Cedars-Sinai will continue as the organization's Official Healthcare Partner, reaffirming its commitment to supporting the health, performance and recovery of beach volleyball athletes throughout California.

Founded in 1962, the nonprofit hosts nearly 1,000 tournaments annually across more than 20 California locations, serving approximately 8,000 active members spanning youth, amateur and elite competition.

“Our continued partnership with the California Beach Volleyball Association reflects Cedars-Sinai’s commitment to helping athletes stay healthy,” said Mark Vrahas, MD, chair of Cedars-Sinai Orthopaedics and Sports Medicine. “Together, we’re giving players of every age and skill level access to expert care that helps prevent injuries, supports recovery and keeps them enjoying the sport they love.”

Through the collaboration, Cedars-Sinai Orthopaedics and Sports Medicine will provide athletes with access to orthopedic specialists, sports medicine physicians and injury prevention resources designed to help players perform safely and recover effectively.

Beach volleyball places unique demands on the body, requiring explosive movement, agility and endurance. Cedars-Sinai sports medicine physicians regularly treat shoulder, knee, ankle and hand injuries, while emphasizing evidence-based injury prevention strategies that help keep competitors in the game.

“Whether treating professional athletes or weekend competitors, our goal is always the same: helping patients return safely to the activities they love,” said Joshua Scott, MD, orthopedic specialist at Cedars-Sinai Orthopaedics and Sports Medicine. “We're excited to continue working with the association to provide guidance on injury prevention, performance optimization and comprehensive musculoskeletal care throughout the season.”

A nonprofit organization, the California Beach Volleyball Association is dedicated to nurturing, promoting and growing the sport through organized tournaments and opportunities for players of all ages and abilities to compete. The organization has helped grow the sport and foster healthy competition for generations of athletes.

“CBVA has been putting on tournaments on California sand for more than 60 years, and keeping our players healthy has always been part of our job,” said Kathy Hubbell, the group’s executive director. “Partnering with Cedars-Sinai gives our athletes—from the kids just learning to bump and serve to the dedicated weekend players who never miss a tournament—access to real experts when they need them. That kind of support is hard to find for a sport like ours, and it makes a difference.”

Read more from Cedars-Sinai Stories and Insights: Proper Precautions Can Net Safety Benefits for Beach Volleyball Players

and Select Medical.

The conference at Dignity Health Sports Park in Carson, California, brought together physicians, athletic trainers, physical therapists, researchers and soccer leaders to discuss emerging trends in athlete care, from emergency preparedness and injury prevention to women’s health and the evolving pressures facing youth athletes.

“One of the most important lessons in sports medicine is that no one succeeds alone,” said Bert Mandelbaum, MD, medical director of the Cedars-Sinai FIFA Medical Centre of Excellence and interim chief medical officer of U.S. Soccer. “Whether you're preparing for a youth soccer match or the FIFA World Cup, teamwork makes the dream work. When physicians, athletic trainers, physical therapists, performance specialists and emergency personnel work together, athletes receive the best possible care.”

Additional conference participants included the six-time MLS Cup champion LA Galaxy, along with fellow FIFA Medical Centres of Excellence partners Duke University and the Hospital for Special Surgery (HSS). 

Emergency Preparedness Starts Before Kickoff

One of the conference's strongest messages focused on emergency action plans, which establish the protocols and personnel needed to respond to medical emergencies during games and training sessions.

Experts emphasized that preparation, communication and rehearsal can save lives when seconds matter. Discussions on sudden cardiac arrest highlighted the critical role of automated external defibrillators and community CPR training.

Tracy Zaslow, MD, a Cedars-Sinai primary care sports medicine specialist who cares for both youth and professional athletes, joined discussions on emergency preparedness and sudden cardiac arrest. Referencing the recent on-field cardiac emergency involving Angel City FC player Savy King, Zaslow underscored the importance of having trained medical personnel, emergency action plans and CPR-capable responders available at sporting events. She noted that while elite teams often have physicians and athletic trainers on the sidelines, broader community education in CPR remains critical because cardiac emergencies can occur anywhere youth and amateur sports are played.

Cedars-Sinai orthopedic specialist Joshua Scott, MD, venue medical officer for World Cup 2026 in Los Angeles, described the extensive World Cup planning underway at SoFi Stadium, including emergency response protocols, imaging access and strategies for managing heat-related illness. With summer temperatures expected to challenge athletes, hydration breaks will be incorporated into matches, Scott said.

Keeping Athletes Healthy

A recurring theme throughout the conference was that the best injury is the one that never happens.

Among the prevention strategies several speakers highlighted was the FIFA 11+, a free, evidence-based warmup program that takes about 15 minutes to complete and has been shown to reduce injuries, including ACL tears, among soccer players. The program requires no special equipment and can be implemented by teams at nearly any level of competition.

Cedars-Sinai orthopedic surgeon Carlos Uquillas, MD, moderated a discussion on ACL injuries and prevention strategies, highlighting the growing emphasis on reducing injury risk before athletes ever require treatment. The session explored the importance of age-appropriate neuromuscular training, proper movement mechanics and evidence-based warmup programs designed to help young athletes move more efficiently and stay healthy throughout their development. The discussion reflected broader injury-prevention efforts underway through the Cedars-Sinai and AYSO partnership aimed at reducing ACL injuries among youth soccer players.

Experts also emphasized preserving meniscal tissue whenever possible because of its critical role in protecting the knee and maintaining long-term performance. Cartilage injuries—which can be difficult to detect on MRI—were also singled out as an underrecognized source of pain and dysfunction among athletes.

The goal, Mandelbaum noted, is not simply helping athletes return to play as quickly as possible, but extending their “play span” by preserving performance, mobility and joint health throughout a career.  

The same philosophy applies to common soccer injuries affecting the groin and core. Cedars-Sinai surgeon Neel Joshi, MD, highlighted advances in understanding sports hernias—also known as athletic pubalgia or core muscle injuries—which can be difficult to diagnose but have a significant impact on athletic performance and return-to-play decisions.

Women Athletes Need Their Own Playbook

A keynote session explored how sports medicine is evolving to better serve female athletes.

Panelists, including University of Colorado School of Medicine orthopedic surgeon and sports medicine specialist Rachel Frank, MD, challenged the long-held tendency to apply research conducted in male athletes to women, emphasizing that “women are not just small men.” Female athletes face different injury risks, physiological considerations and performance factors that require tailored approaches to training, recovery and medical care.

The discussion also highlighted the growing importance of factors such as menstrual health, nutrition, pregnancy, postpartum recovery and mental health in optimizing athlete performance and wellbeing, as well as ongoing efforts to improve resources and support systems across women’s sports.

New Challenges Beyond the Playing Field

The conference concluded with discussions about emerging issues shaping the future of athlete care.

Among them was the growing influence of name, image and likeness (NIL) opportunities. Cedars-Sinai orthopedic surgeon Natasha Trentacosta, MD, discussed how these opportunities are reshaping youth sports by creating new incentives, pressures and expectations, including increased year-round competition, earlier specialization and greater emphasis on visibility.

Additional insight and expertise from Cedars-Sinai included: Casey Batten, MD, Eli Friedman, MD, Michael Gerhardt, MD, Seth Lichtenstein, MD, Clinton Soppe, MD, and Rachel Triche, MD.

Read more from Cedars-Sinai Stories and Insights: Can Rethinking CPR Training Benefit Women?

Preparation was at the center of the 2026 Emergency Care in Sport (ECS) Conference in Woodland Hills, where nearly 200 sports medicine professionals, athletic trainers and healthcare leaders gathered for a two-day immersive training focused on emergency response.

Hosted by the Los Angeles Rams, the National Football League (NFL), and Cedars-Sinai, the conference combined expert-led instruction with hands-on, scenario-based training designed to prepare clinicians and athletic staff to respond to critical situations on the field.

“Sport is unpredictable, and when emergencies happen, there’s no time to hesitate,” said Casey Batten, MD, co-director of Nonoperative Orthopaedics and Sports Medicine at Cedars-Sinai Orthopaedics and Sports Medicine, head team physician for the Rams, and chief medical officer for the LA28 Olympic and Paralympic Games. “This training is about building muscle memory so that when something goes wrong, teams can respond immediately, confidently and in a coordinated way.”

The conference featured a multidisciplinary lineup of national leaders in sports medicine and emergency care, including Reggie Scott, senior vice president of Sports Medicine and Performance for the Rams; Allen Sills, MD,  chief medical officer for the National Football League; and Ron Courson, associate athletic director for Sports Medicine at the University of Georgia.

Through panel discussions and interactive demonstrations, speakers and session leaders emphasized the importance of Emergency Action Plans, proper medical oversight, access to essential equipment, and involving trained sports medicine experts at all levels of sport—from youth leagues to professional teams.

A highlight of the conference was the presentation of the inaugural Dr. Greg Elkins Memorial High School Team Doctor of the Year Award, recognizing exceptional dedication to the care and safety of student-athletes.

The award honors the legacy of Greg Elkins, MD, a nationally prominent and widely respected sports medicine physician known for his decades of service to high school athletes and his leadership in shaping national sports medicine policy.

Elkins Award recipient Clarence Shields, MD, a Cedars-Sinai orthopedic surgeon, was honored for his pioneering work in expanding access to care for underserved student-athletes in Los Angeles.

A Los Angeles native, Shields graduated from Creighton University School of Medicine, completed his orthopedic surgery residency at Los Angeles County-USC Medical Center, and fulfilled his fellowship training in sports medicine at the then–Kerlan-Jobe Orthopaedic Institute. He later served as president of the American Orthopaedic Society for Sports Medicine and as a longtime team physician for the Los Angeles Rams.

In 1994, Shields founded Team HEAL—Helping Enrich Athletes’ Lives—a program that provides athletic training services and healthcare resources to high schools in underserved communities. Today, the program serves more than a dozen schools and 2,800 student-athletes annually and has helped more than 30,000 young athletes since its inception.

“Dr. Shields’ leadership reminds us that sports medicine is about more than treating injuries—it is about protecting futures,” Batten said. “By founding Team HEAL, Dr. Shields expanded access to care for underserved communities and connected local high schools with volunteer physicians who have made a lasting difference in the lives of student-athletes.”

 Read more from Stories and Insights: How to Prevent Sports Injuries in Young Athletes

 

Behind the scenes, that preparation includes building a vast, coordinated medical system designed to support not only the elite athletes taking part in the LA28 Olympic and Paralympic Games, but the coaches, staff, volunteers and spectators.

The Cedars-Sinai Newsroom recently spoke with Casey Batten, MD, chief medical officer for the LA28 Olympic and Paralympic Games and co-director of Nonoperative Orthopaedics and Sports Medicine at Cedars-Sinai Orthopaedics and Sports Medicine, to discuss what it takes to plan medical care at the scale of the Olympic and Paralympic Games—and what it means for athletes, fans and the Los Angeles community.

What is the role of the chief medical officer for the LA28 Olympic and Paralympic Games?

Ultimately, the role of the chief medical officer is to oversee all of the medical infrastructure delivered to all stakeholders—including athletes, coaches, their entourages and spectators.

Medical care for the Olympic and Paralympic Games will take place across multiple settings. One of the central hubs is the polyclinic in the Olympic and Paralympic Village, which primarily serves athletes and those living there, including coaches and support staff.

Beyond that, care extends to training locations and competition venues spread across the region, each requiring its own coordinated medical presence. Ensuring that all of these environments are properly staffed, connected and prepared is a key part of delivering care at this scale.

What types of injuries do you expect to be treating?

As with any major sporting event, we expect to see common overuse injuries, along with strains and sprains—especially as athletes ramp up training closer to the Games.

But one of the biggest concerns isn’t injury—it’s illness. When you think about it, most of these athletes have been training their entire lives for this moment. For many, this is their one shot at the Olympic and Paralympic Games. Even something as simple as a common cold can completely derail years of preparation and impact performance on the world stage.

That’s why, from a medical planning perspective, so much focus is placed on preventing and managing illness. Respiratory infections, gastrointestinal bugs and other viruses are among the biggest risks during the LA28 Games.

