May 22, 2025 • 39 mins
Hosts: Will Sanchez & Dr. Grant Garcia
Colorado Avalanche captain Gabriel Landeskog made NHL history by returning from a career-threatening knee injury after 1,032 days. In this episode, we break down the groundbreaking surgery that made it possible—an osteochondral allograft with tibial tubercle osteotomy—and why this could reshape the future of cartilage restoration in sports.
Dr. Grant Garcia shares expert insight into the surgical details, recovery, mental hurdles, and how this differs from other high-profile injuries like Lonzo Ball’s. If you love sports, medicine, or just amazing comeback stories, this one’s for you.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:17):
Welcome to Sports Doc Talk. I'm Will Sanchez along with our
orthopedic surgeon in sports medicine, Specialist Doctor
Grant Garcia. Before we get into everything,
we were really excited about this, about this podcast and
talking about this particular injury.
But before we get into that, howare you?
(00:39):
How's everything going? Memorial Day weekend, You're
grilling. What?
What's what's happening with youand the fan?
Yeah, so we're good, life's good, you know, the usual
busyness. We actually like boating a lot.
So we have a boat. So we're going to go on our boat
and have a good time. But right now the forecast is
like in the in the 50s and 60s. So for all of you not in Seattle
(01:01):
listening to this, that that's pretty normal around this time
of the year. So unfortunately, we're not
going to get the warm weather that we get every once in a
while. So I think we'll do some a
little grilling, a little hanging out family time away
from all technology. So that's good.
You know, you know, I, I heard the weather is going to recover
for this weekend, so the weathershould be nice.
(01:22):
But yeah, yeah, yeah. But Speaking of recovery, let's
see. Let's give Mike B and the rest
of the fellas out there a shout out for the Recovery Shot Shop.
You know them better than anybody else.
Tell us why you love utilizing. It yeah.
So again, you guys have heard itnon-stop.
A big thanks to our sponsors. Honestly, for patients, this is
this is the this is the way people ask all the time.
(01:45):
You know, I mean, I have multiple patients even today
from the office. They're like, what else can we
do? What's the next level stuff?
I want nutrition, I want best rehab.
I want the best machines. This is a way for you to get
that. And so as a surgeon, I can offer
it and sort of one big pool website.
You can check out my website on the recovery shop.
Again, I get no cut from you signing up.
So the key here is just that I really enjoy it.
(02:07):
It's patients love it, surgeons love it.
If you're a patient and you hearthis, ask your surgeon about it,
ask him to say, hey, I want you to be part of this.
I want to have the stuff that wecan get.
I want the extra stuff after surgery.
And so it's a great opportunity.So reach out to Mike B.
They're awesome. I think you really like it.
And it's it's been a popular thing and people have come up to
me different docs saying thanks again.
(02:27):
So it's awesome. Yeah, it, it definitely is
awesome, man. You know, I've had my experience
with them, so we always give them a thumbs up.
We're about to get into the showand the topic that we wanted to
really talk about because it's it's it's exciting.
And I feel weird saying it that way because you're excited about
an injury and that usually meansthat someone has gone through
(02:50):
something very, very difficult. And we're going to talk about
how difficult this type of injury is and everything that
you have to do to recover from it.
But we also want to let everyoneknow we've got a few submitted
questions from some viewers, andwe're going to tackle that on
toward the end of the show. So just kind of hang tight.
(03:11):
You know, the one that we wantedto talk about is the Colorado
Avalanche captain Gabriel Landiscock.
I mean, he's the type of player that most players either love or
hate, but not too many players say that they hate this guy.
I mean, he's an an outstanding player named captain at 19 years
(03:32):
old and just tells you the type of player he is and the hard
work that goes into being at this elite level.
So we're going to talk about he had this cartilage transplant
surgery in May of 2023 and finally returned to the 2025
Stanley Cup playoffs after 1032 day absence.
(03:55):
And I mean, as we go through this, this all started with an
injury back in 2020 with a skategoing across his quad, right?
And he had this cut and this injury going across his quad.
And we'll get into a little bit more about that.
But just from that injury alone,would you have thought that it
(04:18):
could have been into a situationwhere he wound up being in a
situation where he had to recover the way he did?
Well, no, I mean, we've seen those type of injuries in the
NHL all the time, right? Skate's come across somebody,
skate gets cut, direct blow. I mean, these guys are getting
hit really hard and again, this is the first time an ever a
player has had this surgery and gotten back to the NHL.
(04:40):
And so as a result, no, I would not have expected that.
But generally these cartilage injuries they get, you're not
really expecting them, right? Like you just there, there's,
there's two real main types of these.
There's the ones that are kind of like pre degeneration, right,
'cause I'm a, when you do this, the surgeons, I'm a cartilage
restoration surgeon, similar to Doctor Brian Cole, who's my
mentor. So we, our goal is to prevent
arthritis. So we see cartilage damage and
(05:02):
it's too early, so we try to replace it with other cartilage.
But there's the acute injuries, which is probably here, which is
a little different than when actually Lonzo Ball had, where
you get an acute injury and thenall of a sudden a cartilage hole
happens and you can't save that normal cartilage.
So now you've got to figure out a way to fix it or replace it or
something. So it's this is more of a
traumatic scenario. And that's the difference
(05:24):
between the type of injury that he had versus Lonzo Balls.
Yes, I mean, again, without knowing neither one of their
knees, but just knowing enough of the story and having a lot of
experience in this. I mean, this is this is really
my main bread and butter is the cartilage stuff.
This is what I love to do. This is why people come in and
see me from far away like it's the cartilage stuff.
So feeling I feel pretty confident in hearing, you know,
(05:45):
you know, Alonzo Ball had a meniscus transplant, cartilage
transplant. Never know what happens first.
Is it the cartilage hole or the meniscus?
Usually it's the cartilage. Then the meniscus gets damaged.
In this situation, we know what happened first because it was
really just the cartilage damage.
And so hearing like an we know when it happened, right?
Lonzo Ball can you can look at different back stories and when
has happened. But this one probably the direct
(06:09):
blow caused some sort of cartilage damage and they tried
to get away without surgery for a long time.
I mean, you can imagine these route by the way, the word
routine knee surgery means he went in there and someone did a
clean up. It was the same thing you heard
about with routine knee surgery with Lonzo Ball.
He had routine meniscus surgery didn't mean routine cleanup,
right? That just means something really
simple, just to kind of get something, a little bit of these
(06:32):
pieces cleaned up and then all of a sudden now they're not
better, right? They're getting worse.
And this is what we see out of our athletes in general,
recreational athletes. But it's just rare that they end
up needing something this big asa professional athlete.
And we'll get into that in a minute.
So that when you say clean up right, I'm gonna take a step
back, right? So we have this cut on the quad,
right? And then what's happening?
And please correct me, I'm wrongbecause you're the doctor here
(06:55):
and I just. You you play Doctor on TV though
so this is perfect. Play 1 on TV.
So you have to cut on the quad and then you have this scar
tissue build up, right? And and that's kind of what's
happening there. That then that's when you based
on the pain or whatever the hellelse is happening now you're
going in to get this wear and tear kind of clean up or
(07:17):
scraping that's happening behindthe kneecap it am I kind of on
base there as far as you're saying clean up?
No, but it's but you did describe what probably patients
are thinking. So that's perfect.
But I would say that that's probably not what happened in
the scenario. I would imagine that he got
skate and had traumatic injury and it knocked off a piece of
cartilage, either dislocated thekneecap or just like a direct
(07:41):
blow with the cut and then something like that.
Generally the scar tissue doesn't bring the the damage
cause scar tissue that builds upfrom that.
Unless he actually like had a big surgery at the time would
not. Usually even if you have scar
tissue it doesn't usually rubbing away the cartilage that
takes like years to happen. What I imagine is something like
he got a piece lopped off on whatever part they had to
(08:02):
replace of the cartilage and then it was probably maybe
small, right? And then he kind of like
lingered or because because right after that injury, he
didn't get a scope. So if it wasn't a loose piece,
they probably didn't recognize it or they may have gotten MRI.
It was small. And then all of a sudden this
happens. I said multiple patients in the
last few weeks where two or three years later from this
injury they all of a sudden start developing more pain and
(08:23):
then this hole got better and more uncomfortable.
OK. So then when you're going in for
clean up are are you're just shaving down that area, getting
it down to the surface now? Yeah, so I mean, it depends on
what they were, what their goal was there.
But my expectation hearing is seeing like simple scope,
obviously mid season you don't want to knock the player out,
(08:44):
right? But they're having pain and
you're like, OK, let's try to give him some relief.
So you go in there, 2 simple poke holes and then Brian Cole
did the first surgery. I know exactly what he did.
So he went in there and he's going there with a shaver.
We have like to talk a little bit haircuts kind of like you do
with the meniscus cleanups and then you kind of smooth that
surface out because that irritate that cartilage as it's
kind of flaying off if you causeirritation as you're rubbing
(09:05):
back and forth. So it it is a very simple
procedure, probably 20 minutes. Oh, so it's a quick procedure.
So we're we're thinking more or less less the timeline, right.
So he has his injury in 2020. Obviously with the pandemic,
nobody's playing. So all of his time he's not
playing, goes back on the ice a year later or so.
(09:26):
Pain is there, right? And then for this type of pain,
your leg is straight, OK. But bending the knee, skating,
things like that, you think that's where that's flaring up,
you know, with this type of kneepain.
