear about all in the news, um, with these athletes. So she's going to tear this. She's going to be out, you know, seven, eight months. Uh, she'll get a, probably a reconstruction and there's other fancy things we talked about, but not an athlete at this level, uh, yet. Um, yeah. And again, the interesting thing though, is it's women's basketball.

[00:39:43] Dr.Grant Garcia: So we haven't brought that up as much. We've had a lot of NFL players we've talked about. Um, and what, what people don't understand and what I see actually a higher amount is female athletes coming in with ACL tears. So female athletes are two to eight times higher. men. [00:40:00] And that's really important for people to understand because I do a lot of ACLs and I would tell you that this is very true and it's, it's really high in basketball, but the highest in soccer.

[00:40:12] Dr.Grant Garcia: And so a lot of soccer. So when soccer season comes, unfortunately it's a lot of, and it's young girls too. I mean, Cameron Brink, despite her being in the, uh, the WNBA is she's still young, right? She's just a rookie young girl. Yeah. Yeah. So again, And it's because of the way that it's not because they're female male, but it's because of the way they land, they landed more valgus.

[00:40:33] Dr.Grant Garcia: They have some rotation. They tend to have smaller notches, which means that's what the area where the ACL sits, it kind of impinges. And also women tend to be more at lack. So they tend to have more flexibility. And so that means that their ligaments are a little bit looser, um, but allows them to do other things, right?

[00:40:48] Dr.Grant Garcia: There are a lot more. Flexible. They can do things like that. But again, and it, and for Cameron Brink, who's so tall, um, it could have put her at more risk. But again, it's also just bad luck, right? Like people ask me all [00:41:00] the time. They're like, well, why did this happen? I mean, I have so many, a couple of my friends that were like insanely good skiers.

[00:41:05] Dr.Grant Garcia: They made it through their entire career. No ACL tear. Then they're 35. And Whistler and they fall and they tear their ACL. And they're like, why did that happen? I'm like, listen, it's just bad luck. So a lot of times we just can't explain why it happens.

[00:41:21] Will Sanchez: So the anatomy, the hormonal and the biomechanics of the woman athlete is slightly different than the male.

[00:41:30] Will Sanchez: And that does play a part, or at least the, the numbers or the stats or studies show that they tend to be higher in female when it comes to ACL injuries compared to male. Okay. Did I say that right?

[00:41:42] Dr.Grant Garcia: Yes. Yes. And what we also know is that because that information is important, it's important that teams and understand that you can also prevent these.

[00:41:51] Dr.Grant Garcia: So by doing prehab or by doing pre, you know, injury workouts, by learning, teaching females to not fall into so much valgus, [00:42:00] there's different things you can do to prevent it. Now, obviously someone like Cameron Brink has probably been doing that, right? Like there's no way that you get to that level and they're not preparing her to avoid her from getting injured.

[00:42:08] Dr.Grant Garcia: But nonetheless, for this is a This all of our shows segway into something different, right? Like we start off with the topic and then sometimes we go off the deep end and sometimes we go in

[00:42:18] Will Sanchez: a different direction.

[00:42:20] Dr.Grant Garcia: So any else? So as you're a swimmer,

[00:42:22] Will Sanchez: we go off the deep end.

[00:42:23] Dr.Grant Garcia: Dude, no pun intended. That's right.

[00:42:25] Dr.Grant Garcia: Uh, but anyway, all

[00:42:28] Will Sanchez: right. Very different. I think it's the only sport and I'm not, I'm not putting much thought to it. So someone's definitely going to correct me on this. Right. But college basketball. Depending how deep you go in right now, I was thinking about this with Caitlin Clark, but now even talking about this with Cameron, she played all the way through into the playoffs, March Madness, finished, got drafted and play [00:43:00] professional basketball.

[00:43:01] Will Sanchez: In a month, maybe five weeks. It's the same thing with Cameron, right? Played in the, in the tournament, had a full season going back to the beginning of the college basketball season, got a month off, probably less because it probably went right into practicing. You know, you, you get out of the tournament, you get drafted, you go right to your team.

[00:43:24] Will Sanchez: And then the game start up two weeks later or something like that. Um, right after the draft or, you know, a couple of weeks later after the draft, does that amount of playing and like I say, it could always go back to just bad luck, but the fatigue for a starting basketball player where you are clearly the best player in.

[00:43:45] Will Sanchez: Iowa for Caitlin Clark or Stanford like Cameron, where you are both have the bulk of the minutes and playing the most because that gives your teams the best opportunity to win. Having all of that basketball is going on. [00:44:00] Could that add to something like this happen? Or do we go back to, well, you're just kind of shit out of luck a little bit.

[00:44:09] Dr.Grant Garcia: I would say maybe I used to, would have to say yes. You know, the more low, the more, the quicker turnaround is there, but we're not talking about days. We're talking about weeks, right? Like you, most of us, like if you sit around on the couch for two weeks, like your body actually is worse, right? So I don't know if that quick turnaround is, I don't think in my opinion, I don't think that that's the reasoning.

[00:44:29] Dr.Grant Garcia: I think that the higher amount of games puts her at a higher risk to potentially tear their ACL. Right. And so they had more games in that season, but again, you know, Caitlin Clark didn't do it. So like, it doesn't mean that like, just, I don't know, there's a stat on that to show that that's causing that. I think if they're right,

[00:44:45] Will Sanchez: Cameron, uh, Caitlin Clark's a guard, we're talking about a, a, a taller, a center, right.

[00:44:52] Will Sanchez: Um, and you know, it all plays, but I like the point that you're bringing up a great point. It's the number of games, right? Please think about [00:45:00] it. If you think about her college career, I don't know what she did in the high school or AAU or anything like that, but by far at least her college career, she's played the most amount of games in a calendar year because she didn't end her bad, her college basketball season and then have that break or whatever she would do afterwards before the next fall, she went right into a WNBA season.

[00:45:25] Dr.Grant Garcia: That's true. And again, also the best players usually. Drive their teams to win. So they're usually probably finishing in the March madness also. So anyhow, I don't think it's, I don't think that's the exact reasoning. Um, it's always load management is always important. Uh, it depends on probably the players too.

[00:45:41] Dr.Grant Garcia: We've seen that too with football, right? Like running backs are more low management, wide receivers, other guys, you're not as worried about. So.

[00:45:48] Will Sanchez: All right, let's, uh, let's move on to a couple of the athletes, man. We just, I think we're just full of great news, right? Just talking about all of these injuries for these great athletes.

[00:45:58] Will Sanchez: So we apologize if [00:46:00] it seems a little bit morbid, but this is what we do. We talk about injuries and not only, you know, I mean,

[00:46:05] Dr.Grant Garcia: you don't need it. You don't need me to tell you about who won the gold medals. You go on the news.

[00:46:08] Will Sanchez: Yeah. And when you hear about the injuries, then

[00:46:10] Dr.Grant Garcia: you can come to us.

[00:46:11] Will Sanchez: Exactly. And we're still talking about the Olympics.

[00:46:13] Will Sanchez: Let's go. Uh, Shalise Jones and Alicia Monsoon. They had meniscus tears, uh, in their knee. Can you talk about the difference between a meniscus tear and tearing your ACL?

[00:46:26] Dr.Grant Garcia: Yeah. So can you pull that picture up again? That was good. So, uh, you know, different recoveries, different prognoses, they can come in. So first off, we've talked about this a few times, probably on some of the earlier episodes.

[00:46:39] Dr.Grant Garcia: So it might be good for us to rehash this again. Yeah. Problem you have is a lot of times with the injury report, you don't get information on the meniscus. Right, so they'll say patient the Cameron Brink tore ACL, but did she tear something else in that in the meniscus? And if she did that puts her at higher risk for other issues.

[00:46:53] Dr.Grant Garcia: You can see here that's the meniscus is the two cushions of the knee and then the ACL is in the middle. The ACL gets a lot of [00:47:00] publicity. It's kind of the sexy ligament. It's the most commonly torn one, but honestly the meniscus is way more common. If I would say like, even the last two weeks, I've probably seen like seven ACL tears and I've probably seen like 15 meniscus tears because the meniscus tears is more.

[00:47:14] Dr.Grant Garcia: The most common surgery we do is a meniscus surgery. So it's just way more common. Um,

[00:47:20] Will Sanchez: so that's a real quick scope for Shalise Jones, which is another gymnast. Her having this meniscus tear is this. Better or worse than the injuries that her other gymnastics, uh, teammates have suffered through.

[00:47:34] Dr.Grant Garcia: So that is a loaded question, which may go off on a tangent and I know we're running outta time, so we'll never

[00:47:39] Will Sanchez: run outta time.

[00:47:39] Will Sanchez: It depends on

[00:47:40] Dr.Grant Garcia: where the tear is. It depends on what type of tear it is. I run, run outta time

[00:47:44] Will Sanchez: already. Okay. I ires, sorry. It's because

[00:47:46] Dr.Grant Garcia: you and me do this. This is Okay. So, and then we'll talk about this, this crack that monsoon felt. 'cause this is a really interesting Oh, so basically. You have friends that have had meniscus tears.

[00:47:55] Dr.Grant Garcia: They go in there, they do a little cleanup. Yeah, that's fine. Those are sort of like the simple tears, little pair of [00:48:00] tears, little radial tears, but the tear that you're even seeing here, this is a radial tear. Those are kind of nasty. Cause when you take one of those out, that's equivalent to removing the entire meniscus and that's when you run into problems.

[00:48:11] Dr.Grant Garcia: Right. And we're going to go on one of these that's had problems. Alonzo Ball. This is exactly what happened to Alonzo Ball. Meniscus tear, cleaned up, which we're going to go into this in one second on Monsoon in one of the articles they talked about. And then, again, a problem. And then guess what happened?

[00:48:27] Dr.Grant Garcia: He developed a cartilage hole. And he had no meniscus left. So what was he end up getting? Which we have not talked about as the meniscus transplant, but he got a meniscus transplant and a cartilage transplant, which the meniscus was not announced until recently. They just mentioned the cartilage portion, which is a game changer for their whole procedure.

[00:48:44] Dr.Grant Garcia: And so, yes, it's uncommon, right? Lonzo Ball's the first NBA player to get this. It's one of those risks you have. So if you get a nasty one, it doesn't heal, and you get problems, they go down faster. Generally, the ACL. Players, if you can get [00:49:00] the ACL stabilized, they don't get that risk of arthritis as much.

[00:49:04] Dr.Grant Garcia: The meniscus one is a much worse thing if it goes. So basically, if it goes well for both, you're good. ACLs go well more often. The meniscus can heal. But the long term of the meniscus sometimes is increased arthritis a little bit more than the ACL. Does that make sense? That was trying to be as best I can.

[00:49:21] Dr.Grant Garcia: And again, it depends on what you have to do.

[00:49:24] Will Sanchez: That makes sense. And then for Alicia Monsoon, 2021 Olympian in the 10, 000 meters, she felt a quote unquote, I'm doing air quotes. If you're not watching, she felt a crack in her knee doing a run, which then turned out to be a medial. meniscus tear. So once you talk about the differences, that's when you hear that red

[00:49:46] Dr.Grant Garcia: thing

[00:49:46] Will Sanchez: cracked there.

[00:49:47] Will Sanchez: So what does that? That's not a

[00:49:48] Dr.Grant Garcia: good sign. So that's not good. That's not a good one. You don't want to hear that word. So crack generally means a pop and generally with meniscus tears. There's ones that are little, they get a little tears, a little frame and that's the ones that get [00:50:00] cleanups or they're usually small.

[00:50:01] Dr.Grant Garcia: A cracker pop is usually a big radial tear, which is right there. Radial tear means Like, it looks like someone cut with a scissors like this right across the meniscus. Okay. And generally those are not good and those need to be fixed. And the reason you fix them, which I just mentioned earlier, is if you don't fix them, the only way to take care of them is to remove the entire meniscus.

[00:50:23] Dr.Grant Garcia: And that is not ideal. It happens. We take, I see patients all the time. They've had, they put internal brace in [00:50:28] Will Sanchez: there. What are they doing with that meniscus?

[00:50:31] Dr.Grant Garcia: So we have to fix it. So you would let you do essentially an internal brace. You know, you do, you fix it and it's called, it's actually kind of a fancy thing.

[00:50:39] Dr.Grant Garcia: You do like a rip stop. It looks like a little checker pattern. I got on some one days we'll pull up one of the things and show how we fix one of these, but it's not simple. Not everybody does it like this. Um, but you want to save the meniscus if you can, but again, it's not always a successful procedure, but let's mention something that her coach mentioned when they asked about this, right?

[00:50:58] Dr.Grant Garcia: You said [00:51:00] she looked at quicker fixes, but it would have led to significant problems down the road. So we committed to the long term flow recovery, right? So when you hear that, there's, there's two things here, six month recovery. That's not a meniscus cleanup. Right. That's it. That is a minute. That is a meniscus repair, and they looked at quicker fixes.

[00:51:21] Dr.Grant Garcia: So a lot of the players in the professional sports get quick fixes. So quick fix is the meniscus cleanup. You've seen a player knee cleanup, knee wash, something like that. And they're like back in six weeks. Those are meniscus cleanups. The problem is it leads to significant where we've been knowing this and it's getting more and more obvious that when you have these really bad tears, like a radial tear, you don't owe, it's not best for the athlete to just remove it.

[00:51:46] Dr.Grant Garcia: Right. And we used to do that a lot earlier on. Yeah. Thankfully not in my time, but even before that, um, and the problems down the road are the worst case scenario, which is what you saw from Lonzo ball. That is the worst case scenario. Well, actually, that's not the worst case [00:52:00] scenario. The worst case scenario is some of the NFL players I've seen after the NFL that retire at 27 that have bone on arthritis, right?

[00:52:07] Dr.Grant Garcia: That's the worst case. Yeah, because we still

[00:52:09] Will Sanchez: haven't figured out the arthritis portion of that. That's the medical science that that's the golden goose, right? If we ever figure out how to eliminate that arthritis.

[00:52:20] Dr.Grant Garcia: Well, that's also what we do. I mean, that is the golden goose and we're getting, we're getting a little bit better and we can go and add another tangent.

[00:52:26] Dr.Grant Garcia: But the, the thing is that like, they're one of my specialties. If you see, um, what I do and there's, this is becoming a more common, it's still not that common and why people like to hear this stuff. And I talk about time, it's called cartilage restoration. So how do we restore the cartilage or how do we save the cartilage?

[00:52:43] Dr.Grant Garcia: So the number one way to save the cartilage is if you look on all my posts, there's a hashtag save the meniscus. There's a reason we do that. Right save the meniscus here is so important So that's why she they they're vowing that she saves the meniscus And the crazy thing is these young patients can do really well.

[00:52:58] Dr.Grant Garcia: I mean, I just I just told [00:53:00] the 15 year old today that I don't know if I can fix her meniscus, but if I can fix, but even if it looks like it needs to be fixed, I'm going to fix it because I'm going to see what happens because with a 15 year old, the blood supply is so good. 26 year olds are kind of the same, right?

[00:53:13] Dr.Grant Garcia: I would rather throw a Hail Mary pass and know that it's a 60 percent success rate because if I don't try it, it's 0%.

[00:53:21] Will Sanchez: Yeah, you already know the outcome. Yeah. And, and how old was this patient? Young woman.

[00:53:28] Dr.Grant Garcia: Mine was 15 a day, but this page we're talking about months and she's 26. I mean, they're still young.

[00:53:32] Dr.Grant Garcia: 10,

[00:53:33] Will Sanchez: 000 meters. This is what she competes in. Did you see something like that? You know, you go, well, let's, let's just kind of fix things and depending on how you heal and if everything goes right, then we could discuss whether, you know, you're going back to running these distances again. Well, [00:53:50] Dr.Grant Garcia: and they can do these other things.

[00:53:51] Dr.Grant Garcia: I mean, now you can do ultrasounds. You can do these, they have these special in office scopes you can do. You basically put a tiny needle in with the camera and they can actually see if it healed. Like there's other things they can [00:54:00] do before they release her if they really want to do that. You know, it doesn't, they're going to do every check on her, on her before they feel comfortable with letting her rip.

[00:54:08] Dr.Grant Garcia: Um, but we've seen with these newer techniques, we can get these things to heal. It's just you, the number one thing is getting to it quickly. Right. The longer you wait, the more it stretches out. And the more that once everything stretches out, it's like, imagine like a water sack, like a balloon. Once you blow it up for so long, it won't always contract back.

[00:54:25] Dr.Grant Garcia: So you want to get that thing back. And usually I say six weeks, sometimes even sooner. Like if someone comes to my office and I have an opening, I do it in a week or two. Like it's just, you just got to get it done. I got you. So. That's, that's what happened here. So we're, we're, we're almost out of time,

[00:54:38] Will Sanchez: right?

[00:54:39] Will Sanchez: It's good news. A long recovery, but Derek Rose had something like this. Uh, Roger Federer for you, a tennis fans had something like this. And, um, obviously, uh, Federer is one of the great tennis players of all time. And Derek Rose came back to become a, a contributing NBA player. Never back to the MVP [00:55:00] status.

[00:55:00] Will Sanchez: Uh, But you know, if you can have an entire career in the NBA, uh, to me, that's a pretty good thing. We can go on and on, but we're going to start wrapping it up, um, because we talk too much again. We said,

[00:55:16] Dr.Grant Garcia: I told you before the show, I said 30 minutes and this is what happened. I know it. I knew it. All right.

[00:55:21] Will Sanchez: All right, we're talking Olympics, Dr. Garcia. You ready for a trivia question? Oh, here we go. All right, I think you're gonna get this. You're gonna be close, right? So, um, Paris, this is the third time that Paris has hosted the Summer Olympics. There is one other city that has hosted the Olympics three times.

[00:55:47] Will Sanchez: What city would have hosted the Summer Olympics three times? Now it's Paris and this other city that have done it three times.

[00:55:55] Dr.Grant Garcia: London.

[00:55:57] Will Sanchez: London is the answer. [00:56:00]

[00:56:00] Dr.Grant Garcia: 1908. First time ever. First time ever. Everyone's got to hear this. First time ever I got it correct.

[00:56:05] Will Sanchez: 1908, 1948, and then in, uh, 20, uh, 2010. So you have stumped the trivia question.

[00:56:17] Will Sanchez: That was our Olympic question. And maybe it's another four years before you get it right again. So

[00:56:24] Dr.Grant Garcia: it's going to be, that's right. I'm going to have to do, we're almost, we're at, we're at three years right now. So I got, I got one more year and then I get a pass, then we're good.

[00:56:31] Will Sanchez: Uh, we just want to remind everybody, please check us out at sports.

[00:56:34] Will Sanchez: talk. com. We really appreciate everyone. Check us out in your favorite listening podcast, uh, with his, uh, Apple and Spotify and I heart, and you name it. We're on there. The same jibber jabber. If you're listening to us, check out our YouTube page. Uh, we really appreciate once again, shout out to recovery shop.

[00:56:55] Will Sanchez: We, uh, we really appreciate them. And for all the surgeons who are interested in [00:57:00] participating, uh, feel free to reach out to the recovery shop. Uh, the link is on our website. The link is on dr Garcia's website, or you can check out their website at shop recovery. net. I don't know. What else? Did I leave anything else out, Dr.

[00:57:15] Will Sanchez: Garcia?

[00:57:16] Dr.Grant Garcia: No, I mean, I know we were slow in the summer, but just, you know, we have a lot more in store for everybody. So thanks for listening. Thanks for watching. Uh, enjoy the Olympics. And, um, What are you going

[00:57:28] Will Sanchez: to watch? What's the one go to? What's your go to? What about your wife? What did she got to go to?

