February 4, 2023 • 33 mins
When technology and creativity intertwine great discoveries are explored. This is what is occurring in the orthopedic field. The discussion of restoration versus reconstruction of a torn ACL at times has been debated, but now more than ever restoration has given patients a great option. Orthopedic Surgeon, Dr. Grant Garcia discusses the BEAR Implant. The Bridge Enhanced ACL Restoration (BEAR) technique is a procedure used to treat ruptured or torn ACLs. This new, FDA-approved procedure serves as a much better alternative than traditional ACL reconstruction. It's less invasive and less complex in nature.
Dr. Garcia talks about how the BEAR Implant enables your body to heal its torn anterior cruciate ligament (ACL). The implant is different because it works with your own blood to heal the torn ends of your ACL back together. We discuss who is a prime candidate, and how soon after your injury should you have this procedure done, the pros and cons of restoration versus reconstruction, affordability, and getting insurance to approve this procedure. Dr. Garcia covers all patients' questions. Real topics, real questions, and answers. Dr. Garcia is always at the forefront of technology and the BEAR implant has him excited for his patients as they recover and get back to normality faster than ever. Why might the BEAR implant be good for you? There’s a lot more that we discuss, but I guess you need to listen and enjoy.
Patients can now achieve complete functional restoration without the consequences of traditional ACL surgery. Here are a few fun facts. the BEAR implant is FDA-approved. A tiny incision can place the implant as it will be situated in the space between the two ACL ends. Also, the patient's blood will be added to the BEAR implant to activate clot formation.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:08):
Okay, thank you for everyone forlistening.
I am with Doctor Grant Garcia. He's our orthopedic surgeon and
sports medicine specialist. Check him out at
grantgarciamd.com. We've got a great show for you
today. The topic is the future of
horizons for a CL procedures andthere's so many new innovative
(00:28):
procedures that are coming out that you know, we just got
really excited about it. And when we think about
innovation, right, it's new ideas, technology, finding a way
to advance whatever that is, youknow, the productivity, you
know, in order for all of us to benefit, Doctor Garcia, first
and first and foremost welcome. And to follow up with that, what
(00:51):
is your thought when you think about innovation?
Well, First off, thanks for having me.
When I think of innovation, I think of at least from the
medical standpoint, I think of. Finding a way to do what we do
better, safer, and to make it sothat we improve on what we did
(01:12):
before. You know, if I don't look back,
if I look back on myself four years ago and don't say, wow, I
can't believe I did it that way,I wish, you know, now I do it
even this way, even better. Like, that's a good thing,
right? We ought to always keep getting
better. It doesn't mean that what we did
before either is wrong or not asgood, but.
You know, there's certain things, even technology, that
(01:32):
are even evolving even over the last few years, that make our
lives better, are better for thepatients and make a more
efficient surgery so patients recover faster and you can see
noticeable differences even in that short time period.
Yeah, it's a perfect way to say it.
For my daughter, innovation is straws.
She loves to use a straw for everything.
So, you know, thank God for the innovation of straw.
(01:54):
But all jokes aside, let's talk about some of the things that
really have you excited, especially in when it comes down
to the ACL&ACL procedures. Yeah.
So I mean we'll go through a different series of them.
I think the one that we had talked about a few of these
things after our big meeting in April by kind of recircling back
(02:16):
now that they're more clinical. I think the first thing to talk
about is the bear implant. So it's it's a it's actually
it's actually spelled out BEAR. And it's in an acronym, but
basically what it is, it's pretty impressive, the whole
story. So the whole story is there was
this doctor and she works for atHarvard and basically 10 years
(02:37):
ago designed that hey, how can Ifind a way to turn to heal more
a CL's? Because as we know, for the most
part, until more recently if youtore your ACL, it was mostly a
reconstruction. There's really not a way to grow
back a ligament like that. The same with the PCL, but the
PCL just isn't talked about thatmuch because there's so many
less of those done. But the A/C L's the one we hear
(03:00):
about in the news and all the football players and all the
basketball players. So is there a way that we can
regrow this and so we can keep you back to your native anatomy
and in theory reduce the chancesof you need something in the
future? Faster recovery or easier
recovery and then a more naturalthing because we know that a C
L's aren't perfect and people get repairs and you start
getting revision surgeries. Success rates and return to
(03:23):
sport drop significantly. I mean we'll see how photo
Beckham Junior does, but after #2 it's never the same thing,
you know, so can we avoid that or can we buy more time by doing
this. So not to get in too much of the
details, but basically she spent10 years designing this clinical
trials. You know, you got to test out
something if it's going to be that innovative and it's now
(03:44):
available in the market. It's not commonly done, but it's
available on the market. They've done a few in the East
Coast. We're starting to think about it
over here and start doing it. But basically what you do is you
create a blood clot and turn it into what we call an MCL tear
and actually allow the ligament to heal.
And the indications are pretty are pretty wide and what's
impressive is the indications are actually for young children
(04:06):
up to you know, midlevel adults.So it has a much wider
indication of some of the other procedures that we do.
That being said, there's still alot of clinical data we need to
see, but even if the 100 or 120 patients that have undergone
this, the results are fairly staggering that you're seeing
patients with. A fairly low retail rate of
around you know 7% you know at that and getting back to sports
(04:28):
that they want to do with MRI showing that in some cases the
ACL regrows. So it's pretty impressive.
Just to give a little back story, you mentioned at the
beginning, this was a conversation that we had.
You went to the big Orthopedic conference in Chicago a few
months ago and you came back really excited.
We touched upon it a little bit in one of the shows afterwards
(04:49):
and now it seems like this is really kind of moving forward.
Is that because, you know, the FDA and some of these other
organizations have now given it a thumbs up and saying this is
the way to go? Yeah.
I mean the FDA approval happenedyou know shortly before the
meeting, but now we have sort ofcompanies that can distribute
these out, you know with any of the way they were these products
(05:12):
work. You know, in this case you
didn't in the doctor, she's described it the best.
But basically they're not going to jump on anything unless they
know it's going to get FDA approved, right.
You don't want to pay all those royalty fees and everything else
to the people that worked on it unless you know it's going to be
a sure deal. Like, you know, these companies
like to know that they have a sure deal.
So it took a while to show the data, but then after showing the
(05:33):
data and now they've got a clinical product.
And again, I think this, you know, you in the next year or
two, you're probably going to see version #2 come out right.
You know, we how do we innovate,make this better.
So it's a product that's easier to use.
You know, it's still not the easiest thing to use and it's
very expensive. And so it's not indicated for
everybody and there's not a lot.You know, there's only small
indications around getting more data and evaluate that.
(05:56):
You know, if you have this procedure you have to do within
50 days of the surgery, you know, that's pretty short.
I mean I have patients that comein that have torn their ACL
three months ago, been bounced around for different opinions.
You know, by the time they got to me, if that was the with the
bear implant, you wouldn't be eligible.
OK. So why is that that that's a
perfect segue. Why?
Why is it so important that you have to come within those 50
(06:17):
days of tear in the ACL? Well the the not so smart answer
is that's the way it was FDA approved.
But the answer is that the idea is that basically they tested a
certain timeline. 50 days is what they chose.
And the idea that if you wait longer than 50 days, the
ligaments been torn too long, it's too disrupted, All the
(06:38):
blood flows out of it and it just doesn't feel the way it
should. OK And what else goes into
meeting this criteria? Is there a certain age, a
certain category, you know the what kind of falls into this
category to have this bear implant?
And and for our listeners out there, that is BRIDGE enhanced
ACL restoration implant and thatis the BEAR acronym.
(07:02):
Once again, who fits in that category as far as age and maybe
gender or anything like that? It's really those people that
have had an acute injury age category.