So that is constant, right? Are we talking about just a
constant pain for a professionalskater to skate left and right,
stop on a dime, reverse things like that?
(09:47):
Go ahead. Well, yeah, you're probably
right. I mean, because The thing is
that these cartilage holes are common in athletes, right?
Like when we did the NFL playersand we looked at Mris of them
and stuff like that, they have some bad looking injuries.
We always talk about that like the, you know, when I was doing
the Giants and we were at HSS and we were seeing Mris, I was
like, Oh my God, they were like you, they cover the name and be
like, how old do you think this guy is?
(10:08):
And that's like 45 and he's likeno 22.
It's like, Oh my God, these are Mris.
They're they're going to be beatup, right?
So players have cartilage injuries, but generally we don't
treat them this aggressively because it's just the NFL.
We don't do those type of thingsor we haven't done before.
They're not time tested or whatever you want to say about
these different procedures untilnow.
(10:28):
So a lot of players have these injuries.
This scenario though, it was obviously bad enough that it was
time to do something else. It's the same way with Lonzo
Ball. But we have to come with the
caveat that this is and I don't want to jump ahead to your next
question. Yeah, we're good.
When you have this problem, mostdocs in the I mean, we talked
about this ad nauseam. All these places have gone
(10:48):
teaching talk different team doctors.
I saw the team doctor for the Jazz talk to team doctor for the
Dodgers and they're like, this is Brian Cole is awesome.
Like the fact that he was wanting to be the first one to
do this and now he's done it twice, right?
So no one was willing to take the risk to do this surgery.
This is not a risky surgery. Overall, I do almost over 30 of
these a year. I do a lot of them.
(11:08):
The patients do quite well. This is a very successful
procedure, but never done in professional athletes because we
don't know how it can handle thecrazy high impact, right?
We're just nervous about it. We can take that risk in someone
who's a young athlete because it's been around for 15 years
and it's got good data. But no one wants to be the
first, right? Even in ACL surgeries, We do so
many different types of ACL surgeries, but in the NFL, it's
(11:29):
Patel attendant, like 98% of them.
Even Neil L Trials, one of the best in the world for sports
doctors does not want to do another type of ACL because the
Patel attendant is what the agents expect, right?
So you've got to we talked to support, you're following old
rules. But Brian Cole, right?
He's the master of cartilage. He's the team doctor of all
cartilage for all different, different NFLS and NBA and you
(11:54):
name it, he says, you know what,I don't care anymore.
I'm going to do what I think is the best thing for the player.
And it's going to take a long time to recover.
I mean, 1000 days for both surgeries is a long time for
recovery. I mean that that makes the Tommy
John look light. Yeah, yeah.
And and we're gonna and I, I have some questions about the
recovery. I'm just kind of going through
the timeline now. So he went in there, they
(12:16):
cleaned it out. Obviously the the pain didn't go
away. I'm I'm, I can imagine how many
times they consulted with the Colorado physician, Dr. with
Doctor Cole, with agent, with the, with the, with Bob down the
street and the fan. Yeah, Everybody that has to go
into the decision to say, OK, this is not working, our captain
(12:39):
is not healed. We need to now go into another
procedure and we have to go intothis type of procedure that we
have there. Why don't you describe what that
procedure is and and what this entails?
Yeah. So did you, I want to double
check. Do we, do we confirm that you
got a tibial tubercle osteotomy or is that what you did you read
that? Yes, he had the osteochondral
(13:02):
allograph. That's one part of the
procedure, right? And then the tibial tubercle
this. Is really interesting Well, this
is great so this actually adds another little wrinkle to this
because it's different than Lonzo ball.
So Lonzo Ball had his on the in and outside of the knee.
Do you guys see those Those are the two areas now remember this
is a chat Jeep. This is AAI made knee that will
(13:24):
designed so this is a little different animal than what we
normally see There's no Patella on the front of that right
there's a kneecap that's supposed to go on the front.
So this is kind of like taking that off so you can see what's
going on. But what they, what Doctor Cole
did here, and this is something I do a lot, is he probably
replaced either the trochlea or probably the Patella, which is
the kneecap with a cartilage transplant.
(13:45):
So that cartilage, that plug, itdoesn't stick out like that.
That's just showing you how it'sgoing in the bad cartilage
underneath his cord out like woodworking.
And then you core a fresh piece of cartilage from someone who
recently passed away, someone quite young, unfortunately.
And then you plug that in there.You have no usual screws, just
actually press it in sometimes. Sometimes you have to kind of
(14:06):
slightly tap it in. And then they had to shift his
kneecap, probably because he had, I'm imagining this quad
thing causes battalitis dislocate and it probably
overloaded that. So we did the tubercle osteotomy
to shift him over, which is pretty awesome that he was able
to do this and get this guy backto the NHL.
But a tubercle osteotomy with that is is no joke of surgery.
(14:27):
But again, this is the same guy that got an NBA player back with
a meniscus and a Carlist transplant.
It's like, why not go small yourfirst time?
But they did not. So both of these are legitimate
surgeries and we know both players got back.
So it's very impressive. But that obviously adds to the
timeline, right? Like if it was just the
cartilage transplant, the the length of time is still there,
(14:49):
but the but the overall initial period would not is not as
difficult. The tubercle osteotomy adds
definitely a level of complexityto it.
So, so you're taking this piece and then you're, you're adding
the, the donor piece right to it, correct?
And and that's, that's where you're filling the, the, the
piece that's either been rubbed off or scraped off that's
(15:10):
rubbing that's. Rubbing the pain.
You're adding. Usually it's a focal defect
though. You don't.
It's not like the whole thing's rubbed off and you've got
arthritis. It's just one hole.
Say that again, it's. It's not like you're, it's not
like it's a whole, the whole thing is damaged like the entire
kneecap. It's generally like a focal
piece, right? There's like, imagine it's a
pothole. You have a pothole in the grass.
So you're not going to replace all the grass because you you
(15:32):
won't be able to do that. So you, you core out, you get a
fresh piece of sod. What's interesting though, it's
similar to the sod. You have to have the dirt, you
have to have the roots and you have to have the grass.
The grass is the cartilage, the lower layers like the cartilage,
the bone layer. And you need the bone too.
Because what happens is what's really cool about these
cartilage transplants is even though at a year, if you get an
(15:52):
MRI, you can't really see the difference.
It's actually the scaffold your the, the old person's cells
leave. And if you were to scope them,
sometimes you'd still see the ring like a year or two later of
the the cartilage plug. But it lives on its own.
So it grows into its body as like a transplant.
Now, sometimes the ring closes, but usually you can still see
that very faint line of where you put the cartilage transplant
in. So within a few weeks, it's
(16:15):
growing on its own and so it doesn't need to grow back Carla,
which is pretty cool. This is a nasty injury, right?
I mean, this is a nasty star they're going to squad.
And how far are we looking at a 10/12 inch incision?
Like what's the next this year? That like that, that's how big
mine are for this one. I mean, they're big.
(16:35):
They're 10 centimeters, maybe 6 inches, 8 inches.
It's it's it's this is no joke of a surgery.
This guy. I mean, this is cubical tubercle
osteotomy with the Carl's transplant.
Now these though, but, but like Cole's not going to do that
unless she absolutely needs a TTO, right?
Like I never do a TTO unless sheabsolutely need it.
(16:55):
So they're basically breaking off part of the decap and
shifting it to take off the loadoff this card of the transplant.
But the here's the thing, he doctor Cole's so good and people
and cartilage, when you do cartilage surgery like this, he
knows that if the best shot for him to get back, if he thinks
this is a spot, imagine like thekneecap is out of whack, right?
(17:17):
It's not in perfect alignment. So if he does his transplant,
there's still a lot more load onit.
So the only way to fix it is to offload it.
So to offload it, you need to dothis shift of the kneecap and
you kept in order to permanentlyshift, you got to actually
change the bone, right? Because the bone is connected to
the Patella tendon, which is connected to the Patella, which
is connected to the quad. So he probably got like hit,
smashed his kneecap, broke off apiece of cartilage.
(17:39):
They took it out or they or was not really noticed all the time.
And now all the things start talking pain.
They rescope them in 2022. They're not really getting
better. And then Cole's like, screw
this, let's just do this becauseyou're not getting back if we
don't do it right. It's like, I don't think that he
was given too many options. He's like, either we're going to
do this and you're not going to get back, or we're going to do
(17:59):
nothing and you're not going to get back.
And so that changes the perspective of this.
If he's a professional athlete without knowing the level of
pain, which I'm I'm assuming is extreme, are you?
Doing an NHL player, these guys,I no offense, the other ever
athletes, these are the toughest.
Yeah. There's no way that this was not
painful. But, but if you're not, if
(18:20):
you're not that level of athlete, are you still doing
this on my you know, someone like me or you know Someone Like
You or you're going, well, this is a type of surgery and you
know, we can, you know, make it comfortable enough or is it
something like no, you would do this anyway.
So I would do this anyway. I mean, I've done I've done more
(18:43):
than ten of these surgeries in the last six months.
So this is not something that I this exact procedure.
So this is not something that I don't do.
And I wouldn't indicate generally the age cut off on
this 50 and below roughly is kind of the timeline, but it
depends on the cartilage, right?If you've got great looking
cartilage, but the average for this probably in their mid 30s,
(19:04):
which is, I don't know, I'm assuming that he's a bit
younger, but you know, when you're younger, this you, you
gotta think about doing this because the problem is if you
leave this cartilage hole, not only does this guy get pain.
