Torn Miniscus | Knee Osteoarthritis Treatment | Microfracture | Hip Arthroscopy Labral Tear
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Torn Miniscus | Knee Osteoarthritis Treatment | Microfracture | Hip Arthroscopy Labral Tear

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The Steadman Philippon Research Institute 2006 Annual Report

The purpose of our Basic Science Research is to gain a better understanding of factors which lead to: (1) degenerative joint disease; (2) osteoarthritis; (3) improved healing of soft tissues such as ligaments, tendons, articular cartilage, and meniscus cartilage; and (4) novel and untried approaches of treatment modalities. Our focus is to develop new surgical techniques, innovative adjunct therapies, rehabilitative treatments, and related programs that will help delay, minimize, or prevent the development of degenerative joint disease. In 2006, we collaborated with various educational institutions, predominantly Colorado State University and Michigan State University. We believe that our combined efforts will lead directly to slowing the degenerative processes, as well as finding new ways to enhance healing and regeneration of injured tissues.
The relatively new area of regenerative medicine is an exciting one that has gained global attention. There are many new and inno- vative techniques under investigation by scientists around the world. One of the broad goals of this work can be stated simply as joint preservation. In 2006 we focused our efforts almost exclusively on regeneration of an improved tissue for resurfacing of articular cartilage (chondral) defects that typically lead to degenerative osteoarthritis. We have been working in the promising area of gene therapy in col- laboration with Drs. Wayne McIlwraith and David Frisbie at Colorado State University. We have now completed our initial studies, and we have enough important data to take this project to the next level.
In 2006 we also published an extremely important manuscript that examined the effects of leaving or removing a certain layer of tissue during lesion preparation for microfracture. This manuscript
will help guide surgeons and should improve outcomes of microfrac- ture performed by surgeons worldwide. We also completed data collection of a study involving electrostimulation to enhance
cartilage healing.

CONTENTS:
2 The Year in Review
7 The Steadman-Hawkins Difference 10 Friends of the Foundation
21 The Knee, the Package, and the Gift (Torn Miniscus)
23 Steadman-Hawkins and Össur Team Up
24 Research and Education (Knee Osteoarthritis Treatments)
25 Basic Science (Microfracture)
27 The Human-Horse Connection
28 Bad Knee Leads to Good News
29 Clinical Research (hip arthroscopy labral tear)
37 Impingement Can Lead to Arthritis 45 Biomechanics Research Laboratory 49 IRA Rollover Legislation
51 Education
52 Research Foundation Provides Students
with a Close Look at Medicine
56 Publications and Presentations 67 Recognition

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Torn Miniscus | Knee Osteoarthritis Treatment | Microfracture | Hip Arthroscopy Labral Tear Torn Miniscus | Knee Osteoarthritis Treatment | Microfracture | Hip Arthroscopy Labral Tear Presentation Transcript

  • Steadman◆Hawkins Research Foundation Annual Report 2006Steadman◆Hawkins Research Foundation A 501(c)(3) nonprofit organization 181 WEST MEADOW DRIVE, SUITE 1000 VAIL, COLORADO 81657 970-479-9797 FAX: 970-479-9753 http://www.shsmf.org An International Center for Research and Education — Keeping People Active
  • CONTENTS NOTE 3: CONTRIBUTIONS RECEIVABLE NOTE 7: OPERATING LEASES 2 The Year in Review Contributions receivable at December 31 are due as follows: Mission 4 Governing Boards 2006 2005 Noncancellable operating leases for property and equipment expire in various years through 2010. Two of the property leases require the Foundation to pay all executory costs (property taxes, maintenance 5 Scientific Advisory Committee Due in less than one year $ 192,750 $ 160,750 and insurance). Due in one to five years 113,198 150,000 7 The Steadman-Hawkins Difference 305,948 310,750The Steadman◆Hawkins Research Foundation is dedicated to 10 Friends of the Foundation Less: unamortized discount (25,305) (13,946) Future minimum lease payments at December 31, 2006, are: 21 The Knee, the Package, and the Gift Due from related parties (750) (5,750)keeping people of all ages physically active through orthopaedic $ 279,893 $ 291,054 2007 $ 83,120 22 Corporate and Institutional Friends 2008 83,120research and education in the areas of arthritis, healing, rehabili- 23 Steadman-Hawkins and Össur Team Up Discounts were 8% for 2006. 2009 83,044 2010 75,803 24 Research and Education Approximately 98% of total contributions receivable at December 31, $ 325,087tation, and injury. 2006 and 2005, are from two donors and one donor, respectively. 25 Basic Science The Foundation receives support and pledges from members of the Rental expense of $62,295 and $72,768 for the years ended December 27 The Human-Horse Connection Board of Directors and employees. These pledges receivable are 31, 2006 and 2005, respectively, is recorded in the statements of 28 Bad Knee Leads to Good News included in contributions receivable, related party. activities. 29 Clinical Research History 30 Colorado’s First Family of Skiing NOTE 4: PROPERTY AND EQUIPMENT Property and equipment at December 31 consists of the following: NOTE 8: PENSION PLAN 37 Impingement Can Lead to Arthritis The Foundation has a defined contribution retirement plan under IRS 45 Biomechanics Research Laboratory 2006 2005 Section 401(k). The plan is open to all employees after one year of Equipment $ 1,019,504 $ 774,923 employment. The Foundation’s contributions to the plan are deter-Founded in 1988 by orthopaedic surgeon Dr. J. Richard Steadman, the 49 IRA Rollover Legislation mined annually. The Foundation elected to match 50% of participants’ Furniture and fixtures 1,379 22,326 51 Education Leasehold improvements 10,107 263,793 contributions up to 6% during 2006 and 2005. Under this formula,Foundation is an independent, tax-exempt (IRS code 501(c)(3)) charitable 52 Research Foundation Provides Students 1,030,990 1,061,042 the Foundation made contributions of $20,323 and $19,510 for the Less accumulated depreciation 702,407 846,465 years ended December 31, 2006 and 2005, respectively.organization. Known throughout the world for its research into the causes, with a Close Look at Medicine $ 328,583 $ 214,577 56 Publications and Presentations NOTE 9: RELATED PARTY TRANSACTIONSprevention, and treatment of orthopaedic disorders, the Steadman◆Hawkins 67 Recognition NOTE 5: TEMPORARILY RESTRICTED NET ASSETS During 2006 and 2005, the Foundation received approximatelyResearch Foundation is committed to solving orthopaedic problems that 67 In the Media Temporarily restricted net assets at December 31 are available for the $363,000 and $244,000, respectively, in contributions from related 68 They Go to Steadman First following purposes: parties, including various board members as well as the Steadmanlimit an individual’s ability to maintain an active life. In 1990, Dr. Steadman Hawkins Clinic. 69 Associates 2006 2005was joined by renowned shoulder surgeon Dr. Richard J. Hawkins. Together, 70 Meet Our Staff Education $ 495,325 $ 196,359 NOTE 10: SIGNIFICANT ESTIMATES AND 73 Independent Accountants’ Report Biomechanics research 136,054 286,054 CONCENTRATIONSthey brought the Foundation’s research production in knee and shoulder Time restricted contributions 74 Statements of Financial Position Accounting principles generally accepted in the United States of and pledges — 105,000 75 Statements of Activities Administration 141,838 — America require disclosure of certain significant estimates and currentstudies to a new level. vulnerabilities due to certain concentrations. During 2005, approxi- 77 Statements of Cash Flow $ 773,217 $ 587,413 mately 28% of all contributed support was received from two donors. 78 Statements of Functional Expenses NOTE 6: RELEASE OF TEMPORARILY RESTRICTED 80 Notes to Financial Statements NET ASSETS Net assets were released from donor restrictions by incurring expens- es satisfying the restricted purposes or by occurrence of other events Cover: Dr. Marc J. Philippon, one of the world’s leading experts on hip arthroscopy. specified by donors as follows: 2006 2005 Purpose restrictions accomplished Education $ 266,317 $ 438,099 Biomechanics research 359,144 285,969The Steadman◆Hawkins Research Foundation wishes to express deep appreciation to John P. Kelly, who donated many of the stock photos in this Information systems — 25,000year’s Annual Report and contributed his time to photograph the many Foundation and operating room subjects. Basic science programs 10,465 9,504 Administration 4,029 4,483Kelly is a renowned sports and stock photographer who approaches every photo shoot like a commando. His sense of motion combines with his obvi- Bioskills 4,692 —ous love of natural light to produce vibrant graphic images. He shoots extensively for a variety of prominent manufacturers in the sports and recreation Clinical Research 145,464 —industry; and his experience includes numerous assignments at the Olympics, Wimbledon, U.S. Open Golf, and World Cup Skiing. When Robert Redford 790,111 763,055needed a poster that reflected the spirit of his movie “A River Runs Through It,” he called Kelly. More recently, Redford employed Kelly’s photographic Time restrictions expired Collection of contributionstalents during the making of “The Horse Whisperer.” Whether covering the Olympics or trekking in the Himalayas, Kelly is always ready for his next receivable 105,000 1,900photographic adventure. Total restrictions released $ 895,111 $ 764,955 [81]
  • F ounded in 1988 by orthopaedic surgeon Dr. J. Richard Steadman, the Foundation is an independent, tax-exempt (IRS code 501(c)(3)) charitable organization. Known throughout the world for its research into the causes, prevention,and treatment of orthopaedic disorders, the Steadman◆Hawkins Research Foundation is committed to solving orthopaedicproblems that limit an individual’s ability to maintain an active life. In 1990, Dr. Steadman was joined by renowned shouldersurgeon Dr. Richard J. Hawkins. Together, they established an organization that today has brought research in knee, hip,shoulder, spine and foot studies to a new level. The Foundation has influenced the practice of orthopaedics—from diagnosis to rehabilitation. Recognizing that thebody’s innate healing powers can be harnessed and manipulated to improve the healing process has led to exciting advancesin surgical techniques that are used today by orthopaedists in many practices. The microfracture technique, for example, isnow accepted as a treatment that may make it possible to postpone or even eliminate the need for knee replacement surgery. One of the largest independent orthopaedic research institutes in the world, the Steadman◆Hawkins ResearchFoundation has become the most published and one of the most innovative foundations in orthopaedic research andeducation. Philanthropic gifts are used to advance scientific research and to support scholarly academic programs thattrain physicians for the future. Through its Fellowship Program, the Foundation has now built a network of 160 Fellowsand associates worldwide who share the advanced ideas and communicate the concepts they learned in Vail.THE FOUNDATION’S PRIMARY AREAS OF RESEARCH AND EDUCATION ARE:• Basic Science Research – Undertakes studies to investigate the mysteries of degenerative arthritis, cartilage regeneration, and arthritic changes in the knee and shoulder.• Clinical Research – Conducts “process” and “outcomes” orthopaedic research that aids both physicians and patients in making better-informed treatment decisions.• Biomechanics Research Laboratory – Performs knee and shoulder computer modeling and related studies in an effort to reduce the need for surgical repair.• Education and Fellowship Program – Administers and coordinates the physicians-in-residence Fellowship Program, hosts conferences and international medical meetings, and produces and distributes publications and videotapes.SINCE ITS INCEPTION, THE FOUNDATION HAS HELPED PEOPLE OFALL AGES REMAIN PHYSICALLY ACTIVE THROUGH ORTHOPAEDICRESEARCH AND EDUCATION. IT CONTINUES TO PURSUE ITSGOALS OF:• Understanding and enlisting the body’s innate ability to heal.• Designing and validating surgical and rehabilitation techniques, as well as non-operative treatments for arthritis.• Producing and publishing scientifically validated research in leading medical and scientific journals. [1]
  • The Year in ReviewDear Friends,I t is with great pride and appreciation that we present to you the 2006 Annual Report for the Steadman◆Hawkins Research Foundation. In this report you will find a review of our researchand educational accomplishments for the year, and our vision for the future. We gratefully recognize the generosity of loyal friends and patients. Your continued support has enabled us to achievetremendous research and education initiatives—thank you. Our research directors, their teams, and the Foundation staffcontinue to grow our worldwide reputation through their excellent work. We are most appreciative of their efforts. For 18 years, the Foundation has applied your philanthropic, scientific, and industry support to become one of theworld’s leading orthopaedic research foundations. As a result, the Foundation is the most published clinical research institute forsports medicine in the world. In 2006 alone, our scientists made 189 presentations at scientific meetings around the world andpublished 47 papers in scientific and medical journals. The published results of our research have enabled us to become aleader in the prevention and treatment of injuries and arthritis, leading to improved patient care. From the beginning in 1988, we have focused on improving rehabilitation techniques after surgery. Our research hasproven that aggressive rehabilitation ensures an excellent overall result. Conversely, an excellent surgical result without goodrehab would produce a poor outcome. Following this breakthrough, the Foundation developed and validated the microfracturetechnique, which has now become the gold standard in repairing cartilage defects in the knee, and is being perfected for use in other joints. Today, more than one million patients around the world have benefited from microfracture and are leadingactive lives. Initially, our objective was to create the best clinical research group (page 29) in the world for sports medicine andevidence-based medicine. This is something that has been practiced ever since. Evidence-based medicine will continue to shapechanges in this country’s health care system and become a topic in the 2008 political election debate. Our achievements in 2006 would not be possible without the contributions of more than 800 individuals, foundations,and corporations whose combined support has amounted to more than $2.9 million. With overhead costs less than half ofuniversity research programs, our donors will be pleased to know that more of their support is going directly to researchand education. As the Foundation’s contributions to science and medicine are documented, it is important to celebrate and recognizethe achievements made by our senior research directors and their teams. Karen Briggs, M.P.H., M.B.A., heads the Clinical Research department and oversees the most widely published clinicalresearch organization of its kind in the world. Managing patient expectations following hip arthroscopic surgery continues to bean important research topic. Our research has expanded to include the hip joint, and already the Foundation is becoming aleader in hip-related research. Karen reports that initial findings show that the progression of arthritis in the hip may be preventedor delayed with early intervention. William G. Rodkey, D.V.M., recognized worldwide for his research, heads the Basic Science department. Regenerativecartilage research is a major area for optimism. Dr. Rodkey has continued to focus on regeneration of cartilage tissue that is usedto treat defects on the joint surface. A new topic for future research (shockwave therapy) is reviewed on page 26. Shockwavetherapy is a new and exciting concept to stimulate tissues to heal more rapidly. Michael Torry, Ph.D., is the director of the Biomechanics Research Laboratory, which is becoming a world leader in thedevelopment of biplane fluoroscopy and computer joint modeling. Dr. Torry and his team of scientists dedicated the year tobuilding a one-of-a-kind, biplane fluoroscopy system. One of two institutes in the world to design and house such equipment for [2]
  • research, the sophisticated x-ray system will createmovies or videos of bones and joints in motion. Thisequipment will help Foundation researchers gain abetter understanding of the development and progres-sion of arthritis, resulting in more effective treatments—perhaps prevention—and reduced healthcare costs. Advising our research departments is theScientific Advisory Committee, an integral resource forthe past 18 years. These preeminent, world-renownedscientists have shaped our research. Please read thearticles, C. Wayne McIlwraith: A View from the Top,page 6, and Bone and Joint Research: The Human-Horse Connection, on page 27. Our Fellowship and education programscontinue to be very successful. We graduated sixFellows in 2006 and welcomed seven new Fellowship surgeons for 2007. We now have more than 160 former Fellows worldwideat leading universities and private practices performing excellent sports medicine and keeping people active. Sports medicinecontinues to improve through our education initiatives. In this report, you will meet Adele and Roy Igersheim (page 21) and learn how “The Package” treatment for Adele’sknee arthritis reduced pain, restored function, and resulted in a significant gift to the Foundation. You will also read accountsfrom the Ghent Family, Kim Gustafson, and Mr. and Mrs. O.B. Shelburne—all friends who have benefited significantly from theFoundation’s research, providing them with help and hope. During the past 18 years, our donors have contributed more than $35 million dollars in support of orthopaedicresearch. The results of that research have changed the way physicians look at arthritis, joint disease, healing, and treatments forinjured joints. From this base, our board members, management team, scientists, and physicians are committed to building thenumber one orthopaedic sports medicine research institute in the world. Our state-of-the art facilities and equipment will continueto be updated. The fundraising goal to support the research efforts of the Foundation is expected to triple. The Foundation’sresearch will have a dramatic and positive impact on the acceptance of hip arthroscopy worldwide. The only way to achieve these ambitious goals is with the continued generous support of the people who have receivedtreatment, benefited from Steadman-Hawkins research, or have been made aware of our programs. On behalf of our dedicated board members, researchers, and staff, we wish to thank you, our donors, corporatesponsors, and foundations for your commitment in 2006. We look forward to your continued support and to updating you onexciting advances from the Steadman◆Hawkins Research Foundation.Respectfully yours,J. Richard Steadman, M.D. J. Michael Egan, Jr.Chairman of the Board President and Chief Executive Officer [3]
  • Governing BoardsBOARD OF DIRECTORS John G. McMillian OFFICERS Chairman and Chief Executive Officer (retired)H.M. King Juan Carlos I of Spain Allegheny & Western Energy Corporation J. Richard Steadman, M.D.Honorary Trustee Coral Gables, Fla. ChairmanAdam Aron Norm Waite, Jr. Betsy Nagelsen-McCormackChairman and Chief Executive Officer Vice Chairman Professional Tennis PlayerWorld Leisure Partners, Inc. Orlando, Fla. J. Michael EganMiami, Fla. President Cynthia L. NelsonHarris Barton Cindy Nelson LTD Marc PrisantManaging Member Vail, Colo. Executive Vice President,HRJ Capital Chief Financial Officer and SecretaryWoodside, Calif. Mary K. Noyes Director of Special Services John G. McMurtryRobert A. Bourne Aircast, Inc. Vice President, Program AdvancementVice ChairmanCNL Financial Group, Inc. Freeport, Me. Paige PrillOrlando, Fla. Al Perkins Vice President, Development and Chairman CommunicationsHoward BerkowitzChairman and Chief Executive Officer Darwin Partners Wakefield, Mass. COLORADO COUNCILBlackRock HPBNew York, N.Y. Marc J. Philippon, M.D. The Colorado Council was established asJ. Michael Egan Steadman-Hawkins Clinic an auxiliary board of prominent ColoradoPresident and Chief Executive Officer Steadman◆Hawkins Research Foundation citizens who serve as ambassadors for theSteadman◆Hawkins Research Foundation Vail, Colo. Foundation within the state.Vail, Colo. Cynthia S. Piper Bruce BensonJulie Esrey Trustee Benson Mineral Group, Inc.Trustee Emeritus Hazelden Foundation DenverDuke University Long Lake, Minn. Joan BirklandVail, Colo. Steven Read Executive DirectorJack Ferguson Co-Chairman Sports Women of ColoradoFounder and President Read Investments DenverJack Ferguson Associates Orinda, Calif. Robert CraigWashington, D.C. Damaris Skouras Founder and President EmeritusGeorge Gillett Senior Advisor The Keystone CenterChairman Morgan Stanley, Inc. KeystoneBooth Creek Management Corporation New York, N.Y. Dave GraebelVail, Colo. Gay L. Steadman FounderEarl G. Graves, Sr. Steadman-Hawkins Clinic Graebel Van LinesChairman and Publisher Steadman◆Hawkins Research Foundation DenverEarl G. Graves, Ltd. Vail, Colo. John McBrideNew York, N.Y. J. Richard Steadman, M.D. Aspen Business Center FoundationTed Hartley Steadman-Hawkins Clinic AspenChairman and Chief Executive Officer Steadman◆Hawkins Research Foundation Charlie MeyersRKO Pictures, Inc. Vail, Colo. Outdoor EditorLos Angeles, Calif. William I. Sterett, M.D. The Denver PostSusan Hawkins Steadman-Hawkins Clinic DenverSteadman-Hawkins Clinic of the Carolinas Steadman◆Hawkins Research Foundation Tage PedersonSpartanburg, S.C. Vail, Colo. Co-Founder Stewart Turley Aspen Club Fitness and Research InstituteRichard J. Hawkins, M.D.Steadman-Hawkins Clinic of the Carolinas Chairman and Chief Executive Officer (retired) AspenSpartanburg, S.C. Jack Eckerd Drugs Warren Sheridan Bellaire, Fla. Alpine Land Associates, Ltd.The Honorable Jack Kemp Norm Waite DenverChairman and FounderKemp Partners Vice President Vernon Taylor, Jr.Washington, D.C. Booth Creek Management Corporation The Ruth and Vernon Taylor Foundation Vail, Colo. DenverArch J. McGillPresident (retired) William TuttAIS American Bell Tutco, LLCScottsdale, Ariz. Colorado Springs [4]
  • Scientific Advisory Committee Bay Area Knee Society Honors Dr. Steadman with Lifetime Achieve- ment AwardT he Scientific Advisory Committee consists of distinguished research scientists who represent the Foundation and serve asadvisors in our research and education efforts, in our FellowshipProgram, and to our professional staff.Steven P. Arnoczky, D.V.M. Marcus Pandy, Ph.D.Director Associate ProfessorLaboratory for Comparative Biomedical Engineering Orthopaedic Research University of Texas/AustinMichigan State University Austin, TexasEast Lansing, Mich. Marc J. Philippon, M.D.John A. Feagin, M.D. Steadman-Hawkins ClinicEmeritus Professor of Orthopaedics Steadman◆Hawkins Research FoundationDuke University Vail, Colo.Durham, N.C. William G. Rodkey, D.V.M.Richard J. Hawkins, M.D. Director of Basic Science ResearchSteadman-Hawkins Clinic of the Carolinas Steadman◆Hawkins Research FoundationSpartanburg, S.C. Vail, Colo.Charles Ho, M.D., Ph.D. Juan J. Rodrigo, M.D.National Orthopaedic Imaging Associates Steadman-Hawkins Clinic of the CarolinasSand Hill Imaging CenterMenlo Park, Calif. Spartanburg, S.C. Theodore Schlegel, M.D. T he Bay Area Knee Society, a San Francisco-based organization, pre- sented its annual “Lifetime Achieve-Mininder Kocher, M.D., M.P.H. Steadman-Hawkins Clinic ment Award,” on November 16, toAssistant Professor of Orthopaedic Surgery, Denver, Colo. Dr. Richard Steadman. Harvard Medical School, Harvard School “Every year we present our of Public Health, Children’s Hospital, J. Richard Steadman, M.D. Lifetime Achievement Award to that Boston, Department of Orthopaedic Steadman-Hawkins Clinic individual who we believe has made a Surgery Vail, Colo. substantial contribution to advancingBoston, Mass. the art and science of knee surgery,” William I. Sterett, M.D. commented Dr. Scott Dye, president ofC. Wayne McIlwraith, D.V.M., Ph.D. Steadman-Hawkins Clinic the Bay Area Knee Society. “We see itDirector of the Orthopaedic Research Vail, Colo. as equivalent to the Nobel Prize of the Laboratory knee.” Past recipients have includedColorado State University Savio Lau-Yuen Woo, Ph.D., D. Sc. (Hon.) Jack Hughston, Werner Muller, JohnFort Collins, Colo. Ferguson Professor and Director Feagin, John Insall, Dale Daniel, and Musculoskeletal Research Center Mark Coventry, among others.Peter J. Millett, M.D. University of Pittsburgh The Bay Area Knee Society is com-Steadman-Hawkins Clinic Pittsburgh, Pa. posed of more than 100 orthopaedicSteadman◆Hawkins Research Foundation surgeons who have an academic andVail, Colo. clinical interest in the knee. [5]
  • C. Wayne McIlwraith: A View From the TopBy Jim Brown, Ph.D.T he first question was a simple one: is a whole new revelation as far as treat- How did you get from New Zealand ment is concerned for hip osteoarthritis. Ifto Fort Collins, Colorado? But when his I had run into him when I first had symp-answer began with, “I left New Zealand toms, then maybe I wouldn’t have neededto lead an alpine mountain climbing expe- surgery.”dition in Peru,” it was clear this was not Dr. McIlwraith is also quick togoing to be an ordinary interview. acknowledge the connection between the In fact, there is very little that is ordi- Foundation and the treatment henary about C. Wayne McIlwraith, D.V.M., received. “I couldn’t have gotten the care,Ph.D., Director of the Equine Orthopaedic and others wouldn’t benefit from theResearch Center at Colorado State advances Dr. Philippon will continue toUniversity, and a lot that is extraordinary. make, without research. And researchHe holds three doctoral degrees from could not be done without support fromuniversities in his native New Zealand the Foundation.” The entire process hasand the United States and three honorary affected his perspective both as a surgeondegrees from prestigious schools in Austria, and as patient. “I’ve seen surgery fromNew Zealand, and Italy. He was awarded the other side and it has enhanced mya Diploma of Fellowship at the Royal experience.College of Veterinary Surgeons in London “The research at the Foundationfor Meritorious Contributions to Learning and the application of that research inand a Diploma of Surgery at the the Clinic (and in other clinics around theUniversity of Guelph in Canada, where he world) removes many of the limitationsbegan to specialize in equine surgery. He on what you can do,” says McIlwraith.has operated on more than 10,000 horses “Twenty or 30 years ago, doctors wouldn’taround the world, including a former have repaired a cruciate ligament on anKentucky Derby favorite (Indian Charlie) older person. Now Steadman-Hawkinsand winner (Spend A Buck). Type his physicians are working on 60- and 70-name into Google and you’ll get more year-old patients so they can go skiing What would Dr. McIlwraith like thethan 900 entries. In short, Dr. McIlwraith is again. They ask you what you want to do public to know about the Foundation?arguably the foremost equine orthopaedic and then do their best to help get you “Without basic research, we wouldn’tsurgeon in the world. there. I’m doing so well, I plan to rock- have had the advances in improving Fortunately for the Steadman◆ climb and ski again. I’ll still be able to cartilage repair, getting rid of calcifiedHawkins Research Foundation, he has col- have fun.” cartilage during microfracture, or studyinglaborated with the staff on groundbreak- Earlier in the journey that led him to ways to use gene therapy on top of theing research projects and he serves as a Fort Collins, Dr. McIlwraith got a master microfracture procedure. The results ofmember of the Foundation’s Scientific of science degree at Purdue University as Foundation research are fed right backAdvisory Committee. And fortunately for part of a Ph.D. program. “It gave me an into finding better ways to help people.Dr. McIlwraith, he has been a beneficiary opportunity to do something for the We’re continually finding a betterof Foundation research and the patient- horse.” He later went to Michigan State mousetrap.”first approach of the Steadman-Hawkins University to study human arthroscopy in C. Wayne McIlwraith has seen theClinic. On August 9, 2005, he underwent the knee. He was the only veterinarian top of world as a mountain climber andtotal hip replacement. The osteoarthritis among 120 orthopaedic surgeons, and he is at the top of his professional worldin his hip may have started with a moun- he eventually started doing diagnostic as an equine orthopaedic surgeon andtain-climbing accident 30 years ago. The arthroscopic surgery on the horse. scientist. His contributions as a Scientificsurgery took 55 minutes (“skin to skin,” “My relationship with Dr. Steadman Advisory Committee member and hisas he calls it) and was performed by began when Steadman-Hawkins moved to experience as a recipient of Steadman-Steadman-Hawkins orthopaedic surgeon Vail. Bill Rodkey (William G. Rodkey, Hawkins research has given him a uniqueand hip specialist Dr. Marc Philippon. “I D.V.M., Director of Basic Science Research perspective. He is more than a “Patientdidn’t select my surgeon overnight and I at Steadman-Hawkins) got me together in the News.” He is a former patientwas confident I was in the best hands. He with Dr. Steadman and we started doing who makes news that is benefiting both research on the horse as a model for humans and horses. human orthopaedics.” [6]
  • The Steadman-Hawkins Difference: A Conversation withMike Egan, CEOBy Jim Brown, Ph.D., Executive Editor, Steadman◆Hawkins Research Foundation NewsF or the past two decades the “Within a few years, Steadman◆Hawkins Research Dr. Steadman developedFoundation has quietly positioned itself the microfracture tech-as one of the largest, most productive nique, which was at firstand innovative independent orthopaedic widely criticized by theresearch organizations in the world. Well orthopaedic establish-known within the medical community for ment. Once the success ofits excellence, the rest of the world is now his outcomes becamerecognizing that Steadman-Hawkins has irrefutable, thebecome, simply put, one of the world’s orthopaedic communityleading orthopaedic research foundations. accepted him as a leader The person best qualified to make in his field. The secondthat claim is J. Michael Egan, who joined reason I joined thethe Foundation as Chief Executive Officer Foundation was to ensurelate last year. Egan has an extensive back- an appropriate succes-ground that includes strategic planning, sion. When I met Dr.marketing, financing, and operating 14 Steadman in 1984, he wascompanies in the medical device industry. performing 600 surgicalDr. Richard Steadman, founder of the procedures a year. WithSteadman◆Hawkins Research Foundation, the addition of world-says, “Mike Egan brings a wealth of renowned surgeons, surgical procedures The succession plan is well underway withbusiness knowledge and experience to have doubled during the past three years extraordinary, young doctors joining theour organization, and he has a proven to nearly 4,000. Though Dr. Steadman Clinic. They are the reason for the signifi-record as an innovative, forward-thinking shows no signs of easing off, he is very cant increase in surgical cases. Very talent-and qualified leader.” determined to take the steps necessary ed individuals have joined the Foundation Dr. Steadman established the to carry on the Foundation’s work indefi- as well. Some of the gifted experts are:Foundation in 1988. In 1990, he was nitely. The third reason I’m here is to • Dr. William Sterett, 46, a Steadman-joined by renowned shoulder surgeon continue building the number one Hawkins Fellow, trained in SwitzerlandDr. Richard J. Hawkins. Together, they orthopaedic sports medicine research and Germany in trauma and jointbrought the Foundation’s research facility in the world.” preservation before joining the team inproduction in knee and shoulder studies Vail.to a new level. DIFFERENCE #2 – Surgeons, • Dr. Marc Philippon, 41, came from the We asked Egan to explain why the Scientists and Management University of Pittsburgh and is one ofSteadman◆Hawkins Research Foundation The relationship between the the world’s leading experts on hipis different from all the others. He gave Foundation and the Clinic is unique. The arthroscopy.us 10 answers. Clinic doctors receive no economic benefit • Dr. Peter Millett, 39, also a Steadman- from the Foundation. As a matter of fact, Hawkins Fellow, left Harvard to practiceDIFFERENCE #1 – The Steadman every Clinic doctor contributes financially medicine and conduct research atLegacy to the Foundation. However, the Founda- Steadman-Hawkins. “I came here for three reasons,” tion benefits from the innovative thinking • Dr. Thomas Hackett, 40, came from theexplains Egan. “Number one, I wanted of the Clinic doctors and their patients’ famous Kerlan-Jobe Orthopaedic Clinicto be a part of continuing Richard data is used in the Foundation’s clinical in Los Angeles.Steadman’s legacy. I have watched his research. The Foundation and Clinic have • Dr. Randy Viola, 41, is a hand and upper-vision, which started with the belief that each successfully recruited some of the extremity specialist who trained in Vailthe body has the ability to heal itself, best surgeons, researchers, and manage- as a Steadman-Hawkins Fellow. He alsounfold. He was convinced that an average ment from countries around the world, completed a hand fellowship at Indianasurgical result could become an excellent including Canada, Japan, Holland, China, Hand Center.one with the correct rehabilitation. Early and Germany. “They know,” says Egan, • Dr. David Karli, 36, specializes in thein his career he focused strongly on “that this place is different from institu- non-operative treatment of spinal disor-improving rehabilitation techniques after tions associated with universities. ders and is trained in physical medicinesurgery. Conversely, an excellent surgical The doctors and scientists have the and rehabilitation.result without good rehab would produce freedom to practice clinical medicine anda poor outcome. to pursue research based on their goals, instead of those dictated by a university. [7]
