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Zimmer Biomet launches something new outside the US, a subchondroplasty procedure for bone marrow lesions

Zimmer Biomet Announces the International Release of the Innovative Subchondroplasty® Procedure (press release)

WARSAW, Ind., Feb. 7, 2017 /PRNewswire/ — Zimmer Biomet Holdings, Inc. (NYSE and SIX: ZBH), a global leader in musculoskeletal healthcare, announced today the international release of the Subchondroplasty® (SCP®) Procedure. The Company received CE Mark approval for the commercialization of its SCP Procedure to facilitate distribution in the European Union (EU) and other countries that recognize the CE Mark. Zimmer Biomet also received approval for distribution in Canada, Singapore, Malaysia and Hong Kong.

The SCP Procedure is a minimally invasive outpatient intervention that addresses the defects associated with subchondral bone marrow lesions (BMLs). Diagnosed using an MRI and physical exam, BMLs are associated with stress fractures or micro-fractures of the bone adjacent to the joint. Left untreated, these defects may lead to cartilage degeneration, limited function, pain and a greater risk for joint deterioration.
SCP is performed to repair chronic BMLs by filling them with AccuFill® Bone Substitute Material, a porous injectable calcium phosphate (CaP). The bone substitute is then slowly resorbed and replaced with healthy bone, repairing the bone defect.
The procedure is usually performed along with arthroscopy for visualization and treatment of findings inside the joint. In some cases, an open or mini-open procedure is necessary for access to the defect.
“The Subchondroplasty procedure addresses a previously unmet need in my practice for patients with chronic and painful bone marrow lesions,” said Dr. Christopher Baker, orthopaedic surgeon at Florida Orthopedic Institute in Tampa, Fla. “These patients no longer benefit from conservative treatment, yet are not ready for total joint replacement surgery.”
Initially used only in bone defects of the knee, the SCP Procedure has been successfully performed in other areas including bones of the foot, ankle and hip. Zimmer Biomet now owns 36 patents and eight trademarks in this area, with numerous others still pending.
“The international release of the Subchondroplasty Procedure is a major milestone for our company and for patients with chronic bone marrow lesions,” said David Nolan, Zimmer Biomet Group President, Biologics, Extremities, Sports Medicine, Surgical, Trauma, Foot and Ankle, Office Based Technologies and Zimmer Biomet Signature Solutions. “The procedure offers a tool that fills a gap in the patient treatment algorithm for the surgeon. We are eager to begin our international commercial launch.”
For more information on the SCP Procedure, please visit www.subchondroplasty.com.
About Zimmer Biomet
Founded in 1927 and headquartered in Warsaw, Indiana, Zimmer Biomet is a global leader in musculoskeletal healthcare. We design, manufacture and market orthopaedic reconstructive products; sports medicine, biologics, extremities and trauma products; office based technologies; spine, craniomaxillofacial and thoracic products; dental implants; and related surgical products.
We collaborate with healthcare professionals around the globe to advance the pace of innovation. Our products and solutions help treat patients suffering from disorders of, or injuries to, bones, joints or supporting soft tissues. Together with healthcare professionals, we help millions of people live better lives.
We have operations in more than 25 countries around the world and sell products in more than 100 countries. For more information, visit www.zimmerbiomet.com or follow Zimmer Biomet on Twitter at www.twitter.com/zimmerbiomet.
Cautionary Statement Regarding Forward-Looking Statements
This news release contains forward-looking statements within the meaning of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking statements include, but are not limited to, statements concerning Zimmer Biomet’s expectations, plans, prospects, and product and service offerings, including new product launches and potential clinical successes. Such statements are based upon the current beliefs and expectations of management and are subject to significant risks and uncertainties that could cause actual outcomes and results to differ materially. For a list and description of some of such risks and uncertainties, see our periodic reports filed with the SEC. These factors should not be construed as exhaustive and should be read in conjunction with the other cautionary statements that are included in Zimmer Biomet’s filings with the SEC. We disclaim any intention or obligation to update or revise any forward-looking statements, whether as a result of new information, future events or otherwise, except as may be set forth in our periodic reports. Accordingly, such forward-looking statements speak only as of the date made. Readers of this news release are cautioned not to place undue reliance on these forward-looking statements, since, while management believes the assumptions on which the forward-looking statements are based are reasonable, there can be no assurance that these forward-looking statements will prove to be accurate. This cautionary statement is applicable to all forward-looking statements contained in this news release.

