Latest / Foul Territory / Dr. Neal ElAttrache talks “NanoNeedle”, future of baseball medicine, & TJ surgery on Injury Territory

Transcript

Dr. Neal ElAttrache talks “NanoNeedle”, future of baseball medicine, & TJ surgery on Injury Territory · Foul Territory

• 0:02
  Speaker 1: This is a special injury territory. There's no other way
• 0:05
  Speaker 1: to say it. You know, I've had good guests before,
• 0:07
  Speaker 1: I've had great guests before, and I'll have great guests again.
• 0:10
  Speaker 1: But Neil Elatrosh, that's one of the rock stars of orthopedics.
• 0:15
  Speaker 1: He's treated everybody from Tom Brady to you know, Kobe
• 0:20
  Speaker 1: Bryant with his achilles. There's so many names I could
• 0:23
  Speaker 1: run off, but I'll just let him talk about it.
• 0:27
  Speaker 1: You know, Neil Elatrosh, he's an arithmetic surgeon. He's at
• 0:32
  Speaker 1: Kurlan Joe, which is part of Caesar cy and I.
• 0:34
  Speaker 1: He's the team doctor for both the Los Angeles Dodgers
• 0:37
  Speaker 1: and the Los Angeles Rams. He's a consulting surgeon for everybody.
• 0:41
  Speaker 1: We're obviously talking to him today about the work he's
• 0:45
  Speaker 1: done with the nanoscope, the nano needle, as Arthur ex
• 0:49
  Speaker 1: is calling it. He did Trek Scoubele, the cy Young
• 0:53
  Speaker 1: winner who's on track to come back earlier today. On Thursday,
• 0:59
  Speaker 1: he came back and through his third bullpen session. I'm
• 1:02
  Speaker 1: told it's a thirty five pitch bullpen session. He actually
• 1:06
  Speaker 1: went thirty six pitches. He had to get that last
• 1:08
  Speaker 1: one in and everything's going really well. He's on track
• 1:12
  Speaker 1: to pitch as soon as next week after having loose
• 1:16
  Speaker 1: bodies removed. And Blake Snell he had his surgery on Tuesday,
• 1:20
  Speaker 1: also by Neil Latrosh, also with the nanoscope. So this
• 1:25
  Speaker 1: is something that's rapidly changing where things are going. We've
• 1:28
  Speaker 1: had loose bodies before, we've had kinds that have come
• 1:31
  Speaker 1: back quickly. Yep. Blake Snell himself came back in two
• 1:34
  Speaker 1: months back in twenty nineteen. With this one. Yeah, it's
• 1:39
  Speaker 1: just a different paradigm. This is one of those game changers.
• 1:44
  Speaker 1: So so excited to talk to Neil Latrosh when we
• 1:47
  Speaker 1: come back. This is gonna be the interview. We're gonna
• 1:50
  Speaker 1: sit down with doctor Neil Latrosh from the Curling Joe Clinic.
• 1:56
  Speaker 1: You know, baseball's been living in this cycle where elbow's
• 1:59
  Speaker 1: either rest or break or they get rebuilt. When you
• 2:03
  Speaker 1: first saw the nanoscope, did you immediately think this could
• 2:07
  Speaker 1: change the whole intervention timeline.
• 2:11
  Speaker 2: Well, yeah, for certain things, I thought that this would
• 2:15
  Speaker 2: be a lot less traumatic that we could, especially with
• 2:20
  Speaker 2: procedures that the length of recovery was entirely dependent on
• 2:26
  Speaker 2: how much surgical trauma you you did. In other words,
• 2:32
  Speaker 2: you know, we weren't waiting for tissue that was torn
• 2:37
  Speaker 2: to heal after it's repaired. So you know, that takes
• 2:40
  Speaker 2: a you know, a certain amount of time that's pretty
• 2:44
  Speaker 2: well known and so you know, but if you're not,
• 2:48
  Speaker 2: if you're not repairing tissue and you're simply taking things
• 2:55
  Speaker 2: out of a joint that shouldn't be there, then really
• 2:58
  Speaker 2: the length of time it takes to recover is mostly
• 3:02
  Speaker 2: related to the trauma that you that you uh, you know,
• 3:07
  Speaker 2: cause whenever you're you're doing the procedures. So so the
• 3:11
  Speaker 2: the smaller the instruments, the more delicate, and uh, the operation,
• 3:17
  Speaker 2: the you know, the I think it's going to be
• 3:20
  Speaker 2: directly related to the improved uh.
• 3:22
  Speaker 1: Cover recovery time. So but I.
• 3:26
  Speaker 2: Think that the nanoscope, you know, clearly, clearly the nanoscope
• 3:30
  Speaker 2: would make the biggest difference in a case like that.
• 3:33
  Speaker 2: And uh, you know, the other uses for it, uh
• 3:38
  Speaker 2: you really depend on you know, who the what specialty
• 3:43
  Speaker 2: the surgeon is in and the kinds of uh you know,
• 3:47
  Speaker 2: procedures and repairs that he may be doing. Some of
• 3:50
  Speaker 2: them are are you know, technically difficult to perform. Because
• 3:54
  Speaker 2: it's hard to it's hard to see, uh in certain areas,
• 3:58
  Speaker 2: and it's hard to hard to reach in certain area.
• 4:00
  Speaker 2: So you know, but that gets to be pretty you know,
• 4:05
  Speaker 2: pretty myriad in and it's you know, the the uses
• 4:08
  Speaker 2: of it. But I think the most directly related thing
• 4:12
  Speaker 2: is something that where the downtime is directly related to
• 4:15
  Speaker 2: what what you do in surgery.
• 4:19
  Speaker 1: Yeah, a lot of people are first hearing about the
• 4:21
  Speaker 1: nanoscope or nano needle as ARTHURX is referring to it.
• 4:24
  Speaker 1: Now they're hearing about it, you know, last couple of weeks.
• 4:27
  Speaker 1: But this is something that's been around for a couple
• 4:29
  Speaker 1: of years. You've obviously been doing this. Charistable was not
• 4:32
  Speaker 1: the first guy you tried this on. Can you tell
• 4:35
  Speaker 1: us about how long you've been using it and what
• 4:39
  Speaker 1: what other types of procedures you're using it for.
• 4:45
  Speaker 2: Well, you know, the the joint, the elbow joint does
• 4:49
  Speaker 2: lend itself to the smaller caliber scope. It's a difficult
• 4:54
  Speaker 2: joint to get larger instruments in and safer the smaller
• 4:59
  Speaker 2: the instrum. And so I've I've looked at in the
• 5:03
  Speaker 2: on the inside of an elbow with that just to
• 5:05
  Speaker 2: see what the view was and where where I could go.