There's really not too much of Acutoff compared to some of the
other things. But and again people are pushing
the envelope in what direction you want to have enough of a
(07:23):
stump of the ACL left that you can attach some sutures to it to
bring this sort of thing up to the book.
I think of it in my opinion as like a pretty good looking ACL
that's sort of cut in the middlebecause we've got a good option
for those proximal Acls we want to fix.
So I think it is add another thing in your repertoire.
I think the biggest problem withthis implant is just going to be
(07:43):
the cause because it's it's going to be a challenge.
The biggest challenge, we're going to see this in the future.
It will get better. But the biggest challenge of the
new product like a new medicine,right, is getting insurance to
approve it because they're only going to give a 7A set amount of
money to the facility to do this.
And if it's more expensive than what the product is, it's not
going to be covered. And that's going to be a
(08:05):
problem, especially nowadays with all the hospital shutdowns
you've had and everything else so.
And maybe something, you know, and again, it depends on the
place you work and where you are, but that's going to be the
biggest staller is whether or not this can be affordable for
everybody. You know, we don't want to make
healthcare go out of control trying to do something.
So it is a good option for certain people and people who
want to try innovation. And there are certain people
(08:27):
that'll do better than others and there's certain people
that'll have good success. It's just something to get the
viewers excited, like, hey, there's something out there that
we can do to make you better. Yeah, even if it's not
affordable for everyone. But like anything, as we get
more information and time goes by, hopefully the insurance will
play it, play their part and play nice.
(08:48):
When it comes to all this, just explain a little bit more with
this bear implant, how does it utilize your own blood with the
healing process? What?
What does that what does that really mean?
So basically what you do is you soak it with your blood.
In this sort of collagen membrane and you basically put
(09:11):
that membrane right against the wall where the ACL should grow
back. And the idea is that you're
creating a blood clot so that the scar and the the ligament
knows where to grow back as opposed to right now there's no
clot when you when your ACL tears and if I had their ACL
torn, they know that their knee blew up and they had a lot of
blood in it. Well, that blood went
everywhere. As opposed, if you tear certain
(09:33):
ligaments in the other parts of your body, that'll heal on their
own. So we have a little blood clot
that forms right around with theligaments both attached.
So you're basically turning thisinto one of those ligaments and
so you that blood, the blood clotting in that area with that
collagen membrane will allow theguide the growth factors in that
blood tell your ligament to healin a certain spot, got you.
(09:55):
And you know, we've discussed this already, but for anyone
that hasn't listened to our other shows, just kind of
describe why the the ACL has trouble healing on its own and
you need to have some sort of procedure in order for the ACL
to, you know, be fixed. So the problem with the ACL is
(10:16):
it doesn't have a great blood supply and when it's torn, it's
in the joint. And so like I said before, when
you tear the blood supply of it,it the blood goes everywhere.
It doesn't really have the rightproprioceptive factors on how to
heal. So you know, all of our
procedures are guiding that ACL back to where it's supposed to
go. And it all depends.
I mean, there's different, there's so many different types
(10:36):
of a CL tears, even though you know, a lot of us just think of
a CL tears and ACL tear. As I've even learned more about
this and gotten better at these techniques and done even more
research as someone that has sees a lot of these, I've
learned that there are so many flavors, you know and even on
the MRI now I can tell you if this person's going to be a good
candidate or not before I even go in there.
(10:56):
And so I can save a lot of time and energy.
Plus I can have the discussion with the patients ahead of time
because you really can't do this.
Procedure on somebody without giving them all the
expectations. You know, they need to know the
risks and benefits, especially when you're doing something new
and innovative. Got you.
When people go in for surgery, one of the things they think
about is okay, what are you doing to my body, right.
(11:20):
So you know, you talk about something when we're talking
about, you know, cutting, we're talking about incision, we're
talking about recovery time. So is there a difference between
the Bear implant as far as what type of surgical cuts or
anything like that compared to anormal ACL reconstruction?
(11:42):
I mean, there's some different techniques.
You know, you make a little bigger incision right near the
kneecap is there's certain things you don't have to do,
like take a grasp. So if you take someone part of
their Patella tendon or part of their quad tendon or their
hamstring tendon, you don't haveto do that.
You know, it's relatively minimally invasive.
But it's still a procedure that's being said.
(12:02):
But there are a lot of things wedo to reduce that with this
procedure. And so you know it's it's it's
the same sort of incisions if you had for the for the for the
normal person they wouldn't recognize the difference between
a bear incision and an ACL incision.
They look about the same. Timewise, maybe it's a little
bit faster, but again, it's a, it's a little bit of a unique
(12:23):
technique and we're still working on it.
There's another procedure we'll talk about that is easier and
lower profile. That you know I just recently
did one of these and I can give a little bit more insight into
that option as well. But I think that that's sort of
the the info is like you know you're using small cuts, you're
putting up you know big college and implant in the front of the
(12:43):
ACL to get the clot. We've seen good data and I think
you know we should probably retouch on this in the next few
months to six months to year to kind of see what the data is.
Again it's going to be slow. You know people have to adapt,
insurance companies have to adapt and the surgeons have to
adapt. You know, many people don't want
to do the. Cutting that stuff, because if
you're the first person to do something, it doesn't do as
well. You don't want to be that one
person either. So it's got to be a fine
(13:04):
balance. You know, you touched upon and
that was going to be my followupquestion is time, right?
That's something we talked aboutis if you do this, how long
before I'm, you know, either fully healed or as close to
normal as possible and what are the chances?
Or is it, you know, still the same as far as the injury
(13:26):
reoccurring? So in the matter of times, we
get on the next topic at least ACL repair, which I'd like to
chat about. Yeah, we're going to go into
that right now. That'd be great.
That's this is a harder sell I think than some of the other
ones because the recovery time is about the same time as an ACL
reconstruction. So you're not really saving that
much time the but you're having your own native ligaments.
(13:52):
And there's a little higher retail rate.
So it's a little different sale than my ACL repairs.
That being said, there there arecertain patients that will want
to get the newer technology and want to save their ACL.
You know patients all the time ask me can I get my ACL saved
and I have to tell them, you know, no, we can't do it.
We have to reconstruct the wholething and so.
That might be someone that's interested in it, and again, as
(14:15):
we get more comfortable with theprocedure, we may let people go
faster, do faster things, but sometimes it takes a long time.
You know the transition, anothertopic is a CL repair.
We've talked about this before where we can repair the ACL, no
fancy clot or anything else, butthese newer more innovative
implants, you know that's been around for a long time, longer
(14:35):
than the Bear implant and reallyhas been taken off in the last
year or two and in the last six months when they came out with
this brand new instrumentation Arthrex, it really is a game
changer. And so it took, we're talking
about multiple years. We get to something where we
feel confident enough to do an impatience and innovate and I
(14:56):
think it will make a difference in the patient's outcome.
So let's talk about that repair.What is something that's on the
horizon and not only that that you're really implementing when
you're doing procedures? What?
What is something that stands out for you when it comes to the
ACL repair? So you know I like like I said
the bear implants good, it's gotsome benefits and I think it's
(15:17):
we're going to be seeing in the future patients to keep their
heads up. For articles that come out about
it, you know there are more and more surgeons doing it.
It's only a handful. This repair thing is a little
different animal. So basically what it is, is
people with really good ligaments that just tear one
little piece right off or the tasks to the femur, it's more
common than we think, but most of us aren't looking for it.
(15:38):
So even surgeons aren't really looking for it.
They see an ACL parent MRI and they say okay, this needs to be
reconstructed. Well, those patients can be
fixed and when we cut down all the parameters so.
You know, initially do it on everybody, right?
The problem is you do it on every ACL and every patient, the
failure rate's fairly high. But if you look down at the
detail, we found out that if youdo it on patients over 25 years
(16:01):
old with a proximal pair, not a chronic injury, you know, three
months, three or four months, you can repair these patients
with a very low repair rate. But what the crazy thing about
this is, is the recovery time isonly four months.
