Jacksonville Jaguars’ Dr. Kaplan on Sports Injuries and the PortableConnect

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Toree: Hi there, I’m Toree McGee, and this is the Rapid Recovery Report sponsored by ROMTech, the modern technology of rehabilitation.

This is another episode in our series.  We do these live podcasts and shows every Thursday at 4:00pm Pacific and 7:00pm Eastern, and we’re talking to different guests.  We are ROMTech, in case you didn’t know, and we have a product that we’ll probably be referencing here in the podcast, so if you’re not familiar, let me just tell you about it. 

It is called the PortableConnect, and there it is right there.  Pretty cool.  It’s a high-tech recovery device that’s geared to get patients moving and on the road to recovery faster from injuries and surgeries.  If you want to learn a little bit more about it and about us, you can visit us at www.romtech.com, and follow us on the social handles that are listed below. 

NFL Orthopedic Surgeon, Dr. Kevin Kaplan

Toree: Let’s get right into it, and talk about our guest that we’ve got on the show this week.  I’m so excited.  We’ve got Dr. Kevin Kaplan who’s an orthopedic surgeon in Jacksonville, Florida.  He completed a fellowship in orthopedic sports medicine at the world renowned Kerlan-Jobe Orthopedic Clinic in LA.  Dr. Kaplan is the head team physician for the NFL Jacksonville Jaguars and he has been a physician with the team for 10 years. 

Working among innovators in the field of sports medicine, Dr. Kaplan has been trained in cutting edge arthroscopy of the shoulder, elbow, hip and knee, as well as in joint preserving reconstructing procedures of the shoulder and the elbow.  

I’m so excited.  We have the most fun here getting ready for this show to start.  This is going to be a good one, Dr. Kaplan. 

Dr. Kaplan: Thank you for having me.  It’s good to be here.  

Toree: Yeah, we’re excited.  I’m sure that the most kind of common questions that you get are Jaguars-related, so let’s kind of get started with.  How did you land the gig as the head physician of the Jacksonville Jags? 

Dr. Kaplan: I grew up in Jacksonville, born and raised here, and obviously left for college, med school residency up in New York City, out to LA for a fellowship.  When I was looking for jobs, obviously, I was looking at my hometown, and interviewed with the group I’m with now, Jacksonville Orthopedic Institute, and my partner at the time was the head team physician, and said he wanted an assistant, someone to help out, and took the opportunity, and came, and was the assistant for four years. 

Fortunately, we had a change of leadership and new general manager, and my partner had been doing it for quite some time, and they interviewed myself and two other physicians, and I was honored to get the opportunity.  I was 35 at the time, and I got the head team job, and I’ve had it since.  It’s one of those dream jobs you never think you’re going to A) take care of a professional team because they’re so rare, and B) to get to take care of my hometown team has been awesome. 

Toree: That’s incredible.  Good for you.  I feel like 35 is really young to be chosen for a position doing that. 

Dr. Kaplan: It’s humbling.  You’re in a room.  We have an NFL Physician Society meeting every year at the NFL combine, and when I look around the room, you see guys that are my mentors, Jim Bradley up in Pittsburgh and Walt Lowe in Houston, and Ella Traj in LA, and then you see the Russ Warrens and the Jim Andrews.  You’re in a room full of guys that you just read and study about, and you see at lectures.  It’s one of those things that took obviously the utmost importance in my career, and I’ve had a lot of fun with it.  Met a lot of great people, a lot of great athletes, and just being on the sideline during games is an unbelievable experience. 

Treating Sports Injuries vs. Regular Injuries

Toree: Gosh.  I can’t even imagine.  In working primarily with athletes and sports injuries in your practice, like professional or otherwise, do you treat them differently than you would like a regular injury?  Essentially, do athletes try to push themselves harder where you need to like reel them back in? 

