Dr Paul Rothenberg, MD, is a board-certified orthopaedic surgeon specialising in the operative and non-operative treatment of sports-related injuries to the shoulder, elbow, knee, and ankle.
His expertise includes minimally invasive arthroscopic surgery of the knee and shoulder, cartilage restoration/preservation, and shoulder replacement surgery. An experienced orthopaedic surgeon who has years of experience treating professional and college athletes, he is a former college football player and currently the Director of Sports Medicine and Shoulder Surgery at Optum Orthopedic Institute.
OPN: Could you tell us more about your experience and training background in orthopaedics?
PR: I completed my medical education and residency at the University of Miami, where I developed a strong foundation in orthopaedic surgery, with a focus on sports medicine. During residency, I had the unique opportunity to work closely with elite athletes as part of the medical teams for the University of Miami Hurricanes and the Miami Marlins, gaining invaluable hands-on experience treating high-level injuries. Following residency, I pursued a fellowship in sports medicine at Lenox Hill Hospital in New York. There, I further refined my skills, working with professional sports teams such as the NFL’s New York Jets and the NHL’s New York Islanders, which allowed me to understand the specific demands of treating athletes at the highest levels of competition. This diverse training and experience has shaped my approach to providing personalized and comprehensive care to all of my patients, from professional athletes to everyday individuals.
OPN: What drove you to choose surgery as a career – and sports medicine in particular?
PR: I’ve had a lifelong passion for sports. Growing up, I played baseball, basketball, football, and hockey. My love for athletics continued through college where I played football for four years. My experiences as an athlete gave me a deep understanding of the physical demands of sports and the impact of injuries. When I decided to pursue a career in medicine, my focus was clear—I wanted to specialize in surgery and, more specifically, sports medicine. It was a natural fit for me, combining my love of sports with my desire to help athletes recover and perform at their best. Whether it’s treating high-level athletes or active individuals, I’m driven by the opportunity to get people back to doing what they love.
OPN: As more athletes fall victim to torn ACLs, tell us more about your research into the evolution of ACL repair, such as Bridge-Enhanced ACL Repair, and how athletes are able to continue enjoying their sport following injury?
PR: Early ACL repair surgeries date back over a century, and obviously medicine has come a long way since then. It was an open procedure where they would go in and suture the tear back together. Unfortunately this had a very high failure rate, leading it to be abandoned in favour of ACL reconstruction. For a long time this became the more reliable and successful approach. However, with advancements in surgical instruments, techniques, and implants, ACL repair has experienced a resurgence in recent years. The most notable of these developments came with the ability to use grafts to facilitate healing, and arthroscopic surgeries which enable a minimally invasive way of performing the surgery.
Modern ACL repairs are typically performed when the ligament is torn near its attachment point—either proximally or distally—allowing for reattachment of relatively preserved tissue. The most exciting development in ACL repair is the introduction of Bridge-Enhanced ACL Repair (BEAR) that you mentioned. BEAR is an innovative approach that allows for the possibility of repairing mid-substance tears. This is achieved by using a collagen scaffold, combined with the patient’s own blood, to create an environment where the two ends of the torn ligament can heal together.
ACL repair offers some key advantages over ACL reconstruction. In reconstruction, a tendon graft is used to replace the torn ligament. While effective, the tendon graft must undergo a process called ligamentization, where it gradually transforms its structure to resemble that of a ligament. This process takes time and involves degradation of the graft’s structural integrity, contributing to a longer recovery period. In contrast, ACL repair preserves the native ligament, eliminating the need for ligamentization, which can lead to a faster recovery.
Another benefit of ACL repair is that there is no graft harvesting, which means less post-operative pain and a quicker recovery of strength and range of motion. Additionally, patients avoid complications associated with graft site morbidity, such as anterior knee pain with patellar grafts or knee flexion weakness with hamstring grafts. This can make ACL repair an appealing option for athletes looking to return to their sport more quickly and with fewer complications.
That being said, ACL repair is still associated with a slightly higher failure rate compared to ACL reconstruction in most studies. Because of this, I tend to recommend ACL reconstruction for chronic tears or for individuals with high physical demands, such as elite athletes or manual laborers. However, ACL repair remains an excellent option for recreational athletes or those who need to return to work quickly, as it offers a shorter recovery timeline.
OPN: How important is it to work on improving treatment and recovery methods to get people back on their feet as quickly as possible, with minimal long-term effects? How close are we to achieving this?
PR: It’s absolutely vital to continuously improve treatment and recovery methods, especially in sports medicine, where the goal is to return athletes and active individuals to their pre-injury levels as quickly and safely as possible. Minimizing long-term effects, such as chronic pain or limited mobility, is crucial to preserving quality of life and performance.
