Yes: get an orthopedic second opinion before knee, shoulder or hip surgery when the plan rests on imaging without a hands-on exam, when the diagnosis does not match what the joint is doing, or when the date was set in one short visit. In Boulder, the new patient evaluation with Aneesh Garg, DO, CAQ, double board-certified and fellowship-trained at the American Sports Medicine Institute (Andrews), is 90 minutes: history, exam, your images and diagnostic ultrasound where it helps. Bring the imaging disc and the radiology report. In a spine program, the second opinion recommended conservative care for 662 of 1,088 patients; no study in our read reports that rate for knee, shoulder or hip.
You have a surgery date, a folder of images and a feeling that something was missed. Here is what a real second opinion includes, what to bring to it, and what the published programs found when someone looked again.
What a real second opinion does differently
It re-reads the diagnosis before it touches the plan
A second opinion is only as good as the exam behind it. Dr. Garg takes the history from the first symptom forward, then examines the joint or tendon himself: where it hurts, which movement provokes it, what is weak and what is stable. The question is whether the diagnosis on paper matches the body in the room. A second look matters most when the original recommendation was based on imaging alone rather than a hands-on, dynamic exam, because a picture of a tear is not proof the tear is the source of the pain. Dr. Garg says it plainly on The Treatment Gap: Is Surgery Really Your Only Option?: if somebody begrudges you for getting a second opinion, walk out, because they have made it about themselves and not you.
Spine programs counted the plans that changed
The counted numbers come from spine surgery. A 2021 scoping review of 14 spine second-opinion studies found that 61.3% of second opinions were discordant with the first, and 75% of the discordant ones recommended conservative management; the authors found no prospective studies of following a first versus a second opinion. In one spine program, 1,088 patients who arrived with a prior indication for surgery completed the process: conservative management was recommended for 662 (60.8%) and surgery for 377, with complex spine surgery such as fusion recommended in 3.7%. For the knee, in a Munich cohort, 47 of 142 patients (33.1%) had a replacement within 12 months, and those advised immediate surgery had it sooner; that study did not record whether plans changed. No study in our read reports how often a second opinion changes the plan for knee, shoulder or hip surgery, and none of these proves the second opinion caused the outcome. If your recommendation is a new knee, read the options to weigh before a knee replacement.
The 90 minutes go to your images and your joint
A new patient evaluation at Dynamic Athlete is 90 minutes with Aneesh Garg, DO, CAQ. Dr. Garg reviews any imaging you bring and examines the joint or tendon. Where it helps, he adds point-of-care diagnostic ultrasound, a dynamic assessment of the joint or tendon in motion, which can identify a different source of pain than static imaging alone shows. Tissue is the deciding fact: tendinopathy, partial tears and earlier joint wear are good candidates; complete ruptures and bone-on-bone joints are not. Then he tells you directly whether Dynamic PRP+, Dynamic Stem Cell+, Dynamic Shockwave+ or surgery is the appropriate next step. That sorting is the whole question for a torn rotator cuff and for a worn hip.
The second look comes before the date
The space between a little physical therapy and the operating room is where patients get stuck: injury, maybe a little physical therapy, then a huge gap, then surgery. Dr. Garg’s fellowship at the Andrews Institute shaped his non-surgical first approach: start with what can be done without an incision, and refer when the structure calls for it. Some surgeries, such as a joint replacement, cannot be undone. That is why the second look comes before the date, not after, and why it starts with the exam rather than the calendar. The full comparison is on regenerative medicine or the operating room.
Who should get a second opinion before the date holds
Any one of these four is reason enough to have the plan checked before surgery.
- A surgery date set before anyone sat down and reviewed your imaging with you
- A diagnosis that does not match the exam: the MRI says one thing and the pain says another
- Pain that started or changed after an injection, and no one has re-examined why
- A rushed first consult, with surgery as the one option offered
Before you book, ask
- Will the physician review my actual images, not just the radiology report?
- Will the exam include diagnostic ultrasound of the joint or tendon in motion where it helps?
- If I do need surgery, will you say so and coordinate the referral?
What the second look buys
Some surgeries, such as a joint replacement, cannot be undone. A second opinion is one visit spent making sure the diagnosis is right before a decision like that is made. The goal is not to talk you out of anything. It is to put the ski season, the trail or the afternoons with the grandkids on the right plan, the first time.
Frequently asked questions
Should I get a second opinion before knee surgery?