  • • Dr. Donald Corenman is an orthopaedic In addition, the management team DIFFERENCE #4 – Evidence-Based surgeon with a doctorate in chiropractic has grown to meet the increasing demands Medicine specializing in the treatment of the of the Foundation’s research teams and The records of every patient seen at spine. future direction. Two noteworthy additions the Clinic have been entered into a massive• Lyon Steadman is the CEO of the Clinic. include: database at the Foundation since 1993. Under his stewardship, the number of • Marc Prisant, Executive Vice President and Approximately 450 pieces of information, physicians and surgeries has doubled. CFO, who brings extensive experience as a objective and subjective, exist on every• Charles Ho, M.D., Ph.D., is a world- chief financial officer in venture capital, patient. Egan says there are now 15,000 renowned authority in musculoskeletal including work at several portfolio com- knees (meaning surgical procedures on imaging, specializing in MRI of sports panies, in the fields of biotechnology and knees), 5,000 shoulders, and almost 1,000 and orthopaedic injuries. Dr. Ho’s Ph.D. is proprietary medical devices. hips in the database. Patient outcomes are in electrical engineering. • Paige Prill, development and communi- tracked 5-10 years after surgery. The goal• Karen Briggs, M.B.A., M.P.H., heads the cations officer, who has a broad back- is to monitor progress over a number of Clinical Research department and over- ground in communications and fundrais- years to determine how long patients sees the most widely published clinical ing, managing all aspects of corporate experience continued improvement and research organization of its kind in communications for corporations that whether they require additional the world. include Vulcan, Inc., Microsoft, and surgery. The evidence-based information• Marilee Horan, B.S., coordinates all Turner Broadcasting Systems, Inc. related to patient outcomes is made shoulder-related clinical research. She available to physicians around the world has also managed the quality control of DIFFERENCE #3 – Low Overhead, through presentations, consultations, the clinical database to ensure that all Easy Access, and Good Communication and publications, contributing to their data collected is of the highest quality. “Donors need to know that more of continuing medical education.• William G. Rodkey, D.V.M., recognized their money is going directly into research. Egan gives us an example of how the worldwide for his research, heads the Our overhead costs are less than half of Foundation’s database has changed surgical Basic Science department, which collabo- that of other institutions,” says Egan. “A procedures. “By looking at retrospective rates through his relationships with dollar here goes farther than it does in cases of knee surgery, Clinic physicians universities such as Colorado State other places. learned that portals (openings) traditionally University, Michigan State University, “Other research organizations have used during knee surgery lead to unac- Cornell, Columbia, and the University not been created around one person’s ceptable levels of scar tissue. Moving of Pittsburgh. vision,” says Egan. “They have different the location of one of those portals by a• Michael Torry, Ph.D., director of the entities, including deans, faculty members, few millimeters produces significantly Biomechanics department, has been departments, and colleges, competing for less scar tissue.” recruited by several prestigious universi- funds. Communication is difficult or some- ties, but chooses to stay in Colorado times nonexistent. At Steadman-Hawkins, DIFFERENCE #5 - The Fellowship with the Foundation to pursue signifi- there is a closeness and team approach Program cant research initiatives in the field of that does not exist in other places. Every year, about 650 orthopaedic biomechanics. Everything — doctors’ offices, Foundation surgery residents graduate from medical• Kevin Shelburne, Ph.D., Senior Staff offices, the Clinic, rehabilitation facilities, schools. Between 130 and 150 of them Scientist, is one of the Foundation’s most research laboratories — is in one building. seek to continue their higher education productive and published researchers. The Clinic/Foundation connection is our in sports medicine orthopaedics. Last• Erik Giphart, Ph.D., a native of Holland, greatest asset.” year, 163 applications for the Steadman- is developing the dual-plane fluoroscopy The Clinic/Foundation relationship, Hawkins Fellowship Program were system. the low overhead, and the communication received from young surgeons in the that exists among departments allow the United States and abroad. After interviews Foundation a degree of flexibility that and presentations, six were selected to be others cannot duplicate. Decisions regard- Steadman-Hawkins Fellows. “Most — six ing research efforts can be made quickly, out of eight last year — chosen by our and resources can be redirected as new screening committee accept,” says Egan. opportunities develop. [8]
  • “A majority of them have already been DIFFERENCE #7 – The Patients important and have gained internationalpublished by the time they arrive in Some of the world’s greatest athletes acclaim. Among them are the healingVail for their year of clinical practice have come to Steadman-Hawkins Clinic response, surgery and rehabilitation thatand research — all sponsored by the for treatment. They come because their reduces the incidence of scar tissue; “TheFoundation.” agents or team management understand Package” approach to treat arthritis in The fellowship and education pro- that evidence-based sports medicine can the knees; early arthroscopic interventiongrams are coordinated by John Feagin, get their people back into competition of the hip (which may delay or eliminateM.D. Dr. Feagin is another world-class and performing at the highest level. the need for joint replacement); and iden-authority in orthopaedics who has chosen That kind of recognition might give tifying the biochemical factors that trig-to live in Vail. He is an associate professor the mistaken impression that the Clinic is ger arthritis. And most recently, a newemeritus of orthopaedic surgery at Duke just a place where athletes, entertainers, and exciting Foundation innovation is theUniversity and is considered by many to and world leaders come for treatment. use of dual-plane fluoroscopy, whichbe one of the fathers of sports medicine. But the vast majority of patients are not- combines x-rays, high-speed cameras, and More than 160 former Steadman- so-famous everyday citizens. Dr. Steadman sophisticated software to provide amaz-Hawkins fellows practice all over the says that his greatest source of satisfaction ingly accurate and comprehensive viewsworld, and many are on faculties at is making it possible for all of his patients of real-time motion within the shoulder,leading universities such as Harvard, to be as active as they want to be hip and knee joints. This has never beenStanford, and Michigan. Many of them throughout their lives. achieved until now. “The technology isreturn to Vail twice a year to continue How has the research conducted being tested and should be up andtheir education and to share their experi- filtered down to the neighborhood running by the end of the year. We willences with Steadman-Hawkins physicians jogger? “It means that that person, in be synchronizing the system with magneticand researchers. any city worldwide, might have had a resonance imaging for accurate informa- procedure that was developed here and tion about soft tissue, within and sur-DIFFERENCE #6 – Presentations allows him or her to continue exercising,” rounding the joints, during motion,”and Publications answers Egan. says Egan. “We are already the most publishedclinical research institute for sports DIFFERENCE #8 - The Scientific DIFFERENCE #10 – Growing tomedicine in the world,” states Egan. “In Advisory Committee Become the Number One Sports2005 alone, Steadman◆Hawkins Research Thirteen of the world’s preeminent Medicine Research Facility in theFoundation made 175 presentations at scientists make up the Foundation’s Worldscientific meetings. At the American Scientific Advisory Committee (SAC) — There was one more question forAcademy of Orthopaedic Surgeons meet- possibly the most accomplished group of Mike Egan. Where do you want theing in San Diego earlier this year, seven surgeons and scientists ever assembled as Steadman◆Hawkins Research Foundationstudies on hip arthroscopy were accepted an advisory group. Their role is to provide to be in five years? “We want thefor presentation. The Foundation produced scientific guidance to the Foundation, to Foundation to be the number one sportsfive of those seven studies. help give its work direction, and to pro- medicine research facility in the world. The three major medical journals in vide mid-course corrections when needed. The Clinic expects to have 15-20 doctorsorthopaedic sports medicine are the These world-class scientists not only add on board, each specializing in anJournal of Bone and Joint Surgery, the to the ability of the Foundation to make orthopaedic area of expertise, and weAmerican Journal of Sports Medicine, changes when necessary, they also provide will continue to update our state-of-the-and Arthroscopy. The Steadman◆Hawkins ongoing counsel to the Foundation’s art facilities and equipment. Our budgetResearch Foundation tracked its number doctors and researchers. The ultimate goal to support the research efforts of theof publications in these three journals of the SAC is to ensure that the research Foundation is expected to triple. Theduring a recent three-year period and process leads to improved patient care. Foundation’s research will have a dramaticcompared the results to four other top positive impact on the acceptance of hipacademic sports medicine programs. DIFFERENCE #9 – Breakthrough arthroscopy worldwide. The only way toSteadman-Hawkins ranked first in the Procedures achieve these ambitious goals is with thenumber of publications, ahead of Although Dr. Steadman’s innovative continued generous support of the peopleCleveland Clinic, Hospital for Special microfracture technique, validated who have received treatment, benefitedSurgery in New York City, University of through the Foundation’s research, has from Steadman-Hawkins research, or havePittsburgh, and Methodist Sports received the most attention (more than a been made aware of our programs.”Medicine in Indianapolis. million procedures have now been con- ducted worldwide), other new or improved medical procedures are equally [9]
  • Friends of the Foundation [10]
  • In 2006, we received contributions and grants from 800 individuals, foundations and corporations. This combined support, including special events, amounted tomore than $2,950,574. The Steadman◆Hawkins Research Foundation is grateful for this support andto those who have entrusted us with their charitable giving. We are especially pleased to honor the following individuals, foundations,and corporations who have provided this support. Their gifts and partnershipdemonstrate a commitment to keep people active through innovative programsin medical research and education. Without this support, our work could nottake place. Lifetime Giving 1988 SOCIETY On November 9, 1988, the Steadman◆Hawkins Research Foundation was incorporated as anot-for-profit educational and research organization dedicated to advancing modern medical science and the education of young physicians. The Foundation is deeply grateful to the following members of the distinguished 1988 Society, whose cumulative giving totals $1 million or more. Mr. Herb Allen Mr. and Mrs. George N. Gillett, Jr. Vail Valley Medical Center Dr. and Mrs. J. Richard Steadman [11]
  • The Founders’ Legacy SocietyO ver the years, the Steadman◆Hawkins Research Foundation has been privileged to receive generous and thoughtful giftsfrom friends and supporters who remembered the Foundation intheir estate plans. In fact, many of our friends—strong believers HALL OF FAMEand supporters of our work today—want to continue their sup-port after their lifetimes. The Steadman◆Hawkins Research Foundation is grateful to the follow- Through the creation of bequests, charitable trusts and other ing individuals, corporations, and foundations for their support of thecreative gifts that benefit both our donors and the Foundation, Foundation in 2006 at a level of $50,000 or more. Their vision ensuresour supporters have become visible partners with us in our mission the advancement of medical research, science, and care, as well as theto keep people physically active through orthopaedic research education of physicians for the future. We extend our gratitude to theseand education in arthritis, healing, rehabilitation, and injury individuals for their generous support:prevention. To honor and thank these friends, the Founders’ LegacySociety was created to recognize those individuals who have Mr. Herb Allen – Allen & Pepsi Colainvested not only in our tomorrow but also in the health and Company Mr. Alan W. Perkinsvitality of tomorrows generations. Mr. and Mrs. Earl G. Graves Our future in accomplishing great strides—from understand- Smith & Nephew Endoscopying degenerative joint disease, joint biomechanics, and Mr. Kenneth C. Griffin Mr. and Mrs. Stewart Turleyosteoarthritis, to providing education and training programs—is Mr. and Mrs. William H. Harlanensured by the vision and forethought of friends and supporters Vail Valley Medical Centerwho include us in their estate plans. The Foundations planned Stavros S. Niarchos Foundation Mrs. Alice Waltongiving program was established to help donors explore a variety Ossur North Americaof ways to remember the Foundation. We are most grateful to Zimmerthese individuals for their support in becoming founding membersof the Founders Legacy Society: GOLD MEDAL CONTRIBUTORSMr. and Mrs. Robert M. FisherMs. Margo Garms We are grateful to the following individuals, foundations, and corpora-Mr. Albert Hartnagle tions that contributed $20,000-$49,999 to the Foundation in 2006.Mr. and Mrs. John McMurtry Their continued generosity and commitment helps fund research such as enhancing cartilage healing. This potentially innovative treatmentMr. and Mrs. Edward J. Osmers will help preserve the bodys own joints and tissues by leading toMr. Al Perkins improved quality and quantity of “repair” cartilage produced by theMr. Robert E. Repp microfracture technique, a procedure impacting multitudes worldwide. Aetna Foundation Mr. and Mrs. Charles Johnson American Express Mr. and Mrs. John W. Jordan Mr. and Mrs. Harold Anderson Mr. and Mrs. Peter R. Kellogg Mr. and Mrs. Howard Berkowitz Dr. and Mrs. Glen D. Nelson Mr. and Mrs. Michael C. Brooks Dr. and Mrs. Marc Philippon Arie and Ida Crown Memorial Piper Jaffray & Co. Mr. and Mrs. Lawrence Flinn, Jr. Mr. and Mrs. Steve Read Genzyme Biosurgery Mr. and Mrs. Erich Spangenberg Mr. Kim Gustafson Dr. William I. Sterett Mr. Warren Hellman The Liniger Family Foundation Mr. and Mrs. Roy Igersheim US Bank [12]
  • Friends of the Foundation Chairs Support Foundation WorkSILVER MEDAL CONTRIBUTORSSilver Medal donors contribute $5,000-$19,999 annually to the Foundation. Their support makes it pos-sible to fund research to determine the effectiveness of training programs to prevent arthritis, identifythose who are most at risk for arthritis, and provide a basic foundation to improve post-surgical reha-bilitation programs, thus improving the long-term success of surgical procedures. We extend our deepappreciation to these following individuals for their generous support in 2006:Mr. and Mrs. John Alfond Mr. and Mrs. Frank C. Herringer Ms. Alice Ruth andAlpine Bank Mr. and Mrs. Walter Hewlett Mr. Ron AlvarezMr. and Mrs. Paul Baker Mr. and Mrs. David Hoff Mr. and Mrs. Larry W. RuvoMr. and Mrs. Herbert Bank Mr. and Mrs. Philip E. Hoversten Mr. and Mrs. Paul SchmidtMr. and Mrs. Erik Borgen Mr. and Mrs. Charles Huether Mr. and Mrs. Charles SchwabButterfield & Robinson Mr. and Mrs. George H. Hume Mr. Edward ScottDr. and Mrs. R. David Calvo Mr. and Mrs. Walter Hussman Mr. and Mrs. Brad Seaman Mr. and Mrs. O.B. ShelburneChateau Montelena WineryMs. Caryn Clayman Fred and Elli Iselin Foundation Mr. and Mrs. Bill Jensen Steadman-Hawkins Clinic T he education of orthopaedic surgeons is a critically important mission of theDr. and Mrs. Donald S. Mr. and Mrs. J.B. Ladd Steadman-Hawkins Clinic Steadman◆ Hawkins Research Corenman Mr. and Mrs. S. Robert Levine Denver Foundation. Academic Chairs provide the continuity of fund-Mr. Franco D’Agostino and Mr. and Mrs. Kent Logan Steadman◆Hawkins Research ing necessary to train physicians Ms. Alicia Ziegert Mr. and Mrs. Douglas Foundation for the future, thus ensuring the continued advancement ofMr. and Mrs. Gary R. Donahee Mackenzie Dr. and Mrs. J. Richard medical research. Currently,Mr. and Mrs. John Egan Mr. and Mrs. Charles McAdam Steadman more than 160 Steadman- Hawkins Fellows practice aroundMr. J. Michael Egan Mrs. Betsy McCormack Mr. and Mrs. Richard Strong the world. We wish to expressEncore Dr. and Mrs. Peter J. Millett Mr. and Mrs. Vernon Taylor, Jr. our gratitude and appreciation to the following individuals andDr. John A. Feagin and Mrs. Mr. and Mrs. Trygve E. Myhren T-Bird Restaurant Group, Inc. foundations that have made a Marty Head Mr. Edward D. O’Brien Mr. and Mrs. William R. Timken five-year $125,000 commitment to the Fellowship Program toMr. and Mrs. George N. Gillett, Jr. Mr. Paxson H. Offield Vail Resorts support medical research andMr. Thomas J. Gordon Mr. and Mrs. Paul Oreffice Dr. Randy Viola education. In 2006, five chairs provided important funding forMr. and Mrs. Martin D. Gruss The Perot Foundation Mr. Norm Waite and Mrs. the Foundation’s research andHalliburton Foundation, Inc. Practice Performance Jackie Hurlbutt educational mission. We are most grateful for the supportHarlan Estate – Mr. and Mr. and Mrs. Jay A. Precourt Ms. Karen Watkins from the following: Mrs. William Harlan Mr. and Mrs. Felix D. Rappaport Mr. Mark E. Watson, Jr. Mr. and Mrs. Harold AndersonMr. and Mrs. Mitch Hart ReGen Biologics Mr. and Mrs. Patrick Welsh Mr. and Mrs. Lawrence Flinn Mr. and Mrs. Arthur Rock Dr. and Mrs. Wayne Wenzel The Gustafson Foundation Dr. William Rodkey The Williams Family Foundation Mr. and Mrs. Roy Igersheim Mr. and Mrs. Jay Jordan Mr. and Mrs. Peter Kellogg Mr. and Mrs. Steven Read [13]
  • FellowshipBenefactorF ellowship Benefactors fund the research of one Fellowfor one year at a level of BRONZE MEDAL CONTRIBUTORS$10,000. This is a fully tax-deductible contribution that Medical research and education programs are supported by gifts to the Steadman◆Hawkins Researchprovides an opportunity for the Foundation’s annual fund. The Bronze Medal level was created to recognize those patients and their fami-benefactor to participate in a lies, trustees, staff, and foundations who contribute $10 -$4,999 annually to the Foundation. Donors at thisphilanthropic endeavor by not level support many programs, including the Foundation’s research to validate the success of new treatmentsonly making a financial contribu- for degenerative arthritis and identify factors that influence success. We thank the following for their supporttion to the educational and in 2006:research year but also to get toknow the designated Fellow. Anonymous (3) Mr. and Mrs. Gary Biszantz Mr. and Mrs. J. Marc CarpenterEach benefactor is assigned a Ms. Opal D. Abbink Mr. Stephen Black Dr. and Mrs. Dominic CarreiraFellow, who provides written Mr. and Mrs. Don Ackerman Mrs. Elizabeth H. Blackmer Mr. and Mrs. Donald W.reports and updates of his or her Mr. Joseph Adeeb III Dr. and Mrs. Edward Blender Carringtonwork. We extend our gratitude A/E Betteridge Mr. Albert W. Bluemle Ms. Helen S. Carrocciato the following individuals for Mr. and Mrs. Ronald Ager Mr. Fred P. Blume Mr. Dennis E. Carruththeir generous support: Mr. and Mrs. Ricardo A. Aguilar Mr. and Mrs. John A. Boll Mr. Nelson Case Mr. and Mrs. John L. Allen Mr. and Mrs. Edwin Bosworth Caymus VineyardsMr. J. Michael Egan Mr. Jos Althuyzen Dr. and Mrs. Martin Boublik Mr. and Mrs. Pedro CerisolaMr. and Mrs. Mitch Hart Mr. and Mrs. Jack R. Anderson Mr. and Mrs. Ronald Bower Ms. Judith B. ChainThe Fred and Elli Iselin Mr. and Mrs. John Angelo Mr. and Mrs. Robert Bowers Chalk Hill Estate Vineyards Dr. Julie Anthony Dr. Dennis D. Bowman Winery Foundation Ms. Gloria Arnold Bragg/Curtis Industries Mr. Dax ChenevertMr. and Mrs. John W. Jordan Ms. Wendy Arnold Mr. and Mrs. M.A. Bramante Ms. Kay D. ChristensenMr. and Mrs. S. Robert Levine Ms. Adele Arrowsmith Ms. Martha E. Brassel Mr. Kurt ChristiansenMr. and Mrs. Kent Logan Mr. Alfredo Asali Mr. and Mrs. David R. Braun Mr. David J. ChristieMr. Tim McAdam Mr. and Mrs. Paul Asplundh Mr. and Mrs. David R. Mr. and Mrs. Russ CoburnMr. and Mrs. Jay Precourt Mr. Richard J. Badenhausen Brewer, Jr. Mr. Ned C. CochranMr. and Mrs. Stewart Turley Ms. Elizabeth Baker Mr. William Bradford Briggs Mr. and Mrs. Rex A. Coffman Mr. and Mrs. Ronald P. Baker Ms. Dede Brinkman Mr. Bruce R. Cohn Mr. James Bannon Mr. and Mrs. Wendell Brooks Ms. Elizabeth H. Colbert Mr. and Mrs. Bryant P. Barnes Mr. David F. Brown Mr. Matthew Coleman Mr. and Mrs. Seth H. Barsky Mr. and Mrs. Keith L. Brown Coleman Natural Food Mrs. Edith Bass Mr. Michael J. Brown Mr. Michael Coles Mr. and Mrs. Jack Beal Mr. and Mrs. Don Brownson Mr. Richard A. Conn Mr. John J. Beaupre Mr. Robert A. Bruhn Mr. John Connell Mr. and Mrs. Joachim Bechtle Mr. John Bryngelson Mr. and Mrs. John L. Cook Dr. and Mrs. Quinn H. Becker Mr. and Mrs. John L. Mr. Peter Cook and Mr. Fred L. Bell Bucksbaum Ms. Carol S. Reichman Ms. Marge Bellock Mr. Thomas V. Buffett Dr. and Mrs. Kenneth H. Cooper Mr. and Mrs. John H. Bemis Ms. Brenda A. Buglione Mr. Robert Corcoran Mr. and Mrs. Eythor Bender Mr. Kenneth A. Bugosh Cordillera Mr. Brent Berge Ms. Sandra L. Burgess Ms. Patricia A. Cowan Mr. and Mrs. Hans Berglund Mr. Kurt Burghardt Mr. Stephen R. Cowen Mr. and Mrs. Philip M. Bethke Mr. and Mrs. Preston Butcher Mr. Archibald Cox, Jr. Dr. Debra and Mr. Franch Mr. and Mrs. Rodger W. Bybee Mr. and Mrs. Steven C. Coyer Biasca Mr. Tom Caccia Mr. and Mrs. W. Edward Mr. and Mrs. James Billingsley Ms. Julia Cahill Craighead Ms. Joan Birkland Carmichael Training Mr. and Mrs. Richard V. Crisera Mr. Jim M. Birschbach Systems CTS Dr. Dennis Cuendet Mr. and Mrs. Gary Bisbee Cakebread Cellars Mr. Brian D. Culp [14]
  • Friends of the Foundation Special Recognition and Thank YouMr. James J. Curtis Ms. Slavica Esnault-PelterieMr. and Mrs. Paul Daam Mr. and Mrs. Carlos R.Mr. Robert J. Dalessio EspinosaMr. and Mrs. Daniel Dall’Olmo Mr. and Mrs. Raymond R. EssaryMr. and Mrs. Andrew P. Daly Mr. Paul EssermanMr. Walter A. Daniels Mr. and Mrs. Chris EvansMr. Norris Darrell, Jr. Ms. Gretchen EvansMs. Florent C. David Dr. and Mrs. Frederick EwaldMr. and Mrs. Glenn Davis Faegre & BensonMs. Sydney Davis Fair Isaac and Company, Inc.Mr. and Mrs. Peter Dawkins Falling CreekMr. and Mrs. Michael Dee Mr. and Mrs. Lawrence F. FalterMs. Lore Defield Far Niente WineryDel Frisco’s Double Eagle Mr. Chuck Farmer Steak House Mr. Harold B. FedermanMr. and Mrs. Jack A. DePagterMr. and Mrs. Neil P. Dermody Mr. Daniel J. Feeney Ms. Carol M. Ferguson T he Steadman◆Hawkins Research Foundation organizes special fundraising events. Proceeds from these activities support the research and educational programs of theMs. Rhonda DeSantis Mr. and Mrs. Jack Ferguson Foundation. We are indebted and grateful to individualsMr. and Mrs. William G. Dey Mr. Roland Fischer and corporations for supporting our special events.Dr. Willis N. Dickens Julian M. Fitch, Esq. Since 2003, Pepsi Cola has been a proud supporter ofMs. Nancy P. Dominick Mr. and Mrs. Herbert Fitz the Foundation’s efforts to find solutions—through researchMr. John C. Donaldson Mr. and Mrs. Michael F. and education—to help people keep active and mobile byMr. Wayne B. Dondelinger Fitzgerald reducing or eliminating the disability and pain associatedMr. and Mrs. George D. Dooley Mr. Richard P. Fleenor with arthritis and other joint diseases and injuries.Ms. Catherine Douglas Mr. and Mrs. Walter Florimont Earlier in 2006, WestStar and US Bank and theMr. and Mrs. Robert Downey Mr. Dennis Flynn Foundation formed a partnership through common interest and civic duty. Through community fundraisers, WestStar andDr. and Mrs. Jason Dragoo Dr. and Mrs. Joe Fogel US Bank and the Foundation are generating funds for moreMr. and Mrs. Richard B. President and Mrs. Gerald orthopaedic research and development to better the lives of Drescher R. Ford locals in Colorado and beyond.Mrs. Lee Druva Mr. and Mrs. Stephen Fossett Mr. and Mrs. H. William Harlan, founders of HarlanDuke Energy Foundation Mr. Richard L. Foster Estate, have generously supported the Foundation’s special Matching Gifts Program Mr. John M. Fox events as the featured vintners for our Winter WinemakerMr. and Mrs. Jamie Duke Mr. and Mrs. Thomas Francis Evening in February, have donated Meadowood Napa ValleyMr. Jack Durliat Ms. Anita Fray vacation packages for our auctions, and have made a specialMs. June E. Dutton Mr. and Mrs. Edward Frazer gift of an exclusive Napa Valley Reserve membership.Mr. Keith A. Dutton Mr. and Mrs. Olin Friant We also wish to express appreciation to AmericanMr. and Mrs. Jack C. Dysart Mr. and Mrs. Gerald V. Fricke Express, Vail Valley Medical Center, RE/MAX International,Mr. Maurice M. Eaton Mr. William A. Friley and Vail Resorts for sponsorship of the Foundation’s special events.Dr. and Mrs. Jack Eck Mr. and Mrs. Robert F. Fritch This support has played a major role in our ability toMr. and Mrs. Ulf Edborg Mr. and Mrs. Richard Fulstone conduct critical research, develop leading-edge procedures,Ms. Marcy Edelstein Mr. William B. Gail and and document our procedures and findings for the benefitMr. George Edgar Ms. Elke B. Meier of the entire medical community. By making our researchMr. Palmi Einarsson Mr. James H. Galbreath available to physicians worldwide, the Steadman◆HawkinsMr. Burton M. Eisenberg Mr. and Mrs. Paul E. Gaston Research Foundation is helping to change the way patientsMr. and Mrs. Buck Elliott Ms. Susan S. Gawne are treated.Dr. Gail Ellis Ms. Pamela G. GeenenMr. and Mrs. Henry Ellis Mr. Claude GerardMr. Joe Ellis Mr. Egon GersonMr. and Mrs. Heinz Engel Mr. and Mrs. Bradley GhentMs. Patricia A. Erickson Mr. Dennis J. Giannangeli [15]
  • Winter Winemaker Festival Mr. Cameron P. Giebler Mr. Billy G. Harrison Mr. and Mrs. Jack Gillespie Mr. Densmore Hart Mr. and Mrs. Scott T. Gillespie Mr. Kevin A. Hart Mr. and Mrs. Brian Gillette Ms. Nancy A. Hart Mrs. Betty A. Ginsburg Ms. Esther N. Haskins Ms. Nancy Gire Mr. Ivan Hass Mr. and Mrs. Norbert Gits Mrs. Horace Havemeyer, Jr. Mr. and Mrs. Herb Glaser Dr. and Mrs. Richard J. Hawkins Mr. Greg Glover Ms. Elise Hayes Mr. and Mrs. Matthew A. Gobec Mr. and Mrs. William M. Hazard Ms. Julie A. Goldstein Mr. and Mrs. R.W. Hazelett Ms. Lynette Goldstein Mr. and Mrs. David Healy Golf Tec Mr. and Mrs. Peter S. Hearst Ms. Alejandra Gonzalez Ms. Lynne HeilbronVintner William H. Harlan Presents His Highly De Cosio Mr. John Heilmann andAcclaimed Wines at 2006 Winter Wine Festival Ms. Lari Goode Ms. Karmyn Hall Mr. and Mrs. Charles Gordon Ms. Ursula E. HemmerichS aturday, Feb. 25, 2006, marked the third-annual First Light, First Tracks, and Winter Wine Festival, hosted by TheSteadman◆Hawkins Research Foundation. Both events drew Mr. Marshall Gordon Mr. Robert B. Gorham Mr. Buddy Henry Mr. and Mrs. George Henschkecrowds to enjoy wine, food and early skiing to raise money for Mr. John H. Gorman Here to Help of Vail, LLCthe Foundation. Mr. and Mrs. Richard M. Goss Mr. Jorge Herrera The 2006 Winter Wine Festival featured vintner William Ms. Sheila C. Gouterman Mr. Gerald Hertz andHarlan who served three of his highly acclaimed wines: The Napa Mr. Ben D. Graebel Ms. Jessica WaldmanValley Reserve 2000, BOND “St. Eden” 2001, and Harlan Estate Mr. and Mrs. George T. Graff The William and Flora1997. Harlan’s wines were coupled with the fine cuisine of Ms. Jean Graham Hewlett FoundationThomas Salamunovich of Larkspur. Mr. Robert G. Green Mr. and Mrs. Harley G. Food and wine were followed by an auction to raise money Mr. A.W. Griffith Higbie, Jr.to support the Foundation’s research and educational programs. Mr. and Mrs. William M. Ms. Shyla HighAuctioned items included three, three-day vacation packages toMeadowood, a Relais and Chateaux lodging estate in the Napa Griffith, Jr. Mr. and Mrs. Landon Hilliard IIIValley; a Grand Teton Golf retreat; wines from the Wagner Family Mr. Loyal D. Grinker Ms. Nancy J. Hillstrandof Caymus; and more. Mr. and Mrs. Neal C. Groff Mr. and Mrs. John Hire Without the kindness and generosity of those involved in Grouse Mountain Grill Dr. Charles Hothis and other events, the Steadman◆Hawkins Research Ms. Joyce L. Gruenberg Mr. and Mrs. Donald P. HodelFoundation would not be able to provide research and education Ms. Mary Guerri Mr. Clem J. Hohlto fight the effects of arthritis for millions of people worldwide. Mr. and Mrs. Jerry A. Gutierrez Ms. Jane Hood We wish to extend our thanks and appreciation to the fol- Haber Vision, LLC Mr. and Mrs. James H. Hookerlowing individuals for their help in making this a special evening: Dr. Tom Hackett Mr. and Mrs. Paul J. Horvath Dr. and Mrs. Topper Hagerman Mr. and Mrs. Preston HotchkisGrand Teton Lodge Company Mr. Thomas Salamunovich Dr. and Mrs. Ralph Halbert Mr. Donald R. HoukMr. and Mrs. William Harlan Larkspur Restaurant Mr. Charles Halderman Mr. and Mrs. David G. Howard and Harlan Estate Dr. and Mrs. J. Richard Mr. and Mrs. Thomas M. Hallin Howard Head SportsMr. Robert Trent Jones, Jr. Steadman Mr. and Mrs. James R. Medicine CenterMr. and Mrs. Dave Liniger Steadman◆Hawkins Research Halloran Ms. Loretta HubbardMr. and Mrs. Philip Norfleet FoundationMr. and Mrs. Steven Read Joseph Wagner Mr. and Mrs. Curtis J. Mr. Caleb B. HurttMr. and Mrs. Larry Ruvo Caymus Vineyards Hammond Mr. and Mrs. Paul H. HuzzardMr. Jim Salestrom Dr. and Mrs. Gaines Hammond Ms. Mary Ann Hyde Handelsman Family Foundation Ms. Laurie Z. Hyland Harlan Estate Mr. and Mrs. Dunning Idle IV Ms. Pat Harper Mr. and Mrs. Michael Immel [16]