And obviously we have to realizethis is an athlete discussion,
right? Like I can talk to you about in
the office. We'll get to in the patient
questions, like a the patient discussion I had with him
outside of being a professional athlete is like, do you want to
(19:26):
have a trashy in 10 years, Right.
And to be honest with you, for alot of the athletes, they it's
sad, but they say, I don't care.I want to play for two more
years. My contract's up, right.
We talked about with the Tua thing and we talked about other
players. Yeah, this discussion now where
it's like, do you want to play longer potentially and do not
want to have a trash knee. So it's kind of cool that we can
start saying that like, hey, we can save your knee because like
(19:48):
we know these cleanups do nothing.
I mean the cleanups are like they buy them like 6 months,
they buy them a year. I mean, I'm taking first some
NFL players, I had a guy that kept getting meniscus or
meniscus removed and they said you're just going to do a clean
up and eventually you retired from the NFL and we had to do a
much larger surgery. And so as a result, the these
are we try to do band aids on these athletes because.
(20:10):
The big stuff, if you do it and they're out for sure, then you
also have the legal liability, right?
You're going out doing the doctor, Brian Cole Yeah.
And it's a whole other level, right?
That that's you're putting the Band-Aid on it and kind of
getting them through. And then eventually you get a
scenario and in the right situation where you have a
doctor that goes, this is what we're going to do.
And because it's who he is, they're going, OK, We, you know,
(20:32):
we trust what you're doing. I imagine that this is not going
to, we talked to this before. Remember I mentioned to you
about the Lonzo Ball and this isnot going to be the last time
the surgery is done. Now you have now 2 successful
athletes that have gone back with this surgery and this is
really interesting for the viewers.
This is actually resonating withpatients.
I had a patient I did a Carlos transplant on he exact same
(20:55):
surgery and the TTO he came to me last week and he said, you
know how I knew I could do this?He's like, it was really scary
sounding. You know, I give them all the
expectations of saying worst case, best case, no matter what.
I tell them if I say feel comfortable with this, show them
video testimonials, they don't care.
It's scary, which is totally legitimate, right?
Surgery's scary. Will you know this?
We've both had surgery. He said this particular player
(21:19):
helped him get back because he said if he can get back in 1000
days and I and I think I'll get back in a year, that doesn't
sound that bad. And he said that this motivated
him hearing about this story. And this is exactly why I wanted
to do this podcast. Actually worked out that we got
a little bit delayed in doing this because we was able to have
these patient conversations. But that's the second time I've
heard this. The Lonzo Ball one comes up all
(21:40):
the time. I mean, I've had players, people
being like, yeah, I know what itis now.
Lonzo Ball had it. And it makes so much, I think
for people listening, they're like, well, you know, when
someone tells me they're complaining, they're saying six
months sounds like a really longtime to get back.
I'm like it took two professional as he's 1000 days.
I'm telling you, I think it's I think it'll take you 10 months.
They're like that's not too bad anymore, right?
(22:01):
It sets a new bar, right, Like and and by the way, it's not
that 1000 days means there was something wrong with his
recovery. It's just that going back to the
NHLI think this will continue toget and also this will continue
to get faster. I mean, Cole's not going to let
them go back until he's absolutely, I'm sure, I'm sure
he had like 6 Mris to make sure it looked good, right?
Like everything's getting checked, make sure it's healed
(22:21):
perfectly. Like we're not always doing all
those things in a standard practice.
Because to be honest with you, if the, if we don't, you can't
just do an MRI for free. And so as a result, patients are
paying for it and they're not going to do that unless they
really need to. So it's, it's different than
the, and than this stuff. I mean, these guys just, they
have this print MRI machine. They're like, you know, every
day, every week that someone gets injured.
It's like X-ray, MRI, X-ray MRI.I, I know how and you touched
(22:46):
upon it right now and that's whyI'm thinking about it.
I know how I felt with my surgery, post surgery and I know
how I felt one day to the next. Gung ho ready to tackle the
world. Let's go.
Other times, just laying around,seeing atrophy kick in, you
(23:09):
know, seeing my family, you know, being reliant on them,
just everything. And you just go into this mental
depression, you know, and you'retrying to kind of forge through
it for these athletes that this is their career, their
livelihood. You've worked with athletes.
What is that mental aspect that the athlete is going through
(23:34):
that you've experienced at the professional level with an
injury like this? I mean, it's a lot like when we
get injured, we're like, OK, in a couple weeks we can go back to
doing our jobs, right? This guy's not doing his job for
1032 days, right? Or, and, and in Lonzo Ball's
(23:56):
case, he had a lot of guaranteedmoney.
So that helped I think a little bit if I remember correctly.
But that's not the way some of these contracts are being going
on now, right? You can, if you're an amazing
player and you can really dictate how your contract goes.
So there's a ton of stress, right?
Like they came used to this thing, they got injured and you
know, you get an ACL surgery, you're back in year ish, you get
a meniscus cleanup, 6 to 8 weeks.
(24:17):
All of a sudden now you're talking thinking 1000 days to
get back, right? That's like a humongous factor.
And even though you're going through it now, you're like, I'm
the first guy to get this. Like there are, this is not a
surgery without complications. 32% of these patients end up
needing a clean up at some point.
And Brian Cole's written half the articles on it.
So there's a chance that Lonzo Ball and Gabriel will need a,
(24:41):
another surgery. Now, again, it's that's the
general data. I think that that's a lot lower
in my practice. And I know I'm sure Cole's we
didn't see that many cleanups, but there's a risk with it.
So you're going through this whole recovery trying to get
back and you're like, I really hope the Carlist transplant
works, right? I really hope that the osteotomy
heals. And then I hope I don't have
pain. Oh, and then like, I'm past that
(25:02):
point now. I hope I can like, skate now.
I hope I can skate without pain.Oh, wait a second.
Now I've got to play in the NHL,right?
Like, it's just not. The benchmarks are my patients
generally. And I mean, with the
professional athletes, it's different, but the general
athlete, right? Like I'm bouldering again, like
I'm back to running and doing some squats.
(25:22):
And that's already impressive for this type of surgery.
You know, that's the next level they have to get back to.
So mentally, yes. And when you get to a certain
point, even Cole's going to say,well, you're the first one.
So we don't really have a benchmark.
You are the benchmark. You are the benchmark.
You are the benchmark. Benchmark so it's a lot and the
(25:42):
mental aspect of this is humongous.
I mean it's more than that, right?
It's, I hate to say this, but the athletes are more of the
head cases. And it's, it's, it's, it's real.
I mean, we know the mental anguish of athletic athletics.
We know the mental anguish of coming back from injury.
We know the mental anguish of the pressure, right?
It's, it's real. It happens to both male and
female athletes. I tend to think that the female
(26:02):
athletes are more vocal, which is great about their, the
pressure they're feeling. And the males tend to bottle it
up and it's a problem. We've seen that as well.
Yeah. But the mental aspect of this is
humongous and probably the bigger part.
And we talked about the set nauseam and we know we need to
show about this. And it's just, it is, it is
absolutely humongous. And I will tell you that this is
(26:23):
real for my patients. Absolutely real.
I mean, I have patients that I tell them they need this surgery
and they're in terrible pain andthey need to get back to what
they want to do, probably similar to the way he was.
And I said, you need a TTO, you need a cartilage surgery.
It's going to take you 10 monthsto a year.
And that's obviously a lot lowerthan the 1000 days.
And you just put their hands in their head and they say, how am
(26:44):
I even going to handle three weeks of not working out right?
Like that's a humongous difference.
In the end, they're usually pretty happy.
And I'm sure Gabriel's pretty happy, but there's no way to,
you can't tackle that in the first visit.
You can't tackle in the sixth visit.
You got to just say, hey, listen, I'm and we're probably
going to jump to our question from the audience or from the
(27:06):
viewers. I can't get you through this in
one visit. I can get you through the
process though. I'll be here with you the whole
time. My team will be here with the
whole time. And so at six months to a year,
you know, how am I doing? You're doing great.
How am I doing? You're doing great.
I think it's time to RIP. Thank you.
Like I'm ready. Like they, they get there and
it's usually for them. In this case with these type of
surgeries, it's usually 5-6 months.
(27:27):
So it's not the first few weeks.You're like, I think it worked.
I'm doing great. Yeah, yeah, Now, yeah.
I, I got one more question before we get to a submitted
question, questions from our viewers.
And it's funny because I was thinking about it, I was like,
would this have been possible 10years?
And I go, wait a minute. That's not even the question.
It's like, how far like would would something like this have
(27:48):
been possible five years ago, you know, three years ago.
And I know for and it's probablya two-part question, right?
One for someone like me getting the surgery and now we're seeing
it now for professional athletes.
So it's just happening now. But as far as technology and
where we've come, where the surgery would have been possible
(28:10):
5-10 years from prior. So it would have been possible.
Remember, we just need a lot more data and we need someone
who's going to push the envelope.
So you know, Brian Cole when he's 2530 or 40 and he is, I had
to say that that's young surgeon.
But when he's doing that, he's not ready to push the envelope,
(28:30):
right? So you have most of these
younger team doctors, they're not going to start doing that
stuff and they're not going to get the high level player any
they're going to Neil El trash. They're going to Brian Cole,
right? And then you get to put someone
like him who's a Cardin's masterand he finally gets to push the
envelope. And so now we're able to do it,
but he's got to see thousands ofthese hundreds of these patients
before he's like, I think it's time to do this in pros because
this is ridiculous. They're not getting the care of
(28:50):
the other. My other athletes are getting
right. My D1 college player they did a
transplant on he's back to athletics.