• 5:10
  Speaker 2: So I knew that this would be one of the
• 5:12
  Speaker 2: ideal cases to use it on. The the other things
• 5:17
  Speaker 2: I've done really have been just so I could get
• 5:19
  Speaker 2: a good view of something or a view from a
• 5:22
  Speaker 2: different perspective that I always wondered, you know what this
• 5:26
  Speaker 2: looks like from Like in the back of the knee
• 5:29
  Speaker 2: is another place doing different types of repairs. In the
• 5:34
  Speaker 2: back of the knee joint, you can see you can
• 5:37
  Speaker 2: see the instruments going in from the front. Sometimes you
• 5:40
  Speaker 2: can see them going in from the side if you
• 5:43
  Speaker 2: if you get the scope into the into the into
• 5:46
  Speaker 2: the notch, but you almost never can see it from
• 5:48
  Speaker 2: the back while you're doing it. The other the other
• 5:52
  Speaker 2: thing I'm I've played with on cadavers is using a
• 5:59
  Speaker 2: dual scope, so using a regular sized scope but then
• 6:04
  Speaker 2: parking the nanoscope in a in a different area of
• 6:08
  Speaker 2: the shoulder joint. For instance, if having the nanoscope up,
• 6:15
  Speaker 2: you know, in the subacromial space above the rotator cuff
• 6:19
  Speaker 2: while I'm while I'm performing the operation on the rotator cuff,
• 6:23
  Speaker 2: approaching it from the inside of the joint underneath the
• 6:25
  Speaker 2: rotator cuff and so taking care of partial thickness, rotator
• 6:29
  Speaker 2: cuff tears, things like that that you know, where I
• 6:32
  Speaker 2: now I can see where the sutures going in and
• 6:36
  Speaker 2: where it's coming out on the top surface, if I
• 6:39
  Speaker 2: want to do certain type of repair like that, and
• 6:43
  Speaker 2: the and lastly, I'm just talking about the things that
• 6:47
  Speaker 2: I've had in mind because of challenges that that I
• 6:50
  Speaker 2: want to overcome is I'd like to be able to
• 6:55
  Speaker 2: perform a route consistently anatomic repair of the of the
• 7:01
  Speaker 2: glenning hemoral capsule, the capsule ligaments of the shoulder when
• 7:05
  Speaker 2: they're torn off of the humor headside. So not just
• 7:08
  Speaker 2: the labor repair. You know, I can I can reach
• 7:11
  Speaker 2: about three hundred and sixty degrees around that. That's not
• 7:14
  Speaker 2: the issue. The issue is getting up into the axillary recess.
• 7:19
  Speaker 2: You know, the the armpit is a dangerous place to
• 7:23
  Speaker 2: try to operate. You can't really stick the stuff in
• 7:26
  Speaker 2: there otherwise you know you're going to be in a
• 7:29
  Speaker 2: really a bird's nest of blood, vessels and nerves. And
• 7:33
  Speaker 2: so you know, getting getting a tiny little instrument and
• 7:37
  Speaker 2: scope so that you can directly see that part so
• 7:40
  Speaker 2: that you can repair that.
• 7:42
  Speaker 1: It would be really helpful in certain athletes.
• 7:45
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• 7:48
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• 7:50
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• 8:02
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• 8:02
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• 8:05
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• 8:07
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• 8:10
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• 8:14
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• 8:16
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• 8:20
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• 8:22
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• 8:24
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• 8:26
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• 8:46
  Speaker 1: Yeah, it's amazing. I think back to when Frank job
• 8:49
  Speaker 1: did my shoulder did the same very similar procedure to
• 8:52
  Speaker 1: what Oral Hrscheizer had, which there was actually a time
• 8:57
  Speaker 1: I'm sure you remember this a couple years ago we
• 8:59
  Speaker 1: were all on stae H together and me and Oral
• 9:01
  Speaker 1: that they're talking about our shoulder surgeries for Frank. But
• 9:09
  Speaker 1: one of the things that that you mentioned there is
• 9:12
  Speaker 1: just being able to see. And I've been talking about
• 9:14
  Speaker 1: the nanoscope as almost a diagnostic tool rather than a
• 9:20
  Speaker 1: fix it tool. That's the word I'm looking for there,
• 9:23
  Speaker 1: you know, a repair tool. I think that this is
• 9:26
  Speaker 1: going to be such a jump forward in that, you know,
• 9:30
  Speaker 1: you could and again I'm being a little bit forward thinking,
• 9:37
  Speaker 1: you could essentially take somebody back to the locker room
• 9:40
  Speaker 1: rather than waiting for an MRI and say, you know,
• 9:42
  Speaker 1: how torn is this meniscus? How bad is this tear?
• 9:46
  Speaker 1: Do you think that's a tool for the nanoscope or
• 9:49
  Speaker 1: am I just dreaming?
• 9:51
  Speaker 2: You know? Yeah, I think that you know, in a
• 9:54
  Speaker 2: brief conversation. You you made that comment before, and it
• 9:58
  Speaker 2: struck me, you know, wow, you know they, you know,
• 10:02
  Speaker 2: for for not doing this, you know, as your day
• 10:06
  Speaker 2: job every day in the operating room. That there was
• 10:10
  Speaker 2: actually a pretty astute thought because quite frankly, that that
• 10:15
  Speaker 2: is right now in the literature anyway, the only thing
• 10:20
  Speaker 2: that there is written about this is the diagnostic ability,
• 10:25
  Speaker 2: relating it to your diagnostic ability for instance, an MRI scan.
• 10:31
  Speaker 2: And there's a really, really excellent sports medicine specialist in
• 10:38
  Speaker 2: San Diego who did his fellowship here several years ago
• 10:43
  Speaker 2: at the Crone Joe Clinic. His name is Tal David,
• 10:45
  Speaker 2: and he he did a study. Not sure if it's
• 10:49
  Speaker 2: published yet, but I heard he told me about the
• 10:53
  Speaker 2: results of his study and he compared the MRI scan
• 10:57
  Speaker 2: to the nanoscope and looking at pathology inside the shoulder,
• 11:03
  Speaker 2: and there was no diagnosis where the MRI scan was
• 11:08
  Speaker 2: better than the nanoscope in diagnosing intra articular problem problems
• 11:13
  Speaker 2: inside the joint.