  • Friends of the Foundation Steadman-Hawkins Sanctuary Golf Tournament, August 17Mr. and Mrs. Nathan Ingram Mr. and Mrs. Peter Knoop T he Steadman◆Hawkins Research Foundation was selected by RE/MAX International, a global real estate firm, to hold the third Steadman-Hawkins Golf Classic at the Sanctuary, aAdmiral and Mrs. Bobby Inman Mr. Bob Knous premier golf resort located south of Denver. Proceeds from theInverness Hotel & Ms. Gwyn Gordon Knowlton tournament support the development of new procedures and Conference Center Mr. and Mrs. Walt Koelbel methodology to battle degenerative arthritis. The tournamentDr. and Mrs. Gerald W. Ireland Mr. and Mrs. Rudolf Kopecky was open to the public and included grateful patients and corporate supporters.Dr. and Mrs. Michael D. Iseman Mr. Paul R. Krausch The Foundation thanks Dave and Gail Liniger, owners andITW-Illinois Tool Works Mr. and Mrs. Kenton M. co-founders of RE/MAX International, who created this unique Foundation Krohlow opportunity for the Foundation to develop and enhanceMs. Lorraine M. Jackson Mr. and Mrs. Bob Krohn relationships with those who support our mission. In addition,Mr. and Mrs. Arnold Jaeger Mr. Albert J. Kullas we wish to express our sincere appreciation to the followingMs. Mary H. Jaffe Mr. James Kurtz sponsors and participants:Mr. and Mrs. John V. Jaggers La Tour RestaurantMr. and Mrs. Terry J. Jameson Mr. John LaithwaiteMs. Marian P. Jansen Mr. George Lamb Presenting Sponsors Toby DawsonMr. Lawrence F. Jelsma Mr. and Mrs. Richard D. Pepsi Cola North America Chuck FarmerDr. and Mrs. Ole T. Jensen Landsberger RE/MAX International Walter HussmanCol. and Mrs. John Jeter, Jr. Mr. and Mrs. Frederick C. Lane John Feagin, M.D.Ms. Floann Jett Mr. and Mrs. C. John Gold Sponsors Tim and Alison McAdam American Express Peter Millett, M.D.Mr. and Mrs. Calvin R. Johnson Langley, Jr. Vail Valley Medical Center Myren Media, Inc.Mr. Dan C. Johnson Larkspur Marc Philippon, M.D.Ms. Kim Johnson Ms. Courtney D. Larsen Silver Sponsors Practice Performance, Inc.Ms. Marilyn Johnson Mrs. Madeleine Larson Encore Medical Ed ScottMr. and Mrs. Howard J. Mr. Chester A. Latcham Innovation Sports Stryker Imaging Johnston Mr. and Mrs. Steve Lawson ReGen Biologics Steadman-Hawkins ClinicMr. and Mrs. Boland Jones Mr. and Mrs. Joseph E. Lebeau DenverMr. Charles A. Jones Ms. Dorthy M. Lecker Bronze Sponsors J. Richard Steadman, M.D.Mr. and Mrs. Daniel S. Jones Mr. John E. Leipprandt Arkansas Democratic-Gazette William I. Sterett, M.D.Ms. Danielle V. Jones Mr. and Mrs. Arnold T. Levine Booth Creek Management T-Bird Restaurant Group, Inc. –Mr. John G. Jones Mr. Burton Levy Corp. Outback SteakhouseMr. and Mrs. Robert T. Jones Mr. and Mrs. John Lichtenegger Colorado Orthopedic Stew Turley Imaging/MMI Norm WaiteMr. and Mrs. Darrell L. Jordan Ms. Wendy S. LiggittMr. and Mrs. Jack Joseph Mr. and Mrs. Soren LindFriends at United Way Eagle Mr. and Mrs. James H. Lindell River Valley Ms. Nancy LipskyMr. and Mrs. John Judkins, Jr. Ms. Linda LitchiMr. and Mrs. Kevin Kaczka Ms. Frances L. LloydDr. David Karli Dr. and Mrs. James W. LloydMs. Beth Kasser Mr. and Mrs. Edward D. LongMr. and Mrs. James M. Mr. and Mrs. Ian Long Kaufman Mr. Bernard B. LopezMs. Susan Kaye Ms. Eileen LordahlMr. and Mrs. Raymond Kelley Judge Michele F. LowranceMr. Michael Kelm Mr. and Mrs. Edward F. LukesMr. and Mrs. Jack Kemp Mr. and Mrs. William LurtzMs. Mary Ann Kempf Mr. and Mrs. Frank J. LynchMr. Thomas Kimmeth and Mr. and Mrs. Gerard Lynch Ms. Patricia Gorman Mr. and Mrs. Peter S.Mr. and Mrs. Skip Kinsley, Jr. MackechnieMs. Joanne P. Kleinstein Mr. and Mrs. John MacLean [17]
  • Foundation Celebrates ColoradoEvening, Presented by WestStar andUS Bank. Mr. and Mrs. John Madden III Dr. James Montgomery Mr. Timothy Mague Mr. Taylor Moorehead Mr. and Mrs. James Mahaffey Mr. and Mrs. Jim Moran Mr. Kevin P. Mahaney Mr. and Mrs. Bryan A. Morison Mr. and Mrs. John Maher Mr. and Mrs. Jean-Claude Mr. and Mrs. Jay Mahoney Moritz Mr. and Mrs. Douglas M. Main Ms. Myrna J. Morrison Mr. Paul S. Majewski Dr. and Mrs. Van C. Mow Ms. Sylvia Malinski Ms. Amy E. Mower Ms. Brigid Mander Ms. Jane Muhrcke Ms. Paulette Marcus Mr. Daniel Murillo Ms. Adrienne K. Marks Mr. and Mrs. WilliamT he Steadman◆Hawkins Research Foundation’s orthopaedic research and education programs were the beneficiaries ofthe Colorado Evening, as the Vail Valley’s finest restaurants paired Ms. Lois O. Marmont Mr. and Mrs. Mike Marsh Murphy, Jr. Mr. and Mrs. Ronald R. Myerstheir culinary wares with award-winning vintner BR Cohn to create Mr. David C. Martens Mr. and Mrs. James Nadona culinary extravaganza at Falling Creek restaurant in the Vail Mr. and Mrs. Ronald Martin Dr. and Mrs. R. Deva NathanValley. Ms. Alicia Martinez Mr. Scott C. Naylor We wish to express our sincere appreciation to the following Mr. and Mrs. Rocco J. Martino Mr. and Mrs. Robert Nealsponsors and participants: Matanzas Creek Winery Ms. Barbara A. NelsonPresenting Sponsor Country Club of the Rockies Matsuhisa Mr. and Mrs. Bruce NelsonWestStar and US Bank Mr. and Mrs. John Egan Mr. and Mrs. Grant Maw Ms. Cindy Nelson Ms. Chris Evert Ms. Carol L. May Ms. Janet NelsonWinemaker Far Niente Winery Mr. and Mrs. John McBride Ms. Wendy M. Nelson andBR Cohn Del Frisco’s Mr. Colin A. McCabe Ms. Daisy MitchellBruce Cohn The George N. Gillett Jr. Family Mr. Donald S. McCluskey Dr. Todd Neugent Golden Bear Mr. and Mrs. William H. Mr. Philip A. NewberryRestaurants and Chefs Golf-Tec McElnea, Jr. Ms. Catherine NolanFalling Creek Incredible Adventures, Inc. Mr. and Mrs. John W. McGee Dr. and Mrs. Thomas Noonan Chris Randall, Darrell Jensen Inverness Hotel and Mr. and Mrs. Arch McGill Mr. Jeffrey L. NormanGrouse Mountain Grill Conference Center Mr. and Mrs. James M. Mr. Robert Norris Ted Schneider Mr. Jack Kemp McKenzie Mr. and Mrs. Daniel J.La Tour Restaurant Larkspur Restaurant Paul Ferzacca Mr. and Mrs. Dave Liniger Mr. and Mrs. Calvin McLachlan O’DowdLarkspur Mantanzas Creek Winery Mr. and Mrs. John McMurtry Mr. and Mrs. Ronald Oehl Thomas Salamunovich Matsuhisa Mr. and Mrs. Jose R. Medina Mr. Robert OlsenSplendido at the Chateau Mountain Spirits Travel Mr. and Mrs. Frank N. Mehling Ms. Sarah G. Olsen David Wolford Andy Mill Mr. and Mrs. Enver Mr. Thomas A. OlsenTerra Bistro Restaurant Chateau Montelena Mehmedbasich Mr. and Mrs. John Oltman Kevin Nelson Dr. Tom Noonan Mr. and Mrs. Eugene Mercy, Jr. Mr. Larry O’ReillyThe Wildflower Pepsi Cola Mr. and Mrs. George Middlemas Ortho Rehab Rainer Scharz, Daniel Spurlock Red Sky Ranch & Golf Club Mr. Andy Mill and Mr. Tom O’Shane Ritz Carlton Ms. Chris Evert Mr. and Mrs. Peter H.Auction Donors Mr. William Schneiderman General George Miller OstermanAE Betteridge Fine Jewelry Silver Oak Cellars Mr. Jay D. Miller Mr. John OsterweisBR Cohn Winery St. Regis ResortBragg/Curtis Industries Spiegelau U.S.A. Mr. Michael P. Miller Mr. and Mrs. Ivan OwenButterfield & Robinson Dr. and Mrs. J. Richard Mr. and Mrs. James Millett Mr. and Mrs. Robert M. OwensCarmichael Training Systems Steadman Mr. and Mrs. Peter Mocklin Ms. Barbara K. PalmerCakebread Cellars Telluride Ski Resort Mr. and Mrs. Chandler J. Ms. DiAnn PappChalk Hill Estate Vineyards & Mr. and Mrs. Stew Turley Moisen Mr. and Mrs. Preston Parish Winery Vail Resorts Mr. and Mrs. Robert Mondavi Ms. Carol S. ParksColeman Natural Foods Mr. and Mrs. Steve Wynn Ms. Velma L. Monks Mr. and Mrs. Wayne PaulsonCordillera [18]
  • Friends of the Foundation The Beaver Creek Snowshoe Adventure Series, Presented by Pepsi-ColaMr. Richard Pearlstone Mr. Michael Rootberg Mr. Jeffry S. ShinnMr. and Mrs. William D. PeitzMr. and Mrs. William Perlitz Mr. and Mrs. Michael Rose Mr. Philip Rothblum Mr. and Mrs. James Shpall Mr. Rupe Sidhu T his family-oriented snowshoe event attracts everyone from the first-time snowshoer to theMr. and Mrs. Robert J. Peters Mr. and Mrs. Gary L. Roubos Mr. and Mrs. Mark C. Siefert world’s premier snowshoe ath-Ms. Virginia Pfeiffer Mr. and Mrs. Stanley Mr. and Mrs. Ronnie Silverstein letes. The series is the largest ofPfizer Foundation Matching Rumbough, Jr. Ms. Viki L. Simmons its kind in North America and con- Gifts Program Mr. Robert W. Rust Mr. and Mrs. John Simon sisted of three events throughoutMr. John B. Phillips Ms. Thelma Ruz Dr. Janice Simpson the 2006-07 winter season —Dr. and Mrs. Michael Pietrzak Mr. Chris Ryman and Dr. and Mrs. Steve B. Singleton December 10, 2006; January 7,Mr. David J. Pina and Ms. Nicole Haugland Mr. Joseph H. Sissom 2007; and February 11, 2007. The Ms. Tracy Reilly Mr. Frank C. Sabatini Ms. Damaris Skouras adventure series features 5- andMr. and Mrs. Addison Piper Mr. Herbert E. Sackett Mr. and Mrs. William Slifer 10-K races, walks and runs, slope-Dr. and Mrs. Kevin D. Plancher Ms. Jolanthe Saks Mr. Edmond W. Smathers side sponsor expos, and post-eventMr. Ronald J. Pollack Dr. Henry Salama Ms. Ann B. Smead and plaza parties.Mr. and Mrs. Eric Pollock Sanctuary Mr. Michael Byram Since 2003, Pepsi Cola has been an active supporter of theDr. Robert H. Potts, Jr. Mr. Thomas C. Sando Mr. and Mrs. Bryan D. Smith Foundation’s special efforts to findMr. and Mrs. Graham Powers Ms. Francesanna T. Sargent Mr. and Mrs. James S. Smith solutions — through research andMs. Heidi Preuss Mr. Tom Saunders The Patricia M. & education — to help people keepMr. and Mrs. Paul E. Price Ms. Mary D. Sauve H. William Smith, Jr. Fund active and mobile by reducing orMr. James A. Progin and Mr. Richard W. Scales Mr. and Mrs. John eliminating the disability and pain Ms. Judy Holmes Mr. William D. Schaeffer Sondericker associated with arthritis and otherMr. and Mrs. Matthew H. Ms. Claire E. Schafer Mr. Ryan H. Sontag joint diseases and injuries. Prowse Mr. and Mrs. Richard Schatten Mr. and Mrs. Ricardo A. Souto The North AmericanMs. Susan H. Prowse Mr. Craig Schiffer Mr. James L. Spann Snowshoe Championships, theMr. and Mrs. W. James Prowse Dr. and Mrs. Theodore Spiegelau USA final event in the Series, wraps upMr. and Mrs. Brad Quayle Schlegel The Spiritus Gladius the season with the highest pro-Mr. John Quinlan Mr. Alden Schmidt Foundation file event in the sport.Mr. and Mrs. Merrill L. Quivey Dr. David Schneider Splendido at the ChateauMr. and Mrs. John Radisi Mr. and Mrs. Keith Schneider Mr. and Mrs. Richard StamppMr. and Mrs. David Raff Mr. William Schneiderman Mr. and Mrs. Stephen M.Mr. and Mrs. David Rahn Mr. Emil R. Schnell StayMr. and Mrs. Robert Rakich Mr. Harold Schoenhaar Mr. and Mrs. Lyon SteadmanMr. and Mrs. Napolean Ramos Dr. Clarence Schoenvogel Ms. Mary SteadmanMs. Anne D. Reed Mr. and Mrs. Tom Schouten Ms. Andra SteinMr. Walter G. Regal Mr. and Mrs. Jack E. Schuss Ms. Katherine B. SteinbergMs. Mary K. Reihel Mr. Gerald Schwalbach Ms. Deana E. StemplerMs. Ann Repetti Mr. Mark J. Schwartz Mr. and Mrs. Jeffrey M. SternMr. and Mrs. Greg Repetti Ms. Anne M. Schwerdt Mr. Jack StievelmanMs. Jean Richmond and Mr. and Mrs. Bob Seeman Ms. Mary Stitgen Mr. Horst Essl Mr. and Mrs. Gordon I. Segal Dr. David StollerMr. and Mrs. Donald Riefler Mr. Tim W. Semrau Mr. Hans StorrMr. and Mrs. Ronald Riley Mr. and Mrs. J.M. Sessions III Dr. John A. StracheMr. Huey A. Roberts Mr. O. Griffith Sexton Ms. Gladys StrahlMr. and Mrs. Wayne A. Robins Mr. and Mrs. John H. Shanker Mr. and Mrs. Albert I. StrauchDr. and Mrs. Juan J. Rodrigo Mr. Loren E. Shannon Mr. and Mrs. B.A. StreetMr. David W. Roeder Ms. Mary Ellen Sheridan Mr. and Mrs. Larry StruttonMr. and Mrs. R.J. Rogers Mr. and Mrs. Warren Sheridan Mr. and Mrs. Hjalmar S. SundinMr. Daniel G. Roig Mr. and Mrs. James H. Shermis Mr. Gary A. SymanDr. Richard R. Rollins Mr. Jesse S. Shinagle Mr. and Mrs. Mark Tache [19]
  • Friends of the FoundationAetna Foundation Funds Hall ofChampionsA s patients step out of the elevator on the third floor of the Vail Valley Medical Center, they walk down a long hallwaythat leads to the Steadman-Hawkins Clinic. Photos, posters, and Mr. and Mrs. Dominick A. Mr. and Mrs. Arthur W. Vietzejerseys of famous patients hang on the walls leading to the Clinicreception area. Inspired by Foundation Trustee Earl G. Graves, the Taddonio Ms. Sandra VinnikAetna Hall of Champions, will display memorabilia of famous Clinic Mr. and Mrs. Oscar L. Tang Mr. and Mrs. David S. Vogelspatients who have benefited from the research of the Foundation. Mr. Donald G. Targan Ms. Beatrice B. Von GontardMr. Graves presented a proposal to Aetna that resulted in the Mr. Gerald Taylor Mr. and Mrs. R. Randall$200,000 grant to fund the Aetna Hall of Champions. The hallway Mr. Barry Teeters Vosbeckwill be completed by the fall of 2007. Telluride Ski Resort Mr. and Mrs. Randall O. Voss Mr. Tim Tenney Mr. and Mrs. Matthew V.NFL Charities Awards $125,000 Grant Terra Bistro Restaurant Waidelichfor Orthopaedic Shoulder Research The Wildflower Ms. Susan K. Walters Mr. Armand Thomas Ms. Anne N. Walther For the 13th year, NFL Charities, the charitable foundation ofthe National Football League, has awarded a substantial research Mr. and Mrs. David Thomas III Mr. Hugh Waltongrant to the Steadman◆Hawkins Research Foundation for new and Mr. Derek Thomas Mr. and Mrs. Jerry B. Wardcontinuing work on the causes, treatments, and prevention of Mr. and Mrs. E.A. Thomas Mr. and Mrs. William C. Wardshoulder injuries. Mr. John R. Thomas Mr. Jim Warren The research project, Understanding Three-Dimensional Motion Mr. and Mrs. Robert E. Mr. and Mrs. William R. Weaverof the Shoulder Complex, will provide the scientific knowledge to Thompson Ms. Valerie Weberdevelop more effective approaches to shoulder rehabilitation andstrengthening. The new information will offer significant change in Mr. and Mrs. Alexander Dr. and Mrs. George Weileppthe health care provided to the shoulder patient, allowing for better Thomson III Ms. Betty Weissoutcomes, as well as increasing quality of life in these patients. Mr. and Mrs. J. Daniel Tibbitts Mr. and Mrs. Lawrence Weiss Support from the NFL Charities is vital to the Foundation’s Mr. and Mrs. Roger Tilkemeier Mr. John Welaj andoverall shoulder research program. This motion data is very impor- Mr. and Mrs. Richard W. Mrs. Gina Jelacictant, and numerous research centers around the world are anxiously Tinberg Mr. and Mrs. Kenneth Werthawaiting the results. The data will be instrumental in helpingadvance and validate the Foundation’s computer model of the Mr. James R. Tising and Mr. John A. Whiteshoulder. “This validation process is no small task, as it is computa- Ms. Dianne Lee Mr. and Mrs. George Wiegerstionally very tedious. I have no doubt that this model will revolu- Mr. and Mrs. John C. Tlapek Mr. and Mrs. Joel A. Wissingtionize our basic understanding of how the shoulder really moves, Mr. and Mrs. Brett Tolly Mr. and Mrs. Michaeland what muscles and ligaments are involved,” stated Dr. Michael R. Mr. Stephen A. Tonozzi WodlingerTorry, director of the Biomechanics Research Laboratory. Dr. and Mrs. Mike Torry Mr. Willard E. Woldt The principal investigators are Dr. Torry; Kevin Shelburne, Ph.D.;assistant director Marcus Pandy, Ph.D., University of Melbourne, Mr. Vinnie Tracey Mr. and Mrs. George WombwellAustralia; and staff scientists Takashi Yanagawa, M.A.; and Erik Mr. and Mrs. Mark Train Dr. and Mrs. Savio L.Y. WooGiphart, Ph.D. Trellis Health Ventures and Ms. Linda D. Woodcock NFL Charities is the cornerstone of the National Football THV Management LLC Mr. and Mrs. Alan WorkmanLeagues commitment to community service. It awards sports-related Mr. and Mrs. Otto Tschudi Mr. Oliver Wuff andmedical research grants that advance the body of knowledge of Mr. and Mrs. Rudolph L. Tulipani Ms. Monika Kammelsports medicine for professional and recreational athletes. Mr. and Mrs. James Z. Turner Mr. and Mrs. Steve A. Wynn Mr. and Mrs. Harry D. Turvey Mr. and Mrs. Robert W. Yank Ms. Carroll Tyler Ms. Juli Young Mr. and Mrs. James D. Tyner Ms. Laura J. Youngwerth Mr. Robert M. Umbreit Mr. and Mrs. Jack Zerobnick Dr. and Mrs. Luis H. Urrea Vail Resorts Mr. and Mrs. Leo A. Vecellio, Jr. Mr. and Mrs. James F. Vessels [20]
  • Adele Igersheim: The Knee, The Package, and The GiftBy Jim Brown, Ph.D.S ix years ago, Adele Igersheim was The Package moving full speed ahead — a living “Dr. Steadman said myblueprint for the busy, talented, successful doctors had done what need-American woman. Born, raised, and ed to be done, but that heeducated in Pennsylvania, she graduated thought we could go furtherfrom the University of Pittsburgh, where and give me better mobilityshe met her future husband Roy on a and less pain,” recallsblind date. Now married 37 years, they Adele. “He had developedraised three sons, a telecommunications a technique that was beingexecutive (Daniel) in Virginia, a marine performed only at Steadman-biologist (Brian) in Hawaii, and the Hawkins or by Steadman◆youngest trader (Kevin) at the Chicago Hawkins ResearchBoard of Trade. Roy founded Foundation Fellows aroundManagement Systems Services, an infor- the world.” What Adelemation technology company based in didn’t know was that Dr.Rockville, Maryland. Steadman’s procedure was Roy and Adele Igersheim share a toast during their travels in Along the way, Adele earned a mas- gaining international recog- Eastern Europe.ter’s degree in English, became a profes- nition as “The Package,” andsor of composition and rhetoric, and she was about to receive it. The Gifttaught at the University of Maryland and The Package is a series of arthroscopic During her office visits in Vail, AdeleMontgomery College. In 1985, she found- procedures conducted during one opera- began reading the Steadman◆Hawkinsed her own company, Writers’ Bloc tion. In Adele’s case, the first was chon- Research Foundation’s newsletters. “It wasConsultants, Ltd., which specializes in droplasty, in which a motorized shaving interesting to learn about the researchbusiness and technical writing, and pro- device smoothed out irregular joint sur- being funded and conducted by thevides training, editing, and consulting faces. The second, called lysis of adhesions, Foundation. Much of what was done onservices to help clients “unblock” business removed scar tissue while minimizing my knee was a direct result of thatcommunications. bleeding. Two down, two to go. The third research.” part of The Package was a meniscectomy. She suggested to her husband thatThe Knee Dr. Steadman removed what was left of they find a way to support the Founda- In 1998, Adele was bumped off her her torn meniscus. The final procedure tion. Philanthropy is not a new idea forpersonal fast track. During a trip to Vail was a synovectomy—removal of inflamed the Igersheims. Their family foundationshe fell during a skiing lesson, injured her tissue that lined the joint of her arthritic has provided computers to a nonprofitleft knee, and not surprisingly, got right knee. organization in Maryland and an ambu-up and continued skiing. Back in “I had surgery in the morning and lance, a playground, and a greenhouse—Maryland, however, she knew something at 2:00 p.m. someone was in my room all in Israel. Helping the people of Newwas wrong. The pain in her knee wasn’t and manipulating my leg,” says Adele. Orleans rebuild after Katrina is on theirgoing away and her mobility was limited. “At 8:00 the next morning I was down- short list of potential projects.A torn meniscus was the problem, and stairs in physical therapy. They didn’t give Adele and Roy decided to fund onesurgery to remove part of the shock- my knee one minute to try to form scar of the six Steadman-Hawkins Fellows for aabsorbing structure was supposed to be tissue. In my previous two surgeries back year. Fellows spend a year refining skillsthe solution. It wasn’t. There was more East there had been as much as a week and learning new surgical techniques,pain, even less mobility, buckling of her before therapy had begun.” She also and they participate in research withknee, and eventually, a full-blown case of noticed that the focus of her post-op Foundation scientists. “We liked the ideaosteoarthritis—not an unusual develop- exercises seemed to be more on mobility of supporting a Fellow who will bement following many cases of knee sur- than on strength training. trained in Steadman-Hawkins methodsgery. Solution #2: another knee operation. Less than a year later, Adele is back and who can take his or her skills to othersIt helped the buckling problem, but not on track. She is more “pain-free.” No around the world who have knee andthe mobility, and she had extensive scar more buckling. She walks, stretches, and arthritis problems like mine. We will gotissue as well as more advanced exercises regularly. To say she is more to Vail in August and meet the Fellow weosteoarthritis. mobile is an understatement. In May, she are sponsoring, and he will stay in touch During a physical therapy session, added Eastern Europe to a travel itinerary with us during his stay at Steadman-her personal trainer said, “The next time that, in past years, has included Australia, Hawkins.”you go to Vail, you ought to see a doctor New Zealand, Peru, the Galapagos Islands, Adele Igersheim has a message fornamed Richard Steadman at the Turkey, Greece, and points in the American others who might read her story. “TheSteadman-Hawkins Clinic. He’s the ‘big West. “I don’t plan on skiing downhill Steadman◆Hawkins Research Foundationguru’ (his words, not hers) on knee prob- anymore, but I’ll snowshoe or ski cross- is doing wonderful research and theylems.” Adele took that advice, scheduled country.” are putting it to use. By supporting thean appointment, and went back to Foundation, all of us may someday enjoyColorado in the summer of 2005. a lifestyle as active as we would like it to be.” [21]
  • Corporate and Institutional FriendsCorporate support helps fund the Steadman◆Hawkins Research Foundation’sResearch and Education Programs in Vail, Colorado, and at six University sites. TheFoundation is grateful for the generous support of our corporate donors. In 2006,we received $834,500 in corporate support. This work will benefit patients andphysicians for generations to come.• American Express• Arthrex• EBI Medical Systems• Genzyme• Össur• Piper Jaffray & Co.• Pepsi Cola• RE/MAX International• Smith & Nephew Endoscopy• US Bank• Vail Resorts, Inc.• Vail Valley Medical Center• Zimmer [22]
  • Bracing Research: Steadman◆Hawkins Research Foundationand Össur Team Up Plus: If 15,000 Knees Could TalkC ommon objectives and a shared successful within the orthopaedic world, is partnering with health practitioners like vision make the Steadman◆Hawkins that the terms “unloader” and “unload- Steadman-Hawkins, which uses our prod-Research Foundation and Össur a natural ing” have become common, widely used ucts to deliver successful clinical outcomesmatch. Össur — a leader in the develop- terms for bracing technology. to patients,” says Einarsson.ment and marketing of bracing, support And there are plenty of patients.products, and prosthetics — acquired A New Brace for Knee Knee osteoarthritis is the most commonlong-time Foundation sponsor, Innovation Osteoarthritis form of arthritis and one of the mostSports, in 2006. Now the parent company Unloaders work by separating the prevalent chronic health problems in thehas demonstrated genuine enthusiasm knee bones when the cartilage or liga- U.S. today. That’s not going to improvefor continuing and expanding that rela- ments are damaged. They also effectively any time soon as baby boomers reach thetionship by supporting our research and prevent further joint deterioration and “arthritis years.” More active for longereducation programs. make it possible for knee osteoarthritis than any previous generation, they are Palmi Einarsson, vice president of sufferers to remain physically active. also more prone to arthritis and sportsresearch and development for Össur Össur’s forward-thinking designs injury.Americas, agrees. “Ossur is dedicated resulted in Össur being recognized as ato helping people live a life without 2006 World Economic Forum Technology What Can 15,000 Knees Tell Us?limitations, and the Steadman◆Hawkins Pioneer. The company also has garnered The Foundation is utilizing its data-Research Foundation has a mission to numerous awards, including Time’s base of 15,000 past and present kneeprovide physically active individuals with “Coolest Inventions of the Year,” patients to undertake an ongoing clinicalinformation and care that can improve Fortune’s “25 Best Products of the Year,” study to determine whether unloadertheir overall quality of life. It’s a good fit.” and Popular Science’s “Best of What’s bracing can delay total knee replacement, Headquartered in Reykjavik, Iceland, New” two years running, as well as Frost as well as the effects of bracing on short-and with operations throughout the & Sullivan’s number one ranking in the and long-term pain management forworld, Össur has developed more scientif- Medical Devices Technology Innovation these knee osteoarthritis sufferers. Thisically advanced innovations in recent category for both 2005 and 2006. Össur’s means that the types of solutions that theyears than any other company in its field. products have been featured and highly Steadman◆Hawkins Research FoundationThe Unloader One knee brace for sufferers praised on CBS Evening News, and in the and Össur are researching are going toof knee osteoarthritis and related prob- New York Times and The Wall Street dramatically affect how engaged peoplelems is one such example. Össur’s Journal, just in the latter half of 2006. are in living full, active, and pain-freeUnloader brand name has been so While awards and accolades are lives into the future. undoubtedly gratifying, “What drives us [23]
  • The Year inResearch & Education [24]
  • The Year in Research and EducationBasic Science ResearchWilliam G. Rodkey, D.V.M., Director Traumatic injury to joints is also oftenT he purpose of our Basic Science Research is to gain a better understanding of factors which leadto: (1) degenerative joint disease; (2) osteoarthritis; associated with acute damage to the articular cartilage. Unfortunately, hya- line articular (joint) cartilage is a tissue(3) improved healing of soft tissues such as ligaments, with very poor healing or regenerativetendons, articular cartilage, and meniscus cartilage; potential. Once damaged, articular carti- lage typically does not heal, or it mayand (4) novel and untried approaches of treatment heal with functionless fibrous tissue.modalities. Our focus is to develop new surgical Such tissue does not possess the biome-techniques, innovative adjunct therapies, rehabilitative chanical and biochemical properties oftreatments, and related programs that will help delay, the original hyaline cartilage; hence, the William G. Rodkey, D.V.M. integrity of the articular surface andminimize, or prevent the development of degenerative normal joint function are compromised.joint disease. In 2006, we collaborated with various The result is often OA.educational institutions, predominantly Colorado The importance and the global impact of OA must not be under-State University and Michigan State University. We estimated. The U.S. Centers for Disease Control estimates that in the next 25 years at least 71 million Americans (15 percent to 20 percentbelieve that our combined efforts will lead directly to of the population) will have arthritis, including degenerative arthritisslowing the degenerative processes, as well as finding secondary to injury to the articular cartilage surfaces of the joints.new ways to enhance healing and regeneration of Osteoarthritis is the most significant cause of disability in the Unitedinjured tissues. States and Canada, moving ahead of low back pain and heart disease. By the year 2020, more than 60 million Americans and six million The relatively new area of regenerative medicine is an exciting Canadians will be affected by some degree of osteoarthritis of just theone that has gained global attention. There are many new and inno- knee. OA of other joints will raise this number significantly. The eco-vative techniques under investigation by scientists around the world. nomic impact is enormous. Osteoarthritis alone will consume moreOne of the broad goals of this work can be stated simply as joint than $85 billion of direct and indirect costs to the American public inpreservation. In 2006 we focused our efforts almost exclusively on 2007. The intangibles of this terrible disease include the chronicregeneration of an improved tissue for resurfacing of articular cartilage pain, disability, and psychological distress on the individual plus the(chondral) defects that typically lead to degenerative osteoarthritis. family unit. We believe that our research can have far-We have been working in the promising area of gene therapy in col- reaching effects by greatly enhancing the resurfacing of damaged orlaboration with Drs. Wayne McIlwraith and David Frisbie at Colorado arthritic joints before the disease process reaches the advanced andState University. We have now completed our initial studies, and we debilitating state.have enough important data to take this project to the next level. Several of our earlier studies have shown that a technique,In 2006 we also published an extremely important manuscript that arthroscopic subchondral bone plate microfracture, is a successfulexamined the effects of leaving or removing a certain layer of tissue method to promote adequate cartilage healing. “Microfracture”during lesion preparation for microfracture. This manuscript consists of making small perforations in the bone plate using a bonewill help guide surgeons and should improve outcomes of microfrac- awl to access the cells and the growth factors present in the underly-ture performed by surgeons worldwide. We also completed data ing bone marrow. The technique relies on the body’s own cells andcollection of a study involving electrostimulation to enhance healing proteins present in the marrow to promote healing, thuscartilage healing. avoiding concerns of immune reactions to transplanted tissues or the The following provides some background information and a need for a second surgery to collect grafts or cells. When we evaluatedsummary of our most recent findings. This work is ongoing, and the the healing of full-thickness chondral defects in exercised horses, weencouraging results presented here will allow us to continue to focus were able to show that the use of microfracture increases the amounton this work in the coming years. of repair tissue present in the defect and improved the quality of Osteoarthritis (OA) is a debilitating, progressive disease charac- cartilage repair by increasing the amount of type II collagen (foundterized by the deterioration of articular cartilage accompanied by in normal joint cartilage) present in that repair tissue. Althoughchanges in the subchondral bone and soft tissues of the joint. microfracture was able to increase the major building block of artic- [25]
  • The Year in Research and Educationular cartilage tissue, it did not enhance the production of the other identical but non-functional unit was placed on the opposite leg (con-major components of cartilage thought to be necessary for long-term trol) (Figure 2). All outcome parameters were evaluated with thejoint health. Additionally, as we have previously reported, we have observer blinded (unaware) to the treatments. There were no sub-found that the mechanical aspect of removing a deep layer of the stantial abnormalities or adverse events to report throughout thecartilage, called the calcified cartilage layer, is critical for optimal study. Results of this study in general showed that stimulated limbsformation of repair tissue and healing to the subchondral bone. Our had a significantly greater gait abnormality and response to flexionwork in horses also helped us confirm and refine the rehabilitation throughout the study period. When the distribution of type II colla-program for patients undergoing microfracture. gen (the main component of normal articular cartilage) was assessed With respect to our work on the calcified cartilage layer, we in the repair tissue, a significantly wider distribution was seen in non-had observed that leaving calcified cartilage inhibits the tissue healing stimulated (control) compared to stimulated (treated) limbs. Noand repair response after microfracture. Therefore, we hypothesized other significant differences were noted in any of thethat removal of the calcified cartilage and retaining the underlying comparisons which included musculoskeletal, radiographic, gross,bone would enhance the amount of attachment of the repair tissue biochemical, histological, and immunohistologic outcome parame-compared to retention of the calcified cartilage layer. We confirmed ters. Based on an increase in postoperative gait abnormality andour hypothesis, and these findings were published in the prestigious response to flexion, we feel that this treatment, in its presentAmerican Journal of Sports Medicine in 2006. form, cannot be recommended for early postoperative cartilage A new area of research that has attracted our attention involves resurfacing rehabilitation.use of electrostimulation to speed or enhance healing of cartilage Our laboratory model work on the ACL “healing response” isdefects in conjunction with microfracture. There have been some now complete. This information will help other orthopaedic surgeonsreports in the literature that electrostimulation may help relieve pain gain confidence with the healing response procedure, making themin joints with advanced degenerative osteoarthritis. However, no studies more likely to perform it. In so doing, fewer patients will requirehave been reported that evaluate any potential benefits of electrostim- the expense, time, inconvenience, and discomfort of a formal ACLulation used in treatment of acute cartilage injuries or in conjunction reconstruction. Additionally, other patients unwilling to have ACLwith early rehabilitation after resurfacing procedures such as reconstruction can be offered an alternative with much less morbidity.microfracture. Therefore, we collaborated with investigators at Interestingly, this study has raised some additional questions that weColorado State University and used our well-established cartilage believe can be answered, at least in part, with additional laboratoryhealing model to study this potential healing enhancement technique. studies. We will collaborate with other investigators and use an animalEight horses were entered into the study. Using arthroscopic surgical model to determine whether making puncture holes in a ligamenttechniques (Figure 1), bilateral chondral (cartilage) defects were graft at the time of implantation can lead to more rapid and completemade on the ends of the thigh bone in the knee joint. Treatment formation of new blood vessels in the graft. If so, and if the numberassignments were done in a randomized fashion so that a functional of punctures can be optimized, then faster and more completeelectrostimulation unit was placed on one leg (treated), and an healing enhancement of the ACL graft might be possible. (continued on page 29)Figure 1. All of the procedures performed on the horses in this study were Figure 2. Postoperatively, an electrostimulation unit was applied to eachcarried out using arthroscopic surgical techniques at the Colorado State knee of the horse. Randomly and without knowledge of the investiga-University Orthopaedic Research Center. The surgical set-up and proce- tors, one unit was active (treated) and one was not active (control).dures are essentially identical to those used routinely in our operatingrooms at the Vail Valley Medical Center. [26]
