When it comes to professional athletes, it’s hard to imagine any tougher than mixed martial arts (MMA) fighters who engage in no-holds-barred combat in a cage match.
For 30-year-old professional middleweight fighter AJ Hotchkins of El Paso, Texas, it’s a labor of love.
“I love the challenge of striving to be my best every day,” AJ said. “I love the sport of MMA. I train twice a day, six days a week.”
That dedication has earned him accolades and a second place ranking in the Southwest, where he lives and trains. But over time, years of physical demands — first as a top-ranked college football player for the Oregon Ducks and the University of Texas at El Paso, and now as an MMA fighter — took their toll on his knees.
“My left knee had bothered me for years,” AJ said. “It would get stiff and lock up sometimes. But it was never serious enough to do anything about it.”
But then, in December 2024, he injured his right knee in a fight.
“I knew immediately that something was wrong,” AJ said. “I tried to tough it out for a couple of weeks, but it was so painful and swollen that I couldn’t just push through it this time.”
AJ turned to board-certified sports medicine specialist and orthopedic surgeon Toribio Natividad, MD (El Paso, Texas).
“An MRI showed meniscus tears on both knees and some cartilage wear,” Dr. Natividad said. “AJ is an elite athlete who is physically and mentally tough, so he had likely played through some of the injuries for years. But he had reached a point where it was time to do something about them.”
Dr. Natividad proposed operating on both knees at once to give AJ the best chance of healing quickly and getting back to fighting as soon as possible.
“This is a guy who wants to get back to MMA yesterday,” Dr. Natividad said. “We have to make decisions in the operating room on what will give him the best chance to return to the highest level of competition.”
In the operating room, Dr. Natividad found more significant tears than anticipated. In AJ’s left knee he found a bucket-handle meniscus tear, which he repaired using an all-inside technique with six Arthrex FiberStitch™ 1.5 implants. His right knee had a less severe meniscus tear that Dr. Natividad was able to repair with another three FiberStitch 1.5 implants.
“I placed AJ on protective weight-bearing on both knees for six weeks, initially using a wheelchair and then a walker, which is tough for an athlete like him,” Dr. Natividad said. “But he took it in stride and was incredibly positive and jumped into physical therapy (PT) immediately after surgery.”
With months of rehab ahead of him, AJ was determined to tackle the challenge like he does everything else.
“I had confidence, and I am an optimist,” AJ said. “Where there’s a will, there’s a way. I knew my attitude and mindset were key, and I committed to doing what I needed to in PT to get back to competition.”
After four months of rehab, AJ returned to the gym. He won his first fight back in the cage just nine months after the bilateral knee surgery.
“I knew my knees would hold up,” AJ said. “The surgery went really well, and I trusted the quality of the Arthrex products and the work I put in during PT.”
Dr. Natividad says he is confident in AJ’s repair and his future pursuing the sport he loves.
“We can’t restore you to how God made you,” Dr. Natividad said. “This was significant surgery, but this technology and technique provide us with the best possible tools to return elite athletes like AJ back to the highest level of functioning possible.”
And while AJ says he is continuing to rebuild his lower body strength, he is confident in both his training and the ability to win in competition.
“My trainers and I had to adjust after my surgery, and I knew it would take time to get back to 100%,” AJ said. “But now we’re in a place where my limitations are gone, and I can do everything I want to in the gym and during my fights.”