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Becker’s Healthcare Podcast
Inside the World of Elite Sports Medicine with Dr. Neal ElAttrache
00:37:06
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- [00:00]
A
Hi, everyone, and welcome to the Becker's Spine and Orthopedic Podcast. I'm Sophie Aidas, orthopedic reporter with Becker's Healthcare. And today we have the privilege of speaking with Dr. Neal Elatrache, one of the most renowned orthopedic surgeons in sports medicine. He serves as head team physician for both the Los Angeles Dodgers and the Los Angeles Rams, and is a leading surgeon at the Curland Jobe Institute, a collaboration with Cedars Sinai. His work has helped define modern athlete care, earning the trust of some of the world's most elite competitors. And in this episode, we're going to dive into how cutting edge innovation is transforming recovery for high performance athletes and what the broader orthopedic field can learn from the pressure, precision and progress happening Inside Professional Sports. Dr. Ellich, it's an honor to be speaking with you today. So I guess to start, can you just introduce yourself and share a little bit about your role?
- [01:07]
B
Sure. And thank you very much for your interest. It is an honor for me to be with you. My practice has been in Los Angeles at the Curl and Job orthopedic clinic for 35 years now. I came to Los Angeles to do my sports medicine fellowship right after my residency, which was at the University of Pittsburgh. And I came here to Los Angeles to do the fellowship with Dr. Jobe and the other great doctors, with Dr. Kurland and the rest at the Curling Job Clinic in 1990. And while I was in my fellowship, discussions started about where I would go afterwards. I had already planned on going back to Pittsburgh where I grew up, but I was asked to stay. And so here we are, 35 years later. It's like a blink of an eye. But it was. I couldn't have made a better, better decision as far as being able to fulfill far beyond what I thought that I would be able to fulfill my, my overall dreams and, and what I wanted to do with medicine. And grateful every day the way that, the way that I. Where I ended up and where I've been privileged to work.
- [02:30]
A
Yeah, absolutely. And you have, you know, quite, quite the career and definitely a really renowned figure not only in the orthopedic field, but just generally. Can you. I guess we're going to dive in. You know, if you can explain just how your work with elite athletes has really shaped your broader approach to orthopedic care.
- [02:57]
B
Yes, sure. I had the privilege of training with people who were at the forefront of sports medicine. I found very early on in my training, even going back to medical school, that the greatest thing you could do for yourself and the greatest thing anybody else could do for you is to, is to provide you with a great example, role model, mentor, somebody that would be not only an instructor for the things that you wanted to do and learn, but somebody that would be interested in you. And I became the fellowship director here around 1999, 2000, and was the fellowship director for over 25 years. And I always advised the fellows that were coming through that if you have a decision to make on where to go, where to work, who to surround yourself with, there is nothing that competes with finding a great mentor, somebody that's interested in you and somebody that can teach you every day. And I ended up at a place where, because of who I was working with and who was teaching me and who had taken an interest in me, I was put into an environment far younger than I could have anywhere else, maybe younger than I deserved. But I think that they knew that there would be nothing that I wouldn't do and I wouldn't stop short of putting in the effort and the work to be able to deserve what they were providing me. And so being able to be in an environment that I was able to really focus on what I really loved to do, I never really had to do anything that was out of what I really felt, that was my purpose and my passion. And just to be able to have a practice or make a career or make a living, I was able to focus on the things that really I loved. And so that really took me a long way into advancing, you know, what I do today, that 10,000 hour rule, it applies to pretty much every endeavor I've ever seen. You know, whether it's 10,000 hours or it's just, you know, being able to focus and be repetitive and consistent and just hone your skills and hone your craft, when you have the opportunity to do that, it really pushes you forward. And so, so to answer your question, you know, much, much of it started because of the environment that, that I was, I, I found myself in, that I put myself in and these other great surgeons put me in. And so, you know, being able to, to really study what we do, not just learn how to do the things, but study the science behind the different types of injury patterns and how to treat them and what repairs would be best and work best. I mean, I really became, had the opportunity to become expert in an area. And I don't think you can be expert in these days. There's so much and burgeoning technology that, you know, you would have to become Very familiar with and facile with. I don't think that you can be expert in, in general orthopedics anymore. I think that to be at the level where, where my mentors were to be able to have the responsibility to take care of athletes that were making their living or getting their education, playing their sport, you know, they had to be really, really expert in the science and the techniques of surgery on these kinds of patients. And so that was a great example for me. So I buried myself in studying the things that I would be doing. It's interesting when you look at the evolution of orthopedic surgery and surgery in general. Actually, in the middle 20th century or so, most of our experience in orthopedics came through military medicine. The things that we advanced that, you know, if you look at the, how techniques were developed and advanced and the medications that we used and you know, a lot of that that we took to the general public was honed and learned out of necessity through the military taking care of our, our nation's warriors. And if you look today, if you had to say, okay, what are, what's the impetus for the biggest advances now in orthopedics, certainly sports medicine, I think that it's taken care of high demand, very active, if not elite level athletic patients. And so the demands of, what we need to do to treat their injuries so that they can recover well enough to be able to use their body for their living and this artificial timetable that is put on us to when we have to get them