That's amazing. And you're keeping your native
(16:22):
ligament, so the success rate ofthis procedure is around 5:00 to
7:00 percentish on newer articles.
Repair of the ACL with this new procedure where a regular ACL
maybe is 2 or 3%. Now again the quotes are all
over the place in terms of some numbers and maybe a rounding
error I'm giving you. You're talking about a seven,
(16:42):
nine month recovery versus a four month recovery.
So what's really cool too is youcan you internally brace the
repair and I know you're an expert now at this because we've
talked about this extensively, but the reason it but the reason
the ACL repair got so good is because everyone I'm getting
internal break. So the one I did on Monday is
this newer implant plus I internally brace it right
(17:03):
through the middle of the to give this sort of rebarb
attachment and the biomechanics are amazing.
I mean when I finished the ACL it felt like I did a full
reconstruction on a high level asset and and you're and and
this we're talking about the fertilize ACL at this point,
correct. No, we're not even on that yet.
No. OK then.
(17:24):
This is just repairing the ACL, no fertilization we're going to
be considering and I was talkingwith the company in the last
couple days potentially finding a way to fertilize or do some
sort of biologic to improve the healing success on this.
But what we have now, you know, FDA approval.
Is this implant that you can tighten it up further tighten it
the ACL back to the wall much better than you were able to do
(17:47):
before? And this is only new like over
the last six months, and that's because of the tool that you're
using now. Yeah, the new tool that we use
to be able to be, you can cinch it again and again, so you can
tighten, move the knee around and then tighten it again and
that way you get it as tight as possible back to the wall.
And though I mean just for example, one of the ones I did
on Monday, it went from a very loose knee to like I could tell
(18:08):
you I I test hundreds of knees out.
And I could not tell if this a CL was torn based off the exam
after I finished the surgery. So the jury's still out on you
know everyone the right person to do it on.
But you know I've been really impressed with the data.
I'm doing it on patients. I have a number of patients
lined up that I'm going to do iton in the right indications.
(18:29):
And again when you have a most patients want this because the
success rate is above 90% that you're not going to retare a CL
and. If you only if you give up that
33 or 4% of RETAIR concern and you can recover three or four
months faster, patients are likethis is a nobrainer for me, you
(18:49):
know, because if they care, again a revision from a repair
is very easy to go to a reconstruction, but if you care.
A reconstruction and you get another reconstruction.
The success rate is not nearly as good.
So it seems if you're the ideal candidate, that that would be
the logical first option to do that type of procedure before
(19:14):
doing a complete reconstruction.So the repair, if you're a
candidate, if everything you know lines up to saying okay,
yeah, you're a candidate, This is the way to go, right?
Am I just making an assumption here?
No I think you're that's the way.
Now The thing is again we don't want to do too many of these.
We want to keep looking at the data.
But we've seen a lot of them andseeing how well they've done and
(19:36):
with this new instrumentation, Imean if this isn't work there's
nothing else is going to for a while.
This is the I I I mean I would tell you that before this new
implant came out I would not have gotten my ACL repaired.
I would have had a reconstruction.
But if I have the ACL tear that pattern that works for this and
I can know I can get back in four months with a. 7% Retair
(19:56):
risk. I'm willing to take that risk
even as a surgeon because we do a good job on Acl's.
But they're not always perfect, right?
And you know, and if I can buy myself one more potential
operation or avoid one more operation and let's say they
retair it in four years, I don'tthink that's the case always.
And that's not the case many times.
But if they do, then it's a verysimple reconstruction.
If they Retair, one of my Acl's that I did four years ago with
(20:19):
tunnels already in there, it could be a much bigger animal.
Not so. And again, it's all about risk
affiliation. If you don't want to take that
risk of the 5% or 4% higher chance of tearing, then yeah,
you get the reconstruction. And I tell all my patients,
Ioffer both options. And if I go in there and tissue
doesn't look good, I won't do a repair.
So I'm not going to, I'm going to selectively pick patients
(20:41):
that are ideal candidates for this.
But when they are, this is a very cool option that many
people can't, don't know about because most surgeons don't do
it or they're not willing to take the innovation on this and
try it out again. There's beta backing this.
We've got good studies, good biomechanics.
So I'm there's no, this is an experimental surgery.
(21:02):
This is a newer procedure that'sinnovative, that's going to help
patients get them back faster, get them the things they want to
do with a low risk. And that's the only reason I
was. That's the only reason I decided
to do it, because it matched once it got all those boxes and
it's reproducible, there's a nobrainer.
Do you sit around your with yourteam and I got two questions for
you. But do you sit around with your
(21:23):
team and after you look at all the data and and you like this
is pretty, this is pretty this is pretty cool.
You know, I I've got to try it like where did where does that
kind of jump off where does conversations happen.
You know you're sitting around at lunchtime and say hey I'm I'm
ready to do this. We've got all the data
everything looks good. I feel confident in doing this
first procedure. You know, just kind of what what
(21:44):
is that locker room conversationwhen it comes to?
You orthopedic surgeons and having this new technology and
and things that are coming out that can advance what you're
doing and more importantly have you know better quality for the
patient. All right.
Well now you're asking for The Dirty details.
So I won't go in too much detail, but I'll tell you how it
(22:05):
works. So basically I do a lot of, I do
a lot of these different things.So I'm fortunate enough to work
with the companies to hear aboutthe innovative products first or
early on. So I do a lot of beta testing
for them and these are a lot of these are all FDA approved,
they're just tweaks. But when a bigger thing comes
out of, I hear about it, I have the luxury of working a lot with
a company called Arthrex, and they're one of the biggest
(22:27):
sports companies in the country and I do consulting for them and
work with them and they have a lab in Renton.
And so actually what I'm able todo is actually practice before
the surgery. So I do this a lot.
It's a complicated surgery. I'll practice before the
surgery. It's just like you would for
anybody else. And we've talked about this
before on the show, but I went in the lab and I'm able to do
(22:47):
this and I already seen the dataand I I've done all.
Again, this procedure is not technically that challenging.
It's just you have to find the right person and feel confident
enough that you can do it, you know, and you have to have all
these little check boxes. But if you check all those boxes
and you can do all those things.This is a minor tweet from my
daily stuff that. Makes sense.
You know, on Monday when I did this, I did two other surgeries
(23:08):
that were technically much more challenging.
So it's not that that was the concern in this procedure, but
after seeing it and feeling it and seeing the biomechanics, it
became very, it became very obvious.
So and then what I'll do is my assistants in the room and I
have really good physicians assistants and staff.
And so the team members will go over this procedure again and
again just like you would for anything.
(23:30):
And I'll prepare them for this. Their representatives for the
company are there and they're preparing them for it and
everybody knows we're on this page.
So like for instance, we did this thing and it was perfect.
I mean, everything went as planned and that's generally the
way it goes because I try to prepare as much as possible.
I am definitely not the person that likes to wing it in
surgery. I if I have to do something
(23:50):
audible and change plans, I'll do it.
But that's not the way I live mylife.
You know, I have, I do too many complicated surgeries to go in
there and wing it. So everything I do is been
prepared four or five times ahead of time.
So it's funny because some of mystaff members or the patients
will ask, like, did he look at the MRI or did he review this?
And they'll be like, I think you've probably looked at it
more than you want them to. So you know, I think at this
(24:12):
point, especially with the harder stuff, be prepared.
Do a good job, especially early on, if you're starting to do
something that's new and you getgood results.
And you know, if you pick the right patient and you have the
right mindset, it's all about expectations, right?
And a patient has seen 4 doctors.
No one mentions repair. You mention repair.
