What Is Sports Medicine? Fellowship Training, CAQ Certification & Advanced Care

What Sports Medicine Actually Is

Sports medicine is a medical specialty focused on the musculoskeletal system — the bones, joints, ligaments, tendons, muscles, and cartilage that allow the body to move. It is not limited to professional or competitive athletes. Sports medicine physicians treat anyone whose injury or condition involves the moving parts of the human body, from a teenager who tears an ACL on the soccer field to a retired teacher who develops a rotator cuff tear reaching overhead.

Within orthopedics, sports medicine is a subspecialty that requires additional training beyond the standard five-year orthopedic surgery residency. A sports medicine orthopedic surgeon has completed both a full surgical residency and a dedicated fellowship in sports medicine — typically one additional year of intensive, subspecialty-focused training at a program affiliated with a major university, professional sports team, or high-volume sports surgery center.

The distinction matters. Not every orthopedic surgeon has sports medicine fellowship training, and not every physician who calls themselves a "sports medicine doctor" has completed a surgical residency in orthopedics. Understanding these differences helps patients make informed decisions about who is best qualified to manage their injury.

Fellowship Training — What It Means

A sports medicine fellowship is a post-residency training program accredited by the Accreditation Council for Graduate Medical Education (ACGME). Orthopedic sports medicine fellows train alongside experienced sports medicine surgeons performing high volumes of complex procedures: ACL reconstructions, meniscal repairs, rotator cuff repairs, labral reconstructions, cartilage restoration procedures, and advanced arthroscopic techniques across the knee, shoulder, hip, elbow, and ankle.

Fellowship programs typically involve:

• High-volume arthroscopic surgery — fellows perform hundreds of procedures under direct supervision during the training year, developing technical precision on a compressed timeline that general orthopedic residency cannot replicate
• Team physician experience — many programs include coverage responsibilities for professional, collegiate, or high school athletic programs, exposing fellows to sideline evaluation, acute injury management, and return-to-sport decision-making in real competition environments
• Advanced technique instruction — newer procedures such as hip arthroscopy for FAI correction, cartilage restoration techniques (OATS, osteochondral allograft, microfracture), complex knee ligament reconstruction, and shoulder instability procedures require fellowship-level instruction to perform safely and effectively
• Research and outcomes training — accredited fellowships require scholarly activity, ensuring that sports medicine specialists are consumers and contributors of the evidence base that guides their practice

At Maryland Orthopedic Specialists, our sports medicine surgeons — Dr. Christopher Raffo and Dr. John Christoforetti — are both fellowship-trained in orthopedic sports medicine, and Dr. Christoforetti holds additional subspecialty fellowship training in hip arthroscopy and preservation, one of the most technically demanding areas in the field.

The CAQ in Sports Medicine — Why It Matters

The Certificate of Added Qualification (CAQ) in Orthopaedic Sports Medicine is a board certification issued by the American Board of Orthopaedic Surgery (ABOS) that formally recognizes a surgeon's subspecialty expertise in sports medicine beyond standard orthopedic board certification.

To earn a CAQ, an orthopedic surgeon must:

1. Hold primary ABOS board certification — passing both the written and oral board examinations that all orthopedic surgeons must complete
2. Complete an ACGME-accredited sports medicine fellowship — demonstrating formal subspecialty training, not simply self-designated experience
3. Meet minimum case volume requirements — performing a defined minimum number of qualifying sports medicine procedures documented in the ABOS case log system
4. Pass the CAQ examination — a written examination covering the full breadth of sports medicine knowledge, including non-operative management, surgical techniques, rehabilitation principles, and sports science

The CAQ is not a permanent credential — it requires periodic recertification to ensure that a surgeon's knowledge and practice remain current with an evolving field.

Why this matters for patients: The CAQ is one of the most reliable objective signals that a surgeon has met standardized criteria for sports medicine expertise. Any orthopedic surgeon can claim a special interest in sports medicine. A CAQ-certified surgeon has demonstrated that expertise through a nationally standardized process overseen by the same board that certifies all orthopedic surgeons in the United States.

When you are selecting a surgeon for an ACL reconstruction, a rotator cuff repair, or a hip arthroscopy, asking whether your surgeon is CAQ-certified in sports medicine is a reasonable and important question.

The Role of Athletic Trainers in Sports Medicine

Certified Athletic Trainers (ATCs) are licensed healthcare professionals who specialize in the prevention, recognition, assessment, and rehabilitation of athletic injuries. They are a foundational part of the sports medicine care team — often the first clinical professional an athlete encounters after an injury.

