The Sports Docs Podcast

Overtime – Cuff Repair and the Biceps: To Kill or Not to Kill?
The Sports Docs Podcast | Overtime
Are you a biceps killer? Or do you prefer to leave a normal-appearing biceps tendon alone during rotator cuff repair?
In this episode of Overtime with The Sports Docs, Dr. Ashley Bassett and Dr. Catherine Logan tackle one of the longstanding debates in shoulder surgery: Should surgeons routinely release the long head of the biceps tendon during rotator cuff repair, even when the tendon appears completely normal?
We review a prospective, multicenter randomized clinical trial published in the May 2025 issue of The Journal of Bone and Joint Surgery (JBJS) titled “Preservation Versus Release of Normal Long Head of Biceps Tendon in Repair of Isolated Stage-1 Supraspinatus Tears.”
Conducted across 13 centers in France, this study compared biceps preservation with biceps release (tenotomy or tenodesis) in patients undergoing arthroscopic repair of isolated, minimally retracted supraspinatus tears.
Key Findings
Better functional outcomes with biceps release: At two years, patients undergoing biceps release demonstrated significantly higher Constant-Murley scores (86.8 vs. 82.9) and improved ASES scores compared with those undergoing preservation.
Higher rates of clinically meaningful improvement: 97% of patients in the release group achieved the minimal clinically important difference in Constant score, compared with 88% in the preservation group.
Fewer functional failures: Only 3% of patients undergoing biceps release had a Constant score below 70, compared with 15% in the preservation group.
Fewer reoperations: Four patients in the preservation group required subsequent surgery to address symptomatic biceps pathology, compared with zero in the release group.
Similar rotator cuff healing rates: Ultrasound demonstrated comparable cuff healing between groups, suggesting the functional differences were not attributable to improved tendon healing.
The tradeoff? Popeye deformity: Biceps release was associated with a higher incidence of cosmetic deformity.
Tenotomy versus tenodesis: Subgroup analysis demonstrated no significant differences in functional outcomes between the two release techniques.
What Does This Mean for Clinical Practice?
Does this study justify routinely performing a biceps procedure during rotator cuff repair, even when the tendon looks healthy?
Ashley and Catherine discuss the implications of these findings, including the possibility of occult biceps degeneration, the clinical significance of relatively modest differences in outcome scores, and whether prophylactic biceps treatment may reduce persistent symptoms and future surgery.
They also explore why shared decision-making remains essential, particularly for younger athletes, manual laborers, and patients concerned about cosmetic deformity, cramping, or postoperative strength.
Our Takeaway
This study provides compelling evidence that releasing a normal-appearing long head of the biceps tendon during repair of an isolated stage-1 supraspinatus tear may improve functional outcomes and reduce subsequent biceps-related surgery.
However, statistically significant differences do not always translate into substantial clinical improvements for every patient. Individual patient goals, activity demands, cosmetic concerns, and surgeon experience should continue to guide treatment decisions.
The bottom line: A normal-looking biceps tendon may not always be a normal-functioning biceps tendon. This study adds important evidence to the ongoing debate over preservation versus release during rotator cuff repair.
Article Discussed
Preservation Versus Release of Normal Long Head of Biceps Tendon in Repair of Isolated Stage-1 Supraspinatus Tears.
The Journal of Bone and Joint Surgery (JBJS), May 2025.
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In Part II of our conversation with Dr. Ken Hunt, orthopaedic foot and ankle surgeon at the University of Colorado, we explore two important diagnoses that can complicate ankle injuries: syndesmotic injuries (high ankle sprains) and osteochondral lesions of the talus (OLTs).
This episode of The Sports Docs Podcast is brought to you by BraceLab. Whether you are recovering from an injury, managing everyday discomfort, or just trying to stay active and move confidently, BraceLab has you covered with high-quality, innovative support solutions. 
We’ll tell you a bit more about how they are changing the game for ankle instability later in the show, but for now, you can learn more at BraceLab.com.
For free samples, email samples@bracelab.com and mention The Sports Docs.
We begin with the anatomy and biomechanics of the distal tibiofibular syndesmosis, highlighting how high ankle sprains differ from traditional lateral ankle sprains in their mechanism, clinical presentation, and recovery. Dr. Hunt discusses the importance of distinguishing syndesmotic ligament injury from true mechanical instability, the role of physical examination and advanced imaging, and when surgical stabilization is indicated.
We then review the evolution of syndesmotic fixation, including the transition from traditional screw fixation toward dynamic suture-button constructs such as TightRope. We discuss the evidence supporting suture-button fixation, including improved functional outcomes, lower rates of implant removal, and reduced malreduction rates in some comparative studies.
Next, we shift our focus to osteochondral lesions of the talus, an important consideration in athletes with persistent deep ankle pain, swelling, or mechanical symptoms following an ankle sprain. Dr. Hunt shares his approach to diagnosis, including the complementary roles of MRI and CT, and explains how lesion stability, size, location, subchondral bone involvement, and prior treatment influence management.
We explore the expanding surgical treatment options for talar cartilage injuries, from arthroscopic debridement and bone marrow stimulation to osteochondral grafting and emerging cartilage restoration techniques. Dr. Hunt also discusses how he approaches return-to-play decisions and the importance of evaluating more than symptom resolution alone.
Topics covered include:
High versus low ankle sprains: anatomy, mechanism, and recovery
Diagnosing syndesmotic instability with physical examination, radiographs, MRI, and weight-bearing imaging
Indications for operative versus nonoperative management of syndesmotic injuries
Syndesmotic screw fixation versus dynamic suture-button stabilization
Recognizing osteochondral lesions after ankle sprains
MRI and CT findings that guide talar cartilage treatment
Nonoperative management of stable osteochondral lesions
Arthroscopic versus open approaches to talar cartilage restoration
Bone marrow stimulation, osteochondral grafting, and emerging cartilage repair techniques
Return-to-play considerations following ankle injury and surgery
Clinical takeaway: An ankle sprain is not a single diagnosis. Successful treatment depends on identifying the injured structures, determining whether mechanical instability or cartilage damage is present, and selecting a treatment strategy that addresses the athlete's pathology and functional demands.
Join Drs. Ashley Bassett and Catherine Logan for the second half of this evidence-based discussion on modern ankle injury management.
Listen to Part I for our discussion of acute lateral ankle sprains, chronic lateral ankle instability, and contemporary ligament treatment strategies.
Find the research articles discussed in this episode and more from The Sports Docs Podcast at www.thesportsdocspod.com.