And they're still scared about it.
And they don't think they're going to do it and think they're
going to do poorly. Yeah.
(24:32):
Don't do the surgery. You're going to do well.
But if you're like, wow, I want to try something new.
This doctor seems really excitedabout it.
He's done the research. He knows the right people, and
he feels confident about it. And you and you trust me, then
try it. But again, I give the options.
I'm never pushing people into new surgeries, ever.
It's. And again in Seattle, a nice
thing is we're really technologically advanced and
(24:54):
patients do a lot of research. And it just takes a little bit
of time to understand, like, hey, listen, this is not all.
They're not blowing smoke here. You know, I don't try random
products that I've never heard of or I've never seen.
You know, everything I do has had been delved into the data,
but if you don't innovate, you're doing your patients a
disservice. And I get to I have to
unfortunately see those cases ofrevisions or other problems or
(25:15):
innovation was not tapped into. You know what we've we've
spoken, you know, a lot of sports on our shows and you
know, we we kind of keep it light and we joke around.
So my followup question is, do you have a dance?
You know, after doing that firstprocedure on Monday, everybody's
there, everybody's checking it out and you just comes off you,
you know, you hit that home run or.
(25:36):
You know what whatever sport do you want to do do you have like
a break it off dance you know doyou You fish pump you know or
hooting and hollering like you know what what's the what's the
what's the vibe in the room for you you know do you go home you
you know you look at your wife who's like, yeah I knocked out
of the park you know I'm you know what what what what's
what's the deal with Doctor Garcia and his celebration
there. I do get pretty excited.
(26:00):
You can probably tell for me on the podcast that I'm not a
wallflower, but I I I don't. I'm not a gloater so but I do
like getting. Excited about it.
I did a good job and I did. I did.
I did a good job and that I thatit went well.
But I get really excited. I hate to say it.
I mean, I love doing it. I love working really hard and
(26:22):
taking on really challenging cases and taking on challenging
things and having success. And if something doesn't go
well, I'm like how can I do a better job the next time.
You know, I I think I I'm not going to compare myself to an
athlete, but I think of myself as doing some like a profession
and have you do it well and if something doesn't go well, you
know, you drop the ball in the pass, you don't win the game.
You know you have a complication.
(26:44):
You don't pout about it and not do it again.
You figure it out, you fix the problem and you take it on and
on. And that's the way you have to
do it in surgery. If you're going to take care of
athletes and pro athletes, not everyone of them is going to get
back to their professional sport.
Or you do, you do complicated procedures.
Not everybody's going to do really well, but it's how you
handle the problems that make you will make you who you are,
(27:06):
but you also have to celebrate yourself when something goes
well. You know, I was so excited after
that, you know, after this. I've done a few of these,
actually. That was just talking about the
one I had on Monday, but the oneon Monday when it finished, you
know, when we had an extra prep and things like that, you know,
yeah, there was definitely some high 5.
And I tell the patients afterwards, I'm like, you had a
high five surgery and I think they think I'm joking, but I
(27:27):
actually did do mostly high fives after the surgery
finished. Yeah, and I know it.
And I know you're competitive, man.
We talked about it, man. You've swam and you ski and you
got your watch. So you listen, you are an
athlete and you are competitive and that's why I bring it up it
because I know there's a part ofyou.
You're like, yeah, no, I was just kind of doing this and I
prepared. I was like, Nah, man, you
hooting. Holler and you're like yeah
(27:48):
baby, I there's part of what you're saying is true.
I can't fully disclose, but I'm very excited and I have a lot of
fun in my practice and patients are have a lot of fun And if you
if patients of mine will tell you, you know I get really
excited and people do well and when they don't do well I try to
figure out how to make them better.
(28:09):
So, you know, I I like my job a lot.
I get, I'm very fortunate enoughto be in a practice where I can
innovate so quickly. You know, as a private practice
surgeon and doing the athletes and the people I do, I can
innovate quickly. If I want to do an ACL repair
and I tell my partners this works really well and I can do
the right thing and they trust me because they know all the
stuff that I do. I can do it in day, you know, I
(28:30):
can innovate quickly and do the right thing for the patients and
adapt, which is really cool. It's the best part about my job
and I can take care of patients that really want innovation.
So it's like the best possible scenario.
So on a daytoday basis, I'm really happy.
You know, I get to have fun, I get to get my competitiveness in
and I get to do a little athletics and sports and I
frequently have fist bumps and high fives in my office, so it
(28:52):
makes me happy. It's a great environment.
Listen, I know we've got you already about 30 minutes and
you've been running around. Is there anything else that you
want to kind of get into? I know we touched upon we didn't
even get into fertilize, ACL andeverything else.
So is this something that you want to kind of jump into or you
want to save for another show? I think we should save for
(29:14):
another show. And if anybody wants to listen
to Will's previous podcast with our fertilized ACL plus the man
that invented it actually joinedthe podcast with Will Chad
Lavender, that's a pretty good podcast that you can listen to
too. So I think that probably does
enough service to it and we can talk about it later time.
That's sort of the farthest one I think in terms of innovation
because it's, it requires the same sort of thing.
(29:36):
It's a pretty high cost procedure.
But I think of these things I told you the ACR repair is the
one that's the is right here ready to go and this one can be
done by your surgeon. You know, you can come see me if
you want. I know there might be some other
people in the area that are considering doing it, but if
you're a candidate for it, I would consider it at least to
(29:56):
look at the data. And again, remember every
innovation is your decision, notthe surgeons.
I'm here to give the informationout.
I'm here to do that. But you have to weigh the risk
and benefits. And my goal in the end is I
don't want patients to be upset if something doesn't work.
So I got to make sure that people know I'm excited about
this, but I'm excited about it. If you're excited about it and
you're OK with the risks becausethe benefits are amazing, but
(30:18):
there are risks. So as long as everybody's OK
with that, we're going to have fun.
We're going to do a good job andtry to make as many people as we
can better. And Doctor Garcia is always
prepared and and now that's the most important thing that I want
to convey throughout the show. You know it's.
It's being at the forefront of technology, being prepared,
doing you know, crossing your T's and down your eyes.
(30:40):
You going to the facility to work on these procedures before
you have a patient. And and really that's the whole
purpose of all this is to give kind of information and also
know that you're in good hands. And the most important thing
that you want from anyone is just to be prepared for whatever
they're doing. You know, just like we're trying
to be prepared for this show. All right, Doctor Garcia, here
we go. You ready?
(31:02):
Here we go, here we go. Now, this is a tough one because
it all depends on who you talk to and what research you read
and everything else. So I'm going to give you a pass
on this one. But do you know what?
We could do it roughly the the years or the surgeon that did
(31:23):
the first ACL reconstruction. You always do this to me.
I hope I'm I have a zero. I'm so glad that I'm not a
trivia guy because it would be aterrible.
This is this one's, this one's really not easy.
I did a lot. I did a lot of reading and it
depends who you talk to and and what do you consider.
(31:46):
I know, I know. So if you could give me a
roughly like a timeline, if you give me a timeline, we'll take
it. OK.
I'll give you a year. I think it's probably 19, 65.
OK, we are going back to 1917, Ernest William Hagrove, and he
(32:06):
was a British surgeon. And it's amazing because of all
the research going back. I mean, you've got things
published back in the 1800s whenthey started to realize that
there needed to be something done and in the conversations in
these, in these journals. Because people were getting hurt
(32:27):
and then not being able to walk and they didn't understand what
was going on. And then you had people, you
know, slowly like anything, right.
Exactly what we're talking abouttoday, right.
Whether it's repair and bear implant, it's all starts
somewhere and then people work off of other people and that's
how you get to where you're at now.
And obviously in 1917 is very different than in 2022, the
(32:48):
procedures, but I like to bust your chops.
