AANA25 Hip Access Pass-CLOSING SESSION: The Aging Athlete

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Video Summary
The session focused on biologic treatments, arthritis management, and surgical decision-making for aging athletes in knee, shoulder, and hip joints. Dr. Jason Dragoo discussed biologics like high molecular weight hyaluronic acid (HA) and platelet-rich plasma (PRP), emphasizing that PRP generally shows greater efficacy in reducing pain and inflammation for osteoarthritis, with emerging evidence pointing to optimizing PRP dosing and leukocyte content. Micronized fat tissue and cultured stromal cells represent promising future treatments offering potential disease modification and longer symptom relief, especially when combined with techniques like arthroscopy.<br /><br />Dr. Don Buford highlighted precise ultrasound-guided injection techniques for delivering biologics in knees and shoulders, improving accuracy to maximize treatment outcomes. He described intraosseous injections and subacromial bursa treatments providing sustained relief in older athletes while reducing surgical risks.<br /><br />The orthopedic surgeons debated arthroscopic versus joint replacement procedures. Dr. Alexander Golent emphasized careful patient selection when considering arthroscopy for degenerative knees, noting it is beneficial mainly for specific mechanical symptoms and less severe arthritis. He stressed the importance of assessing patient age, activity level, and disease severity to guide interventions. Dr. J.T. Tokish outlined shoulder treatment algorithms for massive rotator cuff tears, balancing repair, reverse total shoulder arthroplasty, and tendon transfers depending on patient age, function, and muscle viability.<br /><br />Dr. Joseph Rusbarski reviewed hip preservation versus replacement, cautioning against arthroscopy in patients with joint space narrowing or extensive cartilage damage due to high failure rates, advocating total hip arthroplasty as a reliable option even in active middle-aged adults.<br /><br />A debate on management of medial meniscal root tears in middle-aged athletes featured contrasting views: Dr. Kevin Plancher advocated for debridement to quickly relieve symptoms in low demand patients, while Dr. Kevin Bonner presented evidence that root repair improves knee survival, function, and arthritis progression compared to meniscectomy or nonoperative care.<br /><br />Finally, management of ACL tears in older athletes was examined. Dr. Kevin Farmer advocated nonoperative treatment initially in many patients over 50 with less instability given similar outcomes and fewer complications than surgery. Conversely, Dr. Jarrett Woodmass argued for reconstruction in patients with symptomatic instability regardless of age, emphasizing the need to tailor graft choice and fixation techniques to osteoporotic bone. Panelists agreed on the importance of individualized care considering patient goals, activity level, and joint status.<br /><br />Overall, the session underscored evolving biologic therapies and the nuanced decision-making required to preserve joint function and quality of life in the active aging population.
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Keywords
biologic treatments
arthritis management
surgical decision-making
aging athletes
knee joint
shoulder joint
hip joint
platelet-rich plasma (PRP)
ultrasound-guided injections
arthroscopic surgery
total joint arthroplasty