Dr. Kaplan: It’s a great question.  Obviously, professional athletes, that’s their vocation.  When they get hurt, that can potentially change their career.  If you or I unfortunately tear an ACL or something like that, we’re not getting paid to play.  We still have other jobs and we can rehab.  There is a time component in terms of getting athletes back to play. 

Having said that, the biology of an ACL reconstruction, for instance, is no different in our best athlete and then your or I.  You still have to rely on the biology of how you treat these athletes.  You can certainly toe the line.  Once you get towards the end of a rehabilitation, the average return to play, obviously, it’s an average.  Some guys get back really quick.  Some guys get back a little bit slower, and so that all plays into how we get these guys back. 

If an injury happens at the beginning of the season, it’s pretty sure that the player has the whole season plus the offseason to get ready.  When the player gets hurt at the end of the season, then the clock is really ticking.  They get treatment maybe five, six, seven times a week, where you and I may get treatment two or three times a week. 

Toree: Sure.  With competitive edge being so important, obviously, to career athletes, how do you set yourself apart as a surgeon in order to provide that competitive edge to your players? 

Dr. Kaplan: I was taught, obviously, there’s three important A’s, being available to patients and athletes, being affable, just making sure you really take care of them, and get to know them, and then your abilities as a surgeon.  I think that the fourth A that I never really learned that I like to think is just as important is adaptability.  

This field is constantly changing.  The way I learned to do an ACL reconstruction when I started fellowship residency, I should say in 2003, is different than what I do now.  Why?  Because things have changed, technology’s improved, and I think that’s the way that you really continue to make the care for an athlete better, by being able to change with the time and adapt and give them your best, and allow them to get back quicker. 

Relating to Younger Patients

Toree: Yeah, absolutely.  I would imagine that being closer in age to some of the players, I know a lot of them are really really young, but might make your relationship a lot easier to be able to build with them versus somebody that’s out there a lot older than you being a team physician. 

Dr. Kaplan: Yeah.  It’s every year, it gets farther down.  When you ask for your date of birth, you’re like, “You were born when?”  The gray hair starts to come out.  Sometimes, they refer to me as the OG, the old-school gangster,  I don’t know.  It does help to relate.  These guys, when you look at them, they’re very big guys, but they’re but they’re still young men.  Just being able to relate and break things down and explain an injury. 

You look at these guys and they’re in their early 20s, and if you think back to when you were in your early 20s, if you’re on this huge stage, and you have a big injury and your parents aren’t around, and your friends aren’t around, you got to imagine that’s scary.  These guys aren’t going to show it, but if you really just break it down and explain things, and show them MRIs and models, it really helps to build the relationship, and then they trust you, and that goes a long way. 

Toree: Absolutely.  We had Dr. Boghosian in Southern California on our show a few weeks ago, and he brought like a little prop with him.  That was so helpful for me, and I would imagine that that’s the case when you talk to anybody who’s not in the medical field to have anything that you can sort of show them, and tell them about, even like a personal surgery that you’ve had, or something to be able to relate and make it like tangible and easy to understand. 

Dr. Kaplan: Absolutely, videos, models.  I like a patient or an athlete to be able to walk out of a room and be able to explain to a teammate or to a parent or to a friend exactly what’s wrong.  If they leave and they don’t understand, then there’s a lot of miscommunication that can happen, and that can be scary for those guys. 

Dr. Kaplan’s Range of Patients

Toree: Yeah, absolutely.  Now, outside of football players, what other kind of athletes do you typically see with injuries? 

Dr. Kaplan: A lot of the patients that I see in my office now are the crossfitters, the spartan race.  We see a lot of overuse injuries.  Everybody, at least now with COVID too, has been at home and they’re doing the Pelotons and the Tonals and the Mirrors, and so we’re seeing a lot of those overuse injuries just because people have a lot more time on their hands just to do things. 

I can tell you that when COVID started, I had a huge uptick of peck tendon tears and bicep tears.  People were at home working out, hadn’t worked out in a while, and they’re trying to crush weights like they were 20, and they’re in their 40s like myself.  I saw a lot of those injuries.  These days, people are just staying active.  