So this is what we do here. I like.
I like it. Doctor Garcia, I appreciate your
time. I'm pretty sure if you're in
your driveway, your wife's looking at you.
You better you better hurry up and get inside here and take
care of the kids so I don't wanther mad at me.
Doctor Grant Garcia, our orthopedic surgeon and sports
(33:09):
medicine specialist. Check them out.
Grant Garcia, md.com. He has got great information,
procedures, videos, all of our shows.
I mean you name it, the the website is just chock full of
nuts. And just check it out and if you
have any information, give him acall and he's there for you.
Dr. Garcia, thank you for your time and we'll do it again
(33:31):
shortly. Absolutely always a pleasure.
Will have a good night. And they have the family for me.
Thank you very much, Dr. Garcia.Take care.
Bye.
Okay, thank you for everyone forlistening.
I am with Doctor Grant Garcia. He's our orthopedic surgeon and
sports medicine specialist. Check him out at
grantgarciamd.com. We've got a great show for you
today. The topic is the future of
horizons for a CL procedures andthere's so many new innovative
(00:28):
procedures that are coming out that you know, we just got
really excited about it. And when we think about
innovation, right, it's new ideas, technology, finding a way
to advance whatever that is, youknow, the productivity, you
know, in order for all of us to benefit, Doctor Garcia, first
and first and foremost welcome. And to follow up with that, what
(00:51):
is your thought when you think about innovation?
Well, First off, thanks for having me.
When I think of innovation, I think of at least from the
medical standpoint, I think of. Finding a way to do what we do
better, safer, and to make it sothat we improve on what we did
(01:12):
before. You know, if I don't look back,
if I look back on myself four years ago and don't say, wow, I
can't believe I did it that way,I wish, you know, now I do it
even this way, even better. Like, that's a good thing,
right? We ought to always keep getting
better. It doesn't mean that what we did
before either is wrong or not asgood, but.
You know, there's certain things, even technology, that
(01:32):
are even evolving even over the last few years, that make our
lives better, are better for thepatients and make a more
efficient surgery so patients recover faster and you can see
noticeable differences even in that short time period.
Yeah, it's a perfect way to say it.
For my daughter, innovation is straws.
She loves to use a straw for everything.
So, you know, thank God for the innovation of straw.
(01:54):
But all jokes aside, let's talk about some of the things that
really have you excited, especially in when it comes down
to the ACL&ACL procedures. Yeah.
So I mean we'll go through a different series of them.
I think the one that we had talked about a few of these
things after our big meeting in April by kind of recircling back
(02:16):
now that they're more clinical. I think the first thing to talk
about is the bear implant. So it's it's a it's actually
it's actually spelled out BEAR. And it's in an acronym, but
basically what it is, it's pretty impressive, the whole
story. So the whole story is there was
this doctor and she works for atHarvard and basically 10 years
(02:37):
ago designed that hey, how can Ifind a way to turn to heal more
a CL's? Because as we know, for the most
part, until more recently if youtore your ACL, it was mostly a
reconstruction. There's really not a way to grow
back a ligament like that. The same with the PCL, but the
PCL just isn't talked about thatmuch because there's so many
less of those done. But the A/C L's the one we hear
(03:00):
about in the news and all the football players and all the
basketball players. So is there a way that we can
regrow this and so we can keep you back to your native anatomy
and in theory reduce the chancesof you need something in the
future? Faster recovery or easier
recovery and then a more naturalthing because we know that a C
L's aren't perfect and people get repairs and you start
getting revision surgeries. Success rates and return to
(03:23):
sport drop significantly. I mean we'll see how photo
Beckham Junior does, but after #2 it's never the same thing,
you know, so can we avoid that or can we buy more time by doing
this. So not to get in too much of the
details, but basically she spent10 years designing this clinical
trials. You know, you got to test out
something if it's going to be that innovative and it's now
(03:44):
available in the market. It's not commonly done, but it's
available on the market. They've done a few in the East
Coast. We're starting to think about it
over here and start doing it. But basically what you do is you
create a blood clot and turn it into what we call an MCL tear
and actually allow the ligament to heal.
And the indications are pretty are pretty wide and what's
impressive is the indications are actually for young children
(04:06):
up to you know, midlevel adults.So it has a much wider
indication of some of the other procedures that we do.
That being said, there's still alot of clinical data we need to
see, but even if the 100 or 120 patients that have undergone
this, the results are fairly staggering that you're seeing
patients with. A fairly low retail rate of
around you know 7% you know at that and getting back to sports
(04:28):
that they want to do with MRI showing that in some cases the
ACL regrows. So it's pretty impressive.
Just to give a little back story, you mentioned at the
beginning, this was a conversation that we had.
You went to the big Orthopedic conference in Chicago a few
months ago and you came back really excited.
We touched upon it a little bit in one of the shows afterwards
(04:49):
and now it seems like this is really kind of moving forward.
Is that because, you know, the FDA and some of these other
organizations have now given it a thumbs up and saying this is
the way to go? Yeah.
I mean the FDA approval happenedyou know shortly before the
meeting, but now we have sort ofcompanies that can distribute
these out, you know with any of the way they were these products
(05:12):
work. You know, in this case you
didn't in the doctor, she's described it the best.
But basically they're not going to jump on anything unless they
know it's going to get FDA approved, right.
You don't want to pay all those royalty fees and everything else
to the people that worked on it unless you know it's going to be
a sure deal. Like, you know, these companies
like to know that they have a sure deal.
So it took a while to show the data, but then after showing the
(05:33):
data and now they've got a clinical product.
And again, I think this, you know, you in the next year or
two, you're probably going to see version #2 come out right.
You know, we how do we innovate,make this better.
So it's a product that's easier to use.
You know, it's still not the easiest thing to use and it's
very expensive. And so it's not indicated for
everybody and there's not a lot.You know, there's only small
indications around getting more data and evaluate that.
(05:56):
You know, if you have this procedure you have to do within
50 days of the surgery, you know, that's pretty short.
I mean I have patients that comein that have torn their ACL
three months ago, been bounced around for different opinions.
You know, by the time they got to me, if that was the with the
bear implant, you wouldn't be eligible.
OK. So why is that that that's a
perfect segue. Why?
Why is it so important that you have to come within those 50
(06:17):
days of tear in the ACL? Well the the not so smart answer
is that's the way it was FDA approved.
But the answer is that the idea is that basically they tested a
certain timeline. 50 days is what they chose.
And the idea that if you wait longer than 50 days, the
ligaments been torn too long, it's too disrupted, All the
(06:38):
blood flows out of it and it just doesn't feel the way it
should. OK And what else goes into
meeting this criteria? Is there a certain age, a
certain category, you know the what kind of falls into this
category to have this bear implant?
And and for our listeners out there, that is BRIDGE enhanced
ACL restoration implant and thatis the BEAR acronym.
(07:02):
Once again, who fits in that category as far as age and maybe
gender or anything like that? It's really those people that
have had an acute injury age category.
There's really not too much of Acutoff compared to some of the
other things. But and again people are pushing
the envelope in what direction you want to have enough of a
(07:23):
stump of the ACL left that you can attach some sutures to it to
bring this sort of thing up to the book.
I think of it in my opinion as like a pretty good looking ACL
that's sort of cut in the middlebecause we've got a good option
for those proximal Acls we want to fix.
So I think it is add another thing in your repertoire.
I think the biggest problem withthis implant is just going to be
(07:43):
the cause because it's it's going to be a challenge.
The biggest challenge, we're going to see this in the future.
It will get better. But the biggest challenge of the
new product like a new medicine,right, is getting insurance to
approve it because they're only going to give a 7A set amount of
money to the facility to do this.
And if it's more expensive than what the product is, it's not
going to be covered. And that's going to be a
(08:05):
problem, especially nowadays with all the hospital shutdowns
you've had and everything else so.
