Dr. Kaplan on the Rapid Recovery Report

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DISCLAIMER

The content discussed on this program is often medical in nature and is used for informational purposes only. No content discussed should be taken as medical advice. Please consult your health care professional for any medical questions.

Toree McGee (00 : 46)

Hi there. I’m Toree McGee and this is The Rapid Recovery Report sponsored by ROMTech , the modern technology of rehabilitation. So this is another episode in our series. We do these live podcasts and shows every Thursday at 4 PM pacific and 7 PM eastern and we’re talking to different guests. We are ROMTech in case you didn’t know and we have a product that we’ll probably be referencing here in the podcast. So if you’re not familiar, let me just tell you about it. It is called the PortableConnect® and there it is right there. Pretty cool. It’s a high tech recovery device that’s geared to get patients moving and on the road to recovery faster from injuries and surgeries. So if you want to learn a little bit more about it and about us, you can visit us at www.romtech.com and follow us on the social handles that are listed below. But let’s get right into it and talk about our guest that we’ve got on the show this week. I’m so excited, we’ve got Dr. Kevin Kaplan, who’s an orthopedic surgeon in Jacksonville, Florida. He completed a fellowship in orthopedic sports medicine at the world renowned Kerlan-Jobe Orthopaedic Clinic in L.A.  Dr Kaplan is the head team physician for the NFL Jacksonville Jaguars and he has been a physician with the team for 10 years working among innovators in the field of sports medicine. Doctor Kaplan has been trained in cutting edge arthroscopy of the shoulder, elbow, hip and knee, as well as in joint preserving reconstructing procedures of the shoulder and the elbow. So I’m so excited …. we have the most fun here getting ready for the show to start. This is going to be a good one Dr. Kaplan.

Dr. Kevin Kaplan (02 : 24)

Thank you for having me. It’s good to be here.

Toree McGee (02 : 26)

Yeah, we’re excited, we’re excited. So I’m sure that the most common questions that you get are Jaguars related, so let’s get started with that. So how did you land the gig as the head physician of the Jacksonville Jags?

Dr. Kevin Kaplan (02 : 41)

So I, you know, I grew up in Jacksonville, born and raised here and obviously left for college for a med school residency up in New York City then out to L. A. for a fellowship. And when I was looking for jobs, you know, obviously I was looking at my hometown and interviewed with the group I’m with  now, Jacksonville Orthopedic Institute and my partner at the time was the head team physician and said he needed or wanted an assistant someone to help out, took the opportunity and came and I was the assistant for four years and, you know, fortunately, we had a change of leadership and new general manager and my partner had been doing it for quite some time and they interviewed myself and two other physicians and I was honored to get the opportunity. I was, I think 35 at the time. I got the head team job and I’ve had it since and it’s been- it’s one of those dream jobs you never think you’re going to (a) take care of a professional team because it’s so rare and (b) be able to take care of my hometown team and it’s  been awesome.

Toree McGee (03 : 38)

That’s incredible. Good for you. I feel like 35 is really young to be chosen for a position doing that, yeah?

Dr. Kevin Kaplan (03 : 45)

It’s humbling. You know, you’re in a room, we have an NFL Physicians Society meeting every year at the NFL combine and I looked on the room, you know, you see guys that are, you know, my mentors, you know, Jim Bradley up in Pittsburgh and W alt L ow in Houston and Neal ElAttrache in L A. And then you see the Rust Warren’s and the Jim Andrews and you’re in a room full of guys that you just read and study about and you see it lectures and so it’s, it’s one of those things that I took obviously the utmost importance in my career and I’ve had a lot of fun with them and a lot of great people, a lot of great athletes and just being on the sideline during games is just, it’s an unbelievable experience.

Toree McGee (04 : 22)

Gosh, I can’t even imagine. So in working primarily with athletes and sports injuries in your practice like professional or otherwise, right? Do you treat them differently than you would like a regular injury? So essentially like do athletes try to push themselves harder where you need to reel them back in?

Dr. Kevin Kaplan (04 : 39)

It’s a great question. Obviously, professional athletes. So that’s the vocation, right? So um you know, when they get hurt, it can potentially change their career if you or I, you know, having unfortunately tear an ACL or something like that, you know, we’re not getting paid to play, we still have other jobs and we can rehab. So there is a time component in terms of getting athletes back to play. But having said that the biology of an ACL. Reconstruction for instance is no different in our best athlete and then you are I so you still have to rely on the biology of how you treat these athletes. And you know, you can certainly toe the line once you get towards the end of the rehabilitation, the average return to play. Obviously it’s an average. Some guys get back really quick, some guys get back a little bit slower and so that all plays into how we get these guys back. But we’re you know if an injury happens at the beginning of the season It’s pretty sure that the player has the whole season plus the off season to get ready. But when the player gets hurt at the end of the season then the clock is really ticking. And so where you know they get treatment maybe 5-6-7 times a week where you may get treatment two or three times a week.