Another completely different demographic, are you familiar with pickleball?  Have you heard about pickleball? 

Toree: Yes. 

Dr. Kaplan: I see a huge number of pickleball injuries, meniscus tears, shoulder injuries, but a lot of athletes in the generation of the 60s and 70s because they’re still athletes.  It’s just a different type of athlete, are playing a lot of pickleball, and so we’re seeing a lot of those types of injuries.  It’s an interesting phenomenon seeing how all these sports develop throughout the years. 

Toree: Yeah.  I mean, it’d be interesting to talk to some of our other sports surgeons to see if they also are seeing pickleball injuries, if that’s like a Florida thing. 

Dr. Kaplan: Maybe.  It could be.  I didn’t even know what it was, and I had to look it up, and now everybody’s talking about pickleball.  It’s one of those things I got to look up and what are the rules and why are these people getting injured.  It could be a sport that they know or croquet. 

Toree: I remember looking out of my hotel room in Hawaii one year, and being like, that is pickleball out there.  I don’t know why I knew it, but I knew it.  At least it’s in Hawaii too. 

Dr. Kaplan: There you go.  Not just a Florida thing. 

Recovering from an ACL Injury

Toree: A common injury that we hear a lot about in the world of sports involves ACL repairs, which for our audience who might want to learn, it’s an important ligament that’s responsible for back and forth movement of the knee.  What are the traditional techniques that are used to heal an ACL injury? 

Dr. Kaplan: When you tear an ACL, the anterior cruciate ligament, it goes from your thigh bone to your shin bone, femur tibia.  The two bones sit up on top of each other and the ACL prevents them from shifting.  If you tear an ACL, it’s one of those ligaments that doesn’t have the ability to heal.  The MCL, which is another ligament in the knee, which is the medial collateral ligament, when that tears, that can actually heal on its own.  Doesn’t always need surgery.  ACLs, when they fully tear, they don’t have the ability to heal themselves.  

We have to perform an ACL reconstruction.  Our techniques again, like we talked about earlier, have evolved over time.  It used to be big incisions and open techniques, and now we’re doing things a lot less invasive with arthroscopy, smaller instruments, and have the ability to reconstruct the ACL, and there are different ways to do that.  

Using your own tissue, which is called an autograph, which is what I do with all of my high school, collegiate, professional athletes.  There’s other ways to do it with cadaver graphs or allografts.  That’s really kind of a surgeon preference whether or not you use your own tissue or you use a cadaver graft.  I prefer to use a patient’s own tissue.  I just think it makes biological sense and it’s relatively not morbid to do that.

New Methods of ACL Reconstruction

Toree: Okay.  Let’s expand maybe a little bit on that because that’s really really interesting.  The technique that you’re using it’s relatively – is it new, involving like quad tendon grafts to aid in ACL reconstruction? 

Dr. Kaplan: Yeah.  The gold standard ACL reconstruction is what’s called patellar tendon.  Your patellar tendon is the tendon that goes between your kneecap.  If you look down on your knee, kneecap to your shin bone, there’s a little strip of tendon there.  You can take a little piece of the tendon, a little piece of the patella, which is the bone, and a little piece of bone from the tibia, and that’s the gold standard and what I do in a lot of my athletes. 

The downside on doing that can sometimes create a little bit of anterior knee pain.  To avoid that, hamstring is another graft that you can use but that comes with the risk of potentially having some cramping in the back of the leg, especially when you’re doing things like running.  

The quad is the newest technique, the newest graft that we’re using.  You can take a little strip of the quad tendon which is the tendon that’s above the kneecap, and you don’t actually have to take a full-thickness area of the tendon.  You can just take a little strip of it, so it keeps the continuity of the quadricep intact.  I think that’s very important because in the end, the ACL, that tendon will become a ligament. 