What is the main challenge gearing up for the LA28 Olympic and Paralympic Games?

The scale is unlike anything else.

When I first stepped into this role, one of the most eye-opening aspects was just how much detailed planning is required—and how many different teams and functional areas are involved in every decision. Delivering medical care at the LA28 Games isn’t about making decisions in isolation. Every choice requires coordination.

Even something that seems straightforward—like deciding where to place an X-ray machine—can impact multiple departments, from venue operations to logistics to athlete flow. Now multiply those types of decisions across roughly 50 venues, and it quickly becomes a massive, interconnected puzzle.

Having worked in sports medicine for two decades and having supported large-scale sporting events, I can say that nothing compares to the Games. A common comparison is that it’s like putting on seven Super Bowls a day for several weeks—and that really captures the magnitude of what we’re preparing for.

What are you most excited about?

It’s hard to overstate how special the LA28 Games will be.

For most athletes, this is a once-in-a-lifetime opportunity, the culmination of years, often decades, of training and sacrifice. Being able to witness that level of intensity, focus and emotion in person is incredibly powerful. There’s an energy at the Olympic and Paralympic Games that’s hard to describe unless you’ve experienced it, it’s something you feel across every competition, every race and every moment.

I’d especially encourage people to watch the Paralympic Games—the level of competition, the determination and the passion are extraordinary.

Even if you’re not familiar with a particular sport, I think people will find themselves drawn in. Whether it’s Olympic or Paralympic competition, there’s something universally compelling about watching individuals push the limits of what’s possible. 

Read more from Cedars-Sinai Stories and Insights: Safety Tips to Get the Most Out of Exercise

“It means the absolute world,” King said. “There’s nothing better than being back out there on the field with my teammates—especially in front of our home fans and the city of L.A. There’s no other feeling like it.”

A Coordinated Medical Team

After King collapsed on the field last year, on-site medical professionals stabilized her and brought her to Cedars-Sinai, where she was diagnosed with a previously unknown congenital heart condition. Months of intensive medical care and rehabilitation followed.

King had surgery to repair a coronary artery anomaly, then worked through a carefully monitored recovery program that included cardiac rehabilitation and progressive training.

Rachel Triche, MD, an orthopedic surgeon at Cedars-Sinai and chief medical officer for Angel City FC, was on the sidelines the day King collapsed, and helped coordinate her care.

“We are really excited to see Savy get back on the field,” Triche said. “We did a lot of careful planning and created a very rigorous return-to-activity process where everything was closely monitored. She’s done incredibly well and has hit—and exceeded—everything we need to see to feel confident about her returning to play.”

During her recovery, King also underwent a second procedure at Cedars-Sinai—surgery to repair a longstanding wrist injury she had planned to address before her cardiac arrest.

“I had been needing wrist surgery for a long time,” King said. “I had to wait a couple of months until the surgeons felt comfortable with me going under anesthesia again, but the timing ended up working out. My recoveries kind of lined up perfectly.”

Now King is free to focus on what she loves most—playing soccer.

“I’m just excited to be back out there and playing with my teammates again,” she said.

The ‘Team Behind the Team’

Cedars-Sinai has served as the official health partner for Angel City FC since the team’s inaugural season in 2022, providing comprehensive care for players on and off the field.

Sports medicine specialists from Cedars-Sinai Orthopaedics—ranked among the nation’s top orthopedic programs—serve as team doctors.

“As the official medical provider for Angel City FC, we help take care of the athletes from beginning to end,” Triche said. “We administer the pre-participation physicals, we’re on the sidelines during games, and we coordinate care with specialists when needed. If surgery is required, our orthopedic team can provide that as well.”

Cedars-Sinai and Angel City FC also collaborate on community initiatives to improve health education and access for women, families and young athletes. Players make visits to the hospital to meet patients, and the organizations work together to provide on-field experiences for patients and youth soccer clinics across Los Angeles.

For King, returning to the field represents a return to her community, thanks to the support of her teammates, family members and the medical professionals who helped guide her recovery.

“I think any medical professional is just incredible,” King said. “They’re superheroes and deserve more recognition than they get.”

Read more from Cedars-Sinai Stories and Insights: Hormonal Birth Control Might Reduce Female Athletes’ ACL Tears

The conference—Soccer Medicine Updates and New Innovations—is scheduled for Friday, May 22, 2026, at Dignity Health Sports Park in Carson, California. It will be co-hosted by the Department of Orthopaedics and Sports Medicine at Cedars-Sinai and Select Medical, in partnership with Dignity Health. Additional participants include the six-time MLS Cup Champion LA Galaxy, along with fellow FIFA Medical Centres of Excellence partners Duke University and the Hospital for Special Surgery (HSS). 

Cedars-Sinai, Duke University, and HSS represent the only three FIFA Medical Centres of Excellence in the United States, with Cedars-Sinai holding the designation since 2007.

“With the World Cup returning to the United States, this conference reflects our responsibility to share best practices that advance athlete safety and performance on a global stage,” said Bert Mandelbaum, MD, medical director of the Cedars-Sinai FIFA Medical Centre of Excellence, interim chief medical officer of U.S. Soccer and co-chair of the conference. “By bringing together leading experts across disciplines, we aim to translate the latest research and innovation into real-world care for athletes at every level of the game.”

The program will include former and current soccer players and is designed for professional and lay audiences. Programming will explore evidence-based approaches to injury prevention, performance optimization and care for athletes of all levels from youth to adaptive and elite players.

“As the largest provider of outpatient physical therapy and sports medicine in the U.S., we are proud to partner with Cedars-Sinai to co-host this important event showcasing best practices in athlete injury prevention and recovery,” said Alan Evans, vice president of clinical programs and education, Outpatient Rehabilitation Division at Select Medical. “When clinicians, athletic trainers and performance specialists collaborate, we raise the standard of care and help athletes stay healthy, compete at their highest level and return to play safely. Together, we are advancing the future of sports medicine and strengthening the world’s athletic community.”

"We are honored to be part of this collaborative effort to advance athlete care and innovation during this exciting time for Los Angeles," said Julie Sprengel, California president of Dignity Health, a member of CommonSpirit Health. "This educational conference at the Dignity Health Sports Park embodies the shared commitment to excellence that Dignity Health has with Cedars-Sinai and Select Medical."

Advancing Innovation and Collaboration in Athlete Care

The FIFA World Cup is one of the largest sporting events in the world, with 48 teams set to compete across the United States, Canada and Mexico in 2026. Preparing athletes for competition at this scale requires coordinated, multidisciplinary care that spans emergency preparedness, injury management and return-to-play decision-making.

The conference will be in person and feature a dynamic format with internationally recognized faculty who specialize in all aspects of soccer. Programming will include interactive sessions, panel discussions and on-demand educational content, with continuing education credits available.

Sessions will focus on medical and performance challenges, including:

• Emergency action planning for sudden cardiac arrest and cardiac considerations for return to play
• Advances in concussion management and evolving safety regulations
• Mental health considerations
• Knee injury evaluation, treatment and evidence-based return-to-play guidelines
• Common soft tissue injuries and strategies that bridge performance and injury prevention
• Innovations in athlete care, including biologics, youth athlete considerations and burnout prevention
• Team-based, interprofessional approaches to athlete care

The conference Scientific Planning Committee is co-chaired by Mandelbaum and Josh Scott, MD, a nationally recognized sports medicine physician and venue medical director for World Cup 2026 in Los Angeles.

For more information about the conference and to register, click here.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

In this role, Kruse will lead the medical infrastructure supporting Paralympic athletes in Milan—whose medical needs are often complex due to underlying health conditions—along with their coaches and staff.

The Milano Cortina 2026 Paralympic Winter Games will take place from March 6 to March 15, 2026. 

“Dr. Kruse’s deep understanding of elite sport and athlete-centered care makes him uniquely qualified to lead medical operations for Team USA’s Milan Village Sports Medicine Clinic at the Paralympic Games,” said Jonathan Finnoff, chief medical officer of the U.S. Olympic & Paralympic Committee. “His experience supporting athletes with complex medical needs, combined with his leadership across multiple Olympic and Paralympic Games, will be invaluable in delivering world-class care.”

Kruse’s appointment reflects his two decades of experience caring for elite athletes and his deep roots in the Olympic and Paralympic Movement. A former competitive gymnast, Kruse competed on the U.S. Senior National Team for four years. He served as a team physician for USA Gymnastics from 2008 to 2024. He served as part of the Olympic Games medical staff in Rio 2016 and Tokyo 2020. In 2020, he became USA Gymnastics’ medical director, overseeing athlete care through the Olympic and Paralympic Games Tokyo 2020 and Paris 2024.

At Cedars-Sinai, Kruse practices primary care sports medicine and non-operative orthopaedics, with clinical expertise in musculoskeletal injuries, sports concussion, ultrasound-guided procedures and the medical needs of athletes. He also brings specialized insight into treating gymnasts and dancers—experience informed by his collegiate athletic career as a six-time All-American, NCAA Team Champion and captain of the gymnastics team at the University of California, Berkeley.

Much of Kruse’s current work also focuses on preparations for the LA28 Olympic and Paralympic Games. Alongside Casey Batten, MD, chief medical officer for LA28, Kruse serves as Senior Medical Advisor, helping the LA28 Organizing Committee plan medical services for athletes, staff, officials and spectators.

“Dr. Kruse brings an exceptional combination of clinical skill, firsthand athletic experience and medical leadership within the Olympic and Paralympic Movement,” Batten said. “His expertise will be essential in supporting Team USA at Milano Cortina 2026 and as we continue to build a world-class medical system for the LA28 Games.”

Kruse also is a member of the U.S. Olympic & Paralympic Medical Network, through which Cedars-Sinai provides care for Team USA athletes as they prepare for national and international competitions leading to the LA28 Games.

Kruse is available to speak to media about:

• Medical planning and operations for Team USA at the Milano Cortina 2026 Paralympic Winter Games
• Olympic & Paralympic athlete health, safety and performance
• Common injuries and medical challenges in Paralympic and adaptive sports
• Differences in care for Paralympic versus Olympic athletes
• Paralympic and adaptive sports medicine and emerging care models

To arrange interviews, contact Melissa Vizcarra at 719-502-5001 or melissa.vizcarra@cshs.org.

“I had tried many treatment options, but the pain was still interfering with my day-to-day life,” Makkar said.

Makkar, 73, underwent conventional knee replacement surgery for his right knee in 2023. While the procedure ultimately relieved his pain and helped him regain mobility, the recovery was long and difficult. For weeks, he relied on a walker, needed prescription pain medication and avoided social activities as he slowly worked his way back to daily life.  

However, for Makkar’s second knee replacement—this time for his left knee—he benefited from a new approach to the procedure intended to speed recovery and lessen pain.

The new approach worked. This time, Makkar used a walker for only two days, met up with his friends within days and relied on Tylenol instead of prescription painkillers.

“This recovery felt so much easier,” Makkar said.

People are living longer and outliving their joints. However, many patients avoid much-needed surgery because they expect a tough recovery, said Sean Rajaee, MD, chief of Arthroplasty at Cedars-Sinai Orthopaedics, and Makkar’s surgeon for both of his procedures.

To help patients recover faster and walk sooner after surgery—which can reduce the risk of complications, such as blood clots, pneumonia and urinary tract infections—Cedars-Sinai launched an enhanced joint replacement recovery effort. As a result, nearly 80% of total joint replacement patients are walking and going home within 24 hours, up from 68% in 2022.

“Now that patients are hearing about improved techniques and smoother recoveries, there is a growing demand for faster care—and Cedars-Sinai is committed to meeting that need,” Rajaee said.

Building a Better Recovery

To speed recovery time for total joint replacement patients, Cedars-Sinai leaders developed guidelines to identify patients best suited for an enhanced recovery regimen. Surgeons consider factors such as overall health and age. Nurses screen patients to assess their home environment and whether they have reliable support after surgery.