  • Bone and Joint Research: The Human-Horse ConnectionBy Jim Brown, Ph.D.I t is not a coincidence that three of the Horses are bigger and 13 members on the Steadman◆ stronger than humans, but theHawkins Research Foundation Scientific thickness of cartilage in theirAdvisory Committee (SAC) are veterinari- equivalent of the human kneeans. Horses, like humans, suffer trauma is very similar. Research at CSUto the limbs in general and joints in par- showed that, in the long term,ticular. Similar diseases occur in both there was significantly morespecies. Sixty percent of cases in which repair tissue in defective areashorses are retired are due to osteoarthri- after microfracture. In thetis. In order to investigate these common short term, microfractureproblems and develop procedures to treat caused an increase in the pro-them, a collaborative research effort has duction of the specific collagenemerged between the Foundation and contained in articular cartilage.the Equine Orthopaedic Research Center Dr. Steadman’s clinical findingsat Colorado State University. have made microfracture a The men behind the initial arrange- primary technique usedment were J. Richard Steadman, M.D., around the world for promot-Founder and Chairman of the Founda- ing the repair of defects intion; C. Wayne McIlwraith, D.V.M., Ph.D., articular cartilage.Director of the Equine Orthopaedic “Other techniques used in Dr. McIlwrath (right) operating on a horse’sResearch Center at Colorado State; and equine research can be useful stifle (knee) Joint.William Rodkey, D.V.M, Chairman of to humans,” says Dr. McIlwraith.the Advisory Committee and Director “We can control the exercise routine humans, but it’s coming. “We’re still try-of Basic Science at Steadman-Hawkins. of horses and we can submit them to ing to find an agent to carry the geneA third veterinarian and SAC member is athletic exercise. It’s pretty tough to get into the joint without triggering anSteven P. Arnoczky, D.V.M., Director of sheep to trot on a treadmill. We can also immune reaction,” says Dr. McIlwraith. Inthe Laboratory for Comparative do things arthroscopically, which is not addition, researchers are looking into theOrthopaedic Research at Michigan State. possible with smaller species. The only effectiveness of using electrostimulationPioneering work by Dr. Arnoczky has criticism is that the horse doesn’t stand following the microfracture procedure. Ifbeen important in the development of on its hind legs, but it still has the same it works in horses, it will be tried intreatment for meniscus injuries. weight-bearing area where defects in humans. “In December of 1990,” recalls Dr. the cartilage occur.” “Others are doing equine research,”McIlwraith, “Dr. Rodkey introduced me Equine research at Colorado State concludes Dr. McIlwraith, “but theto Dr. Steadman.” He had developed the was able to demonstrate that some of relationship between the Steadman◆straightforward but brilliant idea of the changes occurring as a result of Hawkins Research Foundation and themicrofracture to access healing elements microfracture could not happen without Equine Orthopaedic Research Center isin the bone marrow underneath cartilage it. It has also shown that, for microfrac- unique. No other groups have so manydefects. But he also needed to provide ture to be more effective, the calcified world-class physicians and researchersscientific validation with control subjects, layer of cartilage has to be removed. like Drs. Steadman, Hawkins, Feagin,and we had the horses to fulfill that Without removing it, healing is inferior. Philippon, Sterett, and their colleagues.role. I had been frustrated with previous This kind of basic research has changed The combination of our two groupsmethods of bone marrow access, so a the way Dr. Steadman and his colleagues working together and the support weresearch project was begun by the at Steadman-Hawkins conduct surgery. get from individuals and organizationsFoundation and our Orthopaedic Now, research funded by the Foundation have advanced medicine, as wellResearch Center. It was initially funded and conducted at the Equine Orthopaedic as the fields of human and equineby NFL Charities, the philanthropic arm Research Center is investigating ways to orthopaedics.”of the National Football League.” further enhance healing through gene therapy. The process has not made its way into the clinical arena for horses or [27]
  • Kim Gustafson: Bad Knee Leads to Good NewsBy Jim Brown, Ph.D.T he doorbell rang, but Kim Gustafson Surgical that combines didn’t let it interrupt the conversa- three-dimensional visual-tion. He made his way to the front door, ization with a roboticanswering questions the entire time, and arm that can operatepicked up a package left by a UPS driver. through tiny incisions.Still talking, he opened the package and Since 2003, thelooked, for the first time, at the prototype Gustafson Familyof an experimental “unloading brace” for Foundation has beenskiers that he helped design. supporting research at The brace isn’t Gustafson’s first prod- the Steadman◆Hawkinsuct. He has worked in various marketing, Research Foundation,management, and engineering-related partly because its missionpositions in the United States and Europe is so different from thatfor the past 30 years. “My brother, David, of many other organiza-and I have now set up our own company tions. Gustafson contri-— Opedixlabs — for developing sports- butions have helped osteoarthritis to keep on exercising —related and medically supported products,” fund a chair in the Biomechanics Research even if it’s just walking.”says Gustafson, a 1971 graduate of the department.University of Colorado. “I’ll test this proto- “I became interested in the More Than a Walk in the Parktype on the snow tomorrow and then it Steadman-Hawkins Clinic because of a Kim is not ready to restrict his exer-will go to the Biomechanics Research knee injury I got while jogging in a park cise routine to walking, and he seesLaboratory at the Steadman◆ Hawkins in London,” says Gustafson. “Later, I another big-picture resulting fromResearch Foundation for scientific testing.” hyper-extended that same knee to the Steadman-Hawkins research. “Skiing, If the brace gets to market, a portion extent that it ruptured the ACL. I received especially in Colorado, is a very importantof the sales will go back to the Founda- treatment, but eventually the pain industry. If we start losing the babytion to support additional research. returned, and I had to look somewhere boomer generation to knee injuries andGustafson has been working with Michael else for help. I met John McMurtry, the arthritis, it will have a tremendously nega-Egan, the Foundation’s CEO, and Michael Vice President for Program Advancement tive impact on the state’s economy. ByTorry, Ph.D., who directs the work of at the Foundation, and he suggested that conducting research on new products andthe Biomechanics Research Laboratory, I let Dr. Steadman look at my knee. Two developing new diagnostic, surgical, andto establish an ongoing research effort microfracture surgeries later, I am able to rehabilitation procedures, the Steadman◆between Opedixlabs and the Steadman◆ do three things that I couldn’t do before: Hawkins Research Foundation will continueHawkins Research Foundation. Together, ski, teach other people to ski as an to separate itself from other organizations.”they are also developing a pair of com- instructor with the Vail ski school, and “It’s ironic,” says Gustafson, “thatpression tights, a piece of apparel that work as a wrangler during the summers if it hadn’t been for my knee injuries, Iincorporates a special banding component on a friend’s cattle ranch in the high probably wouldn’t have been curiousthat also takes some of the load off the country of Colorado.” about developing these new products,knees while running, walking, and cycling, and I wouldn’t have realized the uniqueas well as many other physical activities. From One Foundation to Another nature of the research being done at While Kim was being treated at the Steadman-Hawkins. Speaking for myselfThe Gustafson Family Foundation Steadman-Hawkins Clinic, he became and for the Gustafson Family Foundation, But the Steadman◆Hawkins Research aware of the Steadman◆Hawkins it is exciting to be associated with theFoundation won’t have to wait for poten- Research Foundation. When he told his Steadman◆Hawkins Research Foundation,tial sales from Opedixlabs products to get father and siblings about the work being and I hope our relationship will continuefinancial support from Kim and his family. done at the Foundation, the family decid- to grow and benefit people aroundThe Gustafson Family Foundation has ed that its Foundation money would be the world.”been giving money to charitable organi- well spent at Steadman-Hawkins. “Myzations for years. One of the recipients is father is in his 80s and commented thatthe Mayo Clinic, which uses the Gustafson walking is about the only form of exercisedonations to fund the da Vinci Surgical for many older adults,” explainsSystem, a product developed by Intuitive Gustafson. “He said he would like to support research that is making it possible for millions of Americans who suffer from [28]
  • The Year in Research and Education And finally, we are in the early stages of exploring the feasibility microfracture procedure. It is possible that such a compoundof two other areas of research. One area involves the new and exciting might have a protective effect for the healing cells that come fromuse of shockwave therapy to stimulate tissues to heal more rapidly. the bone marrow.This shockwave therapy is similar to that used to pulverize kidney These are exciting times, and we feel that some very excitingstones so that they may be passed without invasive surgery. The second research results lie just ahead for the Basic Science Research grouparea being considered involves the injection of a type of lubricating and the Steadman◆Hawkins Research Foundation.compound into the joint immediately at the conclusion of theClinical ResearchKaren K. Briggs, M.B.A., M.P.H., Director; Marilee Horan, Research Associate; Lauren Matheny, Research Associate; Sarah Kelley-Spearing, Research Assistant; James Bennett, Research Intern; Rebeccca Glassman, Research Intern; David Kuppersmith, ResearchIntern; Dustin Manchester, Research Intern; Tiffany Tello, Research Intern; Jennifer Thorne, Research Intern.T he goal of Clinical Research at the Steadman◆ Hawkins Research Foundation is to conductoutcomes-based research in the area of orthopaedicmedicine that will aid both physicians and patients inmaking better-informed decisions regarding treatment.To achieve that goal, Clinical Research gathers datafrom patients before and after surgery who seek treat-ment for knee, shoulder, hip, and spine disorders.Information that is stored in a database provides atool to understand the patient’s perspective and isthe key to our research. The focus is improvement offunction and quality of life. Future research will target Back row left to right: Sarah Kelley-Spearing, Lauren Matheny,predictors of disability caused by arthritis, predictors Karen Briggs, M.B.A., M.P.H., Marilee Horan, David Kuppersmith. Front row left to right: Jennifer Thorne, Tiffany Tello, Rebeccaof successful surgery, predictors of patient satisfaction, Glassman, Dustin Manchester.patient expectation of treatment, and patient outcomesfollowing surgery. THE KNEE Are Outcomes of Microfracture in the Knee Related to Location? Manuscripts Chondral defects in the knee may be a significant source of disability for patients. Such lesions are often found in combination 16 with other conditions, such as ligament or meniscal injuries, and they may lead to persistent symptoms or progress to more debilitating 11 10 arthritis. Isolated chondral defects in the knee are rare. Microfracture 7 7 7 is a frequently used technique for the treatment of full-thickness chondral defects in the knee joint. Basic science and clinical studies 2001 2002 2003 2004 2005 2006 have demonstrated this technique to be very effective in restoring the Published articular surface of these lesions and restoring function, while elimi- nating pain. We hypothesized that the outcomes of microfracture areClinical Research published manuscripts accepted by peer reviewed dependent on the location of the chondral defect.journals year-by-year. A review of data was performed among patients who underwent only the microfracture procedure for a traumatic or degenerative (continued on page 31) [29]
  • The Brad Ghent Family: Colorado’s First Family of SkiingBy Jim Brown, Ph.D. Needless to say,M emo #1 - To the Colorado Chamber of Commerce:Nominations are now open for the position Brad, Karen, and the girls do not endorse thisof “Poster Family” to promote Colorado announcement nor doskiing. The first candidate is the Brad and they want the attention.Karen Ghent family of Vail. Allow us to Their lives are movingsubmit their credentials. along quite nicely with-• Brad skied at the collegiate level, out these new titles. coached at Colorado University, then joined the coaching staff of the U.S. Bumps Along Women’s Ski Team before becoming a the Way successful businessman in Vail. He owns The contributions and operates two businesses at the Brad and his family Eagle County Regional Airport in Vail, have made to skiing including the Dollar Rent a Car agency. have come at a price.• Karen was a member of the U.S. Ski Karen broke her leg in Team for five years, competed in the a skiing accident when World Championships, is a certified she was 16. Brad rup- United States Ski Association National tured his ACL and tore a The Ghent Family: Band and Karen; front, left to right, Erika, Christa, and Abby. Coach, and is Alpine Director for the meniscus when he was Ski & Snowboard Club Vail, a huge skiing at CU, and he organization with more than 200 kids re-injured it at least one more time later in his skiing career. of last year’s state high school champi- and 20 coaches. Among her many Christa hit a couple of bumps the wrong onship cross-country team. responsibilities is coaching 11- and 12- year-old skiers four days a week. way earlier this year at the U.S. National Ski Championships and suffered essentially Investing in the Foundation• Their daughters, Erika, Christa, and Abby, the same injury (torn ACL, torn meniscus) The experience and friendship the are all skiers, though their schedules are that her dad had experienced as a colle- Ghent family has had with Dr. Steadman packed with other activities. Christa, 16, giate skier. By the way, Christa’s injury has brought them into an ever-widening competed at the U.S. Nationals earlier happened exactly 27 years after her group of people who support the this year. mom’s broken leg. Same event, same hill Steadman◆Hawkins Research Foundation. (Sugarloaf), same leg, same date — “Anything we have done for the Founda-Memo #2 - To the Colorado Karen’s birthday. This is starting to get tion is also an investment in us,” saysChamber of Commerce: spooky. Brad. “Just look at what the Foundation’s Don’t take our word in support of this The common denominator that research has done for Christa. By trackingamazing, multi-tasking Colorado family. emerged during the Ghent family’s thousands of cases and making thatListen to Charlie Meyers, the eloquent, history of sports injuries was Dr. Richard data available to a worldwide medicalaward-winning Outdoors Editor of The Steadman. He was a young orthopaedic community, and by training scores ofDenver Post. “Perhaps it was pure surgeon in Lake Tahoe who mended young doctors in the Steadman-Hawkinsserendipity that two of the finest people Karen’s broken leg. She hasn’t had a prob- Fellowship Program, the probabilityassociated with the U.S. Ski Team came to lem since. He was already becoming a of success in treating injuries like hersbe married — or simply the way that nationally known surgeon when he continues to improve.good folks manage to find each other. “cleaned up” Brad’s damaged knee in “The work of the Foundation givesThat these two were connected by the 1982. Ten years later, Dr. Steadman people like us, as well as those withcommon thread of top-level ski-racing performed his signature microfracture degenerative arthritis,” concludes Brad,competition serves to complete that bond. procedure on Brad. The microfracture “the chance to extend our active lifestylesSuffice to say that Brad Ghent and Karen approach is now being used by thousands for many years to come. I urge otherLancaster Ghent have given so much to of doctors around the world. Skiing is families to join us in supporting theskisport, both as coach and competitor. difficult for Brad, but his knee feels great Foundation. It will be an investment thatThey represent the best spirit of connect- and he can still bike and fish, two more will pay solid dividends to themselves anding through generations of the sport.” of his recreational interests. This year, Dr. others around the world.”Memo #3 - To the Colorado Steadman first repaired Christa’s meniscus and later operated on her torn ACL. She is Memo #4:Chamber of Commerce: two months ahead of schedule in her There is no Colorado Chamber of Nominations are closed. The Ghents rehabilitation program, anticipates a 100 Commerce. No “Poster Family.” No “Firstwin. They are the unofficial spokespersons percent recovery, and expects to be run- Family of Colorado Skiing.” But if therefor Colorado skiing and may be nominated ning and skiing by the end of the year. By were…for another position — “Colorado’s FirstFamily of Skiing.” the way, Christa played youth soccer and, with her older sister, Erika, was a member [30]
  • The Year in Research and Education This analysis of the different locations of full-thickness Knee Continuum of Care Clinical Research Knee Research Program chondral lesions treated with microfracture in the knee joint demonstrated that lesions of the femoral Injury Prevention Non-Operative and Operative Options and condyles respond better to microfracture than those Prediction of the patellar surfaces. Rehabilitation TRAUMATIC DEGENERATIVE Protocols KNEE KNEE INJURY REPLACEMENT Bracing Healing Response Microfracturefull-thickness chondral defect. At a minimum follow-up of two years, Prediction of Microfracture HTO Cartilage Chondrosis in thethe Lysholm score, a score that measures patients’ function, the Damage in Score Validation Chronic ACL Diagnosis of Deficient KneeTegner activity scale, and patient satisfaction score were obtained. ACL Injury Meniscal Tears InjectablesThere were 107 patients available for follow-up at an average of 4.2 Predictors of % Meniscectomy Related to Function Disability in Disability in Chronic ACLyears. The mean age of this patient population was 36. Forty-five Patients with Patient Satisfaction Score Validation Osteoarthritis Otherspatients were female and 62 male. The incidences of lesions at eachof these locations were: 28 medial femoral condyle, 14 lateralfemoral condyle, 40 trochlear groove, 19 patellar, 5 lateral tibialplateau, and 1 medial tibial plateau. M.D.; David Noble, M.D.; Karen Briggs, M.P.H.; and J. Richard There was no significant difference in the size of the lesions Steadman, M.D. The paper will be presented at the 2007 AAOS Annualbetween compartments. The postoperative Lysholm score was not Meeting in San Diego, California and at the 2007 Biennial Meeting ofassociated with age, lesion size, or time of follow-up. However, there the International Society for Arthroscopy, Knee Surgery, andwas a significant relationship with the pre-operative Lysholm score Orthopedic Sports Medicine, in Florence, Italy.and the postoperative Tegner score. The postoperative Tegner scorewas associated with age. Males had higher preoperative Lysholm Tissue loss at meniscectomy correlates with clinicalscores (61 vs. 49) and higher postoperative Tegner scores. When symptoms, function, and activity levelslesions located on the femoral condyles were compared to trochlear Injuries to the meniscus cartilage of the knee are common.groove lesions, there was no difference in post operative Lysholm A torn meniscus is one of the most common reasons to undergoscore, patient satisfaction, or Tegner score. For patellar lesions, the arthroscopic surgery. Absence of meniscus tissue leads to decreasedLysholm score was significantly lower compared to femoral condyle clinical function and reduced activity levels. As the percentage oflesions. Independent predictors of postoperative Lysholm scores were meniscus removed increases, contact area and contact stressespostoperative Tegner scores and the locations of the lesions. increase. A recent study showed that meniscectomies of greater than This analysis of the different locations of full-thickness chondral 50 percent of the meniscus resulted in the greatest changes in thelesions treated with microfracture in the knee joint demonstrated that knee. However, it is unclear how the amount of meniscus tissue lostlesions of the femoral condyles respond better to microfracture than correlates with clinical symptoms, function, and activity.those of the patellar surfaces. In isolated chondral defects treatedwith microfracture, location may be an important predictor of success. L y s h o l m a n d Te g n e r S c o r e sIn spite of these findings, high subjective patient satisfaction was seen, The Lysholm score (0-100, 100=highest) and Tegnerregardless of location. This paper was authored by Stephen Hunt, activity level (0-10, 10=highest satisfaction) are common scoring systems utilized to evaluate outcomes of arthroscopic knee surgery. The Lysholm score measures symptoms and function. The Tegner categorizes individuals based on the activities in which they participate. Outcomes following arthroscopic knee surgery have recently shifted focus to the patient’s perspective. Patient perspective is often driven by various factors, including previous experiences. The Lysholm score and Tegner activity level measure the patient’s perspec- tive of function and activity. The pre-surgical score is often compared to the follow-up score to rate improvement. Improvement in function and activity, along with patientMicrofracture completed on the femoral condyle of the knee. satisfaction, are the primary goals for most knee surgeries. However, these results do not say how the knee compares to someone with normal knee function. [31]
  • This study showed significant correlation at two years follow-up between the amount of meniscus removed at meniscectomy and function, activity, and pain. Few studies have demonstrated a relation- ship between the amount of meniscus tissue removed and the patient functional outcome. In conclusion, this study confirms the importance of preserving as much meniscus as possible at time of the meniscec- tomy. The more meniscus patients lose, the more disability they suffer. This is compounded by decreased activity levels in these patients. In order to prevent loss of function and decreased activity, the meniscus should be preserved by repair whenever possible insteadMeniscus tear in the knee. of meniscectomy. The authors of this study are Karen K. Briggs, M.P.H.; William G. Rodkey, D.V.M.; and J. Richard Steadman, M.D. The purpose of this study was to determine the relationshipbetween the amount of meniscus removed and the function and Do second-look arthroscopic findings and clinical outcomesactivity level of the patient two years following the meniscectomy. correlate in the treatment of degenerative chondral lesionsThe hypothesis of this study was that patients with greater than 50 with microfracture and valgus high tibial osteotomy?percent of the meniscus removed would experience greater decreases Full-thickness chondral defects in the knee present difficultin function and activity levels. problems with numerous proposed treatment options, including The study included 149 patients. The patient age ranged from microfracture, shaving, and cartilage transplantation. These treatments18 to 60 years. Eighty-one patients had an acute injury and no have shown beneficial results when chondral defects are seen inprevious surgery to the involved meniscus. Chronic injuries were isolation, but a more difficult situation involves chondral pathology indocumented in 68 patients who had undergone 1- 3 prior surgeries the setting of varus (turning inward) malalignment and global degen-on the involved meniscus. At the time of the surgery, following the erative chondral changes. While knee replacement remains a viablepartial meniscectomy, the size of the meniscus defect was physically option for these patients, many of these individuals desire to maintainmeasured. The percent of meniscus loss was calculated based on a physically active lifestyle that may not be recommended with aactual measurements. total joint replacement. The purpose of this study was to see if high At surgery, patients had an average of 50 percent of their medial tibial osteotomy, in combination with microfracture, provides ameniscus removed. At two years, the amount of meniscus tissue suitable treatment for degenerative arthritis, varus malalignment, andremaining after surgery statistically correlated patients’ ability to chondral defects of the knee.squat. Patients with no difficulties squatting had on average 51 percent The cornerstone of non-prosthetic treatment for the varusmeniscus remaining, while those who were unable to go beyond 90 degenerative knee in the active patient remains high tibial osteotomydegrees or not at all had on average 24 percent meniscus remaining. (HTO). High tibial osteotomy involves an incision made diagonally The ability to climb stairs was also significantly correlated with through the tibia without completely cutting through the tibia. Thethe amount of tissue remaining. Patients with no difficulties climbing tibia is then opened to a specific, measured degree. A metal plate isstairs had on average 51 percent meniscus remaining, while patients placed over the opening on the inside of the leg to secure the openingwho could only climb one stair at a time had on average 20 percent permanently. A bone and blood mixture is placed in the openingmeniscus remaining. Swelling of the knee was also correlated with between the tibia and the plate. The bone then consolidates andthe amount of meniscus remaining. Patients with no swelling had 52 heals, causing a realignment of the knee and pressure to be takenpercent meniscus remaining, and patients with severe to moderate off of the problem areas, where cartilage has been worn away.swelling had on average 35 percent meniscus remaining. Patients who In addition to HTO, many have attempted to add regenerativehad worse or no improvement in pain symptoms at two years averaged cartilage procedures to improve patient outcomes and increase the42 percent of the meniscus remaining, while patients who had longevity of the procedure. Our chondral resurfacing technique beganimproved pain scores had 51 percent meniscus remaining. In the with the removal of any loose flaps of unstable articular cartilage. Thechronic group of patients, patients who had worse or no improve- calcified cartilage layer was then removed using a motorized shaver.ment in pain symptoms average 11 percent meniscus remaining. A microfracture awl was used to make several two-millimeter holes in The change in Tegner activity for all patients with less than 50 the subchondral bone. These holes were placed as closely together aspercent meniscus remaining average 1.3 compared to 2.7 for patients possible without breaking into each other. This caused a bleedingwith greater than 50 percent meniscus remaining. In the acute group, response in order to generate new cartilage.in patients with less than 50 percent remaining, the average change The average time to second-look arthroscopy was 13 months.in Tegner was 1.6 compared to 2.8 for patients with greater than 50 At the time of second-look arthroscopy, all microfractured lesionspercent remaining. In the chronic patient group, with less than 50 were evaluated for the percent of fill with repair cartilage by visualpercent remaining, the average change was 1.1, compared to 1.9 forpatients with greater than 50 percent remaining. [32]
  • The Year in Research and Education Survivorship, or the percentage of patients who did not require a total knee replacement, was 97 percent at five years and 91 percent at seven years. who want to remain highly active. Multiple authors have treated acute chondral lesions with a variety of resurfacing procedures that include microfracture, shaving, and cartilage transplants.Microfracture prior to high tibial osteotomy. High tibial osteotomy has been recommended for the treatment of varus osteoarthritis in order to decrease pressure on the damaged medial compartment. A medially based opening wedge high tibial osteotomy has the advantage of avoiding some of the complications associated with lateral closing wedge osteotomies, such as further shortening of the limb, problems associated with the proximal tibiofibular joint, and operating near the peroneal nerve. We have been treating both chondral damage and axial malalignment in patients with varus malalignment and degenerative cartilage defects since 1995 with a combined microfracture andRepair tissue 8 weeks following microfracture and high tibial osteotomy. valgus-producing opening wedge high tibial osteotomy. The purpose of this study was to document how long the HTO and microfractureexamination and measurements made using an arthroscopic probe last, patient satisfaction, and functional outcomes. The goal is toof the lesion on both the medial femoral condyle (MFC) and medial avoid knee replacement with a combination of microfracture andtibial plateau (MTP). The average fill of medial femoral condyle opening wedge medial high tibial osteotomy . Our hypothesis waslesions was 84 percent. The average fill of medial tibial plateau that there would be a higher survivorship rate at five to seven yearslesions was 74 percent. Twenty-two knees of the 30 with MFC lesions following this combined procedure.(73 percent) had greater than 80 percent fill. Seventeen knees of Survivorship, or the percentage of patients who did not requirethe 23 with MTP lesions (74 percent) had greater than 80 percent a total knee replacement, was 97 percent at five years and 91 percentfill. Seventeen knees of the 23 that had both MTP and MFC lesions at seven years. Average time to knee replacement was 81.3 monthshad greater than 80 percent fill. in the 12 patients who elected to proceed with knee replacement. All The results of this study support the use of combined opening patients who underwent knee replacement had medial compartmentwedge medial high tibial osteotomy and microfracture for the degen- damage at the time of HTO and microfracture. At three years, meanerative varus knee. The addition of microfracture increased the Lysholm was 73, mean Tegner was 2.8, and mean patient satisfactionamount of coverage of degenerative lesions on the MFC and MTP. was 7.8. At five years, mean Lysholm was 73, mean Tegner activityThe addition of microfracture to opening wedge medial high tibial level was 3.8, and mean patient satisfaction was 7.1. At nine years,osteotomy for the treatment of the degenerative varus knee in active mean Lysholm was 67, mean Tegner was 3.1, and mean patient satis-patients may be an effective treatment option. The observation of faction was 7.1. The degree to which the osteotomy was openedimproved fill of degenerative chondral lesions compared to historiccontrols supports this addition. Ultimately, outcomes and patient satisfaction scores support thecombined procedure of microfracture and HTO. This study has beensubmitted for presentation at the American Academy of OrthopaedicSurgeons for 2008. The authors of this study are Dr. David King, Dr.Andrew Chen, Karen Briggs, Lauren Matheny, Dr. William Sterett, andDr. J. Richard Steadman.Chondral resurfacing and high tibial osteotomy in the varusknee: How long will it last? Active patients with arthritic malalignment of the knee aredifficult to manage. Addressing chondral damage with a resurfacingprocedure is not recommended in the face of axial malalignment.Joint replacement may not be appropriate in this group of people Opening wedge high tibial osteotomy with plate. [33]
