Sports Medicine & Athletic Performance

What Sports Medicine Actually Is

Sports medicine is a subspecialty of orthopedic surgery 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 athletes. A sports medicine orthopedic surgeon treats anyone whose injury involves the moving parts of the body, from a collegiate soccer player with an ACL tear to a 55-year-old cyclist with a rotator cuff rupture.

The distinction from general orthopedics is meaningful. A sports medicine orthopedic surgeon has completed a five-year general orthopedic residency plus a dedicated sports medicine fellowship — typically an additional year of intensive, subspecialty-focused training at a program affiliated with a major university or professional sports organization. This fellowship training concentrates case volume, advanced technique instruction, and team physician experience in a way that general residency training cannot replicate.

Fellowship Training and the CAQ

The Certificate of Added Qualification (CAQ) in Orthopaedic Sports Medicine is a board certification issued by the American Board of Orthopaedic Surgery (ABOS). It requires completing an accredited fellowship, meeting minimum case volume thresholds, and passing a standardized written examination administered by the same board that certifies all orthopedic surgeons. The CAQ must be renewed periodically — it is not a credential that can be earned and set aside.

Asking whether your surgeon is fellowship-trained and CAQ-certified is a reasonable, important question before any significant sports medicine procedure. It is the most objective signal of demonstrated subspecialty expertise.

Our Sports Medicine Surgeons

Dr. James S. Gardiner is a fellowship-trained orthopedic sports medicine surgeon who has practiced in Montgomery County for more than 30 years. His clinical practice spans the full spectrum of sports medicine surgery, and the complete range of knee replacement procedures for patients whose arthritis has progressed beyond the reach of joint preservation.

Dr. Christopher S. Raffo is a fellowship-trained orthopedic sports medicine surgeon specializing in knee and shoulder reconstruction. His practice focuses on ACL reconstruction with graft selection optimization, complex meniscal repair and preservation, rotator cuff repair, shoulder instability, and cartilage restoration. He has served as team physician at the professional, collegiate, and elite youth levels.

Dr. John Christoforetti is fellowship-trained in both orthopedic sports medicine and hip arthroscopy — one of the most technically demanding subspecialties in the field. He is among a select group of surgeons in the region who perform high-volume hip arthroscopy for femoroacetabular impingement (FAI), labral repair and reconstruction, and gluteus medius repair. He also treats knee and shoulder conditions.

Advanced Arthroscopic Techniques

Arthroscopy — operating inside a joint through portals the size of a buttonhole using a small camera and miniaturized instruments — is the foundational tool of sports medicine surgery. Modern sports medicine arthroscopy encompasses procedures that were impossible a decade ago:

Knee: ACL reconstruction with individualized graft selection (patellar tendon, quadriceps tendon, hamstring, allograft), lateral extra-articular tenodesis (LET) for rotational instability control, complex meniscal repair including bucket-handle and root tears, cartilage restoration (microfracture, OATS, osteochondral allograft), MPFL reconstruction for patellar instability.

Shoulder: Rotator cuff repair using double-row and transosseous-equivalent suture anchor constructs, Bankart repair and Latarjet coracoid transfer for instability, remplissage for engaging Hill-Sachs lesions, SLAP repair and biceps tenodesis, AC joint reconstruction.

Hip: FAI correction (cam and pincer osteoplasty), labral repair and reconstruction, gluteus medius and minimus repair, iliopsoas release — all performed arthroscopically or through minimally assisted approaches.

Elbow and ankle: UCL reconstruction (commonly known as Tommy John surgery) for overhead athletes, elbow arthroscopy for loose body removal and impingement, Broström ankle ligament reconstruction for chronic instability.

The Role of Athletic Trainers

Certified Athletic Trainers (ATCs) are the sports medicine system's frontline clinicians. They work on sidelines, in athletic training rooms, and in rehabilitation settings — and they are often the first to evaluate an injury before a physician is involved. Their scope includes acute injury assessment and triage, injury prevention program implementation, post-injury and post-surgical rehabilitation, taping and bracing, and return-to-sport functional testing.

MOS maintains relationships with athletic trainers serving Montgomery County schools and club programs. When an ATC identifies a patient who needs orthopedic evaluation, they can reach our team directly — and we prioritize prompt scheduling for acute injuries.

The Role of Physical Therapists

Physical therapists are the primary drivers of long-term outcomes after sports medicine surgery. Criteria-based rehabilitation — where return to sport depends on meeting objective strength, symmetry, and functional testing benchmarks rather than time alone — is the standard we apply.

Our on-site physical therapy team at both the Bethesda and Germantown locations works in direct communication with the operating surgeon throughout post-operative care. This integration eliminates the fragmentation that occurs when rehabilitation is handled by a separate, unaffiliated outpatient facility with no direct line to the surgeon.

When Surgery Is the Right Answer

The majority of sports injuries are managed successfully without surgery. Conservative care — physical therapy, activity modification, bracing, and appropriately timed injections (corticosteroid or PRP) — is always the starting point unless the injury clearly requires surgery from the outset.

The injuries where early surgical intervention is the most appropriate path include: complete ACL rupture in an active patient, displaced bucket-handle meniscal tear with a locked knee, acute full-thickness rotator cuff tear, acute distal biceps rupture, and complete ankle ligament rupture with instability that fails conservative management.

In every other case, we give conservative treatment a fair trial before recommending surgery — and we explain the reasoning clearly so that you are a full participant in the decision.