Collaboration among surgeons, anesthesiologists, nurses and physical therapists is another key element of the program. Anesthesiologist Michael Kissen, MD, said teams regularly meet to discuss optimal treatment plans, including medication use, procedure timing and wound dressings, with the shared goal of getting patients up and moving within hours after joint replacement surgery.

“Every part of this pathway has existed for a while on its own, but coordinating all these processes and fine-tuning what we do through constant feedback and regular meetings is the novel concept behind creating this pathway,” Kissen said.

Rajaee said educating patients also helps. During presurgical appointments, setting expectations about the recovery plan and explaining the benefits of the approach prepares patients mentally.

The new approach has worked so well that plans are underway to expand the approach to other procedures, beginning with robotic prostate surgeries.

Medical Advances Speed Healing

Advances in pain management play a major role in helping patients walk soon after surgery. Rather than relying solely on general anesthesia, anesthesiologists often use spinal anesthesia, a form of neuraxial anesthesia that numbs the lower body while avoiding many side effects of general anesthesia. Compared with general anesthesia, spinal anesthesia is linked with fewer respiratory complications, less postoperative pain and nausea, reduced need for narcotics, and earlier mobilization.

“Spinal anesthesia has been used safely for years,” Kissen said. “What’s changed is our shift to shorter-acting medications that last through surgery but wear off quickly, so patients can move and start therapy much sooner.”

In addition to spinal anesthesia, anesthesiologists use regional anesthesia techniques, such as peripheral nerve blocks and nerve catheters, to provide longer-lasting pain control after surgery while minimizing opioid use. One commonly used approach for knee surgery is the adductor canal nerve block, which targets sensory nerves while sparing motor function. This allows patients to experience pain relief around the knee without limiting their ability to walk immediately after surgery. In some cases, a catheter is placed near the nerve so a pump can deliver local anesthetic continuously for two to three days after surgery.

Rajaee said robotic-assisted surgery also helps patients walk sooner by reducing tissue trauma and preserving healthy muscle.

Second Surgery, With Less Pain

When Rajaee performed Makkar’s first knee replacement, he used a tourniquet, a common technique that reduces blood flow to the knee to allow surgeons to place an implant.

However, during the second procedure, Rajaee opted for a tourniquet-free approach, a newer method shown to reduce pain after surgery. He also used what’s called a quadriceps-sparing midvastus approach, which avoids cutting through the main tendon attached to the large muscle on the front of the thigh, preserving the tissue.

Anesthesiologists added a low dose of ketamine to target pain pathways not relieved by narcotics during the second surgery. Makkar experienced a smoother recovery and was thrilled with his results.

“At my age, I am super happy I’m walking,” he said. 

Read more on the Cedars-Sinai Newsroom: Cedars-Sinai Slashes Anesthesia Emissions, Reducing Carbon Footprint

Female athletes are up to eight times more likely than male athletes to experience an ACL tear, which often requires surgery and months of recovery.  

ACL injuries can be physically and emotionally devastating for athletes eager to stay competitive. But with proper training, awareness and early intervention, many of these injuries can be prevented or treated to avoid long-term consequences.

To learn why young women are more vulnerable and how they can reduce their risk, the Cedars-Sinai Newsroom spoke with Michael Banffy, MD, chief of Sports Medicine at Cedars-Sinai Orthopaedics.

What is the ACL and what role does it play in the knee?

Banffy: The ACL—or anterior cruciate ligament—is one of four main ligaments in the knee. It crosses over inside the joint and helps control both the rotation and forward movement of the tibia (shinbone) relative to the femur (thighbone). It helps stabilize the knee and protects structures like the meniscus and cartilage during pivoting or cutting movements.

Why are ACL injuries more common in young female athletes?

Banffy: It’s multifactorial. Anatomically, females tend to have a more “knock-kneed” alignment—called valgus—which can put more stress on the ACL when landing or changing direction. They also typically have less muscle mass around the knee compared with males, which limits the protective effect of the surrounding musculature. And we believe hormones, such as estrogen and progesterone, affect ligament laxity and may play a role, though we’re still learning exactly how.

Adolescent females are particularly vulnerable, especially during or after puberty when hormone levels begin to fluctuate more significantly. Recent research—including studies from our own institution—suggests that high levels of estrogen during certain phases of the menstrual cycle may increase ACL injury risk.

Which sports carry the highest risk?

Banffy: Sports that involve jumping, cutting and pivoting—like soccer, basketball and volleyball—tend to have the highest rates of ACL injuries. These movements can put sudden, intense strain on the ligament, especially if athletes haven’t developed proper landing techniques.

How can an athlete tell if they’ve torn their ACL?

Banffy: Often, it’s obvious. Many athletes report hearing a “pop” and experience immediate swelling or instability. But not every tear is dramatic—some are more subtle, especially in non-contact injuries. A common symptom is a feeling of the knee “giving way,” even if there isn’t much swelling or bruising.

How is an ACL tear diagnosed and treated?

Banffy: Diagnosis starts with a clinical exam and is confirmed with imaging, particularly an MRI. For young, active individuals, surgery is strongly recommended to reconstruct the torn ligament—typically using a tendon graft from the same leg. While the patient may feel normal after a few weeks, full recovery and return to sport often takes nine to 12 months to allow the graft to mature.

Can anything be done to prevent ACL injuries in female athletes?

Banffy: Absolutely. ACL prevention programs—which include strength training, neuromuscular control drills and landing technique instruction—are critical. These programs are often built into team warmups and can significantly reduce injury rates when done consistently. For example, simple bodyweight exercises like squats and hamstring-strengthening movements help stabilize the knee, while jump training teaches athletes how to land safely and with control.

What advice do you have for girls eager to return to the field after surgery?

Banffy: Be patient. The ligament may feel fine after a few months, but the biology takes time. Pushing too soon can risk reinjury, which is heartbreaking for athletes. We use force plate testing to measure balance and strength between legs—once the injured leg is at least 85% as strong as the uninjured one, we can gradually reintroduce sport-specific training.

If you’ve already had one ACL injury, your risk of injuring the opposite knee is four times higher. That’s why prevention training is so important—not just before injury, but especially afterward. And while reinjury can be discouraging, it's not the end. Revision surgeries are possible, and many athletes successfully return to sport with the right treatment and rehab.

Read more on the Cedars-Sinai Blog: Beach Volleyball Players and Safety

felt torn knowing the gases she used to make surgery painless for patients were actually hurting the environment.

“It was disturbing to me and hard to reconcile that here I am as a healthcare provider preserving human health, and yet I create a ton of pollution,” Ma said.

Climate change and air pollution are the biggest threats to human health, according to the World Health Organization, and cause—or worsen—a range of health threats, including infectious diseases spread by mosquitoes, ticks or fleas; respiratory illnesses; and heat exhaustion.

According to a study published in Health Affairs, the healthcare industry may be responsible for up to 8% of greenhouse gas emissions, and anesthetic gases account for more than half of the emissions generated during surgery. These gases are especially harmful because they are released directly into the atmosphere. Using the anesthetic gas desflurane for one hour, for example, produces the same carbon emissions as driving a gasoline-powered car for 190 miles.

Ma launched a Cedars-Sinai Medical Center initiative in 2021 to address anesthesiology’s role in the problem. After four years, she and her colleagues have significantly reduced the output of desflurane as well as nitrous oxide, while still maintaining the highest quality of care and safety for patients.

Caring for Patients, Cleaning the Air

In 2021, Ma and anesthesiologist Michael Kissen, MD, started spreading the word with their colleagues about anesthesiology’s role in climate change, and the environmental benefits of switching to alternative gases.

“Anesthesia is sometimes more of an art than a science,” Kissen said. “Every anesthesiologist has their routine and their medications that they lean on, but we wanted to make our colleagues aware of all the risk profiles of these gases beyond what we learned in an anesthesia textbook.”

Anesthesiologists used to rely on desflurane to provide general anesthesia for patients before surgery, but it has 20 times the carbon impact of its alternative, sevoflurane.

Under Ma’s guidance, Cedars-Sinai Medical Center and other Cedars-Sinai patient care centers moved away from desflurane, and in 2023, the hospital officially removed the gas from its approved list of drugs.

With these changes, Cedars-Sinai went from using 1,200 bottles of desflurane in 2021 to fewer than 12 in 2024—achieving a 99% reduction. Ma said the shift is equivalent to taking 250 cars off the road.

The initiative also targeted nitrous oxide—commonly known as laughing gas—which is frequently used by pediatric and obstetric anesthesiologists and for dental procedures. Experts have found that much of the gas is lost before reaching the patient, posing a hazard to the healthcare workers present during surgery and the environment. Nitrous oxide also lingers in the atmosphere for 100 years.

By gradually phasing out nitrous oxide, Cedars-Sinai reduced emissions from 1,111 metric tons of carbon dioxide in 2021 to 234 in 2024.

Eliminating both gases collectively removed about 2,200 metric tons of carbon dioxide emissions over the past four years—roughly equivalent to the annual emissions of 400 homes. The project has gained a champion in Michael Nurok, MB, ChB, PhD, co-chair of the Department of Anesthesiology.

“This initiative is emblematic of Cedar Sinai's commitment to being at the forefront of medical care and science,” Nurok said. “Beyond delivering excellent patient care and outcomes, our team is thinking about the impact of these gases on the environment, employees, and future generations.”

Expanding Eco-friendly Lens

Nurok has taken up the cause, looking for other ways to minimize pollution. He is working with Robert Kaplan, Marvin Bower Professor of Leadership Development Emeritus at the Harvard Business School, on creating a framework for measuring the impact of healthcare devices on the environment—such as implants, devices and medical equipment—as they are processed and transported through supply chains.

With a better understanding of the environmental costs of different approaches to a procedure, physicians will be able to make informed choices about which materials and processes they choose. Much like a nutrition label helps consumers to make wise decisions about what they eat.

For Anesthesiology’s next project, Nurok and Kissen are collaborating with the Department of Orthopaedics and others to measure and reduce the carbon impact of hip replacement procedures.

Bryan Croft, the medical center’s executive vice president and chief operating officer, said this work encourages Cedars-Sinai staff members to be good stewards of its resources and the environment.

“We are thrilled to be able to support anesthesiologists’ mission to reduce greenhouse gases, bettering the world we live in, and we look forward to continuing to support eco-friendly projects,” Croft said.

Read more on the Cedars-Sinai Blog: Cedars-Sinai Appoints Department of Anesthesiology Co-Chairs

The inaugural High School Scholars Program, hosted by Cedars-Sinai Orthopaedics in partnership with the Orthopaedic Trauma Association and sponsored by Stryker, included 50 students from schools including Phineas Banning Senior High School, Crenshaw High School STEMM Magnet, Westchester High School and Dominguez High School. The program offered the students a firsthand look at a future in healthcare.

“Our hope is that we open some eyes up to a career that has been tremendously fulfilling for me and my colleagues,” said Milton Little, MD, chief of Orthopaedic Trauma at Cedars-Sinai and one of the program’s organizers. “We want students to see what’s possible—not just in orthopedics, but across medicine: helping people, building a future, and avoiding the distractions or limitations they may face in their communities.”

Little knows this firsthand. He grew up in Harlem and lived in Los Angeles' pre-gentrified Echo Park in the late 1980s, giving him a deep and personal understanding of the challenges that students from underserved communities often face.

The half-day scholars program featured hands-on simulations, a career panel, and mentorship from orthopaedic surgeons, residents, physician assistants and other healthcare professionals. All were committed to showing students that their background doesn't define their future.

Students rotated through stations where they learned to apply casts and splints. They even drilled into synthetic bones to simulate hardware placement used in trauma surgeries. For many, it was their first time holding a surgical tool—or meeting a physician who looked like them.

“Orthopedic surgery is one of the least accessible specialties for students from underrepresented minority communities,” Little said. “Roughly 80% of orthopedic surgeons in the U.S. are white males. Black orthopedic surgeons make up just 1.5% of the field. That’s why programs like this matter.”