And maybe something, you know, and again, it depends on the
place you work and where you are, but that's going to be the
biggest staller is whether or not this can be affordable for
everybody. You know, we don't want to make
healthcare go out of control trying to do something.
So it is a good option for certain people and people who
want to try innovation. And there are certain people
(08:27):
that'll do better than others and there's certain people
that'll have good success. It's just something to get the
viewers excited, like, hey, there's something out there that
we can do to make you better. Yeah, even if it's not
affordable for everyone. But like anything, as we get
more information and time goes by, hopefully the insurance will
play it, play their part and play nice.
(08:48):
When it comes to all this, just explain a little bit more with
this bear implant, how does it utilize your own blood with the
healing process? What?
What does that what does that really mean?
So basically what you do is you soak it with your blood.
In this sort of collagen membrane and you basically put
(09:11):
that membrane right against the wall where the ACL should grow
back. And the idea is that you're
creating a blood clot so that the scar and the the ligament
knows where to grow back as opposed to right now there's no
clot when you when your ACL tears and if I had their ACL
torn, they know that their knee blew up and they had a lot of
blood in it. Well, that blood went
everywhere. As opposed, if you tear certain
(09:33):
ligaments in the other parts of your body, that'll heal on their
own. So we have a little blood clot
that forms right around with theligaments both attached.
So you're basically turning thisinto one of those ligaments and
so you that blood, the blood clotting in that area with that
collagen membrane will allow theguide the growth factors in that
blood tell your ligament to healin a certain spot, got you.
(09:55):
And you know, we've discussed this already, but for anyone
that hasn't listened to our other shows, just kind of
describe why the the ACL has trouble healing on its own and
you need to have some sort of procedure in order for the ACL
to, you know, be fixed. So the problem with the ACL is
(10:16):
it doesn't have a great blood supply and when it's torn, it's
in the joint. And so like I said before, when
you tear the blood supply of it,it the blood goes everywhere.
It doesn't really have the rightproprioceptive factors on how to
heal. So you know, all of our
procedures are guiding that ACL back to where it's supposed to
go. And it all depends.
I mean, there's different, there's so many different types
(10:36):
of a CL tears, even though you know, a lot of us just think of
a CL tears and ACL tear. As I've even learned more about
this and gotten better at these techniques and done even more
research as someone that has sees a lot of these, I've
learned that there are so many flavors, you know and even on
the MRI now I can tell you if this person's going to be a good
candidate or not before I even go in there.
(10:56):
And so I can save a lot of time and energy.
Plus I can have the discussion with the patients ahead of time
because you really can't do this.
Procedure on somebody without giving them all the
expectations. You know, they need to know the
risks and benefits, especially when you're doing something new
and innovative. Got you.
When people go in for surgery, one of the things they think
about is okay, what are you doing to my body, right.
(11:20):
So you know, you talk about something when we're talking
about, you know, cutting, we're talking about incision, we're
talking about recovery time. So is there a difference between
the Bear implant as far as what type of surgical cuts or
anything like that compared to anormal ACL reconstruction?
(11:42):
I mean, there's some different techniques.
You know, you make a little bigger incision right near the
kneecap is there's certain things you don't have to do,
like take a grasp. So if you take someone part of
their Patella tendon or part of their quad tendon or their
hamstring tendon, you don't haveto do that.
You know, it's relatively minimally invasive.
But it's still a procedure that's being said.
(12:02):
But there are a lot of things wedo to reduce that with this
procedure. And so you know it's it's it's
the same sort of incisions if you had for the for the for the
normal person they wouldn't recognize the difference between
a bear incision and an ACL incision.
They look about the same. Timewise, maybe it's a little
bit faster, but again, it's a, it's a little bit of a unique
(12:23):
technique and we're still working on it.
There's another procedure we'll talk about that is easier and
lower profile. That you know I just recently
did one of these and I can give a little bit more insight into
that option as well. But I think that that's sort of
the the info is like you know you're using small cuts, you're
putting up you know big college and implant in the front of the
(12:43):
ACL to get the clot. We've seen good data and I think
you know we should probably retouch on this in the next few
months to six months to year to kind of see what the data is.
Again it's going to be slow. You know people have to adapt,
insurance companies have to adapt and the surgeons have to
adapt. You know, many people don't want
to do the. Cutting that stuff, because if
you're the first person to do something, it doesn't do as
well. You don't want to be that one
person either. So it's got to be a fine
(13:04):
balance. You know, you touched upon and
that was going to be my followupquestion is time, right?
That's something we talked aboutis if you do this, how long
before I'm, you know, either fully healed or as close to
normal as possible and what are the chances?
Or is it, you know, still the same as far as the injury
(13:26):
reoccurring? So in the matter of times, we
get on the next topic at least ACL repair, which I'd like to
chat about. Yeah, we're going to go into
that right now. That'd be great.
That's this is a harder sell I think than some of the other
ones because the recovery time is about the same time as an ACL
reconstruction. So you're not really saving that
much time the but you're having your own native ligaments.
(13:52):
And there's a little higher retail rate.
So it's a little different sale than my ACL repairs.
That being said, there there arecertain patients that will want
to get the newer technology and want to save their ACL.
You know patients all the time ask me can I get my ACL saved
and I have to tell them, you know, no, we can't do it.
We have to reconstruct the wholething and so.
That might be someone that's interested in it, and again, as
(14:15):
we get more comfortable with theprocedure, we may let people go
faster, do faster things, but sometimes it takes a long time.
You know the transition, anothertopic is a CL repair.
We've talked about this before where we can repair the ACL, no
fancy clot or anything else, butthese newer more innovative
implants, you know that's been around for a long time, longer
(14:35):
than the Bear implant and reallyhas been taken off in the last
year or two and in the last six months when they came out with
this brand new instrumentation Arthrex, it really is a game
changer. And so it took, we're talking
about multiple years. We get to something where we
feel confident enough to do an impatience and innovate and I
(14:56):
think it will make a difference in the patient's outcome.
So let's talk about that repair.What is something that's on the
horizon and not only that that you're really implementing when
you're doing procedures? What?
What is something that stands out for you when it comes to the
ACL repair? So you know I like like I said
the bear implants good, it's gotsome benefits and I think it's
(15:17):
we're going to be seeing in the future patients to keep their
heads up. For articles that come out about
it, you know there are more and more surgeons doing it.
It's only a handful. This repair thing is a little
different animal. So basically what it is, is
people with really good ligaments that just tear one
little piece right off or the tasks to the femur, it's more
common than we think, but most of us aren't looking for it.
(15:38):
So even surgeons aren't really looking for it.
They see an ACL parent MRI and they say okay, this needs to be
reconstructed. Well, those patients can be
fixed and when we cut down all the parameters so.
You know, initially do it on everybody, right?
The problem is you do it on every ACL and every patient, the
failure rate's fairly high. But if you look down at the
detail, we found out that if youdo it on patients over 25 years
(16:01):
old with a proximal pair, not a chronic injury, you know, three
months, three or four months, you can repair these patients
with a very low repair rate. But what the crazy thing about
this is, is the recovery time isonly four months.
That's amazing. And you're keeping your native
(16:22):
ligament, so the success rate ofthis procedure is around 5:00 to
7:00 percentish on newer articles.
Repair of the ACL with this new procedure where a regular ACL
maybe is 2 or 3%. Now again the quotes are all
over the place in terms of some numbers and maybe a rounding
error I'm giving you. You're talking about a seven,
(16:42):
nine month recovery versus a four month recovery.
So what's really cool too is youcan you internally brace the
repair and I know you're an expert now at this because we've
talked about this extensively, but the reason it but the reason
the ACL repair got so good is because everyone I'm getting
internal break. So the one I did on Monday is
this newer implant plus I internally brace it right
(17:03):
through the middle of the to give this sort of rebarb
attachment and the biomechanics are amazing.