Why am I not use this on the pros And so the technology
improved. Yes, over the last five years
we've had the surgery five yearsago.
There is definitely better stuffthat we do and what I did five
years ago for this surgery is different than when I do now.
(29:12):
Not I would say not enough that it it would have changed my
decision to do it a pro athlete now versus then.
I think it's just that Cole's built up enough clout that like
if anybody were to say like, well, why did Cole do it?
Be like, of course he did. He wrote the book on it.
To be honest with you, Cole designed the system that he
probably used. I know he did for Arthrix, the
Carlos transplant set that he used to do his transplant and
(29:33):
Lonzo's ball. So this is a master like he,
he's got the whole system already designed and made to
make it work for him. So if anybody says anything,
it's like this is the guy. Like if there's anybody that's
going to do it and do a good job, it's him.
So like you, there's only you only go down from here in terms
of what other options he had. Anything I, I know you've,
(29:53):
you've done this procedure, anything coming out, you know,
whether it's, you know, donor orequipment or anything like that,
that's coming out. Because I know you go to a lot
of conferences, you're in the conversation with a lot of these
companies. Is there anything exciting out
there that maybe it's not today,but down the road that you can
see that when it comes to surgeries like this that you you
(30:17):
may be excited about or you're hearing rumors about?
Well, really everything's just to be healed faster, right?
Is there biologics that we can enhance the healing of this
graft or can we grow things because the issues we have bone
and car are just a lot harder togrow back and especially in the
Patella cause less things are approved for the Patella than
they are for other parts of the knee, right?
(30:39):
So if you have a Patella, do we have newer techniques that have
better results in the transplants to fix bone?
And we're going to get there. There are a lot of things in
Europe that people are trying and do we have a way to make
this a faster recovery, right? Can we, can we get this
cartilage to grow, integrate andbe ready to go in six months?
Can we do the typical osteotomy and double the bone healing
(31:00):
time? Can we not use metal screws and
use screws that turn into bone and no longer have that?
Yes, we are getting there, but we are definitely not there yet.
So I think in 10 more years there'll be a situation where
this guy will have no metal in his body.
He's gonna have two years metal screws from the
tuberculosiotomy. There's no way about that.
And he's gonna have, you know, his cartilage will be either
(31:21):
grown by itself with the bone or, you know, something
implanted where it just turns into cartilage and it's like a
95% success type of thing. Probably not five years from
now, maybe 10, but we're going to keep getting better.
And it's going to take guys likethis to show that this surgery
works for people to be like, well, wait a second, you know,
we've got to start doing more ofthese.
Great. You just mentioned three
(31:42):
possible things, even though they're not here right now, but
it's already, you know, something that people could
think about. All right, let's take a look at
our viewers submitted questions.For those that are not watching,
I'll read it out loud. One of the questions are how
much the medical field of orthopedics have changed over
time, even with the physicians focusing on only some parts of
(32:02):
the joints such as wrist, hand, shoulders or knees.
From when you started to now. Yeah, I think these are very
broad open end quenches. But I think really the key here
is to say that over time, more surgeons have gotten more
specialized. So, you know, when we came out
of practice with that fellowshiptraining, we used to be say,
hey, listen, we're going to do general orthopedics, right?
(32:24):
We're going to see hips, we're going to see knees.
We're going to see mom and pop injured.
We're going to see that when yougo to a city which is different
than if you're in a smaller small area, a very small town or
something in the middle of the country or somewhere else in the
middle of the state that's not the big city, that still kind of
works. But when you're in a place where
you're in a big city, such as myself in Seattle, you have to
(32:46):
be ready to take on the difficult things because the
cases that are more difficult generally don't see that many of
them if you're not highly specialized.
And so basically what happens isI see a lot less of the basic
stuff. I still do tons of basic sports
stuff, but I've gotten so specialized that there's really
big topics that I will take careof and I will see a lot of like
literally 95% more than most people in the whole area.
(33:09):
But there's also things that I'll see very little of because
I just don't do those things anymore, right?
And so that's, but that's helps the patients, right?
They don't, I don't do those other surgeries.
I tend that to my partners. I send them somewhere else and I
you don't want me to do the surgery for you.
It's not my specialty. But then when it's something
really hard and really specialized like something like
this, like you don't want someone dabbling in the surgery
that he had. That is not a dabble surgery
(33:30):
because I've seen these go really poorly when you don't
know what you're doing. So something like this, you go
find someone that does a lot of them and you get the best person
to do it and then you get a goodresult.
Because when most surgeons do one of them every 10 year over 2
years, some surgeons, the high volume ones, again minimal, but
there are people out there do 12times more.
(33:50):
So then that makes the best sense.
So that's really how it's changed.
And then those people also spendtheir time designing, helping
get the products better 'cause they're higher volume and they
get to see more, right? Like if you design something new
and you don't get to try it for another year because you haven't
seen somebody, like, that's not good, right?
That's just not the way it works.
We always know about this. Every data point shows that so.
Yeah, and and and it's great just from the the amazing guest
(34:12):
that we've had, you know, like adoctor Denard and you know,
shoulder specialist and you knowsome of these other doctors that
we've had, you know, Andre Shaffer right back specialist,
you know, so just that kind of more.
To come. Yeah, more to come, but they're
amazing at what they do. So it's just a a prime example,
kind of like this is their specialty.
(34:34):
And I'm glad you that you made areference to that.
You know, I do these and, and when I feel like there's someone
better, I'm going to point you in that direction.
And, and I hope that other doctors are doing the same way
because that's the type of care that that we want.
All right, let's take a look at our last submitted question for
today. How do you as an orthopedic
surgeon help decide and prepare your patients who are needing to
(34:57):
have surgery, even when the surgery may change their lives
physically? And that's a really good
question. I like that one.
So it's kind of the same thing we talked about.
I mean, you have to address bothsides of the question, right?
You have to address or both sides of the patient.
You got to address the obviouslythe fear, I guess just maybe 3
fear, the pain and expectations,right?
(35:20):
And all those things have two components to them.
They have the physical componentand they have the mental
component, right? So when we address them, the
first thing I like to do with mypatients is I give them sort of
the expectations. So what do you expect to do on
average? That's from a timeline recovery,
pain recovery and success recovery.
Then I'll just talk to them about, you know, like what
(35:40):
you're going to be at, right? And I don't go into too much
detail about your mental stuff at that point because every
person's different, right? There's patients at six months
that are doing really well and they just don't have a good
mental attitude, which is not their fault.
It's just the way their recoveryis.
And each person's wired differently.
So that person needs less discussion of how their knees
doing and more discussion about how their heads doing.
Some people come in and they say, my knees doing really well,
(36:01):
but I'm just worried about it. And those people need more like,
OK, physically you're doing really well and then they get
better, right? And there's a third type that
maybe aren't doing as well physically.
They need to focus on the physical and less on the mental.
Like I, I'm telling you're doingwell or you're mentally not
there yet physically. Let's figure out what's going
on. Do you have another
complication? So that's really how I manage it
with the patients. But the, the biggest thing is
(36:24):
consistency, honesty and full explanations.
The number one way that I help patients prepare for their
surgery is by spending countlesshours, one, in the office with
them. But two, all that stuff on my
Internet, on my website, the videos on every single one of
these surgeries and how I do it.I've spent hours making the
videos. I have blogs on them, I have
(36:47):
discussion points, you name it, video testimonials.
Pretty much every surgery there's a testimony from a
patient that's done it doing well.
There is articles published on there.
There is a surgical video of howI do it, and there's a blog
video me describing it, plus thewebsite.
So when you get in there, there's no questions what you're
going to do. My patients are super informed
now. They may be overwhelmed on the
first visit because this is likea lot.
(37:07):
I mean, you can imagine talking to someone about this, but
that's how we prepare them. That's how you should prepare
the patients. And they can check out your
website at grantgarciamd.com. And then if you want to get in
touch with us, check us out at sports.talk.com.
All sports, all orthopedics, allthe time.
We've got patient information, podcast information.
(37:29):
Check out our transcripts. We want to hear from you.
We're always looking for show ideas, although I think we're
pretty booked the next couple ofweeks.
We've got a lot of folks there, but we're.
Booked for book for a few more than a few weeks will but that's
OK I. Don't want to discourage people,
let let's get keep. Them and also depends on certain
topics. If there's something you want to
(37:50):
do, we've gotten people's topicsin.
We've had guests that we've beenable to sneak in.
I mean, again, we try to load itup.
So you guys have always some good shows coming up.
There are a lot of good speakerscoming up, but it does not mean
there's not a space for you on the show.
But the, you know, I will say there are people we turned down
because it doesn't fit the mold.I want to make sure that if
someone's on the show that the listeners can hear.
So we are, we are fairly picky about our guests, but we've had
(38:13):
some awesome guests that have come out of the blue.
I mean, Tom was amazing, Doctor Dave was amazing.
So we have a mix of everything. And you honestly, you're never
just like you're never going to know what my background's going
to be. You're never going to know what
the next guy is. Going to be that that that is
true. If if there's any reason to
watch our show, check out DoctorGarcia's background because we
(38:35):
never know what's going to be. I'm pretty sure for all the
Chicago Bulls fans out there, when we did the Lonzo Ball with
the Bulls behind them, that was phenomenal.
So any any last words as we wrapup the show?
No, just stay tuned, put your request in.
We love the interaction. Like you said before, we're,
we're open to interaction. We're open to guest requests.