ATCs are present on the sidelines of professional, collegiate, and high school athletic programs. Their responsibilities include:

• Injury prevention programs — implementing evidence-based neuromuscular training protocols that reduce ACL tear rates, ankle sprains, and overuse injuries in athletic populations
• Acute injury assessment — evaluating injuries on the field, determining whether an athlete can return to play safely, recognizing concussions, fractures, and joint dislocations that require immediate referral
• Rehabilitation — progressing athletes through post-injury and post-surgical rehabilitation protocols in close coordination with the treating physician
• Return-to-sport clearance — conducting functional testing to determine objective readiness before an athlete returns to full competition
• Taping, bracing, and equipment fitting — applying protective measures to reduce re-injury risk

The ATC's proximity to athletes over long periods gives them clinical insight that is difficult to replicate in a physician's office — they observe movement quality, training loads, and behavior patterns that influence injury risk. An effective sports medicine practice maintains strong relationships with the athletic trainers serving local schools, clubs, and athletic programs.

The Role of Physical Therapists in Sports Medicine

Physical therapists (PTs) are doctoral-level clinicians who specialize in the restoration of movement, strength, and function following injury or surgery. In the context of sports medicine, physical therapists are essential partners in both non-operative care and post-surgical rehabilitation.

Sports medicine physical therapists provide:

• Post-surgical rehabilitation — structured protocols following ACL reconstruction, rotator cuff repair, meniscus repair, and other procedures that progress patients through defined milestones from early range of motion restoration through return to full sport
• Non-operative injury management — evidence-based treatment of tendinopathies, stress fractures, muscle strains, and overuse injuries without surgery, using manual therapy, therapeutic exercise, and load management
• Movement analysis and biomechanical correction — identifying faulty movement patterns (such as dynamic knee valgus in landing or shoulder impingement mechanics) that predispose athletes to injury or re-injury
• Criteria-based return-to-sport testing — administering validated test batteries including limb symmetry index measurements, single-leg hop tests, and sport-specific movement assessments to determine objective clearance for return to competition
• Education and self-management — empowering patients to understand their condition, manage their loading, and maintain long-term musculoskeletal health

At Maryland Orthopedic Specialists, our on-site physical therapy team at both the Bethesda and Germantown locations works in direct daily communication with our physicians. Post-operative protocols are individualized, and the physical therapist has direct access to the operating surgeon when clinical questions arise — a level of integration that referral-based outpatient PT settings cannot always provide.

Advanced Arthroscopic Techniques in Sports Medicine

Arthroscopy is the foundational surgical tool of sports medicine. An arthroscope is a small camera — typically 4mm in diameter — inserted through a tiny portal into a joint. The surgeon views the interior of the joint on a high-definition monitor while operating through one or two additional portals using specialized instruments no larger than a pencil.

Modern sports medicine arthroscopy has evolved far beyond simple diagnostic procedures or meniscal debridement. Today's sports medicine surgeons perform highly complex reconstructive procedures entirely arthroscopically or through minimally assisted techniques that preserve surrounding tissue, reduce post-operative pain, and shorten rehabilitation timelines.

Knee Arthroscopy

The knee is the most commonly arthroscoped joint in sports medicine. Advanced knee arthroscopy at a fellowship-level sports medicine practice includes:

• ACL reconstruction — using autograft (patellar tendon, quadriceps tendon, hamstring) or allograft tissue passed through precisely positioned bone tunnels drilled arthroscopically; graft selection and tunnel placement are the primary determinants of long-term success
• Meniscal repair — suturing torn meniscal tissue back to its peripheral attachment using all-inside suture devices, inside-out cannula techniques, or hybrid approaches; meniscal preservation is strongly prioritized over excision given the long-term joint-protective role of the meniscus
• Lateral extra-articular tenodesis (LET) — a secondary stabilization procedure added to ACL reconstruction in high-risk patients that controls rotational instability; randomized trial data demonstrate a 67% reduction in graft re-tear rates when added to hamstring autograft ACL reconstruction in young athletes
• Cartilage restoration — microfracture, osteochondral autograft transfer (OATS), and fresh osteochondral allograft transplantation to address full-thickness cartilage defects that would otherwise progress to arthritis
• MPFL reconstruction — reconstruction of the medial patellofemoral ligament for recurrent patellar instability and dislocation
• PCL and multi-ligament reconstruction — addressing posterior cruciate and complex combined knee ligament injuries

Shoulder Arthroscopy

The shoulder is the second most commonly arthroscoped joint, and it has seen some of the most significant advances in sports medicine technique over the past two decades:

• Rotator cuff repair — arthroscopic reattachment of torn supraspinatus, infraspinatus, subscapularis, or teres minor tendons using suture anchors; modern double-row and transosseous-equivalent repair constructs distribute load across a wider footprint, improving healing rates compared to earlier single-row techniques
• Bankart repair and capsulorrhaphy — arthroscopic reattachment of the anterior labrum and inferior glenohumeral ligament for shoulder instability and dislocation; when glenoid bone loss is significant, the Latarjet coracoid transfer procedure provides additional stability through a bone-augmentation mechanism
• Remplissage — an arthroscopic technique that fills the Hill-Sachs lesion on the posterior humeral head with the infraspinatus tendon and posterior capsule, preventing engagement and recurrent instability in athletes with large Hill-Sachs defects
• SLAP repair and biceps tenodesis — repair or tenodesis of the superior labrum and long head of the biceps for overhead athletes and active patients with biceps anchor pathology
• Subacromial decompression and AC joint procedures — acromioplasty, coracoplasty, and distal clavicle excision for impingement and acromioclavicular joint arthritis

Hip Arthroscopy

Hip arthroscopy is among the most technically demanding procedures in sports medicine, requiring specialized traction equipment, precise portal placement, and an understanding of hip joint anatomy that takes years of dedicated practice to master. Dr. John Christoforetti is one of a relatively small number of orthopedic surgeons in the region with subspecialty fellowship training specifically in hip arthroscopy.