I mean when I finished the ACL it felt like I did a full
reconstruction on a high level asset and and you're and and
this we're talking about the fertilize ACL at this point,
correct. No, we're not even on that yet.
No. OK then.
(17:24):
This is just repairing the ACL, no fertilization we're going to
be considering and I was talkingwith the company in the last
couple days potentially finding a way to fertilize or do some
sort of biologic to improve the healing success on this.
But what we have now, you know, FDA approval.
Is this implant that you can tighten it up further tighten it
the ACL back to the wall much better than you were able to do
(17:47):
before? And this is only new like over
the last six months, and that's because of the tool that you're
using now. Yeah, the new tool that we use
to be able to be, you can cinch it again and again, so you can
tighten, move the knee around and then tighten it again and
that way you get it as tight as possible back to the wall.
And though I mean just for example, one of the ones I did
on Monday, it went from a very loose knee to like I could tell
(18:08):
you I I test hundreds of knees out.
And I could not tell if this a CL was torn based off the exam
after I finished the surgery. So the jury's still out on you
know everyone the right person to do it on.
But you know I've been really impressed with the data.
I'm doing it on patients. I have a number of patients
lined up that I'm going to do iton in the right indications.
(18:29):
And again when you have a most patients want this because the
success rate is above 90% that you're not going to retare a CL
and. If you only if you give up that
33 or 4% of RETAIR concern and you can recover three or four
months faster, patients are likethis is a nobrainer for me, you
(18:49):
know, because if they care, again a revision from a repair
is very easy to go to a reconstruction, but if you care.
A reconstruction and you get another reconstruction.
The success rate is not nearly as good.
So it seems if you're the ideal candidate, that that would be
the logical first option to do that type of procedure before
(19:14):
doing a complete reconstruction.So the repair, if you're a
candidate, if everything you know lines up to saying okay,
yeah, you're a candidate, This is the way to go, right?
Am I just making an assumption here?
No I think you're that's the way.
Now The thing is again we don't want to do too many of these.
We want to keep looking at the data.
But we've seen a lot of them andseeing how well they've done and
(19:36):
with this new instrumentation, Imean if this isn't work there's
nothing else is going to for a while.
This is the I I I mean I would tell you that before this new
implant came out I would not have gotten my ACL repaired.
I would have had a reconstruction.
But if I have the ACL tear that pattern that works for this and
I can know I can get back in four months with a. 7% Retair
(19:56):
risk. I'm willing to take that risk
even as a surgeon because we do a good job on Acl's.
But they're not always perfect, right?
And you know, and if I can buy myself one more potential
operation or avoid one more operation and let's say they
retair it in four years, I don'tthink that's the case always.
And that's not the case many times.
But if they do, then it's a verysimple reconstruction.
If they Retair, one of my Acl's that I did four years ago with
(20:19):
tunnels already in there, it could be a much bigger animal.
Not so. And again, it's all about risk
affiliation. If you don't want to take that
risk of the 5% or 4% higher chance of tearing, then yeah,
you get the reconstruction. And I tell all my patients,
Ioffer both options. And if I go in there and tissue
doesn't look good, I won't do a repair.
So I'm not going to, I'm going to selectively pick patients
(20:41):
that are ideal candidates for this.
But when they are, this is a very cool option that many
people can't, don't know about because most surgeons don't do
it or they're not willing to take the innovation on this and
try it out again. There's beta backing this.
We've got good studies, good biomechanics.
So I'm there's no, this is an experimental surgery.
(21:02):
This is a newer procedure that'sinnovative, that's going to help
patients get them back faster, get them the things they want to
do with a low risk. And that's the only reason I
was. That's the only reason I decided
to do it, because it matched once it got all those boxes and
it's reproducible, there's a nobrainer.
Do you sit around your with yourteam and I got two questions for
you. But do you sit around with your
(21:23):
team and after you look at all the data and and you like this
is pretty, this is pretty this is pretty cool.
You know, I I've got to try it like where did where does that
kind of jump off where does conversations happen.
You know you're sitting around at lunchtime and say hey I'm I'm
ready to do this. We've got all the data
everything looks good. I feel confident in doing this
first procedure. You know, just kind of what what
(21:44):
is that locker room conversationwhen it comes to?
You orthopedic surgeons and having this new technology and
and things that are coming out that can advance what you're
doing and more importantly have you know better quality for the
patient. All right.
Well now you're asking for The Dirty details.
So I won't go in too much detail, but I'll tell you how it
(22:05):
works. So basically I do a lot of, I do
a lot of these different things.So I'm fortunate enough to work
with the companies to hear aboutthe innovative products first or
early on. So I do a lot of beta testing
for them and these are a lot of these are all FDA approved,
they're just tweaks. But when a bigger thing comes
out of, I hear about it, I have the luxury of working a lot with
a company called Arthrex, and they're one of the biggest
(22:27):
sports companies in the country and I do consulting for them and
work with them and they have a lab in Renton.
And so actually what I'm able todo is actually practice before
the surgery. So I do this a lot.
It's a complicated surgery. I'll practice before the
surgery. It's just like you would for
anybody else. And we've talked about this
before on the show, but I went in the lab and I'm able to do
(22:47):
this and I already seen the dataand I I've done all.
Again, this procedure is not technically that challenging.
It's just you have to find the right person and feel confident
enough that you can do it, you know, and you have to have all
these little check boxes. But if you check all those boxes
and you can do all those things.This is a minor tweet from my
daily stuff that. Makes sense.
You know, on Monday when I did this, I did two other surgeries
(23:08):
that were technically much more challenging.
So it's not that that was the concern in this procedure, but
after seeing it and feeling it and seeing the biomechanics, it
became very, it became very obvious.
So and then what I'll do is my assistants in the room and I
have really good physicians assistants and staff.
And so the team members will go over this procedure again and
again just like you would for anything.
(23:30):
And I'll prepare them for this. Their representatives for the
company are there and they're preparing them for it and
everybody knows we're on this page.
So like for instance, we did this thing and it was perfect.
I mean, everything went as planned and that's generally the
way it goes because I try to prepare as much as possible.
I am definitely not the person that likes to wing it in
surgery. I if I have to do something
(23:50):
audible and change plans, I'll do it.
But that's not the way I live mylife.
You know, I have, I do too many complicated surgeries to go in
there and wing it. So everything I do is been
prepared four or five times ahead of time.
So it's funny because some of mystaff members or the patients
will ask, like, did he look at the MRI or did he review this?
And they'll be like, I think you've probably looked at it
more than you want them to. So you know, I think at this
(24:12):
point, especially with the harder stuff, be prepared.
Do a good job, especially early on, if you're starting to do
something that's new and you getgood results.
And you know, if you pick the right patient and you have the
right mindset, it's all about expectations, right?
And a patient has seen 4 doctors.
No one mentions repair. You mention repair.
And they're still scared about it.
And they don't think they're going to do it and think they're
going to do poorly. Yeah.
(24:32):
Don't do the surgery. You're going to do well.
But if you're like, wow, I want to try something new.
This doctor seems really excitedabout it.
He's done the research. He knows the right people, and
he feels confident about it. And you and you trust me, then
try it. But again, I give the options.
I'm never pushing people into new surgeries, ever.
It's. And again in Seattle, a nice
thing is we're really technologically advanced and
(24:54):
patients do a lot of research. And it just takes a little bit
of time to understand, like, hey, listen, this is not all.
They're not blowing smoke here. You know, I don't try random
products that I've never heard of or I've never seen.