To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/zimmer-biomet-announces-the-international-release-of-the-innovative-subchondroplasty-procedure-300403563.html
SOURCE Zimmer Biomet Holdings, Inc.

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Hot Startups (just my opinion)

What are the hot startups in Orthopedics right now?
People ask me this question all the time. Orthopedic startups have come and gone for decades. I have a good eye for seeing the ones that are positioned for big disruption and success. This skill served me well in joining Ellipse Technologies just before the startup took off in 2012.
I believe in the 12 startups listed below. These startups are innovating, thinking BIG and taking chances. (This list is 100% my opinion, no one is paying me.)

#1 TracPatch (Sacramento, CA) – Category: Smart Devices

TracPatch is actually a startup within an established orthopedics company, Consensus Orthopedics has been making total joints for over 20 years. Consensus… great work for thinking outside the box on how to improve total joint outcomes. TracPatch is a revolutionary device empowering at-home patient recovery and remote monitoring for effective managed care. With a focus on evidence-based medicine, TracPatch is changing patient care and the future of orthopedics. https://www.tracpatch.com/

#2 Trice Medical (Malvern, PA) – Category: Joint Diagnostics

Trice has a greatly disruptive product, an instant MRI in the doctors office for $450. Patients get an instant diagnosis. A clinical trial will study the diagnostic arthroscopy in the physicians office using a needle with a camera and light source. They are just getting started. Their second generation Mi-Eye is fast and simple as a needle biopsy and the image is great. Raised $18M in Series B and held the first-ever National Sales meeting in 2017. They have a CPT Codes for Diagnostic Arthroscopy. Watch Trice!
An Orthopedics Startup is quietly dominating Dynamic Imaging
http://www.tricemedical.com/

#3 Augmedics (Israel)
Israel-based Augmedics, founded in 2014, created a surgical technology that overlays spinal information on the spine of a patient via a headset.
The AR display combines the digital and physical worlds to effectively allow surgeons to look underneath a spinal patient’s skin. It’s the closest thing you can find to X-ray vision in the real world.
Like the AccuVein systems, Augmedics’ xvision allows users to view the anatomy of a patient without incisions, which enables them to perform more procedures externally or through minimally invasive surgeries.
Billed as “see through surgery,” the xvision system employs transparent AR displays from Lumus, a company that makes many of the see-through AR lenses for high quality commercial headsets.

#4 In2Bones Global (Memphis, TN) – Category: Extremities

In2Bones is on fire! Starting in August 2016, the company completed a consolidation merger with its French subsidiary, In2Bones, SAS (Lyon, France) to form In2Bones Global, Inc headquartered in Memphis, TN. Since the merger, the company has launched several innovative products including the NeoView® PEEK Distal Radius Plate, the NeoSpan® SuperElastic Compression Staple, the Reference Toe System™, AlloAid® PIP, AlloAid® Nail, the CoLink™ Forefoot Plating System, the 5MS™ 5th Metatarsal Fracture Repair System and the CoLag™ Compression Screw System.The CoLag™ Screw represents an entirely new concept in orthopaedic bone fixation.Almost nothing has happened in orthopaedic screw design in the past 25 years.The CoLag™ screw with its “compressive stability” feature highlights the true game changing design work of In2Bones.As is true with all In2Bones implants, the CoLag Screw is providedsterile, UDI compliant and traceable.In2Bones is growing and advancing the science within the extremity market.It is a company to watch!www.i2b-usa.com

#5 ActiveProtective (Philadelphia, PA) – Category: Trauma

AP is trying to solve the coming epidemic of fragility hip fractures as the baby boomers move into their 8th decade. AP has developed a wearable belt that deploys an airbag when a fall is detected to help prevent hip fractures in older adults. They are focusing on a consumer play in the personal safety category (translation – no FDA). Huuuuuge market, a small team, a recently closed $2.6M seed round and a Series A round, and will complete their first pilot in 2017. Watch the Ted Talk (5 mins)
These guys are ones to watch.
http://activeprotective.com/