What determines when an athlete, whether it’s a weekend warrior or a professional athlete, to get back playing is the strength of the muscles in the front of the quad, the extensor mechanism.  That’s usually what takes the longest to come back.  I think that’s a benefit of trying this new graft which is a quad. 

Toree: Okay, that’s really interesting.  Is there a particular reason other than it being new, and what have you seen to make it the way that you prefer to do it, versus like another technique? 

Dr. Kaplan: I think it’s low morbidity.  Patients are able to move quicker, less anterior knee pain.  The graft is very thick.  It’s strong.  It’s sturdy.  With the techniques that some of the companies – I don’t have any kind of business interest in it, but Arthrex is the company that I use for their quad graphs, the technique is very straightforward. 

When you look at the difference between a cadaver graft and a patient’s own tissue, I just think it’s a better option as all these athletes are staying more active.  If someone had an ACL tear and you just needed it for stability, but they’re not going out and doing a spartan race or crossfit or even pickleball, it may not be as important.  The graft to me, the biology of a patient’s own tissue, healing to their own tissue is extremely important.  That’s why I like this.  

I’ve been switching a lot of my older patients.  When I say older, my demographic, 30s, 40s, 50s, to trying to use a quad graft. 

Toree: Yeah, I mean that’s what I was going to say.  It makes sense in my non-medical person brain that your own tissue would be the best case scenario.  This probably doesn’t happen and I really don’t know, but you hear about people having to have surgeries and like people’s bodies rejecting things that didn’t come from themselves.  I’m sure with this sort of thing, you’re not necessarily seeing bodies reject other tissue but I would imagine that it would just adapt a lot better if it’s your own tissue. 

Dr. Kaplan: Yeah, you’re right.  I mean the rejection rate is super low and obviously it’s not typically like an infection risk.  There’s a feel to the knee.  There’s a stability factor.  There’s a strength.  Obviously, you’re taking something that’s a cadaveric tissue, a cadaver graft, which works very well, don’t get me wrong, but it’s frozen graft.  Obviously, it’s sterilized and it’s clean, and the infection risk is low, but then you think about exactly what you said.   

These are fibers in your own body.  They’re live.  They’re active.  They’re healthy.  It just inherently makes more sense to me.  Everybody has a difference of an opinion but I like that idea, I like that concept, and I’m trying to do as many of those as I can and fewer of the cadaver graft.  

Toree: Yeah, well, that makes sense to me too, if that means anything to you. 

Dr. Kaplan: I hope you’ll never tear your ACL.

Preventing ACL Injuries

Toree: At the end of the day, what are your thoughts on preventing injuries like this?  Can it be prevented?  When do you eventually decide that surgery is the only answer to correct the tissue? 

Dr. Kaplan: That’s a great question.  There are a lot of studies looking at ACL prevention type programs, and I think that’s extremely important.  We try to get the high school kids in the area.  I even had a conversation with a colleague about trying to get some sort of program for all the local high schools because the numbers are staggering.  I do probably close to 150 or so ACLs a year, and the numbers just keep increasing because the athletes are younger, they’re playing at high levels year-round.  The longer you play and the less you train in the off season, the higher the chance to have an injury.  ACL prevention programs, without question, should be part of every high school, collegiate, pro athlete’s normal program.  

The unfortunate thing is what you said.  Once it’s tears, it doesn’t just heal.  In order to get back playing and doing the things that they want to do, cutting, pivoting, twisting.  I mean you could live your life without an ACL if you were just going forward and backwards. 

Toree: Sure. 

Dr. Kaplan: As soon as you put your foot on the ground to turn and twist, that’s when your knee can buckle, and that’s obviously an important thing for most athletics. 

Dr. Kaplan’s Patients on the PortableConnect

Toree: Yeah, absolutely.  All right, now we’re not going to let you get out of here without talking about at least something ROMTech.  Can you describe the outcomes in your patients recovery prior to being introduced to the PortableConnect versus now? And what difference are you seeing with patients that are on the PortableConnect?