Yes, especially if the recommendation came from imaging without a hands-on exam, or if the diagnosis does not match how the knee behaves. In a Munich second-opinion program for knee osteoarthritis, 47 of 142 patients (33.1%) had a knee replacement within 12 months of the second opinion, and those recommended immediate surgery had it sooner; that study did not record whether plans changed. It was a prospective cohort, not a trial, so it shows what happened, not what caused it. A second opinion at Dynamic Athlete is a 90-minute evaluation with Aneesh Garg, DO, CAQ that includes the exam, your images and diagnostic ultrasound where it helps.
How often does a second opinion change the surgical plan?
For spine surgery, a 2021 scoping review of 14 studies found that 61.3% of second opinions were discordant with the first, and 75% of the discordant opinions recommended conservative management; the review found no prospective studies. In one spine program, conservative management was recommended for 662 of 1,088 patients who arrived with a surgical indication, and surgery for 377. No study in our read reports how often a second opinion changes the plan for knee, shoulder or hip surgery. A Munich knee cohort found 47 of 142 had a replacement within 12 months, but did not record whether plans changed. None of this predicts what will happen with your joint.
What should I bring to a second opinion appointment?
Bring the imaging itself on a disc or a download link, not only the written report, because the second physician needs to see the pictures. Bring the radiology report, a list of every injection you have had with dates and what was injected, your physical therapy notes, and the surgeon’s written recommendation if you have one. Write down when the pain started, what makes it worse and what you want back, whether that is a run, a ski day or a full night of sleep. With those in hand, the 90 minutes go to your joint rather than to reconstructing your history.
Will my surgeon be offended if I get a second opinion?
A good one will not. Dr. Garg’s view, from The Regen Doc Podcast: if somebody begrudges you for getting a second opinion, walk out, because they have made it about themselves and not you. When a patient tells him they are getting another opinion, he says great, maybe they will see something he does not, then come back so the whole picture is covered. Some surgeries, such as a joint replacement, cannot be undone, so the second look is part of a careful decision, not an insult to the first physician.
What happens at an orthopedic second opinion visit in Boulder?
The new patient evaluation is 90 minutes with Aneesh Garg, DO, CAQ, at 1790 30th St, Suite 270, Boulder. He takes the history, examines the joint or tendon, reviews any imaging you bring and, where it helps, adds point-of-care diagnostic ultrasound to look at the tissue in motion. Then he tells you directly whether Dynamic PRP+, Dynamic Stem Cell+, Dynamic Shockwave+ or surgery is the appropriate next step. You leave with a specific recommendation. If the answer is surgery, we coordinate the referral.
Does a second opinion mean I will avoid surgery?
No, and it should not promise to. A second opinion checks the diagnosis and the timing. In the spine program in our read, the second opinion still recommended surgery for 377 of 1,088 patients, and in the Munich knee cohort, those recommended immediate surgery had it sooner. For some patients the second opinion recommends conservative care, and others are confirmed as surgical candidates. Here, surgery is the last resort, and for some injuries, such as a displaced fracture, it is the right answer from day one. When surgery is the right answer, we coordinate the referral.
Does insurance cover a second opinion in Boulder?
Dynamic Athlete accepts Medicare and Kaiser for consultations and office visits only. PRP, BMA and MFAT are out of pocket. We give a quote after a thorough evaluation. We price the plan for optimal outcomes, not line items off a menu. Cherry financing is available. The value of the visit is the answer itself: a diagnosis checked by a sports medicine physician before a decision you cannot take back.
Where can I get an orthopedic second opinion in Boulder?
At Dynamic Athlete, 1790 30th St, Suite 270, Boulder, with Aneesh Garg, DO, CAQ: double board-certified in sports medicine and internal medicine, fellowship-trained at the American Sports Medicine Institute (Andrews), ISMST-certified, and founder of the American Shockwave Training Institute. The new patient evaluation is 90 minutes, and appointments are usually within the same week, for patients across the Front Range from Longmont, Louisville, Lafayette, Broomfield and Erie. When surgery is the right answer, we coordinate the referral.
Have the plan checked before you give up a season
A second opinion costs an hour and a half. A surgery you did not need costs months of recovery. Book the 90-minute evaluation with Aneesh Garg, DO, CAQ, usually within the same week, and know before you sign.
Book an Evaluation
1790 30th Street Suite 270 · Boulder, CO 80301 · 303-997-1733