  • The Year in Research and Education correlated with postoperative Lysholm. Patients with medial meniscus were at least 15 years old, and were at least two years out from index pathology identified at the time of surgery were 9.2 times more likely surgery. The average follow-up time was 63 months. The average time to undergo knee replacement than those without the condition. from injury to surgery was six days. Excellent Tegner scores were These early-to-intermediate term results are better than those obtained postoperatively in 67 percent of patients, good scores were published with osteotomy alone. The improved survivorship may be seen in 5 percent of patients, fair scores were seen in 10 percent, and due to the addition of the chondral resurfacing procedure or using a poor scores were seen in 18 percent. Excellent Lysholm scores were medially based opening wedge osteotomy rather than a lateral closing obtained in 26 percent of patients, good scores were observed in 35 wedge osteotomy. Offering an unloading osteotomy to patients under- percent, fair scores were obtained in 23 percent, and poor scores going chondral resurfacing or meniscus replacement with minimal were seen in 16 percent of patients. The mean patient satisfaction was degenerative changes may postpone knee replacement indefinitely. 8.5 on a scale of 1-10, 10 being most satisfied. Of the 74 patients, 78 Many of our patients were candidates for knee replacement at the percent of patients rated their results as excellent, 13 percent of time of HTO and microfracture but chose to avoid knee replacement. patients rated their results as good, and 9 percent of patients rated Reasons to avoid knee replacement included age, desired activity their results as poor. level, and personal preference. Patient outcomes also improved This study specifically addresses two controversial issues regard- significantly in our study. ing combined ACL-MCL injuries: (1) non-operative treatment of the Surgical management of the malaligned, painful, arthritic knee MCL lesion, and (2) appropriate timing for surgical reconstruction of in an active individual is challenging. Treatment with combined the ACL following a combined injury. Our results in regard to Lysholm chondral resurfacing (microfracture) HTO can survive multiple knee scores, Tegner activity scores, and patient satisfaction demon- years, postponing knee replacement. Patient satisfaction was high strate that nonoperative treatment of the MCL and an early recon- and Lysholm and Tegner scores significantly improved after this struction of the ACL is a reasonable and safe treatment strategy. This procedure. This study has been submitted for presentation at the study has been submitted for presentation at the American Academy American Academy of Orthopaedic Surgeons for 2008. The authors of Orthopaedic Surgeons for 2008. The authors of this study are Dr. of this study are Dr. Michael Huang, Lauren Matheny, Karen Briggs, Colin Looney, Dr. Peter Millett, Lauren Matheny, Karen Briggs, Dr. Rebecca Glassman, Dr. William Sterett, and Dr. J. Richard Steadman. William Sterett, and Dr. J. Richard Steadman. Early ACL reconstruction in combined MCL/ACL injuries Synvisc Study Most of the orthopaedic literature regarding isolated medial Arthritis is a very common joint disease in which the cartilage collateral ligament (MCL) injuries supports nonoperative treatment, of the joints wears away. As people get older, cartilage loss increases, but treatment strategies remain more controversial for combined and joint lubrication decreases. Although there are viable surgical injuries of the anterior cruciate ligament and medial collateral options, many patients desire a treatment without the invasive nature ligament (ACL-MCL). A multitude of approaches have been proposed, of surgery. Synvisc is a viscosupplementation administered to people including isolated MCL repair, combined treatment of the ACL-MCL, with joint fluid loss (synovial fluid). Viscosupplementation and and combined nonoperative treatment. hyaluronic acid injections have shown to improve symptoms in Furthermore, timing of ACL reconstruction after a combined patients with osteoarthritis. To improve these results, some physicians ACL-MCL injury remains even more controversial. Some surgeons have combined corticosteroid with viscosupplementation. The pur- propose allowing the MCL to heal before ACL reconstruction, while pose of this study was to document outcomes following corticosteroid others support early reconstruction of the ACL, which they believe injection, in conjunction with Synvisc injections, in a series of three. augments MCL healing. All patients who participated in this study were given pain and The purpose of this paper is to present our clinical results with function questionnaires each time they had an injection. Patients early reconstruction of the ACL and nonoperative treatment of the were asked to record pain, function, and symptoms every day for one MCL after combined injuries of the ACL-MCL. ACL reconstruction week after each injection. After the last injection, patients were asked involves debriding the torn ACL and replacing it with a graft of tendon to complete questionnaires at 1, 3, 6, and 12 weeks and 6 months taken from the patient’s own tendons — either the patella or the after the third injection. Currently, we have 25 patients with complete hamstring tendon, or through the use of an allograft (cadaveric tendon, six-months data. We are still enrolling patients and collecting data. either the Achilles or patella tendon). Our hypothesis was that Enrollment will be completed in 2007. An abstract will be submitted patients undergoing treatment for combined injuries within three to the 2007 World Congress of Osteoarthritis. The authors of this weeks of injury would have improved outcomes and activity levels. study are Karen Briggs, Lauren Matheny, and Dr. J. Richard Steadman. All patients in this study had a complete ACL tear reconstructed This study is funded by a research grant from Genzyme. within three weeks of injury, a minimum grade 2 (1-4, with 1 being a sprain and 4 being a complete tear) MCL injury treated nonoperatively, [34]
  • [35]
  • The Year in Research and Education THE HIP months after surgery. Four hip arthroscopy outcome measures were used to report patient pain, function, improvement, and satisfaction. Time frame for Improvement Following Arthroscopic The average patient age was 40 years. Patients had to be a Hip Surgery minimum of six months post-surgery to be included. This study This paper will be presented at the 2007 Annual Meeting of the showed that the greatest improvement in patients under the age of American Academy of Orthopedic Surgeons. Promising results 30 was seen in the first three months following surgery. The greatest following arthroscopic hip surgery have been reported. However, few improvement in patients over the age of 30 was seen at six months studies indicate the duration of rehabilitation and time to functional after the operation. recovery. Patient satisfaction is heavily influenced by patient expecta- In our experience, patients tend to expect the function of their tions. Discrepancies exist between the time frame in which patients hip to be back to normal by about three months postoperatively. expect to improve and the timeframe in which improvement realisti- While this can and does happen for many patients, a large number of cally occurs. The purpose of this study was to document the time patients do not see as much improvement as they would like within frame for improvement of hip function following arthroscopy. the first three months. This extended duration of time necessary for Three hundred thirty-five hip arthroscopies were performed recovery can be a source of frustration and dissatisfaction for patients by Dr. Marc J. Philippon between March 2005 and January 2006. who expect to progress much faster than they actually do. The ability Subjective, patient-completed questionnaires were distributed to to show patients, particularly those over 30, that the majority of patients before surgery and at time intervals of 3, 6, 8, 12, and 14 improvement following hip arthroscopy may not be seen until six months after surgery may help to avoid this scenario. Hip Continuum of Care Improvement following hip arthroscopy is seen as early as Clinical Research Knee Research Program three months and continues for at least the first 12 months after- Injury wards. Younger patients see improvement earlier than older patients. Non-Operative and Prevention Operative Options Guiding patient expectations based on these findings may result in and Prediction higher patient satisfaction following hip arthroscopy. Rehabilitation The authors of this article are Dr. Marc Philippon, Karen Briggs, Protocols TRAUMATIC DEGENERATIVE HIP HIP Brian Maxwell, David Kuppersmith, and Sophie Hines. Testing of INJURY REPLACEMENT Athletes for Clinical 2nd Look Labral ROM and presentation of Repair Impingement: Femoroacetabular Revision Hip Injury Patterns in Professional Hockey Players Football Impingement Hockey and Instability Arthroscopy Little has been published in the literature on intra-articular Outcomes in Baseball Outcome of Patients with DJD hockey-related hip injuries. However, they cause significant disability Femoroacetabular Radiographic Score Validation Studies to Impingement and are a potential cause of early retirement. The description of hip Microfracture Predict Pathology Score Validation injury patterns in the National Hockey League is important in under- Classification of Labral Tears standing, treating, and returning athletes to play. And as the sport of Factors Associated hockey continues to increase in popularity, it is important to identify with Femoroacetabular Impingement potential risk factors. The purpose of this study is to describe patterns of intra-articular hip injuries identified at arthroscopy in the profes- sional hockey player. Improvement in hip outcome following hip arthroscopy. Between October 2001 and September 2006, the senior author, Dr. Philippon, arthroscopically treated 39 hips in 35 male professional 100 hockey players who had debilitating hip pain and an inability to 90 participate in their sport. The average age was 26.5 years. There 80 were nine defensemen, 13 goalies, and 17 offensemen. At the time 70 of arthroscopy, 87 percent had complete labral tears, 87 percent had 60 cam-type femoroacetabular impingement, and 56 percent had pincer- 50 type impingement. Thirty-one percent required microfracture tech- 40 30 nique to treat articular cartilage defects. One hundred percent of 20 goalies had chondral defects. All goalies and offensemen were treated 10 for labral pathology as well as femoroacetabular impingement. 0 The most commonly treated conditions were labral tears, chondral Pre-op 3 mos 6 mos 8 mos 12 mos 14 mos damage, and femoroacetabular impingement. ADL HOS MHH NAH Twenty-nine athletes remain currently active in the NHL level. (ADL HOS = Activities of daily living hip outcome score; Three players returned to sport following hip arthroscopy but have MHH = modified Harris Hip Score; NAH = arthritic Hip Score since retired, and three athletes did not return. (continued on page 38) [36]
  • Impingement Can Lead to Arthritis in the HipEarly intervention may lead to prevention.By: Marc J. Philippon, M.D.; Mara Schener; and David KuppersmithDr. Philippon is an orthopaedic surgeon impingement results from excess bone to treat this disorder. The first is an openat the Steadman-Hawkins Clinic who spe- on the acetabulum. The precise cause of surgical technique that requires a largecializes in treating hip injuries. the impingement is unknown. However, skin incision and dislocation of the hip it likely has both developmental and joint to treat the impingement. ThisA pproximately 120,000 hip replace- ments are performed every year inthe United States. This invasive, open activity-related (contact in sports, for example) components. In both types of impingement, the approach has shown good results, but it is a very invasive procedure. The second approach, which we developed, uses twotechnique is recommended for individu- abnormal contact between the femoral small arthroscopic incisions to removeals with extensive osteoarthritis. We use head and acetabulum during movement the excess bone from the femoral necka minimally invasive arthroscopic tech- causes injury to the labrum and articular and the acetabulum. The goal of thenique that may delay the need for this cartilage. Injuries to the labrum lead to arthroscopic procedure is to relieve theprocedure by slowing the progression of increased movement of the femoral head impingement and create joint clearancehip osteoarthritis. within the acetabulum, resulting in an to stop the bony abutment and soft A significant cause of osteoarthritis unstable joint. Also, tears of the labrum tissue damage. This may lessen thein the hip is thought to be femoroac- result in increased contact forces damage to cartilage and reduce theetabular impingement (FAI). FAI occurs between the femoral head and the later need for total hip arthroplasty.when abnormally shaped bones of the acetabulum. With these increased forces, With this technique the patients do veryhip repetitively bump into each other damage to the articular cartilage may well after surgery. Our recent study willduring movement. As a result, soft tissue result. Injuries to the cartilage over time be presented at the Annual Meeting ofstructures of the hip, including the may increase in size and depth, and the American Academy of Orthopaedicacetabular labrum and the articular carti- ultimately result in bone-on-bone con- Surgeons, and it has shown that profes-lage, are often entrapped and injured. tact. At this point in the disease, the sional athletes can return to elite sportsImpingement is particularly common in only current solution is a total hip following treatment with this procedure.hip flexion and internal rotation, a posi- replacement. In conclusion, impingement leads totion frequently encountered during A recent study we conducted at the cartilage damage, which causesactivities of daily living. Difficulty with Steadman◆Hawkins Research Foundation osteoarthritis. Femoroacetabularputting on shoes and socks, and getting showed that FAI directly correlates to impingement in the hip is a major causeinto and out of a car are common com- large articular cartilage injuries of the of injury to the acetabular labrum andplaints in patients with extensive acetabulum. Hips with cam impingement articular cartilage, hip pain, reduced hipimpingement. proved more likely to have large chon- motion, and accelerated progression of There are two distinct types of dral defects compared to hips without hip osteoarthritis. By intervening early infemoroacetabular impingement — cam cam impingement. This may hasten the this disorder, we are hoping to delay orand pincer. Most commonly, patients onset of hip osteoarthritis. Knowing prevent the onset of hip osteoarthritishave a combination of the two types. the damage that can be caused to the and the need for total hip replacement.Cam impingement results from excess labrum and articular cartilage by FAI,bone located on the femoral neck. Pincer two surgical options have been describedWith cam impingement, the burr, a small With pincer impingement, the burr, a small cutting instrument, is used to remove excess bone fromcutting instrument, is used to remove excess acetabulum.bone from femoral neck.Illustrations: Marty Bee [37]
  • The emerging trends of hip arthroscopy have proven to be acetabular chondral defects, the average alpha angle recorded was 71.5 degrees vs. 56.9 degrees in patients without these defects. safe and effective in correcting hip pathologies Cam-type femoroacetabular impingement as measured by increased alpha angles was statistically associated with loss of hip The emerging trends of hip arthroscopy have proven to be safe range of motion and operative findings of full-thickness and largeand effective in correcting hip pathologies There is an apparent trend chondral defects on the acetabulum. This supports the hypothesis thatwithin the sport of hockey that predisposes athletes to hip pathology. cam-type FAI is associated with early osteoarthritis and that subsequentIt is important for the professional hockey community, including team treatment to reduce the size of the aspheric portion of the femoralphysicians, physical therapists, and trainers, to understand the incidence head may prevent the occurrence or progression of osteoarthritis.of hip pathology associated with hockey. Early detection and interven- The authors of this presentation were Todd L Johnston, Maration of hip pathologies in the professional athlete will be the focus of Schenker, Dr. Marc Philippon, and Karen Briggs.future studies. The authors of this study were Dr. Marc Philippon,David Kuppersmith, and Mara Schenker.Hip Alpha Angles as Radiographic Predictors ofChondral Injury and Decreased Hip Range of Motionin Femoroacetabular Impingement The Arthroscopy Association of North American will presentthe Fellows Award for this paper at the 2007 annual meeting in SanFrancisco. This paper will will also be presented at the 2007 AnnualMeeting of the American Academy of Orthopedic Surgeons in SanDiego, and at the Biennial Meeting of the International Society for Microfracture of the femoral head of the hip joint.Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine, 2007,Florence, Italy. Outcomes Following Hip Arthroscopy with Microfracture Femoroacetabular impingement (FAI) has been proposed as The article will be published in a 2007 issue of the Journal ofa cause of early arthritis in the hip. The femoral head has been Arthroscopy. It will also be presented at the 2007 Annual Meetingdescribed as a round convex ball and the acetabulum a concave of the Arthroscopy Association of North America in San Francisco.socket. In “cam-type” impingement, abnormal bony extensions of Chronic pain is a common condition within the hip, especially in thethe femoral head are thought to cause increased friction and damage older population. The emerging trend of hip arthroscopy has allowedto the articular cartilage of the acetabulum. A measurement routinely for the evolution of many common orthopaedic procedures. Articularused in the clinic to assess bony abnormality in the hip is known as cartilage defects rarely heal, due to its limited restorative capacity.the alpha angle. A large-degree alpha angle corresponds to a large The purpose of this study was to report on early outcomes in patientsbony abnormality of the femoral head/neck. The purpose of this who underwent hip arthroscopy with microfracture. The authorsstudy was to determine whether larger preoperative alpha angles hypothesized that under the correct indications, patient selection,correlated with damage to the articular cartilage or changes in hip and compliant rehabilitation protocol, patients would have improvedrange of motion. clinical outcomes following microfracture in the hip. A specific x-ray image was used to measure the alpha angle on Forty-one patients underwent microfracture in the hip and107 consecutive professional and amateur athletes who had hip pain were available for one year follow-up. The average age of the patientsbetween March and December 2005. Three films were of insufficient was 44 years, and there were 28 males and 13 females. Surgical dataquality to make measurements. There were 64 males and 43 females, and patients’ completed questionnaires were used. Four outcomeand the average age was 28.5. Alpha angles were measured with a measures were used to quantify patient improvement and function.digital goniometer (an instrument to measure hip angles). The angle The microfracture technique in the hip is indicated and performedin which the femoral head became out of round and the mid-axis of similarly to that described by Dr. Steadman in the knee. Furthermore,the femoral neck was measured. One hundred athletes in this series the physical therapy protocol following arthroscopic microfracture inunderwent hip arthroscopy, and surgery data were obtained from a the hip is rigorous and crucial to success.prospective database. In this series of patients, alpha angles wererelated to age, with older patients having higher angles. Larger alphaangles were significantly related to decreased hip flexion, decreased This study demonstrated that microfracture techniqueinternal rotation, and decreased external rotation. Higher alpha to treat articular cartilage defects in the hip canangles were statistically related to full-thickness and large acetabular result in patients regaining some of their lost function,chondral defects. In patients with full-thickness acetabular chondral result in high patient satisfaction, and reduce symptomsdefects, the average alpha angle recorded was 66.14 degrees vs.54.20 degrees in patients without these defects. In patients with large at one-year follow-up [38]
  • The Year in Research and Education The average period from time of injury to time of surgery was3.97 years. At minimum one-year follow-up, patients demonstratedstatistically significant improvement in outcomes measures. The aver-age patient satisfaction was 7 (1-10, 10=highest satisfaction) at fol-low-up. This study demonstrated that microfracture technique to treatarticular cartilage defects in the hip can result in patients regainingsome of their lost function, result in high patient satisfaction, andreduce symptoms at one-year follow-up. The authors of this articlewere Dr. Marc Philippon, Karen Briggs, David Kuppersmith, BrianMaxwell, and Sophie Hines.Early Results of Acetabular Labral Repair The paper was published in the Journal of Arthroscopy. It Anchor placed in hip for repair of torn labrum.will also be presented at the 2007 Annual Meeting of the Arthroscopy ment in pain management and joint preservation. The authors of thisAssociation of North America in San Francisco. Previous arthroscopic study were Dr. Marc Philippon, Dr. Michael Huang, Karen Briggs,intervention has included labral debridement, excision, and repair. and Sophie Hines.It is believed that arthroscopic labral repair restores proper labralstructure, therefore preserving its physiological function. The purpose Labral Tear Morphology Is Associated with Type ofof this study was to report early results of function and patient satis- Femoroacetabular Impingementfaction in patients undergoing labral repair. This study will be presented at the 2007 Annual Meeting of the Eighty-six patients underwent arthroscopic repair of the labrum. American Academy of Orthopedic Surgeons in San Diego. With recentThe average age was 36, with 50 males and 36 females. The data that advances in imaging and arthroscopic treatment of hip disorders,was collected included surgical data, as well as four hip arthroscopy there has been increased attention focused on the acetabular labrum.outcomes measures that quantify level of improvement after surgery. Patterns of acetabular labral tears have been reported to vary with the Patients experienced improvement in function at one year type of femoroacetabular impingement, but no clear associations havefollowing surgery. Early results demonstrate that labral repair in the been made. Cam-type femoroacetabular impingement is defined as ahip leads to improved function and high patient satisfaction. This bony abnormality contributing to an aspherical femoral head. Pincer-study demonstrates the potential of labral repair to facilitate improve- type impingement occurs at the acetabulum where there is excess [39]
  • bony overgrowth in which the front wall impedes the posterior wallof the acetabulum. The purpose of this study was to identify anassociation between labral pathology and type of femoroacetabularimpingement. In this study, 57 patients requiring hip arthroscopy were analyzed.Preoperative x-rays were used to evaluate the type of femoroacetabu-lar impingement. Surgical images were reviewed for labral pathology.Seven descriptive terms were employed to note differences in labralpathology (detached, mid-substance, flattened, complex, frayed, flap,bruised). These same images were also reviewed to evaluate labralcolor (yellow, white), as well as size. The average age of the group was 40 years. Patients withmoderate osteoarthritis were significantly older than those with mini-mal or no osteoarthritis. Cam-type femoroacetabular impingement(FAI) was found to occur in older patients when compared to pincer-type FAI. Patients with pincer type lesions had no or mild osteoarthritis.Patients noted to have flattened labri had pincer impingement, whichwas more common in females with no or mild osteoarthritis.Detached labri were related to cam impingement. Bruised labri wererelated to pincer impingement and were more common in patientswith mild or no osteoarthritis. Flap labral tears were more commonin older patients. Yellow labri were more common in older patients.White labri were more common in younger patients. Labral pathology varies not only according to severity but alsoaccording to underlying hip pathology, specifically bony abnormalitiesat the femoroacetabular interface. Based on the results of this study,there appears to be an association between labral tears and type offemoroacetabular impingement. Cam-type femoroacetabular impinge-ment more consistently produced detached labral tears, while pincer-type impingement produced more bruised and flattened labri. The of the clavicle and in high-demand athletes that may request surgicalinformation from this study should be useful as treatment strategies intervention.for labral pathology increase. Furthermore, a clear and concise A few studies have been published looking at the outcome fromclassification system for labral tears could serve as a basis for out- surgical fixation of displaced claviclar fractures. While most claviclecomes data in the future. The authors of this study were W. Scott fractures are treated nonsurgically with satisfactory outcomes, someKimmerly, Mara Schenker, Karen Briggs, and Dr. Marc Philippon. progress to nonunions and present a problem for the surgeon. Nonunion of clavicle fractures is uncommon, but the incidence isTHE SHOULDER higher than once thought. Since clavicle non-unions can compromise shoulder function, some surgeons elect to surgically repair displacedComplications of clavicle fractures treated with middle-third clavicle fractures. Surgical stabilization of a fracturedintramedullary fixation clavicle has typically been done with either plate-and-screw fixation Collarbones or clavicle fractures account for 25 percent of all or an intramedullary pin device. Several published reports havefractures. This bone covers the top of the chest, between the breast- shown good clinical results in which the patients regained shoulderbone (sternum) and shoulder blade (scapula). These fractures occur function and returned to prior sporting activities.in men under 25 years more frequently than women. The majority of The purpose of this study was to look at the complication ratepatients have shoulder pain and difficulty moving their arm. Swelling of 63 people who underwent surgical treatment of mid-shaft clavicleand bruising of the fracture site is common and once the swelling fractures with intramedullary fixation. Complications were groupedsubsides the fracture can be felt through the skin. Displaced fractures into major (infection, nonunion, malunion) and minor (skin wearare recognized by prominent “tenting” position of the clavicle under and tear, painful hardware, hardware breakage without consequence)the skin. Many acute midshaft clavicular fractures are treated non- categories. Twelve patients experienced complications 22.2 percentoperatively. However, surgical options are appropriate for severely of the time. Sixteen percent were classified as minor (one delayeddisplaced fractures, tenting, and fractures associated with shortening union of the fracture, one person experienced hardware breakage, four had skin wear and tear, four had painful hardware). Four people [40]
  • The Year in Research and Education(6.3 percent) were classified as major complications (one loss offixation that led to nonunion, one other nonunion, and two infections).In this series, no nerve injuries were seen. This is a large series of patients with a low surgical complicationrate. Overall, excellent union rates and function were achieved in themajority of patients, with only a 6.3 percent risk of major complica-tions. While minor complications were common, most were managedeasily and did not interfere with ultimate shoulder function.Historically, the unique S-shape of the clavicle posed a problem forintramedullary fixation, but many of the newer surgical techniquesand devices have been developed to accommodate the clavicle’sunique form. Intramedullary device design modifications, along withimproved surgical technique, should decrease future complication Microfracture of the humeral head of the shoulder jointrates even further. Mean patient-reported pain scores decreased from 3.6 preoper-Outcomes of Full-Thickness Articular Cartilage Injuries of atively to 1.6 postoperatively (0=no pain, 10=worst pain). Patients’the Shoulder Treated with Microfracture ability to work, Activities of Daily Living, and sports activity had a sig- Up to 20 percent of the older population is affected by degener- nificant improvement postoperatively. Painless use of the armative joint disease (DJD). People with shoulder DJD can obtain pain improved after surgery and the average American Shoulder and Elbowrelief and improved function from partial or total shoulder replace- Surgeons Score improved from 60 before surgery to 80 afterwards.ments. Prosthetic use in younger people provides excellent pain relief Average satisfaction with surgical outcome was 7.6 out of 10. Therebut comes with significant restriction in activity and has a limited was no association between age and surgery outcomes. Pain andimplant life span. Young, active patients with cartilage damage in the function improved significantly following surgery. Half of the patientsshoulder present a treatment challenge. Current treatment for chon- were involved in sports and reported that their ability to competedral injuries of the shoulder rely primarily on non-operative treat- improved after the surgery. Greatest improvements were seen inment, which includes anti-inflammatory medication, injections, patients who had isolated lesions of the humerus. Two patients whoand/or physical therapy, to relieve painful symptoms. underwent second-look arthroscopy for new injuries were remark- Research has shown that chondral defects rarely heal on their able in that the area of the previous microfracture was well filledown. The microfracture technique developed by Dr. Steadman is the with fibrocartilage.preferred treatment for chondral defects in the knee by orthopaedic Based on our experience, microfracture is a safe and effectivesurgeons, and several studies have shown good clinical results follow- method for treating shoulder full-thickness chondral lesions. Theseing the procedure. Although the literature on shoulder microfracture early results show that microfracture, combined with other necessaryis sparse compared to the knee, the same basic principles of the sur- surgical treatments, is able to significantly increase patients’ abilitygical technique and healing process are thought to apply. to perform activities of daily living and to participate in athletics. The purpose of this study was to report findings of microfrac- Our data showed the greatest improvement for smaller lesions of thetured lesions in the shoulder joint. We hypothesize that shoulder humerus with the worst results in those with lesions of both jointmicrofracture can result in fill of the chondral lesions and produce surfaces. Additionally, our research shows significant decreases insatisfactory pain relief and improved functional outcomes. pain and improvement in patients’ functional scores. This study will Twenty-two patients with 23 shoulders under the age of 60 be presented at the 2007 Arthroscopy Association of North Americaunderwent shoulder arthroscopy and had microfracture of full-thick- Annual Meeting in San Francisco. The authors of this study areness chondral lesions with an intact rotator cuff. Included were 17 Benjamin H. Huffard, M.D.; Marilee P. Horan, B.S.; Peter J. Millett,men and four women with an average age of 45.5 years. Patients’ M.D., M.Sc.; and Richard J. Hawkins, M.D.pain and functional outcomes were measured using the AmericanShoulder and Elbow Score (ASES = 0-100 points) and patient THE SPINEsatisfaction level (1=unsatisfied, 100=very satisfied). Five patients had microfracture treatment of both the humeral Spine research was started at Steadman-Hawkins in early 2006.and glenoid cartilage, 10 patients had microfracture treatment just In its first year of existence the focus was primarily upon creating theon the glenoid, and eight had microfracture of the humerus only. In spine database. The key to successful research is the database, as itthis series of 22 patients and 23 shoulders treated for full-thickness allows us to compare patient subjective outcomes before and afterarticular defects, six patients went onto a subsequent surgery at an treatment to look at the percent of improvement and assess our care.average of 35 months. Three subsequent surgeries were shoulder The database was built with these patient subjective outcomes, physi-replacements at an average of 41 months. [41]