#6 EnHatch (Hoboken, NJ) – Category: Software

Enhatch is developing AI for the medical device industry focused on improving planning, logistics, and education. Their system can actually predict implant sizing from plain 2D x-rays.
From the website: At Enhatch, we are building a platform for the Enterprise to build better and stronger relationships with their customers that starts before the very first pitch. When you are selling a complex product, like medical devices, jet engines or the like, there are hundreds of touch points with a potential customer before they decide to buy. Many of those interactions are supported by employees who do not have the word sales in their title. Enhatch has the technology to speed up your sales cycle and close more deals by making every employee an advocate for the customer.
In 2015, Enhatch acquired Surgisoft, the most advanced medical device inventory management solution in the industry. Since then, Enhatch has built the industry’s most comprehensive Patient-Driven Technology™ platform enabling device manufacturers and sales teams to easily access the most relevant education materials, patient-specific planning software, inventory controls, sales management tools, and financial reporting.
https://www.enhatch.com/

#7 ReJoint (Milan, Italy) – Category: Total Joints

ReJoint, an entrepreneurial group in Italy is challenging the status quo. This is the first startup to bring together all of the latest technologies for a better TKA product and service. ReJoint is leveraging AI + 3D printing + wearables. They are partnering with Enhatch for the Fit2Kit algorithm. ReJoint has a library of thousands of sizes for each patient (any combination of lateral and medial geometries), but in the end, only one (the perfect fit) is shipped to the surgery. Think no-overhand or under-hang for femoral and tibial bone coverage. First-in-man surgeries are scheduled for early 2019. https://www.rejoint.life

#8 The NextStep Companies (Akron, OH) – Category: Total Joints

Randy Theken, known as the founder of Theken Spine, is a young serial entrepreneur that you have to take seriously. He has just gone “all in” on additive manufacturing. He’s created three complementary companies – NextStep Arthropedix, NextStep Ideas, and Slice Manufacturing Studios – that will deliver disruptive 3D printed technology in total joints. Randy claims, “Within five years, I intend to be able to make the claim: NextStep is the largest medical device manufacturer producing implant devices, using 3D printing technology.” Still pretty stealthy. Stay tuned. For more insight read – A peek into serial entrepreneur Randy Theken’s new venture, NextStep

http://www.theken.us/

#9 CyMedica Orthopedics (Phoenix, AZ) – Category: Sports Medicine

CyMedica is converging two technologies in sports medicine. Think brace + muscle stimulation in a convenient, app-controlled muscle activation. These guys just closed $6M and have a fresh 510(k) clearance.

The e-vive system provides wireless, app-controlled muscle stimulation therapy individualized for each patient’s comfort and convenience, E-vive helps keep patients engaged with their rehab by tracking their progress and allowing data sharing with clinicians.
http://www.cymedicaortho.com/

#10 OrthoSpace (Caesarea, Israel) – Category: Sports Medicine [ acquired by Stryker ]
There are few good options for patients with massive rotator cuff tears. Enter OrthoSpace. They have created a biodegradable balloon that acts as a spacer or bursa between the acromion and the humeral head. The InSpace balloon creates a physical barrier between tissues in the subacromial space. This low invasive procedure just takes a few minutes. OrthoSpace raised $7M last Christmas. OrthoSpace is selling in Europe and enrolling in a US clinical study.

http://orthospace.co.il/

Surgery Animation

#11 Treace Medical (Ponte Vedra Beach, FL) – Category: Extremities

Bunion deformity surgery has a bad rap. Given the vast majority of surgical treatments are “metatarsal osteotomies” with published recurrence rates as high as 78%, it isn’t hard to see why! While osteotomies by nature address only the “symptom” of the bunion, Treace Medical has developed a game-changing surgical treatment, called the “Lapiplasty procedure”, designed to reproducibly correct the multi-plane bunion deformity at its root cause. The company believes Lapiplasty will change the negative stigma of bunion surgery by dramatically reducing recurrence rates and improving the mechanics and function of the affected toe. Over the past year the Lapiplasty procedure has gained rapid clinical adoption and was recently awarded a broad method patent. A large neglected market, a disruptive therapy, plus an “A-list” board of directors with a track record for home runs, puts this one on my radar.