Among the volunteers were medical students from Charles R. Drew University of Medicine and Science, members of the Cedars-Sinai Orthopaedic Department, Ventura Medical Center orthopaedic attendings, Cedars-Sinai anesthesiologists, Cedars-Sinai Orthopaedic Biomechanics Laboratory researchers, representatives from Johnson & Johnson MedTech and instrument specialists from Stryker. Many of the program’s mentors came from backgrounds similar to the students’, making their stories all the more impactful.

“I’m from L.A., so I’m in some rough parts of it,” said Landen Coleman, from Crenshaw High School. “I met a doctor here who’s from Compton, and it was interesting seeing someone who came from my background turn their knowledge into something they can use to get out.”

The event was made possible through collaboration with Team HEAL (Helping Enrich Athletes’ Lives), a Cedars-Sinai community health program that provides high school athletes with access to certified athletic trainers, injury treatment and preventive health education. In addition to supporting athletes, Team HEAL offers students the chance to gain hands-on experience working alongside Cedars-Sinai trainers on the sidelines.

“For many students, athletics opens the door,” said Clarence Shields, MD, medical director of Team HEAL. “But we also want to show them what’s possible beyond the game. By giving them early access to mentors and real-world experiences, we’re helping them see a future in medicine they may not have known was there.”

Students like Aryeh Gustave, a Team HEAL participant from Crenshaw High School, left the program with new ambitions.

“I thought it was kind of weird that we were screwing metal into arms—like, ew,” Gustave said with a laugh. “But if it helps someone heal, I liked it. I’m actually considering doing this in the future.”

For Dayme Moraparra, a student from Dominguez High School, the impact came through the power of lived experience.

“I loved the career panel because I got to hear all their stories,” Moraparra said. “It wasn’t easy for them—and they still broke through the barriers.”

Read more on the Cedars-Sinai Blog: Faces of Cedars-Sinai – Melodie Metzger, Director of Orthopaedics Biomechanics Laboratory

“I probably needed a walker,” said Carroll, 68. “It was that bad.”

An orthopedic surgeon near his home in Northern California recommended a spinal fusion, an invasive surgery in which vertebrae are joined together to stabilize the spine, reducing pain. Recovery can take many months.

“It seemed like a harsh solution,” Carroll said. “But if that was what I needed to get out of pain, I figured it was what I had to do.”

When a physician friend encouraged him to get another opinion, Carroll turned to the Cedars-Sinai Virtual Second Opinion program. It gives patients outside Los Angeles a convenient way to access—at home, from their computer—customized treatment options by the medical center’s experts.

Carroll was quickly connected with spine surgeon Sang Kim, MD, assistant professor of Orthopaedics and director of Orthopaedic Spine Trauma at Cedars-Sinai. Kim evaluated the imaging studies from Carroll’s original surgeon and then made a video call to Carroll to share his opinion about his treatment options.  

“Terry had a foraminal disc herniation—a ruptured disc in the foramen, an area where nerve roots exit the spine and go to different parts of the leg,” Kim said. “That was causing weakness and pain.”

Kim recommended an extraforaminal microdiscectomy—a minimally invasive procedure with a faster recovery time than that of spinal fusion. Instead of fusing vertebrae, he would remove the part of the disc pressing on the nerve root.

Carroll was able to pursue the second option, thanks to Kim's expertise.

“I routinely perform extraforaminal microdiscectomies at Cedars-Sinai, but they are not commonly performed everywhere,” Kim said. “Some surgeons are not as familiar or comfortable with the procedure.”

Carroll told his surgeon in Northern California he was going to Cedars-Sinai for treatment.

“He completely understood, and it was all very professional,” Carroll said.

The surgery was on a Friday, and Carroll walked out of Cedars-Sinai the next day.

“My recovery was almost immediate,” he said. “I had worried that the treatment wouldn’t be a silver bullet, but it was. My goal was to get my life back, and in the hands of a skilled surgeon, I did.”

Sticking With the Original Opinion

Some patients who seek a virtual second opinion at Cedars-Sinai decide to follow their original physician’s treatment plan.

For Barbara Pitcher, of Idaho, spinal stenosis—a narrowing of the spinal canal that puts pressure on the spinal cord—as well as scoliosis—an abnormal spine curvature—were causing hip and thigh pain.

“I’m a very active person and wanted to live my life,” she said.

Pitcher, a retired nurse, saw her local spine surgeon, who recommended a two-level fusion and discectomy. Before proceeding, Pitcher went online and found Cedars-Sinai’s Virtual Second Opinion program. She was encouraged to learn the medical center had a spinal stenosis specialist.

“This is exactly what I need,” Pitcher thought.

Right away, Pitcher was connected with Kim for an online consultation and a review of her MRI. Kim told Pitcher he agreed with the original surgeon’s treatment approach.

“I gave Barbara two options to consider,” Kim said, “but because she had scoliosis and spinal stenosis, I told her I felt fusion surgery was likely the best option for her.”

Pitcher said Kim relieved her anxiety about what to do.

“He was patient, answered every question and put my mind at ease,” she said. “Connecting with a specialist at a larger medical center that does many spine surgeries was great.”

Pitcher decided to have surgery in Idaho, for convenience. Her recovery has been smooth, and she is getting back to the outdoor activities she loves.

“A virtual second opinion from an expert fills the need of people like me who live in a rural area and would like a bit more direction,” Pitcher said. 

Building Trust, Near and Far

Through Virtual Second Opinion, Kim often meets patients like Carroll and Pitcher who live in rural areas and may not have access to a wide range of specialists.

“I feel like I’m making a big difference for these patients,” Kim said. “Sometimes they just need reassurance that the treatment they are considering in their local area is right for them, and I’m happy to provide that.

“Another advantage is the video portion of the Cedars-Sinai second opinion. It helps patients and physicians immediately start to build a rapport in that first virtual meeting. Patients feel comfortable saying, ‘I trust this person to take care of me.’”

Read more on the Cedars-Sinai Blog: Virtual Second Opinion—Here's What to Know

The four newly named leaders have extensive expertise in surgical and nonsurgical sports medicine, enhancing patient care for athletes at all levels.

“Cedars-Sinai continues to build a world-class sports medicine program, and we are thrilled to recognize these outstanding leaders,” said Mark Vrahas, MD, chair of Cedars-Sinai Orthopaedics. “Their combined expertise, passion for treating athletes and commitment to innovation will further elevate our ability to provide leading-edge care to patients at all levels of competition.”

Michael Banffy, MD, has been named chief of Sports Medicine at Cedars-Sinai. Banffy, an orthopedic surgeon specializing in joint preservation, complex cartilage restoration and advanced hip, shoulder and knee arthroscopy, has extensive experience working with professional athletes. He is a team physician for the Los Angeles Rams and an orthopedic consultant to Major League Baseball players and Loyola Marymount University Athletics. Banffy completed his orthopedic surgery residency at Harvard’s Massachusetts General Hospital and Brigham and Women’s Hospital and a fellowship in sports medicine at Kerlan-Jobe Orthopaedic Clinic.

Casey Batten, MD, and Joshua Scott, MD, have been appointed co-directors of Non-Operative Orthopaedics and Sports Medicine. Batten, the lead primary care sports medicine physician for the Los Angeles Rams, was recently named chief medical officer for the LA28 Olympic and Paralympic Games in Los Angeles. He is a primary care sports medicine specialist who focuses on the nonsurgical treatment of athletic injuries and illnesses. Batten earned his medical degree from the Medical College of Wisconsin. He completed his family medicine residency at the University of Tennessee and a sports medicine fellowship at the UC Davis/UC Berkeley Sports Medicine Program.

Scott is a primary care sports medicine physician who is the chief medical officer for the Los Angeles Galaxy soccer team. A former Division I NCAA track and field athlete, Scott completed his residency in pediatrics at the Medical University of South Carolina and fellowship in sports medicine at the University of South Carolina. He is a team physician for Angel City Football Club and a Venue Medical Officer for the 2026 FIFA World Cup in Los Angeles. 

Clarence Shields, MD, has been named medical director of Team HEAL (Helping Enrich Athletes’ Lives) at Cedars-Sinai. Shields, a past president of the American Orthopaedic Society for Sports Medicine, has dedicated his career to sports medicine and improving access to care for underserved student athletes. A longtime leader in the field, Shields has been an NFL physician and an orthopedic doctor for the Los Angeles Rams. He founded Team HEAL in 1994 to provide high school athletes with certified athletic trainers, injury treatment and preventive education. Since its inception, Team HEAL has supported more than 30,000 student athletes in Los Angeles.

Read more on the Cedars-Sinai Blog: Champions for Young Athletes

Batten’s appointment follows Cedars-Sinai’s announcement last fall that it will be the Official Medical Provider for the LA28 Games, serving as a critical resource and medical adviser to LA28 in establishing medical services in the Olympic and Paralympic Village and at sporting venues for the Olympic and Paralympic Games.

Cedars-Sinai also is a supporter of Team USA and one of eight medical institutions in the U.S. Olympic & Paralympic Medical Network, providing medical treatment for Team USA athletes as they prepare to compete in national and international competitions leading up to the Olympic and Paralympic Games Milano Cortina 2026 and LA28. Cedars-Sinai, the exclusive Team USA and LA28 Medical Network provider in Los Angeles and surrounding areas of Southern California, started treating Team USA athletes in 2024.

In his chief medical officer role, Batten will be responsible for all aspects of medical services planning and delivery as the senior medical services official within the Organizing Committee of the Olympic and Paralympic Games. He also will be a primary link with the International Olympic Committee’s Medical and Scientific Commission on all medical services issues and will be a member of the commission. Additionally, he will work directly with the International Paralympic Committee's chief medical officer.

“I am thrilled to serve as chief medical officer and contribute to the health and success of Team USA athletes and the LA28 Games,” Batten said. “Cedars-Sinai and I are fully committed to the highest-quality care for athletes, coaches, team personnel and visitors who will come from around the world to Los Angeles for the Olympic and Paralympic Games.”

Batten has extensive experience treating elite athletes. He is co-director of Nonoperative Orthopaedics and Sports Medicine and director of the Primary Care Sports Medicine Fellowship in the Department of Orthopaedics at Cedars-Sinai. In his clinical practice, he specializes in primary care sports medicine with a focus on nonsurgical treatment of athletic-related injury and illness, as well as diagnostic and interventional ultrasound.

Batten is head team physician for the Los Angeles Rams, participates in numerous NFL committees and is a member of the NFL Physicians Society. He also is an active member and has served on the board of directors of the American Medical Society for Sports Medicine.

Prior to joining Cedars-Sinai, Batten served as director of Primary Care Sports Medicine and fellowship director of the Cedars-Sinai Kerlan-Jobe Primary Care Sports Medicine Fellowship Program. Before Kerlan-Jobe, he was head team physician for the University of California, Berkeley.

“Dr. Batten’s experience will be a major asset to LA28 as we build a world-class support team for the Games and all who attend, including the exceptional athletes visiting Los Angeles in 2028,” said LA28 chief athlete officer, Janet Evans. “His proven track record of clinical expertise and medical leadership in sports medicine are invaluable as we prepare to meet the extensive medical needs of the entire Olympic and Paralympic community.”

Batten and Cedars-Sinai will build on their critical role in supporting Team USA athletes on the journey to the Olympic and Paralympic Winter Games Milano Cortina 2026 and LA28 through the U.S. Olympic & Paralympic Medical Network, expanding their scope and responsibilities to ensure the wellbeing of athletes, coaches, support staff and fans at the LA28 Games.

“Dr. Batten and Cedars-Sinai bring great expertise, care and professionalism to the global Olympic and Paralympic community as Los Angeles welcomes Team USA athletes and international competitors in 2028,” said Jonathan Finnoff, chief medical officer of the U.S. Olympic & Paralympic Committee. “Collaboration is vital to our shared mission of ensuring the health and safety of everyone attending the Olympic and Paralympic Games, and I look forward to strengthening this partnership as we approach LA28."

A graduate of the University of Wisconsin-Madison, Batten earned his medical degree at the Medical College of Wisconsin in Milwaukee and completed his residency in family medicine at the University of Tennessee College of Medicine in Chattanooga. He completed his sports medicine fellowship at the University of California, Davis, and at UC Berkeley. A highly respected educator within the sports medicine community, Batten is a peer reviewer for sports medicine journals and is an invited guest lecturer at events nationwide.

