Faster ACL Recovery: Inside the Fertilized ACL Technique with Dr. Chad Lavender

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:16):
Welcome to Sports Doc Talk. I'm Will Sanchez along with our
orthopedic surgeon in sports medicine, specialist Doctor
Grant Garcia. Obviously Doctor Garcia is
paying hefty money for his ChatGPT background for his mind
is looking little. It stabs me in the head there, I
mean. I don't know what you did.

(00:37):
I'm going to have to work on some of your typing skills.
I don't know what's going on over there.
Yeah. Yeah, I definitely do.
Listen, we're really excited about our guest today, but
before we get to our guests, let's handle a little
housekeeping there. You know we love Mike B in the
recovery shop, but who can talk about the Recovery shop better

(00:58):
than you can? Take it away, buddy.
Yeah. So again, big thanks to our
sponsors, you know, from these, for any surgeons out there, this
has really been nice for me because the patients always ask
what extra we're going to get into.
Extra you can do during the surgery, but how about after the
surgery, right? So after the surgery, the
ability to have sort of sort of advanced rehab stuff, nutrition,
things like that. It's all available here.

(01:19):
And the nice thing is each surgeon can have a customized
page for their patients. So it really is nice.
It's sort of like an A la carte option.
So my patients in Seattle, they love it.
They're always asking questions on what else they can do.
They're going to, we're going tobring up one of the topics they
talk about all the time. But before we jump to that, this
recovery shop thing is awesome. So look into it.
Yeah, and maybe they can find a way to fix my background since

(01:42):
they are able to fix everything else.
So I don't think that's what they mean by the recovery shop.
But shout out to Mike B and everyone else, you know, we
really appreciate them. Listen, we don't care about the
doctor that's coming on because he is the pride of Chesapeake,
WV, right? He is the pride of West

(02:02):
Virginia. Let's bring on Doctor Chad
Lavender. Dr. Lavender, listen, that how
big is that town? That town is less than what 1500
people, 1200 people. I mean, you must be the talk of
the town not only in your town, but across the United States,
across the globe. But what's the feedback just
getting, you know, from the folks in your town?

(02:24):
Oh, you know, I think so. I practice maybe 30 minutes from
where I grew up and beautiful in, in a in a slightly larger
town. Not much, but you know, that's
part of the the beauty of being here where I grew up is I get a
treat, You know, basically my extended everybody here is

(02:44):
related some way to me, right? So, you know, many people I've
known all my life are their kids, you know, And I think so
that's why I've chose to stay inthis area is very fulfilling.
So again to overall to introducehim, Chad Lavender is Marshall
Orthopedic surgeon. The big reason, obviously he's

(03:06):
here for many reasons we'll get to in a second, but you guys
have all heard the thing we've talked about in numerous
episodes even before we had our video episodes, fertilized ACL.
I will tell you that pretty muchweekly to every other week, I
get someone asking about this. I hear it at conferences.
I work with Arthrex 2 just like Chad does.
So I get people talking about this as well.
This is a very hot topic and we'll get into in a second why

(03:28):
it's so important. And then obviously we got some
other twists and turns here. So we're going to talk about the
nanoscope. We've heard about it with we
turned with Chubb when they talked about how his recovery
was better because of the nanoscope surgery he had done.
So we'll pop in and ask Doctor Lavender, who's sort of a
specialist at this, and then obviously he's a football
player, so he can tell us about his experience with the players
and how that coalesced. And then just classic board

(03:51):
certified. So this is awesome.
So thank you so much, Chad, for coming on.
I think everyone's really excited.
I, I want to, you know, kind of hear more about your background,
maybe kind of, I know you talkedbriefly, but sort of how did you
get to this point? And then we can jump into some
of the topics. Yeah, so we talked a very small
town in West Virginia. Very blessed to have a great

(04:11):
family support and community support and coaches and ended up
walking on at WBU and played backup long snapper there.
And then went to medical school at WBU and then attended
Marshall, which is where I currently work for residency.
And then I spent a year specializing in sports medicine

(04:32):
in Richmond at Orthopedic Research of Virginia.
So. Nice.
Yeah, Doctor Levin, I know what you do is really complicated.
And you know, as Doctor Garcia mentioned, you know, we've
talked about this procedure and numerous shows, so we're really
glad that you're here. But is there anything harder

(04:53):
than walking on to West Virginiaand trying to get on the team as
a long snapper and not only getting off of that season, but
pretty much that the seasons that came after that, How
difficult was it? Was it to just be in that
situation and be blessed to be apart of that university?
Oh, it was, it was a dream of mine.

(05:14):
You know, to be able to live your dream is something very few
people get to do. And I had a dream to do that and
then be an orthopedic surgeon. And I'll tell you that I can
remember vividly, Coach Nealon, he looked at us our first team
meeting and he said the hardest thing that you'll ever do in
life is maintain on this football team for four to five

(05:36):
years, you know, because it takes consistent work, much like
medical school. I mean, it's very, very similar
to medical school. I think it prepared me very well
for those years in residency because it was grueling, not
just physically but also mentally, you know, so then you
get to medical school when it's mostly mental, right?
It's not as much physical. But like, I think it was it was

(05:59):
the 5:00 AM workouts and the things they put you through that
really helped the mental toughness, you know?
So yeah, it was really hard. I mean, I'm 5I was 511, maybe
I'm 510 now. I was just the six foot so.
I love it. Well, you can see Will though,
again, this is the reason and Chad can remember, but the

(06:22):
athlete check box is huge for orthopedics, right?
There's a reason for that, right?
They just don't give up. I did 4 years.
I was not football, but swimming.
You know, it's, it's the, it's the commitment, right?
Like the one year athlete, like that's great, right?
That's that you can do that. That's, that's easy to do.
That's hard to do in some cases.But the four years, what you
did, you know, that shows dedication and it's, it's going

(06:44):
to jump right into the next topic, right?
Because what you did for four years now you got to basically
do something and you want to do something that's different than
what people have done before, right?
Like the this fertilize ACL and we can get into in a second,
like this is bucking the norm. Will like this is not like, like
we talked about like ACL repairs, like it's the same sort

(07:06):
of situation. Like nobody, everyone's against
you, right? You're really, they're really
against you and and you have to like kind of be like, am I going
to take this on, right? I mean, Chad, you have the, you
have the weight of, you know, 10,000 or more orthic surgeons
that are like, no, this is the way we've done it for years and
years and years. I mean, what was even that that
started making you think that you could take this on?