  • Physical Exam Findings Relate to Perceived Disability in Spine Patients Both back and neck pain can be extremely disabling to patients, many finding they are unable to participate in any of their regular activities or even walk around their own homes comfortably. However, the standard physician’s spine exam may or may not indicate the level of disability that a patient feels. This was examined in back and neck patients, the purpose being to discover which specific tests in a lumbar physical exam or a cervical physical exam correlate with patient-perceived disability. In both neck and back, decreased range of motion (flexion and extension) correlated with increased subjective disability. Abnormal sensory findings in both back and neck also correlated with increased subjective disability. In the back, the other tests associated with the level of disability felt by the patients were normal versus abnormal stance, motor strength testing, and presence of pain with the straight-leg test. In the neck, the other tests associated with the level of disability felt by the patients were (1) presence versus absence of pain with lateral range of motion (left lateral bending and right lateral bending), (2) brachioradialis reflex testing, and (3) motor strength testing. These results showed that most of thecian assessment (physical exam and diagnosis), and surgical data primary spine physical exam parameters are closely related to patient-(including injections and nonsurgical invasive spine procedures). perceived disability, and more research is needed to determine whichOur spine database currently consists of 1,658 patient subjective tests are most important in determining disability. These studies willentries for back pain and disability, 1,090 patient subjective entries be presented at the 2007 North American Spine Society 22nd Annualfor neck pain and disability, 589 lumbar physical exams, 219 cervical Meeting. The authors of these studies are Donald S. Corenman, M.D.,physical exams, 138 physician diagnoses, 182 surgical cases, and 353 D.C.; Sarah A. Kelley-Spearing, B.A.; David C. Karli, M.D.; Eric L.injections or nonsurgical invasive spine procedures. Once we have Strauch, P.A.-C.; and Rebecca D. Glassman, B.A.patient subjective data two years after surgery, we can begin detailedassessment of outcomes after various surgeries. We can also look at General Health Relates to Disability in Back and Neckoutcomes after two years of conservative care (physical therapy, Patientsinjections, etc., but no surgery). With disabling back or neck pain, patients’ perceptions of their The first studies that can be completed when creating a new own health are often decreased. Data is collected on both of thesedatabase are diagnostic studies. For example, one can compare subjects, and while the back and neck disability indexes are forphysician assessment to patient subjective assessment of disability spine-specific pathologies, the health survey is a general form that isand the extent to which they correlate. These studies allow us to used for our knee patients as well. The purpose of this study was toassess the data we are currently collecting. Thus, we have focused on investigate whether patient-reported spine-specific disability corre-these types of studies, as well as one cadaveric study and one study lates with patient-reported general health. They do in fact correlate.using data from patient charts. Patients who reported increased disability both in neck and back also reported decreased general health, both in the physical categories of Spine Data general health and the mental categories of general health. This study will be presented at the 2007 North American Spine 2006 31 1,458 Society 22nd Annual Meeting. The authors of this study are Sarah A. Kelley-Spearing, B.A.; Donald S. Corenman, M.D., D.C.; Rebecca D. Today 182 2,748 Glassman, B.A.; and Karen K. Briggs, M.P.H. 0 500 1,000 1,500 2,000 2,500 3,000 Upper Extremity Range of Motion and the Effect on Tension Surgery Subjective of the Cervical Nerve Roots. Patients with a compressed cervical nerve root (radiculopathy) have pain and/or numbness and tingling down their shoulder and/or arm and hand. Often these patients have what is called a Bakody’s [42]
  • The Year in Research and EducationSign – they hold the arm of the affected side up in the air with the able to obtain questionnaires from eight (89 percent follow-up).forearm or hand resting on top of their head. This position is believed Average satisfaction was 6.9 on a 0-10 scale, 10 being completelyto release tension on the cervical nerve roots of that side. Thus, if one satisfied. Patients were also asked if they had any new spine symptoms.of those nerve roots was compressed, this position would decrease For patients without new symptoms, average satisfaction was 8.8.the compression. The purpose of our study was to use specimens Patients are always asked to scale their average pain and their worstobtained from cadavers and a tensiometer to measure tension on pain on a scale of 0 (no pain) to 10 (excruciating pain).each cervical nerve root contributing to the brachial plexus, as it Before surgery the average low back pain was 4, and thatvaries with different arm positions. number decreased postoperatively to 3. Seventy-five percent of Specimens from three cadavers of different height, weight, and patients improved. Preoperatively, the worst low back pain (LBP)age, all female, were used in this study. In all specimens, tension of of 9, decreasing postoperatively to 6.4. Eighty-seven percent ofall cervical nerve roots C5 through C8 was decreased with arm eleva- patients improved.tion above 170 degrees and with maximum scapular elevation For patients without new symptoms, preoperative pain means(humeral abduction above 170 degrees also causes scapular eleva- were 4 for average LBP and 9 for worst LBP, and the postoperativetion). The position of the arm in the Bakody’s Sign includes both average LBP decreased to 2.25 (87 percent improved) and worst LBPhumeral abduction and scapular elevation. This study and continua- decreased to 5.5 (100 percent improved). One patient had low backtion of related studies could help identify the presentation of a patient numbness rather than pain and reported 100 percent relief of thewith cervical radiculopathy both in the office and on the playing field paresthesia after surgery.and could also help offer temporary positions and solutions to ease This study demonstrates that a decompression surgery canthe pain for these patients. provide relief to patients with stenotic low back pain and that this This study has been submitted to the American Academy of surgery succeeds in about 90 percent of the patients (90 percentOrthopaedic Surgeons Annual Meeting and to the Cervical Spine had enough improvement with the decompression that they did notResearch Society Annual Meeting and is pending review. The authors go on to a fusion surgery). This study has been submitted to theof this study are Donald S. Corenman, M.D., D.C.; David C. Karli, American Academy of Orthopaedic Surgeons Annual Meeting and isM.D.; Dhruv B. Pateder, M.D.; Sarah A. Kelley-Spearing, B.A.; and pending review. The authors of this study are Donald S. Corenman,Eric L. Strauch, P.A.-C. M.D., D.C.; Eric L. Strauch, P.A.-C.; Sarah A. Kelley-Spearing, B.A.; Karen K. Briggs, M.P.H.; and David C. Karli, M.D.Stenotic Low Back Pain: Outcomes of DecompressionSurgery The Clinical Research Database Low back pain affects at least 80 percent of us at some point in The Clinical Research Database began in 1993 and continues toour lives. The most common cause of this pain is degenerative disc grow. The database includes data on knee, shoulder, hip, and spinedisease. However, occasionally low back pain can be caused by cen- patients. The key to the success of this database is effective manage-tral stenosis, a diagnosis not commonly considered, which we refer to ment of information. At the Steadman◆Hawkins Research Foundation,as stenotic low back pain. Central stenosis occurs when something we have developed a method of managing patients’ outcome informa-(central disc herniation, spondylolisthesis [slipped vertebra], bone tion. In an effort to assess patient outcome following treatment at thespurs, ligament hypertrophy, etc.) compresses the central canal, Steadman-Hawkins Clinic, data are collected on every patient seen.which below L1 is a bundle of nerves rather than the central cord. This data consists of both patient and physician assessment ofThis causes back pain unique in nature, for it is clearly aggravated improvement over the preoperative status. All of the collected data iswith extension activities when the diameter of the central canal stored in a Clinical Research Database. This database is governed bydecreases and thus the compression of the nerves is increased. an Internal Review Board from Vail Valley Medical Center. Our goal isThrough a detailed patient history, this diagnosis of stenotic low back to learn from our patients and validate our treatment protocols in anpain can be determined, which then offers a different treatment effort to provide high-quality health care.option than the standard fusion for back pain. The doctor can Knee Databasedecompress the central canal by removing the factor or factorscreating the compression (a central hernia ion, bone spur, etc.). 54,445The purpose of this study was to determine how many patients here 46,146 48,620 42,168 43,200 40,518have ever undergone a decompression surgery for stenotic low 30,158 34,695back pain and how much relief this procedure offered. 24,680 Charts were reviewed for all patients who underwent a decom- 10,330 10,878 11,330 12,402 13,312 15,261 5,965 7,531 8,777pression surgery here and 12 were found that were operated upon 1998 1999 2000 2001 2002 2003 2004 2005 2006for stenotic low back pain. Two were lost to follow-up (one is Surgery Subjectivedeceased and one has Alzheimer’s), and one (10 percent) requireda fusion (the decompression failed). Of the nine remaining, we were [43]
  • [44]
  • The Year in Research and EducationBiomechanics Research LaboratoryMichael R. Torry, Ph.D.; Kevin B. Shelburne, Ph.D.; Takashi Yanagawa, M.A.; J. Erik Giphart, Ph.D.; Feng Zhang, M.S.;John Brunkhorst, Research Intern; Nils Horn, Research Intern; Ted O’Leary, Research InternT he Foundations Biomechanics Research Laboratory (BRL) is a multidisciplinary laboratoryin which the principles of mathematics and engineer-ing are applied to solving complex problems inorthopaedic medicine. A main objective of the BRLis to explain (empirically) the how and why injuries,treatments, surgeries, and various therapies work forsome individual and not for others.MISSION AND GOALSThe Biomechanics Research Laboratorys mission is to further the sci-entific understanding of basic biological processes and to developinnovative approaches for the understanding, prevention, diagnosis,and treatment of musculoskeletal disease. Back row left to right: Feng Zang, M.S.; Erik Giphart, Ph.D.; Takashi Yanagawa, M.A. Front row left to right: Kevin Shelburne, Ph.D.; Michael Torry, Ph.D.Our goals are to:(1) Foster excellence in teaching, research, scholarship, and service approach is designed to maintain and enhance athletic performance, in orthopaedic biomedical engineering. health, and quality of life for the professional, semi-professional,(2) Prepare orthopaedic medical doctors with functional capabilities collegiate, high school, and the recreationally active individual. The to utilize biomedical technology to enhance patient care. programs provided by the Biomechanics Research Laboratory are(3) Educate the medical profession on the uses of such technical unique, diverse, and encompass a complete range of services for equipment in the clinical decision-making process. the physically active or those wishing to return to an active lifestyle(4) Serve as a center for education, research, and leadership in after injury. biomedical engineering. With the statement “helping physicians to make clinical(5) Prepare students for careers in biomedical engineering decisions” as its doctrine, the Biomechanics Research Laboratory characterized by leadership and communication skills and a also seeks to enhance a world-renowned medical doctor Fellowship commitment to lifelong learning. Program by providing quality research education, guidance, support,(6) Educate the public about the uses of biomedical engineering in and consultation to the partners and medical fellows of the Steadman- orthopaedic medicine. Hawkins Clinic.(7) Publish scholarly research in scientific, peer-reviewed journals in order to increase the quality of care in orthopaedic in general. 2006 IN REVIEW: DIRECTOR’S MESSAGEOVERVIEW 2006 (and 2007 to come) was deemed largely an in-house development and growth period for the BRL group. I am tremendously The Foundations Biomechanics Research Laboratory (BRL) is pleased with the effort the BRL has shown over the last year. In 2006,a multidisciplinary laboratory that applies quantitative, analytical, and we dedicated ourselves to building a one-of-a-kind, biplane fluo-integrative methods to the field of orthopaedic medicine. The staff of roscopy system. This system is quite complex and has required con-kinesiologists, mechanical engineers, biomedical engineers, and siderable development time from the staff, and anytime you chargecomputer scientists integrate clinical care, research, and education through areas of scientific discovery there are always delays andwith the resources of world-renowned medical doctors in order to obstacles to overcome. Despite these, the BRL still managed to publishimprove the treatment of musculoskeletal diseases. This focused at a rate that is consistent with its publication history. The work out- put for the BRL for the year 2006 has been exemplar, with 13 refereedResearch intern Ted OLeary, the captain of the University of Denvers abstracts presented at four national and international scientifictwo-time NCAA championship hockey teams, prepares for a slap shot inthe Biomechanics Research Laboratory. [45]
  • evidence that valgus (outward angulation) bracing slows the progres- sion of knee OA. The mechanism by which valgus bracing relieves pain and improves function is not fully understood, perhaps because there are multiple factors involved. Valgus bracing applies an external load to the knee that may shift knee load from the medial side to the lateral side. In addition, unlike lateral heel wedging, knee bracing produces measurable changes in how people walk. Recently, the Biomechanics Research Laboratory undertook a study to determine the change in knee load that may be achieved by a lateral heel wedge and a valgus knee brace during level walking. Based on the results of previous studies, our primary hypothesis was that both lateral heel wedges and valgus knee braces produce signifi- cant changes in the force transmitted by the medial side of the knee. The effect of a lateral heel wedge and valgus brace on knee load was calculated using a combination of laboratory measurements and three-dimensional computer simulation. The results showed that both lateral heel wedging and valgus knee bracing reduce medial knee loading during walking. However, knee bracing had a greater capacity for reducing medial knee load than did lateral heel wedging. The valgus brace achieved a reduction in medial knee load throughout each stride of walking, whereas the lateral heel wedge was effective only when the force between the footconferences. The BRL has also produced seven original full-length and the ground was high. Nonetheless, the effect of either interven-research papers. It is important to note that the quantity of the work tion was not dramatic. Even with a knee brace and lateral heelis backed by substantial quality. Each year our research gets stronger wedge, the medial side of the knee still transmitted the vast majorityand stronger, and we are receiving recognition from our peers for the of joint load. In addition, the ability of lateral heel wedges and valgusquality of our work, states Dr. Torry. Some of our research for the bracing to reduce medial knee load is reduced when knee loadsyear 2006 is summarized below. are high to begin with. These results are consistent with the clinical finding that these treatments are less effective in patients withEFFECTIVENESS OF FOOT ORTHOSIS AND KNEE BRACING moderate to severe knee OA.FOR REDUCING KNEE LOADS DURING WALKING. MECHANICAL VALIDATION OF A CLINICAL TEST TO For most people, the majority of the joint load at the knee is IDENTIFY HIP INSTABILITYborne by the medial, or inner, side. This concentration of joint loadmay explain the clinical observation that knee osteoarthritis (OA) The majority of patients who require hip arthroscopy are young,occurs most frequently toward the medial side of the knee. The aim active individuals with a history of hip or groin pain. In these athletes,of treating knee OA with orthotics is to reduce pain and increase sometimes the onset of hip pain is traumatic after a fall or collision.function by reducing the knee load. The strategy is supported scien- At other times the onset is chronic due to excessive range of motiontifically by the relationship between pain and knee load in knee OA and overuse. These injuries often lead to excessive hip laxity, whichpatients. The use of lateral heel wedges to relieve knee pain and if left undetected or untreated, develops into debilitating labral tears.reduce knee load is based on the premise that placing a lateral wedge Thus, the early identification and diagnosis of hip instability is para-under the foot will shift load away from the medial side of the knee. mount to effective treatment and prevention of further hip degenera-The clinical success of lateral wedges has been documented in a tion. An established and reliable clinical exam to detect hip instabilitynumber of studies that found reduced use of pain medication in is needed and is currently non-existent.patients who wore a lateral heel wedge. However, clinical studies Dr. Marc J. Philippon has significant experience treating patientsalso indicate that the effect of the lateral wedge may be limited with hip capsular laxity. He has developed a clinical exam, the hipbecause it has little positive impact on persons with more advanced log roll test, to assess varying degrees of capsular laxities. During theknee OA and no impact on progression of the disease. hip log roll test, the patient will lie straight on his or her back on the Akin to lateral heel wedges, there is good evidence that knee examination table and is instructed to relax into a resting position.bracing provides some pain relief and a modest degree of improved The examiner firmly places his hands around the knee, rotates the legfunction. However, like lateral heel wedges, there is no convincing outward, and assigns one of four hip log roll grades indicating “no to severe” hip laxity. [46]
  • The Year in Research and EducationImages from biplane fluoroscopy system that is used to validate hip clinical exams. To mechanically validate the 4-grade hip log roll test, we have TSAs performed annually in the United States increased from aboutdesigned the following two experiments: (1) a selective cutting exper- 5,000 in the early 1990s to over 20,000 in 2005. This is largely dueiment of the iliofemoral ligament in cadaver specimens to establish to the aging population and its desire to stay active, but it is also duethe sensitivity of the log roll test to deficiencies in the two bands of to better prosthesis designs, better surgical techniques, and morethe iliofemoral ligament (the hip’s primary constraint to outward experienced surgeons. Depending on the underlying pathology, tworotation); and (2) an objective evaluation of the iliofemoral ligament types of prostheses are used: primary or inverse. While the overalland, as well, the hip log roll test in patients while in the operating outcomes that are reported after shoulder replacements are good,room. Outward rotation while performing the log roll test will be normal shoulder function is on occasion not fully restored and themeasured objectively with a highly accurate x-ray motion analysis reasons for this are not well understood.system (3D fluoroscopy; translational and rotation accuracies of 0.1 Currently, the laboratory techniques used to measure shouldermm and 0.1 degrees, respectively). All hip log roll evaluations will be motion (kinematics) in living subjects (in vivo) are quite limited asperformed by Dr. Philippon and three athletic trainers to assess inter- they do not measure with sub-millimeter levels of accuracy. In addi-observer reliability of the grading of the hip log roll test. To date, a tion, it is impossible to measure the motion of the shoulder bladesuccessful pilot study has been performed, and we are actively (scapula) using standard laboratory techniques due to its significantpursuing funding for this project. movement under the skin during shoulder motion. Even attaching The results of this study will help validate the hip log roll as a optical markers to pins inserted directly into bones will result in jointclinical exam to pre-operatively identify and diagnose hip laxity, as kinematic errors of 2-4mm, which is still insufficient to measure thewell as help assess the ability of operative capsular modification pro- subtle motion changes expected to cause significantly different func-cedures (such as thermal capsulorrhaphy and/or capsular plication) tional outcomes after shoulder TSA. Therefore, new experimentalto correct this laxity. It is our belief that a validated hip log roll test data during functional motions measured with sub-millimeter accura-will improve the identification and diagnosis of hip instability, as well cy are needed to improve our understanding of the shoulder as wellas assist rehabilitation following arthroscopic repair. This will greatly as prosthesis motion and function.benefit patients who are currently undiagnosed or even misdiagnosed This study uses a novel biplane fluoroscopy system that imagesand those who will be treated arthroscopically. the bones and implants in patients directly to measure shoulder kinematics with sub-millimeter accuracy. We will record kinematics of 20 primary TSA, 20 inverse TSA, and 20 healthy subjects while3-DIMENSIONAL MEASUREMENT OF IN VIVO SHOULDER performing four basic motions of daily living, which are also partMOTION USING BIPLANE FLUOROSOCOPY of standard clinical evaluations. Measurements will be made of the shoulder joint pre- and six months post-TSA for both implant types Patients who have continued shoulder pain and loss of function and will be compared to healthy shoulder motion. We hypothesizein the presence of advanced joint disease and who have failed non- that these measurements will reveal that shoulder kinematics followingoperative treatment are often managed by undergoing a total shoulder primary or inverse TSA are significantly improved (closer to normal)replacement or Total Shoulder Arthroplasty (TSA). The number of compared to pre-TSA. We also hypothesize that kinematic differences [47]
  • Very little information exists to describe the motions of the body in youth or adult ice hockey players.will be directly correlated with clinical outcome and with durability/ subscapularis muscle during this examination and to determinesurvivorship of the implants. To date, we have recruited several whether, in fact, this test is appropriate to isolate a subscapularis tear.healthy subjects, are in the process of imaging the first shoulders, An upper extremity computer model was employed to estimate forcesand are actively pursuing funding for this project. in the shoulder. The subscapularis muscle produced the largest The results of this study will lead to a deeper understanding of torque (3.6 Nm) during the negative position. In the negative posi-diseased shoulder motion and of implant motion following TSA, and tion without the subscapularis, the force to the abdomen by hand wasof normal shoulder motion. We hope it will also lead to the discovery decreased from 93 N to 5 N. Thus, the subscapularis muscle is theof outcome predictors based on postoperative (abnormal) implant major contributor to internal rotation torque during the belly-pressmotions, improved implant designs, and more satisfied patients. test. This data provides theoretical evidence that the belly-press test is an appropriate exam for a subscapularis muscle tear. SIMULATIONS OF SUBSCAPU- LARIS CLINICAL EXAMINATIONS. ANALYSIS OF ICE HOCKEY MOVEMENTS IN YOUTH AND The “belly-press test” is a clinical ADULT PLAYERS examination to help diagnose a sub- Ice hockey is a popular winter sport throughout Canada and scapularis tear (one of the rotator cuff many parts of the United States, and its popularity is rising due to muscles) in the clinic. A patient is increased exposure in many non-traditional, geographic areas. Ice asked to press the abdomen region by hockey combines tremendous speeds with aggressive physical play rotating the arm internally as shown in and therefore has great inherent potential for injury. A large majority the figure below. Despite widespread (more than 75 percent) of the injuries suffered by hockey players clinical use, the actual mechanics of occurs due to an impact with either another player or with the how this test actually works is largely boards. These impacts lead to the high number of concussions, knee unknown. The purpose of this study medial collateral ligament sprains, acromioclavicular joint injuries, was to understand the function of the and ankle sprains. In addition to these common injuries, many other [48]
  • The Year in Research and EducationImage of professional hockey player being analyzed in Biomechanics Research Laboratory.injuries do not result from impact. Adductor strains, sacroiliac dys- 28-foot ice slab. “It’s not real ice, but a really, really close facsimile,”function, chondral injuries, labral injuries, and many of the previously states Torry. The research project is designed to provide performancementioned problems occur without the influence of impact. data on ice hockey players ranging in age from 12 to over age 40. The Biomechanics group has dedicated itself to understanding The data derived from this study will be compared among the agehockey injuries. While sounding simple, this is no small feat. The ranges to determine similarities and differences in different shotfirst issue was to build an “ice rink” in our laboratory, because if you and skating mechanics across the lifespan. This data, it is hoped, willwant to study hockey, you have to study skating techniques. With help provide information on how and why both youth and adult hockeyfrom BRL Intern Ted O’Leary (former Denver University Hockey Team players obtain or exacerbate orthopaedic injuries.member and two-time NCAA Champion) the BRL laid down a 12- byTaking Advantage of the Charitable Gift IRA RolloverLegislation: “It Was Easy and It’s Good Stuff for Mankind”“W e wanted to utilize the full mini- Biomechanics Lab. Why mum distribution required from did they make thatour IRA and have it make a difference,” choice? Their son, Kevinsays O.B. Shelburne. “It was so easy. And a B. Shelburne, Ph.D., agift to the Foundation — that’s good stuff senior staff scientist infor mankind.” That’s what prompted him the lab, keeps themand his wife, Rita, to take advantage of abreast of the cutting-Congress’ 2006 legislation, the Pension edge research andProtection Act, permitting charitable gifts accomplishments of theto be transferred from IRAs directly to char- lab. With a distin-itable organizations. guished career in the The Shelburnes’ tax bracket is at a space program, Kevin is The Shelburnes, with a family of three children, eight grandchildren, andlevel that making an outright gift to the now a leading world two great-grandchildren, are retired and live in the Texas hill country.Foundation isn’t financially advantageous. researcher in biome- After growing up and marrying in Texas, they moved to Wisconsin, where Mr. Shelburne received a Ph.D. in geology and pursued a 32-year careerBy taking advantage of the legislation, they chanics and computer with Mobil Oil.made a wonderful gift and satisfied their modeling of joints,minimum distribution requirement without which is transforming gift did that! It’s a great way to feel con-increasing their taxable income. approaches to surgery and treatment. nected to the difference you can make.” “We don’t have a medical history with For others who may be considering aOur Gift Did That! the Foundation,” adds Mr. Shelburne. gift, Mr. Shelburne encourages folks to do The Shelburnes created the Rita and “We’ve never been patients, but we like so. “It’s a great feeling to help people.O.B. Shelburne Fellowship Fund in the the research areas of the Biomechanics Lab, And this was a wonderful and easy oppor- and when advances occur we can say our tunity to get involved.” [49]
  • [50]