#12 Green Sun Medical (Fort Collins, CO) – Category: Spine
These guys have developed a smart brace for scoliosis for children. Goal is to reverse the scoli forces as the kid grows, to have a more comfortable brace that kids will actually wear, and to avoid surgery. Currently in clinicals.

Suggest a hot startup that I missed – [email protected]

A peek into serial entrepreneur Randy Theken's new venture, NextStep

Entrepreneur Randy Theken’s next step is as hectic as ever (Crains Cleveland)

Selling three spinal implant companies for $200 million just wasn’t enough for Randy Theken.
So he started three new companies, hired 25 people and bought a 3-D printer that can make things out of titanium.
Now he’s about to start building a highly automated manufacturing plant in Akron. It’ll be right next to the Theken Terminal — a former airport terminal that houses the so-called “NextStep” family of companies.
The $12 million plant will serve as the center of operations for one of his new companies, NextStep AM, which stands for “additive manufacturing.”
That company already is making 3-D printed titanium parts for Theken’s new medical implant company, NextStep Arthropedics, but it’s also talking to other potential customers, including SpaceX, which designs, manufactures and launches advanced rockets and spacecraft.
NextStep Arthropedics plans to make some parts for the ultra-ambitious spacecraft manufacturing company, which is led by PayPal cofounder Elon Musk, but it has yet to finalize a formal agreement.
Theken (pronounced “taken”) spent $1.2 million on his new Arcam 3-D printer.
Why? Through ebeam sintering, it can create titanium objects in almost any shape.
For example, Theken held up a hip implant that NextStep Arthropedics plans to release early next year, assuming it wins approval from federal regulators.
The top of the dome-shape device looks like a metal honeycomb. That scaffolding helps the patient’s existing bone grow into the device.
“It’s impossible to machine this cup using standard, conventional machining equipment. Cannot be done,” said Theken, who added that the company also plans to make other joint implants.
His third new company is a business accelerator called NextStep Ideas. Like other accelerators, the company would provide office space and mentoring to startup companies in exchange for a “small equity stake” in those businesses, Theken said.
NextStep Ideas has already had conversations with about a half dozen companies, including a few that were not in the medical industry. It has yet to accept applicants, Theken said, adding that the company is still developing its evaluation method.
Theken believes that he and his team — half of whom have previously worked for him — can provide young companies with a lot of advice and services. They certainly have some experience.
Theken formed his first medical company, a mechanical testing and regulatory consulting firm called Theken Orthopaedic, in 1992. In the late-1990s, he started making his own medical implants: First he developed spine fixation screw systems through a company called Theken Spine, and a few years later he started Theken Disc, which developed discs designed to be implanted in the spine.
In 2005, he bought another company, Therics, which made synthetic bone products.
All that work paid off big time: In 2008, he sold the three product companies to Integra Life Sciences for $200 million.
He stayed on board with Integra’s spine division for two years. Afterward, he took a three-year hiatus from the medical industry.
Theken kept busy, though. He bought a 40% stake in a Chicago-based acne-treatment company called Neaclear, and he bought a similar stake in another business in the assisted living industry. And he attended to all sorts of personal things he had put on the backburner.
“When you’re waking up every day and all you’re focused on is all these businesses, you find out how much other stuff you didn’t get done,” he said.
Just as his noncompete agreement was about to end, however, he had a conversation with Gregg May, a sales and marketing executive who had left Integra and gone on to work for another medical implant company.
“He goes, “I’m working 80 hours a week. It would sure be nice, if we’re going to work this hard, to do it for ourselves.’ That began the conversation,” Theken said. “ “Hey Randy, what are you going to do?’ ”
May serves as president of NextStep Arthropedics. Another alumnus of Theken’s previous companies, Jeff Lietzke, serves as in-house counsel, and he’s president of NextStep Ideas.
About a dozen executives and employees who worked for Theken’s previous companies and Integra ended up joining the NextStep companies.
Theken’s timing was good: He started forming the new businesses in 2013, right around the time that Integra moved its Northeast Ohio operations to California.
The 3-D printing company is scheduled to have its new 30,000-square-foot manufacturing plant up and running early next year, but don’t expect NextStep AM to hire large numbers of new employees when that happens.
Humans will move parts from one station to another, but robotic arms and other automated equipment will take care of the rest of the manufacturing process.
They’ll also be inspected, cleaned and packaged by automated equipment.
However, Theken is planning to hire seven more people who previously worked for him: He plans to start yet another company, which will develop implants for foot, ankle, hand and trauma injuries.