(07:26):
So I think it I would go back, Iwould go back a second and say
we're we're practicing OK, whichis in small town West Virginia.
And I wasn't a team doctor for ex NFL team or Division One
Power 5 program. And the patients that came to me

(07:48):
trusted me and, you know, and, and we would have informed
consent and I would say, look, Ithink this is going to help you.
This is what we, you know, we'replanning.
This is research. And they trusted me.
And the patients that are in thetrial that you're going to
mention, many of those are from this area and they had full

(08:09):
trust in what we were doing. You know, so it's, it's, it's
interesting. In the very, very early days, we
weren't under the microscope, microscope like you're
discussing. And then really quickly it
turned into, OK, I'm on a stage and there's 1000 orthopedic
surgeons out here and they're wanting to throw tomatoes at me.

(08:30):
I mean it, I can remember it. I can, I can remember the first
time that I presented just the technique, OK, just the
technique. And I'm outside and I'm nervous
and you know, because like you said, it's one thing to present
in front of people about Acls and hamstrings versus quad

(08:51):
tendons. It's another to present a
completely mind changing, you know, procedure.
And so I remember the guy outside, one of the reps, he
came up to me, he said, and he was telling me this story about
a mountain biker or an X Games type guy.
And he was like, and he said theworst thing that can happen is I
could die, you know, And I was like, why are you telling me

(09:13):
that when I'm getting ready to go on stage, man, come on.
And so that kind of lightened mymood and I came up there.
I think it's all about putting things in perspective.
And really, you know, I would, and I and I've talked to other
innovators since in the last eight years and you know, I
would say that there's really, there's really three different

(09:35):
phases. There's the very difficult early
phase where everyone is against the idea.
They really don't want to believe or don't have open
minds. Then they start asking questions
and they're inquisitive. Then you get to the phase where
people start to adopt the procedure and ask about the
procedure and want to learn about the procedure.

(09:58):
We really got to the third phasefairly quickly and I would say,
you know, I think our first, ourfirst publication on the
procedure was around 2017, 2018.And you know, there's two
different parts of the procedurewe'll talk about again.
But I would say that the internal brace was more

(10:19):
controversial than even the biologic portion.
Interesting that's it's funny because Will and I think about
that and that's Will's favorite topic.
So be careful when you bring up the word internal brain.
He gets way too excited and the surgery I bring up, he wants to
add it. So, but anyhow, the that's,
that's amazing, right? Because to me, I had, you know,

(10:41):
I had six people with ACL tears today in the office and every
one of them I was like, that's the internal brace part's not
the problem. Like that's been studied, you
know, and so they and they're and they're coming in like 2 of
them asked for the internal brace.
And so to me, that you saying the internal brace part was the
hard part, the beginning is super interesting because that's
just the difference now with theInternet, right?
Like in the last two weeks, I'vehad people with ChatGPT, they

(11:03):
came to me, we talked about AI and they're like, hey, my
surgery, I need to have this. I'm like, you came up with that
idea. They're like, yeah, it's an
internal brace. They want to have a quad.
And I'm like, did you talk aboutthe surgeon?
They're like, no, ChatGPT told me what I needed.
I'm like, that's interesting. But anyhow, the fact that that's
out there, right? Yeah, it's yeah, Yeah.
So, you know, I can remember in the early days, we were in

(11:25):
Naples and I ran into Doctor PatSmith, who he was doing it with
hamstrings and some canine research at the same time that I
was using it as part of our fertilized bio ACL, OK.
And so we were simultaneously really doing the initial
research on the internal brace and there were so many questions

(11:46):
about does it cause synovitis? Does it work?
Does it over constrain the knee?You can talk about all those
things. And now sitting here eight years
later, it's not controversial anymore, but like it.
When you ask me the question, what was the hardest part of the
selling the procedure or talkingabout the procedure, I would say

(12:07):
I had a lot more questions and concerns about the internal
brace than using the bone graft in the bone.
Interesting. Well, I, I see that part.
I meant more like, I think we'llget into the recovery timeline.
But yeah, I mean, selling the biologic idea, at least in my
practice, has never been the challenge in terms of like, you

(12:30):
know, everyone wants, like we talked about this to recovery
shop, we talked about these other things.
Well, like everybody wants the best, right?
Like the these patients are coming in and they want the
best. And so, you know, Chad's got
this sort of super innovative new technique, like they're
super interested and he's got the trust locally.
Like I know I grew up, I grew upwhere I practice.
So I have the same situation. I mean, I see people I went to

(12:50):
school with, coached, you name it.
Like those are the patients thatare more willing to trust me and
try something like this that's different.
And I understand that, which is that's interesting that that
background was there for you. Do you know what?
So can you explain? I want to govern over this
fertilized ACL in a second. Can you explain what the
importance of dealing with the ACL was?
Like what's the, I can go in nauseam, but obviously you're

(13:11):
the one here and you're the expert.
Why'd you choose the ACL Like, well, why'd you choose ACL
reconstruction and why'd you choose something like this?
What was the reasoning? Man, rotator cuffs are a lot
more easy for me in the OR like,I mean, you know, you can do a,
a double row rotator cuff and like, I can't tell you how many
times I've said, man, I should have developed a new rotator

(13:32):
cuff procedure. It takes 35 minutes, you know,
but and, and the, and the ACL, all you know, an autographed ACL
takes longer than that. But no, the reason is because in
my opinion, when you have a re rupture of an ACL in a 17 year
old, you're almost that's almostlike athletic, the end of their

(13:57):
athletic career in most cases, because you take an injury that
was maybe one year and now you've made it at least two
years long off the field, right?So in most cases, let's say you
get hurt in August, you missed that football season.
You come back in the spring, youre tear, you miss a whole nother
season. So my goal was, and here's how

(14:18):
we got started with this process.
A patient came in, for example, and did not want a staged
reconstruction, OK. And so you start to think about
ways that you can improve the healing process and the bone.
And that's kind of how I came upwith the idea of using bone

(14:39):
graft in a primary setting. You understand what I mean?
So instead of instead of stagingwith bone graft and then going
back in, I said, OK, I wonder ifthis would work.
And then once I did it, once I started saying, OK, let's just
do this in all of our primaries to improve the healing process.
And it made sense to me. Yeah.