You know, everything I do has had been delved into the data,
but if you don't innovate, you're doing your patients a
disservice. And I get to I have to
unfortunately see those cases ofrevisions or other problems or
(25:15):
innovation was not tapped into. You know what we've we've
spoken, you know, a lot of sports on our shows and you
know, we we kind of keep it light and we joke around.
So my followup question is, do you have a dance?
You know, after doing that firstprocedure on Monday, everybody's
there, everybody's checking it out and you just comes off you,
you know, you hit that home run or.
(25:36):
You know what whatever sport do you want to do do you have like
a break it off dance you know doyou You fish pump you know or
hooting and hollering like you know what what's the what's the
what's the vibe in the room for you you know do you go home you
you know you look at your wife who's like, yeah I knocked out
of the park you know I'm you know what what what what's
what's the deal with Doctor Garcia and his celebration
there. I do get pretty excited.
(26:00):
You can probably tell for me on the podcast that I'm not a
wallflower, but I I I don't. I'm not a gloater so but I do
like getting. Excited about it.
I did a good job and I did. I did.
I did a good job and that I thatit went well.
But I get really excited. I hate to say it.
I mean, I love doing it. I love working really hard and
(26:22):
taking on really challenging cases and taking on challenging
things and having success. And if something doesn't go
well, I'm like how can I do a better job the next time.
You know, I I think I I'm not going to compare myself to an
athlete, but I think of myself as doing some like a profession
and have you do it well and if something doesn't go well, you
know, you drop the ball in the pass, you don't win the game.
You know you have a complication.
(26:44):
You don't pout about it and not do it again.
You figure it out, you fix the problem and you take it on and
on. And that's the way you have to
do it in surgery. If you're going to take care of
athletes and pro athletes, not everyone of them is going to get
back to their professional sport.
Or you do, you do complicated procedures.
Not everybody's going to do really well, but it's how you
handle the problems that make you will make you who you are,
(27:06):
but you also have to celebrate yourself when something goes
well. You know, I was so excited after
that, you know, after this. I've done a few of these,
actually. That was just talking about the
one I had on Monday, but the oneon Monday when it finished, you
know, when we had an extra prep and things like that, you know,
yeah, there was definitely some high 5.
And I tell the patients afterwards, I'm like, you had a
high five surgery and I think they think I'm joking, but I
(27:27):
actually did do mostly high fives after the surgery
finished. Yeah, and I know it.
And I know you're competitive, man.
We talked about it, man. You've swam and you ski and you
got your watch. So you listen, you are an
athlete and you are competitive and that's why I bring it up it
because I know there's a part ofyou.
You're like, yeah, no, I was just kind of doing this and I
prepared. I was like, Nah, man, you
hooting. Holler and you're like yeah
(27:48):
baby, I there's part of what you're saying is true.
I can't fully disclose, but I'm very excited and I have a lot of
fun in my practice and patients are have a lot of fun And if you
if patients of mine will tell you, you know I get really
excited and people do well and when they don't do well I try to
figure out how to make them better.
(28:09):
So, you know, I I like my job a lot.
I get, I'm very fortunate enoughto be in a practice where I can
innovate so quickly. You know, as a private practice
surgeon and doing the athletes and the people I do, I can
innovate quickly. If I want to do an ACL repair
and I tell my partners this works really well and I can do
the right thing and they trust me because they know all the
stuff that I do. I can do it in day, you know, I
(28:30):
can innovate quickly and do the right thing for the patients and
adapt, which is really cool. It's the best part about my job
and I can take care of patients that really want innovation.
So it's like the best possible scenario.
So on a daytoday basis, I'm really happy.
You know, I get to have fun, I get to get my competitiveness in
and I get to do a little athletics and sports and I
frequently have fist bumps and high fives in my office, so it
(28:52):
makes me happy. It's a great environment.
Listen, I know we've got you already about 30 minutes and
you've been running around. Is there anything else that you
want to kind of get into? I know we touched upon we didn't
even get into fertilize, ACL andeverything else.
So is this something that you want to kind of jump into or you
want to save for another show? I think we should save for
(29:14):
another show. And if anybody wants to listen
to Will's previous podcast with our fertilized ACL plus the man
that invented it actually joinedthe podcast with Will Chad
Lavender, that's a pretty good podcast that you can listen to
too. So I think that probably does
enough service to it and we can talk about it later time.
That's sort of the farthest one I think in terms of innovation
because it's, it requires the same sort of thing.
(29:36):
It's a pretty high cost procedure.
But I think of these things I told you the ACR repair is the
one that's the is right here ready to go and this one can be
done by your surgeon. You know, you can come see me if
you want. I know there might be some other
people in the area that are considering doing it, but if
you're a candidate for it, I would consider it at least to
(29:56):
look at the data. And again, remember every
innovation is your decision, notthe surgeons.
I'm here to give the informationout.
I'm here to do that. But you have to weigh the risk
and benefits. And my goal in the end is I
don't want patients to be upset if something doesn't work.
So I got to make sure that people know I'm excited about
this, but I'm excited about it. If you're excited about it and
you're OK with the risks becausethe benefits are amazing, but
(30:18):
there are risks. So as long as everybody's OK
with that, we're going to have fun.
We're going to do a good job andtry to make as many people as we
can better. And Doctor Garcia is always
prepared and and now that's the most important thing that I want
to convey throughout the show. You know it's.
It's being at the forefront of technology, being prepared,
doing you know, crossing your T's and down your eyes.
(30:40):
You going to the facility to work on these procedures before
you have a patient. And and really that's the whole
purpose of all this is to give kind of information and also
know that you're in good hands. And the most important thing
that you want from anyone is just to be prepared for whatever
they're doing. You know, just like we're trying
to be prepared for this show. All right, Doctor Garcia, here
we go. You ready?
(31:02):
Here we go, here we go. Now, this is a tough one because
it all depends on who you talk to and what research you read
and everything else. So I'm going to give you a pass
on this one. But do you know what?
We could do it roughly the the years or the surgeon that did
(31:23):
the first ACL reconstruction. You always do this to me.
I hope I'm I have a zero. I'm so glad that I'm not a
trivia guy because it would be aterrible.
This is this one's, this one's really not easy.
I did a lot. I did a lot of reading and it
depends who you talk to and and what do you consider.
(31:46):
I know, I know. So if you could give me a
roughly like a timeline, if you give me a timeline, we'll take
it. OK.
I'll give you a year. I think it's probably 19, 65.
OK, we are going back to 1917, Ernest William Hagrove, and he
(32:06):
was a British surgeon. And it's amazing because of all
the research going back. I mean, you've got things
published back in the 1800s whenthey started to realize that
there needed to be something done and in the conversations in
these, in these journals. Because people were getting hurt
(32:27):
and then not being able to walk and they didn't understand what
was going on. And then you had people, you
know, slowly like anything, right.
Exactly what we're talking abouttoday, right.
Whether it's repair and bear implant, it's all starts
somewhere and then people work off of other people and that's
how you get to where you're at now.
And obviously in 1917 is very different than in 2022, the
(32:48):
procedures, but I like to bust your chops.
So this is what we do here. I like.
I like it. Doctor Garcia, I appreciate your
time. I'm pretty sure if you're in
your driveway, your wife's looking at you.
You better you better hurry up and get inside here and take
care of the kids so I don't wanther mad at me.
Doctor Grant Garcia, our orthopedic surgeon and sports
(33:09):
medicine specialist. Check them out.
Grant Garcia, md.com. He has got great information,
procedures, videos, all of our shows.
I mean you name it, the the website is just chock full of
nuts. And just check it out and if you
have any information, give him acall and he's there for you.
Dr. Garcia, thank you for your time and we'll do it again
(33:31):
shortly. Absolutely always a pleasure.
Will have a good night. And they have the family for me.
Thank you very much, Dr. Garcia.Take care.
Bye.
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