A Q&A with Bioventus about their biologics business

The Biologic Shift (ODT Mag by Sean Fenske)

While I’ve touched on the growing field of biologics within the orthopedic industry (most recently observed during my trip to the NASS annual meeting in Boston last year), I haven’t had too many opportunities to speak with the providers of these innovative offerings. As such, while attending the NASS event, I was sure to meet up with a representative from Bioventus—a company that provides these more natural-based alternatives exclusively.
Although I’ve spoken with Bioventus in the past, this was my first introduction to the Surgical division. To address the questions I had regarding this division and its offerings for the spinal sector, Steven Moore, a senior product manager with Bioventus Surgical, was kind enough to take time out to address my queries. In this interview, Moore shares his insights on the company, the biologics offerings, and what he expects in the near future.
Sean Fenske: Can you please provide a bit of background information on Bioventus?
Steven Moore: Bioventus was established in 2012, spun out of the biologics division of Smith & Nephew. The company is privately held and headquartered in Durham, N.C., with its international headquarters in Hoofddorp, The Netherlands. Bioventus also has offices in Memphis, Tenn.; Newport Beach, Calif.; Australia, and Canada, as well as a research and development site in Boston.
The company has two product portfolios for orthobiologics—Bioventus Active Healing Therapies and Bioventus Surgical—which were created and continue to evolve through a combination of internal product development, product/business acquisition, and distribution agreements.
Fenske: How rapidly are orthobiologics growing within the orthopedics industry?
Moore: A recent study by iDATA Research indicated the global orthobiologics market stood at $4.3 billion in 2014, and is predicted to reach $5.9 billion in 2021.
Fenske: What’s driving the growth and/or the shift away from more traditional technologies?
Moore: Surgeons are continually looking for solutions that may provide greater patient benefit through technological advances and often look for what may be new, effective, and interesting to use in the clinic and OR. However, traditional technologies still play a prominent role due to their ability to deliver outcomes in different patient populations and may facilitate their ability to achieve cost control measures including consolidation of vendors at hospital systems and healthcare facilities. These measures have led to the closer assessment of new technologies to ensure they can reduce costs and/or achieve better patient outcomes.
Fenske: Your spine portfolio was the result of a number of acquisitions. What made these technologies particularly attractive?
Moore: The surgical business at Bioventus was started in the fall of 2014. We have pursued a strategy that would quickly give us a broad portfolio to meet the needs of both physicians and healthcare facilities to include premium and value-based offerings of allograft, cell and marrow, and synthetic solutions. We also wanted to invest in products that are differentiated and backed by clinical data, without compromising ease-of-use factors like having great handling properties.
Fenske: Are you seeking to further expand your spinal fusion fill portfolio or perhaps even seek out a biologic alternative to spinal fusion entirely?
Moore: We are always seeking products to add to our surgical orthobiologics portfolio that fit within our strategic corporate plan, meet an unmet clinical need, are backed by clinical data, and/or provide positive outcomes for surgeons and patients.
Fenske: How do your products differ from comparative technologies on the market? What’s unique about them?
Moore: We group our portfolio into three categories: allograft, cell and marrow, and synthetic. Within each category, we have a flagship offering. For allograft, it is Osteoamp; for cell & marrow, Cellxtract; and for synthetic, it is Signafuse.
Osteoamp maintains and preserves a wide array of naturally occurring growth factors found in bone and bone marrow, is supported by clinical data and positive patient outcomes, and is more cost effective than comparable offerings.
Signafuse is the only synthetic bone graft substitute on the market that combines bioglass, hydroxyapatite, and beta-tricalcium phosphate in an optimized ratio, which kick starts and supports the body’s natural regenerative healing process.
Cellxtract is a unique technology designed to reduce the dilution of peripheral blood, maximize the number of cells collected in bone marrow aspirate, and complement both our allograft and synthetic offerings.
Fenske: What do you foresee in terms of biologics for the spinal space? What’s coming in five to ten years?
Moore: We believe biologic technologies designed to fit a more minimally invasive approach, including patient specificity, will appear on the market. We also expect stem cells will continue to collect clinical data and evolve in their product iterations. In addition, Bioventus expects to launch its next generation designer bone morphogenetic protein (BMP) during this time frame.
The following video provides a look at how the company’s Osteoamp product works for spinal fusion.

