AOSSM: New President, New Building and Renewed Commitment to Innovation // New Rothman Institute President, Alex Vaccaro, M.D., Talks Major Expansion // and More!

AOSSM: New President, New Building and Renewed Commitment to Innovation

Robert Arciero, M.D. the new president of the American Orthopaedic Society for Sports Medicine (AOSSM), spent 20 years as an Army surgeon and earned a Bronze Star. Now, as he moves forward in his new role as head of AOSSM, he is putting his past to work and is ready to welcome the future. Dr. Arciero, chief, sports medicine division, Department of Orthopaedic Surgery, University of Connecticut Health Center tells OTW, “There aren’t enough orthopedic surgeons in the military so we rely on each other very much and can only do our work via a team approach to patient care. This solidified in me an attitude of ‘let’s do this together’ and had led me to be very open to other people, ideas, and situations. As president I will essentially be a conductor of great people who are as committed as I am to furthering our mission of education and optimizing sports care.”

“We will soon be moving into a new building, something that is very much needed because the orthopedic learning center of the past needed updating. We are going from 1970s technology to ‘Star Wars’ as far as the technical capabilities and options with didactic lectures and conferences. For example, if someone has an innovative technique in the surgical care of a torn anterior cruciate ligament (ACL) that surgeon can come in and perform the procedure and it can be webcast to any hospital in the world. We can also archive it and make it available for our membership to review at the time of their choosing.”

“As president I will be keeping an eye on how we as a subspecialty devoted to the care of patients with sports injuries are doing as far as proving that our treatment truly makes a positive impact. We are busy caring for patients, but we need to validate those treatments. Intuitively, we surgeons have always believed that our treatments resulted in a positive impact because of our experience and because of older, retrospective studies, but we need prospective randomized trials that prove our interventions and techniques actually work and have a positive impact on the quality of life for our patients.”

“Another critical new area is the concept of Physician Performance Standards. We must also be able to show that the members of our subspecialty society meet established performance standards. We all get certified and recertified, but we must be able to demonstrate that we meet every single performance standard out there. This will guarantee that all active patients from the elite athlete to the recreational athlete to the master’s level athlete will have access to superior care.”

“I am following a lot of giants who have held the post of president…and we have a tremendous staff. I basically don’t want to mess up this fine tuned engine. If there is one area in which I hope to make a positive impact in the next years is to improve the quality of sports care for those who cannot pay. I would like to increase our members understanding of how many well deserving, underserved athletes there are in this country. A 16 year old with a severe sports injury isn’t just out for the season…they could be ‘down’ for life. This weakens them, and can affect their future socioeconomic status. There are many financial pressures, of course, and it’s easy to not treat people who cannot pay. But there must be a way to increase the number of my colleagues who are dedicating time to these athletes.”

Alexander Vaccaro, M.D., Incoming Rothman President, Talks 90% Expansion

Alexander Vaccaro, M.D., an academic orthopedic surgeon with 560 peer-reviewed articles to his name, is the newly-minted president of the famed Rothman Institute in Philadelphia. Dr. Vaccaro, also named chairman of orthopedics for Sidney Kimmel Medical College at Thomas Jefferson University, sees a future of strong growth for the Rothman Institute. He told OTW, “Our mission at the Rothman Institute is to lead the way for clinical and operational transformation into an era of medicine that demands quality, service and cost effectiveness in every aspect of health care. We expect over the next year to expand our operations into new regions of New Jersey and Pennsylvania based on our mission of academic, clinical and research excellence.”

“Every decision I make will be based on the need to keep our three original pillars of excellence standing: academic, educational, and clinical. There are many groups that are busy and profitable, but our institution stands out because in order to join our team you must be talented in all three areas. If you are fast, safe, and great on the clinical side that is still not enough to be part of the Rothman Institute. You must also demonstrate a commitment to research and education. So, for example, if a hospital expresses interest in affiliating with us, they must prove that they will emphasize these things.”

“We are walking into a world that has significantly changed in terms of periodic payments, capitation, employee healthcare, etc. In order to make value based decisions we will rely on big data. I want to know every complication that can possibly happen to any of our surgeons in spine, hand, shoulder, etc. We can only track—and rectify—those situations with the help of large databases.”

His initial goal? “I would like to strengthen our affiliation with Thomas Jefferson University and work alongside the new president, Stephen Klasko, M.D. I believe that we can create a symbiotic relationship whereby we can together bring excellence in orthopaedic care to the communities in which we serve.”