(38:56):
We've, we have had every little possibility of that.
And I love the patience bringingit up too.
So anything you guys need, let us know.
We're we're always, we're happy for our listeners.
Thank you. Yes, once again, yeah.
Thank you for listening. And Doctor Garcia, thank you for
your time. Bye.
Welcome to Sports Doc Talk. I'm Will Sanchez along with our
orthopedic surgeon in sports medicine, Specialist Doctor
Grant Garcia. Before we get into everything,
we were really excited about this, about this podcast and
talking about this particular injury.
But before we get into that, howare you?
(00:39):
How's everything going? Memorial Day weekend, You're
grilling. What?
What's what's happening with youand the fan?
Yeah, so we're good, life's good, you know, the usual
busyness. We actually like boating a lot.
So we have a boat. So we're going to go on our boat
and have a good time. But right now the forecast is
like in the in the 50s and 60s. So for all of you not in Seattle
(01:01):
listening to this, that that's pretty normal around this time
of the year. So unfortunately, we're not
going to get the warm weather that we get every once in a
while. So I think we'll do some a
little grilling, a little hanging out family time away
from all technology. So that's good.
You know, you know, I, I heard the weather is going to recover
for this weekend, so the weathershould be nice.
(01:22):
But yeah, yeah, yeah. But Speaking of recovery, let's
see. Let's give Mike B and the rest
of the fellas out there a shout out for the Recovery Shot Shop.
You know them better than anybody else.
Tell us why you love utilizing. It yeah.
So again, you guys have heard itnon-stop.
A big thanks to our sponsors. Honestly, for patients, this is
this is the this is the way people ask all the time.
(01:45):
You know, I mean, I have multiple patients even today
from the office. They're like, what else can we
do? What's the next level stuff?
I want nutrition, I want best rehab.
I want the best machines. This is a way for you to get
that. And so as a surgeon, I can offer
it and sort of one big pool website.
You can check out my website on the recovery shop.
Again, I get no cut from you signing up.
So the key here is just that I really enjoy it.
(02:07):
It's patients love it, surgeons love it.
If you're a patient and you hearthis, ask your surgeon about it,
ask him to say, hey, I want you to be part of this.
I want to have the stuff that wecan get.
I want the extra stuff after surgery.
And so it's a great opportunity.So reach out to Mike B.
They're awesome. I think you really like it.
And it's it's been a popular thing and people have come up to
me different docs saying thanks again.
(02:27):
So it's awesome. Yeah, it, it definitely is
awesome, man. You know, I've had my experience
with them, so we always give them a thumbs up.
We're about to get into the showand the topic that we wanted to
really talk about because it's it's it's exciting.
And I feel weird saying it that way because you're excited about
an injury and that usually meansthat someone has gone through
(02:50):
something very, very difficult. And we're going to talk about
how difficult this type of injury is and everything that
you have to do to recover from it.
But we also want to let everyoneknow we've got a few submitted
questions from some viewers, andwe're going to tackle that on
toward the end of the show. So just kind of hang tight.
(03:11):
You know, the one that we wantedto talk about is the Colorado
Avalanche captain Gabriel Landiscock.
I mean, he's the type of player that most players either love or
hate, but not too many players say that they hate this guy.
I mean, he's an an outstanding player named captain at 19 years
(03:32):
old and just tells you the type of player he is and the hard
work that goes into being at this elite level.
So we're going to talk about he had this cartilage transplant
surgery in May of 2023 and finally returned to the 2025
Stanley Cup playoffs after 1032 day absence.
(03:55):
And I mean, as we go through this, this all started with an
injury back in 2020 with a skategoing across his quad, right?
And he had this cut and this injury going across his quad.
And we'll get into a little bit more about that.
But just from that injury alone,would you have thought that it
(04:18):
could have been into a situationwhere he wound up being in a
situation where he had to recover the way he did?
Well, no, I mean, we've seen those type of injuries in the
NHL all the time, right? Skate's come across somebody,
skate gets cut, direct blow. I mean, these guys are getting
hit really hard and again, this is the first time an ever a
player has had this surgery and gotten back to the NHL.
(04:40):
And so as a result, no, I would not have expected that.
But generally these cartilage injuries they get, you're not
really expecting them, right? Like you just there, there's,
there's two real main types of these.
There's the ones that are kind of like pre degeneration, right,
'cause I'm a, when you do this, the surgeons, I'm a cartilage
restoration surgeon, similar to Doctor Brian Cole, who's my
mentor. So we, our goal is to prevent
arthritis. So we see cartilage damage and
(05:02):
it's too early, so we try to replace it with other cartilage.
But there's the acute injuries, which is probably here, which is
a little different than when actually Lonzo Ball had, where
you get an acute injury and thenall of a sudden a cartilage hole
happens and you can't save that normal cartilage.
So now you've got to figure out a way to fix it or replace it or
something. So it's this is more of a
traumatic scenario. And that's the difference
(05:24):
between the type of injury that he had versus Lonzo Balls.
Yes, I mean, again, without knowing neither one of their
knees, but just knowing enough of the story and having a lot of
experience in this. I mean, this is this is really
my main bread and butter is the cartilage stuff.
This is what I love to do. This is why people come in and
see me from far away like it's the cartilage stuff.
So feeling I feel pretty confident in hearing, you know,
(05:45):
you know, Alonzo Ball had a meniscus transplant, cartilage
transplant. Never know what happens first.
Is it the cartilage hole or the meniscus?
Usually it's the cartilage. Then the meniscus gets damaged.
In this situation, we know what happened first because it was
really just the cartilage damage.
And so hearing like an we know when it happened, right?
Lonzo Ball can you can look at different back stories and when
has happened. But this one probably the direct
(06:09):
blow caused some sort of cartilage damage and they tried
to get away without surgery for a long time.
I mean, you can imagine these route by the way, the word
routine knee surgery means he went in there and someone did a
clean up. It was the same thing you heard
about with routine knee surgery with Lonzo Ball.
He had routine meniscus surgery didn't mean routine cleanup,
right? That just means something really
simple, just to kind of get something, a little bit of these
(06:32):
pieces cleaned up and then all of a sudden now they're not
better, right? They're getting worse.
And this is what we see out of our athletes in general,
recreational athletes. But it's just rare that they end
up needing something this big asa professional athlete.
And we'll get into that in a minute.
So that when you say clean up right, I'm gonna take a step
back, right? So we have this cut on the quad,
right? And then what's happening?
And please correct me, I'm wrongbecause you're the doctor here
(06:55):
and I just. You you play Doctor on TV though
so this is perfect. Play 1 on TV.
So you have to cut on the quad and then you have this scar
tissue build up, right? And and that's kind of what's
happening there. That then that's when you based
on the pain or whatever the hellelse is happening now you're
going in to get this wear and tear kind of clean up or
(07:17):
scraping that's happening behindthe kneecap it am I kind of on
base there as far as you're saying clean up?
No, but it's but you did describe what probably patients
are thinking. So that's perfect.
But I would say that that's probably not what happened in
the scenario. I would imagine that he got
skate and had traumatic injury and it knocked off a piece of
cartilage, either dislocated thekneecap or just like a direct
(07:41):
blow with the cut and then something like that.
Generally the scar tissue doesn't bring the the damage
cause scar tissue that builds upfrom that.
Unless he actually like had a big surgery at the time would
not. Usually even if you have scar
tissue it doesn't usually rubbing away the cartilage that
takes like years to happen. What I imagine is something like
he got a piece lopped off on whatever part they had to
(08:02):
replace of the cartilage and then it was probably maybe
small, right? And then he kind of like
lingered or because because right after that injury, he
didn't get a scope. So if it wasn't a loose piece,
they probably didn't recognize it or they may have gotten MRI.
It was small. And then all of a sudden this
happens. I said multiple patients in the
last few weeks where two or three years later from this
injury they all of a sudden start developing more pain and
(08:23):
then this hole got better and more uncomfortable.
OK. So then when you're going in for
clean up are are you're just shaving down that area, getting
it down to the surface now? Yeah, so I mean, it depends on
what they were, what their goal was there.
But my expectation hearing is seeing like simple scope,
obviously mid season you don't want to knock the player out,
(08:44):
right? But they're having pain and
you're like, OK, let's try to give him some relief.
So you go in there, 2 simple poke holes and then Brian Cole
did the first surgery. I know exactly what he did.
So he went in there and he's going there with a shaver.
We have like to talk a little bit haircuts kind of like you do
with the meniscus cleanups and then you kind of smooth that
surface out because that irritate that cartilage as it's
kind of flaying off if you causeirritation as you're rubbing
(09:05):
back and forth. So it it is a very simple
procedure, probably 20 minutes. Oh, so it's a quick procedure.
So we're we're thinking more or less less the timeline, right.
So he has his injury in 2020. Obviously with the pandemic,
nobody's playing. So all of his time he's not
playing, goes back on the ice a year later or so.
(09:26):
Pain is there, right? And then for this type of pain,
your leg is straight, OK. But bending the knee, skating,
things like that, you think that's where that's flaring up,
you know, with this type of kneepain.
So that is constant, right? Are we talking about just a
constant pain for a professionalskater to skate left and right,
stop on a dime, reverse things like that?
(09:47):
Go ahead. Well, yeah, you're probably
right. I mean, because The thing is
that these cartilage holes are common in athletes, right?
Like when we did the NFL playersand we looked at Mris of them
and stuff like that, they have some bad looking injuries.