• 11:15
  Speaker 1: Uh.
• 11:15
  Speaker 2: But however, there were there were a couple of diagnoses
• 11:19
  Speaker 2: where the nanoscope was better than the MRI scanner. And
• 11:22
  Speaker 2: we all know that there's places in the knee and
• 11:24
  Speaker 2: then the shoulder, for instance, where that particular area because
• 11:29
  Speaker 2: maybe the the angle changes. You know, when you're when
• 11:33
  Speaker 2: you're doing a MRI scan of a joint, you know
• 11:37
  Speaker 2: there would be certain places where the line of the
• 11:41
  Speaker 2: cuts of the scan are going to be slightly oblique.
• 11:44
  Speaker 2: You're going to lose a little bit of resolution compared
• 11:47
  Speaker 2: to the other views that you're getting of other areas
• 11:50
  Speaker 2: of the joint. And those areas are getting smaller and smaller,
• 11:56
  Speaker 2: But there still are some areas where you know, okay,
• 12:00
  Speaker 2: I know the I know the resolution here is not
• 12:02
  Speaker 2: going to be perfect. I think that this might be
• 12:05
  Speaker 2: happening maybe maybe not. Those are the areas like, for instance,
• 12:09
  Speaker 2: where the biceps tendon comes into the joint and in
• 12:12
  Speaker 2: the shoulder joint, okay, to see what and actually the
• 12:16
  Speaker 2: name of the lesion indicates that it's so difficult to
• 12:20
  Speaker 2: see diagnostically, like a hidden lesion. It's the it's the
• 12:25
  Speaker 2: little little straps that keep the biceps stable in the
• 12:30
  Speaker 2: top of the groove in the shoulder joint and the
• 12:33
  Speaker 2: actual condition of the bicep itself inside the joint. Uh
• 12:38
  Speaker 2: that is that those areas become very oblique to the
• 12:42
  Speaker 2: to the standard cuts that an MRI scan gets and
• 12:45
  Speaker 2: so your resolution is not is not great and and
• 12:49
  Speaker 2: so you find yourself sort of guessing at what what
• 12:54
  Speaker 2: may be happening right there and trying to relate it
• 12:56
  Speaker 2: to whatever physical exam findings you have.
• 12:59
  Speaker 1: And so, uh, you know.
• 13:01
  Speaker 2: But for diagnostic purposes, long answer to what you just said,
• 13:06
  Speaker 2: you're exactly right that diagnostic issues are going to be
• 13:11
  Speaker 2: probably the first great use of it. Also to observe
• 13:17
  Speaker 2: and diagnose where you are in the healing phase of
• 13:20
  Speaker 2: certain things like a meniscus repair. You know, there are
• 13:23
  Speaker 2: certain meniscus tears that you really want to see, do
• 13:29
  Speaker 2: we have robust tissue that has has healed here or
• 13:33
  Speaker 2: are we still vulnerable because that athlete is going to
• 13:37
  Speaker 2: about to go back to applying significant weight and torque
• 13:43
  Speaker 2: on that spot. And so you know, to be able
• 13:46
  Speaker 2: to stick an instrument the size of a needle with
• 13:50
  Speaker 2: a chip on the end of it and to actually
• 13:52
  Speaker 2: look at it and see it is going to be
• 13:57
  Speaker 2: a very very helpful thing.
• 14:00
  Speaker 1: Game changer. Yeah. I can remember the first time we met,
• 14:03
  Speaker 1: I think it was two thousand and five. It was
• 14:06
  Speaker 1: at Jim Andrews conference and he was saying anytime he
• 14:09
  Speaker 1: had a shoulder. He would just call you and we
• 14:13
  Speaker 1: were talking about that. The thing that I remember, and
• 14:15
  Speaker 1: I've probably quoted more than any other doctor, is you
• 14:18
  Speaker 1: said about shoulders, it's like putting together a puzzle without
• 14:22
  Speaker 1: the box top. I'm trying to figure out what it
• 14:24
  Speaker 1: looked like before it did And that's always stuck with me.
• 14:29
  Speaker 2: Yeah, you know, you should you know the stuff that
• 14:34
  Speaker 2: we're seeing now. You know, I thought that I thought
• 14:37
  Speaker 2: that it was difficult to figure out the way so
• 14:40
  Speaker 2: many shoulders looked, you know, to begin with, whenever we
• 14:44
  Speaker 2: were first having that discussion. But you know, the guys
• 14:49
  Speaker 2: that are coming in even at a young age now
• 14:52
  Speaker 2: into the professional ranks eighteen nineteen, twenty years old, twenty
• 14:57
  Speaker 2: one years old, The amount of baggage that some of
• 15:01
  Speaker 2: these kids have and they're coming up and they're performing
• 15:06
  Speaker 2: at elite levels, and then when they finally break, it's
• 15:11
  Speaker 2: pretty astounding. Uh So it you know, being able to
• 15:16
  Speaker 2: to see the joint in its uh you know, lack
• 15:20
  Speaker 2: of a better district, like its natural habitat to stick
• 15:24
  Speaker 2: a to stick a little needle in there that doesn't
• 15:27
  Speaker 2: take up space, that doesn't in and of itself limit
• 15:30
  Speaker 2: motion and watch the shoulder move or watch the joint move,
• 15:35
  Speaker 2: and to see what some of these structures really do
• 15:38
  Speaker 2: whenever under normal human motion. It's going to be fascinating.
• 15:44
  Speaker 2: I think that the the the uses and and the
• 15:48
  Speaker 2: knowledge that we're going to get by using it, you know,
• 15:52
  Speaker 2: probably or unanticipated, you know. Uh, And every every time
• 15:57
  Speaker 2: somebody some of the great you know, the greatest things
• 16:01
  Speaker 2: have been borne out of very simple, simple, you know,
• 16:05
  Speaker 2: philosophies or inventions. You know that this is this is
• 16:08
  Speaker 2: simply an optic tool that is made miniature, and so
• 16:14
  Speaker 2: to be able to take it where we haven't been
• 16:16
  Speaker 2: able to go before. When when when specialists use this thing,
• 16:21
  Speaker 2: that they're gonna come up with different ideas and how
• 16:24
  Speaker 2: they can accomplish different things. It's gonna for some things,
• 16:28
  Speaker 2: it is going to change the paradigm of how certain
• 16:29
  Speaker 2: repairs are done, you know.
• 16:31
  Speaker 1: And so.