(15:01):
So, well, that's to jump in thatthat's we talked about this with
Chubb. So basically you get these
patients with big tunnels and soyou don't want to do another ACL
on them. And So what he's saying is that
he found this way to try to like, can I bone graft and do
the ACL the same time to skip that step?
Yeah, but the inspiration was off the re rupture, right.
So after the re rupture, that was the inspiration.
And then once you caught on to something that you're like this

(15:24):
is working, then that became your primary for any procedure
that had to do with the ACL, notjust a re rupture, but the
inspiration to kind of, you know, be motivated about finding
a solution, especially for theseyoung adults that are losing 2
plus years of their athletic career came from this re
rupture, which is which is fascinating.

(15:46):
So it's as as we talk to other doctors and we hear about
inspirations is usually that inspiration to help someone to
help the patient have a better quality of life.
So I always find that key when Ihear these things to saying this
is what motivated me. This is what inspired me was to
find a solution. And when you?
Talk about the delay, what's the, what is the delay in the

(16:08):
recovery of ACL, right? Like you talk about tunnel
healing, right? So what's that?
That is part of your process as well, I'm assuming.
Yeah. And I think the biggest, the
biggest reason I, I chose ACLS is my main interest of, of
research and, and innovation. It's because of my, it goes back
again to my, my upbringing and, and, you know, having friends

(16:32):
that tore their ACL both in highschool and college and seeing
what they went through to get back from that surgery.
And my thought process was OK, yeah, the Patella tendon may be
a great autographed, but it or is there another option that
hurts last, possibly long term hurts less earlier and we can

(16:53):
get patients back easier and, and, and maybe let their
recovery be be easier and and more thorough.
You know, that that was my that was my whole thought process.
Some of those questions we're actively still studying almost a
decade later, guys. I mean, and when we get to the
study, we can talk about that, but I mean, it's, it's, it's

(17:14):
unbelievable how long it takes to find answers, you know, I
mean, real, legit answers, not just we can do this.
I think it works. It works in some people, right?
You know, does it actually work?And so can you describe, I know
we have this really nice slide here and I want to get to this
and just kind of show this for the viewers, but can you

(17:35):
describe your newest tech? Because obviously you've done
some slight modifications and trying to make the perfect
titration. You don't have to go through too
crazy details, but you know, people have seen this.
I've already talked about the first, just like the fourth
time, but obviously the first time having Someone Like You,
the expert that invented it on, Can you tell the viewers kind of
what you're doing right now to do a fertilization so they
understand the differences? Yeah, that's what they think

(17:56):
they do, but. Man, that's an excellent point.
That's a really excellent point because early on, the first time
that I published it, it was witha Patella tendon graft and I, I
threaded an internal brace through the interference screw
on the tibia. Long story short, I was using a

(18:16):
patellar tendon graft. Then I used amnion.
You know, I went through an amnion stage and then I settled
on the use of a quad tendon withthe composite graft, the bone
grafting in the tunnels and an internal brace right next to the
to the quad tendon. So I settled on the soft tissue

(18:37):
graft with an internal brace andthe composite grafting of both
tunnels. And that that period and that
process probably took a year or two.
And then we started actively looking at our results.
And still to this day now I'm looking back at some of the six
year data that we have, you know, and trying.

(19:00):
I mean, we had a research meeting this evening before I
came on here and we're actively trying to find those that may be
interested in looking up those results, call them patients
still, you know, finding patients, seeing how they're
doing. And I mean it.
It's a late, It's a labor of intense love.
You know, research is, I would say.
So and then you're adding biologics.

(19:21):
So what are you usually adding to this?
Because so for the graph you take which is so we can learn
about that. But.
In, in simple terms, what we're adding is we'll we start the
procedure and we take bone marrow aspiration from their
shin bone. Okay, that liquid gets spun and
you could take you can use PRP or you could use BMC, which is

(19:43):
bone marrow concentrate that's been that has stromal cells
don't really like to use the word stem cells.
OK, so stromal cells. So it has stromal cells within
that BMC. So that's liquid.
And we'll add that to a demineralized bone matrix.
That's, that forms a putty. OK, It's, it's thicker and it,

(20:06):
and it forms a really almost solid putty.
That's a graft. And those two components really
form our, our composite graph that we inject into the, into
the tunnels. So that's kind of how we come up
with with with the the. Slush puppy People like to call
it a slush puppy because it's itlooks like a slush puppy.

(20:28):
Yes, and it coats the graphs. The idea is it coats the inside
the tunnels for the listeners. And there's a gap right now.
There's just, there's just nothing's there.
It's a if you, unless you like have a perfect tight squeeze,
which you won't get the ACL through, you have to have a
little bit of a gap. So now you're basically
accelerating that hopeful healing process.
So let's go to the clinical trial and then maybe Chad can
explain it to us because this issort of the big one.

(20:51):
Yeah. So this, you know, let's go
ahead and talk about this. So 20/21 is your date here and
it didn't fully publish in Arthroscopy, the Journal of
Arthroscopy until late last year, 2024, so there.
And we started before COVID. So we're talking about 2019, we

(21:13):
started enrolling in this trial or earlier.
And the reason is, so you enroll, OK, 60 patients or 100
patients, you do their surgeries, then after their
surgeries you have to wait two years to properly publish.
It doesn't matter if you're looking at six month CT scans, 2

(21:35):
week results, three month top test, it's not getting published
until two years after that last patient.
Well, especially in the journal.You published it, right?
Yeah. I mean, you go, you went.
Big, yeah. That's that we went big and,
and, and there's always flaws that people will point to in any
study, but in our study it was randomized and it was

(21:58):
controlled. It was a randomized controlled
trial, 60 patients and we used both autographs and allographs
based on age. So it wasn't just a bunch of 18
year old soccer players, right. We're we're looking at across
all age ranges and made sure that all that was even OK.