  • The Year in Research and EducationEducationGreta Campanale, coordinator on medical coverage of Major League Baseball’s Colorado Rockies,T he Foundations primary mission is to conduct research that can be applied directly toorthopaedic medicine. To this end, education is also the NFL’s Denver Broncos, the U.S. Ski Team, and Eagle County High School sports teams. The stream of knowledge and information flows both ways.an important part of our work. We offer training The Fellows, having completed their formal training in leadingthroughout the year to physicians in residence, to orthopaedic programs, share knowledge they have gained from years of training with the physicians and scientists of the Foundation.visiting medical personnnel, and during international D r. B r e t t C a s c i o was born and raised in New Orleans,medical meetings. In addition, the education depart- Louisiana. He attended Duke University, where he majored in historyment produces videotapes and educational programs and biology and played club football and baseball. He graduated withon the internet. Members of the staff report their honors from Louisiana State University Medical School in New Orleans, where he was president of Alpha Omega Alpha. Dr. Cascioresearch through publications, presentations, and completed his orthopaedic surgery residency at The Johns Hopkinsposters. The education department provides adminis- Hospital, where he was named Administrative Chief Resident. Dr.trative support for educational programs and confer- Cascio is a captain in the U.S. Army Reserves. His two main areas ofences, responds to the press, and teaches high school research are cartilage regeneration and the medicolegal aspects of compartment syndrome. Dr. Cascio has presented his research atstudents about human anatomy and injury. several national meetings, including the American Academy of Orthopaedic Surgeons and the International Cartilage Repair Society, and has published his work in journals such as the Journal of BoneFELLOWSHIP PROGRAM: Learning As We Teach and Joint Surgery and Clinical Orthopaedics and Related Research. Considered one of the most prominent and rigorous academic D r. M i c h a e l H u a n g graduated summa cum laude with anfellowship programs in orthopaedic sports medicine, the Steadman- undergraduate degree in neuroscience from the University ofHawkins Fellowship Program is at the core of the Foundation’s educa- Pennsylvania. He attended medical school at Washington Universitytional effort. Each year, six young orthopaedic surgeons are chosen School of Medicine in St. Louis. His orthopaedic surgery residencyfrom more than 100 candidates to become Steadman-Hawkins was completed at the University of Iowa Hospitals and Clinics. Dr.Fellows. They are with us for an intensive 12-month training period to Huang was involved with the Cedar Rapids Roughriders Hockey team,refine their skills in orthopaedic surgery and to investigate the causes, helping them win the United States Hockey League’s Clark Cupprevention, and cures of degenerative arthritis, as well as the treatmentand prevention of injuries. Our goal is to prepare our Fellows to be (continued on page 53)the leaders in the field of orthopaedic sports medicine for theremainder of their careers. The Foundation currently maintains a network of more than 160 How do surgeons get accepted intoFellows who share advanced ideas and inspire each other to higherlevels. We are fortunate in Vail to work with the best young physicians the Fellowship Program?in the world. Their insight and enthusiasm during this rewardingprogram has demonstrated to us many times over that we, too, learnas we teach. E very year, on average, approximately 600 surgeons gradu- ate from orthopaedic residency programs in the United States. These surgeons become board certified and are ready to enter practice. A select few elect to continue their educa-2006-07 Steadman-Hawkins Fellows tion for one more year in a fellowship program such as Six new members of the incoming “class” of Steadman-Hawkins Steadman-Hawkins’ program. Last year more than 160 applica-Fellows spend a year refining their skills as they make final prepara- tions were received by the Foundation from young surgeonstions for a career as orthopaedic surgeons. Each Fellow has the around the world. After interviews and presentations, six wereopportunity to be actively involved in Clinical Research, Basic Science, selected by the screening committee.and Biomechanics research. In addition, they also experience hands-(continued on page 53) [51]
  • Local Students Get a Look at a Real Knee: ResearchFoundation Provides Students with a Close Look at MedicineBy Scott N. Miller, Preston Utley/Vail DailyK ate McAtavey thought she might be the one to run out of the room, butshe did fine. McAtavey and a group ofstudents from an anatomy class atColorado Mountain College were recentlyinvited to a special presentation in thedepths of Vail Valley Medical Center.There, Dr. Brett Cascio would stick anarthroscope into a real human knee, thendissect the joint. The knee came fromsomeone who donated his or her body toscience after death. "I was a little nervous about it,"McAtavey said of watching Cascio explainhow the knee joint works. "But Im doingall right now." In fact, as Cascio got deeper intothe anatomy of the joint, the students Dr. Brett Cascio shows Colorado Mountain College students the inside of a knee.gathered around for a closer look at thetendons, arteries, and nerve bundles. "This is taking what we read and patients before and after surgery. Coming to Vail has been a goodmaking it real," McAtavey said. Thomson plans to attend nursing school experience for Cascio, whose own The chance to look at real body parts starting next year and was excited to see research has focused on regeneratingup close is an experience usually reserved some up-close medical work. "It really human cartilage, something that not longfor students at universities and teaching helps make the connection between class ago couldnt be done. Some of that workhospitals. This class got the chance work and reality," Thomson said. involves "microfracture" knee surgery, abecause of the Steadman◆Hawkins The reality, seen from just one joint, procedure that, in many cases, can getResearch Foundation. The Foundation, is that human anatomy is complex, and professional athletes playing again.which works with, but is separate from, any surgery has little room for error. "If "People are working on a lot ofthe Steadman-Hawkins Clinic, brings in this looks hard, thats because it is," things," Cascio said. "But nothing reallydoctors from around the world to study Cascio said as students watched on a works better than microfracture." Thatsurgical techniques at the Clinic, then video screen as he examined the knee work, with research conducted by theengage in their own research projects. joint with the tiny, flexible arthroscopic Foundation and surgery performed by The doctors work also includes some camera. "If it looks easy, thats because the Clinic, has applications far beyondteaching sessions. Classes from local high I’ve practiced. Because its so easy to leave stadiums and arenas.schools take part in those sessions once or scars or damage nerves, much of that For Smith, that benefit is filteringtwice a year. Matt Smiths Colorado practice is done on donated body parts down to his students. "This kind of thingMountain College students have started when doctors are still in training.” is huge," Smith said as Cascio continuedcoming only recently, thanks to a connec- After orthopaedic residency, many his work in another room. "To get in heretion. “One of my students worked at the physicians apply for "fellowships." The and see a real human knee is a uniquehospital and arranged this,” Smith said. Steadman-Hawkins Fellowship Program experience." Several of Smiths students work at is one of the most sought after in Reprinted with permission from the Vail Daily, Vail,the hospital this semester. One of those orthopaedics. Of the approximately 600 Coloradostudents, Heather Thomson, cares for physicians who graduate from orthopaedic residency programs in the United States, approximately 120 (160 applied in 2006) apply for the Steadman- Hawkins Fellowship. From this pool of applicants, only six per year are selected. [52]
  • The Year in Research and EducationDr. Steadman, right, with Steadman-Hawkins Fellow Dr. Kevin Crawford.championship in 2005. His research experience includes evaluation Louis. During his training, Dr. King’s research was published in Theof the role of angiogenesis in osteochondral healing. He is published Journal of Bone and Joint Surgery, Seminars in Arthroplasty, andin journals such as Spine, Journal of Pediatric Orthopaedics, and Techniques in Sports Medicine. Dr. King was the recipient of thethe Iowa Orthopaedic Journal. Leonard Marmor Foundation Award for outstanding resident research D r. B e n j a m i n H u f f a r d graduated from Lehigh University in for his paper on femoral deformity in tibia vara. His other areas ofBethlehem, Pennsylvania, with a bachelor of science degree in civil interest include biologic resurfacing in glenohumeral arthroplasty andengineering. He attended Yale University for the post-baccalaureate meniscal repair devices.premedical program from 1995 to 1996. Following his premedical D r. C o l i n L o o n e y graduated magna cum laude fromtraining, Dr. Huffard attended the Yale University School of Medicine, Washington and Lee University with a bachelor of science degree ingraduating with his doctorate of medicine, in 2001. Dr. Huffard com- biology. He was a member of the Phi Beta Kappa Honor Society. Hepleted an internship in general surgery at the New York Hospital in completed his doctorate of medicine in 2001 from Duke University2002 and his orthopaedic surgery residency was completed at the School of Medicine, graduating as a member of the Alpha OmegaHospital for Special Surgery. Dr. Huffard’s current research is “A Alpha Honor Society. He finished his orthopaedic surgical residencycomparison of Achilles tendon repair strength using the Krackow at the Duke University Medical Center in Durham, North Carolina. Dr.Suture with the Achillon7 Tendon Repair System: An anatomic in Looney served as the resident team physician for the Duke Universityvitro biomechanical study.” Additionally, Dr. Huffard spent time as a basketball and football teams and has also served as the residentresearch assistant at the Young-Penny Lab in Boston, Massachusetts, physician for the North Carolina Central University. He has beenfrom 1996 to 1997. He is published in Foot & Ankle International published in numerous journals, presented at several meetings, andand has made presentations at the American Pediatric Society for has been active in research.Pediatric Research, the Society for Neuroscience, and the World D r. Yi - M e n g ( B e n g ) Ye n graduated cum laude from theFederation of Neurology Research Group on Huntington’s disease. University of California, Los Angeles, with degrees in chemical engi- D r. D a v i d K i n g graduated from the University of Virginia, neering and economics. He completed his master of science degreewhere he was an interdisciplinary major in neuroscience. He then in engineering before starting in the Medical Scientist Trainingobtained a medical degree from Emory University and completed his Program at UCLA. He completed his Ph.D. in biological chemistry andresidency in orthopaedic surgery at Washington University in St. was named Alpha Omega Alpha during medical school. He finished [53]
  • The Year in Research and Education Where are they now. . . M embers of the graduating class of 2005/2006 Steadman-Hawkins Fellows are busy establishing new careers in orthopaedics. Mark Adickes, M.D., has joined the medical staff at the his orthopaedic residency training at the University of California, Los Roger Clemens Institute for Sports Medicine and Human Angeles. He has been published in numerous journals and has Performance in Houston, Texas. received awards for both basic and clinical science. Once he com- Dominic Carreira, M.D., is completing foot and ankle fel- pletes his fellowship at Vail, he will start a Pediatric Orthopaedic lowships with Dr. Pierce Scranton in Kirkland, Washington, Fellowship at Boston Childrens Hospital. and Dr. Mark Myerson in Maryland. Ultimately, he will D r. T h o m a s Vi e h e hails from Newport Beach, California. In reside in Fort Lauderdale, Florida, where he will practice as 1995, he graduated with distinction in all subjects with his bachelor a foot, ankle, and hip arthroscopy specialist providing of arts degree in history from Cornell University. In 2001, Dr. Viehe orthopaedic services for high schools in Broward County graduated from the Medical College of Wisconsin. He served as the and professional teams. student body president from 1999 to 2000. Dr. Viehe comes to Vail after having completed his orthopaedic residency training at Emory A. Martin Clark, M.D., has moved to the Phoenix area, University in Atlanta. Once he completes his fellowship at Vail, he will where he is working as a sports medicine specialist in a start a Foot and Ankle Fellowship with Dr. Roger Mann in Oakland, growing group called The Core Institute. California. Dr. Viehe has been active in researching several projects involving femur fractures. His findings have been presented before the Stephen A. Hunt, M.D., has joined a private practice in American Academy of Orthopaedic Surgeons, the Orthopaedic Bedminster, New Jersey. Trauma Association, the Southern Orthopaedic Association, and the Todd L. Johnston, M.D., proudly joins his father’s busy Georgia Orthopaedic Society. Additionally, he has been part of a spine practice in Waterloo, Iowa, at the Cedar Valley Medical infection research project presented at the annual meetings of the Specialists. He is excited to have the opportunity to make American Academy of Orthopaedic Surgeons, the North American an impact on the community in which he grew up. Spine Society, the Southern Orthopaedic Association, and the Georgia Orthopaedic Society. Dr. Viehe has also published a paper in Scott W. Kimmerly, M.D., has joined the practice at Arthroscopy on the effects of electrocauterization in the arthroscopic Emory University Department of Orthopedics. management of chondromalacia of the knee. Dr. Yi-Meng Yen, left, assists Dr. Philippon, center. [54]
  • A. Martin Clark, M.D., and Mark Adickes, M.D.:Different Paths, Same DestinationBy Jim Brown, Ph.D.O ne was born in Minnesota and raised in northern Virginia. The other wasborn in Germany, the son of an Army chap-lain, and grew up on military bases all overthe world. One did his undergraduatework at Harvard; the other earned a busi-ness degree at Baylor. One went toColumbia Medical School, then to NewYork Presbyterian for his residency; theother to Harvard Medical School at age 35,where he was the second-oldest in his class, Dr. Clark (left) assists Dr. Steadman. Dr. Adickes examines a patient.then to the Mayo Clinic. Impressive differences in results of two kinds of ACL family and enjoying the surroundings.”résumés so far, but there’s more. surgery, working on hip arthroscopy papers Adickes shares that sentiment. “I am One played professional squash, won with Dr. Marc Philippon, and writing a amazed at how collegial the Clinic andfour U.S. National Championships, and chapter in a book chapter on rotator cuff Foundation staffs have been. Dr. Steadmanrepresented the United States in the World repairs with Dr. Peter Millet. is a truly humble man—and there are notGames and Pan American Games. The Adickes is investigating the outcomes many humble surgeons — who caresother had at 10-year career in professional of arthroscopic knee and hip surgery on deeply about patients. At Steadman-football, including three with the NFL players, and he is reviewing 130 video- Hawkins they only hire people who treatWashington Redskins, where his team won tapes of microfracture procedures to com- colleagues and patients the same way. Ita Super Bowl. One is newly married. The pare the results performed on those with was like wearing a pair of well-worn slip-other has been married 13 years and has degenerative knee conditions to patients pers — very comfortable — right from thefive children. who suffered traumatic knee injuries. start. My wife, Jackie, is amazed that every Who are these former sports stars and Says Clark, “The Foundation generates person she meets there is so nice and sofuture orthopaedic superstars, and how did so many ideas for research, there is never a happy.”their paths finally converge as Steadman- lack of projects from which to choose.”Hawkins Fellows? What’s Next? Adickes adds that, although the staff makes you think the research was your Dr. Clark and his wife, Maja, will beWhy Steadman-Hawkins? idea, they probably knew what needed to moving to Phoenix this summer. He will be “I started hearing about Steadman- be done all along and were waiting for the a sports medicine and hip arthroscopy spe-Hawkins when I was a resident in New right person to come along. cialist at the Core Institute, a clinic andYork,” recalls A. Martin Clark, M.D., “not One way those who are interested can research facility with a structure closelyonly because of its reputation as one of support the Foundation is by sponsoring a resembling that of the clinic in Vail and thethe premier clinics in the world, but also Steadman-Hawkins Fellow. During their Steadman◆Hawkins Research Foundation.because of the volume of research con- August-to-July terms, each Fellow is asked Dr. Adickes will join the staff at Memorialducted at the Foundation and published in to stay in touch with his or her sponsor. Hermann Hospital in Houston as co-direc-scientific journals.” Clark, Adickes, and their colleagues write tor of a new sports medicine group that Mark Adickes, M.D., heard about letters, talk on the phone or in person, and will, among its other programs, provideSteadman-Hawkins when he was a player keep their sponsors informed about their services to the Houston Rockets, Houstonin the United States Football League and work and their plans. Comets, and Rice University.the National Football League, and laterwhen he began his medical studies. A Personal Message Looking Back“You have these incredibly accomplished What would Drs. Clark and Adickes Now that both men are completingsurgeons out there who are also brilliant tell potential supporters of the Steadman◆ their one-year Fellowship programs, theyscientists and world-class researchers. Hawkins Research Foundation? “You can look back at their experiences with aAlmost everybody I knew wanted to get in would be investing your money in research perspective that lived up to their expecta-as a Steadman-Hawkins Fellow, but only a that is meant to help active people main- tions. “When you are not part of thefew are invited. (Six per year out of tain an active lifestyle,” says Clark. Steadman-Hawkins family, you sort ofapproximately 120 applicants, to be exact.) “At Steadman-Hawkins, there is a wonder why their outcomes are so good,”“I did well in med school and on my MCAT, group of dedicated surgeons and fellows says Clark. “But once you are there, youbut I was still nervous about my chances.” who take research that has been done, is begin to understand that there is a magic about the Clinic and the Foundation and being done, and will be done very serious-Research Interest the way the whole thing works. I soaked it ly,” concludes Adickes. “The Foundation’s In addition to clinical, operating up and have enjoyed every minute. It is research will better the lives of people withroom, and educational responsibilities, one year in your life when you get to train orthopaedic problems. Your support will beeach Fellow at the Steadman◆Hawkins with the best orthopaedic surgeons in the money well spent.”Research Foundation participates in world, as well as spending time with yourresearch efforts. Clark is looking into the [55]
  • Publications and Presentations [56]
  • Publications & PresentationsA primary goal of the Foundation is to distribute the results of its research. In 2006, principal investigators and Fellows published 47 papers in scientificand medical journals and delivered 189 presentations to a variety of professionaland lay audiences worldwide.2006 PRESENTATIONS Briggs KK, Steadman JR. Psychometric Crawford K, Briggs KK, Steadman JR. properties of the Lysholm knee score and Psychometric Properties of the IKDC ScoreBitting SS, Schlegel TF, Boublik M. Grade Tegner activity scale for osteoarthritis of for Meniscus Injuries of the Knee. Poster,III lateral collateral ligament injuries of the knee. 2006 European Society of Sports American Academy of Orthopaedicthe knee in professional football players. Traumatology Knee Surgery and Surgeons 73rd Annual Meeting, Chicago,National Football League Physicians Arthroscopy, Innsbruck, Austria, Apr 2006. Mar 2006.Society Annual Scientific Meeting,Indianapolis, Feb 2006. Briggs K, Hines S, Rodkey WG, Crawford K, Briggs KK, Steadman JR. Steadman JR. Lysholm score and Tegner Reliability, validity, and responsiveness ofBriggs KK, Kocher MS, Rodkey WG, activity level in normal knees. Poster. the IKDC score for meniscus injuries of theSteadman JR. Psychometric properties of European Society of Sports Traumatology, knee. Arthroscopy Association of Norththe Lysholm knee score and Tegner activity Knee Surgery and Arthroscopy, Innsbruck, America, Hollywood, Fla, May 2006.scale for meniscus injuries of the knee. Austria, May 2006.Poster. 6th International Cartilage Repair Giphart JE, Shelburne KB, Torry MR.Society Symposium, San Diego, Jan 2006. Briggs K, Hines S, Rodkey WG, Biplane Fluoroscopy for Motion Analysis. Steadman JR. Patient knee function and Philips Surgery 3D-RX Intro and TrainingBriggs KK, Hines S, Steadman JR. Patient activity level 5 years post-arthroscopy Meeting, Miami, Fla, Oct 2006.knee function and activity level 5-year post- compared to normal values. Poster.arthroscopy compared to normal values. European Society of Sports Traumatology, Gobezie R, Lee D, Krastins B, Kho A, ChaseAmerican Academy of Orthopaedic Knee Surgery and Arthroscopy, Innsbruck, M, Sarracino D, Millett PJ. Highly SensitiveSurgeons 73rd Annual Meeting, Chicago, Austria, May 2006. and Specific Synovial Fluid ProteinMar 2006. Biomarkers for Osteoarthritis Identified Briggs KK. Clinical Outcomes Research. Using Proteomic Analysis. AbstractBriggs KK, Hines S, Steadman JR. Lysholm Piper Jaffray Investors Summit, Vail, Review, Annual European Congress ofscore and Tegner activity level in normal Mar 2006. Rheumatology: European League Againstknees. Poster. American Academy of Rheumatism, Amsterdam, Netherlands,Orthopaedic Surgeons 73rd Annual Corenman DS. Artificial Disc Replacement: Jun 2006.Meeting. Chicago, March, 2006. The Controversy. Steadman◆Hawkins Research Foundation Orthopaedic & Spine Lecture Series, Vail, May 2006.Reaching Out to the WorldT he Foundation’s research findings are shared with physicians and scientists around the world. We offer training throughout the year to physicians in residence, visiting medical personnel, and participants at the international medical conferences that we host. To reach professionals who are unable to come to us, Foundation scientists and physicians report their research worldwidethrough peer-reviewed publications and presentations. We have produced more than 480 papers, 1,200 presentations and 80 teachingvideos — many award-winning — that have been accepted by medical and scientific journals and organizations worldwide. We disseminate our findings to the general public and school students as well, through videotapes, educational programs, theInternet, and media outlets. [57]
  • Gobezie R, Krastins B, Lavery K, Warner JP, Millett PJ. Nonunion and Post-Traumatic Millett PJ. Massive cuff tears: what to doMillett PJ. Complications Associated with Arthritis of the Shoulder: Arthroplasty when all else fails? Rocky Mountainthe Use of Pain Control Infusion Pumps Challenges. Orthopaedic Update 2006: Shoulder and Elbow Society Inaugural(Pcips) After Arthroscopic Shoulder Shoulder, Elbow, Hip and Knee, Vail, Jun Meeting, Vail, Jun 2006.Surgery. Poster, American Orthopaedic 2006.Society for Sports Medicine 2006 Annual Millett PJ. Glenoid Exposure—How to seeMeeting, Hershey, Pa, Jul 2006. Millett PJ. Periprosthetic Fractures of the it every time. Rocky Mountain Shoulder and Humerus. Orthopaedic Update 2006: Elbow Society Inaugural Meeting, Vail,Hackett TR. Elbow Disorders of the Shoulder, Elbow, Hip and Knee, Vail, Jun Jun 2006.Overhead Athlete. Steadman◆Hawkins 2006.Research Foundation Orthopaedic & Spine Millett PJ. Common Adult ShoulderLecture Series, Vail, Jun 2006. Millett PJ. Management of Complex Disorders — Update for 2006. Piper Jafray Deformities with Prosthesis Adaptable in 3- Investors Summit, Vail, Mar 2006.Hackett TR, Torry MR, Decker MJ, Sabick D. Orthopaedic Update 2006: Shoulder,M, Noonan T, Hawkins RJ, Millett PJ. Elbow, Hip and Knee, Vail, Jun 2006. Millett PJ. Non-prosthetic options for proxi-Diffrerences in kinematics between youth mal humerus fractures. Rocky Mountainand professional baseball players. Millett PJ. Complex instabilities—bone and Shoulder and Elbow Society InauguralAmerican College of Sports Medicine soft tissue deficiencies. Rocky Mountain Meeting, Vail, Jun 2006.Annual Meeting, Denver, Jun 2006. Shoulder and Elbow Society Inaugural Meeting, Vail, Jun 2006. Millett PJ. Technique-endoscopic scapu-Holsten DG, Rodkey WG. An all-inside lothoracic bursectomy. Rocky Mountainsuture technique for use with Collagen Millett PJ. Advanced strategies for rotator Shoulder and Elbow Society InauguralMeniscus Implants (CMI). Poster, European cuff repair. Advanced Shoulder Meeting, Vail, Jun 2006.Society of Sports Traumatology, Knee Arthroscopy Course, Denver, Sept 2006.Surgery and Arthroscopy, Innsbruck, Millett PJ, Gobezie R, Krastins B,Austria, May 2006. Millett PJ. Partial articular-sided Tsaniklides N, Warner JP. Interference supraspinatus tendon avulsions repair tech- Screw vs. Suture Anchor Fixation for OpenKernozek TW, Torry MR, Wallace BJ, Miller nique. International Shoulder Symposium, Subpectoral Biceps Tendesis: Does itEJ. Biomechanics of a failed single legged Naples, Fla, Apr 2006. Matter? 20th Congress of the Europeanlanding due to fatigue. American College of Society for Surgery of the Shoulder and theSports Medicine Annual Meeting, Denver, Millett PJ. Management of the patient with Elbow, Athens, Greece, Sept 2006.Jun 2006. an acute dislocation with a rotator cuff repair. International Shoulder Symposium, Millett PJ. Advanced strategies in arthro-Krastins B, Sarracino D, Thornhill TS, Naples, Fla, Apr 2006. scopic rotator cuff repair: SubacromialMillett PJ. Identification of a Protein decompression/distal clavicle excision.Biomarker Profile for Osteoarthritis in Knees Millett PJ. Management and new tech- Advanced Techniques for Rotator CuffUsing Proteomic Analysis. American niques for SLAP repairs. International Repair, Biceps Tenodesis. MastersAcademy of Orthopaedic Surgeons 2006 Shoulder Symposium, Naples, Fla, Apr 2006. Shoulder Course, Las Vegas, Dec 2006.Annual Meeting, Chicago, Mar 2006. Millett PJ. New techniques for managing Millett PJ, Gobezie R, Krastins B,Millett PJ. Sports Medicine. Upper AC dislocations. International Shoulder Tsaniklides N, Warner JP. InterferenceExtremity. Moderator. Society of Military Symposium, Naples, Fla, Apr 2006. Screw vs. Suture Anchor Fixation for OpenOrthopaedic Surgeons, Honolulu, Dec 2006. Subpectoral Biceps Tenodesis: does it mat- Millett PJ. Proximal humerus fracture ter? Abstract Review. AmericanMillett PJ. Cuff Repair with Biologic update: percutaneous pinning vs plating vs Orthopaedic Society for Sports MedicinePatches. Orthopaedic Update 2006: hemiarthroplasty. International Shoulder 2006 Annual Meeting, Hershey, Pa, Jul 2006.Shoulder, Elbow, Hip and Knee, Vail, Jun Symposium, Naples, Fla, Apr 2006.2006. [58]
  • Publications & PresentationsMillett PJ. Arthroscopic treatment of shoul- Pacheco IH, Gobezie R, Krastins B, Philippon MJ. Can we treat FAI by theder instability - surgical workshop. 11th Tsaniklides N, Millett PJ. AC Joint scope. Part II: Arthroscopy and the Labrum.International Shoulder Course for Open and Reconstruction with CA Ligament Transfer AO North America Symposium on SurgicalArthroscopic Surgery, Munich, Germany, Using the Docking Technique. American Preservation of the Hip, Mammoth Lakes,Oct 2006. Academy of Orthopaedic Surgeons 2006 Calif, Jan 2006. Annual Meeting, Chicago, Mar 2006.Millett PJ. Arthroscopic rotator cuff repair - Philippon MJ. Can we treat FAI by thestate of the art techniques lecture. 11th Pacheco IH, Gobezie R, Krastins B, scope. Part III: Vail outcomes. AOInternational Shoulder Course for Open and Tsaniklides N, Millett PJ. AC Joint North America Symposium on SurgicalArthroscopic Surgery, Munich, Germany, Reconstruction with CA Ligament Transfer Preservation of the Hip, Mammoth Lakes,Oct 2006. Using the Docking Technique. Abstract Calif, Jan 2006. Review. American Orthopaedic Society forMillett PJ. Live surgical demonstration - Sports Medicine 2006 Annual Meeting, Philippon MJ. Arthroscopic treatmentarthroscopic double row rotator cuff repair. Hershey, Pa, Jul 2006. of femoroacetabular impingement. Hip11th International Shoulder Course for Surgery in the Young Adult, Banff, Alberta,Open and Arthroscopic Surgery, Munich, Pandy MG, Shelburne KB, Torry MR. Role of Canada, Jan 2006.Germany, Oct 2006. the lower-extremity musculature in main- taining knee stability during gait, Special Philippon MJ. Arthroscopic hip labralMillett PJ. Arthroscopic treatment of SLAP Featured Session, in: The Structure and repair. Smith & Nephew Global Salestears and posterior instability — surgical Function of Articular Cartilage and the Meeting, Miami, Fla, Jan 2006.workshop. 11th International Shoulder Initiation, Progression, Treatment andCourse for Open and Arthroscopic Surgery. Rehabilitation of Knee Osteoarthritis. Philippon MJ. Biomechanics of injury inMunich, Germany, Oct 2006. American College of Sports Medicine athletes. Masters Course Arthroscopy Annual Meeting, Denver, Jun 2006. Association of North America, Chicago,Millett PJ. Complex and revision shoulder Jan 2006.surgery. Visiting Guest Surgeon — Country Philippon MJ, Schenker ML, Briggs KK,of Bermuda, Oct 2006. Stubbs AJ. Second-look Arthroscopy of Philippon MJ. My approach to labral tears. Chondral Lesions of the Acetabulum treated Masters Course Arthroscopy Association ofMillett PJ. Complex and Revision Shoulder with Arthroscopic Microfracture. 6th North America, Chicago, Jan 2006.Instability. JOJ Kaiser Permanente Symposium International Cartilage RepairOrthopaedics Symposium, San Francisco, Society. Poster presentation, San Diego, Philippon MJ, Schenker ML, Briggs KK,Nov 2006. Jan 2006. Kuppersmith DA. Return to sport following arthroscopic decompression for femoroac-Millett PJ. Shoulder instability: bone and Philippon MJ, Briggs KK, Schenker ML, etabular impingement in athletes: a reviewsoft tissue deficiencies. Society of Military Stubbs AJ. Factors associated with carti- of 45 cases. American Orthopaedic SocietyOrthopaedic Surgeons, Honolulu, Dec 2006. lage defects in the hip identified at for Sports Medicine Specialty Day, Chicago, arthroscopy. 6th Symposium International Mar 2006.Millett PJ. Management of Rotator Cuff Cartilage Repair Society, San Diego, JanDisease. From the Sublime to the 2006. Philippon MJ, Schenker ML, Briggs KK,Ridiculous. Steadman◆Hawkins Research Kuppersmith DA. Return to sport followingFoundation Orthopaedic & Spine Lecture Philippon MJ. Can we treat FAI by the arthroscopic decompression for femoroac-Series, Vail, Aug 2006. scope. Part I: Vail Technique. AO North etabular impingement in athletes: a America Symposium on Surgical review of 45 cases. Annual Meeting ofNoonan T, Torry MR, Decker MJ, Sabick M, Preservation of the Hip, Mammoth Lakes, the American Academy of OrthopaedicHackett TR, Hawkins RJ, Millett PJ. Forces Calif, Jan 2006. Surgeons, Chicago, Mar 2006.at the Shoulder During the Baseball Pitch inYouth and Professional Baseball Throwers.American College Sports Medicine AnnualMeeting, Denver, Jun 2006. [59]
  • Philippon MJ , Armfield DR, Martin RR, Philippon MJ. New frontiers in hip Philippon MJ, Schenker ML, Briggs KK,Towers J, Robertson D, Almusa E, Kelly B. arthroscopy. Steadman◆Hawkins Research Stubbs AJ. Demographics of cam andMR arthrography of the hip to detect partial Foundation Orthopaedics & Spine Lecture pincer hip impingment. Biennial Meetingtears of the ligamentum teres. Annual Series, Vail, Apr 2006. of the European Society for SportsMeeting of the American Academy of Traumatology and Knee Arthroscopy,Orthopaedic Surgeons, Chicago, Mar 2006. Philippon MJ, Schenker ML, Briggs KK. Innsbruck, Austria, May 2006. Second-look arthroscopy of chondralPhilippon MJ. The role of arthroscopic hip lesions of the acetabulum treated with Philippon MJ, Schenker ML, Briggs KK,labral repair and capsulorrhaphy in the arthroscopic microfracture. Arthroscopy Stubbs AJ. Second-look arthroscopy oftreatment of hip disorders. Instructional Association of North America Annual chondral lesions of the acetabulum treatedCourse Lecture on Hip Arthroscopy. Meeting, Miami, Fla, May 2006. with arthroscopic microfracture. PosterAnnual Meeting of the American Academy presentation. Biennial Meeting of theof Orthopaedic Surgeons, Chicago, Philippon MJ, Martin RR, Schenker ML. European Society for Sports TraumatologyMar 2006. A three-year outcome study of hip and Knee Arthroscopy, Innsbruck, Austria, arthroscopy. Poster presentation. May 2006.Philippon MJ, Turner AS, Trumble TN, Arthroscopy Association of North AmericaWheeler DL, Torrie A, Kelly BT, Arnoczky Annual Meeting, Miami, Fla, May 2006. Philippon MJ, Martin RR, Schenker ML.SP. Arthroscopic hip labral repair: a new in A three-year outcome study of hipvivo model. Poster presentation. Annual Philippon MJ, Schenker ML, Stubbs AJ. arthroscopy. Poster presentation. BiennialMeeting of the American Academy of Four to six-year follow-up of hip arthro- Meeting of the European Society for SportsOrthopaedic Surgeons, Chicago, Mar 2006. scopies in professional athletes. Poster Traumatology and Knee Arthroscopy, presentation. Arthroscopy Association of Innsbruck, Austria, May 2006.Philippon MJ, Crawford K, Briggs KK. North America Annual Meeting, Miami, Fla,Three to five year follow-up of hip arthro- May 2006. Philippon MJ, Stubbs AJ, Schenker ML,scopies in professional golfers. Poster Briggs KK. Factors associated with revisionpresentation. Annual Meeting of the Philippon MJ. Capsulolabral Complex hip arthroscopy. Poster presentation.American Academy of Orthopaedic Deficiency in the Hip. Advances of Hip Biennial Meeting of the European SocietySurgeons, Chicago, Mar 2006. Arthroscopy, Paris, France, May 2006. for Sports Traumatology and Knee Arthroscopy, Innsbruck, Austria, May 2006.Philippon MJ, Martin RR. Can hip pain Philippon MJ. Arthroscopic Partial Femoraldistribution distinguish between labral Head Resurfacing. Advances of Hip Philippon MJ, Schenker ML, Briggs KK,tears and iliotibial band syndrome? Arthroscopy, Paris, France, May 2006. Stubbs AJ. Clinical presentation of hipPoster presentation. Annual Meeting of instability. Poster presentation. Biennialthe American Academy of Orthopaedic Philippon MJ. Arthroscopic Reconstruction Meeting of the European Society for SportsSurgeons, Chicago, Mar 2006. of the Ligamentum Teres. Advances of Hip Traumatology and Knee Arthroscopy, Arthroscopy, Paris, France, May 2006. Innsbruck, Austria, May 2006.Philippon MJ. New frontiers in hiparthroscopy. Smith & Nephew Analyst Philippon MJ. Arthroscopic Treatment of Philippon MJ, Schenker ML, Briggs KK,Meeting, Chicago, Mar 2006. Labral Injuries in the Hip. Advances of Hip Stubbs AJ. The log roll test for hip instability. Arthroscopy, Paris, France, May 2006. Biennial Meeting of the European SocietyPhilippon MJ. Arthroscopic labral repair in for Sports Traumatology and Kneethe hip. Smith & Nephew Advances in Hip Philippon MJ, Schenker ML, Stubbs AJ. Arthroscopy, Innsbruck, Austria, May 2006.Arthroscopy, Chicago, Mar 2006. Four to six-year follow-up of hip arthro- scopies in professional athletes. Biennial Philippon MJ. New Frontiers in HipPhilippon MJ. Hip arthroscopy in athletes. Meeting of the European Society for Sports Arthroscopy, 3rd Annual Sports MedicineInternational Society for Ski Traumatology Traumatology and Knee Arthroscopy, Conference, Akron, Ohio, June 2006.and Winter Sports Medicine, Pyrenees, Innsbruck, Austria, May 2006.Spain, Mar 2006. [60]