back, I always tell, I always tell the players, look, your knee doesn't really care when the first game is, when the regular season starts. You know, it, it requires a certain amount, you know, of time and, and rehab to get ready. Having said that, you know, the reality of the situation is that these are livelihoods that are in the balance. And so to be able to repair and reconstruct these injured guys and gals and to do it strong enough that it will withstand the aggressive rehab necessary to get them back at this crazy artificial timetable and to hold up so that they, they don't re injure that, you know, the entire, and ruin the entire repair reconstruction. You know, this has led to development of techniques, both surgical techniques, diagnostic techniques, and also rehab techniques that is able to accomplish this. So I would say that our work with this extremely active population, whether it's an active aging population, which we see with rotator cuff injuries and, and some of the things that are associated with maybe the aging population, but now the aging population is very, very Active, and they really need to be able to get back and do the things that they've always been told would be healthy for them. But that active population, and then certainly this elite level athletic population that we've been able to take techniques that have been proven to work well with them and take it and it, and our entire population of patients benefits from it.
- [10:21]
A
Yeah, well, thank you for, for that explanation. And I, I love what you said at the beginning, just about, you know, your passion for what you do. And I think it's, it's very clear in your work that you love what you do and you, you've really been able to hone your craft. And I think another thing that you said that stood out to me was just, you know, you have this responsibility of taking care of athletes who, you know, being active, like you said, is their whole livelihood. And so, you know, I read in that press release that you've worked with more than, you know, 150 NFL players only since 2023. You know, what goes through your mind when an athlete's entire career, you know, may hinge on the outcome of a single procedure?
- [11:14]
B
Well, you know, I, I think that I've never really been distracted or, or nervous or anything going into anything that I was prepared to do. So I would say that, and that goes for anything. I was never nervous going in to take a test. I was never nervous going into surgery as long as I was prepared. And I determined a long, long time ago that I would never go into surgery unprepared. And so it doesn't matter if it's something that's routine, that we've done a thousand times, or if it's something that is going to require something innovative that I'm going to have to try for the first time to be able to accomplish what I need to do for that patient. I'm as prepared as I can possibly be. And so I tend not to get too distracted by the gravity of the situation. I've put in all the effort I can possibly put in at that point, or I wouldn't be doing, I wouldn't be doing the case. You know, I, I don't hesitate. If there's somebody more expert in certain, certain things than me to do something that would be necessary to really help a patient, I don't hesitate to refer them to who, if I think they can get better care somewhere, then I, I'm, I certainly that ultimately I, I, I want their encounter with me to lead to them becoming as good as they can possibly be in the outcome. Whether that means I'm giving them advice, I'm giving them a little benefit of my experience or if I'm referring them to somebody that I think is an expert, that what I want is for, for them and myself to be able to look back and say, you know, I contributed to them getting back and getting the result they need. And so, you know, I wouldn't be doing a surgical case on somebody if I, if I didn't think that I could give them the best chance of, of the outcome that they want. So yeah, I, I actually was surprised a little bit when I saw that number. I, I, I don't have a running tally that I keep from the public information stuff that Yahoo was able to, to get and the estimation of the guys that were coming through the combine into the NFL, they were able to determine that, that, that number that I've operated on since 2023, which, which actually surprised, surprised me too. But you know, what may not be obvious is that every one of the, I, I feel responsible for every single one of those guys from the time that they come to see me to the time they get back on the field. And so I, I have wanted to learn everything about medication, pain medication, I've, I've wanted to learn everything about new rehab techniques and, and, and I, I'll go and, and watch these, the guys that are in from out of town when I'm in town over the weekend. I'll go on Saturdays and I'll go to physical therapy and I'll, and I'll go with them and, and be with the group of guys that athletes that I have in town and be with them in physical therapy. And, and I, I learned so much about it. I learned so much about the process, you know, early on, right after surgery and then the return to play part, you know, it's been invaluable to me. And so I, I felt like even at my advanced age at this point, I, I'm, I still feel like a sponge. I, I, I, I want to, I want to learn and know anything that is out there, that is on the horizon or coming that can help me be better at helping these guys. And so I think that once again, focusing on my task, my craft, and be willing to take it from beginning to end and be involved with every single phase and stage that they go through, I think that that is probably what these guys deserve and what, what is my obligation. And so, you know, that's 150 in over the past two and a half years. And I don't know, probably Double that overall in the NFL that are actively playing. That's a lot of, a lot of people. But what an enormous privilege it is to be able to interact that intimately with even one of these guys and for them to trust, you know, trust me and trust the process. It's such a gift to be, to have the privilege of doing what we do. And whether your patient is a professional athlete that's in the newspaper, or whether they are teaching at your kids school or whether they're making a living, you know, doing something in your hometown, the privilege that it is to have that kind of relationship, trust and, and intimacy with, with another person. It's, I don't think that there's anything like what we do that can provide a person with that, you know, so it's a, it's, it's a labor of love and, and it's a, it's a real responsibility and obligation that I feel like I, I have in order to repay that kind of privilege to, to have that kind of trust.