(22:18):
And half the half the patients received the augmentation with
the internal brace and the biologics.
The other half didn't. And what we found is the half
that had the bio ACL fertilized ACL had improved function at
just 12 weeks as you see 80%, they scored 80% on their hop

(22:43):
testing, which is a measure of their function compared to the
opposite group which was around 35% and many of those patients
didn't even perform the hop testing, so.
That's pretty impressive at 12 weeks.
That's just not. Common.
No, it's not. And so not.
And the and the bigger issue is we found that the the tunnel

(23:04):
widening was less OK. So radiographically the bone
incorporation was better and there were no re ruptures in
either group. And several, every single
subjective measurement that theyfilled out on their surveys
throughout the study favored thegroup that was augmented.

(23:26):
Only a couple were statisticallysignificant, but they all
favored the augmentation group. So based on this study, we've
put our heads together and we said, OK, how do we see if
what's important now? So we did the randomized control
trial. So we said, well, let's look at

(23:47):
this in a larger population of athletes and let's look at less
than 25 years old, OK. So currently right now at
Marshall, what we're doing is we're doing a 125 patient
prospective earlier return to play study and what we're doing
is looking, we're seeing if thatthree month hop test is similar.

(24:08):
And I think right now if I pulled it up on my computer,
it's 70 percent, 75 S very similar to that 80% at three
months. We're testing Mris at six months
and we're seeing on average lessthan or equal to 1mm widening on
the femur and the tibia, which is about exactly what we found.
And we're also seeing, you know,we're, we're not seeing poor

(24:32):
results. Does that make sense?
So not reroute those types of. Things well, so this is great so
I, I don't want to cut you off Iwant to make sure that we you're
doing a fantastic job presenting.
I want to make sure the layman people can do this 'cause this
is, these are the people who come in like the orthopedic
surgeons, like we read the fertilization cell.
We get it like I, I'm all on board.
I love this. So this, the tunnel widen on the
CT scan for everybody listening is like the concern of some of

(24:55):
these soft tissue grafts is theyhave bigger tunnels.
That's one issue. The second issue is the, the
reason they can't get back faster is for many reasons, but
one of them is because the ACL isn't healed to the wall fast
enough. And so that's why people are
scared to let people go back at 78910 months.
So you basically showed that your way is getting the bone to
heal faster and that they're stronger.
So it's like the perfect trifecta, which is why you've

(25:17):
shown some crazy videos of some people doing insane things at a
much faster rate. I mean, I know you're.
Laughing. Those didn't go over well.
Those didn't go over very well. I don't know where the PD
community I'm sure. It didn't.
I'm sure it didn't, but I loved it.
So I mean I remember seen the first one like 3 years ago.
I was like, is this real? So it's pretty awesome.

(25:37):
I talked to somebody today, I don't know, they were maybe 6 or
8 weeks and I said so. So they were asking about an
activity and I was like, listen,if if you do that, just don't
tell me about it, you know, I mean.
So I was like, no, but I think the idea is that you're it's you
feel a lot more confident with, you know, I had those patients
come in there six months, you'relike, I'm still nervous and

(25:58):
you're like, no, listen, I know that this is stronger.
I've done the tests on this, right?
Like just so the listeners know,you don't normally get ACT scan,
you don't normally get an MRI atsix months, right?
That's a study based thing. So you're doing every check,
right? AJSM is going to be like, I
don't trust this thing. It's totally out of here.
And we need to make sure like this was literally sealed tight

(26:18):
study. So they did everything possible,
like anything negative that someone can think about, you
already covered it. And so that's really important
for the listeners. So we did CTS and Mris in our
previous trial when we compared the groups.
This trial we're doing 6 months Mris and the reason is we can
you know it's less radiation on 125 patients.
So that would have been hard to get through the IRB.

(26:40):
So the Mr. is can still tell us the the tunnel widening which
you know it's like us like I said less than 1mm at six months
in both groups right now and I think we're up to 70 patients.
So the other thing that we're finding and we're looking at is
I have an independent radiologist that's looking at

(27:00):
the signal of the ACL graft. So I'm trying to, so some of
what we do in research and what we're doing with this study,
we're also doing hop testing at three months, 4 1/2 months and
six months and I'm doing virtualreality testing.
So I hook them up to AI have somebody that that's their whole

(27:20):
job is they take our ACL patients and they put sensors on
them and they do door CV testingand they do virtual reality
testing on a, on a screen like aPlayStation Move.
You know, it's not that. But and then that gives them
lymph symmetry indices and things of that nature that will
be able to go hopefully four years from now and say, OK, the

(27:44):
patients that had issues or re ruptures or didn't do what, you
know, when you look at the RSI scores and, and all these
things, we'll, we'll go to try to correlate that with all that
data that we're getting. So, you know, we're trying to
get a treasure trove, if you will, of data not.
And like I said, maybe we'll find that, you know, the, the

(28:07):
signal to noise ratio on an MRI of the ACL graft after, after
this is improved and that helps,helps you with your re rupture
rate. I don't know.
But like you're right, we, we want to look at every detail
that we can and not just not just say, well, these patients
score better on a subjective measurement.
Yeah, and I mean it matters too,right?

(28:29):
Like the data is good, but you want to make sure you have
everything covered, right? Like as patients don't really
know what the OR their IKD scoremeans or anything else, they're
like, oh, that's great. They want to know, am I going to
be stronger faster? Am I going to get back longer?
And is there higher? Am I going to rupture sooner if
I go back earlier? Because right, the whole debt,
the whole thing we've ever been taught is that the sooner you go
back, the sooner you re rupture,right?

(28:50):
You go back before six months. You know, there's a concern.
Not in this case, but you know what I mean?
Like there's been data about that.
So that's a concern, which is why we never let people RIP
until 7-8 months until we've hadnew data.
I know you're, I know you're laughing about it, but it's a
big deal. I mean, that's I'll.
Tell you a story. So Doctor Tim Hewitt, who is a

(29:13):
world expert in bio mechanics after ACL reconstruction, he's
the one that wrote all of the data that we have on
preventative techniques for ACL,you know, for female athletes
and things. So a mutual acquaintance of
ours, we're at a conference. We didn't know each other.