Toree McGee (05 : 46)

So with competitive edge being so important to career athletes, how do you set yourself apart as a surgeon in order to provide that competitive edge to your players?

Dr. Kevin Kaplan (05 : 58)

Uh You know, I was taught obviously there’s a three important A’s is being Available to patients and athletes, being Affable. You know, just making sure you really take care of them and get to know them and then your Abilities as a surgeon. But I think that the fourth A  that that I never really learned that I like to think is just as important as Adaptability. This field is constantly changing and the way I learned to do an ACL Reconstruction w hen I started fellowship residency, I should say in 2003 is different than what I do now. Why? Because things have changed, technology has improved and I think that’s the way that you really continue to make the care for an athlete better by being able to change with the time and adapt and give them your best and allowing them to get back quicker.

Toree McGee (06 : 41)

Yeah. Absolutely. I would imagine that being closer in age to some of the players, I know a lot of them are really, really young but might make you know, your relationship a lot easier to be able to build with them versus you know, somebody that’s out there a lot older than you being a team physician.

Dr. Kevin Kaplan (06 : 56)

Yeah. You know, it’s every year it gets farther down, you know, you look at their date of birth, you’re like “you were born when!?”, and then the gray hair starts to come out, you know, as they refer to me as the O. G. You know, old school gangster, I don’t know, so that’s you know, but it does help to relate I think you know, these guys when you look at them, they’re very big guys, but they’re still young men, so just being able to relate and break things down and explain an injury. You look at these guys and they’re in their early twenties and if you think back to when you were in your early twenties, if you’re on this huge stage and you have a big injury and your parents aren’t around your friends aren’t around- you’ve got to imagine that’s scary, these guys aren’t going to show it. So if you really just break it down and explain things and show them MRIs and models, it really helps to build the relationship and then they trust you and that goes a long way.

Toree McGee (07 : 48)

Absolutely. We had Dr. Boghosian in Southern California on our show a few weeks ago and he brought like a little prop with him that was so helpful for me. And I would imagine that that’s the case, when you talk to anybody who’s not in the medical field to have anything that you can sort of show them and tell them about- even like a personal surgery that you’ve had or something- to be able to relate and make it tangible and easy to understand.

Dr. Kevin Kaplan (08 : 13)

Absolutely videos, models. I like a patient or an athlete to be able to walk out of the room and be able to explain to a teammate or to a parent or to a friend exactly what’s wrong. I f they leave and they don’t understand, then there’s a lot of miscommunication that can happen and that can be scary for those guys.

Toree McGee (08 : 31)

Absolutely. So now, outside of football players, what other kind of athletes do you typically see with injuries?

Dr. Kevin Kaplan (08 : 39)

You know, a lot of the patients that I see in my office now are the cross-fitters, the spartan race, we see a lot of overuse injuries and at least now with COVID too, everyone has been at home and they’re doing the Pelotons and the Tonals and the Mirrors. So we’re seeing a lot of those overuse injuries just because people have a lot more time on their hands just to do things. I can tell you that when COVID started, I had a huge uptick of pec tendon tears and bicep tears. People were at home working out haven’t worked out in a while and they’re trying to crush weights like they were 20 but they’re in their forties like myself. And so I saw a lot of those injuries. Um, but these days people are just staying active. Another demographic, completely different demographic- Are you familiar with pickleball? Have you heard about pickleball?

Toree McGee (09 : 25)

Yes!

Dr. Kevin Kaplan (09 : 27)

So, I mean, I see a huge number of pickleball injuries, you know, meniscus tears, shoulder injuries, but a lot of a thletes in the generation of the 60s and 70s, because there’s still athletes, it’s just a different type of athlete are playing a lot of pickleball and so we’re seeing a lot of those types of injuries. So it’s an interesting phenomenon saying how all these sports developed throughout the years,

Toree McGee (09 : 47)

It would be interesting too, to talk to some of our other sports surgeons to see if they also are seeing pickleball injuries. If that’s like a Florida thing….