“Dr. Batten is the perfect physician leader to serve as chief medical officer for the LA28 Games,” said Peter L. Slavin, MD, president and CEO of Cedars-Sinai. “The entire Cedars-Sinai team stands with Dr. Batten in dedicating ourselves to serve our community and country as we prepare for the Games.”

About Cedars-Sinai

Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars-Sinai is known for its national leadership in transforming healthcare for the benefit of patients and in developing new approaches to treatment and educating tomorrow’s health professionals. Cedars-Sinai serves as the official health partner for the Los Angeles Rams and the Angel City Football Club and treats professional and elite athletes throughout the world to ensure they perform at the highest levels. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.

About LA28 Olympic and Paralympic Games

The LA28 Games will mark Los Angeles’ third time hosting the Olympic Games, previously hosted in 1984 and 1932, and first time to host the Paralympic Games. Los Angeles will host the world’s most elite athletes in 2028 as it welcomes Paralympians and Olympians from around the world to compete on the biggest stage in sports. The LA28 Games are independently operated by a privately funded, nonprofit organization, with revenue from corporate partners, licensing agreements, hospitality and ticketing programs and a significant contribution from the International Olympic Committee. For more information, visit LA28.org.

About Team USA

Founded in 1894 and headquartered in Colorado Springs, Colorado, the United States Olympic & Paralympic Committee serves as both the National Olympic Committee and National Paralympic Committee for the United States. The USOPC is focused on protecting, supporting and empowering America’s athletes, and is responsible for fielding U.S. teams for the Olympic, Paralympic, Youth Olympic, Pan American and Parapan American Games, and serving as the steward of the Olympic and Paralympic movements in the U.S. For more information, visit TeamUSA.com. 

Read more on the Cedars-Sinai Blog: How Some Sports Injuries Can Cause Arthritis at an Early Age

Taking the right precautions can help athletes at all levels to stay in the game and avoid unnecessary setbacks.

The Cedars-Sinai Newsroom spoke with Michael Banffy, MD, chief of Sports Medicine at Cedars-Sinai Orthopaedics, to learn how to prevent common spring sports injuries and safely ease back into an active lifestyle.

What are the most common springtime sports injuries?

Banffy: As people get back into their sporting activities, if they haven't done much during the winter, they have a higher risk of soft tissue injuries like muscle pulls, ligament strains or even sprained ankles. If they push too hard, too fast, they may also develop chronic overuse injuries like tennis elbow or shin splints.

For example, if someone decides to start running again and immediately goes out for a 10-mile run, they’re putting themselves at risk for injury. Instead, gradually building up—starting with 1 or 2 miles and progressing from there—can help condition the muscles and joints properly.

How can sports injuries be prevented?

Banffy: You don’t want to go from zero to 100. It’s important to have some level of physical activity—even if it’s not your main sport—so that your muscles stay strong and flexible. Strength training and flexibility exercises, such as yoga or Pilates, are essential to maintaining muscle balance and joint stability.

Cross-training is also key. In baseball, for example, we strongly encourage players not to play year-round. Athletes want to be the best and may think that constant practice is the way to get there, but overuse leads to injury. Doing something different in the offseason—like throwing a football instead of a baseball—uses a different biomechanical motion that can help preserve joint health while maintaining overall fitness.

How can you tell if it’s muscle soreness or an injury?

Banffy: Most of us experience muscle soreness as we get back into any activity, and that’s normal. Typically, soreness will resolve with rest. But a true injury usually happens suddenly during the activity.

For example, if you’re playing tennis and suddenly feel a pop in the back of your leg, that’s likely an acute injury that needs medical attention. In contrast, if you just feel general muscle fatigue after playing, that’s expected and can be managed with stretching and recovery techniques.

What are some recovery tips?

Banffy: If it’s mild soreness or a low-grade strain, stretching and light movement can help. Oral anti-inflammatories like Advil or Aleve can also help manage discomfort.

Other key recovery strategies include getting enough sleep, staying hydrated and allowing proper rest between activities. Research shows that dehydration is directly linked to muscle injuries, especially hamstring strains. If you're not drinking enough fluids, your muscles are more prone to fatigue and strain.

To stay properly hydrated, plan ahead and make sure you have enough liquids during activities—especially if you're exercising in hot weather, where your hydration needs increase. Pairing hydration with adequate sleep and proper nutrition will help your body recover and reduce the risk of injury. If pain persists or worsens, it’s important to seek medical advice to rule out a more serious injury.

Read more on the Cedars-Sinai Blog: Play Like the Pros—Take a Break

“We extend a warm welcome to Dr. Whitlock, who brings to our team years of extensive clinical and research expertise in hip preservation, a rapidly growing subspecialty field,” said Mark Vrahas, MD, chair of Orthopaedics at Cedars-Sinai. “Dr. Whitlock has a reputation for providing superior individualized care and treatment for young people with hip pain and damaged hip structures, helping preserve the natural hip joint and restoring normal hip function to help delay or prevent future hip replacement surgery.”

Whitlock is one of the few specialists in the U.S. skilled at performing periacetabular osteotomy (PAO), a complex surgery to treat hip dysplasia, a condition in which the hip socket is not shaped to support the upper part of the thigh bone.

Whitlock also is an expert in the treatment of slipped capital femoral epiphysis, a condition in which the top of the thigh bone slips out of position; hip impingement, in which the bones of the hip joint fit together improperly; Perthes disease, a rare childhood condition in which blood supply to the head of the thigh bone is interrupted; and large osteochondral defects of the hip using osteochondral allograft tissue. He also has special expertise in pediatric orthopedic trauma. 

“Dr. Whitlock is an excellent addition to our Pediatric Orthopaedic Program, bringing a specific skillset and knowledge of hip treatments that can help prevent progression of arthritis,” said David Skaggs, MD, executive vice chair of Orthopaedics at Cedars-Sinai, co-director of the Cedars-Sinai Spine Center and director of Pediatric Orthopaedics at Cedars-Sinai Guerin Children’s. “His expertise further emphasizes our commitment to addressing the unique orthopedic needs of children and adolescents who need early interventions using the most innovative treatments.”

In his research, Whitlock develops materials from natural sources to treat avascular necrosis and osteochondral defects—conditions that can cause significant joint pain and dysfunction. He has authored numerous studies published in high-impact, peer-reviewed medical journals and has presented his work at national and international orthopedics conferences.

Whitlock joins Cedars-Sinai from Cincinnati Children’s Hospital Medical Center, where he was co-director of the Hip Preservation Program, associate professor in the Department of Orthopaedic Surgery at the University of Cincinnati College of Medicine and associate professor of Clinical-Affiliate Biomedical Engineering at the University of Cincinnati College of Engineering and Applied Science.

“It is a privilege to be part of the exceptional orthopaedics team at Cedars-Sinai and Guerin Children’s—among the best in the U.S. for improving musculoskeletal health,” Whitlock said. “I look forward to helping more patients feel better, move better and avoid additional challenges with their hips as they get older.”

Whitlock earned his medical degree from Drexel University College of Medicine and his doctorate in chemical and materials engineering from the University of Cincinnati College of Engineering. He completed his medical residency at Wake Forest University Health Sciences and fellowships in pediatric orthopaedic surgery at Children’s Hospital Los Angeles as well as the Maurice E. Muller Foundation of North America European Traveling Fellowship in Hip Reconstruction in Switzerland, Denmark and Italy.

Whitlock was named an Emerging Leader by the American Orthopaedic Association. In 2022, he received the William Harris Foundation Career Development Award in Hip Surgery-ANCHOR (Academic Network of Conservational Outcomes Research), established by the Department of Orthopaedic Surgery at Washington University to facilitate training and career development in hip preservation.

Read more on the Cedars-Sinai Blog: Hip Health – Expert Guidance on Maintaining Your Joints

Fewer than 10% of practicing orthopedic surgeons are women, according to the American Academy of Orthopaedic Surgeons. The Perry Initiative, a nonprofit organization that partners with medical institutions nationwide, aims to narrow the gender gap in orthopedics and engineering.

“Traditionally, the representation of women in science, engineering and math lags behind,” said Carol Lin, MD, an orthopedic trauma surgeon and one of the program’s organizers at Cedars-Sinai. “This program is a way to show young women that they can have a family, a career, and be an orthopedic surgeon or engineer.”

More than 50 high school and medical students from across Los Angeles participated in this year’s two-day event. Students engaged in a mix of lectures and hands-on workshops.

Medical students connected with orthopedic mentors and practiced advanced techniques like external fixation and intramedullary nailing. High school students were introduced to the basics of orthopedic surgery through interactive stations where they used power drills and saws on synthetic bones to learn how physicians repair fractures and reconstruct torn ligaments. 

“What I love about these workshops is seeing students start off intimidated by the power tools because they've never used them before,” Lin said. “By the end of the day, they're confidently saying, ‘I think this fracture needs a few more screws.’”

Melodie Metzger, PhD, an orthopedic biomedical engineer and co-organizer of the program at Cedars-Sinai, emphasized the importance of early exposure for these students.

“Orthopedics is a field where problem-solving and innovation intersect,” Metzger said. “Programs like The Perry Initiative allow young women to see how their passion for science and engineering can translate into impactful careers. It’s about showing them that they have a place here.”

Young women interested in applying for an upcoming The Perry Initiative event can click here.

Read more on the Cedars-Sinai Blog: Faces of Cedars-Sinai – Melodie Metzger, Director of Orthopaedics Biomechanics Laboratory

That’s why Gregory Jones, RN, injury prevention and outreach coordinator for the hospital’s Trauma Program, is on a mission to help older adults avoid risk factors and prevent falls. Jones has been giving talks at community centers across Los Angeles County leading up to Falls Prevention Awareness Week Sept. 23-27.

“Prevention is the best cure for the disease of trauma,” Jones tells audiences. “Many falls are preventable, and knowledge is power, so the more everyone is aware of the ways to prevent a fall, the better.”

The National Council on Aging reports that every 11 seconds, an older adult is treated in a hospital emergency department for a fall-related injury. According to the U.S. Centers for Disease Control and Prevention, at least 300,000 people 65 and older visit a hospital every year for a hip fracture from falling.

Jones said most people will be able to get up if they fall. Still, for some, a fall can lead to lost independence, disability or even death.

“People who have fallen once have a greater risk of falling again,” Jones said. “Another risk factor is feeling unsteady or off balance, needing support to walk, or holding onto furniture when walking around the house.”

Other fall risk factors include:

• Taking medicines that can cause lightheadedness or drowsiness
• Home hazards, such as slippery surfaces, lack of railings, clutter or inadequate lighting
• Numbness in the feet
• Weak leg muscles
• Vision problems

Jones tells older people that simply knowing whether they’re at greater risk of falling is just part of the equation.

“You also must correct what could cause you to fall or has already caused a fall,” he said.

Cedars-Sinai’s outpatient Geriatrics Program offers consultations for falls and fall prevention.

Its outpatient Bone Health Coaching Program, part of the Geriatric Fracture Program in the Department of Orthopaedics, provides bone health and fall risk evaluations and counsels patients on how to reduce the risk of fragility fractures—typically in the hip, spine or wrist—which can occur when a person falls from a standing position.

“The risk of falling and breaking a bone is much greater for people with poor bone quality from osteoporosis or osteopenia,” said nurse practitioner Kathleen Breda, associate director of Orthopaedic Clinical Programs. “Because poor bone quality isn’t usually obvious, many people don’t know they have a problem with their bones until they fall and break one. Proactive care to protect bones is crucial to long-term quality of life. Our Bone Health Coaching Program helps people at risk for a fall before they break a bone or helps them avoid another fracture if they fall again.”

The Cedars-Sinai Geriatrics Program and Bone Health Coaching Program have received Age-Friendly Health System Committed to Care Excellence recognition, which means they work to improve bone fracture outcomes through the “4Ms” model of care: learning what matters most to each patient, optimizing medications, helping them maintain mobility and monitoring mental state.