(29:33):
He had just written a paper thatsaid you need to wait two years
to get back after an ACL or else, right.
And. So this is going to go well.
Yeah, so they, they set us down at a lunch at a it was at a it
was at a meeting in Nashville. And so we sat down and we
started talking. We're across from each other
and, and he, he's hammering me about the technique and my

(29:56):
thought process and you know, and I'm listening to him and
his, his views on things, which he makes sense and he has data
behind and, and he's a, he's a world class researcher.
So rather than us getting into an argument, we end up realizing
that, hey, the only way to really figure this out is to

(30:17):
work together. So he comes to Marshall and now
we're working together on this research study and he's studying
the bio mechanics. I'm studying, you know, I'm
doing the surgeries and the clinical scores and the Mris and
we're putting our heads togetherto find out if 6.
And we're letting patients go back at six months and then

(30:39):
we're going to say, hey, is it smart or not, you know, and, and
let's figure this out is if theydid, if they went back at six
months, what was their re rupture rate and what's that
compared to in other studies? And.
We'll show that comparison up there.
Yeah. So, Chad, I mean, this is
amazing, right? Well, he found the highest
critic possible for his study and decided to make him his

(31:02):
colleague. Yeah, that's insanity.
Yeah, I love it. Like if your study works, I am
all in. I already believe in this.
But like you did the worst possible research thing ever and
you found your biggest critic todo the work for you.
So like, this is incredible. Like listeners like there is,
you cannot fight this man. Like he has done everything
possible to try to destroy what he's doing and he's still not

(31:23):
doing it, so that's fantastic. I think you, you don't want to,
no matter what you're doing, youknow, you don't want to surround
yourself with yes people. You want people in the room that
are going to question everythingyou do.
Because if I get on a show like this or if I get up on a podium,
I want to have already answered those questions that you're

(31:43):
going to ask me. I mean, it just makes sense,
right? So, so he was able to come in
and really look at, look at helpus design this, this, this study
that we're doing now, which is, it's, it's called a early return
to play study after, after fertilized ACL.
And yeah, we're doing 125 patients.
We're going to follow him for two years and then five years

(32:06):
and, and, and all that. So.
We'll pull that back up. Don't go away from that slide.
I need him to look at that. I like this.
So everyone thinks this is good because Chad's getting the heat
here, but I'm about to get the heat in like a like a month when
this when this publishes and I'mgoing to get the heat in terms
of like my own patients asking about this.
So it's important that I show them all this stuff because

(32:27):
they're going to want to know itlike this podcast.
Can you listen to and I'm going to hear you're on your podcast.
You said this. And so it's important like,
right, Chad, Chad has his own thing.
He's invented this fertilized ACL.
But there's hundreds of thousands of doctors that are
doing this and they're going to see this and they're going to
say, hey, listen, tell me more about this.
I want to know about the six month recovery.
We're looking at it, the limb symmetry, the tunnel widening.

(32:47):
But this comparison is really important and people come to
that. So again, six month is not
crazy, right? We have our own patients that
are non traditional AC LS that are 6 months, seven months.
So this is not insane. And again, I think part of this
is what your technique is and part of it is probably you feel
comfortable at 12 weeks with them doing the strengthening the
limb symmetry, right? I would imagine it's kind of a

(33:08):
combination of everything. Let me explain our thought
process there for a second. So when we went into the design
process of the study and I talked to Doctor Hewitt, we were
going to do like several different arms of the study and
have some patients able if they pass testing that to go back at
4 1/2 months. And I go to a couple conferences

(33:30):
and I realized that, hey, peopleare still up there on stage
talking about nine months. And I come, I talked to him, I
said, listen, let's just I've let every patient for 10 years
go back at six months. Let's just show that that's
safe. Let's get an actual re rupture
rate with the internal brace andthe biologics and let's prove

(33:53):
that part of it before we go crazy and try to and try to
reinvent the whole rehab process.
You see, I think that's why that's how we fell on a on a six
month time frame. And the other thing I want to
point out if I can is people andsurgeons and patients sometimes
take grains of what's out there and they say, oh, I'm going to

(34:18):
get back like within six weeks or 12 weeks because these
patients did well at 12 weeks. That's not what we're promoting.
That's not what we've shown. We're showing improved results
at 12 weeks, but in, in no case have I signed a letter of
release at 12 weeks. OK.
So I think that's, that's important to point out.

(34:38):
I wait until the 6th. Even if they passed their their
hop testing and and and are doing excellent.
I wait until six months. It's important too that you're
saying that, right? Because they all take this and
they were like, well, that was me, but I'm not average, right?
I'm better than average. So I'm a four month there.
And what you're saying too is the shock factor, right?

(34:59):
Like the video I had seen showedthe 4 1/2 month insane response.
And so like you said, like even someone like myself that's all
on board with this. I work with Arthur.
I do the biologics, I'm all intothe innovative stuff and I'm
looking at this like, holy cow, right?
Like it's not someone who's beenindoctrinated for 20 years and
did the exact same surgery, right?
It's a it's a shock. So the six months to me, I'm

(35:21):
like, I can handle that. Like I can easily tell my
patients three more months, I'm going to cut your time in half.
That sounds insane. Like that's the other thing too,
is it? It almost seems like too good of
AI, hate to say the word sales pitch, but you know, locally,
right? But you've got patients flying
in for this surgery right now. And so the idea is that like you
want to be careful with your pitch too, because you are
selling it, you're still sellingthe procedure to the patient.