Dr. Kevin Kaplan (09 : 58)

Maybe. It could be, it could be, I didn’t even know what it was and I was looking it up to try to help people. Everybody’s talking about pickleball and so I just wanted to look it up to see what are the rules and why are these people getting injured? Or croquet…. you know… it could be a Florida thing.

Toree McGee (10 : 11)

I remember looking out of my hotel room in Hawaii one year and being like that is pickleball out there, I don’t know why I knew it, but I knew it. So at least it’s in Hawaii too.

Dr. Kevin Kaplan (10 : 22)

There you go, not just a Florida thing.

Toree McGee (10 : 24)

So a common injury that we hear a lot about in the world of sports involves ACL repairs which, for our audience who might want to learn, it’s an important ligament that’s responsible for back and forth movement of the knee. So what are the traditional techniques that are used to heal an ACL injury?

Dr. Kevin Kaplan (10 : 42)

So when you turn ACL, the anterior cruciate ligament, goes from your thigh bone to your shin bone, femur, tibia. Uh And it, you know the two bones set up on top of each other and the ACL prevents them from shifting. And if you tear an ACL, i t’s one of those ligaments that doesn’t have the ability to heal, the MCL, which is another ligament- the name which is the medial collateral ligament- when that tears it can actually heal on its own and doesn’t always need surgery. A CLs, when they fully tear, they typically don’t have the ability to heal themselves. Then we have to perform an ACL reconstruction, and our techniques again like we talked about earlier, have evolved over time. It used to be big incisions and open techniques and now we’re doing things a lot less invasive with arthroscopy, smaller instruments and have the ability to reconstruct the ACL. T here’s different ways to do that using your own tissue which is called an autograft, which is what I do with all of my high school collegiate professional athletes. And then there’s other ways to do it with cadaver grafts or allografts and that really is kind of a surgeon preference whether or not they use your own tissue or use a cadaver graft. I prefer to use a patient’s own tissue. I just think it makes biological sense. Um It’s relatively not morbid to do that.

Toree McGee (11 : 55)

Okay – so let’s let’s expand maybe a little bit on that because that’s really really interesting. So the technique that you’re using – is it relatively new involving like quad tendon grafts to aid in ACL reconstruction?

Dr. Kevin Kaplan (12 : 07)

Yeah so you know the gold standard ACL reconstruction is what’s called patellar tendon. So your patellar tendon is the tenant that goes between your kneecap. If you look down on your kneecap to your shin bone, there’s a little strip of tendon there, you can take a little piece of the tendon, a little piece of the patella, which is the bone and a little piece of bone from the tibia. And that’s the gold standard. What I do in a lot of my athletes as you, you know the downside of doing that can sometimes create a little bit of anterior knee pain. And so to avoid that, you know, hamstring is another graft that you can use, but that comes with the risk of potentially having some cramping in the back of the leg, especially when you’re doing things like running. So the quad is the newest technique, the newest graft that we’re using. And you can take a little strip of the quad tendon, which is the tendon that’s above the kneecap. And you don’t actually have to take a full thickness area of the tendon. You can just take a little strip of it so it keeps the continuity of the quadricep intact. And I think that’s very important because in the end the ACL, that tendon will become a ligament. But what determines when an athlete or whether it’s a weekend warrior, a professional athlete to get back playing is the strength of the muscles in the front. The quadrant that the extensive mechanism and that’s usually what takes the longest to come back. So I think that’s the benefit of trying this new graft, which is a quad.

Toree McGee (13 : 25)

Okay. That’s really interesting. So is there a particular reason I guess other than it being new- what have you seen to make it the way that you prefer to do it versus any o ther technique?

Dr. Kevin Kaplan (13 : 41)

I think that it’s low morbidity, patients are able to move quicker, less anterior knee pain. The graft is very thick, it’s strong and sturdy and with the techniques that some of the companies that I don’t happen to have any kind of business interests in, but Arthrex  is the company that I use for the quad grafts. The technique is very straightforward and I think when you look at the difference between a cadaver graft and a patient’s own tissue, I just think it’s a better option. As  all these athletes are staying more active. You know, someone had an ACL tear and you just needed it for stability but they’re not going out and doing a spartan race or CrossFit or even pickleball. It may not be as important, but the graft to me, the biology of a patient’s own tissue healing to their own tissue is extremely important. And so that’s why I like this. I’ve been switching a lot of my older patients. W hen I say older, like my demographic, you know, thirties, forties, fifties. So it’s using trying to use a quad graph.