One important way to take action to prevent a fall, Jones and Breda said, is by building balance, strength and flexibility through an exercise program. Cedars-Sinai offers Forever Fit classes for older adults, led by its Community Health Improvement professionals.

Other ways to prevent a fall include regularly reviewing medications with a physician or pharmacist to make sure side effects don’t increase fall risk, getting an annual vision and hearing checkup, and keeping the home environment uncluttered.

Jones encourages taking small steps—no pun intended—on the path to fall prevention.

“Start by taking a look around the house—that throw rug in the hallway may be pretty but is it a fall hazard?” he said. “I also recommend a night light or flashlight for the bathroom or bedroom. Use a cane if your doctor says you should. Be sure you’re wearing the right shoes.

“But at the same time, don’t get overwhelmed. You don’t have to do all these things all at once. Start small.”

Jones will discuss fall prevention on Wednesday, Sept. 18, at 10 a.m. at West Hollywood Comprehensive Service Center, 7377 Santa Monica Blvd., and on Friday, Sept. 20, at 11 a.m. at Jewish Family Service, 11338 Santa Monica Blvd.

Read more on the Cedars-Sinai Blog: Bone Health Breakdown—How to Prevent Fractures

“I am excited to have Dr. Tuchman as a partner in elevating and building the Cedars-Sinai Spine Center,” Skaggs said. “I have enjoyed partnering with Dr. Tuchman in research, educating the next generation of spine surgeons, and in the operating room. It takes a comprehensive team including both neurosurgical and orthopedic spine expertise to build on our foundation of leading-edge research while at the same time providing the highest-quality clinical care.” 

Tuchman, an assistant professor of Neurosurgery at Cedars-Sinai, attended medical school at the University of Miami Miller School of Medicine and completed his neurosurgery fellowship at the University of Southern California. Before joining Cedars-Sinai in 2018, Tuchman also completed a spine deformity fellowship at Columbia University Medical Center in New York.

It was during his residency that Tuchman discovered the complexity, challenges and rewards of providing adult spinal care, and he did extra training in treatment of spinal malalignments and deformities such as scoliosis, sagittal plane deformities and flat back syndrome.

“These surgeries have impressive impacts on people’s quality of life,” Tuchman said. “The spine is the center connection point for your extremities and brain, and anytime there's a structural issue, it can cause devastating consequences. With reconstructive spine surgery, we can often restore function and relieve pain, taking someone who is basically homebound, or even bedridden, and getting them back out into the world.”

Tuchman also conducts research focused on outcomes for spine surgery patients, and treats adult patients with rare spinal conditions such as achondroplasia, a genetic condition that truncates the growth of the arms and legs and is the most common form of short-limbed dwarfism.

He said proper selection of spine patients—and treatments—is paramount. An open dialog between the patient and the surgeon is essential so that the patient feels comfortable expressing their wants and needs and the surgeon can adapt a treatment plan to address those things.

“One of the biggest challenges for a spine surgeon is determining whether we can genuinely help,” Tuchman said. “If a patient’s spine problem is not going to respond well to spine surgery, then that person shouldn't have spine surgery, and if a spinal malalignment isn’t affecting the patient’s quality of life, perhaps it does not need to be treated.”

Keith L. Black, MD, chair of the Department of Neurosurgery and the Ruth and Lawrence Harvey Chair in Neuroscience at Cedars-Sinai, said that the robust resources of Cedars-Sinai and Cedars-Sinai Spine Center also are key factors in quality care.

“Spine surgery is a team sport and we have internists, cardiologists, physical and occupational therapists, anesthesiologists, surgical technicians, pain specialists, hospitalists, and top-notch nurses working with our surgeons to care for hundreds of spine surgery patients each month,” Black said. “Dr. Tuchman taking the reins as co-leader means continued excellence for the team and the best possible outcomes for our spine patients.”

Read more on the Cedars-Sinai Blog: Seeking a Second Opinion for a Spine Condition

“We are seeing an epidemic of pickleball Achilles tendon injuries,” said Cedars-Sinai orthopedic surgeon Timothy Charlton, MD.

Pickleball is the fastest-growing sport in the United States, especially among older adults, and offers a fun, social way to boost physical activity. With 13.6 million players and a 200% increase in participation over the past three years, pickleball’s rapid rise is notable. So is the increase in injuries.

SportsMed.org says injury numbers have increased nearly ninefold in the past decade. In 2023, pickleball injuries in the U.S. accounted for more than $350 million in medical costs.

The Cedars-Sinai Newsroom spoke with Charlton, a foot and ankle surgeon and a United States Professional Tennis Association certified instructor, to discuss common injuries, prevention, and the benefits of playing racket sports.

What type of outdoor sports injuries are you seeing this summer?

We're seeing a significant number of injuries from tennis and pickleball, with pickleball gaining immense popularity in the last five years. In tennis, shoulder injuries are common, while both tennis and pickleball players frequently experience lower extremity injuries, particularly Achilles tendon tears. These injuries have become especially prevalent in pickleball, reaching epidemic proportions and affecting older age groups that typically wouldn't suffer from Achilles tendon injuries. This increase in injuries is largely due to the rapid rise in the number of people playing pickleball, often without adequate preparation or conditioning.

Why are there so many pickleball injuries?

Pickleball is really fun, and I encourage anyone to play it, but it's important to do so in a healthy way. We're seeing many injuries because new athletes are returning to the court after a long time away or are starting to play competitively without proper training. This creates an environment where injuries are more likely to occur. Specifically, we're seeing a significant number of Achilles tendon ruptures in the 60 to 70 age group, often among women. This is a demographic that historically didn't experience such injuries as frequently before the rise of pickleball.

What is an Achilles tendon rupture and how is it treated? 

An Achilles tendon rupture is a complete or partial tear of the Achilles tendon, which connects the calf muscles to the heel bone. This injury often occurs during activities that involve sudden, forceful movements, such as jumping or sprinting, which are common in sports like tennis and pickleball.

Treatment for an Achilles tendon rupture can vary depending on factors like the patient's age and activity level. There are two main treatment options. One option is non-operative, involving a cast and functional brace. The other option is surgery. Both approaches aim for the same endpoint: It typically takes about nine months before a patient can return to a basic level of competition.

Recovery can take several months, and the risk of re-rupture or other complications can be reduced by following a rehabilitation plan and avoiding premature return to high-intensity activities.

Why are Achilles ruptures common injuries when playing pickleball?

Achilles tendon ruptures in pickleball often occur due to the movement patterns and body positions typical in the sport. Players frequently move backward and then forward while staying very upright, with their feet aligned in the same direction. This increases the strain on the Achilles tendon. In contrast, professional pickleball and tennis athletes, who rarely experience Achilles tendon ruptures, maintain a low, athletic stance with their feet turned outward, like a duck. To prevent Achilles tendon ruptures, recreational players should adopt this lower, more stable stance with feet positioned outward.

Can an Achilles injury be prevented?

Yes, an Achilles injury can be prevented with proper techniques. The simplest recommendation for preventing an Achilles tendon rupture on the tennis or pickleball court is to adopt a low, athletic stance and position your feet outward, like a duck.

To make this a habit, try touching your racket to the ground. This action naturally lowers your body and helps position your feet outward, reducing the strain on your Achilles tendon and preventing the injury. This stance helps avoid the problematic alignment of your feet with your plane of motion.

What are the advantages of playing racket sports?

Tennis, pickleball, and racket sports in general are wonderful for many reasons. These sports have been proven to extend life and contribute to overall health. If you look at vibrant individuals in their 80s, 90s, and even 100s, many of them play racket sports or swim.

Playing racket sports can help you maintain a healthy lifestyle, provided you practice proper techniques to avoid injuries. Our goal is to keep you on the court, enjoying the sport you love, and out of the doctor's office. By staying injury-free, you can continue to experience the joy and passion these sports bring to your life.

Read more on the Cedars-Sinai Blog: Torn Achilles Tendon FAQ

When Grace was 12, her father, an orthopedic surgeon, gave her a hug and noticed that something wasn’t quite right.

“I remember my dad hugged me and was feeling my back and said, ‘you have scoliosis,’ I didn’t even know what that was,” said Grace. “I didn’t think it was a big deal, I thought I was fine and thought he was just being weird, but it turns out I had scoliosis.”

Grace, who grew up appearing in popular shows and movies like The Handmaid’s Tale, Young Sheldon, I, Tonya and Ghostbusters: Afterlife, began to notice her physical appearance gradually morphing into someone else.

By the time Grace turned 16, her scoliosis began to affect her work. For red carpet events, she would have her dresses altered so that one side was longer than the other to camouflage her scoliosis. On stage and in front of the cameras, Grace would stand as straight as she could, but by the end of the day, she would be tired and in pain.

“I had started to notice just how crooked I was standing and so were people around me,” said Grace. “I'd get in trouble on set all the time. They'd always be telling me, ‘Stand up straight,’ ‘Stop slouching,’ ‘Mckenna, you're on your mark, but you're all the way over here,’ ‘We need you to stand up,’ and so on.”

As Grace's quality of life declined, her parents could not watch their daughter in pain and knew that if her career was to continue, surgical intervention would need to be considered. Grace’s father heard of the right surgeon for the job: David Skaggs, MD, director of Pediatric Spine and Pediatric Orthopaedics at Cedars-Sinai Guerin Children’s. 

When Grace met with Skaggs, her spine was at a 50-degree curve.

“What was unique about Mckenna is that her waist really looked asymmetrical, the layperson could see from across the room that something was going on,” said Skaggs. “When she bent forward she had a big hump on her back and she was becoming increasingly aware of it.”

With her rapidly deteriorating spine, Skaggs agreed that spinal surgery was the best option. The catch—she would need to heal and recover ahead of filming for the second Ghostbusters film.  

“She asked me, ‘is there any way I could have surgery and carry a 40-pound pack?’ I said, Of course you can. We'll get you back to filming.”

Skaggs and his multidisciplinary team got to work and performed spinal surgery, inserting metal rods, also known as spinal instrumentation, and screws across six vertebrates to straighten her spine.

“The reason we have surgery and care for these kids is so they can return to a normal life,” said Skaggs. “Now when we look at Mckenna, you can almost not tell that she ever had scoliosis or surgery. Mckenna’s body looks perfectly symmetrical and she’s over an inch-and-a-half taller.”

Following her successful surgery Grace took to social media to share her journey and encourage others.

“Mckenna was a rockstar,” said Elaine Butterworth, RN, pediatric nurse navigator and the director of Patient Experience and Education for the Pediatric Spine Program. “I remember her videotaping herself getting out of bed for the first time, when she was at her most vulnerable time and she not only recorded it but later posted it to help other kids.”

Back in the spotlight, Grace was standing tall and straight—just in time to walk the Ghostbusters carpet.

Read more on the Cedars-Sinai Blog: Supporting the Spine From Adolescence to Adulthood.

Building on decades of local experience, Congress Orthopaedic Associates Inc. and Risser Orthopaedic Group will continue to offer high-quality, personalized and coordinated care to patients.

The two groups have formed one comprehensive practice that will strengthen a shared commitment by Cedars-Sinai and Huntington Health, an affiliate of Cedars-Sinai, to enhance the wellbeing of patients across the region. The practices’ combined 29 specialists and support staff serve patients at locations in Pasadena and Arcadia.

“We are proud to welcome two of the most trusted orthopaedic practices in the San Gabriel Valley to Cedars-Sinai, expanding our ability to provide comprehensive orthopedic services to the local community through Huntington Health,” said Jill Martin, executive vice president of Cedars-Sinai Medical Network.

Huntington Health will continue as the primary hospital to admit and provide high-quality orthopedic services—including total joint replacements and spine surgery—to Congress and Risser patients, as it has done for years.

“By working even more closely with these two outstanding practices, we can offer members of the community an even better, more coordinated experience throughout their care journey,” said Lori J. Morgan, MD, MBA, president and CEO of Huntington Health. “We look forward to continuing to support these groups in providing high-quality orthopedic care in the San Gabriel Valley.”