(35:44):
So it making sure that it's sortof like the appropriate
expectations. But this is awesome.
I, I think it's really importantthat we brought that up.
So thank you, Chad, I really. Appreciate it.
I do think there's we have a important aspect of protection
for our patients. You know, I mean, and, and
because sometimes and, and a lotof times patients will call
from, you know, I mean, we've had patients come from other

(36:05):
countries to this small town in West Virginia.
And I know they get here and they're like, what in the world
is this the right idea? You know, so and they, and
sometimes they get lost to follow up.
I mean, you know, as much as we try to call.
But anyways, I'll tell you that that it's very important to make

(36:25):
sure you carefully word what you're saying, especially in
promotional activities. I've learned a lot about that.
I mean, and we still do let patient like any videos that you
see me repost generally are posted by the patient.
OK, So I don't really do a lot of posting of the videos
anymore. Like most of our videos are

(36:46):
patient driven post because they're excited about their
rehab. And you know, I and I and I and
we want to support that, but we don't let them go out and play
it at three months. And, and I think that was the
that was a big misconception that we were rushing people out
there. And that was, you know, let's
let's talk about that for a second because that was

(37:08):
frustrating to me, OK? That's important.
This is good. Because because we were putting
so much work into the design of the technique, the design of the
research and, and following up on patients and, and really
closely my, I mean, I literally at, at times have sent people to
high schools to make sure we getdata on patients that were lost

(37:30):
to follow up at certain time points.
That's how, I mean, that's how much we're, how passionate we
are to get the research data, you know, and so it's
frustrating when people would come back and say, you're out
here telling people they're going to just write, you're
rushing them back to activity. And, and that's just not, that's
not true. That's a false narrative if you

(37:52):
get. More from your peers more than
anybody else, and not so much. Yeah.
Oh yeah. I mean because I don't.
Know if I'd call it peers but. Yeah.
I mean what happens is somebody goes into his office and they
say, well, Doctor Lavender over there at Marshall is letting
people go back at 3, three months and that's just not true.

(38:12):
And so when they call us, you know, and and they get to me and
and what and aren't we have a protocol We do with out of state
patients. When that when I do finally talk
to them, I spend 20 minutes or more talking to them about
expectations. Don't come here for surgery.
If you think you're going to be at released at three months,

(38:32):
that's not OK. And it happens this time of
year, every year because they, the football players want to get
back before football season. It's just not going to happen.
OK, now maybe the end of the season, maybe if they're a high
level player and they play in December or January or whatever,
that's different. But like it's just not going to
happen in three months. And so very, very, I make sure

(38:55):
that I'm very clear with them about expectation.
And, you know, come here if you,if you believe in the procedure,
if you believe in the science or, you know, if you, if you
trust us, but, but don't have that expectation that you're
just going to be progressed at arapid pace on purpose.
You know, and, and you know, I mean, I, every night it seems

(39:19):
like I'm texting with patients about their rehab and things
like that from out of town. And I mean, I think that's a
very important part of the process is making sure they have
an understanding at each stage what they're allowed or not
allowed to do. It sounds like you've got a lot
of support from Marshall. What, what, what has that, that
experience been for, for you and, and, and for your peers?

(39:42):
They're just kind of working at the facility, embracing the fact
that you're, you're doing something that's cutting edge
and embracing all that. What, what has that experience
been and how's that helped, you know, to get you where you're at
now? Really it's the hospital system
and and Marshall both. You know, I can't say enough
about some of the residents thathave been involved with me.

(40:05):
I mean, we've had residents thathave won awards.
And really put in, you know, that study that got published,
for example, I'm going to say his name, Andy Shaver, Doctor
Shaver, he put in at least 50 hours of work after this after
the study got really not denied.But you know, the like accepted

(40:28):
with revisions kind of stage. I mean, it was it was a ton of
work on his part. And without people like that in
your life and in your workplace and supporting you, man, you
can't do this. You know, I mean, it took me, I
mean, we got the book finished and maybe six months, but it was
every morning I was up, you know, 530 or 6 because they're

(40:50):
in a different country doing their revision.
So they would send it to me lateat night and then I'm up doing
it before I go to work. It was, that was the thing that
was different than a study because you write a study once
you write that book chapter, it seemed like over and over and
over, you know, there was alwaysa different edit.
But but yeah, back to your point, you know, Marshall's been

(41:11):
great. And I think, you know, I'll say
this as you go through your career, it's very difficult
because, you know, you, you exponentially grow in volume and
it's very difficult to continue to grow with that volume.
You know, there's days we'll go to clinic and see 90 people, 80
people and, and have patients for, you know, have telehealth

(41:35):
and all this stuff. You know, and, and it's very,
you have to add staff and, and kind of grow with that.
And Marshall's been great about supporting this in all aspects,
you know, and it's really cool to look back on where we came
from and, you know, and, and thearea we're in.
If you've never been here, you should come and, and see how

(41:57):
small of an area it is. You know, I mean, it's really
remarkable that it that somewhere like this people come
to, you know, but it's. Amazing.
That's awesome. Well, I think I think that that
this is a it's a perfect segue, but also we're all listeners.
We've talked about this. What does it take?
Right? Like this is not like a guy woke
up north picture and he came up with the idea.

(42:18):
He started doing this on people and now like a week later, he's
got results. This is hours and hours and
hours of grind. This is years of discussion.
And this is also understanding that like innovation's not easy.
There's nothing easy about what you had to do and the heat that
you had to take. And like, it's all great.
Now we can talk about this like we got pictures from AII, got

(42:39):
patients coming to ask about thefertilized ACL who are in
Seattle, who have seen your stuff, right?
Like this. You've had, there's a lot of
work to get here. Now you're at the top and you've
done it and it's really awesome.And I'm, and I would just say
that it's extremely impressive. But thank you for sharing your
story because I think people need to hear this because again,
this is the most important part.What's the background, right?
The sexy stuff's great. Like at the end you got the

(42:59):
marketing, you've got arthrax back in, you like all those
things are amazing, but that is not it is not easy.
I'd like to say something about that because you that, that's a,
that's probably the most excellent point that anybody
could ever make is research is hard.
And when I got, when I got started with that study, as we

(43:22):
mentioned six years ago, I was 38 years old and you know, I'm
like a young guy then. And that thing that finally gets
published, I mean, 1/2 a decade.And so they're like, well, what
are you going to do now? And I said, I don't know,
probably my last study. I'm just going to be honest you.