We always talk about that like the, you know, when I was doing
the Giants and we were at HSS and we were seeing Mris, I was
like, Oh my God, they were like you, they cover the name and be
like, how old do you think this guy is?
(10:08):
And that's like 45 and he's likeno 22.
It's like, Oh my God, these are Mris.
They're they're going to be beatup, right?
So players have cartilage injuries, but generally we don't
treat them this aggressively because it's just the NFL.
We don't do those type of thingsor we haven't done before.
They're not time tested or whatever you want to say about
these different procedures untilnow.
(10:28):
So a lot of players have these injuries.
This scenario though, it was obviously bad enough that it was
time to do something else. It's the same way with Lonzo
Ball. But we have to come with the
caveat that this is and I don't want to jump ahead to your next
question. Yeah, we're good.
When you have this problem, mostdocs in the I mean, we talked
about this ad nauseam. All these places have gone
(10:48):
teaching talk different team doctors.
I saw the team doctor for the Jazz talk to team doctor for the
Dodgers and they're like, this is Brian Cole is awesome.
Like the fact that he was wanting to be the first one to
do this and now he's done it twice, right?
So no one was willing to take the risk to do this surgery.
This is not a risky surgery. Overall, I do almost over 30 of
these a year. I do a lot of them.
(11:08):
The patients do quite well. This is a very successful
procedure, but never done in professional athletes because we
don't know how it can handle thecrazy high impact, right?
We're just nervous about it. We can take that risk in someone
who's a young athlete because it's been around for 15 years
and it's got good data. But no one wants to be the
first, right? Even in ACL surgeries, We do so
many different types of ACL surgeries, but in the NFL, it's
(11:29):
Patel attendant, like 98% of them.
Even Neil L Trials, one of the best in the world for sports
doctors does not want to do another type of ACL because the
Patel attendant is what the agents expect, right?
So you've got to we talked to support, you're following old
rules. But Brian Cole, right?
He's the master of cartilage. He's the team doctor of all
cartilage for all different, different NFLS and NBA and you
(11:54):
name it, he says, you know what,I don't care anymore.
I'm going to do what I think is the best thing for the player.
And it's going to take a long time to recover.
I mean, 1000 days for both surgeries is a long time for
recovery. I mean that that makes the Tommy
John look light. Yeah, yeah.
And and we're gonna and I, I have some questions about the
recovery. I'm just kind of going through
the timeline now. So he went in there, they
(12:16):
cleaned it out. Obviously the the pain didn't go
away. I'm I'm, I can imagine how many
times they consulted with the Colorado physician, Dr. with
Doctor Cole, with agent, with the, with the, with Bob down the
street and the fan. Yeah, Everybody that has to go
into the decision to say, OK, this is not working, our captain
(12:39):
is not healed. We need to now go into another
procedure and we have to go intothis type of procedure that we
have there. Why don't you describe what that
procedure is and and what this entails?
Yeah. So did you, I want to double
check. Do we, do we confirm that you
got a tibial tubercle osteotomy or is that what you did you read
that? Yes, he had the osteochondral
(13:02):
allograph. That's one part of the
procedure, right? And then the tibial tubercle
this. Is really interesting Well, this
is great so this actually adds another little wrinkle to this
because it's different than Lonzo ball.
So Lonzo Ball had his on the in and outside of the knee.
Do you guys see those Those are the two areas now remember this
is a chat Jeep. This is AAI made knee that will
(13:24):
designed so this is a little different animal than what we
normally see There's no Patella on the front of that right
there's a kneecap that's supposed to go on the front.
So this is kind of like taking that off so you can see what's
going on. But what they, what Doctor Cole
did here, and this is something I do a lot, is he probably
replaced either the trochlea or probably the Patella, which is
the kneecap with a cartilage transplant.
(13:45):
So that cartilage, that plug, itdoesn't stick out like that.
That's just showing you how it'sgoing in the bad cartilage
underneath his cord out like woodworking.
And then you core a fresh piece of cartilage from someone who
recently passed away, someone quite young, unfortunately.
And then you plug that in there.You have no usual screws, just
actually press it in sometimes. Sometimes you have to kind of
(14:06):
slightly tap it in. And then they had to shift his
kneecap, probably because he had, I'm imagining this quad
thing causes battalitis dislocate and it probably
overloaded that. So we did the tubercle osteotomy
to shift him over, which is pretty awesome that he was able
to do this and get this guy backto the NHL.
But a tubercle osteotomy with that is is no joke of surgery.
(14:27):
But again, this is the same guy that got an NBA player back with
a meniscus and a Carlist transplant.
It's like, why not go small yourfirst time?
But they did not. So both of these are legitimate
surgeries and we know both players got back.
So it's very impressive. But that obviously adds to the
timeline, right? Like if it was just the
cartilage transplant, the the length of time is still there,
(14:49):
but the but the overall initial period would not is not as
difficult. The tubercle osteotomy adds
definitely a level of complexityto it.
So, so you're taking this piece and then you're, you're adding
the, the donor piece right to it, correct?
And and that's, that's where you're filling the, the, the
piece that's either been rubbed off or scraped off that's
(15:10):
rubbing that's. Rubbing the pain.
You're adding. Usually it's a focal defect
though. You don't.
It's not like the whole thing's rubbed off and you've got
arthritis. It's just one hole.
Say that again, it's. It's not like you're, it's not
like it's a whole, the whole thing is damaged like the entire
kneecap. It's generally like a focal
piece, right? There's like, imagine it's a
pothole. You have a pothole in the grass.
So you're not going to replace all the grass because you you
(15:32):
won't be able to do that. So you, you core out, you get a
fresh piece of sod. What's interesting though, it's
similar to the sod. You have to have the dirt, you
have to have the roots and you have to have the grass.
The grass is the cartilage, the lower layers like the cartilage,
the bone layer. And you need the bone too.
Because what happens is what's really cool about these
cartilage transplants is even though at a year, if you get an
(15:52):
MRI, you can't really see the difference.
It's actually the scaffold your the, the old person's cells
leave. And if you were to scope them,
sometimes you'd still see the ring like a year or two later of
the the cartilage plug. But it lives on its own.
So it grows into its body as like a transplant.
Now, sometimes the ring closes, but usually you can still see
that very faint line of where you put the cartilage transplant
in. So within a few weeks, it's
(16:15):
growing on its own and so it doesn't need to grow back Carla,
which is pretty cool. This is a nasty injury, right?
I mean, this is a nasty star they're going to squad.
And how far are we looking at a 10/12 inch incision?
Like what's the next this year? That like that, that's how big
mine are for this one. I mean, they're big.
(16:35):
They're 10 centimeters, maybe 6 inches, 8 inches.
It's it's it's this is no joke of a surgery.
This guy. I mean, this is cubical tubercle
osteotomy with the Carl's transplant.
Now these though, but, but like Cole's not going to do that
unless she absolutely needs a TTO, right?
Like I never do a TTO unless sheabsolutely need it.
(16:55):
So they're basically breaking off part of the decap and
shifting it to take off the loadoff this card of the transplant.
But the here's the thing, he doctor Cole's so good and people
and cartilage, when you do cartilage surgery like this, he
knows that if the best shot for him to get back, if he thinks
this is a spot, imagine like thekneecap is out of whack, right?
(17:17):
It's not in perfect alignment. So if he does his transplant,
there's still a lot more load onit.
So the only way to fix it is to offload it.
So to offload it, you need to dothis shift of the kneecap and
you kept in order to permanentlyshift, you got to actually
change the bone, right? Because the bone is connected to
the Patella tendon, which is connected to the Patella, which
is connected to the quad. So he probably got like hit,
smashed his kneecap, broke off apiece of cartilage.
(17:39):
They took it out or they or was not really noticed all the time.
And now all the things start talking pain.
They rescope them in 2022. They're not really getting
better. And then Cole's like, screw
this, let's just do this becauseyou're not getting back if we
don't do it right. It's like, I don't think that he
was given too many options. He's like, either we're going to
do this and you're not going to get back, or we're going to do
(17:59):
nothing and you're not going to get back.
And so that changes the perspective of this.
If he's a professional athlete without knowing the level of
pain, which I'm I'm assuming is extreme, are you?
Doing an NHL player, these guys,I no offense, the other ever
athletes, these are the toughest.
Yeah. There's no way that this was not
painful. But, but if you're not, if
(18:20):
you're not that level of athlete, are you still doing
this on my you know, someone like me or you know Someone Like
You or you're going, well, this is a type of surgery and you
know, we can, you know, make it comfortable enough or is it
something like no, you would do this anyway.
So I would do this anyway. I mean, I've done I've done more
(18:43):
than ten of these surgeries in the last six months.
So this is not something that I this exact procedure.
So this is not something that I don't do.
And I wouldn't indicate generally the age cut off on
this 50 and below roughly is kind of the timeline, but it
depends on the cartilage, right?If you've got great looking
cartilage, but the average for this probably in their mid 30s,
(19:04):
which is, I don't know, I'm assuming that he's a bit
younger, but you know, when you're younger, this you, you
gotta think about doing this because the problem is if you
leave this cartilage hole, not only does this guy get pain.
And obviously we have to realizethis is an athlete discussion,
right? Like I can talk to you about in
the office. We'll get to in the patient
questions, like a the patient discussion I had with him
outside of being a professional athlete is like, do you want to
(19:26):
have a trashy in 10 years, Right.
And to be honest with you, for alot of the athletes, they it's
sad, but they say, I don't care.I want to play for two more
years. My contract's up, right.