This video is about Ken HuntOn today’s episode of The Sports Docs Podcast, we’re joined by Dr. Kenneth Hunt, Professor of Orthopedic Surgery and Chief of Foot and Ankle Surgery at the University of Colorado, Director of the UCHealth Foot and Ankle Center, and team physician for University of Colorado Athletics and the Denver Nuggets.
This episode of The Sports Docs Podcast is brought to you by BraceLab. Whether you are recovering from an injury, managing everyday discomfort, or just trying to stay active and move confidently, BraceLab has you covered with high-quality, innovative support solutions. 
We’ll tell you a bit more about how they are changing the game for ankle instability later in the show, but for now, you can learn more at BraceLab.com.
For free samples, email samples@bracelab.com and mention The Sports Docs.
In Part I, we take a comprehensive look at lateral ankle sprains and chronic ankle instability. We discuss how to evaluate the athlete with an acute ankle injury, red flags that should prompt consideration of associated pathology, and when advanced imaging is warranted.
Dr. Hunt walks us through his approach to early treatment, including the role of bracing, progressive weight bearing, and rehabilitation. We discuss what makes an effective ankle brace, when athletes should continue bracing after returning to sport, and why bracing should complement—not replace—proprioceptive and neuromuscular training.
We also review the factors that may predict progression from a first-time ankle sprain to chronic ankle instability, including impaired jumping and landing ability and persistent deficits in dynamic balance.
The conversation then shifts to management of chronic instability. Dr. Hunt explains when persistent instability becomes a surgical problem and how the Broström procedure has evolved from traditional anatomic repair to modern techniques incorporating arthroscopy, contemporary anchor technology, and, in selected patients, internal brace augmentation.
We discuss:
Evaluation of the acute lateral ankle sprain
Red flags for associated ankle pathology
When to obtain MRI or other advanced imaging
Bracing during acute recovery and return to sport
Proprioception, balance, and neuromuscular rehabilitation
Risk factors for chronic ankle instability
Return-to-play considerations and the PAASS framework
Indications for surgery in chronic lateral ankle instability
Modern Broström repair
Internal brace augmentation: who may benefit and whether every Broström needs it
Part II: High Ankle Sprains & Osteochondral Lesions of the Talus
In Part II, we will continue our conversation with Dr. Hunt and turn our attention to syndesmotic—or “high”—ankle sprains and osteochondral lesions of the talus.
We examine the evolving management of syndesmotic injuries, including evidence comparing suture-button fixation with traditional syndesmotic screws. We discuss the potential advantages of dynamic fixation, including improved functional outcomes, fewer implant-related complications and hardware removals, and lower rates of malreduction.
Finally, we tackle osteochondral lesions of the talus, reviewing diagnosis and treatment options ranging from nonoperative management to microfracture, cartilage and bone grafting, and newer cartilage-restoration strategies.
Articles Discussed
Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability
American Journal of Sports Medicine, 2016
Brace for Impact: A Retrospective Analysis of the Modified Broström-Gould Procedure With and Without Internal Brace Augmentation
Cureus, 2023
Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials
American Journal of Sports Medicine, 2019
Evaluation and Management of Osteochondral Lesions of the Talus
Cartilage, 2017
Modified Broström vs Suture Tape Augmentation: A Systematic Review
Journal of Foot and Ankle Surgery, 2025
Internal Brace Augmentation Versus Modified Broström-Gould Procedure for Chronic Lateral Ankle Instability: A Systematic Review and Meta-analysis of Functional and Radiographic Outcomes
Journal of Orthopaedic Surgery and Research, 2026

