AANA25 Shoulder Access Pass-CLOSING SESSION: The Aging Athlete

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Video Summary
The session focused on managing aging athletes with joint issues, particularly biologic treatments, surgical decision-making, and outcomes related to knees, shoulders, and hips.<br /><br />Jason Dragoo discussed biologics like PRP (platelet-rich plasma), hyaluronic acid (HA), and micronized fat injections to decrease joint pain and inflammation, noting high molecular weight HA offers better efficacy and PRP shows greater benefits than HA alone. Emerging evidence suggests certain PRP preparations with higher platelet counts and lymphocytes may improve responses. Combining PRP with HA demonstrated synergistic benefits lasting up to two years. Micronized fat injections showed strong biological effects, outperforming PRP+HA in some studies, and may enhance outcomes post-arthroscopy. Cultured stromal cells (stem cells) represent a future, potentially disease-modifying approach under FDA review.<br /><br />Don Buford emphasized ultrasound-guided precise injection techniques for knees and shoulders to increase efficacy and reduce miss rates. He highlighted intraosseous injections to delay total joint replacement and detailed protocols for targeting meniscal tears, tendinopathy, and bursitis.<br /><br />Alexander Golent reviewed arthroscopic treatment versus replacement for degenerative knees. He stressed patient selection, noting younger, active patients with isolated lesions may benefit from joint preservation procedures, whereas older or multimorbid patients are better candidates for arthroplasty. Outcomes vary; arthroscopy can sometimes worsen arthritis if misapplied.<br /><br />JT Tokish outlined shoulder management algorithms for massive rotator cuff tears, weighing repair versus reverse shoulder replacement based on arthritis presence, patient age, functional status, and muscle viability. He advocated tailoring treatment to functional demand and recovery tolerance.<br /><br />Joseph Rusbarski covered hip arthroscopy versus replacement, showing that joint space narrowing, dysplasia, and cartilage damage increase risk of arthroscopy failure and conversion to replacement. Choosing appropriate patients and counseling on realistic expectations remains crucial.<br /><br />The debate on medial meniscal root tears in middle-aged patients featured Kevin Plancher advocating debridement to quickly relieve symptoms in poor tissue quality or advanced arthritis, while Kevin Bonner presented extensive data supporting root repair to improve function, delay arthritis progression, and reduce knee replacement rates, cautioning that debridement often results in worse outcomes.<br /><br />Finally, talks on ACL tears in older athletes presented contrasting views. Kevin Farmer highlighted successful nonoperative management in many patients over 50 but noted higher complication rates and limited osteoarthritis prevention with surgery. Jarrett Woodmass argued for reconstruction in patients with instability and high functional demands regardless of age, recommending allografts and attention to bone quality.<br /><br />Overall, the session emphasized individualized treatment strategies for aging athletes balancing biologic therapies, precise injection techniques, judicious use of arthroscopy, and appropriate surgical interventions to optimize joint preservation, function, and quality of life.
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Keywords
aging athletes
joint issues
biologic treatments
PRP therapy
hyaluronic acid
micronized fat injections
ultrasound-guided injections
arthroscopic treatment
joint replacement
meniscal root tears
ACL tear management