Holy Cow! CME Credit on the Fast Track? // and More!

STOP Courting Disaster with Kids and Football … Holy Cow! CME Credit on the Fast Track? … Boden Laments Innovation Slowdown … Powerfully Sensitive New Tool Measures Meniscal Trim vs. Repair

Powerfully Sensitive New Tool Measures Meniscal Trim vs. Repair

Christina R. Allen, M.D. is an orthopedic surgeon with the University of California, San Francisco (UCSF). She has received a grant from the Orthopaedic Research and Education Foundation (OREF) for her work on imaging. Regarding her project, “Quantitative MR Imaging Evaluation of Articular Cartilage and Kinematic Changes in the Knee After Meniscectomy, ” Dr. Allen told OTW, “We are looking at changes in cartilage stresses in knee loading conditions after surgery…examining the differences between the surgical knee and the opposite knee. We don’t know how long it will take to develop changes on a microscopic level, but this allows us to track how things are changing. Also, we will be able to get information on whether it is best to trim or to repair the meniscus.”

“Our system is very sensitive to cartilage changes. The imaging system—“T1-rho”—will pick up structural changes and will let us know how much stress the cartilage is under. We need to know if we are really helping by repairing the meniscus. What about the long term health of the knee? We will have more answers after this work is complete.”

STOP Courting Disaster With Kids and Football

Paul Saluan, M.D. is an orthopedic surgeon at Cleveland Clinic Sports Health. He tells OTW, “My thoughts turn to football at this time of year. My son started playing football this year, his eighth grade year, for the first time. I was in discussion with one of my co-team physicians on the sidelines of an intersquad collegiate scrimmage over the weekend as well, and our discussion turned to my son starting play at the eight grade level. We went further and got onto the topic of 1st and 2nd graders in full equipment and full contact football. We both agreed that this is a recipe for disaster on multiple levels. Kids this age, typically 6-9 years old have a larger head to body ratio than their more fully grown counterparts in 6-8th grades. This leads to less neck control and theoretically more concussion risk. I am not aware of any studies to date on this age group yet, but I have a feeling we will be seeing some evidence in the near future of increased injury risk. It is also hard to refute the fact that these kids will have 4-5 more seasons of lifetime head trauma at a young age than their peers who started playing in 6th grade. We all know that the younger you are when you sustain your first concussion, the more significant the injury.”

“It is a shame that we continue in the direction of pushing the envelope in younger and younger individuals, because the reality is that once these leagues start, it then becomes the standard approach to the grooming process of that particular sport. It becomes almost impossible for young individuals to competitively progress to the next level without becoming involved in one of these leagues. We need to let kids play more and train less. There is such a thing as ‘too much, too soon.’”

Holy Cow! CME Credit on the Fast Track?

Ted Miclau, M.D. is professor and vice chair of Orthopaedics at UCSF and director of the UCSF/San Francisco General Hospital OrthopaedicTrauma Institute (OTI); he has recently led a webinar on technology in orthopedics. He tells OTW, “Aside from new implants, technology continues to grow in orthopedics, and there are lot of new resources available to surgeons. They are not only available to those who can go to meetings or live in urban areas…those in rural areas and those abroad can benefit as well. Mo Bhandari, M.D., who is with McMaster University, has spearheaded a novel online resource called Myorthoevidence.com. It allows doctors throughout the world to look up the best evidence available for any given orthopedic problem. The site emphasizes the vast growth in the amount of papers available, and attempts to help interpret them.”

“Another terrific web based option is VuMedi.com, a surgical video site established by Roman Giverts when he was a graduate student at Berkeley. He has an enormous amount of videos from academic institutions and he has a database of 40, 000 surgeons who have signed up from all over the world. Remote conferences are also the wave of the future. I recently moderated a session on current controversies in orthopedics where we had four panelists who were all participating remotely. We had some of the most interesting talks I’ve ever heard on the subjects. The project ran quite smoothly, and we had substantial participation—220 people from around the globe. There were live, interactive question and answer sessions; also, CME credit was available.”

“In addition to surgeon education, technology is also burgeoning in that more and more journals are available online, and thus an increasing number of surgeons abroad are able to access top orthopedic publications. Additionally, there is telemedicine, wherein we use the Internet to provide clinical care at a distance. Our program has just received a grant to use telemedicine to improve clinical treatments, and this technology can also be used following disasters. There are obstacles to the adoption of telemedicine, however, such as infrastructure development. You could do rudimentary telemedicine if you had a simple Internet connection, but the important thing is that both places—the location that is broadcasting and the location that is ‘receiving’—are compatible. There is also an issue with lack of acceptance by government payers or insurers, medicolegal liability (because you’re not actually seeing the patient), the regulatory challenges involved in treating patients across state lines, etc. Given these challenges, the low lying fruit for telemedicine is to treat patients within one’s own state, and to treat people in rural areas where there is no specialist care. “

"Lastly, technology is progressing in the area of global research. We are working with Mo Bhandari’s group to develop a global database of the incidence of global trauma. More and more surgeons abroad have access to the Internet, but they still need direction and a coordinating center to maintain the database. In due time, this will progress as well.”

Newly Minted Orthopedists Establish Three Awards

Mark Morrey and Matt Abdel met at the University of Wisconsin (UW) School of Medicine and Public Health, and were both drawn to the idea of helping others. Both Drs. Abdel and Morrey have recently completed their orthopedic surgery residencies at the Mayo Clinic and have just begun the terms as Mayo Scholars, which involves traveling the globe to further their education. Not wanting to leave their UW medical students behind, the duo has established three endowed scholarship funds to benefit medical students from the University of Wisconsin. Students may apply for the Abdel-Morrey Orthopedic Surgery Award, the Class of 2007 Excellence in Orthopedic Surgery Award, and the Philip M. Abdel Memorial Scholarship.

Boden Laments Innovation Slowdown

Scott Boden, M.D. is director of The Emory Orthopaedics & Spine Center and professor of Orthopaedic Surgery at Emory University School of Medicine. Dr. Boden has been thinking a lot lately about innovation. He tells OTW, “My concern in the current financial and regulatory climate is that few device companies are willing to make the longer term investments in highly innovative new products and technologies, but instead are focusing on 510(k)-approvable often ‘me too’ type products with a shorter approval process. A second concern stems from the potential impact on health care consolidation over the next few years and what the impact will be on smaller start up companies that are often the source of some of the more innovative advances.”

“I think the rate of new technology innovation will slow for a couple reasons. The economy is causing much pressure for companies to produce short term numbers. Also, major innovations often require long PMA [premarket approval] approval process, and with the uncertainty of health care reform and pricing pressure, companies are more reluctant to make those longer term investments.”

Asked how he would proceed if he were at the helm of a commission to promote innovation in the field, Dr. Boden told OTW, “One of the biggest challenges to new technology is the cost required to actually prove their value. I think I would try to incentivize value-based products somehow rather than me-too products.”

Tim Morris New VP at EOS

Tim Morris, formerly the General Manager at Trumpf North America, is now Vice President, EOS of North America, Inc. Morris spent ten years at Trumpf, where, among other things, he oversaw the sales and service activities of the Laser Technology Division. Morris has worked in a wide range of other fields, including aerospace, automotive, medical, and consumer electronics. At EOS, Morris will be involved in managing sales/marketing, service/application engineering and administration. He will also oversee the EOS of North America, Inc. family of companies such as Advanced Laser Materials (ALM) and Integra, which specialize in researching and developing engineered materials for additive manufacturing processes, along with providing comprehensive customer support.