• 16:34
  Speaker 2: It's a it's a great advancement in in an extremely
• 16:38
  Speaker 2: common uh you know, the thing that we do which
• 16:42
  Speaker 2: is arthroscopically look at at joints. And I've even seen
• 16:47
  Speaker 2: a report where it's being used endoscopically by general surgeons
• 16:51
  Speaker 2: now too. So you can imagine what you're going to
• 16:55
  Speaker 2: be do, be able to do with different organs and
• 16:57
  Speaker 2: things like that in the in the body with a
• 17:01
  Speaker 2: scope the size of a needle.
• 17:03
  Speaker 1: That's pretty amazing. Now, how much of this is the
• 17:05
  Speaker 1: device itself and how much of this is just rethinking
• 17:08
  Speaker 1: how aggressive we can be, whether it's with elbows or
• 17:11
  Speaker 1: shoulders or even these.
• 17:15
  Speaker 2: I think it's a little both. I think that you know,
• 17:18
  Speaker 2: we were we were not able to do the things
• 17:24
  Speaker 2: that we're doing now to the shoulder on a a
• 17:27
  Speaker 2: in a throwing athlete with the the the procedures that
• 17:33
  Speaker 2: preceded the scope, because the invasiveness and what it would
• 17:39
  Speaker 2: take to get there and get out of there, and
• 17:42
  Speaker 2: the amount of surgical trauma you would cause, the return
• 17:47
  Speaker 2: to range of motion and the time of return of
• 17:50
  Speaker 2: range of motion and rehab was so unpredictable that that
• 17:54
  Speaker 2: some of the procedures that we do now routinely on
• 17:58
  Speaker 2: on throwing athletes, uh, we we really would have been
• 18:01
  Speaker 2: reluctant to do before. And so you know, the ability
• 18:06
  Speaker 2: to get to to get there and leave very little
• 18:09
  Speaker 2: trace of of of you being there other than repairing
• 18:13
  Speaker 2: torrent tissue, you know it. It really is largely responsible
• 18:18
  Speaker 2: for our ability to do the kinds of procedures we
• 18:22
  Speaker 2: do now and to allow these guys to get back
• 18:25
  Speaker 2: to doing something as something as extreme as throwing a
• 18:30
  Speaker 2: ball the way that these guys do. I mean, if
• 18:34
  Speaker 2: if it takes you two years to get your motion back,
• 18:37
  Speaker 2: I mean, the sport moves on. For a lot of
• 18:38
  Speaker 2: these guys, there's not enough time in their career and
• 18:42
  Speaker 2: their in their life to to wait for something like
• 18:45
  Speaker 2: that to heal.
• 18:46
  Speaker 1: So, you know, I.
• 18:49
  Speaker 2: Always I always looked at indicator surgical indications as when
• 18:55
  Speaker 2: when you're first learning them, that you learn them as
• 18:58
  Speaker 2: if they're absolute, uh, that this this procedure is indicated
• 19:04
  Speaker 2: for this person, and this procedure is not indicated for
• 19:08
  Speaker 2: this person. What I what I learned as I went
• 19:11
  Speaker 2: through and I watched some amazingly talented surgeons work, is
• 19:17
  Speaker 2: that indications are also in part related to the surgeon's
• 19:23
  Speaker 2: ability and the surgeon's ability to accomplish a procedure with
• 19:29
  Speaker 2: very little surgical trauma and surgical morbidity. It expands the
• 19:34
  Speaker 2: indications for different operations. So I saw Frank Job, for instance,
• 19:39
  Speaker 2: willing to do things that other surgeons thought would be contraindicated.
• 19:44
  Speaker 2: You know, for certain athletes simply because Frank Frank, you know,
• 19:50
  Speaker 2: looked at those people sort of in a curious way,
• 19:56
  Speaker 2: not not realizing that you know, technically speaking, I mean
• 20:02
  Speaker 2: he was he was in a different class. You know,
• 20:05
  Speaker 2: he was able to do things surgically, and so I
• 20:08
  Speaker 2: saw the indication his surgical indications were really really broad.
• 20:15
  Speaker 2: Pushed the horizon out for what he thought could be done,
• 20:18
  Speaker 2: simply because he knew that he could. He could try
• 20:22
  Speaker 2: certain things and do certain things because technically he was
• 20:26
  Speaker 2: able to do. It came naturally to him, and in
• 20:30
  Speaker 2: his mind, I think he was probably doing the math
• 20:32
  Speaker 2: of Okay, well, if I know I'm not going to
• 20:33
  Speaker 2: make him worse, let's try this because the other things
• 20:37
  Speaker 2: don't work, and so you know, so we all benefit
• 20:40
  Speaker 2: from that, you know. And I think that this technologically,
• 20:44
  Speaker 2: that this an instrument like this, where the size of
• 20:48
  Speaker 2: the instrument is such that it's going to cause such
• 20:51
  Speaker 2: little invasion that I think that, you know, it's going
• 20:54
  Speaker 2: to expand our indications for certain things.
• 20:58
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• 21:56
  Speaker 1: F O U L. Absolutely. Now, I do want to
• 21:59
  Speaker 1: be clear. Normally I wouldn't ask you about specific patients,
• 22:02
  Speaker 1: but you are authorized to talk about both Tarrek Schoogl
• 22:05
  Speaker 1: and Blake Snail, So I am going to be specific
• 22:07
  Speaker 1: here with Terrek, what made you say this guy is
• 22:10
  Speaker 1: the right candidate for this approach. You know that you
• 22:13
  Speaker 1: were quoted as saying you were looking for the perfect
• 22:15
  Speaker 1: patient for this What made him that perfect patient?
• 22:19
  Speaker 2: Well, so for his specific diagnosis. First of all, you know,
• 22:25
  Speaker 2: a taking out a loose body not not having to
• 22:32
  Speaker 2: cause any other uh sort of surgical trauma or bleeding
• 22:36
  Speaker 2: or anything like that, by by shaving a spur, let's say,
• 22:40
  Speaker 2: which we often have to do in throwing athletes. That
• 22:45
  Speaker 2: that this would be the difference between uh, you know,
• 22:51
  Speaker 2: a recovery time there would be potentially three months.
• 22:56
  Speaker 1: Uh.
• 22:56
  Speaker 2: Some people would wonder, wait a second, all you're doing
• 22:59
  Speaker 2: would be taking a four milimeter scope in and then
• 23:03
  Speaker 2: another grasper in. Well, you know when you have to
• 23:06
  Speaker 2: go through through the areas of the elbow that you
• 23:09
  Speaker 2: have to go through a four millimeter or five milimeter
• 23:12
  Speaker 2: tunnel through there, through the triceps or through the tissues
• 23:17
  Speaker 2: in the back of the elbow. They're going to bleed
• 23:20
  Speaker 2: a little bit, the elbow is going to be swollen.