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www.cloganmd.com
www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

On today’s episode of The Sports Docs Podcast, we’re discussing the 2026 Orthopaedic Journal of Sports Medicine article, “The Impact of Lateral Extra-Articular Tenodesis on Knee Range of Motion After Pediatric Anterior Cruciate Ligament Reconstruction,” by Hamad and colleagues from UCLA.
The use of lateral extra-articular tenodesis (LET) alongside ACL reconstruction continues to increase, particularly in young athletes at high risk for reinjury. While growing evidence suggests that LET can improve rotational stability and reduce ACL graft failure, questions remain about whether adding an extra-articular restraint may increase the risk of postoperative stiffness.
In this retrospective cohort study, the authors evaluated 412 pediatric ACL reconstructions, including 167 patients who underwent ACL reconstruction with LET. The primary outcome was restricted range of motion at three months, defined as a ≥5° extension deficit or ≥15° flexion deficit compared with the contralateral knee.
We discuss several key findings:
Restricted range of motion at three months occurred in 16.8% of ACLR + LET patients compared with 10.2% following isolated ACL reconstruction.
After adjustment for patient and surgical factors, LET was associated with approximately twice the odds of restricted postoperative motion.
Female sex was the strongest predictor identified, with more than four times the odds of restricted motion.
Most motion deficits involved flexion rather than extension.
Although most patients with early motion loss did not require another procedure, 4.2% of the LET group underwent manipulation under anesthesia and/or lysis of adhesions compared with 0.4% of the isolated ACL group.
We also discuss why these findings should not discourage surgeons from performing LET in appropriately selected athletes. 
Instead, the study highlights a potential trade-off between graft protection and early postoperative motion, reinforcing the importance of appropriate patient selection, careful LET positioning and tensioning, early restoration of knee motion, and close postoperative surveillance.
Finally, we review the limitations of this retrospective study and discuss how evolving LET indications, graft selection, fixation techniques, rehabilitation adherence, and surgical technique may influence these findings.
The takeaway: LET provides meaningful protection for the ACL graft in young, high-risk athletes—but surgeons and rehabilitation teams should remain vigilant about restoring motion and identifying patients who begin to fall behind early in recovery.
Article
Hamad et al. The Impact of Lateral Extra-Articular Tenodesis on Knee Range of Motion After Pediatric Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2026.
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In this special Athlete Highlight episode, we are back with Cub Swanson & Dr. Sohrab Gollogly - bringing together two sides of the surgical experience: the athlete who underwent surgery and the surgeon who performed it.
Professional mixed martial artist and UFC Hall of Famer Cub Swanson joins his surgeon, orthopedic spine specialist Dr. Sohrab Gollogly, for a conversation about endoscopic spine surgery—from the athlete’s perspective and the surgeon’s point of view.
In This Episode: Part Two
In the next episode, we’ll continue the discussion and shift our focus to postoperative recovery and return to play following endoscopic spine surgery.
What does recovery look like for a professional fighter? When can an athlete begin training again? And what does it take to get back to the highest level of competition?

Meet Our Guests
Cub Swanson
Cub Swanson is a veteran professional mixed martial artist and one of the most respected featherweights of his generation.
Swanson turned professional in 2004 and became a standout in the WEC before making his UFC debut in 2011. Known for his exciting and aggressive fighting style, he has faced many of the biggest names in MMA and has built a professional career spanning more than two decades.
He was inducted into the UFC Hall of Fame’s Fight Wing in 2022.
Outside the Octagon, Cub is a father of three and is passionate about mentoring the next generation of fighters and giving back to the sport that helped transform his life.
Dr. Sohrab Gollogly
Dr. Sohrab Gollogly is a fellowship-trained, board-certified orthopedic spine surgeon with more than 20 years of experience treating spinal disorders.
Based in Monterey, California, Dr. Gollogly specializes in minimally invasive and endoscopic spine surgery, with particular interests in motion preservation and avoiding unnecessary fusion surgery.
He completed his medical training at the University of Washington, orthopedic surgery residency at the University of Utah, and advanced fellowship training in adult spine surgery in Lyon, France, as well as pediatric spine surgery in San Diego.
Dr. Gollogly is also a founding member of the EndoSpine Academy at Balgrist University Hospital in Zurich, where he is involved in surgeon education and the advancement of endoscopic spine techniques.
Why This Conversation Matters
Endoscopic spine surgery continues to evolve, and for athletes, the potential advantages of minimally invasive approaches extend beyond the operating room.
For a professional fighter, the goals may include more than relieving pain or treating a structural problem. Motion, strength, function, recovery time, and the ability to return to a high-demand sport all matter.
By hearing directly from both the athlete and surgeon, this episode explores what happens when those goals intersect—and what the decision-making process looks like when the stakes are a professional career.

The Sports Docs Podcast
Hosted by Dr. Ashley Bassett and Dr. Catherine Logan
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