[00:57:33] Will Sanchez: She's like, leave me alone. Get out of my way.

[00:57:35] Dr.Grant Garcia: We swimming. I'm a swimmer. I like the swimming and I, I'm going to watch the Olympics. The gymnastics.

[00:57:41] Will Sanchez: Oh, I gotta, I gotta watch Simone. Uh, it is Abso absolutely amazing. Oh,

[00:57:46] Dr.Grant Garcia: by the way, for you rugby. I like the kayaking. I like the kayaking. We're gonna get off topic, but I like the, I don't want to go any further with this, but I like the kayaking.

[00:57:53] Dr.Grant Garcia: That's so cool. We, we got two

[00:57:54] Will Sanchez: minutes to go further. We love the kayak. Kayaking is awesome. Um, rugby fans, uh, [00:58:00] the women and like I said, I have no idea what the results would be by the time we listened to the show, but the women. Rugby team have made the medal round is the first time the men or women have ever made the medal round for rugby to shout out to a sport that doesn't get enough love.

[00:58:17] Will Sanchez: Um, I figured that you were going to watch the breakdancing competition, but maybe you'll just stick to swimming their

[00:58:23] Dr.Grant Garcia: skateboarding. Who knows?

[00:58:25] Will Sanchez: Thank you, Dr. Garcia. I appreciate it, man. Have a good one. And by the way, we've got Arthrex folks coming in. We got some really cool tools and stuff that we're going to talk about.

[00:58:36] Will Sanchez: We're going to get ready for our kickoff season 2020. NFL season. We're going to talk Chubb. We'll talk Aaron Rodgers. We got Joe Burrow coming back. We've got an exciting fall season coming ahead. So we're really excited. We're going to have guests, you name it. We'll talk about it and we'll do our thing.

[00:58:57] Will Sanchez: Will Sanchez, Dr. Garcia, thank you very much. [00:59:00] Say bye to the audience, Dr. Garcia.

[00:59:03] Dr.Grant Garcia: Bye guys. Thanks for listening. Audio Transcript

[00:00:38] Dr.Grant Garcia: I'm good. I'm really excited for our guests today. Grant Kastner is going to be awesome. Talk about some innovative technology before we introduce him and talk about this amazing product is going to show us we have a really nice sponsorship we want to talk about. So today this episode sponsored you by recovery shop.

[00:00:57] Dr.Grant Garcia: And really, you know, this has been awesome for me. [00:01:00] I use this for my patients. And the problem is that, you know, when you get surgery, a lot of patients are like, Hey, what else can I do? What can I do to get better? What can I do to recover faster? I heard about all these braces and these creams and these patches and cooling products.

[00:01:13] Dr.Grant Garcia: We'll talk about one of those today. Recovery drinks, nutrition. We've had nutrition supplements on. You've had a lot of these people on here and the problem is that in the office, the patients are asking me tons of different questions. They'd ask me, where do I get them? Can you go on Amazon and help me find them?

[00:01:27] Dr.Grant Garcia: You know, a lot of things and it's just so time consuming. So I started partnering with this place called the recovery shop. And what it is, is it offers. The surgeon's ability to offer their patients all of these products I'm talking about, they can get pretty much anyone you want aftermarket and they're, you know, really high quality and it works together to help your patients find it all in one spot, and then they can, you know, buy those things for their surgery as they see fit.

[00:01:50] Dr.Grant Garcia: And it's really been a game changer for my patients. They really love the products they are offered. They're a lot more trusting than having to go through a bunch of Amazon reviews. And you know, I really [00:02:00] encourage it. So if any surgeons are interested, again, this is signed up for the surgeons for their, their patients to get them better.

[00:02:06] Dr.Grant Garcia: Feel free to reach out. I have a link on my website or you can visit the website link here for recovery shop. And yeah, thank you again, guys. Shop

[00:02:15] Will Sanchez: recovery. net. So be sure to check it out. Dr. Garcia, let's let's talk a little bit about our guests today and what our listeners and viewers are in for. [00:02:26] Dr.Grant Garcia: Well, you're in for a real treat. This is a product used by both the hosts of this, and it has been a game changer and basically started for us in. December, early December. And we have patient number one here who wants to show his experience.

[00:02:41] Will Sanchez: Yeah, it's a, it's, it was absolutely amazing. And you know, for those have listened to the show.

[00:02:46] Will Sanchez: Thanksgiving morning, I tore my Achilles. I went in for surgery. And then in December, I've got my nice, I love it. Nice package. Let's look back to December, 2023, [00:03:00] when I received that package. Hey, welcome everyone. I got a great package here from Nice Recovery System, a great company out there in Colorado.

[00:03:08] Will Sanchez: I want to thank. Grant Kashner: for sending this to me. This is really going to help me with my healing process, a cold and compression therapy system. Got a cool little boots, got all these great accessories, exactly whatever you need. So I'm really looking forward to utilizing this. I am 11 days out of.

[00:03:27] Will Sanchez: surgery. I ruptured my Achilles tendon. Thankfully for, for me Dr. Anthony Yee from orthopedic specialist of Seattle's did the procedure. In fact, he did the speed bridge procedure, which you might have had heard from our previous shows. So as soon as I can get out of this cast, start getting this compression therapy system working.

[00:03:47] Will Sanchez: I'm looking forward to getting healed and I'll keep everyone updated on my process. And what a product it was. I'm really excited to talk about it. And anyone that's thinking about it, that's a [00:04:00] patient that has gone through healing. This was absolutely incredible. And we're really excited to have Dr.

[00:04:05] Will Sanchez: Dr. Grant cash. Everybody's a doctor. He's so

[00:04:09] Dr.Grant Garcia: excited. Grant to have you on here. He can't even contain himself.

[00:04:13] Grant Kashner:: No, no. Thank you guys. I appreciate it. And yeah, that's certainly a great video. I've been through it myself being under the knife three times. So a patient as well as you know, luckily the first employee and yeah, been kind of worn all the hats as far as you know, getting to where we are today.

[00:04:28] Grant Kashner:: So thank you guys for having me. I'm excited to be here.

[00:04:31] Dr.Grant Garcia: Awesome. Before I tell my experience, Grant, once you tell them about we keep telling everybody about this nice machine, we'll show a secret little video. But why don't you tell everybody what it does? Because while we'll did amazing job, we still don't really know what it does.

[00:04:44] Grant Kashner:: Sure. So at the kind of the most basic definition, it's kind of the best pain control device on the market, right? It does cold and compression without the need for ice. So we use a thermoelectric technology. Where it gets the the water to a targeted [00:05:00] temperature in between kind of a 4 degree temperature range from 59 to 42 degrees.

[00:05:05] Grant Kashner:: And stays at a constant you know, temperature once it reaches that. So it's just kind of the best, you know, for lack of better term mousetrap on the market. Newest technology and kind of the most portable package for the patient.

[00:05:17] Dr.Grant Garcia: Yeah, this is awesome. So for those patients out there, so I I've gone through surgery.

[00:05:22] Dr.Grant Garcia: I've tried the old ice machines and my wife, I can tell you when I had to get this done, she was. Not pleased with having to change the ice bags every couple hours. We found every trick possible. We tried Frozen peas we tried frozen stuff and thrown in the water because that we literally could not produce enough ice To cool it down and I'm a sucker for ice.

[00:05:43] Dr.Grant Garcia: I ice my shoulder if it hurts. So when We started meeting up with Grant and we first were able to offer this product cause we were the first in the one of the first in the state to have this option for our Washington state patients. I was like, well, Grant, I love this. This is awesome. It sounds cool.

[00:05:57] Dr.Grant Garcia: But like. Let's try it first, right? [00:06:00] Cause I want to make sure that if I try, I always tell Will this, like my patients get offered innovative technology. I want to feel confident. And if I'm going to sell the product to my patients to get really excited about it, I want to make sure it is a difference. So the minute I grant got me one, he sent it to my house.

[00:06:13] Dr.Grant Garcia: I put it on. It was a huge difference. I mean, we're talking about. The cooling system has five cooling depths. I always, I'm a max kind of guy. So I went to five right away. Probably not always the best thing when you're post surgery, but you know, five up there, you don't ever refill it with ice, which is so fricking awesome. [00:06:29] Dr.Grant Garcia: Just a little bit of water. And the compression was really a big difference. And I think Will's nodding his head because he felt the huge difference as well. I mean, even I'm a guy that throws ice bags on my shoulders after I work out sometimes. And this was better than that. And my wife looks at it and goes, Oh, I really wish we had that for your surgery.

[00:06:45] Dr.Grant Garcia: That would have been a much better thing. And then it was funny because I had my father in law over. Who had surgery on his shoulder and he tried it and he was like, this is, what is this thing? This is awesome. And then I also had one of my good friends and she's pretty particular on things. She's actually was one of our [00:07:00] podcast recommenders early on.

[00:07:02] Dr.Grant Garcia: And she tried on her shoulder after she had sold the surgery and she was like, I'm sold. I wish I had this for mine. So right then and there, I knew we were onto something good. And it's a, it's kind of taken off after that. So thank you again, grant for getting, introducing us to this awesome product.

[00:07:15] Dr.Grant Garcia: And the patient experience has been off the hook. You know, they're, They're so happy. I don't want to take too much thunder, but we had to, we have patients. The crazy part of my job is I get patients with two knees, right? And so a year ago I did a couple of patients with their knees and then they wanted their other side done.

[00:07:30] Dr.Grant Garcia: And I got to literally have the head to head experience and patients when they tried it, they were like, why didn't you give me this before? I'm like, dude, listen, I wish I had the technology earlier, but we didn't. So anyhow, it's a, I really appreciate it. This is awesome. I'm so excited to have you on here and I want the viewers to be able to understand this better.

[00:07:48] Grant Kashner:: No thank you, and you kind of hit the nail on the head. It's we, we, I didn't, I didn't know this coming into the business, and I would've thought, you know, I would've, you know, definitely not thought this was the, the train of thought. We have patients that actually call us [00:08:00] and you know, they're, they're looking at doctors or, you know, surgeons in certain areas, and the ones that offer the nice machine.

[00:08:07] Grant Kashner:: They're considering going to them versus the ones that don't. And you know, we obviously have to tell them, you know, go to the surgeon that is the highest recommended that does the surgery that you need. Right. And then we will, we'll, we'll, you know, obviously we're about the the post-op process after, but that was something that we saw too, was just how much it really does affect the patient experience post-op in a very dramatic way.

[00:08:29] Grant Kashner:: So I'm glad you guys kind of see the same thing.

[00:08:31] Will Sanchez: Yeah, let me jump in real quick. It is not only great for the patient, it is great for your marriage. And dr Garcia alluded to that, that I was, this is not, this is, this is your saving relationships and marriages and partnerships. So thank you. Because the fact that I put it's what I felt was like an ounce or two ounce and I, and I'll let you describe [00:09:00] it of water into this machine and it's running for about a month.

[00:09:05] Will Sanchez: And, and I'm like, how is this possible? And I'm utilizing this at least once an hour, throwing this on, wrapping it up, putting the compression, getting the cold in there, utilizing this. My wife is sitting there with the remote. Like, well, all I got to do is just get food for this man. I don't have to get. An ice bag every hour and running to the [00:09:26] Dr.Grant Garcia: torture, torture, you're

[00:09:29] Will Sanchez: saving relationship.

[00:09:31] Will Sanchez: Forget about the patients. The technology is amazing. But the fact is that the fact that our wives still love us after disrupting their lives for months. I can't thank you and everyone there at nice. Thank you for saving our relationships. Well, I will come in today.

[00:09:49] Grant Kashner:: Yeah. We're going to add a, you know, marital bliss as well.

[00:09:53] Grant Kashner:: I

[00:09:56] Dr.Grant Garcia: love it. I love it. And y'all one more last shout out. So [00:10:00] I, my partner just had a big knee surgery. And he comes to me and he's like, Hey man, my knee's pretty stiff. And I've been doing the ice compression with the ice buckets and it's, it's, I don't know. I'm just still stiff. And I'm like, dude, did you hear about this thing I'm offering?

[00:10:12] Dr.Grant Garcia: He's like, what are you talking about? Right. And so I was like, Hey, I call Grant. He ships it to him next day. Such a, such a move, man. I really appreciate it. And he, he literally, this is my partner is amazing, but he doesn't really say much. Like he's chill and he's not going to like complain. He hasn't complained about anything.

[00:10:28] Dr.Grant Garcia: I had to literally ask him how he's doing. He's operated like a day, a month, a week and a half after like a massive surgery. I mean, this guy's tough. And he comes to me, he goes, All I wrote was nice, nice exclamation Mark. And he comes in the next day and he was like, dude, that was awesome. That is so much better.

[00:10:43] Dr.Grant Garcia: I can't believe it. So thanks again. I mean, it's been nonstop. People are nonstop impressed with the product. So it's I, I feel bad for other people that aren't able to offer it. But again, it's not that hard. And we'll get into like, you know, anybody can offer this option. This is not something that because I [00:11:00] do, you know, You know, I work with recovery shop and I work with you guys and stuff like that, that, you know, I have elite product access to it.

[00:11:06] Dr.Grant Garcia: No, there's the whole point of this show is to show people that anybody can have it. And patients want it. And it's the same thing we talked about before from a marketing standpoint. I mean, I hate to say it guys, but you know, when you're a surgeon, like patients come to me because I offer innovative stuff.

[00:11:19] Dr.Grant Garcia: Like it doesn't, I try to do a good job. I think I've got a decent reputation, but really like you said, people are calling, they're calling Arthrex, they're calling other companies and they're like, who should we go to? Right. And that's brings patient referrals and it's not like you should sign up for this or, you know, it's not, it's not a subscription or anything, but it's not like you should do something because it helps that.

[00:11:37] Dr.Grant Garcia: But if it's from a marketing standpoint and it's good for your patients, this is a win, win, win, right? Everybody wins. And that's always the key here in a, in a type of relationship. So any go, thanks again, Grant. This is awesome. Do you want to I want to kind of. Stop talking a little bit less and let you talk some more. [00:11:53] Dr.Grant Garcia: 'cause obviously I want everybody to hear about this. We don't

[00:11:55] Will Sanchez: even need grant cash. Grant, just hang out. Let us talk for you. In [00:12:00] fact, you don't just sit back. You got nice hat on. You got, this is great. He looks good. He's killing. And just go like that because we're doing all the talking for you. But , I appreciate it.

[00:12:13] Will Sanchez: We can tell you we are terrible

[00:12:14] Dr.Grant Garcia: on this.

[00:12:15] Will Sanchez: We are terrible. Hey, why don't you tell us a little bit about the company and how it started and the founder, let's kind of get down to the roots and what was the inspiration to, to start to look into this technology and how it developed from day one to where you're at right now?

[00:12:34] Grant Kashner:: Sure. No, and it's actually a really cool story. So our founder and CEO, Michael Ross, he you know, for Just, you know, again, not not the, you know, kind of kind of a buzzword. He term was a serial entrepreneur right in his career. A few different businesses move to Boulder to kind of figure out his next move.

[00:12:53] Grant Kashner:: Right? While he was in Boulder, he decided to take up ski racing right at the young age of 46 years old. So. If you [00:13:00] guys know about downhill ski racing you're going about 85 miles an hour turning, you know at about 45 degrees, you know every, let's call it, you know, few hundred yards. So I'm, I'm, I'm sure you know what happens next to a 46-year-old, you know.

[00:13:15] Grant Kashner:: Man, and he he destroyed one of his knees blew his IT band off, tibial plateau every ligament and was essentially you know, ski and ski out to the Steadman Clinic in Vail. So he had a series of surgeries done by Tom Hackett. At at Steadman and then used it, used our competitive product, which is a game ready.

[00:13:36] Grant Kashner:: And I know you're not supposed to say your competitors, but they did a great job you know, kind of seeding the market with a really good product. And then honestly just didn't ever product innovate. So Michael used this product, realized that there, you know, was just inefficiencies and there was better technology on the market.

[00:13:52] Grant Kashner:: So. Just being, you know, hard headed and kind of spiteful started engineering a better product and about two [00:14:00] years later brought a pretty good working prototype to the Stedman clinic showed Dr. Hackett as well as Dr. Philipp on, and they were, you know, jumped all over it. Technology wise similar, you know, you, Dr.

[00:14:11] Grant Kashner:: Garcia, they also love kind of the innovative technology and wanted to, you know, stand behind, especially an American made product, right. We're even then we set up, you know, American manufacturing in Boulder through a contract manufacturer. And then now we make everything in house. So long story short from there, he went to working on the FDA.

[00:14:32] Grant Kashner:: And then somehow, you know, I called him when I had a couple other things going on, just on some kind of, you know, advice and the timing worked out and this was in April of 2016. So I hopped on board and it truly was you know, a garage company, but he didn't have a garage. So it was in his home office.

[00:14:49] Grant Kashner:: So and then from there, about two months later, they were he was actually getting married. So we had to find an office building. So that kind of started the whole business was we had three units [00:15:00] produced. And we had to find an office, so it's been yeah, you know, every kind of building block figuring out this business.

[00:15:08] Grant Kashner:: I don't know if you guys are, you know, no, no, a lot about the, kind of the, the very niche kind of DME market, but it's it's a very interesting world as far as, you know, no insurance and figuring out kind of delivery service and product and, you know, just how to, how to How to bring a good solution to the market.

[00:15:26] Grant Kashner:: Right. And I feel like, you know, eight years later we finally have have arrived. So, you know, overnight success just takes, you know, about, you know, eight to 10 years.

[00:15:38] Dr.Grant Garcia: Well, this is, it's interesting for the viewers to hear that last part you said about, you know, the difficulty of the DME market. What they're not realizing is that like you don't have like a nice rep on the ground.

[00:15:48] Dr.Grant Garcia: Right. Like, it's not like, you know, you hear guys here about these products, like, you know, there's amazing arthritis products. There's lots of other ones we've talked about, you know, when we get those things, those are in, those are surgeries, like they're getting delivered before [00:16:00] we got a ton in house.

[00:16:01] Dr.Grant Garcia: Like I could do pretty much any surgery I want in house. It's all there. I got a little bag and I can grab whatever I need. This has to be shipped from all over. And so it's got to be shipped with quality and it's got to be functional. But I think the one really important thing about the product is that it's despite how tech, how smart is and technology driven it is, it's actually pretty easy to use and like you just don't need instruction manuals, which is really good for the patients because everyone, you know, and we have a lot of smart patients, but the technology can be a challenge, especially when you start doing, you know, in the total knee population as you get a little bit older, you know, they're not a big fan of using their phone or remotes or things like that.

[00:16:36] Dr.Grant Garcia: So again, It's a little less than my patient population, but overall, you know, there's so many outlets for this. And so it's amazing to have a technology that's simple, but effective. What what other institutions, I know you guys do a lot of Stedman. Are there any other places you guys have worked with around the country or you're kind of like I know you guys do a lot with HSS now too.

[00:16:54] Dr.Grant Garcia: Any other place for the viewers to kind of hear places you've worked with? Cause again, you're a lot bigger company than you were from three machines now. [00:17:00]

[00:17:00] Grant Kashner:: Yeah. Yeah. Yeah. So our roots are obviously in our backyard in Colorado, right. Where Michael got his you know, kind of, kind of got, got his, you know, fixed and kind of on this track.