The specialists at Congress and Risser offer expert care in general orthopedics and specialty areas, including knee, ankle, foot and hip, hand and wrist, shoulder and elbow, and neck and spine, as well as joint replacement, sports medicine, occupational medicine and orthopedic oncology. Physicians and staff provide a wide range of innovative treatment options, including noninvasive approaches and minimally invasive surgery. They also offer advanced diagnostic imaging and rehabilitation services such as physical therapy.

Congress is a well-known medical name in the area, where it has served patients for more than 60 years. It now has offices in Pasadena and Arcadia.

“For more than six decades, Congress Orthopaedic Associates has been dedicated to offering high-quality patient care, leading-edge research and comprehensive patient education,” said William M. Costigan, MD, director of the Congress Associates Center for Spinal Surgery and Study. “We look forward to furthering that commitment through our new relationship with Cedars-Sinai and Huntington Health.”

Risser’s history in Pasadena dates to the 1930s, when its founder, Joseph C. Risser, MD, began providing orthopedic care in the community. Risser’s current leaders said they look forward to enhancing services for communities that have long come to rely on the group for high-quality orthopedic care.

“Providing expert care close to where patients work and live in the San Gabriel Valley helps support the best outcomes for our patients,” said Daniel Laster, MD, medical director of Risser Orthopaedic Group. “Our patients have been at the center of all that we do, and we look forward to caring for them for many years to come.”

Imagine a world in which the digital watch on your wrist tracks not only your step count, but also your blood sugar, heart rate, blood pressure and respiration. Then, the watch automatically sends a personalized health snapshot to your physician, alerting them to early signs of disease.

That scenario could become reality in the near future, according to Joseph Schwab, MD, director of the Cedars-Sinai Center for Surgical Innovation and Engineering, who is leading innovative research in wearable healthcare technologies.

Schwab, also Cedars-Sinai’s director of Spine Oncology for Orthopaedic Surgery, will present the latest trends in his research about wearable health technology during the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in San Francisco, Feb. 12-16. During the conference, Schwab also will participate in the President’s Symposium, sharing insights on generative artificial intelligence (AI), such as ChatGPT. He also will discuss healthcare privacy issues that can occur with these technologies.

The Cedars-Sinai Newsroom sat down with Schwab to discuss the scope of his research and how he sees AI impacting the future of healthcare.

What makes your lab different from other research facilities?

My co-director, Hamid Ghaednia, PhD, is a mechanical engineer and our lab is unique in the sense that it is heavily engineering-based. A lot of what we are doing day to day is building things. So rather than test tubes and microscopes, we have lathes and band saws. We have several 3D printers and a whole room dedicated to electronics, where we solder devices together. The research team’s engineering expertise is a key differentiator, and our clinical and engineering partnership is distinctive to what we do. Not only do we have the equipment, but we have the know-how to go with it.

We are one of the few research facilities in the country where we can identify a clinical need, discuss it, come up with a potential solution, build that solution and begin testing, all within one center.

What are a few of the innovations you’re working on?

Our focus area is wearable devices. Consumer wearables on the market are essentially motion trackers. They may have an accelerometer or gyroscope that can simply measure your position or motion to track steps and other data. What we’re doing is different in that our devices are sending energy—in the form of light, electrical energy and sound—into the tissues, and we can measure that energy as it leaves the tissue, and we can deduce things based on how the energy was affected by the tissue.

For example, when you are at the doctor and they use a reflex hammer above your knee to test for a reflex reaction, they are only able to identify the presence or absence of the reflex. Instead, wearable devices that we are developing can quantitate the reflex response—things like how long it took to respond, the robustness of the response, etc. We can give a very specific number connotation to these data points, which we hope will translate into better diagnoses.

How is AI used in the work you do?

The sensors on our wearable devices receive an incredible amount of data from the energy after it has traveled through the tissue, which requires advanced computing power to interpret. At its core, AI is just that—very advanced mathematics and computer programming. We utilize AI to interpret the data captured and correlate it to clinical problems.

Separate from our wearable technologies, we are also able to use AI to make predictions on a smaller scale for use in clinical practice, such as interpreting electronic health data. For instance, a patient may be considering a procedure that has a 5% risk of complication for the whole population; however, using AI to interpret their personal health information, we may learn that their individual complication risk is closer to 25%. This could heavily impact their decision-making. Giving more precise predictions like this is a form of personalized medicine.

Who can benefit from these new technologies?

These technologies can truly benefit everyone across the healthcare spectrum. Patients whose health data is analyzed could receive more personalized care. They could be directed to more precise tests to get an accurate diagnosis and personalized treatments, for example, and may ultimately have better outcomes.

There’s even the potential for a positive impact on healthcare payers and insurance companies by making the right treatment decisions, and thus reducing health expenditures. There are so many opportunities and benefits.  

Where do you see this field headed in the next five to 10 years?

In my opinion, it won’t be too long before we stop using the terms artificial intelligence and machine learning altogether because it will just be integrated into everything we do, running in the background as common practice. It will no longer be a mystery.

As it relates to wearable technologies, I see these becoming part of the expected process of medical assessments. There is the opportunity to learn so much more through these devices than you would glean from a basic physical examination, and the data can be captured in advance of a patient even seeing the provider. A medical appointment can become much more accurate and efficient when the provider has already been able to review and interpret the data collected.

Wearable technology and the integration of AI into the consumption and delivery of healthcare is only going to continue to grow with time, and I think people will become very comfortable and begin to rely on these devices in a good way.

Read more from Cedars-Sinai Discoveries Magazine: Artificial Intelligence Advances

Earlier this year, Joseph Schwab, MD, joined Cedars-Sinai as the new director of Spine Oncology for Orthopaedic Surgery and the director of the Center for Surgical Innovation and Engineering, leading the expansion of the spine oncology program, providing destination expert care for patients with challenging spine disorders.

“Our growing spine and orthopaedic teams represent an unparalleled fusion of specialized expertise dedicated to transforming patient care,” said Mark Vrahas, MD, chair of Cedars-Sinai Orthopaedics. “Our newest faculty bring with them highly tailored skills that will give patients personalized care and optimal outcomes.”

Joining Schwab are three new orthopaedic specialists.

Andrew Bach, DO, a physiatrist with a focus on physical medicine and rehabilitation, specializes in non-operative solutions for spinal issues.

Motivated by personal experience, Bach is dedicated to alleviating back pain without resorting to surgery whenever possible.

During his college years, Bach grappled with back pain and was advised to undergo spine surgery. Seeking alternative opinions, he was referred to a non-operative spine specialist who successfully relieved his pain, without having to undergo unnecessary surgical procedures.

Bach aims to guide patients toward accurate diagnoses and surgical evaluations only when necessary.

“Dr. Bach's involvement is crucial to our comprehensive spine care program, focusing on non-operative approaches,” said Theodore Goldstein, MD, vice chair of the Spine Center at Cedars-Sinai. “His role includes collaborating with therapists, devising spine protocols, and infusing energy, expertise, and cohesion into the often-challenging transition from in-patient care to acute or chronic rehab as needed."

Bach holds a Doctorate in Osteopathic Medicine from Midwestern University Arizona College of Osteopathic Medicine and completed his residency in Physical Medicine and Rehabilitation at Wayne State University School of Medicine.

Pediatric orthopaedic surgeon Amelia Lindgren, MD, brings expertise in hip dysplasia, lower extremity deformity, and skeletal dysplasia.

Lindgren will provide care at Cedars-Sinai Medical Center in Los Angeles and at Providence Cedars-Sinai Tarzana Medical Center.

“We look forward to the contributions Dr. Lindgren will make to our shared goals and endeavors,” said David Skaggs, MD, director of Pediatric Orthopaedics at Cedars-Sinai Guerin Children’s. and director of Spine Service. “Her expertise will allow us to provide specialized care to our growing pediatric population.”

Lindgren completed an orthopedic surgery residency at the University of California, San Diego, and a fellowship in pediatric orthopaedic surgery at Nemours-DuPont Children’s Hospital in Wilmington, Delaware. 

Spine surgeon Christopher Mikhail, MD, specializes in healing complex spinal pathologies, including spinal deformities such as scoliosis, congenital anomalies, and degenerative scoliosis.

Mikhail's expertise in spinal deformity surgery, as well as robotics and navigation, allow him to utilize the most advanced technology for preoperative surgical planning with artificial intelligence to execute surgical plans with the highest accuracy.

Mikhail completed residency in orthopaedic surgery at the Ichan School of Medicine at Mount Sinai Hospital in New York City and a combined orthopaedic and neurosurgical spine fellowship under the tutelage of Lawrence Lenke and Daniel K Riew at the Och Spine Hospital at New York Presbyterian at Columbia University, and Weill Cornell Medical Center.  

Read more on the Cedars-Sinai Blog: Seeking a Second Opinion for a Spine Condition

That is, until May 2020, when his active lifestyle took a sudden downhill turn.

Two months after Mulholland’s high school junior varsity lacrosse season came to an abrupt end due to the COVID-19 pandemic, a playful roughhousing wrestling match with friends at a park ended with a devastating injury.

“I blew out my entire knee and tore everything–my ACL, my LCL, my PCL–my IT band tore off of my femur, my kneecap dislocated, and my peroneal nerve also tore,” said Mulholland. “After that, everything from my knee down was paralyzed.”

Mulholland’s right leg was left with damage to his peroneal nerve–a branch of the sciatic nerve located in the lower leg. After undergoing reconstructive knee surgery, Mulholland developed foot drop, a condition characterized by the inability to lift up and roll out the foot.

“As soon as I met with an orthopaedic surgeon, I found out that my athletic career would be pretty short-lived and that it was going to be really hard to recover from a nerve or foot drop injury,” said Mulholland.

The National Institutes of Health estimates that over 120,000 people are affected by foot drop each year. However, the actual number may be higher, as some patients may go unreported or undiagnosed.

Ten months after his knee surgery, Mulholland could still not move his foot and was advised by medical experts to wait to see if his peroneal nerve would reawaken on its own.

“There was a lot of waiting and no great solution. I became antsy,” said Mulholland’s mother, Jennifer Mulholland. “Here’s a three-sport athlete with remarkable physical and mental abilities, that I just knew if I asked for help a solution was out there.”

After speaking with more than 15 specialists from throughout the U.S, the solution began to unfold after a conversation with orthopaedic surgeon Glenn Pfeffer, MD, director of the Foot and Ankle Surgery Program at Cedars-Sinai.

“Dr. Pfeffer is our angel doctor,” Jennifer Mulholland said. “He personally called us and said, ‘I've got your guy,’ and that it wasn’t him, but one of his colleagues, Dr. Seruya.”

Thirty minutes later, the Mulhollands were talking with Mitchel Seruya, MD, director of the Peripheral Nerve and Microsurgery Fellowship at Cedars-Sinai  Medical Center and a pediatric plastic surgeon with Guerin Children’s.

“Dr. Seruya’s approach was not just surgical; it was a lifeline,” recalled Jennifer Mulholland.

A Window of Time

Seruya, who is among the few surgeons in the U.S. who perform innovative electrical bypass techniques called nerve transfers, saw the potential for recovery, but he’d be working against time.  

“Unfortunately, so many patients are told to give nerve injuries time to heal, but what they don’t realize is there is an expiration date, or a time clock, working against you,” said Seruya. “Meaning that by 12 to 18 months, these nerve injuries become irreversible.”

Although it had been 11 months since getting injured, Mulholland was a candidate for a nerve transfer surgery, a procedure that involves rerouting healthy and expendable nerves to compensate for damaged ones, effectively restoring the electrical signals needed for proper muscle function.

“It's a way of borrowing electricity from one functional nerve to restore movement in another area affected by nerve damage,” said Seruya. “In Riley’s case, we rerouted the nerve from his big toe to the paralyzed muscles in the front of the leg.”  

During surgery, Seruya went into Mulholland's inner calf area, found his toe electricity, isolated it, used a nerve stimulator to test and make sure the toes were bending strongly, then divided the electricity to route it from his inner calf area out to the front of the leg.