- [16:54]
A
Yeah, what a beautiful way to put that. And I like what you said too about just with, you know, orthopedic surgery and really with anything in life, everything is sort of a lifelong learning experience. And I think that that's especially true in orthopedics. And you know, things are obviously evolving and changing every day world. So it's important, you know, to have just that learning mindset. And the other part you mentioned is just, it really shows how much you do care, you know, about each and every patient that you have. Just the fact that you're, you know, willing to be in those physical therapy sessions and like you said, sort of be there every step of the way with your patients is pretty remarkable. I want to circle back because we've been alluding to the, to the Yahoo. Sports thing, but I just want to emphasize that Yahoo. Sports recently named you, you know, one of the 25 Game Changers to watch in 2025, highlighting your ability to, you know, help these athletes return to competition faster and often even stronger than they were before. Is there one innovation or approach that you think has really made that possible for you?
- [18:21]
B
Yeah, it's a really good question. I'll give you the general philosophy and then more specifically what I did. So generally what I was in search of and constantly am still searching is I need whatever treatment I do repair surgical technique and repair reconstruction technique. I need it to do two things. I need it, number one, to provide the normal, normal enough function and integrity to be able to get these guys competing back at A, at a high level, number one. Number two, it needs to be able to withstand the demands of whatever physical therapy and rehab is going to be necessary to get them there. So I think that there's been some very big advances on the therapy side of things. And so I always talk to our physical therapists and the team trainers, guys like Reggie Scott, who is the head athletic trainer for the, for the Rams, and brilliant guy. And just working together with people like that, you. You learn so much. And what I needed to know was what do you need to do to mobilize this joint, to get the joint ready to go? And from whatever scientific things I can, I can learn and understand what stage of maturation do these tissues need to be at so that they can start to really train aggressively again. And so that then was the first step is understanding exactly what they have to do and how. What, what the therapists and trainers have to do in order to get them ready to play. And then it's up to me then to figure out, you know, what do I need to do to make a repair. Reconstruction resilient enough and durable enough that it'll withstand it. So if, if you're. If the therapy doesn't match the surgical technique and vice versa, then it's never going to work out. And so I pretty quickly realized that in order to accomplish what these guys needed to do in a certain time frame, you know, and what they were going to do with their body once they got back, those demands are constantly changing. And the stress and strain that they put on their bodies now is. It's significantly greater than when I started. For instance, if I can digress, you know, the average fastball on a professional pitching staff at the time when Tommy John first got his operated on operation that was named after him, the Tommy John operation was somewhere around 88, 89 miles an hour. 1974. You know, when I learned how to do that surgery from Dr. Jobe in 1990, 91, the average velocity was around 90. The average velocity now is 95, a little over 95. Every team has multiple guys that can throw at 100. The amount of force and spin that they put on the ball and the movement that they get on the ball is these circus type pitches that they throw put enormous strain and stress on the shoulder and elbow. And so the, the techniques that we had previously to be able to reconstruct and repair the onocolateral ligament in a Tommy John or to take care of the tissues in the shoulder, those aren't probably good enough anymore. Those techniques don't hold up well enough. And so we've had to adapt. And so the general philosophy has been, show me what they need to do and show me what you trainers and therapists need to do to get them there, and I'll figure out an operation that'll hold up to it. Okay, so that was my general quest then. From a technical standpoint, what I do, whether it's with ligament or tendon reconstruction or repair, I wanted to have the most durable, not only strong, but durable repairs possible. And it needed to be done in an anatomic way so that I didn't change the anatomy, I wouldn't affect their range of motion, which would be devastating even to lose a couple degrees of motion for a pitcher. And I needed to be able to do it. So that would withstand very quick rehab before those tissues are mature. And so I started to tinker with placing suture that would be compatible with the tissues that we have to repair or reconstruct so that it would share the load, but not entirely shield the load, because those tissues need exposure to physiologic loads to be able to mature properly and to get strong. I spent a lot of time doing research on methods of repairing rotator cuff tendons, Achilles tendons, triceps tendons, and patellar tendons so that the suture, the way I would put it in and the way that it would function, would load share, so that all the stress and strain of early motion and early strengthening in therapy wouldn't. All that load wouldn't go directly and expose the repair to that. That some of that load, which would be damaging, would be plastically deforming. So