Toree McGee (14 : 42)

Yeah, I mean, that’s what I was going to say. It makes sense in my non-medical person brain that your own tissue would be the best-case scenario. You know what I mean? Because I mean and this probably doesn’t happen, and I really don’t know, but you hear about people having to have surgeries and peoples’ bodies rejecting things that didn’t come from themselves. I’m sure with this sort of thing, you’re not necessarily seeing bodies reject other tissue, but I would imagine that it would just adapt a lot better if it’s your own tissue.

Dr. Kevin Kaplan (15 : 15)

Yeah, you’re right. I mean the rejection rate is super low and obviously it’s not typically an infection risk but there’s a field to the knee. You know, there’s a stability factor; there’s a strength and you know obviously you’re taking something that’s a cadaveric tissue cadaver graft which works very well, don’t get me wrong. But it’s you know, frozen graph that then you  know obviously it’s sterilized and it’s clean and the infection risk is low, but then you think about exactly what you said. I mean these are fibers in your own body there live, they’re active, they’re healthy and it just inherently makes more sense to me and everybody has a difference of opinion. But I like that idea. I like that concept and I’m trying to do as many of those as I can, and fewer of the cadaver grafts.

Toree McGee (15 : 59)

Yeah, well, that makes sense to me, too, if that means anything to you. (Dr. Kevin Kaplan: Well hopefully you never tear your ACL!)

Toree McGee (16 : 04)

So at the end of the day, what are your thoughts on preventing injuries like this? Like, can it be prevented? And when do you eventually decide that surgery is the only answer to correct the tissue.

Dr. Kevin Kaplan (16 : 15)

That’s a great question. There are a lot of studies looking at ACL prevention type programs. Uh, and I think that’s extremely important. We try to get the high school kids in the area and I even had a conversation with a colleague about trying to get some sort of program for all the local high schools. Because the numbers are staggering. I mean, I do probably close to 150 or so ACLs a year. And the numbers just keep Increase because the athletes are younger. They’re playing at high levels year-round. Uh, and you know, the longer you play and the less you train, you know, in the offseason, the higher the chance to have an injury. So ACL prevention programs without questions should be part of every high school collegiate pro athletes normal program. The unfortunate thing is, is what you said and once it’s tears, you know, it doesn’t just heal and so in order to get back playing and doing the things that they want to do cutting, pivoting, twisting. You can live your life if you were just without an ACL if you’re just going forward and backwards. As soon as you put your foot on the ground to turn and twist, that’s when your knee can buckle and that’s obviously an important thing for most athletics.

Toree McGee (17 : 23)

Absolutely. All right now, we’re not going to let you get out of here without talking about at least something ROMTech, right? So, can you describe the outcomes in your patient’s recovery prior to being introduced to the PortableConnect versus now? And what difference are you seeing with patients that are on the PortableConnect?

Dr. Kevin Kaplan (17 : 43)

It’s been a great addition in terms of my post-operative protocols. The patients love it. They move very quickly. You know, I try to get patients in therapy as quick as possible. But now this is, you know, the day of the day after surgery and they get their knee moving and I think one of the things that you and I alluded to earlier is what is that edge? What is the most important thing? And I think getting the quad fired early. Getting it to- and what I mean by that is the quadricep muscle- getting it to contract early, I think is paramount in the end. You see a lot of quadriceps atrophy and muscle weakness and that happens so quickly after surgery. It’s sometimes unbelievable. So I think a competitive edge here is you’re getting patients on a machine that not only moves for them but then gives them that ability to start contracting their muscles. And then that whole mind-muscle connection I think is very understated in rehabilitation, because I see some patients that come back. This is obviously before I was doing ROMTech and they just couldn’t get their muscle to fire. They couldn’t do it. And I know they could. But for some reason, whatever that mind-muscle connection, which I think is very important, wasn’t there. Now I’m seeing these guys come back. They’ve been on ROMTech, they’re moving, they look good, t heir knees are fully extended and they can fire their quad. And the quicker you fire quad, the quicker the muscle is going to come back. In the end, what mitigates injury risk and what allows a patient to get back to playing, It’s not the ACL, because those are going to heal, you know, with our autografts and they’re going to become a ligament. But what it really is do they have the strength of their leg to protect them from further injury? So THIS is the competitive advantage that we need in our patients to get them moving quicker. So I love it.

Toree McGee (19 : 20)

Yeah, Well that’s awesome. I never thought about anything having to do with like a muscle and mind kind of connection, but it makes total sense. I mean, especially if you’ve been favoring your injury before you have surgery, that’s like trying to limit the movement, and then after surgery you’re assuming oh my gosh it’s gonna hurt if I move it, and even that might make it so that you just don’t want to deal with it at all.