– See more at: http://www.odtmag.com/contents/view_online-exclusives/2017-01-17/the-biologic-shift/#sthash.G4bchCwl.dpuf

Baseball's next miracle surgery

Baseball’s next miracle surgery (FanSided by Will Carroll)
“It’s a game changer.”
That phrase is often just hype, but when you hear it come from not one, but four of the top orthopedic surgeons in the country, it’s time to take note.
True changes in sports medicine come about once in a generation. Tommy John surgery, the arthroscope, the use of orthobiologic agents like PRP — these innovations are now part of the sports medicine landscape, and regularly help athletes come back from injuries that were career-altering or even career-ending not that long ago.
The latest new method isn’t on the drawing board; it’s in athletes already. And we’re about to see a lot more of it.
The innovation is really a product, not a surgery. It’s called SutureTape and it’s made by Arthrex, the large medical device manufacturer, after consultation with some of the top orthopedic surgeons. It’s use in surgery is called “InternalBrace.” The tape is affixed during surgery to brace a ligament or reconstruction as it heals, allowing early load and sometimes even return to play prior to complete biologic healing.
Many of the surgeons who consulted Arthrex on the development of SutureTape were on the stage at the recent Lewis Yocum Baseball Medicine Conference, run by the Kerlan-Jobe Clinic and super-surgeon Neil ElAttrache’s staff. A discussion among ElAttrache, Dr. John Conway of the Ben Hogan Clinic in Fort Worth, Dr. Orr Limpisvasti and Dr. Steven Shin of Kerlan-Jobe showed just how much potential this has.
Dr. Orr Limpisvasti is at the forefront of this research, working closely with Arthrex to develop the techniques and the best practices for this surgery. “We’re actively researching what the best ways and places to use this. Obviously, we’re always guided by the patient and getting the best result for him or her. What this technique is allowing us to do is safely putting the athlete back in the game faster while decreasing their risk of reinjury during the healing process.”
In essence, Limpisvasti’s technique is to use the SutureTape to enhance the injured ligament or tendon, weaving it into the structure. It acts as a check on the ligament, strengthening and limiting the motion. This allows a much quicker return to function, because the SutureTape doesn’t need to heal. It provides immediate strength and stability, allowing the ligament itself to heal.
What that means for the athlete is more of their most valuable resource: time. In some cases, Limpisvasti has seen the time it takes for an athlete to return to play cut in half. For a severe knee injury like an ACL tear, that could mean reducing recovery time from nine months to four. For a thumb injury, it could go from three months to four weeks. In one example, a bull rider was able to return from an elbow reconstruction in four months, not the year it typically takes.
“It’s not appropriate for everyone,” said Limpisvasti. “It needs good tissue to repair, so a lot of chronic to acute — like what we see with pitchers who wear out their elbow until it finally pops — might not be candidates. We’re learning where it can best be used.”
However, the technique is already being used on athletes. Dr. Jeff Dugas of Andrews Sports Medicine in Birmingham recently reported that he’s done 50 operations on damaged elbow ligaments. The results are almost too good, with no documented failures. By comparison, Tommy John surgery has about a 17 percent failure rate over a large population.