(43:43):
Know if it takes? If it takes almost a decade to
do a I will say too I want to point out that one interesting
thing that you learned. So you know our re rupture rate
right now has been about 3% compared to 10% that we've seen.
So we have 3% re rupture over 10% contralateral tears in our

(44:08):
patient population. OK.
We haven't, we haven't changed contralateral tears, which in my
opinion points to two things, the validity of our research,
but also the fact that contralateral tears are a
separate subset and unrelated tohow well the ACL is on, on that
knee. You know, I think, I think, I

(44:30):
think it proves the patients aregetting back to a high level of
sport. And therefore they're, they're,
they have a high level of contralateral tears.
The other thing I wanted to point out is we found, I think
it was 9 to 10% of a re of a, ofa of a need for necessary of a

(44:51):
need for a manipulation and or release in our study and and it
wasn't different between the twogroups.
That's. Important And so you know what I
did, I said, what, what is different about my out of state
patients? Because my out of state
patients, man, they came in hereand, and, and they're here for
two weeks and they come in inevitably at 2 weeks and

(45:15):
they've got 120° of motion, they've got quad rays, they're
walking. I mean, the one guy, you know,
that went viral with a TikTok who was walking without
crutches, like literally the same day of surgery.
And I said, what's what's different about this patient
population? Well, you could, you could, you
can say several things, one of which is they're here solely

(45:37):
focused on their ACL and they'vemade a major commitment
financially and time wise to come here to have it 100%.
That's a separate population of folks.
Or you could say they just want they knew that I wouldn't let
them out of West Virginia till they get.
Their I don't know, I think I think both pointed to but I

(45:57):
would tell you my out of state patients in general have some of
the most incredible results because it's like it I kind of I
hate saying the word out of state like professional athlete,
but they're like they got all the time in the world.
Like you're like, I'm taking off2 weeks.
I'm flying out there. I don't care what happened.
I'm going to make this look good.
And you know, the TikTok guy probably had a lot of motivation
for it to look good. He's now exploded on there.

(46:17):
He's like, I got a showroom on my knee, right.
Like they're more in there. The social media aspect of it is
also yeah, and. I think so.
So what the point I was going tomake is So what I started doing
as I said, well maybe my local patients are not going through
therapy as frequent. OK, So I went old school and and

(46:39):
got as many CPM machines as I could possibly get and we leased
these to the patients now. And so we retrospectively looked
and I haven't published this. If anybody out there wants to
publish a medical student or whatever, I I don't have.
Time reference Spark stock talks, they know you.
Gave a whole time to write up every paper.

(47:01):
But but anyways, what we found was, you know, that 10% went
down to I think 2 out of the last 100 patients.
Wow. And so you could make a case.
You know, the reason CPMS went away is they didn't make a long
term differences. Remember we talked about two
year dates. But man, for an athlete, getting
that motion back and not having to have a manipulation is

(47:23):
everything. And that 10% manipulation need
is very similar to I think Zorogyny's data after quads, you
know, with, with his, I think hepresented it was like 7 or 8%.
So I think that's. It's the most common surgery I
do for ACLS. It's the most common second
surgery by far right, like this week, last couple weeks I spent

(47:45):
half the patients are mine and half somebody else's from an ACL
surgery. So it, it, it's, it's no doubt a
problem. It's funny, my complex knees, my
meniscus transplants, HTO's, they don't get stiff because I
give them CPM right away. Cole and I, I learned that at
rush, like I'm super aggressive with the CPM.
So my bigger surgery is actuallyget lice with he's less than my
AC LS. It's because of what you're
saying. And I'm like, oh, CPM is old

(48:07):
school, right? And that's not the case.
You were talking about secondaryprocedures.
I wanted to go ahead and tell you I've had about four
patients, two of which I think were in our trial that had
secondary meniscus tears, OK, late like a year or two out
after they play the season and they had major knee injuries,

(48:29):
tear their meniscus and I go in and they tore their internal
brace in the ACL looks great. I just.
Have that happened? You had one of these?
See, so it's, we weren't crazy eight years ago, you know, I
mean. I literally just had 1-2 weeks
ago. Meniscus tear, internal brace
tore. Somehow I forgot to hit the
video button because I wanted toshow that off on social media

(48:51):
because I was like, this is crazy.
It's I've seen it before, but this was like very obvious ACL
perfect quad, just like you're talking about like I wish it was
a fertilized ACL. That would have been sicker, but
it wasn't. But anyhow, it was it was pretty
cool. Chad, I want to do your last
part because if I don't, we haveto get off at an hour because
that social media is not like over an hour.

(49:12):
So we got 10 minutes to talk about Nano and if I keep going
we could talk to you for like. We got like 5 minutes because we
we need a little football. We got we got to talk and Chad,
we are not interrupt. We're not trying to cut you off,
you're just an amazing guest. But can we talk about the Nano
really quick for you? Because I know you want to.
Bring that up. All right, here's the nano
needle. This is live and that's what it

(49:33):
is. So you might want to go to the
slides you have and we can talk about real quick.
So yeah, explain to the patientswhat's the difference?
Like why do you needle? So the nano needle is much, I
think I sent a slide over, but the nano needle is much smaller.
There you go. It's 2.4mm versus 5.9 or
slightly smaller than on a regular sheath.

(49:55):
So you're, you're, you can do itthrough a really a needle stick
really with it's, it's so much less invasive.
You're pushing less fluid into the joint.
And you know, I was an early adopter to this back when it was
called the nanoscope, which was way, you know, it's bulkier now
it's just a needle scope. And they're also getting ready

(50:17):
to release, hopefully soon, the Nano needle 2 point O.
Show that well. Is going to improve resolution
greatly. I've had the chance to look at
these in the lab. So the old nano I've compared,
I've got video comparing the oldnano to the new nano to a
regular scope. And the new nano that's coming

(50:38):
out is very, it's very, very close.
It's HD and it's close to a standard scope and you're just
using the needle. And so it's remarkably more
vivid and gives you that great visualization that you need.
And So what we're going to be able to do with that is you're
going to be able to do secondaryview like I wrote about this in

(51:01):
the book years ago, because I knew this was where this was
headed. You can park that in a joint,
say the shoulder and it'll give you.
And now with the new software, you'll be able to put picture in
picture or side by side views and have a standard scope view
with a nano needle or multiple nanos and be able to work almost
hands free, right? And so that's where I think it's