[00:17:10] Grant Kashner:: So Stedman is the big, you know, kind of start from there. You know a lot of docs kind of train there and then go other places. Right. So we do a big volume of business in TCO. So in Minnesota, right. A lot of activity there. I think we're partnering

[00:17:25] Dr.Grant Garcia: with them now. We're Pelto. We're part of the alliance.

[00:17:28] Dr.Grant Garcia: So that's cool.

[00:17:29] Grant Kashner:: So yeah a very big presence there. Obviously HSS is another, you know, very big kind of stronghold for us. We do a good volume of work in resurgence in the Atlanta market as well. So yep. And then we have been growing significantly in the Carroll Clinic and the Dallas market.

[00:17:48] Grant Kashner:: You know. Kind of rapidly as we, and you know, Dr. Garcia, you kind of hit it on the head, right? It's you need good stewards of the product, right? We're the manufacturer and you know, we, we want to [00:18:00] choose with good people to represent us in the market because people, people remember the doc and they remember the product, right?

[00:18:06] Grant Kashner:: They don't really remember the people in between that because it's who fixed them and then what helped them after getting fixed, right? So it's really important to have good people that represent the product because If they don't deliver it or they don't service the patient or they don't, you know, communicate with the patient or communicate with the doc and the physician and the staff, then the patient experience just isn't like doesn't follow the quality of the product.

[00:18:32] Grant Kashner:: So the main, you know, a lot of the driver of our growth is also choosing really good partners to represent the product in certain markets. And that's kind of what goes hand in hand, right? We have a really good network, a really good product, and then we choose really good partners that service the product stewards to the patient.

[00:18:49] Dr.Grant Garcia: And I don't want to jet out of this topic, but one thing for the people that are listening is one, and this is a kind of a full circle episode. So, you know, one of the, one of the good ones you guys have is recovery shop. [00:19:00] So we work with them. And if, you know, a surgeon's part of recovery shop, they can get that product to their patients really easily.

[00:19:07] Dr.Grant Garcia: And it's been, they've been amazing. And again, I don't want to overdo it. Cause we already talked about them as a sponsorship, but for people to know, like this all is intertwined, right? How does this work? It's not like, you know, as good as grant is he can't deliver them all himself. So he's got to have someone help him.

[00:19:21] Dr.Grant Garcia: And so they've done an amazing job. And, and anybody knows that you can know when you partner like this, it's really nice to know that, like. You said like grants team is amazing, but also adding another amazing team like the recovery shop guys together allows us to automatically, you know, I patients are getting these things flown in all the time, you know, and if there's any issue, like sometimes patients will forget and they'll get it like the last minute and they get it to him overnight.

[00:19:42] Dr.Grant Garcia: Like this. It's not always easy in the winter snowstorms, but you know, we get the service has been amazing. And again, I'm in Seattle. It's not very easy to, We have the hardest place to go. I mean, it's one of the farthest distances from anywhere in the country. And patients have been really pleased.

[00:19:56] Dr.Grant Garcia: We've been doing this for, you know, six months. So anyhow, so [00:20:00] that's good for patients to know, like, how it works. Kind of behind the scenes. And it's easy, again. If, and again, what's, so what's the, so let's say a patient's listening to this, right? Or a doc's listening to it. Can a, can a patient, How does a patient, like let's say a patient wants to get one of these machines can they work through you guys or do they talk, can you talk to your surgeon?

[00:20:18] Dr.Grant Garcia: What do you guys recommend? What's the easiest thing? So

[00:20:21] Grant Kashner:: kind of it works both ways, right? What I always say is there needs to be an actionable event for which is a patient getting injured, right? Then, then what happens is that actionable event drives to a physician who writes a script for that, Patient right to obviously get surgery and then, you know, be fixed.

[00:20:39] Grant Kashner:: So it really drives from the patient side, right? The patient need. So that's really patients can get ahold of us and then physicians as well, right? We get a lot of surgeons that kind of, you know, see what you're doing, Dr. Garcia, right. And see what, you know, the guys at HSS are doing and see what the guys that, you know, resurgents are doing and see what, you know, kind of [00:21:00] the big clinics that really run very efficiently and very, you know professionally are doing and, and obviously want to copy it.

[00:21:06] Grant Kashner:: So mostly yeah, if patients want to rent it, they can, they can get in contact with us. We will get them in contact with the recovery shop who will service them. You know, immediately. That's another reason why we do such good work with them as I can send them a patient referral. And I know within 30 minutes, that patient's going to be contacted and you know, just have We'll have a very good service experience.

[00:21:33] Dr.Grant Garcia: That's important for them. And also for the patients, you mentioned something that's really important and it's, it's kind of confusing to think about it, but this is a rental guys. And I'll tell you why that's such a good idea because it sounds weird, right? You're renting a system and then you're giving it back.

[00:21:47] Dr.Grant Garcia: Right. But the, I own an ice machine and it's in my garage and I can't get rid of it. And, and I'm a Seattle guy, you know, we're [00:22:00] environmentally friendly here. And I've got a huge plastic thing sitting in my garage, and I know all my other patients have a huge plastic thing sitting in their garage. And so, they never get used again, or they get used once, or my friends take it from me and borrow it.

[00:22:16] Dr.Grant Garcia: And now you can rent something and you only get it for a couple weeks and then you can give it back. Which is great. And then it's reused. Essentially it's recycling, right? Which is awesome because you don't need this for, this is not a 10, 12, 14 week product, right? You know, for me, most of my patients are renting three weeks, four weeks.

[00:22:33] Dr.Grant Garcia: What do you think on average people for you guys are doing usually?

[00:22:37] Grant Kashner:: It all depends on case, right? So you know, for me that I had you know an ACL revision with an let, right. I was more in that eight. Kind of a six, eight week bracket. 'cause I was pushing it pretty hard in the rehab. Right. I'd say primarily most people are in that three week, right?

[00:22:55] Grant Kashner:: Four week, maybe five week range. And then scopes, you know, a [00:23:00] couple really what happens is the first two weeks are the pain control. Then once they start getting into pt, right. Just depending on how aggravated that kind of joint gets. Kind of deems how, you know, how [00:23:11] Will Sanchez: much,

[00:23:11] Grant Kashner:: how much they're going to need it.

[00:23:13] Grant Kashner:: But, but generally it's usually about two to four weeks. And just to add one thing to your point, Dr. Garcia, every patient gets a brand new wrap. So each wrap is a single patient use. I just wanted to clarify that. So that's

[00:23:27] Dr.Grant Garcia: important to remember. Yeah, no, no, no,

[00:23:29] Grant Kashner:: no. You get a brand new wrap super high quality four layer.

[00:23:34] Grant Kashner:: You know, air, water, and then the outside, you know, yep, exactly. So they're all ergonomically designed per joint or per site. And yeah, we keep expanding the wrap line. Well, I saw your video with our old ankle wrap, but we just brought on a new ankle wrap, which I was like, no, I wanted to get you that one, but [00:23:53] Dr.Grant Garcia: we'll get them up.

[00:23:54] Dr.Grant Garcia: We've got to give them an upgrade.

[00:23:55] Will Sanchez: Up. I want to say this. Listen, I don't know what these, these folks here are [00:24:00] talking about. Three weeks, four weeks, six weeks. I did not want to give it back. Okay. Because it was just like something was feeling a certain way. I had swelling. You know, you still kind of recover.

[00:24:13] Will Sanchez: You kind of go, I did not wanna give it back. I got my FedEx sticker to send it back, and I was just. Real sad face is putting in the bubble wrap and it just really folding it nicely. I was like saying goodbye to a friend. And then the first time I needed to use ice, I was angry. I was like these SOBs and I had to send it back. [00:24:37] Will Sanchez: So listen, yeah, send it back, utilize it. But the problem is once you get used to it and you utilize it and it's so simple and so effective that you don't want to give this back. So I don't, you know, I'm, I'm, I'm going off on a tangent here, but I was really angry when I had to send it back and disappointed my wife came with me to FedEx and to drop it off.

[00:24:58] Will Sanchez: So,

[00:24:59] Dr.Grant Garcia: so your, your wife's gonna [00:25:00] have to go with you cause it's a marital thing. Remember, right? With this nice

[00:25:02] Will Sanchez: machine.

[00:25:03] Dr.Grant Garcia: And then, and when you give it back, you're going to be sad. But when you get it, you're going to be happy. It's kind of a, it's a, this is a good, I like this part. So, yeah, I mean, basically what you're, what you guys can hear is that, you know, this, and the nice thing too, is like, Grant will say, when you work with these companies, the recovery, or, you know, just directly with you guys, If someone wants to keep it, they can, you know, they just extend the rental.

[00:25:24] Dr.Grant Garcia: It's not something you have to return, you know, and then re rent it or something like that. And what's cool is you guys keep coming out with new wraps, right? The, I like for my patients, the knee, we started doing a lot of straight wraps. Can you show the straight one over there? But then, you know, grants, like we have something even better.

[00:25:40] Dr.Grant Garcia: We have an articulating wrap. I think this is what separates you guys even more from the other companies too. Would you say, I mean, you have so many more options and it's customizable. I mean, you have a hip wrap. That's crazy. Right. Like I tried a few of these and they're really impressive. And [00:25:54] Grant Kashner:: that's kind of what what our company is built on, right.

[00:25:56] Grant Kashner:: Is innovation around, you know, we kind of saw [00:26:00] what Michael's really good at is seeing what our competition does and doesn't do well, right.

And they don't, they don't. They don't product innovate and they don't keep the, you know, the, the, the, the products moving forward. So the unit that we first produced in 2015, while it looks the same has probably, you know, 15 or so upgrades internally and slight, you know, slightly externally as well.

[00:26:25] Grant Kashner:: That we just want to keep upgrading the technology. Like we just put a brushless pump in there from a brushed pump. Right. Because the technology in the market is up, you know, is, is updated from eight years ago. And the wraps, that's another big area that we look at, right. We are bringing out ones that, you know, people aren't even really considering an amputee wrap, right.

[00:26:46] Grant Kashner:: A glove. We have an integrated. Solution with Aspen on their on their, on their bracing line where we can integrate cold into bracing. Right? We have a new ankle boot that fits into a boot Walker. So we're really [00:27:00] trying to to cover everything. Right? We have a new elbow specific come into the market as well.

[00:27:05] Grant Kashner:: That covers the distal bicep. So, like, we're really trying to look at, kind of the complicated stuff that not a lot of companies can cover. And really, really have good solutions for it.

[00:27:15] Dr.Grant Garcia: I think that's really important. What you just said, Grant, I think it's important. You said like the, sorry, well, I just say, make sure patients hear that.

[00:27:23] Dr.Grant Garcia: Like this is this product going to keep getting better too, which is awesome. And it's made for everybody. It's not like, Some things like the, you get two pads, right? It's like a back and that's it. And trust me, I had back and I was using a knee pad because there was no lumbar. There was no lumbar stuff.

[00:27:39] Dr.Grant Garcia: So yeah, I know it's, it's amazing. So anyhow, so keep going. Well, I'm sorry to interrupt.

[00:27:43] Will Sanchez: No, not at all. What you're saying is absolutely makes sense. I just wanted to kind of put up there and talk about what this is and just kind of describe it a little bit more for those that haven't used it. Right. So I alluded to that in the beginning, right?

[00:27:56] Will Sanchez: So you have this Pretty much it looks like a box. We've shown [00:28:00] it if, but if you're listening, just want to give you a description is a blue box. It has an led screen. You can set compression, no compression, how cold from one to five. So it gives you a lot of options, but going back to the no ice. What is, or how many ounces of water are you adding to the tank and what is the timeline depending on how, how long you use it, that you can keep, keep that on before you have to even add more water to it.

[00:28:31] Grant Kashner:: Sure. So great question. And we have a couple parts of the machine that aren't really, you know, pumped out there like that. And one being the water, right? It's nine ounces of water fits in the tank. Each wrap holds about, or, you know, let me use milliliters. Cause it kind of just converts a little bit easier.

[00:28:47] Grant Kashner:: 350 milliliters are in the tank, right? Each wrap holds about a hundred to 150 milliliters. So that's actually what we cool. And the other kind of. is extra, right? It's a [00:29:00] So essentially, unless th of, you know, kind of eva know, there's a couple of of the connector every on might have to put a coupl 2 3 months, just dependin hot it is outside, you kn Yeah, apart from that, the machine will actually tell you when it's too low.

[00:29:23] Grant Kashner:: And, you know, there are some, you know some machines in clinic that they probably, you know, because it's at a nice, in a nice cool area and, you know, it's been connected to the same wrap for, you know, forever. It's probably, they probably haven't put any water in it in, you know, a year or two. So.

[00:29:39] Dr.Grant Garcia: That's just amazing. That's amazing. That's just, I mean, that's just ridiculous. I, like, I felt bad keeping the water in there for like three days. Yeah, no, it's change it, but it's amazing what it can do.

[00:29:50] Grant Kashner:: And and for patients really the biggest thing, and I kind of touched on this, is it's the kinda the best pain control mechanism, right?

[00:29:56] Grant Kashner:: And it stays at a constant temperature. Now we have preset [00:30:00] programs on this and. Again, it's not one of those things that we pump out there, but if you know about it, then, you know, then the patients love it. So our preset timing programs have a 10 cycle memory. So that meaning we have you know, a 30 on 30 offsetting, which gets the patient 10 hours of runtime, 30 minutes on 30 minutes off without them having to touch the unit.

[00:30:20] Grant Kashner:: So for pain control at night, it's a game changer. Because usually to, you know, to heal, you need to sleep. Right. And if you can't sleep because of pain, you're usually grabbing for opiates, right? Because that helps you kind of leave the pain and sleep because this runs at that 10 hours of 30 on 30 off, your pain control mechanism is consistent, right?

[00:30:42] Grant Kashner:: And it's there every time so that you're not grabbing that three a. m. Right. Or, you know, you know, tapping your wife and saying, honey, yeah, go, go get me some ice. Fill this up. Exactly. Or

[00:30:55] Dr.Grant Garcia: pills or pills. So That's a huge thing. I [00:31:00] think that the opioid sparing is all over man, and it's a big deal, right? We've already we don't want to I don't want to go into the opioid pandemic and all the craziness But it's a big deal and for patients.

[00:31:12] Dr.Grant Garcia: I have so many patients that come in They're like I won't want to use a single opioid I'm like, well, I totally get it and I want to find every way possible. You know, I'm looking at all different alternatives. We're always looking for new technology to reduce that, but it's tough for these huge surges we're doing.

[00:31:26] Dr.Grant Garcia: I mean, the patients that benefit the most from the nice machine are the biggest surgeries. I mean, everyone benefits, but like my bigger, my more complex surgeries get a huge, huge, huge benefit from it. And I basically tell them it's just almost a non factor that they should get it right. But opioid use is humongous.

[00:31:43] Dr.Grant Garcia: And the fact is ice is so harmless and this machine's harmless. You know, again, I maxed out, I do ice bags and I've gotten some shoulder burns before on ice bags. And I had the nice machine cranked up. It felt just, it's crazy. It felt just as cold as the ice bag, but I didn't get a single concern about that.[00:32:00]

[00:32:00] Dr.Grant Garcia: Like I never, my wife at first was like, take it easy. Cause she knows I go all out with the ice and and, and I, I cranked that thing up to five and it felt just as good and just as relieving. But. Without the concern for the burn. And so that's why this 30 on 30 off.

[00:32:13] Will Sanchez: That's a big selling point right there.

[00:32:15] Will Sanchez: I think what you said right there, because sometimes we'll cheat it also, and maybe not use ice, but one of those ice packs that are kind of gel and that.

is a different type of cold. And if they, you apply that to the skin, you're having other issues, other complications. So that's another great thing to consider because for the same reason we're talking about either one, I can't make ice fast enough.

[00:32:42] Will Sanchez: I don't have the space in my freezer to buy an ice bag. Maybe I have some gel ice gel things that maybe I'm using something like that. If I use it, you know, I don't use it properly. I can cause skin irritations and things like that. So I think it's another way to kind of promote the technology and the benefit [00:33:00] of using the nice recovery system.

[00:33:02] Grant Kashner:: You actually just brought up a really good point that I don't think a lot of consumers or people know kind of about thermo kind of regulation on the skin. Right. So. If it's too cold, right? Meaning it's below 38 degrees, so the, so the nice goes to 42 degrees for a very specific reason, right? It's the coldest that you can get before you start to vasso constrict on the patient, right?

[00:33:25] Grant Kashner:: Which again, doesn't create blood flow, doesn't create the best healing environment, right? There's, there's a lot of reasons why you don't want it too cold. All the news, all the newest studies out of actually Nicholas Institute of sports medicine and technology in New York city, they actually did a bunch of trauma studies and saw the perfect temperature and the perfect kind of millimeters of mercury or compression level that created the, the, the best healing mechanism for the patient.

[00:33:52] Grant Kashner:: Right. And it's actually about 49 Fahrenheit. And about 15 millimeters of mercury or about our low [00:34:00] of squeeze. Right. And Dr. Garcia, to your point, everybody, especially athletes and just kind of high, you know kind of high motor individuals. We all, we want it cold, cold, cold, cold, cold, and squeeze, squeeze, squeeze, squeeze.

[00:34:12] Grant Kashner:: Right. But I

[00:34:14] Dr.Grant Garcia: put max on everything. So I'm just going to explain. I am definitely that person.

[00:34:18] Grant Kashner:: No, but it actually, all the. And we actually are hearing this now. It's funny how when we first came in, it was like, people were like, it's not getting cold enough. Right? And now everybody's like, no, we actually, it's perfect.

[00:34:28] Grant Kashner:: You guys, you know, it's kind of the best overall healing setting. So to your point, it's, you know, it's skin safe, it's, you know electronically controlled, right? By software on the, on the temperature. And, yeah, it really is for those big surgeries. I've had a couple absolutely massive ones just from being injured, you know, doing extreme sports.

[00:34:49] Grant Kashner:: It was I was shipping it around when I was flying to meetings and everything. I was overnighting it to hotels because it literally was the most important piece of equipment. And I was [00:35:00] like, you know, I was like, thank God I worked for this company because I'd be, I'd be running the, I, I mean, I, I would have bought one by now.

[00:35:07] Dr.Grant Garcia: Yeah. Well, I mean, it's, and also, but it's important for the listeners to know, I, I wouldn't recommend like taking this on all your trips with you. Cause it isn't, it isn't super small, but it's actually pretty easy. It's so light. I mean, how many pounds is it? You said nine pounds.

[00:35:22] Grant Kashner:: Yeah. And it comes in a carry case, which you can carry on.

[00:35:25] Grant Kashner:: Don't check it. Right. Just carry it on as a second carry on, if

[00:35:29] Dr.Grant Garcia: you need to. Yeah, it's not bad. I mean, the thing is, I've you guys ever carried one of those ice buckets? It's like so heavy, filled with water and ice. So, I mean, this full is still not even that heavy. So it's great for people, especially, you know, any type person can bring it around and carry it.

[00:35:45] Dr.Grant Garcia: Well, and pro sports, right?

[00:35:47] Grant Kashner:: So everything else is pretty big. So we do really well with pro sports because and college and high school because there's no ice in the dorms. It's really hard to find ice on the road, on the, in the hotels, on the team [00:36:00] bus. On the team plane. So we do really well with any, you know, teams that are traveling or people that are traveling that you know, kind of are needed, are, are needed.

[00:36:12] Grant Kashner:: The technology on the road as well.