you'd end up with slack in a repair that, that some of that load would be shared with the way we put suture in. And so, you know, a big, a big step forward for me was in rotator cuff repair when we devised the bridging type repairs that became known as the suture bridge, and all the interconnected, interlocking repairs, so that every point of repair, there's load sharing between anchors, and you can bypass the area of healing tissue to bone so that there's no motion at that interface. And, and so when you conceive of the technique, then the next step is to really study it scientifically. And we spent a couple years in the lab studying pressurization of tissue on bone and the mechanical strength and the cyclic loading until we presented then the technique, we, we went back and really did what we thought we should do, improving it scientifically. And so then that Came out in the early 2000s and we were able to really very quickly change the way those types of tendons are repaired all over the world. And so that was my big step forward into developing techniques and materials and anchors and suture that would accomplish my general purpose, which was to provide repairs and reconstructions that would be durable and strong enough to withstand this crazy timetable to get these guys back. And so, so that the same sort of philosophy then was adopted. And with, with tendon repairs all over the body most recently, you know, Achilles repairs have gotten a lot of press because there's an explosion of these Achilles tears in these young athletic guys, pro athletes, and how do you protect the repair from stretching and failure, but yet do it in a, do the things so that the player can come back in a, in a short amount of time with the proper strength and explosion that they need out of that muscle. And so, you know, the techniques that we developed on one part of the body has been adapted and modified to function the same way on another part of the body. And that's been very rewarding for me.
- [26:52]
A
Yeah, well, thank you. It truly is incredible. And I think you sort of mentioned too, like just, just that three legged, it sort of seems like a three legged stool. Like you're like, show me, you know, what, what's wrong. And you know, for the trainers and therapists, show me what, what you need to do to get them there. And then like you said, you'll, you'll take it from there and you'll provide the operation that along with, you know, the durable repairs, the suturing, I think is another thing that really makes you stand out. So my next question is just, you know, you're trusted by many of these professional athletes and professional teams. What would you say it takes to sort of earn that level of trust? You know, not just from the athletes, but from the entire, you know, teams and organizations.
- [27:49]
B
Yeah, you know, the decision makers for this type of thing, you know, I, I think that the athlete is always sort of should be. Have a major say in, you know, who's going to take care of them. But you know, how does the athlete know, you know, what to do? And so usually that, that they rely on agents or other players that have had that experience, that experience with that injury somewhere. And, but there's always this moment where you meet the player and I think that the same critical thing is necessary, whether it's with a team, whether it's with the medical staff of a team, front office, the agent, and it's how do you develop trust And I think that some of it is, some of it is very tangible, the things that you do, your body language and showing just this innate care, concern, attention that you're paying to somebody. But I don't know what other ingredients go into authenticity, being authentic. And it's a calculation that everybody does whenever they meet somebody. These athletes are really, really, they, they know quicker than pretty much any other group of people I've ever seen. They know who they trust and, and who is still. They still need to work on it, you know, and it's a, a calculation that goes, goes through them pretty quickly. And, you know, with some guys, you know, it, it takes a little time and familiarity to, to earn it. It can be broken in a millisecond and never recovered. And so I think that, you know, this is something that, you know, some, some people are born with, you know, the ability to instantly relate and be empathetic. And then the person you're dealing with instantly knows, oh, this, this is a team. This is on my team. And some people don't have that innately in, in their, in their personalities. But that doesn't mean that you can't work on it. You know, you, you know, I think that anybody can do what's necessary to. When, when you walk into a room and you're meeting with somebody for the first time, take your hand off the doorknob, you know, sit down and, you know, look at them in the face and, and sort of study, they're going to tell you a lot about their emotions and what they're going through just by, you know, how they, how they express themselves and, and how they look and, and you're going to come from entirely different worlds and backgrounds from, from people. And, but if you can't bridge that interpersonal gulf and gap that is going to exist between you and, and you're taking care of, you're always going to be a little bit handicapped with regard to that level of, of, of intimacy and trust. You know, you've, you've got to do what it takes to meet the people where they're at and where they, where they've come from. It's always been something that's been in my nature. So, you know, but I think that anybody needs to work on it if you're going to try to do what we do.