(51:23):
going, but I, I think the Nano is, is outstanding also.
So we just finished a randomizedcontrol trial with the Nano
multi center showing that it had56% less narcotic use in the 1st
24 hours. Wow, that's huge, That's huge,
that's huge. This was just for standard Nisco

(51:44):
partial menisectomies. Dr. Argentar, who was in
Washington, DC, was the other site and we randomized patients.
I think we had 70 or 80 patientsin that trial.
We'll be publishing that sooner rather than later.
I'm not waiting for two years onthat one because we're just
going to no, it's too it because2 the two and six week scores

(52:06):
were better. And so that's all we're looking
for, right. So I don't I'm not waiting two
years. So we'll get that out there.
But we also did a retrospective review and showed the same.
So I can tell you a certainty that the Nano gives you very
similar to better scores and less pain, you know, less
narcotic use, which I think we're all trying to decrease the

(52:28):
amount of narcotic need after any surgery, right?
So I think that that that has long lasting.
That's why I wanted to bring that up because I think the Nano
has long lasting ramifications. And the thought process will
always asking what's next, right?
Smaller scopes, tighter spaces and multiple views, right?
Like what's going to make me more?

(52:49):
So you have the nanoscope, right?
Newer technology, maybe a littlehigher cost with newer
technology, but like it comes ata price, right?
Faster OR time. Can you get 2O2?
So you're not having someone hold the scope moving around,
You're trying to play the game like sideways, upside down.
What are they looking right now?You got multiple views and can
you do your surgery more efficiently, right?
You said a 35 minute rotator cuff.

(53:09):
Can you do it in 20 'cause you're not spending so much time
transferring portals? Yeah, and safer.
So I'll put it in the back of the knee when I'm doing APCL.
I mean, this is huge. It's direct visualization, so I
can tell a patient I'm going to be watching while we're drilling
your tunnel right next to the vessel.
You know, I mean, so we have, weput all those techniques in the

(53:29):
book years ago and now I think people are actually going to
start adopting them when the when the visualization come
becomes HD, you know, but but yeah, it's been fun, man.
You know, I, I've had a lot of fun doing these innovative
techniques and learning and I, Iwill say to any younger surgeons

(53:50):
out there or residents, researchmakes you learn and question
more each day. You know, you, you find answers,
but for every answer you find, it seems like you ask 10 more
questions. So.
Well, and I would also say what's interesting is you, you
know, you went from a small townteam doctor, Nella Marshall,

(54:14):
people are flying in for your surgery, right?
You've, you've now had the sort of fame of your innovation.
And that adds another layer too,right?
It's like you did all this work and all of a sudden now you get
on a podium for Arthrics or for some other company and you're
and you're up there and you're talking now you got 1000
surgeons. And you know, the first time
you're bringing this up, it's nojoke, right?
It's not, it's no longer you're just in the small little

(54:35):
facility or small area talking like this.
People are listening, right? You know, you're on this
podcast, you're on other podcasts like you, you've got a
presence. So you've also got to back it up
too. You've got a lot of like a lot
of prep practice. It's been a lot of fun.
You know, I can remember when wehad we had an article one day,
you know, life has a way of justcompletely I, I will say this

(54:56):
completely humbling you, but youknow, we had I can remember one
day the the Sporting News article hit and I thought I knew
it was coming out sometime soon and and you know, and I thought,
man, this is going to be awesome.
And then it hits and like my daywas the same as every other day
of my life, you know what I mean?
And it was just like, OK, on to the next day, you know, what's

(55:19):
the next? What's the, But it's taken us
all over the country. I mean, I've been all over the
country doing education and, andtalks and really have, I've met
some fascinating people across this country, surgeons,
patients, really talented individuals across all like
from, from all walks of life. You know, you just, it's, it's,

(55:42):
it's really remarkable. And so, yeah, I think, I think
that there's that small town appeal of the story.
But you know, it's been a lot offun.
And I think, you know, I will always say, you know, keep the
main thing, the main thing. And that's, that's patient care.
And that's, that's a week. That's what we're trying to
improve, the patient experience and their outcome. 100% Well,

(56:07):
Chad, this has been awesome. I know Will has some Will
you're. You're no, we're just going to
wrap it. Up you have a few minutes will
only. No, no, we're just going to wrap
it up once again. Doctor Lavender, thank you for
taking so much time. I know you're excited.
You brought back Coach Rich Rodriguez.
Are you excited about your Mountaineer?

(56:27):
We got a it's really excited there.
What's going on? I play.
I played for I played for Rich Rod.
And then also Marshall's new coach, Tony Gibson was on that
staff. So both coaches in state.
You know, I played Fort W and I was down.
My son, he's like he's 9 and he was down at Gibson's camp and I

(56:48):
got to talk to him and I was saying, man, life comes full
circle. You know, I mean, here you are
here. And but what was funny is he
called, he told me, he said I never dreamed my first day here
at Marshall. I get called about somebody
wanting to get in to see you foran ACL.
You are doing the hometown of. Awesomeness that is so fun.

(57:12):
That was great, man. We, we, we, we're getting
excited about that football season.
Here we're excited at Marshall and WBU, you know, with two new
coaches, so we're excited with both of them so.
You got your tickets, you going to go?
Oh. Yeah, OK.
I knew that. I knew that.
Doctor Lavender, thank you so much for your time.
We really appreciate it. This was absolutely wonderful.

(57:32):
I, I felt like we have so many other things to, to chat about
and I mean, we can go on and on.The good, the good guests like
you, we could go forever. This is like we're going to have
to have like a 24 hour show sometime.
It's just crazy. Like these guys are so fun.
And you know, I think the great thing is I don't know how many
years ago we were on together, but we have a lot more to talk
about this time. So, you know, that's, that's a

(57:54):
good thing, right guys? Always, it is a good thing
you're doing good work. So thank you, Chad.
I really appreciate it. Thank you, Chad.
Lavender, thank you so much. Thank you for your time.
Doctor Garcia, say goodbye. Bye.
Bye. Thank you.
Bye.

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