[00:36:14] Dr.Grant Garcia: That's an awesome point. Remember I would do the training room for, you know, giants and the Mets, et cetera. And like, there was just like ice flying off the handles there. And like every guy wanted ice, but I can imagine that like, that's kind of the old way of doing things.

[00:36:29] Dr.Grant Garcia: You know, you get a couple of these machines and you know, the major leagues. or the NFL and it's so much easier just to throw it on and you can run it so much longer, you know, like the, you know, they, these pictures they'll come out and they got like an ice here, ice here and it's, and it's just not, it's not efficient.

[00:36:45] Dr.Grant Garcia: Right. And if they're, they can't do that on the plane, cause it's going to melt. Well, and that option,

[00:36:50] Grant Kashner:: it's really important to get the relief when you're needed, right? Like even, even a quick 20 minute session without having to, you know, fumble with ice, especially if you're. [00:37:00] Let's say you're on the road, you're moving around, right?

[00:37:03] Grant Kashner:: You're kind of six, eight weeks, 10 weeks out. Right. And that thing gets inflamed. Just having that machine there and the confidence that you can just hit a session quickly and not have to worry about it was the biggest confidence booster as well. Mentally coming back from an injury. And I think that's slept on a lot too.

[00:37:20] Grant Kashner:: And kind of forgotten is like kind of the mental battles that go along with injuries. And the pain and the, you know, the, will I get back to doing what I want to do and be where I want to be? And you know, alleviating the pain and at least getting, you know, range of motion and starting the PT process and having the, the post op process a little bit smoother is a major game changer as far as the mental, you know that's something that also really isn't talked about in the surgery.

[00:37:46] Grant Kashner:: It's always like no opiates, make sure you're doing this, but it's also like, Hey. you're, you know, that, that after surgery, you're feeling good about, you know, kind of getting back to where you want to be.

[00:37:58] Dr.Grant Garcia: Oh yeah. I mean, I, I tell [00:38:00] patients now I've gotten so used to the, I'm like probably 35 percent therapist now in the, right.

[00:38:06] Dr.Grant Garcia: Like I do a lot of surgeries, but I'm it's therapist. I mean, I tell patient, I'm like, you're going to be back in seven months, but this is not going to be back for at least a year. It's hard. And I think But one thing that's really nice about this option, just like so many other stuff we talked about is it gives patients the confidence that you're really invested in their, you know, their non opioid presence, recovering faster, because like, a lot of these patients, they come in and I try to, I got a lot of stuff on my website and everything else, and so they, you know, they know that I'm thinking about other things, but it's good for them to be like, you know, a lot of people get in the surgery and they're like, all the surgeon cares about is surgery.

[00:38:40] Dr.Grant Garcia: I am going to operate, I am going to fix you, I am a machine, and then you're going to be done with me. Right, that's the concern, that's the fear of like half my, I mean I do so many second opinions because of the fear of machine. It's a huge problem and listen, I'm not going to lie. I love surgery. Okay.

[00:38:59] Dr.Grant Garcia: I love [00:39:00] fixing people. But at the same point I really like people when I fix somebody, I want them to feel totally safe and confident and I want them to feel that they're getting the best care possible and that I'm not just another person churning out a patient in the office. I'm there to, I want to see them the whole way.

[00:39:14] Dr.Grant Garcia: You know, I have patients come by. Every week, someone goes, are you going to see me after surgery? And I'm like, did someone tell you that that wasn't going to happen? I was like, I see everyone as much as I can because I want to make sure you're doing well, right? And this is one of those things. I want to make sure patients do as well as possible.

[00:39:29] Dr.Grant Garcia: So offer the most innovative technology in the operating room, offer the best prehab, and then offer the best stuff postoperatively. And this is one of these options for them. And it's, it's important for me because less opioids, they have less pain. They have the less, they have less marital issues. They have less comfort, you know, all these things, right?

[00:39:48] Dr.Grant Garcia: Well,

[00:39:50] Will Sanchez: Oh yeah, I've got a two part question for you. Are you doing anything for kids sizes? Has there been any studies that, [00:40:00] you know, you say, okay, well, we're working on kids sizes and also this is the age that's appropriate. Like, so have you gone down that road yet?

[00:40:08] Grant Kashner:: It's actually a really good question.

[00:40:10] Grant Kashner:: And we, we, we, we have, to some extent, we've started down that path. And it's kind of stemmed from a couple of things. One is our HSS peds department. Right. We get a lot of, you know, unfortunate, you know, but, but, but fortunately for us, we can start to get ahead of it, right. And we can bring out products that really fit that age.

[00:40:31] Grant Kashner:: Mostly it's about 12 and up. Right. It's. But it's the smaller and, and not even peds. It's just kind of, you know, smaller people and even smaller, old, you know, ladies in general. And, and mostly the shoulders, right? We can, we can, we can fit a leg, we can fit a knee, we can fit an ankle. It's the shoulders and the hips that are the kind of the biggest target areas for us.

[00:40:53] Grant Kashner:: And that's really something that shoulders primarily we are focused on first, then hips, [00:41:00] everything else we can kind of maneuver right now with our current wraps. But we like to kind of, again, gauge the need. We love to work with, you know surgeons and facilities and, you know, orthopods that say, Hey, What about this?

[00:41:15] Grant Kashner:: Right. And something we haven't thought about or looked at, right. We, we can produce it and we can produce it pretty quickly. Or if we need to make changes, right, we have it, we have the process dialed so that that's a big, going to be a big focus of ours. Moving forward as a, a big peds line. It's exciting.

[00:41:31] Grant Kashner:: And

[00:41:31] Dr.Grant Garcia: that's so important. What you just said. I think the, for the surgeons listening and for the patients, you know, this is not just a product, like a machine that just pumps cold, this is more. This is the sales experience. This is the concierge aspect. If you have a problem, you can call them. This is working with surgeons who know what they're doing, working with the partnerships like recovery shop, but finally feedback, right?

[00:41:56] Dr.Grant Garcia: I've done so many, we've done so many company discussions [00:42:00] on this thing. And you tell somebody something and it just goes in one ear and comes out the other. And the fact is like, what you're saying is like, we listen to feedback. You know, the HSP is guys, that's where I trained. Right. They do so much peds and I, in my practice now I do 12 and up as well.

[00:42:14] Dr.Grant Garcia: And so for those patients, you know, you don't want to feel like they're underserved and this is not, this is a good way a kid could use. This is not a dangerous product. It's just more of the size fitting, right? Like anybody can use this. There's nothing, there's nothing kids have, I kind of have ice on their bodies and kids do stupid things with regular things.

[00:42:30] Dr.Grant Garcia: So this is not a dangerous product. Trust me, I have kids. So this idea, it will knows this too, but anyhow, the, the, the point being is that It's nice to hear that you guys are like, we just keep hearing this more innovation and this product, this, something, this is simple, right? It's a, it's a box that's got amazing technology in it that makes things cold and compresses, which is a phenomenal, but it's more than just that.

[00:42:51] Dr.Grant Garcia: It's like so many other things that are important that people don't think about, right? Like, what about a small arm? What about an elbow?

[00:42:57] Will Sanchez: Those are

[00:42:57] Dr.Grant Garcia: coming, right? Those, all those things you guys keep continuing [00:43:00] to improve. And it's just, it's just awesome. And, and we're looking forward to, you know, the, the next year or two and seeing what more is to come.

[00:43:07] Dr.Grant Garcia: Oh yeah, we got a lot under the hood. But we'll

[00:43:10] Grant Kashner:: add something to your kind of point you said before, right? It's, you know, you're, you're also a therapist, right? You fix the patients mentally, physically, all of that. And we hear that frequently on our side too, is that, you know, if you call us, you're going to talk to a human.

[00:43:25] Grant Kashner:: Right. You know, you, you know Dr. Garcia, you can text me and I'm gonna reply quickly. Right. It's like, and, and, and patients have that same experience, right? It's 'cause we, well we've been patients ourselves first, right? It's founder and CEO owned from an injury. So that really matriculates through the entire company where.

[00:43:45] Grant Kashner:: We understand the patient experience through and through, and you really feel that in the company and the products and how we treat people. And, you know, it kind of just perpetuates the whole company. And that's why we, you know, really, really like working with surgeons like you, dr. Garcia, [00:44:00] because, you know, we align so well.

[00:44:02] Grant Kashner:: Just in our basic ethos and the way we do business and the way we, you know, want to treat people. And that's really important to us from a medical, you know, I know we're a medical device manufacturer, but just as a, you know, a company and as, you know, as a person as well we like to work with good people and treat people well.

[00:44:19] Dr.Grant Garcia: I mean, I wouldn't call, you know, the thing I want to take your listeners see is, is we talk about a lot of different device things, but the mentality here, that one reason I like working with. Them so much. I think the patients like it is I do feel like it's a patient first mentality And that's a challenge to find all the time as will and I've talked about in the market.

[00:44:35] Dr.Grant Garcia: You know the ability like You know, you're coming out with all you don't have to make all those things A lot of these companies just make three pads, right? There's no reason you need to make a baby elbow pad No. Right. There's no reason for it. You still sell a lot of stuff and you do well financially, but that's not big deal. [00:44:50] Dr.Grant Garcia: Like, that's not the part, part the purpose for you. Mm-Hmm. The purpose is you, is you want people to feel good about it and do well, and that's why you have a product like that. That's why you guys worry about the, [00:45:00] the temperature you can do and you don't wanna max out here and you want to educate and things like this, the podcast so people can understand what it's all about.

[00:45:08] Dr.Grant Garcia: Right. It's not just a little box that does compression. There's more to it. There's so much that goes behind it. And to, you know, to hear there's constantly being updated. It just makes people feel good. Right? Like you don't want something that's been stagnant. You don't want old technology. Patients don't want that.

[00:45:21] Dr.Grant Garcia: At least the ones that I deal with. And they want to know they're getting something that's updated and better, and that's what they get. Do you, do you want to last, I guess, one more topic and then we can go and maybe quick future stuff. Do you, for any doctors interested. And using this, what do you recommend?

[00:45:36] Dr.Grant Garcia: I know we've talked about the recovery shop. That's an awesome outlet. So again, guys, check it out. And they work really well with the nice team. If someone wants to get involved and make sure they offer this product, cause I have a feeling after this episode, we're going to get a few. What do you recommend?

[00:45:50] Grant Kashner:: So I would say let's, we love to obviously get the product and like you guys, right? Let your, your experience. I want to put the product in your hands, make sure it works well for [00:46:00] them. They love it. Their patients love it. Their staff loves it. Right from there. We can figure out the details about the rental piece and how we figure out, you know, how we get it delivered.

[00:46:09] Grant Kashner:: That's usually what I like to start with is. Either, you know, contact me, go through our website and let's get you a demo. So will you wanna [00:46:16] Dr.Grant Garcia: put the website up one more time? There you go guys. Yep. You have a,

[00:46:19] Grant Kashner:: A form on there you can fill out. And again we like to start with a demo. Just to make sure you know, you like our company, you like our product, right?

[00:46:27] Grant Kashner:: We we align well, and then from there we can figure out kind of all the details in the middle.

[00:46:33] Dr.Grant Garcia: I like to say if you guys, if you guys liked it from the podcast, make sure you drop the podcast in your likes. So that grant knows, you know, you heard it on here so you have some background information.

[00:46:42] Dr.Grant Garcia: So again, you heard it from us here. Go to the nice recovery if you're interested and let 'em know what what you want to know. 'cause so I think practice and Dr always

[00:46:50] Grant Kashner:: go through you and you can connect us. You know, we, you know how to get ahold of me, whatever works as well. So yeah, whatever works. [00:46:56] Grant Kashner:: That's awesome.

[00:46:56] Dr.Grant Garcia: Yeah, you guys can reach out to us at wws sports do com. Doc. com. If you're [00:47:00] curious again, all outlets, we like to make sure I listen, I'm a competitive guy, but if every single person in the whole world got, got access to all this stuff, that's all I care about to me. I care. Number one, that your patients get this and they have access to this.

[00:47:14] Dr.Grant Garcia: I get no benefit from selling nice machines. All right. I'm getting no cut from this. I just think it's such a good idea. And like, I care way more about all this technology, you know, 99 percent of the stuff I talk about a hundred percent, I get no cut on it, but all I care about is that the patients get it.

[00:47:28] Dr.Grant Garcia: Do better. And they hear about this stuff and that, you know, either they come to me and offer it, or they go to somebody else that can offer it again. I'm not here to ask you that the only person that offers in the world is someone like me. There's tons of people that can offer it and anybody can. And so it's really important for people to know that.

[00:47:43] Grant Kashner:: Well, no, and I, I appreciate what you guys are doing here and sorry. Well, you can, but. I always tell people, right? It's the information's free, right? The, the app, you know, the the implementation is where it costs you. Right. But you guys do such a good job of being subject matter experts on [00:48:00] the information side of this niche that we're in that for patients, for surgeons, for, it just adds to your brand and your, you know, your expertise, right?

[00:48:10] Grant Kashner:: It's like, you know, about all the other elements of surgery around it. So obviously you probably have studied exactly what you do very well too. Right. So that's where I think, you know, apart from, you know, there's no monetary benefit, but you're the, the, I look at it and I say, wow, you know, from a patient standpoint, that would be a surgeon that I'd want to go to, and I've had five orthopedic surgeries myself, unfortunately.

[00:48:37] Grant Kashner:: So I look at the docs that are really pushing it because I'm like, They're really looking at all the elements for the patient, not just cutting, right? They're really looking at the holistic approach, underst, and that is so important in today's day with. With surgery and with the patient, you know, with, with the patient satisfaction.

[00:48:56] Grant Kashner:: So that's all I'll say on that. You guys are doing a great job. [00:49:00]

[00:49:00] Dr.Grant Garcia: We got to keep this. I knew we were going to go to an hour. Will, every time you say we're not going to go to an hour, we're going to go to our, we got to have one more last quick thing. We got to get Grant out of here. Show us the new technology coming really briefly.

[00:49:11] Dr.Grant Garcia: And then we got to go.

[00:49:13] Grant Kashner:: Okay. So this is coming soon. It's our first retail product. Quickly. The on the most efficient way. To, to cool. To cool. Your core temperature is through special nerve endings, which are in your, the palms of your hand, the bottom of your feet, and the back of your neck, right? So long story short the only reason that your muscles fail.

[00:49:36] Grant Kashner:: Right during workouts or, you know, running, sprinting, lifting, everything is because of heat, right? They get too hot and the heat causes them to fail. So if you've ever done a set of bench press and you feel that pump out feeling, it's because ATP is, it is not being delivered to the muscle anymore because it's too much heat being delivered.

[00:49:55] Grant Kashner:: So that being said, what this does, it's called the rock, right? It's a [00:50:00] palm cooling device. And again, there's so much around palm cooling on Huberman, Rogan you know, Dr. Craig Heller out of Stanford across the board, everybody, you know, all the girls basketball teams in the final four, the Duke men's basketball team, baseball team, everybody's using palm cooling because of the performance benefits.

[00:50:17] Grant Kashner:: So traditionally on the market, there hasn't been a good delivery of the product, right? So what we do really well is we deliver precise colds. In a very slick and innovative product that does it very well. So the, the rock does that it gets to a targeted temperature and stays there and the performance gains around it are insane to say the least.

[00:50:39] Grant Kashner:: So everyone we've given it to, it's been. We're, we're, we're, we're, you know, we're trying to keep it behind the curtain before we do a full launch on it, but you guys are the first, not anymore. Now to actually see, I know you, you're the first ones to actually see the product, so

[00:50:55] Will Sanchez: there you go off and running there. Before we before we wrap it [00:51:00] up and, we want to promote and go check out nice recovery dot com. And if you do go to the webpage, please check this page out and try to explain to everyone what is going on here. With all of the dogs before you grant. What is happening on your web page for those that can't see it, the entire team, including Grant and Michael Ross, the founder, they all have this beautiful dog in their hands and this is their picture, their team picture, their individual picture.

[00:51:36] Will Sanchez: Whose idea was this? How did this come about? I have to know before we let you go.

[00:51:41] Grant Kashner:: So we no, it's great. Right. We, Michael, our founder, right. He's he, he loves to, you know, kind of do things, you know, kind of a unique and special, you know, kind of way. Right. And he doesn't like to do things stuffy and didn't, you know, he wanted to put team pictures on there in a way that really [00:52:00] represented our company well, and he got a puppy.

[00:52:02] Grant Kashner:: And the puppy is obviously as, you know, as cute as it gets. So we had a round of pictures with the puppy. And yeah, it's been a big we actually hear a lot about the pictures. So I think, you know, we're a boulder company, so we're very into our animals. You know, we have, we have, We have dogs in the office frequently.

[00:52:21] Grant Kashner:: So it just kind of fits our brand and we want it to come off as like, you know, it's like, we're a patient we're, we're, we're not a stuffy medical device company. Right. We'll, we'll actually talk to you like a human. We'll ask what you're like, what surgery you haven't done. Right. What's, what's going on?

[00:52:36] Grant Kashner:: Do you have somebody taking care of you? What do you have somebody, you know, like, like we actually care about the, like. You know, the the details. So having a puppy kind of, you know, I guess shows that we have at least a softer side and we're not you know, a traditional medical device company. We, we love

[00:52:52] Will Sanchez: it.

[00:52:52] Will Sanchez: And we thank you so much. Grant Kastner CCO at nice recovery system. Thank you for taking some time and being a part [00:53:00] of the show. We really appreciate it.

[00:53:02] Grant Kashner:: Yeah. Thank you guys. This was this was great. So I, I really appreciate you guys having me on.

[00:53:08] Will Sanchez: Dr. Garcia. What can we say, man? It was absolutely fantastic.

[00:53:13] Will Sanchez: Having Grant on and we're listen, man, we, we, well, we say we do it less than an hour, we got to get to less than an hour, but there's so many great things to talk about. We have so many great guests that is hard to, and you know, it's just one of those things, but we both love the product. This was easy.

[00:53:31] Will Sanchez: This was like. No homework needed for this show.

[00:53:34] Dr.Grant Garcia: So much homework on these shows, but not this one. This was,

[00:53:38] Will Sanchez: this was an absolute layup. I don't know how we coordinated with all the green that's going on. That's not Celtics fans.

[00:53:44] Dr.Grant Garcia: We're not Celtics fans,

[00:53:45] Will Sanchez: Celtics fans. And as we wrap it up, man, we always like to let everybody know, check us out at sports.

[00:53:51] Will Sanchez: talk. com. You have Dr. Garcia's face there with a nice little purple tie represent his, his colors. But more [00:54:00] importantly, we have our podcast.

We have our transcripts of the show. We have absolutely everything. He mentioned that you can find information on the nice recovery. com. All of that stuff. So, I mean, who better to explain it?

[00:54:13] Will Sanchez: Last words, Dr. Garcia, because I'm going to jibber jabber all over the place. How do you want to wrap up this show as we say goodbye?

[00:54:20] Dr.Grant Garcia: Well, first off, it was awesome guests. And as usual, we got close to an hour and it was just too much fun. The product's awesome. You can find everything, like you said, on our website and you hit, there's a link that goes to my main website and you can find the recovery shop.

[00:54:35] Dr.Grant Garcia: You can find my accelerated recovery stuff and we'll have this podcast. For the nice, in addition, you can find ways to access it and, you know,purchase it and find their website. We have, we want to make this easy for patients. We want to make it easy for surgeons. They want to get involved. Again, no cut from us.

[00:54:50] Dr.Grant Garcia: The key here is just so you get the best possible options and you hear about the products. Again, all orthopedics, all sports, all the time. That's what I want our patients to have and hear the most [00:55:00] cutting edge technology. So thank you.