Dr. Kaplan: It’s been a great addition in terms of my post-operative protocols.  The patients love it.  They move very quickly.  I try to get patients in therapy as quick as possible but now this is the day of, the day after surgery, and they get their knee moving. 

I think one of the things that you and I alluded to earlier is what is that edge, what is the most important thing.  I think getting the quad fired early, and what I mean by that is the quadricep muscle, getting it to contract early, I think is paramount in the end.  You see a lot of quadricep atrophy and muscle weakness, and that happens so quickly after surgery. It’s sometimes unbelievable. 

I think a competitive edge here is you’re getting patients on a machine that not only move for them but then gives them that ability to start contracting their muscles.  That whole mind-muscle connection is very understated in rehabilitation because I see some patients that come back, this is obviously before I was doing ROMTech, and they just couldn’t get their muscle to fire.  They couldn’t do it.  I know they could but for some reason, whatever, that mind-muscle connection which I think is very important wasn’t there. 

Now, I’m seeing these guys come back.  They’ve been on ROMTech.  They’re moving.  They look good.  Their knees fully extending and they can fire their quad.  The quicker you fire your quad, the quicker the muscle is going to come back.  In the end, what mitigates injury risk and what allows the patient to get back to playing, it’s not the ACL, because those are going to heal with our autografts and they’re going to become a ligament but what it really, is do they have the strength in their leg to protect them from further injury.  This is the competitive advantage that we need in our patients to get them moving quicker, so I love it. 

Toree: Yeah, well, that’s awesome.  I never thought about anything having to do with like a muscle and mind kind of connection but it makes total sense, especially if you’ve been favoring your injury before you have surgery.  That’s like trying to limit the movement, and then after surgery, you’re assuming, oh my gosh, it’s going to hurt if I move it, and even that might make it so that you just don’t want to deal with it at all. 

Dr. Kaplan: Absolutely.  It’s a shutdown.  You have the injury.  It scares people.  You feel it pop.  Your knee swells.  Your quad shuts down.  You try to rehab them a little bit, then you put them through a traumatic event which is surgery, even though it’s precise, and then you’re back in that cycle again.  If we can break that cycle, I’m really interested to find. 

Obviously, I’m new using the ROMTech over the last several months, but every ACL gets it now, and it has the opportunity to.  The reviews are great.  Patients in the early clinical outcome, we have some studies that were obviously I’m going to hopefully help with the study coming up on ACLs.  I think they’re going to be interesting in terms of how quickly that quad tone returns and how quickly these guys are able to show that they’re functionally better because they’re starting much quicker with a better machine. 

Toree: Yeah, absolutely.  Well, this has been super informative for me, and I hope everybody else.  I hope it was as much fun for you as it was for me to be here with us today. 

Dr. Kaplan: I truly enjoyed it.  I got to bring a model next time.  Now, I realized I didn’t bring a model. 

Toree: Yeah, we won’t be one-upped by one of our others.  We’ll get you back on, so you can redeem yourself, but this was awesome.  Thank you, Dr. Kaplan, so much.  We appreciate it. 

You can find Dr. Kaplan online at Kevinkaplanmd.com.  You can follow him on twitter @kevinkaplanmd and harass him a little bit and tell him how awesome he was on our podcast. 

Dr. Kaplan: Thanks for having me.

Toree: Yeah, of course.  Well, thanks so much for taking the time.  Thank you to everyone that was watching us today.  If you have any questions, comments, concerns, go ahead and drop them in the comment section.  We read everything.  If you have suggestions for moving forward, any guests you’d like to hear from, let us know.  You can always check us out at www.romtech.com and follow our social channels.  Thank you guys so much, and we’ll see y’all next time.

Disclaimer: The content discussed on this program is often medical in nature and is used for informational purposes only.  No content discussed should be taken as medical advice.  Please consult your healthcare professional for any medical questions.

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