- [31:26]
A
Yeah, great points there. And, and I think that what you just said, meeting, meeting patients where, where they're at. And I mean, I could tell from just talking to you that you're very personable, you know, and you're, you're a comfortable person to, to talk to. And I'm sure that is definitely, you know, recognized with your patients.
- [31:51]
B
There's a saying that I always, that I never forgot Frank Jobe. I don't think that he was the one that was the originator of it, but he, he certainly, you know, instilled that in me. And he said, look, you know, your patients, whether they're players or not players, they're, they're not going to really care as much about everything, you know, and everything you can do until they know that you care about them. You can be the most brilliant person on the planet. And unless if somebody thinks that you care about them, they really couldn't care less about what you know. And so that, that doesn't take a lot of studying. That doesn't take anything other than trying to understand exactly what's happening with this person, what's happening with this patient. You know, that and specifically what we do. I mean, it goes a long way if you, if you can take the time to understand what that person has to do, understand something about their sport, understand what they, what their assignment is, understand, you know, the things that they have to do. And when, you know, that goes a long way to telling that player, that patient, oh, this guy, you know, he's, he's making the effort to really understand me and what I've, what I've been going through.
- [33:11]
A
Right? So, yeah, yeah. And it's kind of like you said, I mean, I've heard this before too, but, you know, not having your hand, you know, on the doorknob, right. And really taking the time to, to sit with and get to know these patients. And I think oftentimes, you know, that part, that partnership between patient and surgeon. I was just talking about this earlier today, is not equal. Because for surgeons, I think that, you know, the operation might be the easy part because you've done it hundreds or even thousands of times. But the post operative care, you know, especially the rehabilitation and the patient's ability to sort of work through that discomfort is often, you know, what really determines the difference in outcomes.
- [33:59]
B
100%. Right.
- [34:02]
A
The last thing I want to ask you, you here is, you know, even with all your accolades and leadership roles, you're still operating and you're still mentoring and you're still innovating every day. So I'm curious, you know, just what continues to drive you and what advice would you give to the next generation of orthopedic leaders?
- [34:28]
B
Well, the answer to your first question, most of it's positive. Some of it may be pathologic. I'm so grateful that I found something that I love, that I wanted to put in the work to be good at. And I still love it. I still love being in the operating room. I still love being in physical therapy after surgery with, with guys. And I, I, I love it on a human level. I love it, you know, on the technical level, I love working with my hands. And, and that's all the positive side. And I'd say that's 90%, that's the answer. I think there's 10% maybe that I don't want to face, that I don't know if I really know who I am without doing what I am. And I don't know that that's all, all that healthy. I think that maybe it's probably not healthy, but the greatest joy in my life is my wife and daughters. But I really am not me. I don't feel like I'm me, you know, without doing what I do. And I think I better find that other part of me, you know, I think it's everybody. I think that, you know, I may, whether it's maybe insecurity or what or what, but I was nobody before I, before I started to do what I do, and it gave me everything. And so it's, it's hard to divorce the what I do from me, you know, hard for me to ever fake not doing it. And the day is going to come when, when, you know, I think that patients would be better served by, you know, having somebody else do their surgery. I just hope I know that day before anybody.
- [36:29]
A
Yeah. Well, thank you so much, Dr. Alatrache. This has been an incredibly insightful conversation, and thank you so much for sharing, you know, your experience and your perspective with us. That is all for today's episode of Becker's Spine and Orthopedic Podcast. A big thank you to Dr. Ellatroche for joining us and offering such valuable insights into the future of sports medicine and orthopedic care. Thank you for listening, and we'll see you next time.