• 23:24
  Speaker 2: You're going to have to clean out some thickened and
• 23:27
  Speaker 2: flame tissue to be able to get to see the
• 23:30
  Speaker 2: loose body that you're looking at because you've got to
• 23:32
  Speaker 2: get that bigger scope further into the joint to be
• 23:35
  Speaker 2: able to see it. And all those tissues are going
• 23:40
  Speaker 2: to bleed and they're all going to have healing time,
• 23:42
  Speaker 2: and so it's going to take a certain amount of
• 23:44
  Speaker 2: time for that swelling to go down the range of
• 23:46
  Speaker 2: motion to come back. And then at this time of
• 23:50
  Speaker 2: the year, that's a big issue because at this time
• 23:54
  Speaker 2: of the year, the player has already gone through the
• 23:58
  Speaker 2: pre training for spring training, he's gone through spring training,
• 24:03
  Speaker 2: and with these pictures, what they're doing in pre training
• 24:06
  Speaker 2: and spring training is they're building up the volume and
• 24:09
  Speaker 2: stamina in their shoulder, building up their arm strength and
• 24:13
  Speaker 2: there their stamina, and they're getting themselves back into that
• 24:17
  Speaker 2: five day routine where they beat themselves up. Then they
• 24:22
  Speaker 2: recover and they go through a process, a consistent process
• 24:28
  Speaker 2: of throwing, recovery and strength maintenance, and then they do
• 24:33
  Speaker 2: it again five days later. And so getting their body
• 24:37
  Speaker 2: into that routine that that all takes it's it's gearing
• 24:41
  Speaker 2: up the machine. That all takes time. And so then
• 24:45
  Speaker 2: if you remove them from that routine and remove them
• 24:48
  Speaker 2: from throwing, then while you're waiting for the tissues to
• 24:52
  Speaker 2: heal and range of motion to come back, and bleeding
• 24:54
  Speaker 2: to go away. Then then then you need to ramp
• 24:58
  Speaker 2: up again because you've you've deconditioned them for four weeks.
• 25:03
  Speaker 2: So a four week layoff of throwing doesn't mean that
• 25:06
  Speaker 2: they're back throwing and pitching in five weeks. A four
• 25:09
  Speaker 2: week layoff from throwing means you restart the clock somewhere
• 25:12
  Speaker 2: back where they were building up their their standing again,
• 25:16
  Speaker 2: getting back into their routine. So it typically this time
• 25:19
  Speaker 2: of the year when you when you take out loose
• 25:21
  Speaker 2: bodies from a pitcher's elbow, it typically takes somewhere, you know,
• 25:25
  Speaker 2: ten to twelve weeks for return to competition where we're
• 25:28
  Speaker 2: seeing them back in their Dodger uniform, let's say, and
• 25:34
  Speaker 2: they're they're pitching against another team, and so you know,
• 25:39
  Speaker 2: judging from where he was in the season, and the
• 25:42
  Speaker 2: fact that the the nanoscope would help me get into
• 25:48
  Speaker 2: the places where that this loose body was, I knew
• 25:51
  Speaker 2: where it was looking at on the MRI scan, and
• 25:57
  Speaker 2: so I knew where I would have to go. I
• 26:00
  Speaker 2: doing this would would would eliminate the need for me
• 26:04
  Speaker 2: to make a big hole through the tricep tendon and
• 26:08
  Speaker 2: get this loose body out, because I'd be no matter
• 26:10
  Speaker 2: where it drifted off to during the case, I'd be
• 26:13
  Speaker 2: able to get this little needle into wherever it was
• 26:15
  Speaker 2: and and be able to either nudge it back into
• 26:18
  Speaker 2: a place where I could reach it or at least
• 26:19
  Speaker 2: be able to see it. And and lastly, from a
• 26:24
  Speaker 2: sort of an investigative standpoint, I really wanted it to
• 26:30
  Speaker 2: be a case where the nanoscope itself was the difference.
• 26:34
  Speaker 2: That it wasn't the the well, you know, maybe the
• 26:38
  Speaker 2: nanoscope was part of the treatment or you know, you know,
• 26:41
  Speaker 2: his recovery time was partially aided by you know, the nanoscope.
• 26:46
  Speaker 2: I wanted it to be that the nanoscope was the difference,
• 26:49
  Speaker 2: and uh, and see if it was, and see if
• 26:51
  Speaker 2: it was or not, and so we would know, okay,
• 26:53
  Speaker 2: we'll sticking the little needlescope in there was or was not,
• 26:58
  Speaker 2: you know, a difference, Mayer in how quickly a guy
• 27:01
  Speaker 2: can recover. And so all those things put together, plus
• 27:07
  Speaker 2: the overall you know, warrior type attitude that Trek Scuball has,
• 27:13
  Speaker 2: you know, I just I think it was the perfect scenario.
• 27:17
  Speaker 1: Absolutely, And today he threw a thirty five pitch full
• 27:21
  Speaker 1: intent bullpen. I don't know if you know that you've
• 27:23
  Speaker 1: been with patients all day, but I didn't know that
• 27:26
  Speaker 1: things are certainly trending that way now. Obviously it's a
• 27:29
  Speaker 1: little bit of a coincidence that Blake Snell, a pitcher
• 27:34
  Speaker 1: for your team the Dodgers, had a similar injury and
• 27:37
  Speaker 1: it has now had surgery. He had it earlier this
• 27:39
  Speaker 1: week again with the nanoscope. Do you feel that this
• 27:44
  Speaker 1: is going to quickly become the standard of care?
• 27:48
  Speaker 2: I think that for people that are taking care of
• 27:52
  Speaker 2: patients or athletes where you know, the time of recovery
• 27:57
  Speaker 2: is an issue to any degree, I think will we'll
• 28:02
  Speaker 2: find this a very useful tool. I think, you know,
• 28:05
  Speaker 2: as far as standard of care, Yeah, you know, I
• 28:09
  Speaker 2: I I don't. I don't know that those things take
• 28:11
  Speaker 2: a long time to sort of drift through the U
• 28:16
  Speaker 2: through through the medical community. But I think that it's
• 28:20
  Speaker 2: you'll find early adopters quickly change into you know, the
• 28:25
  Speaker 2: mainstream adoption of of this thing. If you're taking care
• 28:28
  Speaker 2: of people that that uh, you know, the time of
• 28:32
  Speaker 2: recovery or difficult to reach and see. Uh, you know, uh,
• 28:38
  Speaker 2: injuries are are an issue.