Learning to Walk

Six months post-surgery, Mulholland could flex his foot to lift up and roll out his ankle, the first step on the road to his recovery.

The process of walking is now completely different for Mulholland. Now, when Mulholland’s brain tells his toe to move, his foot moves instead. That’s because the nerve that was once connected to his big toe is now connected to the muscles that move his foot and ankle.

“I never knew that walking was so important or how much brain power it actually takes to do a stride,” said Mulholland. “Thinking about having to walk with every stride, ‘left, right, left, right,’ it doesn’t really wrap around your mind unless you experience it.”

Mulholland ultimately returned to the lacrosse field to go on to help the team win two back-to-back state championships, was crowned as the second-leading scorer, and made the all-state team his senior year.

Today, Mulholland is the only starting freshman on San Diego State University’s lacrosse team. As for his education, Mulholland is now studying neuroscience because of his passion for the mind-body connection, which all started with that fateful knee injury.

“This was my comeback kid,” Jennifer Mulholland said. “What he was able to overcome, how he overcame with the help of Dr. Seruya, really giving him this fortitude and the possibility to regain motion, regain the ability to walk normally again and regain the ability to play on the field and to absolutely shine like the most incredible star.”

Learn more about the Brachial Plexus and Peripheral Nerve Surgery program at Cedars-Sinai. 

Sixteen-year-old Rishee Ray is making history at Cedars-Sinai as the first pediatric patient to undergo halo-gravity traction ahead of spinal surgery.

Rishee has spent most of his life in a wheelchair due to a condition known as spinal muscular atrophy, a group of inherited diseases that affect the muscles responsible for voluntary movement in the body. 

The condition caused Rishee to develop severe scoliosis, with a 135-degree curve in his spine that was compressing vital organs and impairing his ability to sit upright. Additionally, he developed severe kyphosis, another dramatic curve from the side of his spine.

“When we looked at the right side of the chest, we could see his ribs literally stacked on top of each other, causing severe restrictive lung disease,” said Kenneth Illingworth, MD, pediatric spine surgeon at Cedars-Sinai Guerin Children’s. “Not only that, but there was also severe shoulder imbalance and coronal imbalance when he was sitting down.”

Illingworth said that to correct the extreme curvature in Rishee’s spine, spinal fusion surgery was the best option. However, because the curvature was so severe, surgery would have to wait while Rishee underwent a different treatment.  

“When you have curves that are that large, it makes it extremely challenging to operate on,” said Illingworth. “It also makes it extremely dangerous to the spinal cord.”

As a prelude to surgery, Illingworth recommended halo-gravity traction, a method that gently stretches and straightens the spine using a lightweight metal ring or halo that is attached to the skull with small pins.

Once the halo is in place around the head, it is attached to a pulley system, and weights are gradually added to slowly straighten the curved or compressed spine.

Most halo-gravity traction procedures on children last between three and eight weeks. For Rishee, it was a five-week process.

“At first it was difficult; it was this new thing on my head, but I got used to it,” said Rishee.

Pooja Ray, Rishee's mother, provided constant support, staying by Rishee’s side day and night, sleeping alongside him at Cedars-Sinai Guerin Children’s.

“We’ve been in the hospital for 40 days, but we have a purpose, so I don’t give my comfort that much of a thought, my goal was more important,” Pooja said.

The process ultimately yielded remarkable results.

Halo-gravity traction reduced Rishee’s curvature by half, decreasing it from 135 to approximately 70 degrees. And the straightening gave Rishee an additional three inches in height.

“I know it looks barbaric, but trust me, it’s one of the best procedures when you have to do corrective scoliosis treatment,” said Pooja.

After the halo traction device proved successful, Illingworth proceeded with the spinal fusion surgery, providing Rishee with relief from the severe lung compression he had been enduring and improving his daily comfort in his wheelchair—a critical element of his everyday life.

With the successful surgery behind him, Rishee can now sit upright, igniting a newfound sense of hope and optimism for his future.

“I feel more confident,” said Rishee. “I am able to control my neck and body better and can hold my head up and sit up straight without any external support.”

Rishee, who divides his time between India and Los Angeles, is back to his hobbies of swimming and painting and is pursuing higher education. He feels tremendous gratitude to his care team at Cedars-Sinai and to his mother.

“My mom was a great support, both emotionally and physically,” said Rishee. “Without her, this couldn’t have been possible.”

Read more on the Cedars-Sinai Blog: Seeking a Second Opinion for a Spine Condition

Schwab combines extensive experience in translational research and clinical trials with a record of high-quality clinical care. He specializes in the management of benign and malignant bone tumors as well as spinal disorders, including stenoses and myelopathy. His expertise will drive transformative advancements in spine oncology and surgical technology at Cedars-Sinai.

“Dr. Schwab's visionary leadership and profound impact on orthopaedic surgery make him an invaluable addition to our leadership team,” said Mark Vrahas, MD, chair of Cedars-Sinai Orthopaedics. “His expertise aligns seamlessly with our mission to deliver exceptional patient care and to pioneer new frontiers in orthopaedic medical research."

Schwab will lead the expansion of the spine oncology program, providing destination expert care for patients with challenging spine disorders. Under his direction, the Center for Surgical Technology and AI Research will foster interdisciplinary surgery discovery as Cedars-Sinai advances the development of innovative AI and predictive algorithmic applications for complex spine and musculoskeletal oncology care.

"I am honored to join Cedars-Sinai and contribute to the advancement of spine oncology and surgical technology," Schwab said. "Backed by an exceptional team and leading-edge facilities, we are ready to make groundbreaking strides in patient care, research and innovation."

Schwab comes to Cedars-Sinai from Harvard Medical School, where he served as an associate professor of Orthopaedic Surgery. He also was chief of the Orthopaedic Spine Center, director of Spinal Oncology and co-director of the Stephan L. Harris Center for Chordoma Care at Massachusetts General Hospital. Additionally, he directed the SORG Research Laboratory, the Center for Physical Artificial Intelligence at Mass General and the Mass General Brigham Orthopaedic Registries.

Schwab is joined at Cedars-Sinai by a team of researchers from the SORG Research Laboratory, including mechanical engineer Hamid Ghaednia, PhD, whose research focuses on the development of biomedical devices and wearables using a combination of analytical and machine learning algorithms.  

Schwab received his medical degree and a master's degree in clinical pathology from Chicago Medical School and completed his residency at the Mayo Clinic, followed by fellowships in spine surgery at the Hospital for Special Surgery in New York and the Rizzoli Institute in Bologna, Italy. He also completed a fellowship in orthopaedic oncology at Memorial Sloan Kettering Cancer Center and received a second master’s degree from the Harvard/MIT Clinical Investigator Training Program.

Read more on the Cedars-Sinai Blog: Seeking a Second Opinion for a Spine Condition

Team HEAL provides high school athletes with the resources they need—including injury treatment, prevention and education—to safely participate in school sports. By providing comprehensive support, Team HEAL leaders hope to break down barriers and build bright futures for students.

“We are thrilled to welcome seven additional schools into the Team HEAL family,” said founder and Cedars-Sinai Kerlan-Jobe Institute surgeon Clarence Shields Jr., MD. “By expanding our reach from five schools to a dozen, we are ensuring that more young athletes have access to top-notch care, training, mentorship, and resources that can truly be life-changing.”

The expansion schools—each with a median of 90% of the student body qualifying for free or reduced-price lunches—exemplify Team HEAL's commitment to fostering growth in communities facing socioeconomic challenges.

The new schools participating in Team HEAL include John Marshall High School, Bell High School, Esteban E. Torres High School, Fairfax High School, King/Drew Magnet High School of Medicine and Science, Jordan High School Magnet, and Nathaniel Narbonne High School. 

Team HEAL already is established at Carson High STEAM School, Crenshaw High School STEMM Magnet, Phineas Banning Senior High School, Susan Miller Dorsey Senior High School and Westchester Enriched Sciences Magnets.

The program equips the schools with resources such as Team HEAL scholarships, athletic training room equipment and supplies, injury clinics at designated urgent care locations, and educational opportunities for students, athletic trainers and school administrators.

Team HEAL's distinctive approach lies in its dual emphasis on athletic excellence and injury prevention, ensuring that young athletes safely can achieve their full potential. 

Participation in athletic programs offers more than just physical activity, it provides an avenue for personal growth, character development, and opportunities for higher education.

"Through this expansion, we aim to impact the lives of more than 2,800 student-athletes, giving them the tools they need to succeed on and off the field,” said Shields.

Read more on the Cedars-Sinai Blog: Champions for Young Athletes

“We have a new understanding of bracing from recent studies that showed wearing a brace just at nighttime does some good,” said David Skaggs, MD, executive vice chair of the Department of Orthopaedics at Cedars-Sinai and director of Pediatric Orthopaedics at Cedars-Sinai Guerin Children’s. “So, we are now more aggressive about trying to prevent scoliosis from getting to the point where you need surgery or even that you would need to wear a brace to school as a teenager.”

Scoliosis can develop in infancy or early childhood, affecting more than 100,000 children in the United States each year. Early detection is key as is following the condition throughout a young person’s life.

“One of the unique features of the Pediatric Spine Program at Cedars-Sinai Guerin Children’s  is we have nurse navigators who will follow you from before your first appointment to after you go away to college, guiding you through your journey,” Skaggs said. “You’re also not just gaining access to pediatric treatment but to all of Cedars-Sinai Spine, one of the largest spine centers in the nation. We can offer continuity of care for the rest of your life.”

During Scoliosis Awareness Month in June, the Cedars-Sinai Newsroom spoke with Skaggs about the latest developments in pediatric scoliosis, treatment options and how to identify it.

What are the signs of scoliosis?

“Scoliosis in the simplest form is a curved spine of 10 degrees or more. In reality, it’s a bit more complicated because the spine is not only curved, but it’s twisted. That’s important because one, it might make somebody look like they have a big hump in their back, and two, it twists around the lungs, so it compromises someone's ability to take a full breath.”

How is scoliosis normally identified?

“The most common type of scoliosis is teenage scoliosis, which is called adolescent idiopathic scoliosis. That is what people are generally screened for in schools and it’s the most common reason why a patient is referred to a specialist for scoliosis. Parents can also look for a lack of symmetry in a child’s back when they’re bent over at the waist and raise any concerns with their pediatrician or a spine specialist, who will use an X-ray to make a definitive diagnosis.”

Why don’t some patients get diagnosed until they’re teenagers?

“Most of the time when someone has scoliosis, they don’t even know they have it because there’s no symptoms, no pain or other issues going on. They start to notice their body looks just a little bit sideways, maybe one shoulder is a little bit higher, or one side of the chest protrudes a little bit. It’s quite subtle the body changes that take place over time and the lack of pain or other problems often mean that the scoliosis is not diagnosed for years.”

How is scoliosis treated?

“There are only two options to treat scoliosis that are scientifically proven. One is surgery, and that’s the last resort. Any teenager or person in their early 20’s, if the curve is over 45 to 50 degrees, surgery should be considered unless there are extenuating circumstances. What we want to do is prevent the need for surgery. The other is bracing and what a brace does in general is stop the scoliosis from progressing.”

Is a brace still effective if only worn at night?

“From a recent study we learned that in patients who are less than 10 years old, even with a small amount of scoliosis like 15 or 20 degrees, starting part-time bracing at night only can actually reverse or improve the scoliosis. So, one of the ways that we've changed how we treat patients at Cedars-Sinai Spine, is we're more likely to recommend part-time bracing earlier for smaller curves. It’s understandable that many patients don’t want to wear a brace to school, and it’s probably better to wear it at night than not wear it at all.”

Are there any new options for surgical treatment?

“One newer option for some eligible patients allows us to correct the spine’s curve without fusing the spine—vertebral body tethering. It allows motion and growth over time. You take a curve and around the outside of the curve you basically put in screws and a rope. Then you allow the inside of the curve to grow, and the outside doesn't grow, it straightens. While it can shorten recovery time for those who qualify, it’s not right for everyone who needs surgery.”

Read more on the Cedars-Sinai Blog: Supporting the Spine From Adolescence to Adulthood.