Dr. Kevin Kaplan (19 : 44)

Absolutely. I mean they just  shutdown. You know you have the injury, it scares people, you feel a pop, your knee swells, your quad shuts down, you try to rehab them a little bit, then you put them through a traumatic event which is surgery even though it’s precise and then you’re back in that cycle again. So if we can break that cycle, I’m really interested to find- I mean obviously I’m new using the ROMTech over the last several months but every ACL gets it now and it has the opportunity to. And the reviews are great and patients in the early clinical outcomes, we have some studies that were obviously I’m hopefully help with the study coming up on ACLs, I think are going to be interesting in terms of how quickly that quad tone returns and how quickly these guys are able to show that they are functionally better because they’re starting much quicker with a better machine.

Toree McGee (20 : 28)

Absolutely. Well this has been super informative for me and I hope everybody else. I hope it was as much fun for you as it was for me to be here with us today.

Dr. Kevin Kaplan (20 : 36)

I truly enjoyed it. I gotta bring a model next time. I didn’t bring a model you know. Next time…

Toree McGee (20 : 41)

We won’t be one upped by one of our others, so we’ll get you back on so you can redeem yourself. But this was awesome. Thank you Dr. Kaplan so much. We appreciate it. You can find D r Kaplan on line at kevinkaplanmd.com . You can follow him on twitter @kevinkaplanMD and harass him a little bit and tell him how awesome he was on our podcast.

Dr. Kevin Kaplan (21 : 03)

Yeah, thanks for having me.

Toree McGee (21 : 04)

Of course. Well, thanks so much for taking the time. Thank you to everyone that was watching us today. If you have any questions, comments concerns, go ahead and drop them in the comments section. We read everything. If you have suggestions for moving forward and any guests you’d like to hear from, let us know and you can always check us out at www.romtech.com and follow our social channels. Thank you guys so much and we’ll see you all next time. 