• 28:41
  Speaker 1: You know, yeah. Now, you obviously spent decades watching pictures
• 28:45
  Speaker 1: evolved physically. We were talking about this yesterday. Velocity is up,
• 28:49
  Speaker 1: workloads are different, biomechanics are are different. We actually know
• 28:53
  Speaker 1: them all the spin and pitch design. Are we entering
• 28:57
  Speaker 1: at an euro where surgery itself has to become less
• 28:59
  Speaker 1: and vay because the athletes are simply too valuable to
• 29:02
  Speaker 1: lose for this longer period of time.
• 29:07
  Speaker 2: Well, I think the answer to the second one is
• 29:11
  Speaker 2: we were definitely in an era where where we can't
• 29:15
  Speaker 2: afford to have the surgery that we do cost cost
• 29:22
  Speaker 2: a inordinate amount of time out Now, having said that,
• 29:29
  Speaker 2: it's funny because I hadn't thought about that until now
• 29:32
  Speaker 2: when you ask that question that while I'm saying that,
• 29:35
  Speaker 2: I can tell you that the operations that I am
• 29:40
  Speaker 2: doing on these elbows to stabilize them are more and
• 29:46
  Speaker 2: more elaborate. I'm doing more and more, you know, And
• 29:50
  Speaker 2: so you know, I think that I'm I'm causing less
• 29:56
  Speaker 2: and less overall surgical trauma because I you know, at
• 30:02
  Speaker 2: this point, I've put in my ten thousand hours and
• 30:04
  Speaker 2: and and I I can get, I can get I
• 30:08
  Speaker 2: can get around a joint. You know, you know, without
• 30:12
  Speaker 2: leaving leaving much abnormal scar tissue. But but I I'm
• 30:17
  Speaker 2: actually I'm doing more on these elbows. It seems like,
• 30:23
  Speaker 2: you know, they're they're figuring out a way to to
• 30:26
  Speaker 2: over to over tax and to defeat the procedures that we're.
• 30:33
  Speaker 1: Doing quicker and quicker.
• 30:34
  Speaker 2: You know.
• 30:36
  Speaker 1: I was just looking.
• 30:36
  Speaker 2: At a picture today that came in and one of
• 30:42
  Speaker 2: the big big issues now is is, you know, the
• 30:45
  Speaker 2: the average age of pictures that that get a Tommy
• 30:48
  Speaker 2: John has gone down significantly since you and I started
• 30:52
  Speaker 2: working together like this. And uh, and so guys are
• 30:55
  Speaker 2: coming into the minor leagues and major leagues already having
• 30:58
  Speaker 2: had a Tommy John. And at the incidents of injury
• 31:06
  Speaker 2: to the ligament is now thirty five percent of major
• 31:12
  Speaker 2: league pitchers will need a Tommy John. So the clock
• 31:17
  Speaker 2: starts ticking. And just because I put a new ligament,
• 31:21
  Speaker 2: and doesn't mean that my chances of this thing surviving
• 31:26
  Speaker 2: in an entire career any better than God's chances. And
• 31:29
  Speaker 2: if God's ligament costs thirty five percent of them, you know,
• 31:35
  Speaker 2: an operation, then even if they've already had a Tommy John,
• 31:39
  Speaker 2: when they come into the professional baseball there's still So
• 31:44
  Speaker 2: my point is that we're doing more and more revision work.
• 31:47
  Speaker 2: We're doing more and more work on elbows that have
• 31:50
  Speaker 2: already had surgery to fix this problem, but we're sending
• 31:54
  Speaker 2: them right back into the war and there's still bullets
• 31:58
  Speaker 2: being shot at these guys and some of them going
• 32:00
  Speaker 2: to get hit again, and we've got to fix them again.
• 32:02
  Speaker 2: So and so what they're able to tear the things
• 32:07
  Speaker 2: we put in just like they're dab tear, they're normal stuff.
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• 33:12
  Speaker 1: I talked with Jeff Dugas on this show a couple
• 33:14
  Speaker 1: of weeks ago. If you haven't watched that, please check
• 33:17
  Speaker 1: that out. But the failure rate on internal brace has
• 33:23
  Speaker 1: been exceptionally low, to the point where I'm still trying
• 33:26
  Speaker 1: to confirm whether we've had one in the major leagues
• 33:30
  Speaker 1: you mentioned, you know, God's ligament versus the one you
• 33:33
  Speaker 1: put back in. Do you think that's going to be
• 33:36
  Speaker 1: the case that we're going to get better and better
• 33:38
  Speaker 1: at the internal brace or whatever comes after it.
• 33:42
  Speaker 2: Yeah, So we we've had several several failures note of
• 33:47
  Speaker 2: the internal brace. But but it's it's interesting because the
• 33:52
  Speaker 2: way they fail is different. We're seeing we're seeing a
• 33:58
  Speaker 2: new pattern of of injuries now that we never used
• 34:02
  Speaker 2: to see. And uh uh I think that Keith Meister
• 34:07
  Speaker 2: and I are probably blessed or cursed whenever you look
• 34:11
  Speaker 2: at it with with with you know, sort of left
• 34:15
  Speaker 2: to fend for what the heck we do with this,
• 34:18
  Speaker 2: you know. But we're we're we because you know, the
• 34:24
  Speaker 2: sort of a small pool. I mean, we we use
• 34:27
  Speaker 2: each other's experience to to help ourselves, you know, and
• 34:31
  Speaker 2: and so we share cases with quite a bit, and
• 34:34
  Speaker 2: we're seeing the same pattern of injuries that that you know,
• 34:39
  Speaker 2: when we send each other pictures, you know, it's the
• 34:41
  Speaker 2: same thing. And so they they're still because of the
• 34:46
  Speaker 2: high spin rates. Well it's not just the velocity. I
• 34:51
  Speaker 2: had a picture come in here today that had had
• 34:53
  Speaker 2: a Tommy John done six years six and a half
• 34:57
  Speaker 2: years ago, and uh, and his best his best combination
• 35:03
  Speaker 2: of pitches is he throws a four seam fastball and
• 35:08
  Speaker 2: he's able to locate it, you know, really consistently in
• 35:11
  Speaker 2: difficult places to hit. So even though in a ninety
• 35:15
  Speaker 2: four four mile an hour fastball is I mean, it's
• 35:19
  Speaker 2: pretty commonplace now in Major League Baseball, but his local
• 35:24
  Speaker 2: yeah no, but his location is really astounding. But what's
• 35:28
  Speaker 2: more devastating is that he he throws this, this high
• 35:33
  Speaker 2: spin off speed pitch this uh, this that that looks
• 35:37
  Speaker 2: like a fastball to a hitter. In fact that his
• 35:40
  Speaker 2: arm speed is going higher faster than his fastball. But
• 35:45
  Speaker 2: he's got a twelve mile an hour differential and an
• 35:49
  Speaker 2: eighteen inch movement on the ball, and so that that
• 35:53
  Speaker 2: is basically unhittable. You know, if he if he throws
• 35:56
  Speaker 2: that combination to any hitter, and it's almost unhittable if
• 36:03
  Speaker 2: he puts the ball you know where it should be.