[00:55:02] Will Sanchez: Yeah. And think twice before you give the nice recovery nice package.

[00:55:05] Will Sanchez: I, I should have just kept it and just avoided his phone calls. That would have been the smart way to do it. Now I'm all disappointed. Thank you, boys and girls and everyone else. We had a great show. Thank you for listening to sports doc talk. Thank you to our guests, Grant Cashner there and nice recovery.

[00:55:23] Will Sanchez: And we'll catch you next time. Bye. Dr. Garcia. Audio Transcript

[00:00:30] How are you, Dr. Garcia? I'm good. I'm, you know, we've had, like you said, so many good guests, but you know, it's time for us just to hang out. You know, we haven't done this in a while. You used to do this pretty much all the time. Uh, and we've had some phenomenal guests. Um, and you know, people were getting tired of just hearing me and you talk all the time, but I FaceTime. 

[00:00:49] So this is good. Uh, this actually, this topic, Um, while near and dear to my heart and we get lots of patients asking about it, it was actually a patient [00:01:00] request. So we had someone go through the website. You've seen we've had a couple of those we've presented on recently since we've had the new sports stock talk website and you know, the patients actually, uh, it's actually a patient of mine, um, but they went separately through the website to ask this question and I thought it was really good because. 

[00:01:17] Especially the patients for me, you know, we see a lot of local patients. We have patients that drive three or four hours and then we have patients and this patient is actually from out of the state. And so they'll come from out of the state and they want, they want something different, right? Like, you know, They don't want to fly up for surgery and say, Hey, listen, I want to go fly to you. 

[00:01:34] You know, you do, you do a decent ACL or whatever, but they want to know like, is there anything else you can do? And in some cases there is sometimes there isn't, but they, you know, they want to ask those questions, right? Cause they haven't, they feel like there's more out there. They've done research, they've done Dr. 

[00:01:48] Google, which we know is never the best thing. Um, but it does help in some, it does help in some aspects because I think the problem you have is you don't always know what you don't know. And you don't know what the surgeon doesn't want [00:02:00] you to know, or you don't know what's available and what options are. 

[00:02:03] We've already seen different ways of doing ACLs. We've seen different ways of doing ACL repairs. I mean, even in the city of Seattle, if you went to three different doctors, two of them may never even bring up the word repair. And so it's important for people to have all these information. It's also why it's important for second opinions. 

[00:02:16] But I think the point here is biologics is in its infancy. And it also matters about how you ask the right questions. So the thought is, you know, they've heard about the repairs, they've heard about bear, they've heard about ACLs injuries. They've read about this thing called bio ACL, which we'll get into in a minute. 

[00:02:33] And we've actually talked about on the show, just a different name. Um, You've heard about bone marrow, you've heard about PRP. So we're gonna talk about like, how does it all integrate together and kind of work our way down from the basics to more complex. Um, and hopefully the listeners will learn a little bit on the way. 

[00:02:48] Yeah, it's, uh, like we said, it's right up your alley and, uh, you know, talking about, uh, you know, our ACL injury surgery and biologics, uh, event. And as we get it right before we get into that though, I'm kind of backtracking a [00:03:00] little bit here. You know, we're six months into the new year and we had, uh, you know, uh, Dr. 

[00:03:06] Acevedo and Bashai and, uh, uh, Dr. Jazieri and, and, you know, with his peptides and different techniques and, uh, whether it's Leah Winter, which was at the end of 2023 before we started 2024, uh, just kind of reflecting, uh, already just the tremendous amount of shows and, and we have some great guests lined up. 

[00:03:29] As we, you know, Oh my God, head into the summer. And next thing you know, it'll be fall again. And the kids are off to another grade and, but I'm getting ahead of myself. So let me just kind of slow down a little bit, but I think it's just a great reflection to just to thank the audience members, to thank our guests. 

[00:03:45] That have listened, watched, and been a part of the show that have reached out that want to have these conversations. And we just want to thank you. And whether you're watching us on YouTube, check us out on Spotify or Apple or any of your favorite platforms. So I'm just giving a [00:04:00] quick, you know, tip of the hat. 

[00:04:01] And if you're watching right now, I'm tipping my little hat right over to, to all the fans and guests. And just thank them, uh, anything that you want to add there before we get into talking about ACLs without surgery and all this good stuff. Yeah. So, I mean, it's just. Yeah, the guests have been phenomenal. 

[00:04:18] We have more to come. You know, I think one thing we've heard, I've heard a lot from actually from other orthopedic surgeons I've talked to, or other people in the industry, medical device companies, et cetera. What they like, I think most about the podcast, which we didn't think about originally was, While it's all sports, all orthopedics, that doesn't always mean surgery. 

[00:04:37] We're talking about innovation, nutrition, talking about how other people deal with interpersonal stuff. I mean, Acevedo and Bechet are two of some of the best surgeons I know, and they didn't spend most of their time not even talking about the surgeries. We talked about how you prep for surgery, all the behind the scenes stuff. 

[00:04:53] I mean, this show is keeping it real. You've heard so much stuff that you will not hear on many places and [00:05:00] getting to hear how it works behind the scenes. We had the tech. You know, the tech show, obviously with us, you know, that people don't even hear about that stuff, right? You may be here to the cocktail party. 

[00:05:09] If you happen to run in and be, be with a surgeon, they've had a few drinks. Maybe they'll tell you the truth. Um, but you know, the, the thing is it's, it's a really exciting, um, and there's more to come and you're going to see other things that you're not expecting. Right. Other guests that are, maybe you're not surgeons. 

[00:05:24] Right. That are going to come in and they're going to have topics that are, that are important for orthopedics or sports, but maybe not always surgery involved. So anyhow, we're getting off topic again, like we always do. And we're trying to keep, that's okay. It's part of what we do, but going back, Hey, check out the tech trends unveiled. 

[00:05:39] That was a great episode. And let's give a shout out to Dr. Schaefer. Right? He was another guest that we had on. Just so many. So if we forgot anybody, just, we're always thinking about you. But right now we just, you know, kind of jumping around, but let's talk about this ACL injuries, surgeries and biologics. 

[00:05:57] And the first thing, when you sent your notes over to [00:06:00] me was like you, like you mentioned, to start the show. This was a request. This was someone that wanted more information about it. So when we talk about A. C. L. Injuries that heal without surgery, um, can you start with, like, primary repair? Like, what does that entail? 

[00:06:17] When you when you think about Or, or when you're discussing primary repair when it comes to these ACL injuries. Perfect. So we'll go one step back further. So there's a lot of hype. You may have seen the articles. You're looking at your Apple news and you see ACL repaired without surgery. Magic, right? 

[00:06:34] They'll get like 200 MRIs. It's usually a European, European study and no offense to the Europeans, but you know, they, they, they tend to have, it tends to be, I know a different different data sets, at least for some of these things. Um, and it's in a journal you've never heard of. And they're saying, hey, they repaired all these ACLs. 

[00:06:52] You gotta be really careful about this because it's someone that does a lot of ACL repairs now. Um, you know, when I get in there, I pretty much I've never been in one where I get in [00:07:00] there and all of a sudden the ACLs completely stuck to the wall and I don't have to do anything to just kind of attach it like we talked about with the tightrope and it goes back there. 

[00:07:07] I mean, I was had one last week and I said, there's absolutely no way this would heal on its own. You know, these ACLs, they were tracked. Imagine like recoil, right? There's a springiness to the ligament. And so when they tear, they recoil. So while they're still stuck on the wall of the, the femur, they're pulled back. 

[00:07:23] And when you stretch them out and retighten them, it's amazing to see how they go right back into the orientation of when you see a normal ACL. Because we do a lot of surgeries on people that have normal ACLs for other reasons, since we, we know what it looks like anatomically to be normal. And so you got to be really careful because the idea of it healing is not the case now maybe in patients with partial ACLs. 

[00:07:44] So that's a different topic and we're not going to go too much into it. But partial ACLs or sprains are actually fairly common too. We see probably, I would say maybe out of one out of every ten ACLs I see is a sprain. Now again, I'm seeing more surgical ACLs. It's a bias to come to the surgeon with a [00:08:00] surgery ACL, but people that sprain their ACLs, we see a lot, especially my team, you know, Tim, the teams I cover and everything, because they're coming to me regardless of whether it needs surgery, um, these partial ACLs where it's like either a partial bundle or it's just a little bit of a stretch, you know, those are ones that sometimes can get away without surgery. 

[00:08:18] And I tell patients maybe 30, 40 percent of patients may need surgery at some point and sometimes it's lower, you know, you never know, it depends on the amount of injury and that's where biologics, you know, such as potentially PRP, which is where we take your blood and spin it down or bone marrow. We take bone marrow out, maybe helpful again. 

[00:08:36] We don't have a lot of data on it. They've looked at ACLs and PRPs for sprains and the data does show that some studies show there may be some slight benefit. And others show nothing at all. So it's something to be aware of now doing PRP when you acutely injure it. There's no downside. We'll talk about these biologics. 

[00:08:54] There's no downside to biologics except for the cost. And not covered by insurance. Like me just really, it's the platelet [00:09:00] rich plasma, which is the PRP. So if anyone's listening, doesn't know what dr Garcia is mentioning, uh, like myself, as I'm, you know, I'm just a, uh, doctor on the radio here, but platelet rich. 

[00:09:13] plasma. Um, for the PRP people out there. So I'm sorry to interrupt Dr Garcia. Go ahead. No, that's perfect. And that's a good segue. You get, it's important to mention that. So anyway, so the PRP or the platelet rich plasma, the bone marrow aspirate, which is from your bone marrow, like your hip, your knee, you know, we can take it from all different places. 

[00:09:29] And the idea is in the acute phase, you give that to somebody and maybe to help them heal. Now, like I said before, data's mixed. So that's the, that's the idea. That's on the non surgical, maybe biologics options. And that's something that people can try again. There's no downside except for the cost. So, you know, depends on the place you go. 

[00:09:46] But there's a cost these things and they're not covered by insurance. So if you have to be aware of that, you know, that does change the aspect and that's important to bring up. It's just like the Tech trends, you know, all these sexy biologics we're going to talk about. They are not covered by [00:10:00] insurance and it's different than like implants. 

[00:10:02] So like if you have an implant, it's all bundled in the price, right? So you can basically like sometimes it's more expensive and it's something that won't, it can't be done because it's just too expensive. The surgery won't cover it. Your insurance won't cover it. And there's no way to get around that with biologics. 

[00:10:18] It's never covered by insurance and there's no way to get around it getting covered by insurance because basically, They're expensive to do. And so the patient has to be on the patient's own as to do it. So understanding all this stuff sounds really great when it comes to the biologic side, but people who ever get these are paying out of pocket extra for them. 

[00:10:36] Real quick. Is that something also that the insurance can, uh, find a way to excuse saying, You don't really need this or you might not need this. We can treat this differently. It may not be at the level of biologics, but you know, fine. We can put a bandaid on it. It might not be the, the, you know, nice H wrap band to hold it together, but [00:11:00] it's still as effective. 

[00:11:01] Is that their way of kind of working around, you know, uh, paying for some of these things? Yeah. So the, the, we still use codes, like I told you before. Yeah. Uh, for these, these biologics as a PRP code, there's a bone marrow asper code, but they're considered experimental and Don't get scared by the word experimental because it doesn't mean you're being experimenting on and no one's ever done this before It just means that's the insurance company's way of saying we're never paying for this There's not enough And and the good news for you is you can actually pay for it because in some of these things Yeah, we've talked about some of the implants They're so expensive that an insurance company will never pay for them by contractual rules. 

[00:11:38] You're not allowed to pay extra So then you're just, you're just stuck. You just don't know. You just never get it versus this. At least you can get off. There's no contractual rules that you can do it. So that's the one thing. And it's, they're really safe. I mean, there's no downside. Like I said, to most of these things, except for the cost. 

[00:11:54] We're getting sidetracked on that, but just to have patients hear this, uh, you know, that's how it works. Um, [00:12:00] but basically talk about repair. So, you know, we talked about this before and you could bring it up, you know, my favorite, which is the tight rope repair, um, for ACL. So, uh, Let's say you decide you want biologics or you're like, Hey, I want to biologics and I need my ACL fixed. 

[00:12:14] Well, obviously in one of the, the, the, our, um, our request was how do you save proprioception? So the idea behind the repair, we've brought about this about a million times now in this podcast is that if you save the ACL, these patients, they, I'll tell you, I done a lot of these, I'm up to like 40 or more. 

[00:12:31] And we just, we just flew down to San Diego to teach about this. So, you know, this is a hot topic. We fix them with this device. And they, if you know, when it goes on to heal their, they can, their knee feels better because of the proprioceptive things are saved, right? When we do a reconstruction and we're removing all of that, or a lot of it, as much as the doctor tells you to try to save as much, you can't really do a good ACL reconstruction by keeping the entire ACL there. 

[00:12:57] So the idea is you're saving some of the proprioceptive receptors, [00:13:00] which is important for certain people. Um, if it heals and then, you know, there's less, less stuff that comes out. You're not making a big a bone tunnels. And there's less pain. You know, the patients are doing a lot. They're doing, they're feeling different. 

[00:13:14] That being said, not everybody's a candidate, like I brought up before. I would say, I do a lot of ACLs, so I'm probably done, you know, if I'm doing probably one every six or seven, now my indications keep getting a little bit broader as I get better. Do more of these and I see, okay, this group is doing really well. 

[00:13:29] I'm going to broaden a bit more. This group is doing really well. And I'm going to keep going slowly, so I do this appropriately. Because again, I told patients before, I'm not here to experiment, but I want to give them the cutting edge stuff. So, what people don't understand is they always ask, you know, they ask for biologics with this too. 

[00:13:45] They're like, hey, what else can I do? Like, ACL repair, that's great. Like, that's old news. Right. We're onto new, new stuff. What's the newest thing you can do or what they don't realize. And you can bring up this little, the little pick device is that whenever time we do a repair, whether it's a bear, an ACL repair with the tight [00:14:00] rope, a combination of both, we'll get into that in a second. 

[00:14:03] We use this device. This is a, this is a power pick. There's other ways of doing this too. And basically what we do is we make little holes. in the bone where the ACL and the PCL sit. And we actually do this for meniscus tears as well. And this brings bone marrow in. So it's actually covered by insurance, this procedure. 

[00:14:19] So that actually is nice for patients because they're not paying out of pocket for the PRP, which is the platelet rich plasma or the bone marrow. And there are people that are looking at whether we can add more biologics. Can we add bone marrow, which you, you know, don't always get from just this alone that's concentrated or platelet rich plasma that's concentrated. 

[00:14:36] And it's the same thing they've looked at with meniscus tears. Again, it's hard to show a big difference because this micro fracture thing causes improved healing as it is. So that's already, it's hard to show something that's as effective as this and biologics being better. Does that make sense? Yeah, I guess my question is, um, this tool is creating [00:15:00] the holes, right? 

[00:15:01] And then what do you mean that it's promoting bone marrow? So you'll see, and we don't have a video to show you, but when I do this, you see a fat bone marrow coming out as you're doing it. And by creating a hole, now it's going in and then doing it's own, it's coming out. Coming out. Okay. So you're essentially going out into the knee and what it does actually simulates an ACL tear. 

[00:15:24] Because we've seen when you, when you tear your meniscus and then you tear your ACL at the same time and you do the surgery at the same time, they heal way higher rates than if it just meniscus alone. So you want to simulate this ACL tear, um, and even if you don't, when you do a reconstruction or a new repair, you're not making as big of tunnels, you're not doing as much trauma, and so as a result, you want to still simulate this ACL tear. 

[00:15:49] Fluid stuff coming in. So people will heal. So how does that risk your recovery by doing this procedure? Like you're, you're adding this, um, [00:16:00] uh, you know, lack of better word, kind of like simulating this injury in order to promote healing. That's a perfect exam. So I tell patients sometimes they'll have a little bit more swelling in the first few weeks, but. 

[00:16:13] We also have tricks to reduce the swelling that we give patients medicine called TXA. So. It's negligible. The problem is, you know, if I have a something that's going to increase your success rates by 25 percent for a meniscus Yeah It's pretty hard for me not wanting to do that regardless if you feel swollen for two more weeks, right? 

[00:16:30] Like any patient any person would say I would want that I want to heal better with the first time you try it then dealing with swelling for two or three weeks So that's really the that's the downside of doing this Uh, it's pretty low. Um, but people are looking at this. I mean, we're, we're looking at this. 

[00:16:47] I work with, you know, I work with the Arthrex company. You've probably seen a lot of my stuff. Uh, you know, we're looking at finding ways to add more biologics. They're talking about putting collagen patches on to help the ACL heal. And so we're, they, we're [00:17:00] getting there. And one of the ones that does this is bear, you know, let's bring that up to like, we've talked about this before 

[00:17:08] the thing, the thing with the bear here is people don't get is that they think the bear is the entire surgery. And we just posted our newest video. We actually use the Arthrex ACL tight rope. And then all we do at the end is slide the bear down there and add it. So the way that was FDA approved as a different type of technique, and we continue to improve this. 

[00:17:29] If you look online, there's like 20 now videos out. All these are the top guys doing bear ACLs and each one of them does something different. So it's just wild because the idea of bear is literally just the implant. All it is, is the collagen implant soaked in whole blood. And put into the knee and then everything else they don't really like it's really not a step for doing that. 

[00:17:48] Like the old technique, the FDA approved us great, but it's not as strong in my opinion. And so that's why I started doing the tightrope with them. And then I'll add the bear like I just did one a few weeks ago. And so what we're seeing with [00:18:00] that is that you're hopefully going to have, you know, you, you get the ACL to hold up to the wall. 

[00:18:04] And then the bear implant, which is this collagen with, uh, you know, The whole blog, people are actually using PRP sometimes. And there, as soon as you know how this works, as soon as it hits the market, you have all these like smart surgeons that are like trying to figure out a better way to make it better. 

[00:18:21] And they're all trying to tinker a little bit cause they want to find the golden ticket. Like which one's going to be even better than what's currently out there. Right. Yeah. And it's. I hate to say the word off label because not really because there's really not a label for how you should do this. Like there's a technique guide, but the FDA doesn't say you have to do it this way. 

[00:18:36] They just want you to make sure you, you have to do a certain things that are, that are allowed, which is like, you know, soak the blood, put in the knee, lay the groundwork down. And then it's up to if you're going to be a little creative or what works for you. And then I'm going to oversimplify it for people that are listening to the show. 

[00:18:50] They may not really understand. Think of you having a hole in the wall. Right? And then you're creating this compound, right? And it was stucco and you're [00:19:00] you're covering the hole to in order for it then to harden and heal correctly. And this is kind of what this bear implant, this bridge enhanced ACL repair is kind of happening. 

[00:19:13] Obviously, I'm dumbing it down here, uh, and not to, to take anything away from it, but it's just kind of gives you a visual idea of what this, this compound or silly putty or whatever you want to call it, that's kind of holding everything together so it can heal correctly. Right? Am I wrong in that assessment there? 

[00:19:32] You're pretty good on that. I mean, we brought this up before, but like the MCI, which is the ligament on the outside of your knee almost never needs surgery. And so what they're doing is trying to turn this into an MCL tear. So ACLs used to never heal. That's the thought process. And now we're doing more repairs. 

[00:19:46] The bear's out. People are doing more bears. And the idea is that basically it causes clot that guides it to keel in a very, you know, we've heard of the word college and impregnated. Everything's college and impregnated. Right. The what about UCL internal [00:20:00] brace? We talked about this from the, from Brock Purdy and the throwing collagen impregnated suture. 