Toree McGee (04 : 22)Gosh, I can’t even imagine. So in working primarily with athletes and sports injuries in your practice like professional or otherwise, right? Do you treat them differently than you would like a regular injury?So essentially like do athletes try to push themselves harder where you need to reel them back in? Dr. Kevin Kaplan (04 : 39)It’s a great question. Obviously, professional athletes. So that’s the vocation, right? So um you know, when they get hurt, it can potentially change their career if you or I, you know, having unfortunately tear an ACL or something like that, you know, we’re not getting paid to play, we still have other jobs and we can rehab. So there is a time component in terms of getting athletes back to play. But having said that the biology of an ACL. Reconstruction for instance is no different in our best athlete and thenyou are I so you still have to rely on the biology of how you treat these athletes. And you know, you can certainly toe the line once you get towards the end of the rehabilitation, the average return to play.Obviously it’s an average. Some guys get back really quick, some guys get back a little bit slower and so that all plays into how we get these guys back. But we’re you know if an injury happens at the beginning of the season It’s pretty sure that the player has the whole season plus the off season to get ready. But when the player gets hurt at the end of the season then the clock is really ticking. And so where you know they get treatment maybe 5-6-7 times a week where you may get treatment two orthree times a week. Toree McGee (05 : 46)So with competitive edge being so important to career athletes, how do you set yourself apart as a surgeon in order to provide that competitive edge to your players? Dr. Kevin Kaplan (05 : 58)Uh You know, I was taught obviously there’s a three important A’s is being Available to patients and athletes, being Affable. You know, just making sure you really take care of them and get to know themand then your Abilities as a surgeon. But I think that the fourth A that that I never really learned that I like to think is just as important as Adaptability. This field is constantly changing and the way I learnedto do an ACL Reconstruction w hen I started fellowship residency, I should say in 2003 is different than what I do now. Why? Because things have changed, technology has improved and I think that’s the way that you really continue to make the care for an athlete better by being able to change with the time and adapt and give them your best and allowing them to get back quicker. Toree McGee (06 : 41)Yeah. Absolutely. I would imagine that being closer in age to some of the players, I know a lot of themare really, really young but might make you know, your relationship a lot easier to be able to build withthem versus you know, somebody that’s out there a lot older than you being a team physician. Dr. Kevin Kaplan (06 : 56)Yeah. You know, it’s every year it gets farther down, you know, you look at their date of birth, you’re like “you were born when!?”, and then the gray hair starts to come out, you know, as they refer to me as the O. G. You know, old school gangster, I don’t know, so that’s you know, but it does help to relateI think you know, these guys when you look at them, they’re very big guys, but they’re still young men,so just being able to relate and break things down and explain an injury. You look at these guys and they’re in their early twenties and if you think back to when you were in your early twenties, if you’re on this huge stage and you have a big injury and your parents aren’t around your friends aren’t around- you’ve got to imagine that’s scary, these guys aren’t going to show it. So if you really just break it down and explain things and show them MRIs and models, it really helps to build the relationship and then they trust you and that goes a long way. Toree McGee (07 : 48)Absolutely. We had Dr. Boghosian in Southern California on our show a few weeks ago and he brought like a little prop with him that was so helpful for me. And I would imagine that that’s the case, when you talk to anybody who’s not in the medical field to have anything that you can sort of show them and tell them about- even like a personal surgery that you’ve had or something- to be able to relate and make it tangible and easy to understand. Dr. Kevin Kaplan (08 : 13)Absolutely videos, models. I like a patient or an athlete to be able to walk out of the room and be able to explain to a teammate or to a parent or to a friend exactly what’s wrong. I f they leave and they don’t understand, then there’s a lot of miscommunication that can happen and that can be scary for those guys. Toree McGee (08 : 31)Absolutely. So now, outside of football players, what other kind of athletes do you typically see with injuries? Dr. Kevin Kaplan (08 : 39)You know, a lot of the patients that I see in my office now are the cross-fitters, the spartan race, we see a lot of overuse injuries and at least now with COVID too, everyone has been at home and they’redoing the Pelotons and the Tonals and the Mirrors. So we’re seeing a lot of those overuse injuries justbecause people have a lot more time on their hands just to do things. I can tell you that when COVID started, I had a huge uptick of pec tendon tears and bicep tears. People were at home working out haven’t worked out in a while and they’re trying to crush weights like they were 20 but they’re in their forties like myself. And so I saw a lot of those injuries. Um, but these days people are just staying active. Another demographic, completely different demographic- Are you familiar with pickleball? Have you heard about pickleball? Toree McGee (09 : 25)Yes! Dr. Kevin Kaplan (09 : 27)So, I mean, I see a huge number of pickleball injuries, you know, meniscus tears, shoulder injuries, but a lot of a thletes in the generation of the 60s and 70s, because there’s still athletes, it’s just a different type of athlete are playing a lot of pickleball and so we’re seeing a lot of those types of injuries. So it’s an interesting phenomenon saying how all these sports developed throughout the years, Toree McGee (09 : 47)It would be interesting too, to talk to some of our other sports surgeons to see if they also are seeing pickleball injuries. If that’s like a Florida thing…. Dr. Kevin Kaplan (09 : 58)Maybe. It could be, it could be, I didn’t even know what it was and I was looking it up to try to help