• 36:06
  Speaker 4: And so.
• 36:08
  Speaker 2: The spin that's necessary to do that is enormous. You're
• 36:13
  Speaker 2: talking about spin rates that are just like it's hard
• 36:17
  Speaker 2: to believe that so many guys can throw triple digits,
• 36:20
  Speaker 2: you know, to get the spin that these guys are
• 36:23
  Speaker 2: getting is pretty amazing. And listen to this. They're doing
• 36:26
  Speaker 2: it without the Tacki substance. So that's the other thing
• 36:29
  Speaker 2: that happened. All at the same time, they eliminated the
• 36:33
  Speaker 2: Tacki substance while they were emphasizing max effort on spin
• 36:39
  Speaker 2: or velocity, and they put in a pitch clock, so
• 36:42
  Speaker 2: you can't recover the same amount of time between pitches.
• 36:45
  Speaker 2: So you get a guy that's thrown now sixty pitches
• 36:49
  Speaker 2: and he's got a desk grip on the ball. You
• 36:51
  Speaker 2: should see how some of these guys grip the ball
• 36:53
  Speaker 2: now to make it look like a different pitch and
• 36:57
  Speaker 2: to make it spin like it does. They're maxing out
• 37:01
  Speaker 2: their their flexer and pronator tension. And so when you
• 37:06
  Speaker 2: look at the pattern of injury of these hybrid reconstructions,
• 37:10
  Speaker 2: that hybrid is where you put the grapht in and
• 37:12
  Speaker 2: you add an internal brace. If you look at the
• 37:16
  Speaker 2: pattern of injury, they primarily start in the flexer and
• 37:21
  Speaker 2: pronator tendon that is immediately adjacent to the ligament. And
• 37:26
  Speaker 2: so when when when you get micro tears or partial
• 37:29
  Speaker 2: tears of the of the flexer pronator tendon, because it's
• 37:34
  Speaker 2: basically it's intimately attached to the bone with the ligament,
• 37:38
  Speaker 2: you're pulling off part of the ligament too, so you're
• 37:40
  Speaker 2: spraining the ligament and and uh, it's the same pattern.
• 37:45
  Speaker 2: The whole rest of the graph looks beautiful, and then
• 37:48
  Speaker 2: you have this, you know, sort of combination of flexer
• 37:51
  Speaker 2: pronator and part partly ligament injury on an elbow that's
• 37:55
  Speaker 2: been operated on. And so what we started doing was
• 38:00
  Speaker 2: simply repairing those and not not putting a new graft
• 38:04
  Speaker 2: in because the rest of the ligament you couldn't do
• 38:06
  Speaker 2: better than what it was. It is just that that
• 38:09
  Speaker 2: that sleeve had to be reapplied there so so that
• 38:14
  Speaker 2: that it's given rise to a whole new type of
• 38:17
  Speaker 2: treatment for these things, which is a repair of a
• 38:19
  Speaker 2: previously reconstructed you know, uh, graft and ligament. So you
• 38:25
  Speaker 2: know there there, they'll never be an end. I don't
• 38:30
  Speaker 2: think too the different ways that these guys can beat
• 38:35
  Speaker 2: what we do.
• 38:36
  Speaker 1: It's amazing. Now. You know you came up under Frank
• 38:40
  Speaker 1: Job and lou Yoakam. You helped evolve Tommy John. You
• 38:44
  Speaker 1: invented docking, your procedure with David Elchack. I forget the
• 38:48
  Speaker 1: exact name you had for that.
• 38:50
  Speaker 2: Yeah, it wasn't my name. People combined our initials and
• 38:53
  Speaker 2: and talk. It was basically putting in single tunnels on
• 38:58
  Speaker 2: the top and bottom, putting the without doing having to
• 39:02
  Speaker 2: do a figure of eight with a lot more drill holes.
• 39:06
  Speaker 1: But you've worked alongside James Andrews Fister. You mentioned when
• 39:10
  Speaker 1: you look back at where the field was when you
• 39:13
  Speaker 1: started and where it is now, what to change the most.
• 39:17
  Speaker 1: The fans probably don't realize.
• 39:23
  Speaker 2: I think that probably the the what does what doesn't
• 39:29
  Speaker 2: meet the eye to the fan in any of these
• 39:32
  Speaker 2: high level sports is the is the amount of work
• 39:36
  Speaker 2: and experience and practice and unfortunately, uh physical baggage that
• 39:43
  Speaker 2: those young athletes are carrying with them. When you watch
• 39:47
  Speaker 2: them compete and perform, it's a lifetime of dedication to
• 39:51
  Speaker 2: what they've done, uh and to where they've gotten themselves.
