Robin West, MD, has spent her career rebuilding torn anterior cruciate ligaments. She believes the biggest opportunity in sports medicine is making that surgery less necessary.
As chief of Inova Sports Medicine at Fairfax, Va.-based Inova Health System, Dr. West leads one of the country’s premier orthopedic sports medicine programs. She serves as a team physician for MLB’s Washington Nationals and previously spent 18 years caring for NFL players in Pittsburgh and Washington, D.C.
Few surgeons understand ACL injuries better. That is precisely why she believes healthcare has been asking the wrong question. “We’re good at reconstructing ACLs, fixing them,” Dr. West told Becker’s. “But really, the real opportunity over this next decade is preventing that first tear, because after the first tear, you have a much higher risk of tearing the second one.”
Every year, more than 200,000 Americans tear an ACL. Roughly 70% of those injuries occur without contact, according to Dr. West. An athlete lands awkwardly, pivots suddenly or changes direction, and the ligament ruptures without another player ever touching them.
That statistic has shaped much of her career. If most ACL tears happen without contact, many of them should never happen at all.
The 15-minute solution almost nobody uses
The frustrating part, Dr. West said, is that sports medicine already knows how to reduce many ACL injuries. Neuromuscular training programs, such as the Prevent Injury and Enhance Performance program, FIFA 1+ and Sportsmetrics have demonstrated that simple, movement-based exercises performed before practice can dramatically reduce injury risk.
“This is really a warm-up strategy,” Dr. West said. “It’s a 10- to 15-minute warm-up, and it’s integrated into practice three times a week. If you’re utilizing this, then it can prevent an ACL injury by about 50% to 60%.”
Athletes do not even have to perform the program perfectly to benefit. Research has shown that completing the exercises roughly 70% to 75% of the recommended time captures most of the protective effect, Dr. West said.
The science is no longer the obstacle. Implementation is. “I don’t see a lot of the neuromuscular training done anywhere,” she said. “People talk about it, but no one really does it.”The reasons have little to do with medicine. Practice time is limited. Coaches prioritize skill development. Athletes want to compete. As seasons become busier, warm-ups are often the first thing shortened.
Dr. West believes that mindset overlooks what the programs are actually accomplishing.
“It’s not just kind of a fluffy little thing that we’re doing on the side,” she said. “We’re working to get these athletes stronger, faster and safer.”
Her argument to coaches is deliberately practical. Healthy athletes stay on the field.
“If we can keep our athletes healthy, you’re going to have athletes available right in the season and at the end of the season,” she said. For her, injury prevention is not simply a medical initiative. It is a competitive advantage.
The business model prevention challenges
The larger challenge extends beyond coaches. It reaches healthcare itself. Orthopedic surgery remains largely built around treating injuries after they occur. Prevention works differently. Every injury avoided is one less operation performed.
“As orthopedic surgeons, we’re paid to do surgery, and healthcare systems are paid for the surgical volume,” Dr. West said. “But my point has always been we are very focused on injury prevention, and here at Inova, it’s a really big strategy of ours to keep our patients healthy.”
She sees no contradiction. A health system’s responsibility, she argues, extends beyond the operating room. “We are a healthcare system for the whole person and the whole athlete,” she said. “It’s not just about the surgery and the recovery, but it’s about the physical and the mental recovery.”
An ACL tear changes far more than a knee. Athletes lose seasons. They lose teammates. Families reorganize schedules around rehabilitation appointments. “When someone tears their ACL, they’re not only missing the season, they’re missing their friends, their family dynamics have changed, so it’s a big hit all around,” Dr. West said.
The athletes who need prevention most
Dr. West believes one of the greatest failures of current prevention efforts is who receives them. Athletes with the greatest resources often have access to personal trainers, strength coaches and specialized performance programs. Those with fewer resources frequently receive none of those advantages.
“It’s the patients who have the most that are getting the access and availability,” she said. “But not everyone has the access, the financial resources and the support to get that.”
The disparity is particularly significant for female athletes competing in sports such as soccer, basketball and lacrosse, where ACL injury rates remain substantially higher than in many other athletic populations. For Dr. West, prevention should not depend on a family’s ZIP code or ability to pay.
The investment she would make first
Asked where health systems should invest first, Dr. West did not mention AI, robotics or new surgical technology. She talked about people.
Athletic trainers already working in schools are often overwhelmed caring for injured athletes, leaving little time for injury prevention. Club sports frequently have no athletic trainers at all.
“We’re lucky that the athletic trainers are at the high schools, but they’re inundated,” she said. “They don’t have time to focus on the prevention side.”
Her vision is straightforward. Train athletic trainers specifically in neuromuscular injury prevention. Deploy them throughout schools and youth sports organizations. Teach coaches and team captains to lead the warm-ups themselves so the programs become routine rather than optional. “Get out there and work with all of our athletes across the area, not just the privileged ones,” she said.
Orthopedic surgery has spent decades making ACL reconstruction more precise. Dr. West believes the next decade should be measured by something different. How many reconstructions never have to happen.
The technology already exists. It is not another implant. It is not another surgical technique. It is a 15-minute warm-up that most athletes still never perform.
And for one of the country’s leading ACL surgeons, that may represent the greatest opportunity in sports medicine.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
