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