• 39:56
  Speaker 2: And uh, you know, it's a lifetime of work that
• 40:01
  Speaker 2: they put in. And so a couple of things, I mean,
• 40:04
  Speaker 2: number one, when they get injured and that you know
• 40:09
  Speaker 2: your privileged enough to treat you know, any of these
• 40:12
  Speaker 2: guys that, yeah, you need to have a real appreciation
• 40:17
  Speaker 2: for the amount of time and dedication and that they've
• 40:21
  Speaker 2: put into what they're doing as this to be a
• 40:25
  Speaker 2: major focus of their life. And you develop a you know,
• 40:30
  Speaker 2: real respect and for for everything that you do and
• 40:36
  Speaker 2: every bit of advice you give them, you all you
• 40:39
  Speaker 2: you take it so much more personally and seriously, you know,
• 40:44
  Speaker 2: and so because you know, you see, it's not just
• 40:48
  Speaker 2: a past pastime, you know. And and but the other
• 40:52
  Speaker 2: side of the coin is when I look at some
• 40:55
  Speaker 2: of these guys that what got them there I see
• 40:59
  Speaker 2: traces of all the work that they did from when
• 41:02
  Speaker 2: they were you know, a young kid, a growing athlete,
• 41:07
  Speaker 2: an athlete that still had open growth plates, and so
• 41:09
  Speaker 2: they completely changed forever the shape of their shoulder or
• 41:12
  Speaker 2: their elbow because because they started to practice, not only compete,
• 41:17
  Speaker 2: but practice their sport year round, and they started to
• 41:20
  Speaker 2: do things that they saw that their adult professional heroes
• 41:25
  Speaker 2: were doing, like throw a heavy ball in order to
• 41:28
  Speaker 2: improve their performance. And these kids started to do the
• 41:32
  Speaker 2: same thing that their heroes were doing, but they were
• 41:34
  Speaker 2: doing it with open growth plates on immature skeletons that
• 41:39
  Speaker 2: could still change their shape, and who knows what would
• 41:43
  Speaker 2: happen once that happened. Well, we're starting to see what
• 41:46
  Speaker 2: happens now, yeah, you know it. We're seeing the injuries
• 41:50
  Speaker 2: that the whole thing was set in motion by the
• 41:54
  Speaker 2: changes that they made in their skeleton when their growth
• 41:56
  Speaker 2: plates were still open that when they were doing that,
• 41:59
  Speaker 2: all the all of this repeated trauma without the ability
• 42:02
  Speaker 2: to recover. So I think that the biggest thing that
• 42:06
  Speaker 2: what fans don't see is everything that is taken this
• 42:11
  Speaker 2: person physically to get there for the fan to be
• 42:15
  Speaker 2: able to go and cheer them on and watch what
• 42:19
  Speaker 2: they do and be amazed at how they're able to
• 42:22
  Speaker 2: do it.
• 42:23
  Speaker 1: You know, last question for you, Neil. You know, last
• 42:26
  Speaker 1: time we were together, I feel like I'm a name dropping.
• 42:30
  Speaker 1: Arnold Schwarzenegger was telling me stories about how you worked
• 42:33
  Speaker 1: on him, how he and Sylvester Stallone passed in the
• 42:38
  Speaker 1: recovery room. You've worked on everybody, from Tom Brady to
• 42:42
  Speaker 1: Kobe Bryant. When you take a look at these athletes,
• 42:46
  Speaker 1: does it ever occur to you just who they are
• 42:51
  Speaker 1: and do you treat them any different than the you know,
• 42:55
  Speaker 1: the high school kid that comes in off the street.
• 42:58
  Speaker 1: One of the questions I always ask doctor is, uh,
• 43:01
  Speaker 1: doctors like you superstars? How could somebody get to you?
• 43:06
  Speaker 1: Are you accessible to to them the same way you
• 43:09
  Speaker 1: are to with Tom Brady?
• 43:12
  Speaker 2: Yes, the answer to that is yes, you know it. Uh,
• 43:18
  Speaker 2: I can, I can. I can't run a cove conveyor belt.
• 43:23
  Speaker 2: I can't see you know, a hundred patients today. I
• 43:28
  Speaker 2: can't operate on ten patients a day because it's just
• 43:33
  Speaker 2: because you know, the the amount of focus and attention
• 43:40
  Speaker 2: and follow up that I have to pay to uh,
• 43:46
  Speaker 2: to one of these athletes is is so time consuming
• 43:51
  Speaker 2: the and it and I I I have to look
• 43:54
  Speaker 2: at every MRI scan myself. I I I need to
• 43:58
  Speaker 2: see it in my head before I even consider operating
• 44:01
  Speaker 2: on it. And I already have to see the operation
• 44:04
  Speaker 2: in my head, you know, a dozen times before I
• 44:07
  Speaker 2: actually do the procedure. And so you know, I I don't.
• 44:12
  Speaker 1: I can't.
• 44:13
  Speaker 2: I can't see the volume of people. So the answer
• 44:17
  Speaker 2: is yes, but you know, it may take me a
• 44:22
  Speaker 2: little time to be able to see somebody. But you know,
• 44:27
  Speaker 2: but because of the nature of my practice, I can't.
• 44:31
  Speaker 2: I can't treat somebody one way the way I just
• 44:33
  Speaker 2: described it and be so intimately involved with the details
• 44:37
  Speaker 2: and spend the time in their recovery and rehab and everything,
• 44:41
  Speaker 2: and do that for one person and pick and choose
• 44:45
  Speaker 2: who I do that for and who I sort of
• 44:47
  Speaker 2: phone it in for. I I can't do that. And
• 44:49
  Speaker 2: so what's happened to me over the years is that
• 44:52
  Speaker 2: I treat everybody the same. And and I actually, you know,
• 44:57
  Speaker 2: I found out a long time ago that it's the
• 45:01
  Speaker 2: guy that hasn't made it yet. It's the young kid
• 45:04
  Speaker 2: that still need has something to prove, that probably needs
• 45:09
  Speaker 2: what I do even more than somebody like a Kobe
• 45:12
  Speaker 2: Bryant or Tom Brady who's already made it.
• 45:16
  Speaker 1: You know, hey will again so much. Thanks to doctor
• 45:24
  Speaker 1: Latrosh for taking a time out of his busy day.
• 45:28
  Speaker 1: It was at the end of the day he was
• 45:30
  Speaker 1: seeing patients, he done surgery. The fact that he took
• 45:34
  Speaker 1: time out to talk to me, I can't thank him enough.
• 45:38
  Speaker 1: Let's make sure I get all these titles and Neil
• 45:40
  Speaker 1: Latrosh is an orthopedic surgeon in sports medicine. He's director
• 45:43
  Speaker 1: of medical services for the Los Angeles Dodgers and the
• 45:46
  Speaker 1: Los Angeles Rams at the Curlan Joe Klinic associated with
• 45:50
  Speaker 1: cedar Cy and I here so much. Thanks again to
• 45:55
  Speaker 1: Neil Latrosh's team for putting that together. Thanks to Dylan Shaw,
• 45:59
  Speaker 1: our producer, for or making sure everything got scheduled properly.
• 46:03
  Speaker 1: And thanks to the Foul Territory Network to you make
• 46:06
  Speaker 1: sure you like subscribe to all those things. This has
• 46:09
  Speaker 1: been an absolutely special episode of Injury Territory. I hope
• 46:13
  Speaker 1: you enjoyed it. We'll see you next time here on
• 46:15
  Speaker 1: Injury Territory.