We talked about with the Tua thing and we talked about other
players. Yeah, this discussion now where
it's like, do you want to play longer potentially and do not
want to have a trash knee. So it's kind of cool that we can
start saying that like, hey, we can save your knee because like
(19:48):
we know these cleanups do nothing.
I mean the cleanups are like they buy them like 6 months,
they buy them a year. I mean, I'm taking first some
NFL players, I had a guy that kept getting meniscus or
meniscus removed and they said you're just going to do a clean
up and eventually you retired from the NFL and we had to do a
much larger surgery. And so as a result, the these
are we try to do band aids on these athletes because.
(20:10):
The big stuff, if you do it and they're out for sure, then you
also have the legal liability, right?
You're going out doing the doctor, Brian Cole Yeah.
And it's a whole other level, right?
That that's you're putting the Band-Aid on it and kind of
getting them through. And then eventually you get a
scenario and in the right situation where you have a
doctor that goes, this is what we're going to do.
And because it's who he is, they're going, OK, We, you know,
(20:32):
we trust what you're doing. I imagine that this is not going
to, we talked to this before. Remember I mentioned to you
about the Lonzo Ball and this isnot going to be the last time
the surgery is done. Now you have now 2 successful
athletes that have gone back with this surgery and this is
really interesting for the viewers.
This is actually resonating withpatients.
I had a patient I did a Carlos transplant on he exact same
(20:55):
surgery and the TTO he came to me last week and he said, you
know how I knew I could do this?He's like, it was really scary
sounding. You know, I give them all the
expectations of saying worst case, best case, no matter what.
I tell them if I say feel comfortable with this, show them
video testimonials, they don't care.
It's scary, which is totally legitimate, right?
Surgery's scary. Will you know this?
We've both had surgery. He said this particular player
(21:19):
helped him get back because he said if he can get back in 1000
days and I and I think I'll get back in a year, that doesn't
sound that bad. And he said that this motivated
him hearing about this story. And this is exactly why I wanted
to do this podcast. Actually worked out that we got
a little bit delayed in doing this because we was able to have
these patient conversations. But that's the second time I've
heard this. The Lonzo Ball one comes up all
(21:40):
the time. I mean, I've had players, people
being like, yeah, I know what itis now.
Lonzo Ball had it. And it makes so much, I think
for people listening, they're like, well, you know, when
someone tells me they're complaining, they're saying six
months sounds like a really longtime to get back.
I'm like it took two professional as he's 1000 days.
I'm telling you, I think it's I think it'll take you 10 months.
They're like that's not too bad anymore, right?
(22:01):
It sets a new bar, right, Like and and by the way, it's not
that 1000 days means there was something wrong with his
recovery. It's just that going back to the
NHLI think this will continue toget and also this will continue
to get faster. I mean, Cole's not going to let
them go back until he's absolutely, I'm sure, I'm sure
he had like 6 Mris to make sure it looked good, right?
Like everything's getting checked, make sure it's healed
(22:21):
perfectly. Like we're not always doing all
those things in a standard practice.
Because to be honest with you, if the, if we don't, you can't
just do an MRI for free. And so as a result, patients are
paying for it and they're not going to do that unless they
really need to. So it's, it's different than
the, and than this stuff. I mean, these guys just, they
have this print MRI machine. They're like, you know, every
day, every week that someone gets injured.
It's like X-ray, MRI, X-ray MRI.I, I know how and you touched
(22:46):
upon it right now and that's whyI'm thinking about it.
I know how I felt with my surgery, post surgery and I know
how I felt one day to the next. Gung ho ready to tackle the
world. Let's go.
Other times, just laying around,seeing atrophy kick in, you
(23:09):
know, seeing my family, you know, being reliant on them,
just everything. And you just go into this mental
depression, you know, and you'retrying to kind of forge through
it for these athletes that this is their career, their
livelihood. You've worked with athletes.
What is that mental aspect that the athlete is going through
(23:34):
that you've experienced at the professional level with an
injury like this? I mean, it's a lot like when we
get injured, we're like, OK, in a couple weeks we can go back to
doing our jobs, right? This guy's not doing his job for
1032 days, right? Or, and, and in Lonzo Ball's
(23:56):
case, he had a lot of guaranteedmoney.
So that helped I think a little bit if I remember correctly.
But that's not the way some of these contracts are being going
on now, right? You can, if you're an amazing
player and you can really dictate how your contract goes.
So there's a ton of stress, right?
Like they came used to this thing, they got injured and you
know, you get an ACL surgery, you're back in year ish, you get
a meniscus cleanup, 6 to 8 weeks.
(24:17):
All of a sudden now you're talking thinking 1000 days to
get back, right? That's like a humongous factor.
And even though you're going through it now, you're like, I'm
the first guy to get this. Like there are, this is not a
surgery without complications. 32% of these patients end up
needing a clean up at some point.
And Brian Cole's written half the articles on it.
So there's a chance that Lonzo Ball and Gabriel will need a,
(24:41):
another surgery. Now, again, it's that's the
general data. I think that that's a lot lower
in my practice. And I know I'm sure Cole's we
didn't see that many cleanups, but there's a risk with it.
So you're going through this whole recovery trying to get
back and you're like, I really hope the Carlist transplant
works, right? I really hope that the osteotomy
heals. And then I hope I don't have
pain. Oh, and then like, I'm past that
(25:02):
point now. I hope I can like, skate now.
I hope I can skate without pain.Oh, wait a second.
Now I've got to play in the NHL,right?
Like, it's just not. The benchmarks are my patients
generally. And I mean, with the
professional athletes, it's different, but the general
athlete, right? Like I'm bouldering again, like
I'm back to running and doing some squats.
(25:22):
And that's already impressive for this type of surgery.
You know, that's the next level they have to get back to.
So mentally, yes. And when you get to a certain
point, even Cole's going to say,well, you're the first one.
So we don't really have a benchmark.
You are the benchmark. You are the benchmark.
You are the benchmark. Benchmark so it's a lot and the
(25:42):
mental aspect of this is humongous.
I mean it's more than that, right?
It's, I hate to say this, but the athletes are more of the
head cases. And it's, it's, it's, it's real.
I mean, we know the mental anguish of athletic athletics.
We know the mental anguish of coming back from injury.
We know the mental anguish of the pressure, right?
It's, it's real. It happens to both male and
female athletes. I tend to think that the female
(26:02):
athletes are more vocal, which is great about their, the
pressure they're feeling. And the males tend to bottle it
up and it's a problem. We've seen that as well.
Yeah. But the mental aspect of this is
humongous and probably the bigger part.
And we talked about the set nauseam and we know we need to
show about this. And it's just, it is, it is
absolutely humongous. And I will tell you that this is
(26:23):
real for my patients. Absolutely real.
I mean, I have patients that I tell them they need this surgery
and they're in terrible pain andthey need to get back to what
they want to do, probably similar to the way he was.
And I said, you need a TTO, you need a cartilage surgery.
It's going to take you 10 monthsto a year.
And that's obviously a lot lowerthan the 1000 days.
And you just put their hands in their head and they say, how am
(26:44):
I even going to handle three weeks of not working out right?
Like that's a humongous difference.
In the end, they're usually pretty happy.
And I'm sure Gabriel's pretty happy, but there's no way to,
you can't tackle that in the first visit.
You can't tackle in the sixth visit.
You got to just say, hey, listen, I'm and we're probably
going to jump to our question from the audience or from the
(27:06):
viewers. I can't get you through this in
one visit. I can get you through the
process though. I'll be here with you the whole
time. My team will be here with the
whole time. And so at six months to a year,
you know, how am I doing? You're doing great.
How am I doing? You're doing great.
I think it's time to RIP. Thank you.
Like I'm ready. Like they, they get there and
it's usually for them. In this case with these type of
surgeries, it's usually 5-6 months.
(27:27):
So it's not the first few weeks.You're like, I think it worked.
I'm doing great. Yeah, yeah, Now, yeah.
I, I got one more question before we get to a submitted
question, questions from our viewers.
And it's funny because I was thinking about it, I was like,
would this have been possible 10years?
And I go, wait a minute. That's not even the question.
It's like, how far like would would something like this have
(27:48):
been possible five years ago, you know, three years ago.
And I know for and it's probablya two-part question, right?
One for someone like me getting the surgery and now we're seeing
it now for professional athletes.
So it's just happening now. But as far as technology and
where we've come, where the surgery would have been possible
(28:10):
5-10 years from prior. So it would have been possible.
Remember, we just need a lot more data and we need someone
who's going to push the envelope.
So you know, Brian Cole when he's 2530 or 40 and he is, I had
to say that that's young surgeon.
But when he's doing that, he's not ready to push the envelope,
(28:30):
right? So you have most of these
younger team doctors, they're not going to start doing that
stuff and they're not going to get the high level player any
they're going to Neil El trash. They're going to Brian Cole,
right? And then you get to put someone
like him who's a Cardin's masterand he finally gets to push the
envelope. And so now we're able to do it,
but he's got to see thousands ofthese hundreds of these patients
before he's like, I think it's time to do this in pros because
this is ridiculous. They're not getting the care of
(28:50):
the other. My other athletes are getting
right. My D1 college player they did a
transplant on he's back to athletics.
Why am I not use this on the pros And so the technology
improved. Yes, over the last five years
we've had the surgery five yearsago.
There is definitely better stuffthat we do and what I did five
years ago for this surgery is different than when I do now.