people. Everybody’s talking about pickleball and so I just wanted to look it up to see what are the rulesand why are these people getting injured? Or croquet…. you know… it could be a Florida thing. Toree McGee (10 : 11)I remember looking out of my hotel room in Hawaii one year and being like that is pickleball out there, I don’t know why I knew it, but I knew it. So at least it’s in Hawaii too. Dr. Kevin Kaplan (10 : 22)There you go, not just a Florida thing. Toree McGee (10 : 24)So a common injury that we hear a lot about in the world of sports involves ACL repairs which, for our audience who might want to learn, it’s an important ligament that’s responsible for back and forth movement of the knee. So what are the traditional techniques that are used to heal an ACL injury? Dr. Kevin Kaplan (10 : 42)So when you turn ACL, the anterior cruciate ligament, goes from your thigh bone to your shin bone, femur, tibia. Uh And it, you know the two bones set up on top of each other and the ACL prevents them from shifting. And if you tear an ACL, i t’s one of those ligaments that doesn’t have the ability to heal, the MCL, which is another ligament- the name which is the medial collateral ligament- when that tears it can actually heal on its own and doesn’t always need surgery. A CLs, when they fully tear, they typically don’t have the ability to heal themselves. Then we have to perform an ACL reconstruction, and our techniques again like we talked about earlier, have evolved over time. It used to be big incisions and open techniques and now we’re doing things a lot less invasive with arthroscopy, smaller instruments and have the ability to reconstruct the ACL. T here’s different ways to do that using your own tissue which is called an autograft, which is what I do with all of my high school collegiate professional athletes. And then there’s other ways to do it with cadaver grafts or allografts and that really is kind of a surgeon preference whether or not they use your own tissue or use a cadaver graft. I prefer to use a patient’s own tissue. I just think it makes biological sense. Um It’s relatively not morbid to do that. Toree McGee (11 : 55)Okay – so let’s let’s expand maybe a little bit on that because that’s really really interesting. So the technique that you’re using – is it relatively new involving like quad tendon grafts to aid in ACL reconstruction? Dr. Kevin Kaplan (12 : 07)Yeah so you know the gold standard ACL reconstruction is what’s called patellar tendon. So your patellar tendon is the tenant that goes between your kneecap. If you look down on your kneecap to your shin bone, there’s a little strip of tendon there, you can take a little piece of the tendon, a little piece of the patella, which is the bone and a little piece of bone from the tibia. And that’s the gold standard. What I do in a lot of my athletes as you, you know the downside of doing that can sometimes create a little bit of anterior knee pain. And so to avoid that, you know, hamstring is another graft that you can use, but that comes with the risk of potentially having some cramping in theback of the leg, especially when you’re doing things like running. So the quad is the newest technique,the newest graft that we’re using. And you can take a little strip of the quad tendon, which is the tendon that’s above the kneecap. And you don’t actually have to take a full thickness area of the tendon. You can just take a little strip of it so it keeps the continuity of the quadricep intact. And I think that’s very important because in the end the ACL, that tendon will become a ligament. But what determines when an athlete or whether it’s a weekend warrior, a professional athlete to get back playing is the strength of the muscles in the front. The quadrant that the extensive mechanism and that’s usually what takes the longest to come back. So I think that’s the benefit of trying this new graft, which is a quad. Toree McGee (13 : 25)Okay. That’s really interesting. So is there a particular reason I guess other than it being new- what have you seen to make it the way that you prefer to do it versus any o ther technique? Dr. Kevin Kaplan (13 : 41)I think that it’s low morbidity, patients are able to move quicker, less anterior knee pain. The graft is very thick, it’s strong and sturdy and with the techniques that some of the companies that I don’t happen to have any kind of business interests in, but Arthrex is the company that I use for the quad grafts. The technique is very straightforward and I think when you look at the difference between a cadaver graft and a patient’s own tissue, I just think it’s a better option. As all these athletes are staying more active. You know, someone had an ACL tear and you just needed it for stability but they’re not going out and doing a spartan race or CrossFit or even pickleball. It may not be as important, but the graft to me, the biology of a patient’s own tissue healing to their own tissue is extremely important. And so that’s why I like this. I’ve been switching a lot of my older patients. W henI say older, like my demographic, you know, thirties, forties, fifties. So it’s using trying to use a quad graph. Toree McGee (14 : 42)Yeah, I mean, that’s what I was going to say. It makes sense in my non-medical person brain that your own tissue would be the best-case scenario. You know what I mean? Because I mean and this probably doesn’t happen, and I really don’t know, but you hear about people having to have surgeries and peoples’ bodies rejecting things that didn’t come from themselves. I’m sure with this sort of thing, you’re not necessarily seeing bodies reject other tissue, but I would imagine that it would just adapt a lot better if it’s your own tissue. Dr. Kevin Kaplan (15 : 15)Yeah, you’re right. I mean the rejection rate is super low and obviously it’s not typically an infection risk but there’s a field to the knee. You know, there’s a stability factor; there’s a strength and you knowobviously you’re taking something that’s a cadaveric tissue cadaver graft which works very well, don’t get me wrong. But it’s you know, frozen graph that then you know obviously it’s sterilized and it’s clean and the infection risk is low, but then you think about exactly what you said. I mean these are fibers in your own body there live, they’re active, they’re healthy and it just inherently makes more sense to me and everybody has a difference of opinion. But I like that idea. I like that concept and I’m trying to do as many of