[00:20:05] Well, in this, the FDA didn't have the internal brace. So now I do an internal brace. I do a tightrope and then I add the bear at the end brace. The thing you're trying ask your, the thing you're trying to ask yourself is, wait a second, you're doing an ACL tightrope, which is identical to the other surgery you're talking about, and all you do for the bear is just add the bear. 

[00:20:24] And the answer is yes. So the problem is there's no head to head studies at this point because is it the bear? Is it both? What's ha what is causing this improvement, healing, or peer patients doing well? So, so there's no study right now saying, um, And this is all right. I'm going off track. I apologize. I like it. 

[00:20:45] No, this is good. I'm talking too much. I want to hear your question. When you do a surgery and you say, okay, I did the bear. I did the tight rope. I did, you know, whatever I'm doing. And then I say, I did these [00:21:00] three different techniques for this. That's not going into, uh, some kind of database that they get, then you can have, you know, the recovery time, the patient, this, this was what happened and it goes into a national database where everybody's now kind of keeping track and or some kind of form. 

[00:21:17] Is there nothing out there like that? Where I, instead of the FDA just kind of doing their own studies, but you know, the surgeons themselves. They are putting in the combination. Well, I only did the bear and I did the tight rope or I only did the tight rope for this one. And then you're seeing those comparisons based on the severity of the injury. 

[00:21:37] Oh man, you were open up a can of worms. I love it. Well put. No, it's great. So, um, first off, those studies are expensive, right? So who's going to pay for them, right? Like, are you going to have the search? Google docs. It's not, no, because you got to get permission for the patient, right? Like, it's not like I can just throw in HIPAA. 

[00:21:55] Yeah, technically. I mean, uh, technically a study where no [00:22:00] patient's information is given out is, is okay. But what about within your office, right? Or, or your doctors or still has to be approved. So to be approved, I can't start logging a spreadsheet, like a whole, like a, there's like a committee that has to like, look at this and I'm going to talk to the committee. 

[00:22:16] Can you take me to your next conference? I've got a couple. I will. I will. So, so basically we're going to try not to get too off topic here, but basically the idea is it costs a lot of money to keep systems to do that. And we're getting there. Bayer has their own reps, the people that bring the implant and they ask questions about the surgery, like when did the Powell was the patient, when they get injured, how they choose you. 

[00:22:36] They ask all those questions. They keep track of it. And every six months I get a message from them with the entire national information in it. It's all confidential at this point because they're, they got what they want to publish it and make it, you know, peer reviewed and, you know, fully, fully reviewed and checked out, but yes, the answer is, it's really hard to do all these in certain places. 

[00:22:53] I'm prior practice, so I don't have a lot of research assistance, you know, and I don't have fellows, but a lot of places I've worked, HSS. And, [00:23:00] uh, rush their machine so they would have someone in the hour like writing everything down patient when they signed 15 consent forms. One of them is the IRB. So they're illegally allowed to were allowed to keep their information and follow it. 

[00:23:11] Um, so yeah, I mean, you can and you can track it retro. You can track it afterwards. There's different. We can look up codes and stuff of patients. And I've done that before. And then you can call them a two or three years later and see how they're doing. So we're going to get there. We're just not there yet. 

[00:23:26] And this stuff so new. Um, but you're going to see more things coming out of the pipeline, but imagine surgery comes out, you need at least one, two years, if not three years after the surgery, because you gotta make sure enough of the surgeries have been done. So we're just not there yet, but this comparative study is a really interesting one, and it's something that some of the companies are thinking about. 

[00:23:42] So, one of the things they've been doing with the bear, It's actually grinding it down into the, because you may have seen it's like this big honking piece of collagen and then you put stuff on it and then it starts to get gooey and you put it in the knee. Some guys are grinding it down, soaking it with stuff and then just squirting it in the knee. 

[00:23:59] So it doesn't, [00:24:00] there's, we're finding other ways to deliver it to you and that's another like, You know, maybe off label, but that's a biologic thing is like, is this just the, is it just the, it doesn't have to be the actual implant size. It's just the stuff in the knee that you can get in there. Okay. And it's always going to be kind of like a silly putty, right? 

[00:24:16] You're never going to throw it into like a, uh, a NutriBullet and grind it up and then sprinkle it in there and do some kind of concoction. You never know. You never know. And, and, and one of these questions we always have is, can we do, well, how do we keep it in there? So the word collagen, like a lot of these different things we talk about. 

[00:24:33] They're, they have a, they have something that brings it in. It's a conduit. So that's the idea behind this collagen thing is it can soak up the blood and then it starts to create clot formation. Um, and yeah, everything's about conduits. Like if you just push stuff in the knee, it just like floats around and disappears, right? 

[00:24:49] Like the idea is like, that's great, but with some of these things you want a delivery system. And so that's where this becomes challenging because then you start talking about manipulating biologics. And then that technically is [00:25:00] FDA. Oh geez. Put some balloons on there. That's exciting. So manipulating, you want to be careful. 

[00:25:06] So you gotta, you gotta stay with it. And I think you got to stay with the new limits. I definitely think they put the balloon. Anyhow. So we, uh, so that's, that's it for the ACL repair and biologics. Oh, that was perfect. Let's see if we can do it. Will it work? I'll try one more time. Air quotes. It's not working. 

[00:25:25] No. Maybe we'll get better. I think everything is better. We should end every segment with balloons. So I think that is perfect. No, it's, uh, it's fascinating to think about that. And it was interesting because, you know, you obviously made the point that you needed to stay, not just put it in there, but to stay, because, uh, you know, my first visualization of when I was making the joke about, you know, grinding it up and Nutribullet is like, you know, if you ever had a wound and you put salt, In the wound, you see it bubble up, right? 

[00:25:58] And it starts to, you know, [00:26:00] obviously it's painful and things like that, but it bubbles up and kind of kills everything. You see everything kind of happening. I was just having this vision of you sprinkling this, this concoction into, you know, the knee and, uh, And who knows what works. But anyway, we get, we get sidetracked. 

[00:26:15] Um, let's, let's move on. And I know we were talking about the key components, benefits of the Bayer implants and ACL. And, uh, you wanted to jump into, uh, ACL grafts and things like that. Yeah. I mean, so, you know, one of the guys, uh, the listener patient is he's already had an ACL done. So he's wants to know more about the graft options, right. 

[00:26:35] Cause the repair is sexy, but You know, there's a lot of ACLs that are done and people have an injury again and they want to know what to do after it, right? Or there's people that can't get their ACL repaired, right? Like, the idea of the ACL repair is very sexy, it's very cool, but it's not for everybody. 

[00:26:47] I mean, it's like less than 10 percent of patients. And so it's just most patients are never going to have that option. Dr. Justin Marchegiani Wow, I did not realize that, why is that? Dr. Brandon Miller There's some people pushing the envelope, but it's [00:27:00] really the certain pattern of tear. It's got to be torn off the femur. 

[00:27:03] Um, if you look at it, you know, I can't remember the exact data, but it's like maybe 10, 20%. And maybe we should be repairing a few more of these and we're starting to get better at it. But, you know, I'm a surgeon that pushes the limit. I do probably the most repairs in Seattle. Uh, if not the whole area, um, I teach on this and I'm still not comfortable trying to repair all these ACLs. 

[00:27:22] It's just, we're not there yet. But you have a program of rehabilitation anyway, also. Yes. And I'm a proponent of all these things. I'm a proponent of reconstructions. I'm a proponent of all these things. It's just, it's important for the listeners to understand. So, I think the important thing you should understand is it's not just like adding biologics and doing, so let's move on to the ACL reconstruction because that's actually the more common thing. 

[00:27:43] So, you know, let's say your surgeon doesn't want to repair it or it's not a repairable tear. Well, majority of them get reconstructions and when you get a reconstruction, there's three things you got to figure out a way to improve if you want to, if you want to get someone back faster. So like all of this is like, people do this, people are worried [00:28:00] about their graft healing, like the grafts will heal. 

[00:28:05] It's just a question of how long it takes. And so that's the thing that people, I think people are worried. They think that if they're going to get biologics, that they're going to basically, they're going to heal way better than anybody else. And then they're not, they're going to get back faster or they're going to get back, uh, and have a stronger ACL. 

[00:28:20] That's not the case here. There's some things we'll talk about that may add some structural integrity to it, which we've mentioned before, but really it's about speed, right? Like if I could do an ACL on you, the reason people want the ACL repair is it's faster recovery. Not the bear. You've got to follow the protocol, but the repair tight rope, people are back faster. 

[00:28:37] And so that's why they choose it. I mean, it's, I literally I'll offer it. It's like 95 percent of people. So this fertilized ACL is a perfect point, but you want the graft to heal to the bone faster. So it depends on the graft option. You've got patella tendon, which is bone. So that'll heal versus other tenant options, which is what the fertilized ACL is. 

[00:28:55] And then member, you're taking a tendon out, which is a tendon is a bone to [00:29:00] muscle attachment. So you've got the hamstring tendon, you have the quad tendon. There's a few other options too, but you're putting in, you wanna make it into a ligament. So a ligament is where it's attached to bone on both sides. 

[00:29:12] And so it's gotta go a process where it goes ligamentization, where it basically turns into a ligament, and then you wanna make sure it doesn't tear as it's getting bigger and better. And so the idea is if you can make it heal faster and you can make it remodel faster. And you can keep it safe and stable. 

[00:29:30] Then you've come up with the perfect solution. And so the idea behind this fertilize HCL, which we've heard about it, you actually interviewed, we talked about it and then actually was a couple of years ago and then Chad Lavender reached out to you, you had a whole topic with him. And so, you know, maybe we'll have you be a great guest to have on at some point. 

[00:29:48] Now, yeah, Adam Marshall, you know, he's, yeah, he's, uh, And, and he's a sports guy too, so it'll be interesting. Uh, you know, maybe he might be a good one for the fall as we get into football [00:30:00] season. He'll be excited for college fall for sure. I think I added him to the list. This would be great. Yeah. So typical ACL nine months to a year to get back. 

[00:30:07] And so what, uh, Dr. Lavender, Chad Lavender has done is something called the fertilized ACL. And actually my, um, my, uh, patient asked about this. It's called. For Arthrex company itself, it's called bio ACL. It's the same basic principle. And so what they do is they take PRP or your own blood and they put it with, you know, uh, allograft bones called mineral bones. 

[00:30:29] So the hope, the key is to hopefully it's a conduit. So it's like soaks it up and then they inject it into the tunnels. And then they can take some of your own bones. So they have this, this device that as you shave, it sucks bone up and it filters it. Imagine like a, um, a pool filter. And so the bones all mixed up there. 

[00:30:45] It's your own bone with some other bone and then the PRP, and then you can inject it in the tunnels and the whole, and what he is trying to show is that patients will get the bone to bone healing bone to tendon healing faster. And then potentially the ligament [00:31:00] is faster and so therefore they can get back faster. 

[00:31:02] So he has looked at some studies and shown some patients that have gotten back at six months with this. Now the caveat, which if you look at the studies, and I know we've done some of these, is he's had some trials where he's had really good results, but some of the trials, not all the patients came back for the follow up. 

[00:31:22] And so you've got to be a little careful, right? Because Who's the most likely patient not to come back to a follow up? 

[00:31:31] I don't know, would it be a young person? Probably someone who's not happy. Right? If you're gonna get called, and all of a sudden, in two years. So I'm not, it's not that his data is not accurate. I totally, I, I think it's awesome what he's doing. I'm, I'm all for it, and I think it's legitimate. But the, the, the, the, the You know, if you, when you start losing followup at two to three years, you have to be say, Hey, listen, is this, is this, uh, is, are all of these patients, did you lose followup because they left the state and that's totally legitimate? 

[00:31:58] And that happens all the time. Like [00:32:00] there's, it's really hard to find if you're doing surgeon and people and they're flying in for surgery, that they're going to call you back or listen to the pickup, right? That doesn't mean that you just have to have a little bit of a healthy bias. Or healthy skepticism and say, Hey, listen, this is pretty awesome what they're doing. 

[00:32:14] They are getting patients back. I mean, I've seen promos for this, uh, you know, it's pretty impressive. And these patients, you know, we talked about this, they're, they're returned to sport function. They're 80 percent of normal compared to 35 percent for regular ACL. They're functional tests. Um, yeah. They're 80 percent of the 30%, um, and their CT scans, which is cat scan, where you look at bone, show that they had less tunnel widening and they're already starting to form bone around the quad tendon. 

[00:32:39] Now, again, this is only for one type of ACL, which is quad, which is where you take a piece of your quad. It's not for patella tendon and it's not for hamstring, which are actually way more commonly done ACLs. And so it's something to be aware of too. It's only been tested on one type of ACL. So there's a lot of caveats to this, but it's really cool because he's addressed everything that we're concerned about [00:33:00] and he's pushing the envelope because no one's willing to do this. 

[00:33:03] I mean, he's just, he's, he's letting these guys rip. I mean, he's releasing them to full activity at six months. And that's terrifying because if you have a kid tear their ACL at six months after you let them go inadvertently is that's that's really traumatizing, right? And he's a surgeon. I mean, as a prior practice surgeon, I don't know if I get away with that. 

[00:33:24] Like I'd have to, I have to see some data before I did it. Just cause, you know, patients would immediately tell everyone, you know, my surgeon let me go at five months and they'd say, he's crazy. Right. And like the ACL repair, I had to slowly integrate it in. And I had to see how the first patient did second patient. 

[00:33:38] Okay. I'm going to let more and more do it. And he obviously has gone for the gusto. So I have only utmost respect for someone like that. It's something that patients would be aware of. So this is a biologic option. So we do your ACL, we add either bone marrow or PRP, one or the other. And then we do this putty, which helps grow it in faster. 

[00:33:57] Okay. And it's a little bit technically challenging too, um, [00:34:00] and the idea is you do it all but doesn't go inside the knee, right? Just stays in the tunnels. So you know, and there's, and there's a certain way they do it too. It's a, it's a different technique than some of us do for the ACL. So you've got to do everything exactly as a study or you're technically not following it. 

[00:34:12] The protocol. Yeah. Does that make sense? Yeah. So it's a, it's, it's really good. I mean, it'd be nice that this needs to be expanded basically. It needs to be expanded for other surgeons because I haven't seen, when I was looking up for this show, I looked up fertilized ACL or bio ACL and he's the only one that's published about it. 

[00:34:27] And so it would really be nice to see someone else who didn't invent the technique showing good study results as well. So there's a lot more work to be done, but this is something really interesting for patients and it's definitely a viable option. I think it's totally legitimate. I just want to see more information. 

[00:34:41] Yeah. I mean, it's, uh, it's really interesting. Uh, and just to think about, you know, we were thinking about this, uh, this mix that we've been talking about for now, uh, for a while now. And how does that evolve? Yeah. Right. Does that keep evolving to, you know, finding the right [00:35:00] mixture and, you know, whether it's, you know, holding, not holding soft or harder, you know, like how that affects certain things, but obviously, um, you know, you do test on cadavers and things like that. 

[00:35:12] Is there a way to kind of expanding on this quote unquote kind of silly putty that you're utilizing, uh, to fill in the gaps on, you know, just cadavers or do eventually you need to have. You know, real folks to get real data, uh, going forward. If you're doing different mixtures, kind of a little bit on conversation right now. 

[00:35:33] Yeah. I mean, the nice thing about this is that none of these things are dangerous. They're doing other than like, you know, the idea of dangerous is like, you know, something that's not approved for patients, but all this stuff, like the putty, the PRP, you know, Yeah. Uh, everything I talked about, we put that in me all the time. 

[00:35:46] I just, I did two of these today. Like I added putty and I added PRP and patience today. Like it's a little, I got to say putty too. You're going to be saying putty to everybody. No, but it's called, we actually call it. I go open the putty. It looks like putty. It looks like putty. [00:36:00] So all of these things we're already doing in the knee all the time. 

[00:36:04] And so what he did is found a concoction that works for him. He kept it regimented. He documented it. And then he looked to push it to the next level. And he did everything right. MRIs, CT scans. Watch the players getting ready. The one thing that you got to understand though is they probably had really good physical therapy and probably therapists that were willing to let them rip. 

[00:36:24] Right? That is incredibly important. You stole my thunder, I was about to say that. No, keep going. You know what I'm talking about. I was going to ask you, I was like, wait a minute, this all tells me in order for him to say, Hey, six months, go. What kind of physical therapy are they getting? Is it once a week or they're in there, you know, mandatory? 

[00:36:42] How many days, right? So that's the even bigger conversation now besides the surgery is right. Because we talk about it, right? You know, hand in hand, your physical therapist, the homework, when you go home, how much are you working? How much are you doing? You know, what's the requirement? If you have this type of surgery, you want to get back at six [00:37:00] months while you're seeing your physical therapist three times a week. 

[00:37:02] So, you know, these are, you know, mandatory. You know, questions that you would like to, to, uh, to know besides the procedure, what's really going into it. What's the Molotov cocktail in order for you to have success. I think it's a perfect point. And I mean, remember I do ACL repairs. My patients still come in slow sometimes because PTs are so nervous, they've never seen this protocol before. 

[00:37:24] So like, these are probably finely tuned for the clinical trial. Right. They saw the same therapists who did all of these. And so that's where you got to be careful. Can you extrapolate this general population? I mean, if I'm operating on, I have a patient, she, she flew in from Montana for an ACL repair. 

[00:37:39] Like I have no way of dealing with her physical therapist in Montana, right? I, we have patients that come in. I can't, I can't. I have to have a surgery that will, that they can follow my protocol, but they're still nervous. I mean, even some of my regular ACLs, if I'm more advanced than some other surgeons, or I do something differently, they still want to keep it their own way because they're nervous. 

[00:37:59][00:38:00] So they also, they don't want to be responsible. They feel responsible. The person tears their ACL to at six months to a year. Are you doing video calls for out of state folks after a post op? I usually will just do phone calls. Uh, the video I find doesn't add a lot of value except for just looking each other in the camera. 

[00:38:17] And it's really hard because I can't just FaceTime them because of the HIPAA. So I have to use like a program. And so then if you have to schedule it, we used to do video calls during the pandemic and we've stopped because it's really hard to schedule stuff for patients cause they, they want to be called at a certain time. 

[00:38:34] But if you have time in the middle, they, so we just do phone calls out of state. And it works perfectly fine. If patient wants a video call, I'm happy to arrange it. But usually, I mean, most of the time you're just talking to the doctor. Gotcha. Gotcha. All right. Let's move on because I'll sidetrack you continuously here. 

[00:38:49] Yeah. So let's put up that slide to look at the growth factor. So we talked about, this is with reconstruction. The fertilized acetyl is the best example we have for biologics. So it's important again, we brought this up and we can throw this [00:39:00] off in a second. Everything we're looking at is called autologous, which means it's from your own body. 

[00:39:04] There's allogeneic, which is from somebody else. Uh, and those are just two doctors, you know, lay, uh, medical terms. And again, you got to be careful here. You want to make sure, again, the FDA doesn't really regulate whether you use these things. It just, as long as you don't manipulate them. And that's the biggest thing we talked about. 

[00:39:20] You don't want to over manipulate these, um, and manipulation means like doing stuff beyond the machines process, like trying to add other factors in that no one talked about. You didn't consent them for that. And again, we don't do that. And a lot of people, I don't know anybody that does, but it's just important for people to understand. 