(29:12):
Not I would say not enough that it it would have changed my
decision to do it a pro athlete now versus then.
I think it's just that Cole's built up enough clout that like
if anybody were to say like, well, why did Cole do it?
Be like, of course he did. He wrote the book on it.
To be honest with you, Cole designed the system that he
probably used. I know he did for Arthrix, the
Carlos transplant set that he used to do his transplant and
(29:33):
Lonzo's ball. So this is a master like he,
he's got the whole system already designed and made to
make it work for him. So if anybody says anything,
it's like this is the guy. Like if there's anybody that's
going to do it and do a good job, it's him.
So like you, there's only you only go down from here in terms
of what other options he had. Anything I, I know you've,
(29:53):
you've done this procedure, anything coming out, you know,
whether it's, you know, donor orequipment or anything like that,
that's coming out. Because I know you go to a lot
of conferences, you're in the conversation with a lot of these
companies. Is there anything exciting out
there that maybe it's not today,but down the road that you can
see that when it comes to surgeries like this that you you
(30:17):
may be excited about or you're hearing rumors about?
Well, really everything's just to be healed faster, right?
Is there biologics that we can enhance the healing of this
graft or can we grow things because the issues we have bone
and car are just a lot harder togrow back and especially in the
Patella cause less things are approved for the Patella than
they are for other parts of the knee, right?
(30:39):
So if you have a Patella, do we have newer techniques that have
better results in the transplants to fix bone?
And we're going to get there. There are a lot of things in
Europe that people are trying and do we have a way to make
this a faster recovery, right? Can we, can we get this
cartilage to grow, integrate andbe ready to go in six months?
Can we do the typical osteotomy and double the bone healing
(31:00):
time? Can we not use metal screws and
use screws that turn into bone and no longer have that?
Yes, we are getting there, but we are definitely not there yet.
So I think in 10 more years there'll be a situation where
this guy will have no metal in his body.
He's gonna have two years metal screws from the
tuberculosiotomy. There's no way about that.
And he's gonna have, you know, his cartilage will be either
(31:21):
grown by itself with the bone or, you know, something
implanted where it just turns into cartilage and it's like a
95% success type of thing. Probably not five years from
now, maybe 10, but we're going to keep getting better.
And it's going to take guys likethis to show that this surgery
works for people to be like, well, wait a second, you know,
we've got to start doing more ofthese.
Great. You just mentioned three
(31:42):
possible things, even though they're not here right now, but
it's already, you know, something that people could
think about. All right, let's take a look at
our viewers submitted questions.For those that are not watching,
I'll read it out loud. One of the questions are how
much the medical field of orthopedics have changed over
time, even with the physicians focusing on only some parts of
(32:02):
the joints such as wrist, hand, shoulders or knees.
From when you started to now. Yeah, I think these are very
broad open end quenches. But I think really the key here
is to say that over time, more surgeons have gotten more
specialized. So, you know, when we came out
of practice with that fellowshiptraining, we used to be say,
hey, listen, we're going to do general orthopedics, right?
(32:24):
We're going to see hips, we're going to see knees.
We're going to see mom and pop injured.
We're going to see that when yougo to a city which is different
than if you're in a smaller small area, a very small town or
something in the middle of the country or somewhere else in the
middle of the state that's not the big city, that still kind of
works. But when you're in a place where
you're in a big city, such as myself in Seattle, you have to
(32:46):
be ready to take on the difficult things because the
cases that are more difficult generally don't see that many of
them if you're not highly specialized.
And so basically what happens isI see a lot less of the basic
stuff. I still do tons of basic sports
stuff, but I've gotten so specialized that there's really
big topics that I will take careof and I will see a lot of like
literally 95% more than most people in the whole area.
(33:09):
But there's also things that I'll see very little of because
I just don't do those things anymore, right?
And so that's, but that's helps the patients, right?
They don't, I don't do those other surgeries.
I tend that to my partners. I send them somewhere else and I
you don't want me to do the surgery for you.
It's not my specialty. But then when it's something
really hard and really specialized like something like
this, like you don't want someone dabbling in the surgery
that he had. That is not a dabble surgery
(33:30):
because I've seen these go really poorly when you don't
know what you're doing. So something like this, you go
find someone that does a lot of them and you get the best person
to do it and then you get a goodresult.
Because when most surgeons do one of them every 10 year over 2
years, some surgeons, the high volume ones, again minimal, but
there are people out there do 12times more.
(33:50):
So then that makes the best sense.
So that's really how it's changed.
And then those people also spendtheir time designing, helping
get the products better 'cause they're higher volume and they
get to see more, right? Like if you design something new
and you don't get to try it for another year because you haven't
seen somebody, like, that's not good, right?
That's just not the way it works.
We always know about this. Every data point shows that so.
Yeah, and and and it's great just from the the amazing guest
(34:12):
that we've had, you know, like adoctor Denard and you know,
shoulder specialist and you knowsome of these other doctors that
we've had, you know, Andre Shaffer right back specialist,
you know, so just that kind of more.
To come. Yeah, more to come, but they're
amazing at what they do. So it's just a a prime example,
kind of like this is their specialty.
(34:34):
And I'm glad you that you made areference to that.
You know, I do these and, and when I feel like there's someone
better, I'm going to point you in that direction.
And, and I hope that other doctors are doing the same way
because that's the type of care that that we want.
All right, let's take a look at our last submitted question for
today. How do you as an orthopedic
surgeon help decide and prepare your patients who are needing to
(34:57):
have surgery, even when the surgery may change their lives
physically? And that's a really good
question. I like that one.
So it's kind of the same thing we talked about.
I mean, you have to address bothsides of the question, right?
You have to address or both sides of the patient.
You got to address the obviouslythe fear, I guess just maybe 3
fear, the pain and expectations,right?
(35:20):
And all those things have two components to them.
They have the physical componentand they have the mental
component, right? So when we address them, the
first thing I like to do with mypatients is I give them sort of
the expectations. So what do you expect to do on
average? That's from a timeline recovery,
pain recovery and success recovery.
Then I'll just talk to them about, you know, like what
(35:40):
you're going to be at, right? And I don't go into too much
detail about your mental stuff at that point because every
person's different, right? There's patients at six months
that are doing really well and they just don't have a good
mental attitude, which is not their fault.
It's just the way their recoveryis.
And each person's wired differently.
So that person needs less discussion of how their knees
doing and more discussion about how their heads doing.
Some people come in and they say, my knees doing really well,
(36:01):
but I'm just worried about it. And those people need more like,
OK, physically you're doing really well and then they get
better, right? And there's a third type that
maybe aren't doing as well physically.
They need to focus on the physical and less on the mental.
Like I, I'm telling you're doingwell or you're mentally not
there yet physically. Let's figure out what's going
on. Do you have another
complication? So that's really how I manage it
with the patients. But the, the biggest thing is
(36:24):
consistency, honesty and full explanations.
The number one way that I help patients prepare for their
surgery is by spending countlesshours, one, in the office with
them. But two, all that stuff on my
Internet, on my website, the videos on every single one of
these surgeries and how I do it.I've spent hours making the
videos. I have blogs on them, I have
(36:47):
discussion points, you name it, video testimonials.
Pretty much every surgery there's a testimony from a
patient that's done it doing well.
There is articles published on there.
There is a surgical video of howI do it, and there's a blog
video me describing it, plus thewebsite.
So when you get in there, there's no questions what you're
going to do. My patients are super informed
now. They may be overwhelmed on the
first visit because this is likea lot.
(37:07):
I mean, you can imagine talking to someone about this, but
that's how we prepare them. That's how you should prepare
the patients. And they can check out your
website at grantgarciamd.com. And then if you want to get in
touch with us, check us out at sports.talk.com.
All sports, all orthopedics, allthe time.
We've got patient information, podcast information.
(37:29):
Check out our transcripts. We want to hear from you.
We're always looking for show ideas, although I think we're
pretty booked the next couple ofweeks.
We've got a lot of folks there, but we're.
Booked for book for a few more than a few weeks will but that's
OK I. Don't want to discourage people,
let let's get keep. Them and also depends on certain
topics. If there's something you want to
(37:50):
do, we've gotten people's topicsin.
We've had guests that we've beenable to sneak in.
I mean, again, we try to load itup.
So you guys have always some good shows coming up.
There are a lot of good speakerscoming up, but it does not mean
there's not a space for you on the show.
But the, you know, I will say there are people we turned down
because it doesn't fit the mold.I want to make sure that if
someone's on the show that the listeners can hear.
So we are, we are fairly picky about our guests, but we've had
(38:13):
some awesome guests that have come out of the blue.
I mean, Tom was amazing, Doctor Dave was amazing.
So we have a mix of everything. And you honestly, you're never
just like you're never going to know what my background's going
to be. You're never going to know what
the next guy is. Going to be that that that is
true. If if there's any reason to
watch our show, check out DoctorGarcia's background because we
(38:35):
never know what's going to be. I'm pretty sure for all the
Chicago Bulls fans out there, when we did the Lonzo Ball with
the Bulls behind them, that was phenomenal.
So any any last words as we wrapup the show?
No, just stay tuned, put your request in.
We love the interaction. Like you said before, we're,
we're open to interaction. We're open to guest requests.
(38:56):
We've, we have had every little possibility of that.
And I love the patience bringingit up too.
So anything you guys need, let us know.
We're we're always, we're happy for our listeners.
Thank you. Yes, once again, yeah.
Thank you for listening. And Doctor Garcia, thank you for
your time. Bye.
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