those as I can, and fewer of the cadaver grafts. Toree McGee (15 : 59)Yeah, well, that makes sense to me, too, if that means anything to you. (Dr. Kevin Kaplan: Well hopefully you never tear your ACL!) Toree McGee (16 : 04)So at the end of the day, what are your thoughts on preventing injuries like this? Like, can it be prevented? And when do you eventually decide that surgery is the only answer to correct the tissue. Dr. Kevin Kaplan (16 : 15)That’s a great question. There are a lot of studies looking at ACL prevention type programs. Uh, and I think that’s extremely important. We try to get the high school kids in the area and I even had a conversation with a colleague about trying to get some sort of program for all the local high schools. Because the numbers are staggering. I mean, I do probably close to 150 or so ACLs a year. And the numbers just keep Increase because the athletes are younger. They’re playing at high levels year-round. Uh, and you know, the longer you play and the less you train, you know, in the offseason, the higher the chance to have an injury. So ACL prevention programs without questions should be part of every high school collegiate pro athletes normal program. The unfortunate thing is, is what you said and once it’s tears, you know, it doesn’t just heal and so in order to get back playing and doing the things that they want to do cutting, pivoting, twisting. You can live your life if you were just without an ACL if you’re just going forward and backwards. As soon as you put your foot on the ground to turn and twist, that’s when your knee can buckle and that’s obviously an important thing for most athletics. Toree McGee (17 : 23)Absolutely. All right now, we’re not going to let you get out of here without talking about at least something ROMTech, right? So, can you describe the outcomes in your patient’s recovery prior to being introduced to the PortableConnect versus now? And what difference are you seeing with patients that are on the PortableConnect? Dr. Kevin Kaplan (17 : 43)It’s been a great addition in terms of my post-operative protocols. The patients love it. They move veryquickly. You know, I try to get patients in therapy as quick as possible. But now this is, you know, the day of the day after surgery and they get their knee moving and I think one of the things that you and Ialluded to earlier is what is that edge? What is the most important thing? And I think getting the quad fired early. Getting it to- and what I mean by that is the quadricep muscle- getting it to contract early, I think is paramount in the end. You see a lot of quadriceps atrophy and muscle weakness and that happens so quickly after surgery. It’s sometimes unbelievable. So I think a competitive edge here is you’re getting patients on a machine that not only moves for them but then gives them that ability to start contracting their muscles. And then that whole mind-muscle connection I think is very understated in rehabilitation, because I see some patients that come back. This is obviously before I was doing ROMTech and they just couldn’t get their muscle to fire. They couldn’t do it. And I know they could. But for some reason, whatever that mind-muscle connection, which I think is very important, wasn’t there. Now I’m seeing these guys come back. They’ve been on ROMTech, they’re moving, they look good, t heir knees are fully extended and they can fire their quad. And the quicker you fire quad, the quicker the muscle is going to come back. In the end, what mitigates injury risk and what allows a patient to get back to playing, It’s not the ACL, because those are going to heal, you know, with our autografts and they’re going to become a ligament. But what it really is do they have the strength of their leg to protect them from further injury? So THIS is the competitive advantage that we need in our patients to get them moving quicker. So I love it. Toree McGee (19 : 20)Yeah, Well that’s awesome. I never thought about anything having to do with like a muscle and mind kind of connection, but it makes total sense. I mean, especially if you’ve been favoring your injury before you have surgery, that’s like trying to limit the movement, and then after surgery you’re assuming oh my gosh it’s gonna hurt if I move it, and even that might make it so that you just don’t want to deal with it at all. Dr. Kevin Kaplan (19 : 44)Absolutely. I mean they just shutdown. You know you have the injury, it scares people, you feel a pop, your knee swells, your quad shuts down, you try to rehab them a little bit, then you put them through a traumatic event which is surgery even though it’s precise and then you’re back in that cycle again. So if we can break that cycle, I’m really interested to find- I mean obviously I’m new using the ROMTech over the last several months but every ACL gets it now and it has the opportunity to. And the reviews are great and patients in the early clinical outcomes, we have some studies that were obviously I’m hopefully help with the study coming up on ACLs, I think are going to be interesting in terms of how quickly that quad tone returns and how quickly these guys are able to show that they arefunctionally better because they’re starting much quicker with a better machine. Toree McGee (20 : 28)Absolutely. Well this has been super informative for me and I hope everybody else. I hope it was as much fun for you as it was for me to be here with us today. Dr. Kevin Kaplan (20 : 36)I truly enjoyed it. I gotta bring a model next time. I didn’t bring a model you know. Next time… Toree McGee (20 : 41)We won’t be one upped by one of our others, so we’ll get you back on so you can redeem yourself. But this was awesome. Thank you Dr. Kaplan so much. We appreciate it. You can find D r Kaplan on line at kevinkaplanmd.com . You can follow him on twitter @kevinkaplanMD and harass him a little bit and tell him how awesome he was on our podcast. Dr. Kevin Kaplan (21 : 03)Yeah, thanks for having me. Toree McGee (21 : 04)Of course. Well, thanks so much for taking the time. Thank you to everyone that was watching us today. If you have any questions, comments concerns, go ahead and drop them in the comments section. We read everything. If you have suggestions for moving forward and any guests you’d like to hear from, let us know and you can always check us out at www.romtech.com and follow our social channels. Thank you guys so much and we’ll see you all next time.

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