We’re getting closer to achieving this with newer techniques, such as advanced ACL repair and Bridge-Enhanced ACL Repair (BEAR), which provide quicker recovery times and better preservation of the native ligament. While there’s still work to be done, especially in reducing the slightly higher failure rates of some newer procedures, we’re making significant strides in offering patients faster recoveries with fewer long-term complications. Continued innovation in surgical techniques, rehabilitation protocols, and patient selection will help us push even further toward that goal.
OPN: What’s the best part of your job?
PR: The best part of my job is helping people get back to doing what they love. Whether it’s an athlete returning to their sport or someone simply regaining the ability to live pain-free and be active again, the reward comes from seeing my patients recover and thrive. Being able to guide them through the process, from surgery to recovery, and witnessing their success is incredibly fulfilling. Knowing that I’ve played a role in helping them regain their mobility and quality of life is what drives me every day.
OPN: … and the worst?
PR: The toughest part of my job is managing the emotional and physical toll that comes with difficult outcomes or setbacks. No matter how skilled we are as surgeons, sometimes the body doesn’t heal as we hope, or complications arise. It’s hard to see patients struggle through setbacks, especially those who have worked so hard toward their recovery. Dealing with these situations and keeping patients motivated through challenges is definitely one of the hardest aspects of the job.
OPN: What has been the highlight of your career so far?
PR: The highlight of my career has been seeing myself in my patients, especially young athletes. As a former college athlete, I know firsthand the fear and uncertainty that come with an injury. One of the most rewarding aspects of my work is helping athletes realize that not only can they return to their sport, but they can also find fulfillment beyond competition once their athletic careers come to an end. I hope that I can be the same kind of role model for them that I had in my life—those who helped guide me toward the path I’m on today. Watching them overcome challenges and continue to chase their dreams reminds me why I chose this career—to make an impact, both on and off the field.
OPN: Are you planning to attend or speak at any medical conferences or events over the next year? If so, which ones?
PR: Yes, I attended the Shoulder 360 Course in Miami this past May, which was a fantastic opportunity to engage with colleagues and learn about the latest advancements in shoulder surgery. Looking ahead, I plan on attending the American Orthopaedic Society for Sports Medicine (AOSSM) annual meeting next year. It’s one of the premier events for sports medicine professionals, and I’m excited to continue learning, sharing insights, and networking with other experts in the field.
OPN: If you weren’t an orthopaedic surgeon, what would you be?
PR: The second coming of Joe Namath? I kid. I honestly don’t know what else I would do, I think this is always what I wanted to be and was meant to be. As I mentioned I was a multi-sport athlete for most of my life, and still have a deep appreciation for the importance of recreational athletics. I was never destined for NFL stardom. Helping people keep that as part of their lives is incredibly rewarding, and when I went through a serious injury the medical professionals who helped me get back on the field put me on the path I am on today. Because as much as we talk about professional and college athletes, proper treatment of injuries goes beyond the playing field. I want my patients to be able to walk their children down the aisle, to pick up their grandchildren, and just be able to get around into old age without a past injury getting in the way of their quality of life. So while I’m still holding out hope the Jets might give me a call to suit up and help them get a ring, I love what I do and feel that it is what I was always meant to be doing.
OPN: What would you tell your 21-year-old self?
PR: At 21, I had just missed my junior football season due to injury, and it felt like the end of the world. I would reassure myself that I would get back on the field, but more importantly, that there is a fulfilling life beyond sports. I’d also remind myself that while competitive sports may eventually end, sports will always be a part of my life—whether through my career or the lessons it’s taught me. Trust the process, enjoy the journey, and know that every setback shapes your future in ways you can’t yet see.
OPN: If you were Health Minister for the day what changes would you implement?
PR: I would make sure athletes, especially young student athletes, have better access to the knowledge and care they need to prevent serious injury. Such increased medical knowledge about injuries would pay dividends beyond the playing field, again helping ensure people can maintain peak physical shape well into old age.
OPN: How do you think the future looks in the field of orthopaedic surgery?
PR: The future is exciting. The first successful ACL surgery happened in 1885, and arthroscopy wasn’t introduced until 1980. In the decades since then we have seen spectacular growth in research improving surgical treatment options as well as rehabilitative programs. The BEAR was first used in surgery in 2015 and approved by the FDA in 2020, and I think the lessons we learn from those successes can not only help improve ACL repair but improve outcomes across the field of orthopaedic surgery. For me it is all about the patient. These medical advances help people get back to life as they know it, and I eagerly await what the future holds.