The procedures Dugas carried out were on the ulnar collateral (UCL) ligament in the elbow. But, unlike in Tommy John surgery, the new technique and the new material allow Dugas to repair the ligament rather than replace it.
Dugas told me he’s using the same technique first developed by Scottish surgeon Gordon Mackay, who focuses on rugby. (Several of the other doctors I spoke to mentioned Mackay as well.) Dugas has, in the past, described the surgery as “taping up the ligament,” but that doesn’t seem to fully capture it.
Dugas has worked on baseball pitchers, but not at the pro level. However, Dr. George Paletta recently used Dugas’ technique on St. Louis Cardinals pitcher Seth Maness. Maness had a partial-thickness tear of his UCL and had the surgery as an alternative to Tommy John.
Normally, the rehabilitation time after Tommy John surgery is between 12 and 14 months, though there’s been some movement on that timeline in the last few years. The return time from this new repair is expected to be around six months.
That’s a huge gain, especially considering the salaries pro players are on. Maness, a 27-year-old reliever, is hardly Matt Harvey or Stephen Strasburg in terms of value, but he was worth $1.4 million dollars last season. Cutting his rehab time in half could theoretically be worth around half a million.
Another technique that’s becoming increasingly popular involves the use of orthobiologic agents. Several pitchers, including Garrett Richards of the Angels and Masahiro Tanaka of the Yankees, treated small ulnar collateral ligament tears by using PRP (plasma rich platelet) or stem cell injections (stem cells are usually taken from aspirated bone marrow extracted from the patient’s own hip).
These injections have been used more frequently despite a lack of scientific certainty about how they actually work. It’s clear at this point the injections do no harm, but they haven’t been successful as consistently as InternalBrace.
There’s a possibility, however, the two techniques could be combined. Limpisvasti said the use of orthobiologics along with the InternalBrace would preserve both the biology and the biomechanics.
The next step is more research and development — the toughest part now is determining exactly how much tension to put in. This is easier in some areas than others. Dr. Steven Shin told me, for example, that the thumb gives a good guide for tension when it’s placed at a certain angle.
After Dr. Frank Jobe did the first Tommy John surgery, it was almost three years before he did another. We’re not likely to see that kind of gap between Maness and the next athlete. In fact, other professional and high-level collegiate athletes have already had the procedure.
Dr. Shin spoke about an athlete that was able to return inside of six weeks from an InternalBrace procedure on a torn thumb ligament. Dr. Shin couldn’t name the athlete due to privacy regulations, but I believe it was Andrelton Simmons of the Los Angeles Angels. He returned from the surgery in a little over five weeks, where others took 10 to 12.
Dr. John Conway told a story about repairing the elbow ligament of a bull rider. The rider’s rope arm was damaged and repaired, and the athlete was able to return in four months, rather than a year, with no issues with the elbow. This is despite the obvious violent movement and tension on the elbow from the mechanics of rodeo riding.
Limpisvasti used the technique on a college football player with a sprained ACL, an injury that used to end careers and is these days typically a season-ender at least. Limpisvasti used this technique in a partially torn ACL in a collegiate football player with an unstable knee following repair and internal brace. “He pressed back to full return (largely against my advice) in around eight weeks because he felt so good,” Limpisvasti explained.
All the doctors I spoke with told me they’re doing this procedure regularly. There are many more athletes I suspect have benefitted from internal brace. Chris Paul recently had his thumb repaired by Dr. Shin and is expected to return in six to eight weeks. If he comes back sooner, you’ll know why. Holly Holm is returning from a severe thumb ligament tear and will be fighting soon for a UFC title.
All that this surgical technique lacks is a catchy name, but that will be tough. This technique works in so many different places that we won’t have one pioneer like a Tommy John. What we’ll have is athletes coming back in-season rather than the next season. We’ll have athletes returning from injuries and getting back on the field quicker, with fewer setbacks. We’ll have less time on the disabled list and more time in the game.
We should just call it a miracle.

Zimmer Biomet launches something new outside the US, a subchondroplasty procedure for bone marrow lesions

Hot Startups (just my opinion)

A peek into serial entrepreneur Randy Theken's new venture, NextStep

A Q&A with Bioventus about their biologics business

Baseball's next miracle surgery

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