Advanced hip arthroscopy at MOS includes:

• Femoroacetabular impingement (FAI) correction — arthroscopic reshaping of the femoral head-neck junction (cam lesion) and/or acetabular rim (pincer lesion) that causes abnormal contact and cartilage damage in active patients; outcomes are significantly better when performed by high-volume hip arthroscopists
• Hip labral repair and reconstruction — suture anchor reattachment of the torn acetabular labrum to restore the hip joint's suction-seal mechanism; when the native labrum is deficient or irreparable, reconstruction with autograft or allograft tissue is performed
• Gluteus medius and minimus repair — arthroscopic or mini-open repair of tears of the abductor tendons of the hip, sometimes described as the "rotator cuff of the hip," frequently missed in women over 50 with lateral hip pain
• Iliopsoas release — arthroscopic lengthening of the iliopsoas tendon for internal snapping hip syndrome and iliopsoas impingement

Elbow and Ankle Arthroscopy

• Elbow arthroscopy — loose body removal, osteophyte debridement, posterior impingement release, and lateral epicondyle debridement for conditions common in throwing athletes and overhead workers
• Ankle arthroscopy — anterior and posterior impingement debridement, osteochondral lesion treatment, and syndesmotic assessment; often combined with ligament reconstruction procedures for chronic ankle instability

Why Advanced Arthroscopy Requires Subspecialty Training

The technical demands of modern sports medicine arthroscopy are not adequately captured by general orthopedic training alone. A surgeon performing 10 to 15 arthroscopic ACL reconstructions per year develops different technical fluency than one performing 80 to 100. The same principle applies to hip arthroscopy, complex meniscal repair, and cartilage restoration — procedures where case volume, fellowship mentorship, and ongoing subspecialty practice translate directly into measurable differences in outcomes.

Published data support this relationship. Studies in the orthopedic literature consistently demonstrate that surgeon experience and case volume are independent predictors of outcomes for arthroscopic shoulder stabilization, ACL reconstruction, and hip arthroscopy for FAI. Choosing a fellowship-trained, high-volume sports medicine surgeon is not a matter of prestige — it is a clinically meaningful decision that affects your results.

The Sports Medicine Care Continuum at MOS

Effective sports medicine is not a single physician working in isolation — it is a coordinated system. At Maryland Orthopedic Specialists, that system includes:

• Fellowship-trained orthopedic sports medicine surgeon — Diagnosis, surgical decision-making, operative care, return-to-sport clearance
• CAQ-certified sports medicine subspecialist — Advanced non-operative management, injection therapy, PRP, imaging-guided procedures
• Physical therapist (on-site) — Post-operative rehabilitation, non-operative injury management, movement analysis, return-to-sport testing
• Certified Athletic Trainer (ATC, community partners) — Sideline coverage, acute injury assessment, prevention programs, school and club sport liaison
• Diagnostic imaging (in-office X-ray, MSK ultrasound) — Real-time imaging without separate facility referral

This integrated model means that the patient who comes in with an ACL tear is evaluated by the surgeon who will perform the reconstruction, imaged in the same building, and rehabilitated by a physical therapist who communicates directly with that surgeon throughout recovery — without the fragmentation that characterizes care spread across multiple unaffiliated providers.

Clinical References

1. Memon M, Kay J, Cadet ER, Shahsavar S, Simunovic N, Ayeni OR. Return to sport following arthroscopic Bankart repair: a systematic review. J Shoulder Elbow Surg. 2018;27(7):1342–1347. doi:10.1016/j.jse.2018.01.026. PMID: 29622461. https://pubmed.ncbi.nlm.nih.gov/29622461/
2. Kholinne E, Singjie LC, Marsetio AF, Al-Ramadhan M, Jeon IH. Return to physical activities after arthroscopic rotator cuff repair: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023;33(6):2645–2654. doi:10.1007/s00590-022-03448-x. PMID: 36792854. https://pubmed.ncbi.nlm.nih.gov/36792854/
3. Getgood AMJ, Bryant DM, Litchfield R, Heard M, McCormack RG, Rezansoff A, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial. Am J Sports Med. 2020;48(2):285–297. doi:10.1177/0363546519896333. PMID: 31940222. https://pubmed.ncbi.nlm.nih.gov/31940222/

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