But as he looks out over the Delaware River he sees another goal. “I would like to expand the Rothman Institute into Central New Jersey. Yes, there will be some entities and individuals who will not send out a welcome party, but I believe the community will welcome us. Our goal is not to displace anyone, but to bring to that area the exceptional quality care that Rothman is known for. At this time, we have a total of 105 physicians working throughout southeastern Pennsylvania and New Jersey; I see no reason why we can’t grow that to over 200 surgeons going forward.”

“I’ve been asked to chair other orthopedic departments in the past, but none of those situations would have resulted in a perfect role. In the back of my mind there was always the thought, ‘It would be fantastic to be chair at Thomas Jefferson.’ The committee searched for approximately six months and last week they interviewed all three final candidates. Any one of them could have run a major orthopedic facility. Frankly, I got lucky.”

Incredible New MRI Form Picks Up “Bruised” Cartilage

It took a West Point graduate and specialist in military intelligence to find key new clues in solving an osteoarthritis (OA) mystery. Constance Chu, M.D. is professor and vice chair of research in the department of Orthopaedic Surgery at Stanford University. Dr. Chu, director of the joint preservation center and chief of sports medicine at the VA Palo Alto, told OTW, When I started practice 15 years ago at the University of Pittsburgh, I was seeing young people in their 20s and 30s with end stage OA. What they had in common was that they had suffered anterior cruciate ligament (ACL) tears as teenagers. I was also doing ACL reconstructions and finding that the articular cartilage usually appeared normal at the time of ACL injury. Yet, 10 to 15 years later, the cartilage was gone. I decided to see if there was cartilage damage underneath the surface after ACL tear that we just weren’t able to see at arthroscopy or with regular MRI. And, if so, whether these subsurface injuries could heal.”

“Conventional wisdom holds that articular cartilage does not heal, and that damaged cartilage inevitably progresses to OA given enough time. Through some amazing imaging technology known as ultrashort echo time (UTE) enhanced T2* mapping, however, we were able to show that articular cartilage and meniscus can heal subsurface injuries after anatomic ACL reconstruction. I began this work by looking into ways to visualize what I termed ‘invisible cartilage damage.’ I drew upon my time after West Point, where I served in the Army and commanded an image intelligence unit. One of our tasks was to locate weapons or signs of military activity that our adversaries worked hard to hide from us. We used special imaging tools and software to help visualize what was hidden from view to determine what they really had. As a physician, I thought advanced imaging techniques would help us see potentially reversible cartilage damage well before the onset of clinical OA because there is no cure once you hit that stage.”

In regular MRI scans, the deep articular cartilage and meniscus can be considered hidden from view. If you look at a regular MRI scan of the deepest layer of articular cartilage, it appears black because you are not picking up the signal due to the very short relaxation time of the tissue. My collaborator, a physicist, worked out a way to acquire very short echo times clinically and we obtained a supplement to my NIH [National Institutes of Health} R01 grant to do bench to bedside studies on the value of UTE acquisitions in uncovering deep subsurface cartilage damage. Those studies were encouraging. About the same time, I learned techniques for anatomic ACL reconstruction from Freddie Fu, M.D. so we began a prospective clinical study on patients receiving anatomic ACL reconstructions. From the beginning, it was clear that we were picking up subsurface cartilage and meniscus injuries that were not evident on regular MRI scans or by arthroscopy. The two-year data was incredible. The abnormally high UTE signal in the deep cartilage and meniscus seen at ACL injury was gone at two years follow-up. Rather, the two year scans were similar to that of uninjured knees.”

Of this little-known imaging technology, Dr. Chu says, “UTE is a very specialized technique that is not widely available‹clinically with only a few centers in the world able to scan patients. The University of Pittsburgh, where I did this work, is one. We are in the process of putting procedures in place at Stanford. The image processing to elicit the information from the MRI scans is also not trivial. Because this work is getting traction, I believe that in just a couple of years we will see more facilities with access to UTE.”

“While it is thrilling to be able to show this early damage, our finding that articular cartilage retaining intact surfaces can heal deep tissue injuries is a major breakthrough in the search for new strategies to prevent or delay the onset of osteoarthritis. I liken the UTE signal change to showing a deep bruise in the articular cartilage. If you suffer a blow to your arm and get a bruise, most people don’t keep hitting the same spot because it hurts. If someone did, the skin would probably break open. Articular cartilage doesn’t have nerves so when the cartilage has been bruised, patients don’t know it. If we are now able to show someone that they have this bruise, and also that the cartilage can recover from the bruise, then they can decide to rest the joint until it improves. To be able to show cartilage damage at a reversible stage and to help patient’s understand why they need time to recover their joints is quite an advance in patient care because these steps may help prevent devastating OA later on.”