[00:39:35] So everything we're talking about is your own body. Um, there are people that do stem cells from amniotic fluid and things like that. We are not talking about that today. There is not a lot of data on that stuff. So you just gotta be careful and it's incredibly expensive. So I want you to that next in the next slide. 

[00:39:52] So again, this is a, this is a really good, I always have to quote the studies from this. This is Rodriguez and Merkineck all 2021. Um, but this is [00:40:00] really good for patients to see this. These are reconstructions and these are the growth factors that they're currently looking at. So they're looking at growth factors, stem cells we talked about, bone marrow, aspirate. 

[00:40:08] autologous tissue, pharmaceuticals, and there's different types of things. So go to the next slide. You'll see what we're kind of going at. So these are everything that people are currently looking at. And so if you want to ask what biologic you're looking at, we're looking at everything. BMP, BMP growth factors are, is basically that putty we talked about. 

[00:40:27] So can they add that and make people's ligaments heal harder to bone? Yeah. There's a bunch of other ones. Fibroblastic growth factor. I'm just going to go on and on and on and on. This TGF beta is really important and there's been some studies that can you add it back and help people heal their ACLs better. 

[00:40:43] Um, so, you know, again, this is going to get a little boring, so I don't want, you know, you people ask about biologics, but then there's a lot of information in the background because you can't just throw in these potions. You got to look at the data, see if it's safe. VEGF is one that we hear about. The problem with VEGF is it increases blood flow. 

[00:40:58] So is that, you know, [00:41:00] we see VEGF actually in cancers. So you want to make sure you're not just throwing that into people and causing more vascularity in an area. And then you've seen PRP. This fibrin clot's really interesting. So the idea behind it is, uh, it's, you actually make these clots. But again, it's the idea is can you put the fibrin clot or have PRP in some sort of gel form and then bring it, bring it in the knee? 

[00:41:21] It's a conduit, right? If you just inject PRP. Into the knee. It might help with some anti inflammatory properties like for arthritis, but is it going to stay where you want it to stay? So you have to have a conduit to get it in there and the fibrin clots nice because that's that's a thicker Modality, so it's important for people to hear this and understand, you know, what each of these things means I think we probably can get off that. 

[00:41:46] That's, that's good. I don't want to get, I don't want anybody to start yawning on us. No, no, it's good. And if anyone's listening on the podcast, please check us out on our YouTube page. We have some slides, we have some information. [00:42:00] Uh, the negative is that you're going to see our faces, but besides that, we've got some really good information here. 

[00:42:05] So, uh, please check out our YouTube page. All right. Let's talk about this PRP there. Go ahead, buddy. When we talk about the PRP, um, I want to go back one more thing though. I go back up to the other slide real quick. So there's the DBM putty you keep bringing up. So the idea they've looked at this and they looked at this with how does it combine with graphs from animals because a lot of these studies are in animals. 

[00:42:27] They looked at different factors, you know, can you add the PRP and then add, you know, collagen scaffold and can you apply it? And they've seen in models of rats and rabbits that if you add this DBM putty, it increases the tendon to bone healing. So again, the key is to soup up the healing so that your tendon that's in the tunnels closes off with bone quickly. 

[00:42:51] One reason that's good is because you can hopefully stress it sooner. But the second reason is some of these grafts like a quad or a hamstring, they're [00:43:00] soft tissue so they can windshield wiper. It doesn't happen usually with In the short period, but one reason if you get the tunnels healed faster, there's less likely chance that they'll get bigger. 

[00:43:09] And when they get bigger, you can imagine what happens when they get bigger. They can get looser, right? Looser. And so you don't want that again, not that common if done well, but you know, if there's an, if the tunnels are off and you don't have them healing fast enough, they can cause a little wiggle factor. 

[00:43:26] What do you mean by tight, like tighten quickly? Like, what is that timeline? You know, when, when these are kind of like, you know, hardening and, you know, it's getting set in place. What's the timeline from when. You're operating, are we talking a week, two weeks, two months? Like what's the process there for that healing for to get heart? 

[00:43:46] It depends on the person, six months to a year and maybe more. And so that's why people aren't ready to go back yet. And sometimes we don't know. I mean, we're not getting MRIs and CT scans at everybody. I mean, like you're ready to go back. Does that make sense? Yeah. And so that's something to be [00:44:00] aware of. 

[00:44:00] So the idea is like, can you give them this thing so you boost them and then you let them go back faster knowing that they've healed faster or assuming, but you know, we deal with fractures all the time. I told you I do these osteotomy sort of realignments. Last week I saw three patients back. They were all within five years of each other. 

[00:44:16] One patient was 20, was 50 percent healed, one patient was 80 percent healed, and one patient was completely healed. Exact same surgery, exact same surgeon, within like 3 weeks apart. And what were the age of the patients? 45, 50, 52. Okay, we're not this is I'm talking about like literally everything the same. 

[00:44:38] So we don't know how can we make one better than the other, but maybe that patient that was a slow healer, if we had known that we would have added some stuff. So can we make them all the same? Can we get these patients back? That's another thing to be concerned about. Obviously, you know, Chad Lavender's patients were really young, right? 

[00:44:53] But the average age of an ACL tear now is like 27 to 29. And that's, I would say that's pretty common. Like I do a lot of young [00:45:00] kids. But I also do patient, I do do patients in their 30s, 40s, 50s, uh, that have ACLs that want to get back because there's lots of data they do well too. And so it's important to understand that as patients get older, they don't heal as fast. 

[00:45:13] And so would this fertilize ACL work on 40 year olds? I don't know. Would they be able to get back in six months? Would they even care if they get back in six months? Because everyone can say that I really want to get back in six months, but like these patients from Marshall, they're, you know, high level athletes, right? 

[00:45:29] Like three or four months for a pro athlete's great, but does it really make a difference? for a recreational athlete. Like everyone wants to be back faster, but does it really make a difference now? You know, I'm sorry, keep going while you're doing it. And I'll add my last piece. No, no. Yeah. Because I'm about to ask you something about when it comes to the age, right? 

[00:45:49] So I'm just going to jump the gun. So try to remember what you were going to say. You know, we're talking about the ages and we talk about the Biologics, especially of each individual, [00:46:00] right? And if you're a baseball fan, one of the biggest stars in baseball got hurt again, uh, Ronald Acuna. And, uh, he is, he tore his ACL and his left knee on May 26, right. 

[00:46:12] Before that in 2021 tore his right ACL. So now he's torn his left ACL in 2021. He tore his right ACL 2018. He sprained his left ACL. Um, so between when he was 20 years old and now that he's 26 years old, he's had two ACLs. and a sprain, both ACLs on each leg knee. So, you know, you know, is it, is it something that because of the ACL, maybe other things weaken, or it's just sometimes just your body and the way you hold up and are able to just deal with the rigors of life, right? 

[00:46:54] Every body type is different. And that's why I'm kind of bringing this in when you're talking about the comparison, the [00:47:00] 45 to 50 to 53 year old, same procedure, same everything else. different results. Is that an example or is it a little bit more to it? No, it's example. There's some patients that just are higher risk, right? 

[00:47:12] Like, I mean, I did two, two ACLs today and both patients had ACL done on the other side. So it's just, some people are higher risk. I mean, once you tear your first ACL, the second ACL is 6 percent risk on the other side, just from the idea that you've already had one ACL. Um, it's actually higher risk to re tear your ACL on the other side than it is to re tear the ACL you just had done. 

[00:47:39] So it's, think about that. Yeah. So the, and that's what happened with him, right? Like it's just, these, some people are at higher risk and there's anatomy issues. There's, you know, it's higher in females. It's the way they land. And again, he's male, but it's the same type of thing. The, you know, One of the patients today was male, um, that had had other side done. 

[00:47:58] So it's just [00:48:00] people are at higher risks and we want, it's a key is, can we identify those risks? I mean, we, we're going to do as much as we can and we'll, you know, I'd like to finish up this part. Um, we're doing as much as we can to prevent people from having retairs. And there's lots of things we talked about, you know, adding the internal brace. 

[00:48:14] Can we add biologics? Can we do some fertilized option, um, to help them not have that issue? What, uh, It band tinnitus is like, can we add all these other things so that they don't have that happen again? And now we're getting digressing, but the idea here is what you're hearing about is. And what patients want is, I don't want to do this again. 

[00:48:33] I want to do it once, I want to do it right, and I want to make it perfect. Well, it's never going to be perfect, but can we make it right? And can we give you a better shot than you currently have? Which is what we're doing here. Oh, I did it! The balloons! So, it must be the, it must be this or something doing that. 

[00:48:50] So, can we, can we I think your daughters are sitting in another room with your wife and they've got some kind of remote control or something clicking on the [00:49:00] button, the balloon button. Oh. Yes. So anyway, so that's the idea behind this is can we give you let people like up? Um, so with the PRP, you can bring that up. 

[00:49:10] We'll go through that quickly. Uh, they looked at, they looked at this for adding, you know, PRP again, this take your own blood and then this is injecting the knee and in a surgery, you'd add it into the ACL and there's different conduits that you can use this through. We've talked about this, adding putty, adding collagen, you name it. 

[00:49:29] And so, they showed in this one study that there were like 109 knees, 101 patients. So they obviously, some people were bilateral. It's a Burtis et al. Uh, and they had a lower retail rate for the younger patients that had the PRP college and matrix added. Um, now began one study. So be, you know, be aware of this, but there is a, there is a study showing that there is improvement. 

[00:49:53] There's also a study showing that that maybe these people, uh, this is Vogren et al. [00:50:00] And some of these people that got the PRP, a different study, uh, that they maybe had higher blood flow into the ACL graft. So again, you're getting the ligament, turning the ligament faster, hopefully. And then again, sort of like a VEGF, which is that blood flow thing I told you about, but obviously a different type of material. 

[00:50:19] And some of these are gels. So they're PRP that's in a gel. You can see that that's actually what, that's what PRP looks like. It's a, Maybe usually not that exact color. So, uh, but it's usually around that color. And then can you put that into a gel? So it just stays there and resorbs. Like it's like a, um, a time release capsule, right? 

[00:50:36] Like you've seen medicines that are quick acting, but you want, in this case you want something that's slow release. So this is another, another option. There is some data on it. It's just not really good. And I, I don't routinely offer this to my patients. You know, there's, If patients really wanted it, I tell them, you know, I'm happy to do it, but obviously it is also an added cost. 

[00:50:55] Uh, so, you know, we're not, we're not there yet, but it's just some interesting information. [00:51:00] Let's briefly bring up the BioBrace. I think it's important to see it. Um, I don't want to overdo this. So this is a relatively new implant. Um, it was designed for a lot of things. You can see rotator cuffs here. Uh, you have this idea. 

[00:51:14] So the idea behind this is to. Uh, it's another collagen reinforcement or microfilament. And then basically what it is, is it's, it's got a strength modulus to it. So it's like an internal brace type of thing, but it's supposed to reabsorb with the tissue and people are doing ACLs with this. And actually my patient or what do you mean reabsorb with the tissue? 

[00:51:33] What does that mean? It's supposed to grow in with the tissue and add some structural basis to it. I got you. So it stays in. I got you. Where it has really been helpful is in hamstrings. So in hamstrings, people take their hamstring tendons. They're generally smaller. Then the average ACL we do and in under 25, we've seen less and less people recommending doing them. 

[00:51:52] So the idea that we used to do is if the tampering wasn't big enough, we would add cadaver tendon to right. So make it bulkier. [00:52:00] But now what people are doing is they're adding this bio brace to it to make it thicker. The problem is obviously it's expensive, so it's not everyone might not be able to get it. 

[00:52:09] Um, but the idea is that there's good strength and you know, they've been seeing that if you, the goal is if you can get these hamstring tendons, like imagine we're going to get too off topic, but basically if you take a tendon, imagine the width you want the width of a tendon, the width of your tendon, your ACL to be bigger than eight millimeters. 

[00:52:28] But if you take a small girl or a small woman, um, a lot of times it's smaller than that. It's seven millimeters. So how do you make it bulkier? Well, this is a, this is a biologic that you can add with some soaking of other Biologics and you can add it right into the ACL. And there's some idea that we don't haven't seen enough. 

[00:52:44] Most of the articles on there are not actually, um, studies, but basically they're showing techniques how to do it. So we're not there yet, but there is some future hope for this potential option for patients. Are you adding anything to this implant? Like, are you, [00:53:00] you know, coding this in something or coding it where, you know, putting a PRP on it before you put it like it, or is it just kind of going in there? 

[00:53:09] Is this something that you can add to it as well before, uh, putting this in? Yes. I mean, you can add, um, You can add like PRP, you can add bone marrow, and a lot of times you just basically integrate it into the graph. So there's certain suturing techniques you can use as well. Um, you don't really need to add much for this because it's really its own thing. 

[00:53:30] Uh, and so again, we're, it's, it's, the idea is can we, How does this going to enhance the strength of our graft? And especially one of the highest risks, the highest risk you are tearing your ACLs between three and six months. And so by adding this, can we prevent that from happening? Right? Again, this is not that common. 

[00:53:48] I mean, I can't think of anybody on my half my head and my patients that's torn their graph at three to six months, but like, The reason is they're also not going crazy, right? But, but Chad Lavender's patients are [00:54:00] going nuts at three to six months. So that's the other issue. So can they go faster? And then therefore they've got this backup tissue. 

[00:54:06] So we are, we're, we're attacking these things in really good ways and we're going to get there, but we're just not there yet. Um, I think let's kind of skip over this last one for the sake of time. But basically the last thing is allografts. So we've talked a lot about your own tissue, right? Like there's hamstring, there's quad, there's teletenin, but some patients, It's not an option. 

[00:54:28] They either had, I mean, I had a girl that's just 24. She had three failed ACLs. They took every single piece of her tissue. So she's got nothing left. So what are you going to do? Well, how can I make it better? Well, there's some studies in this in sheep, but again, using cadaver tendons, combining the BMAC bone marrow aspirate and the PRP. 

[00:54:47] And they did see some improved incorporation. Again, just the, just the sheep study. Um, and there's some ideas also looking at, can you add this sort of, this is bone marrow seen from the hip, you get from the knee. Now here [00:55:00] is AVN. So they're injecting it into the knee to kind of help it heal, but you can see other ways you can do it. 

[00:55:05] This is, we can take it from the crest here. This is in the back. Um, and the idea is that they've seen that hopefully maybe the tunnels won't get as wide with these tendon, these, uh, these cadaver graphs. Again, it depends on the type of cadaver graph to use. I use, um, Exclusively patella tendon. So it comes with bone on both sides. 

[00:55:22] So the idea is behind that is there's no concern for this windshield wiper. Remember I told you about that where it goes back and forth, back and forth. But a lot of people don't use that type of cadaver graft. They use something else that's got tendon on both sides. So if you have that, you have to get it to heal faster. 

[00:55:38] And how do you do that? Maybe you add something like this. So there's a lot of You've got to think about when you talk about this and be careful you're not comparing apples to oranges, right? So this was done on probably soft tissue, which is what we talked about that I don't use for allograft. So it may not be compatible for someone like me and the way I'm doing it may be [00:56:00] different or may heal better or worse. 

[00:56:01] You know, we don't know. Um, I've had good results with it, but it's important to understand that everything is a little bit different and there's, there's so many caveats to this. But also ACL is a real, we'll go into this. We'll just talk about this very briefly, but ACL is a really good surgery. It's definitely not perfect, but there's some of my happiest patients and they get back to things they want to do. 

[00:56:21] Again, not perfect. There are patients don't get back to the sports they want to do, but it's just, it's also really popular surgery because it's really common. One of the most common surgeries I do is ACLs, but it's just hard. You got to be careful, right? Like you'd never want to do a surgery for an ACL kid. 

[00:56:36] And then make them worse, right? Like that's the whole most horrible thing you can possibly do because these are not like, it's like you get your second and third and your fourth within a couple years. Like that's not a good thing for you. Like, it's not like you just go redo an ACL l and it's no big deal, right? 

[00:56:50] Like it is a big deal. No, it's not cool. Even though it's obviously life threatening. It's not, it's not cool. Those none of it is. So let's talk about this last topic. So we've gone in a lot of biologics. [00:57:00] We've talked about a ton. I mean, this could be like a three hour show of your scene. Well, we, we got two and a half minutes left. 

[00:57:05] Well let, let's talk about the last piece. It's all well and good. But one of the concerns is like, how, how do you get, why are things not healing as fast? Well, some studies have shown that basically, the reason things don't heal as fast sometimes is there's an indolent infection. So like, people will tell you like, my graft failed at like a year. 

[00:57:23] And thankfully I haven't had those issues, but that can happen. I've heard about it. And one thought is that maybe the graft, the certain thing you put in had a little bit of infection in it, but not bad enough to cause a real infection, right? Like it's a subclinical, like you don't notice it. And as a result that the graft failed or over time after two to three years, all of a sudden you get an MRI and then ACL is gone. 

[00:57:43] Like, how did that happen? The patient never felt a pop. So it did dissolve from the infection. So what we're doing now for every single ACL I do, allograft, you name it, I wrap the ACL in something called vancomycin, which is an antibiotic. And there's been studies that show it drops the infection [00:58:00] rate to literally zero. 

[00:58:01] And I'll knock on one. I have not had one. An infection after an ACL is an absolute devastation and you never want that. So the thought process is not only in like, it's great to prevent the big one, right? Like, I never want that to happen. Yeah, it's pretty uncommon. But these indolent infections, there are some thoughts that are way more common. 

[00:58:20] And so Ken, And it improved their healing just by wrapping their ACL antibiotics. Yeah. So that you left a big one for the end. I mean, that's, I know that's amazing. I think the problem here is that patients are so worried about getting their ACL better. They don't realize they're already doing a lot of things. 

[00:58:44] And so the problem I think is, Is I just told you a lot of really sexy awesome stuff, but then we've got to start executing on it, right? Like we've got it once the data comes out. You got to push it, right? Like if my bear patients are getting the same surgery as my [00:59:00] acl tyro, but my acl tyro patients are allowed to go back at five months and my bears are making them wait till nine months because the fda protocol Am I doing the right thing for my patients with the B. 

[00:59:09] E. A. R.? Yeah, it's uh, if you're gonna tell people that you're reducing the chance of infections and that after this is one thing less to worry about, that's a big one because that's obviously a main concern. Oh, it's that time. Dr. Garcia, we're going to wrap it up here. This was a great episode. So happy and check us out at sports doc talk. 

[00:59:36] com. We've got a lot more information, a lot more stuff going on. We really appreciate everyone listening to the show.
Thank you very much. Thank you.Audio Transcript

[00:00:28] Will Sanchez: And be sure to check out our website where we have previous shows and we have transcripts. We have so much information that we provide, especially from you, Dr. Garcia. I've rambled on for over a minute. Let's welcome you in, man. How are you, Dr. Garcia?

[00:00:45] Dr. Grant Garcia: I'm great. This is awesome. I'm so excited. It's always so fun when we get to, you know, we've had, we get a lot of guests on here and we've had different doctors and everything else, but it's so fun to see a topic that comes up or your patients ask about, [00:01:00] and then you find like the best expert for it.

[00:01:03] Dr. Grant Garcia: And plus, A normal, cool orthopedic surgeon. So this is going to be super fun. I'm a little worried that we're likely going to try to go over an hour. So we'll keep me in check because I have a feeling this is going to be one of those times. I've already had a pre conversation with Reza, and I'm not sure we're going to be able to make it.

[00:01:20] Dr. Grant Garcia: under an hour. Do not go off the deep end, okay? So I'm just letting you know. I've never done that before, Will, right? I've never done that before. No, no, no. So let me introduce, before you put them on, let me introduce. So when in, uh, in the office and you know, Will, you brought this up a couple of shows ago, but in the office patrons keep asking me about supplementation.

[00:01:39] Dr. Grant Garcia: They're asking about post recovery. We're going to go into that. This is, we have first good topic on nutrition, but they're asking me about how they can get better after my ACL surgeries and my cuff surgeries, my big surgeon meniscus cartilage transplants, where they get significant atrophy and it takes them nine, 12 months to fully recover.

[00:01:55] Dr. Grant Garcia: And they're, and these are Seattle patients. They're looking up everything and they want to know the best of the best. Like, how do I get to the next [00:02:00] level? And for a long time, we had very little. We're starting to get more things through different things we'll talk about.

[00:02:05] Dr. Reza Jazayeri: Yeah.

[00:02:05] Dr. Grant Garcia: But one of the number one things is nutrition.

[00:02:07] Dr. Grant Garcia: And then you're seeing on LinkedIn, people are talking about nutrition. How do we get people better, faster? And this is not just knee replacements, patients with hip fractures, you know, patients that are elderly that need to gain their muscle back. This is athletes. And I mean, I see athletes All the time that we operate on and they come in and their their leg looks like half the size and they felt they only had surgery like three or four weeks ago.

[00:02:25] Dr. Grant Garcia: Right? So how do we get them stim faster? And patients are like, how do I get my quads back faster? And one of these things is nutrition. And Uh, Dr. Jazayeri, who we're going to have on in a second, we have a big article called J AOS. And so it's one of like the number one journal we all look at. And he wrote the, he was the lead in this article about amino acids.

[00:02:43] Dr. Grant Garcia: So immediately after seeing this, having seen his content online, I reached out to him and he was, um, awesome to come on our show today and tell us a little bit more about this and understand like what's so hot about this. We're at an infancy right now. We're going to see more and more of this coming up and people are looking how they can get their patients back faster.

[00:02:59] Dr. Grant Garcia: And [00:03:00] this is one of those things. And he started this awesome company. So I'm really excited to have them on. Let's bring them on

[00:03:04] Dr. Reza Jazayeri: guys. Thanks for that intro. I totally agree. This is an exciting topic for all of us. And, uh, Like I was sharing with you Grant earlier, I'm, I'm a fan of you and the stuff that you're doing.

[00:03:16] Dr. Reza Jazayeri: So it's just kind of great to be able to, um, share ideas and especially this one. I think it's, it's, it's something that people are interested in. We're interested in, and we're, like you said, we're, we're at the infancy. So, um, uh, I think it's our challenge and our kind of responsibility to kind of know.

[00:03:35] Dr. Reza Jazayeri: this material because our patients are demanding it. And I think it's a part of now our practice to understand this, if we can have this dialogue.

[00:03:43] Dr. Grant Garcia: Yeah. And it's important to, you know, uh, res is a sports surgeon down in California. He does the same stuff I do. He's curl and Joe fellowship. Awesome. One of the top sports fellowships in the country.

[00:03:53] Dr. Grant Garcia: So, you know, he gets these things and he and I have the same mindset of like, how can we get these patients that are athletes back faster? And [00:04:00] And you're getting the same patients in downtown in California, you know, they they're active patients They're like, I don't want to sit around for two days. I don't want to sit around for two weeks, right?

[00:04:07] Dr. Grant Garcia: And so you developed this thing So I guess tell us more about the practice and the interest you have and then we'll get into the nitty gritty too

[00:04:15] Dr. Reza Jazayeri: Yeah. Yeah, you know, um, I think we're all a product of where we trained kind of who we are And then also where we practice and our patients around us. Right.

[00:04:24] Dr. Reza Jazayeri: And so I'm like a block down from Gold's gym, Venice. Right. So my patients are, I have a sports practice, like do you like you, but I also do a lot of shoulder and arthroplasty and revisions. And I'm the guy in my practice who like, no one wants to touch the stuff. And then they're like, just give it to rise a heel, do it.

[00:04:41] Dr. Reza Jazayeri: And I'm like, okay, you know, I'm happy to do it. Right. So I have almost like a sports trauma practice. And I say trauma because peck ruptures, biceps tears, hamstring ruptures. You know, these are these athletes who are on a different level and who are coming in with much higher expectations for [00:05:00] me. So throughout the years of my practice, I have Learn to kind of now have higher expectations of my patients to say, Hey, if you expect me to do this, then I need you to optimize yourself.

[00:05:11] Dr. Reza Jazayeri: And I think that's where I started to realize, look, you and I can sit here and talk about ACL graphs and screws or buttons or suspension or flip cutter or this and that. That's already kind of tapped out what we ask our patients to do. How can they optimize themselves? What are they bringing to the table?

[00:05:32] Dr. Reza Jazayeri: How can they be a better fit patient to have a better success? This is where I think we can make a big impact on their outcomes. So this is how I got into the nutritional piece.

[00:05:43] Dr. Grant Garcia: Well, and I think you're making a point point, you know, patients are like, why can't I get back? You know, why is, why is the ACL surgery you guys did 10 years ago, still at nine to 10 month recovery now?

[00:05:52] Dr. Grant Garcia: Why is the shoulder surgery, the rotator cuff, that one, or the pec ruptures? I mean, those are massive tears. Why do they still take so long to recover? [00:06:00] And the problem is that patients, and I think you're perfect point. When I think that we should really emphasize this and will, you can hear this too, but you got to flip it around on them because it's not just my surgery.

[00:06:10] Dr. Grant Garcia: Like your work, right? You do an hour, a half of work. They're doing hours and hours of stuff. And so they're expecting your work. to get them back as quickly as possible. But if you don't do the extra stuff, I always tell them the PT and the recovery stuff, that's actually way more important than even the surgery, right?

[00:06:26] Dr. Grant Garcia: Because you know, there's, there's so many different things you can ways you can fix it, right? It doesn't really mean they're not all perfect and they're not all the best, but the other stuff is important.

[00:06:33] Dr. Reza Jazayeri: You know, basically when these patients are coming in, they're already at a disadvantage because they took a hit.

[00:06:40] Dr. Reza Jazayeri: And what happens to the patients after an ACL injury or any kind of injury, actually, the muscle starts to change its physiology. It becomes kind of resistant to growth and there's both neurological and physiological changes. So, you know, I have this philosophy of the [00:07:00] surgical athlete. So I treat all my patients like an athlete training for an event and that event is their surgery.

[00:07:06] Dr. Reza Jazayeri: So I tell him, look, we got to prep you up for this. We got to get you ready. So all my A. C. L. S. Get prehab, they get B. F. R. I get him into exercising before the surgery. I check The nutritional status before surgery, we do all these things to prime them up. How are

[00:07:22] Dr. Grant Garcia: you checking their, sorry, interrupt. How are you checking their nutritional status?

[00:07:25] Dr. Grant Garcia: What are you doing?

[00:07:26] Dr. Reza Jazayeri: So albumin is, uh, uh, uh, uh, albumin and prealbumin, um, are good ones to check. And we can get into that a little bit more. That, that really ends up being a factor in, in the, in the elderly group. But it's interesting. You'll also pick it up in younger patients, especially revisions.

[00:07:44] Dr. Reza Jazayeri: infections. Um, and you know, I'm in California, so I'm getting a lot of these vegetarians and vegans and don't get me wrong, I'm, I'm, I'm vegetarian myself, except when I'm eating steak, you know, but, but, but the reality is these patients don't heal the same way. They just don't

[00:08:00] because they're not getting the substrates.

[00:08:02] Dr. Reza Jazayeri: And so when you check these variables, you're actually better off holding off on surgery for a little bit, optimizing them, getting them ready. So when they, you know, when they enter the operating room, they have all the necessary variables. Besides just the implant that we do in order to get them to heal faster.

[00:08:18] Dr. Reza Jazayeri: So kind of what this graph is showing here is that this decrease in mobilization is is a problem because they have muscle loss. And so if you can kind of mitigate that by improving prehab, you build the resilience. And this is what we'll talk about when nutrition comes in to also improve their muscle resilience.

[00:08:36] Dr. Reza Jazayeri: So This hit that they take, everybody gets this, by the way, this is the best case scenario, guys, this is a healthy athlete, you get someone to do a joint arthroplasty, that line is much lower, much further down, and then the one with the hip fracture, 30 percent die in a year, so, We have a lot of work to do in this kind of opportune time where the body's really breaking down its own tissue.

[00:08:59] Dr. Reza Jazayeri: [00:09:00] And this is where, you know, the, the, the strategies through, you know, nutrition and amino acids come in to really effectively mitigate that drop that you see right there.

[00:09:09] Dr. Grant Garcia: I see a lot more of this too. If I do a lot of meniscus cartilage transplants, struggling in the cartilage patients, they're struggling for like a year, two years, three years.

[00:09:18] Dr. Grant Garcia: So then they do their surgery. And the problem you have is like, I mean, I had patients today, they're nine months out, they have no pain, but they're still feeling like they're, they're tell us got not tracking right or something because their quads been shut down for like 10 years,

[00:09:30] Dr. Reza Jazayeri: you know, before surgery.

[00:09:32] Dr. Reza Jazayeri: Um, and then after surgery, and then the amount of atrophy that we've seen, the quadriceps is really profound. And if you look at, we let most of our athletes, they want to get back by a year. Sometimes they're pushing to get back even earlier. But if you really critically look at the literature on ACLs, for example, at one year, not many patients are at 100%.

[00:09:52] Dr. Reza Jazayeri: Actually, most are about 75 percent other contralateral side. And so a lot of them are not getting back to where they want. And it's [00:10:00] closer to a year and a half to two years before, after an auto, after an autograph, they were able to get back to higher nineties. And so interestingly, we see the most we rupture rates in the first 12 months in the early phase.

[00:10:14] Dr. Reza Jazayeri: And so that's where I think Improving on the muscle side is just as important as getting the graft to heal.

[00:10:22] Dr. Grant Garcia: And we always talk about this in ACLs, right? When we do an ACL, your patients are always like, they're like, I make them so focused on their number. And obviously that's, there's a lot of other things contributing, but like quad strength is so essential for the testing.

[00:10:34] Dr. Grant Garcia: Right. And there's the 90 percent factor we look for and they're just harped on it. But if, but it's like, it becomes a situation where if they're like 75%, they feel like they let me down at 10 months. Right. And I'm like, listen, it doesn't not. And they all want to be, the problem is you get like 80, we brought this up.

[00:10:48] Dr. Grant Garcia: You got the Adrian Peterson who probably went back too early, but this is a freak of nature. Right. And he goes back at six months. So they assume everyone should be back at that Sam. Well,

[00:10:58] Dr. Reza Jazayeri: Well, he was probably on [00:11:00] some supplements that helped him.

[00:11:01] Dr. Grant Garcia: There we go.

[00:11:02] Will Sanchez: No, no, no, no. There we go. I like the way you say supplements.

[00:11:06] Dr. Grant Garcia: Perfect segue. I

[00:11:08] Will Sanchez: think Aaron Rodgers was on some supplements also after his Speedbridge, uh, surgery.

[00:11:14] Dr. Reza Jazayeri: That's, um, actually I can't say yes and I can't say no, but I can tell you that Everyone, uh, you know, uh, uh, curling job, for example, who, who, um, you know, they're very familiar with, with, with the amino acid supplement and it's, it's at their DMV.

[00:11:29] Dr. Reza Jazayeri: So we, you know, we, that's something that, you know, we're using and professional athletes and, uh, it's, it's being supported by, you can read between

[00:11:37] Dr. Grant Garcia: the lines. Well, Neil ElAttrache is at curling job. And they're on DME for that. So therefore you can read between the lines. We're

[00:11:43] Dr. Reza Jazayeri: very fortunate. Dr. Ellis has been a supporter of accelerated recovery.

[00:11:47] Dr. Reza Jazayeri: It's, it's, it's, it's been great. Yeah. Um, so I think that's what, so, you know, one thing to kind of recognize is look, everyone's going to have a hit, but it's mitigating that hit. And if you don't drop, then you don't have to [00:12:00] fight to get back up. And the older you get, the harder it is. And I'll just tell you this, it takes 12 weeks of strength training to put on.

[00:12:10] Dr. Reza Jazayeri: what you lose in two weeks of immobilization. So it's a it's a big difference in how fast you lose and how hard it is to gain. And so if you can prevent the loss, that's the win right there.

[00:12:23] Will Sanchez: Yeah, I just want to jump in real quick. Um, obviously you're, you know, we're not talking about the Achilles, but just because it happened to me, I had surgery on December 1st and, um, just sitting around for a couple of weeks was just absolutely brutal.

[00:12:38] Will Sanchez: And then so much muscle loss, uh, you know, calves, so much skinnier and, you know, just doing the work now, calf raises, seated calf raises, trying to do, you know, single leg stuff. But, You know, as you said, because I sat around for, you know, a month and a half. Um, before putting, you know, weight bearing and little by little, I'm [00:13:00] still nowhere close to where I was when I was running, playing, jumping, and moving.

[00:13:05] Will Sanchez: So just, it resonated with me when you said, you know, in two weeks. You're already gonna have this sustained muscle loss, let alone sitting around, um, you know, for a month and change, almost two months, and then slowly starting to, you know, get, become active again. And also having those, you know, those restrictions in your mind as well, saying, well, you know, can I do this?

[00:13:29] Will Sanchez: What can I do? Am I going to hurt myself? Because, you know, same thing you're talking about re injuring, you know, it's, you know, You guys tell me, but the re injury part could happen when those first six months, right? So that's kind of like in the back of your mind as well. So there's so much that a patient thinks about and it's great to hear that you're saying, Hey, this pre op preparation should be a part of You know what you do and obviously, you know, you can talk about when the situation doesn't call for when you [00:14:00] have to go in because it's an emergency and you don't have the flexibility to do that.

[00:14:04] Will Sanchez: Yeah. What are those situations where you can't, you know, prepare your patient in advance for surgery? Is this something that stands out?

[00:14:12] Dr. Reza Jazayeri: Oh, yeah. I mean, you know, I was telling you earlier. Some of my practice is like sports trauma where they're coming in with an immediate tear or rupture. It's not, it's not so elective, right?

[00:14:21] Dr. Reza Jazayeri: So those cases, um, then you, you, you don't have that opportunity to pre have them. So it's even more important to, to really start the weight bearing. So, so weight bearing is something that is something where we can really help patients with preventing muscle loss. And so, uh, this is where, look, everything ties in.

[00:14:40] Dr. Reza Jazayeri: There's no magic bullet, right? But, but if you have a very strong construct that you feel confident in that, that, that, that, that implant then gives you the ability to wait there earlier. Okay. And so then if you can wait there earlier because of your implant, then you can have less muscle loss. And if you can bring on the [00:15:00] supplementation along with exercise and then tack on like BFR, okay.

[00:15:05] Dr. Reza Jazayeri: Then you see how you got this Domino effect of multiple things meshing so you can't just say it was just this one thing It's really this comprehensive approach and then don't forget. It's the mindset too You have your pictures are going to have this fear of getting back. So You know, I never want to say hey, I got this.

[00:15:23] Dr. Reza Jazayeri: There's this magic bullet it's really understanding all of it, but not leaving anything on the table because you don't want to shortchange the surgery that you did by just missing out on these key variables.

[00:15:34] Will Sanchez: I got I got a quick follow up. Um, how important is it for your P. T. Person to be on board with what your your mindset is for your patient?

[00:15:45] Will Sanchez: post op. And how does that normally work? Because there's different variables like, hey, you know, pick one of these places you go and I'll see you in six months, you know, how hands on are

[00:15:58] Dr. Reza Jazayeri: you? So the [00:16:00] time that the physical therapist spends with the, with that patient is way more than they spend with me.

[00:16:05] Dr. Reza Jazayeri: And so the reality is, the better that relationship is, the better that patient is going to do. And so for me, my, my ideal ACL patient, for example, is they have their physical therapist that I know at the prehab. So they're already working with them. So it's not like, you know, Samantha comes out of her A. C.

[00:16:23] Dr. Reza Jazayeri: L. And says, Who am I going to go to? And then, you know, find somebody. And then they're like, Okay, hi, Samantha. Nice to meet you. It's no, no, no. How did the surgery go? We've been working for a few weeks together. I know where you're at. So you have the report. So for me, the physical therapy piece is extremely important and the literature has already shown prehabilitation before, you know, these kind of surgeries actually does enhance the recovery process.

[00:16:44] Dr. Reza Jazayeri: So, um, That's a very they're all important but that particular relationship is something that I try to foster

[00:16:52] Dr. Grant Garcia: So let's talk about really quick She'll pull up the amino acids peptides because people keep asking about it and they're using interchangeably But they're not and you were mentioning before, you know [00:17:00] ones and one we can have potentially one.

[00:17:02] Dr. Grant Garcia: We're not there yet um Perfect. Yeah, so there's amino acids. So kind of run through this real quick with us. Okay,

[00:17:09] Dr. Reza Jazayeri: okay, so You know, what you see on here is when our body is going through surgery, it's a very unique time. The requirement for these building blocks is extremely elevated. It's about 80 percent more.

[00:17:26] Dr. Reza Jazayeri: Why is that? Because, well, let's back up and say, okay, what are amino acids? So think about the vocabulary that we have with our alphabets, right? We got 26 letters and we can use these 26 letters to create sentences and paragraphs and tell the whole story. Okay, And you're only doing that with 26. So amino acids, our entire body has only 20 amino acids, but these 20 amino acids can similarly be kind of coupled to have a particular [00:18:00] function.

[00:18:00] Dr. Reza Jazayeri: Okay. And so these 20 amino acids come together to form all the precursors that we need for muscle and for bone mineralization and collagen synthesis. So this is where your body is really requiring these amino acids. to produce these things that we are really looking for in a orthopedic surgical recovery.

[00:18:21] Dr. Reza Jazayeri: Those are the three variables, in addition to all the enzymes and immunity for, uh, for fighting off infection. And so there's this demand that's really elevated. What happens is when you don't have those available. When you and I were cavemen, you broke down your, you broke your leg and you fell. Well, you have fat sores.

[00:18:43] Dr. Reza Jazayeri: Everyone knows fat is there for, so you don't starve. You don't have a reserve for skeletal, for, for amino acids that's hanging around. That's your muscle. So you actually start to harvest, you break down your own muscle to provide these key amino acids. So this is what happens when people lose weight [00:19:00] after surgery.

[00:19:01] Dr. Reza Jazayeri: fat. They actually just l because you broke down yo to provide these really k you need for all these di And guess what happens af have much appetite. People want to eat. And guess wh before surgery. You tell is. So this is why now yo such a change. So our protocol now with with with the accelerated recovery program, we do carb loading, right?

[00:19:27] Dr. Reza Jazayeri: I mean, think what a marathon runner with a jujitsu fighter go into their fight fasted. They're gonna do terrible, right? And so if you go into, but so guess what? When you go into surgery after overnight fast, our livers have about 120. Maybe if you're really well trained, maybe 150 grams of glycogen after overnight fast, it's almost gone.

[00:19:47] Dr. Reza Jazayeri: By the time you hit surgery, You don't have much. So your body says, okay, no problem. I'm just going to go to my muscle, break it down. Gluconeogenesis breaking you, you know, make new glucose from muscle. And so essentially you're [00:20:00] harvesting your own tissue. This is why now we're providing the amino acids and the carbohydrates.

[00:20:06] Dr. Reza Jazayer