  • Publications & PresentationsPhilippon MJ. Outcomes of Hip Philippon MJ. New Frontiers in Hip Philippon MJ. Anatomy of the Hip. DrayerArthroscopy. 3rd Annual Sports Medicine Arthroscopy. Piper Jaffray Investors Physical Therapy Conference, Hilton Head,Conference, Akron, Ohio, Jun 2006. Summit, Vail, Mar 2006. S.C., Oct 2006.Philippon MJ. Diagnosis for intra-articular Philippon MJ. Femoroacetabular Philippon MJ. Evaluation of Hip Pathology.hip pain. 3rd Annual Sports Medicine Impingement. University of Washington Hip Drayer Physical Therapy Conference, HiltonConference, Akron, Ohio, Jun 2006. Course, Seattle, Sept 2006. Head, S.C., Oct 2006.Philippon MJ. New Frontiers in Hip Philippon MJ. Labral Repair Techniques. Philippon MJ. Surgical ArthroscopicArthrscopy. Steadman◆Hawkins Sports University of Washington Hip Course, Intervention. Drayer Physical TherapyMedicine Symposium, Spartanburg, S.C., Seattle, Sept 2006. Conference, Hilton Head, S.C., Oct, 2006.June 2006. Philippon MJ. AVN Treatment and Chondral Philippon MJ. Arthroscopic CapsularPhilippon MJ, Schenker ML, Briggs KK, Resurfacing. Smith & Nephew Hip Plication and Thermal Capsulorrhaphy.Stubbs AJ. Clinical Presentation of FAI. Arthroscopy Course, San Francisco, Sept Warwick Sports Hip Conference, Warwick,American Orthopaedic Society for Sports 2006. England, Oct 2006.Medicine Annual Meeting, Hershey, Pa,June 2006. Philippon MJ. Evaluation of the Philippon MJ. Arthroscopic Partial Femoral Professional and High Level Athlete with Head Resurfacing. Warwick Sports HipPhilippon MJ. Can the Labrum be Hip Pain. Smith & Nephew Hip Arthroscopy Conference, Warwick, England, Oct 2006.Repaired? An Animal Model. 5th Course, San Francisco, Sep 2006.Symposium on Joint Preserving and Philippon MJ. Does Microfracture Work inMinimally Invasive Surgery of the Hip, Philippon MJ. The Function of the Labrum the Hip? Warwick Sports Hip Conference,Ottawa, Canada, Jun 2006. and Iliofemoral Ligament. Smith & Nephew Warwick, England, Oct 2006. Hip Arthroscopy Course, San Francisco,Philippon MJ. Biomechanics of injury in Sept 2006. Philippon MJ. Arthroscopic Reconstructionathletes. Masters Course Arthroscopy of the Ligamentum Teres. Warwick SportsAssociation of North America, Chicago, Jul Philippon MJ. Labral Repair Technique. Hip Conference, Warwick, England,2006. Smith & Nephew Hip Arthroscopy Course, Oct 2006. San Francisco, Sept 2006.Philippon MJ. My approach to labral tears. Philippon MJ. Arthroscopic AcetabularMasters Course Arthroscopy Association of Philippon MJ. Rationale and Repair of the Rim Debridement and Labral Repair.North America, Chicago, Jul 2006. Ligamentum Teres. Smith & Nephew Hip Warwick Sports Hip Conference, Warwick, Arthroscopy Course, San Francisco, Sept England, Oct 2006.Philippon MJ. Surgical Evaluation and 2006.Management of Femoracetabular Philippon MJ. Labral Repair Video Session.Impingement. 15th Annual Current Issues of Philippon MJ. Femoroacetabular Arthroscopy Association of North AmericanMRI in Orthopaedics and Sports Medicine, Impingement. Vermont Sports Medicine Fall Course Meeting, Palm Desert, Calif,San Francisco, Aug 2006. Conference, Burlington, Oct 2006. Nov 2006.Philippon MJ. Hip Dissection and Philippon MJ. Acetabular Labral Repair. Philippon MJ. Arthroscopic CapsularArthroscopy. 5th Annual Current Issues of Vermont Sports Medicine Conference, Plication & Thermal Capsulorrhaphy.MRI in Orthopaedics and Sports Medicine, Burlington, Oct 2006. International Hip Arthroscopy Meeting,San Francisco, Aug 2006. Hamburg, Germany, Nov 2006. Philippon MJ. Outcomes Following HipPhilippon MJ. New Frontiers in Hip Arthroscopy in Professional Athletes. Philippon MJ. Labral Tears - Diagnosis,Arthroscopy. The Vail Rotary Club, Vail, Vermont Sports Medicine Conference, Resection, and Repair. International HipSept 2006. Burlington, Oct 2006. Arthroscopy Meeting, Hamburg, Germany, Nov 2006. [61]
  • Philippon MJ. Labral Repair. Steadman- Rodkey WG, Steadman JR. Briggs KK. Rodkey WG. Collagen Meniscus ImplantsHawkins Fellows Meeting, Vail, Dec 2006. Tissue gain after placement of Collagen (CMI): Clinical experience and long term Meniscus Implants (CMI) following partial follow-up. International Association forPhilippon MJ. New Frontiers in Hip meniscectomy. Poster. European Society of Joint Reconstruction, Munich, Germany,Arthroscopy. Steadman-Hawkins Fellows Sports Traumatology, Knee Surgery and Oct 2006.Meeting, Vail, Dec 2006. Arthroscopy, Innsbruck, Austria, May 2006. Rodkey WG. Microfracture: What’s new?Rodkey WG, Steadman JR, Briggs KK. Rodkey WG, Steadman JR. Briggs KK. International Association for JointTissue gain after placement of a collagen Development and use of the “Tegner Index” Reconstruction, Munich, Germany, Oct 2006.meniscus implant following partial menis- to assess effectiveness of arthroscopiccectomy. 6th International Cartilage Repair treatment of the knee meniscus on return Rodkey WG. High tibial osteotomy (HTO)Society Symposium, San Diego, Jan 2006. to activity. Poster. European Society of and microfracture. International Sports Traumatology, Knee Surgery and Association for Joint Reconstruction,Rodkey WG, Steadman JR, Briggs KK. Arthroscopy, Innsbruck, Austria, May 2006. Munich, Germany, Oct 2006.Development and use of the “Tegner Index”to assess effectiveness of arthroscopic Rodkey WG, Steadman JR, Montgomery Rodkey WG. The two-incision technique fortreatment of the knee meniscus on return to WH, Hormel S, Briggs KK. New Tissue ACL reconstruction. Controversies in Softactivity. Poster. 6th International Cartilage Growth after Collagen Meniscus Implant Tissue Knee Surgery, Polish ArthroscopyRepair Society Symposium, San Diego, (CMI) Placement into Meniscus Defects. Society and University of Lublin, Lublin,Jan 2006. 2006 American Orthopaedic Society for Poland, Oct 2006. Sports Medicine Annual Meeting, Hershey,Rodkey, WG, Briggs KK, Steadman JR. Pa, Jun 2006. Rodkey WG. ACL healing response tech-Tissue Gain after Placement of a Collagen nique. Controversies in Soft Tissue KneeMeniscus Implant Following Partial Rodkey WG. Collagen Meniscus Implants Surgery, Polish Arthroscopy Society andMedial Meniscectomy. American Academy (CMI): Long-term results. International University of Lublin, Lublin, Poland, Octof Orthopaedic Surgeons 73rd Annual Workshop on Preserving and Regenerative 2006.Meeting, Chicago, Mar 2006. Meniscal Surgery, Reisensburg Castle of Gunzburg (University of Ulm), Germany, Rodkey WG. Collagen Meniscus ImplantsRodkey, WG, Briggs KK, Steadman JR. Jul 2006. (CMI) for meniscus reconstruction.Tissue gain after placement of a collagen Controversies in Soft Tissue Knee Surgery,meniscus implant following partial menis- Rodkey WG, Steadman JR. The two-incision Polish Arthroscopy Society and Universitycectomy. ACL Study Group Biannual technique for ACL reconstruction: The Vail of Lublin, Lublin, Poland, Oct 2006.Meeting, Kohala Coast, Hawaii, Mar 2006. experience. Sportsmedizin Gardasee 2006 (University of Giessen), Riva di Garda, Italy, Rodkey WG. Microfracture for chondralRodkey WG, Steadman JR, Briggs KK. Sept 2006. defects. Controversies in Soft Tissue KneeDevelopment and use of the “Tegner Index” Surgery, Polish Arthroscopy Society andto assess effectiveness of arthroscopic Rodkey WG. New tissue growth after University of Lublin, Lublin, Poland, Octtreatment of the knee meniscus on return to placement of the Collagen Meniscus 2006.activity. ACL Study Group Biannual Meeting, Implant (CMI). Sportsmedizin GardaseeKohala Coast, Hawaii, Mar 2006. 2006 (University of Giessen), Riva di Garda, Rodkey WG. Patellar tendinosis in competi- Italy, Sept 2006. tive athletes. Controversies in Soft TissueRodkey, WG, Briggs KK, Steadman JR. Knee Surgery, Polish Arthroscopy SocietyTissue gain after arthroscopic placement Rodkey WG. Meniscus replacement and and University of Lublin, Lublin, Poland,of a Collagen Meniscus Implant (CMI) transplantation: In favor of the Collagen Oct 2006.following partial medial meniscectomy. Meniscus Implant (CMI). Joint GermanArthroscopy Association of North America, Congress of Orthopaedic Trauma SurgeryHollywood, Fla, May 2006. 2006, Berlin, Germany, Oct 2006. [62]
  • Publications & PresentationsRodkey WG. Research, development and Shank J, Singleton S, Hawkins J, Decker Steadman JR. Meniscus Replacement andevaluation of the Collagen Meniscus MJ, Torry MR. A Comparison of Supination Transplantation — Pros and Cons: Pro:Implant. International Medical Device and Elbow Flexion Strength in Patients With Collagen Meniscus Implant. Joint GermanResearch and Development Summit, Either Proximal Biceps Release or Biceps Congress of Orthopaedics and TraumaRancho Mirage, Calif, Nov 2006. Tenodesis. American Orthopedic Society of Surgery 2006, Berlin, Germany, Oct 2006. Sports Medicine Annual Meeting, Hershey,Rodkey WG, Briggs KK, Steadman JR. Pa, Jun 2006. Steadman JR. Lifetime AchievementClinical symptoms, function, and activity Award. Bay Area Knee Society Meeting,levels correlate with meniscus loss during Shelburne KB, Torry MB, Sterett WI, San Francisco, Nov 2006.meniscectomy. Poster. World Congress on Steadman JR, Pandy MG. Muscle andOsteoarthritis 2006, Osteoarthritis Research ligament restraints to the adductor moment Steadman JR, Briggs KK, Rodkey WG.Society International, Prague, Czech during normal gait. International Society Association between patellar mobilityRepublic, Dec 2006. of Ligaments and Tendons Conference, and patellofemoral chondral defects. 6th Chicago, Mar 2006. International Cartilage Repair SocietyRodkey WG, Steadman JR, Montgomery Symposium, San Diego, Jan 2006.WH, Hormel S, Briggs KK. New tissue Shelburne KB, Torry MR, Sterett WI, Pandygrowth after collagen meniscus implant MG. Effect of tibial plateau angle on knee Steadman JR. Joint Preservation. Piper(CMI) placement increases activity levels loads during activity. World Congress of Jaffray Investors Summit. Vail, Mar 2006.after two years. Poster. World Congress on Biomechanics. Munich, Germany, Aug 2006.Osteoarthritis 2006, Osteoarthritis Research Steadman JR. Traumatology of AlpineSociety International, Prague, Czech Shelburne KB, Kim H-J, Fernandez JW, Skiing. XV International Congress on SportsRepublic, Dec 2006. Giphart JE, Torry MR, Sterett WI, Pandy Rehabilitation and Traumatology: The MG. Dependence of tibiofemoral load on Rehabilitation of Winter and MountainRodkey WG. Collagen Meniscus Implants: body position in two-legged stance. World Sports Injuries, Turin, Italy, Apr 2006.Research, development and evaluation of Congress of Biomechanics, Munich,the CMI. Polish ICRS Club and Warsaw Germany, Aug 2006. Sterett WI. High Tibial Osteotomy andCity-Wide Grand Rounds. Warsaw, Poland, Unicompartmental Knee Replacement.Dec 2006. Steadman JR. Chondral Resurfacing Piper Jaffray Investors Summit, Vail, Patient Selection, Technique, and Results. Mar 2006.Rodkey WG. Update on microfracture: AOSSM Latin AmericanTraveling Fellows,Patient selection, techniques, results and Vai, Jun 2006. Sterett WI. The Post-Meniscectomy Knee:new thoughts. Polish ICRS Club and Evaluation and Management. InstructionalWarsaw City-Wide Grand Rounds, Warsaw, Steadman JR. Better Patient Care through Course Lecture. American Academy ofPoland, Dec 2006. Research. Vail Valley Medical Center Orthopaedic Surgeons 73rd Annual Community Trustees, Vail, Jul 2006. Meeting. Chicago, March, 2006 .Schlegel TF. New Advances in Rotator CuffRepair Technology: The AutoCuff System. Steadman JR. Update on Microfracture: Sterett WI. Joint Preservation in the Post-European ArthroCare Physicians Meeting, Patient Selection, Technique, and Results. Meniscectomy Knee. PaterswoldeFrankfurt, Germany, Jul 2006. 15th Annual Current Issues of MRI and Conference, The Netherlands, Apr 2006. Sports Medicine. San Francisco, Aug 2006.Schlegel TF, Boublik M, Godfrey JM. Sterett WI. Joint Preservation and HighComplete Proximal Adductor Longus Steadman JR. Microfracture. International Tibial Osteotomy. AOSSM Traveling Fellows,Ruptures in Professional Football Players. Cartilage Repair Society Surigcal Skills Vail, Jun 2006.AOSSM Specialty Day, Chicago, Mar 2006. Society, Hollywood, Fla, Oct 2006. [63]
  • Sterett WI. Immediate Surgery is Best for Strauch EL. Cervical Spine Injuries in the Torry MR, Sabick M, Decker MJ, HackettFirst Time Dislocator. Rocky Mountain Athlete. Steadman◆Hawkins Research TR, Hawkins RJ, Millett PJ. Differences inShoulder and Elbow Society Inaugural Foundation Orthopaedic & Spine Lecture trunk control between youth and profes-Meeting, Vail, June 2006. Series, Vail, Jul 2006. sional American baseball pitchers. World Congress of Biomechanics. Munich,Sterett WI. Clavicle Fracture Fixation with Strauch EL. Recognition and Management Germany, Aug 2006.Plates. Rocky Mountain Shoulder and of Spinal Injuries. Vail Ski Patrol, Vail,Elbow Society Inaugural Meeting, Vail, Nov 2006. Torry MR, Mow VC, Andriacchi TP,Jun 2006. Steadman JR, Reigger-Krough C. The Strauch EL. Clearing the Cervical Spine. Structure and Function of ArticularSterett WI. Joint Preservation and US Ski Team Conference, Beaver Creek, Cartilage and the Initiation, Progression,Osteotomies Around the Knee. Instructional Colo, Nov 2006. Treatment and Rehabilitation of KneeCourse Lecture. 2006 AOSSM Annual Osteoarthritis. Session Chair. AmericanMeeting, Hershey, Pa, Jul 2006. Strauch EL. Perioperative Management of College of Sports Medicine Annual the Surgical Spinal Patient. Educational Meeting, Denver, Jun 2006.Sterett WI. Proximal Tibial Valgus Lecture for the nurses at VVMC, VailOsteotomy Opening Wedge EBI Plate Dec, 2006. Warner JJP, Gobezie R, Lavery K, Cole BJ,Technique. International Cartilage Repair Millett PJ. Interobserver and intraobserverSociety: Surgical Skills Course, Hollywood, Stubbs AJ, Briggs KK, Philippon MJ. variability in the diagnosis of SLAP lesionsFla, Oct 2006. Arthroscopic Management of among experienced shoulder arthro- Femoroacetabular Impingement. Multimedia scopists: a study of 73 surgeons across twoSterett WI. Lower Extremity and ACL Issues Education Center. Annual Meeting of the continents. American Shoulder and Elbowin Patrolling, Vail Ski Patrol Update. Vail, American Academy of Orthopaedic Surgeons 23rd Closed Meeting, Chicago,Nov 2006. Surgeons, Chicago, Mar 2006. Sept 2006.Sterett WI. Joint Preservation. Community Stubbs AJ, Briggs KK, Philippon MJ. Viola R. Evaluation and Treatment ofPresentation, Battlement Mesa, Colo, Hip Arthroscopy: Operative Set-up and Common Elbow Disorders. Steadman◆Nov 2006. Anatomically Guided Portal Placement. Hawkins Research Foundation Orthopaedic Multimedia Education Center. Annual & Spine Lecture Series, Vail, Sept 2006.Sterett WI. Common Orthopaedic Injuries & Meeting of the American Academy ofMechanisms in Alpine Skiing & Snow- Orthopaedic Surgeons, Chicago, Mar 2006. Yanagawa T, Torry MR, Shelburne KB,boarding. Medical Emergencies in Ski and Pandy MG. Contributions of the rotator cuffSnowboard Sport, Vail, Nov 2006. Torry MR. Understanding Joint Function muscles to glenohumeral joint mechanics and Implant Design. Piper Jaffray Investors during the belly press. World Congress ofSterett WI. ACL Reconstruction and Summit, Vail, Mar 2006. Biomechanics, Munich, Germany, Aug 2006.Rehabilitation, Denver, Dec 2006. Torry MR, Sabick M, Decker MJ, Hackett Yanagawa T, Torry MR, Shelburne KB,Sterett WI. PCL, Posterolateral and Medial TR, Hawkins RJ, Millett PJ. Shoulder Pandy MG. Moment arms of the upper andCorner. Community Presentation, Grand Kinematic and Kinetic Pitching Profiles in lower portions of the subscapularis muscle.Junction, Colo, Dec 2006. Youth and Professional Baseball Players. World Congress of Biomechanics, Munich, World Congress of Biomechanics, Munich, Germany, Aug 2006.Strauch EL. An Overview of Common Spinal Germany, Aug 2006.Pathologies. Eagle Valley High SchoolHealth Science Lecture Series, Gypsum,Colo, Apr 2006. [64]
  • Publications & Presentations2006 PUBLICATIONS Hackett TR, Torry MR, Decker MJ, Sabick Millett PJ, Clavert P, Hatch GF 3rd, Warner M, Noonan TJ, Hawkins RJ, Millett P. JJ. Recurrent posterior shoulder instability.Briggs KK, Kocher MS, Rodkey WG, Differences in kinematics between youth Journal of American Academy OrthopedicSteadman JR. Reliability, validity, and and professional baseball players. Surgery. 2006;14:464-476.responsiveness of the Lysholm knee score Medicine and Science in Sport andand Tegner activity scale for patients with Exercise. 2006;38 (Suppl):S39-S40. Millett PJ, Wilcox RB 3rd, OHolleran JD,meniscal injury of the knee. Journal of Bone Warner JJ. Rehabilitation of the rotator cuff:& Joint Surgery American. 2006;88:698-705. Kernozek TW, Torry MR, Wallace BJ, Miller an evaluation-based approach. Journal EJ. Biomechanics of a failed single legged American Academy of Orthopedic Surgery.Carreira D, Bush-Joseph CA. Hip landing due to fatigue. Medicine and 2006;14:599-609.arthroscopy. Orthopedics. 2006;29:517-523. Science in Sports and Exercise. 2006;38 (Suppl):S23-S24. Millett PJ, Porramatikul M, Chen N,Carreira DS, Mazzocca AD, Oryhon J, Zurakowski D, Warner JJ. Analysis ofBrown FM, Hayden JK, Romeo AA. A Krishman SG, Steadman JR, Millett PJ, transfusion predictors in shoulder arthro-prospective outcome evaluation of arthro- Hydeman K, Close M. Lysis of pretibial plasty. Journal of Bone & Joint Surgeryscopic Bankart repairs: minimum 2-year patellar tendon adhesions (anterior interval American. 2006;88:1223-1230.follow-up. American Journal of Sports release) to treat anterior knee pain afterMedicine. 2006;34:771-777. ACL reconstruction. In Sanchis-Alfonso V, Monto RR, Cameron-Donaldson ML, Close editor. Anterior Knee Pain and Patellar MA, Ho CP, Hawkins RJ. Magnetic reso-Crawford K, Philippon MJ, Sekiya JK, Instability. London, Springer 2006:295-303. nance imaging in the evaluation of tibialRodkey WG, Steadman JR. Microfracture eminence fractures in adults. Journal ofof the hip in athletes. Clinics in Sports Lowery DJ, Farley TD, Wing DW, Sterett Knee Surgery. 2006;19:187-190.Medicine. 2006;25:327-335. WI, Steadman JR. A clinical composite score accurately detects meniscal pathology. Noonan TJ, Torry MR, Decker MJ, SabickEnseki KR, Martin RL, Draovitch P, Kelly BT, Arthroscopy. 2006;22:1174-1179. M, Hackett TR, Hawkins RJ, Millett PJ.Philippon MJ, Schenker ML. The hip joint: Forces at the Shoulder During the Baseballarthroscopic procedures and postoperative Madsen M, Marx RG, Millett PJ, Rodeo SA, Pitch in Youth and Professional Baseballrehabilitation. Journal of Orthopedic Sports Sperling JW, Warren RF. Surgical anatomy Throwers. Medicine and Science in SportPhysical Therapy. 2006;36:516-525. of the triceps brachii tendon: anatomical and Exercise. 2006;38(Suppl):S67. study and clinical correlation. AmericanFrisbie DD, Morisset S, Ho CP, Rodkey WG, Journal of Sports Medicine. 2006;34:1839- Pandy MG, Shelburne KB, Torry MR. RoleSteadman JR, McIlwraith CW. Effects of 1843. of the lower-extremity musculature in main-calcified cartilage on healing of chondral taining knee stability during gait. Medicinedefects treated with microfracture in Martin RL, Enseki KR, Draovitch P, and Science in Sports and Exercise.horses. American Journal of Sports Trapuzzano T, Philippon MJ. Acetabular 2006;38(Suppl):S67.Medicine. 2006;34:1824-1831. labral tears of the hip: examination and diagnostic challenges. Journal of Philippon MJ. New frontiers in hipGobezie R, Millett PJ, Sarracino DS, Evans Orthopedic Sports Physical Therapy. arthroscopy: the role of arthroscopic hipC, Thornhill TS. Proteomics: applications 2006;36:503-515. labral repair and capsulorrhaphy in theto the study of rheumatoid arthritis and treatment of hip disorders. Instructionalosteoarthritis. Journal of American Martin RL, Kelly BT, Philippon MJ. Course Lecture. 2006;55:309-316.Academy of Orthopedic Surgery. Evidence of Validity for the Hip Outcome2006;14:325-332. Score. Arthroscopy. 2006;23. Philippon MJ, Schenker ML. Arthroscopy for the treatment of femoroacetabular Martin RL, Schenker ML, Philippon MJ. impingement in the athlete. Clinics in Sports A three-year outcome study of hip Medicine. 2006;25:299-308. arthroscopy. Journal of Orthopedic Sports Physical Therapy. 2006;36(A6): 2006. [65]
  • Publications & PresentationsPhilippon MJ, Schenker ML. A new method Schlegel TF, Siparsky P. Disorders of the Terry MA, Steadman JR, Rodkey WG,for acetabular rim trimming and labral Acromioclavicular Joint. In Johnson, DL, Briggs KK: Microfracture for chondralrepair. Clinics in Sports Medicine. Mair, SD editors. Clinical Sports Medicine. lesions. Surgical Techniques in Sports2006;25:293-297. Philadelphia, Mosby Elsevier. 2006:255-264. Medicine. Lippincott Williams and Wilkins. Chapter 58, 2006.Philippon MJ, Schenker M, Briggs K. Shelburne KB, Kim H-J, Fernandez JW,Second-Look Arthroscopy of Chondral Giphart JE, Torry MR, Sterett WI, Pandy Torry MR. Biomechanics of Youth PitchingLesions of the Acetabulum Treated with MG. Dependence of tibiofemoral load on Injuries. Biomechanics Magazine. January,Arthroscopic Microfracture. Arthroscopy. body position in two-legged stance. 20062006;22(Suppl): 29-e30. Journal of Biomechanics. 2006; 39(Suppl 1): S44. Torry MR, Sabick M, Decker MJ, HackettPhilippon MJ, Stubbs A, Schenker M, TR, Hawkins RJ, Millett P. ShoulderBriggs K. Factors Associated with Revision Shelburne KB, Torry MR, Pandy MG. Kinematic and Kinetic Pitching Profiles inHip Arthroscopy. Arthroscopy. Contributions of muscles, ligaments, and the Youth and Professional Baseball Players.2006;22(Suppl):e30-e31. ground-reaction force to tibiofemoral joint Journal of Biomechanics. 2006;39(Suppl 1): loading during normal gait. Journal of S511.Rodkey WG, Arnoczky SP, Steadman JR. Orthopedic Research. 2006;24:1983-1990.Healing of a surgically created partial Torry MR, Sabick M, Decker MJ, Hackettretachment of the posterior cruciate liga- Shelburne KB, Torry KB, Sterett WI, Pandy TR, Hawkins RJ, Millett P. Differences inment using marrow stimulation: an experi- MG. Effect of tibial plateau angle on knee trunk control between youth and profes-mental study in dogs. Journal of Knee loads during activity. Journal of sional American baseball pitchers. JournalSurgery. 2006;19:14-18. Biomechanics. 2006;39(Suppl 1): S62. of Biomechanics. 2006;39(Suppl 1): S503.Rodkey WG, Briggs KK. New tissue growth Steadman JR. The Psychological Aspects of Torry MR, Schenker ML, Martin HD,after collagen meniscus implant (CMI) Healing the Injured Athlete. In Johnson, DL, Hogoboom D, Philippon MJ.placement increases activity levels after Mair, SD editors. Clinical Sports Medicine. Neuromuscular hip biomechanics andtwo years. Osteoarthritis and Cartilage. Philadelphia, Mosby Elsevier. 2006:57-59. pathology in the athlete. Clinics in Sports2006;14 (Supp B):S 205. Medicine. 2006;25:179-197. Steadman JR, Cameron-Donaldson ML,Rodkey WG, Briggs KK, Steadman JR. Briggs KK, Rodkey WG. A minimally inva- Torry MR, Shelburne KB. Biomechanics ofClinical symptoms, function, and activity sive technique ("healing response") to treat Youth Pitching Injuries. Sports Performancelevels correlate with meniscus loss during proximal ACL injuries in skeletally immature Journal. November, 2006.meniscectomy. Osteoarthritis and Cartilage. athletes. Journal of Knee Surgery.2006;14 (Supp B):S 41. 2006;19:8-13. Warner JJ, Gill TJ, OHolleran JD, Pathare N, Millett PJ. Anatomical glenoid recon-Rodkey WG, Steadman JR. Arthroscopic Steadman JR, Rodkey WG, Briggs KK, struction for recurrent anterior glenohumer-meniscus regeneration with collagen scaf- Rodrigo JJ. “Debridement and al instability with glenoid deficiency usingfolding. In: Scott WN, ed. Insall & Scott Microfracture for Full-thickness Articular an autogenous tricortical iliac crest boneSurgery of the Knee. Philadelphia, Churchill Cartilage Defects.” In Scott WN, editor, graft. American Journal of Sports Medicine.Livingstone Elsevier. 2006:494-497. Surgery of the Knee 4th edition. 2006;34:205-212 Philadelphia. Churchill Livingston. 2006:359-Schlegel TF, Hawkins RJ, Lewis CW, Motta 366 Yanagawa T, Torry MR, Shelburne KB,T, Turner AS. The effects of augmentation Pandy MG. Moment arms of the upper andwith Swine small intestine submucosa on Sterett WI, Briggs KK, Farley T, Steadman lower portions of the subscapularis muscle.tendon healing under tension: histologic JR. Effect of functional bracing on knee Journal of Biomechanics. 2006;39(Suppl 1):and mechanical evaluations in sheep. injury in skiers with anterior cruciate liga- S505.American Journal of Sports Medicine. ment reconstruction: a prospective cohort2006;34:275-80. study. American Journal of Sports Medicine. 2006;34:1581-1585. [66]
  • Recognition The Steadman◆Hawkins Research Foundation made headlines in the featured headline article in the March 24 issue of Academy News,2006 with numerous papers being accepted by prestigious medical the daily publication of the 73rd Annual Meeting of the Americanand scientific societies and journals. Academy of Orthopaedic Surgeons held in Chicago. The year started off with a very significant acceptance. The Congratulations to the Clinical Research Department and to for-Journal of Knee Surgery published the first Foundation paper on a mer Steadman-Hawkins Fellow Dr. Kevin Crawford. The Arthroscopyprocedure pioneered by Dr. Steadman and developed and validated Association of North America presented the 2006 Resident Fellowby the Foundation, “A Minimally Invasive Technique (‘Healing Essay Award to Kevin Crawford, M.D., for the paper “Reliability,Response’) to Treat Proximal ACL Injuries in Skeletally Immature Validity and Responsiveness of the IKDC Score for MeniscusAthletes.” Injuries of the Knee.” Co-authors included Karen Briggs, M.B.A., Another paper produced, “Patient Knee Function and Activity M.P.H.; William G. Rodkey, D.V.M.; and J. Richard Steadman, M.D.Level Five-Year Post-Arthroscopy Compared to Normal Values,” wasIn the MediaTHE FOUNDATION HAS BEEN MENTIONED OR FEATURED Dr. Steadman and the Foundation were featured in the NovemberRECENTLY IN NATIONAL AND INTERNATIONAL MEDIA. 16 issue of the German news magazine Focus. The article is titled “Audience with the Knee Pope.” “He has treated Kahn, Ronaldo,The December 17 The Sunday Times (London) edition reported on Deisler, and Klitschko. When the knees of the stars are in a pinch,the return to action of professional soccer player Joey O’Brien they fly to the Rocky Mountains to see Richard Steadman, the famous(Bolton Wanderers). Team Manager Sam Allardyce says, “O’Brien has knee surgeon.”gone under the knife of the Colorado surgeon Richard Steadman, In the article Dr. Steadman remarked that the satisfaction iswho was responsible for rescuing the careers of Ruud van Nistelrooy incredible when a patient wins a gold medal. But it is much betterand Alan Shearer. when you know you have improved the lives of millions of recreational “Joey will be back soon,” Allardyce said. “Steadman spotted an athletes.area of scar tissue under Joey’s knee that was so small it could be “Since 1990, Steadman-Hawkins, with 90 employees andeasily missed by a scan. He has cleaned the knee out and given Joey a physicians in the Clinic and the separate Research Foundation,rehab program. He has no problems at all now.” has developed and perfected many new procedures such as the meniscus implant and microfracture.” [67]
  • Sports injury? They go to Steadman firstJohn Marshall, Associated Press where it seems just about every elite ath- BREAK IT TO FIX IT lete goes when they need to get fixed up Using work other people had done (though anyone can go if they have a with bone marrow, Dr. Steadman believed referral). he could drill tiny holes in the bone so Steadman◆Hawkins Research that cells from the marrow could help Foundation CEO Michael Egan said there’s regenerate damaged cartilage and pre- a misconception that so many athletes vent the onset of arthritis. It has become come to the clinic because, well, it’s where the treatment of choice for doctors other athletes have gone before. around the world since the foundation “But these athletes and the people validated the technique in 1994. who represent them are very sophisticat- “It (the success) has very much been ed when it comes to health care,” he said, the genesis of Dr. Steadman,” Egan said. “because it’s such a big part of their “Lots of doctors start foundations, but it’s financial well-being. They come here very rare that you would see one become because of care and because of results. If the top institute of its kind. That’s we didn’t have that, they wouldn’t be because of his original, tremendous dedi- coming here.” cation.” But Steadman didn’t do it alone. He THE MAN BEHIND THE METHOD brought in Dr. Richard Hawkins, one of It all started with Dr. Richard the world’s top shoulder specialists, to Steadman. help run the foundation and has sur- He was running a successful orthope- rounded himself with some of the bestV AIL, Colo. - We needed a hockey puck for a biomechanics demonstra-tion, so lab director Mike Torry headed dic clinic in South Lake Tahoe back in the 1970s - specializing in knee procedures - minds in orthopaedic medicine, both on staff and on the Foundation’s medical when he was approached by the owner of advisory board. The Foundation alsoupstairs. Vail to switch mountain ranges. Dr. brings in six fellows each year, who are“He’ll probably come back with one Steadman was reluctant at first, but typically the top medical students fromsigned by Mario Lemieux,” someone changed his mind when he was offered a around the world.joked. donation to start up a foundation. Now the Foundation, located in the A strong believer in research, Dr. Vail Valley Medical Center, has an annualTorry returned a few minutes later with a Steadman wanted to quantify his own budget of over $2 million, treating footpuck and, sure enough, it was signed by results instead of relying on others. To do and ankle, spine, hand and, most recently,Lemieux. that, he set up a database that could hip injuries. It has spent over $22 million track every procedure — it’s up to about over the past decade on research, educa-“We might not want to scuff this one 15,000 knees and 5,000 shoulders — tion, and support programs, and has hadup,” Torry said, drawing laughter from which he used to prove or disprove more than 400 papers accepted by scien-the group. whether what he was doing was working. tific journals. Thing is, there was probably a few “In doing the research ourselves, we And the Foundation keeps pushingmore Lemieux pucks up there. In fact, can have our own results. It gives us an toward the front of the field, searchingthere’s just about every kind of sports opportunity to talk to patients about the for new ways to prevent and heal injuries,memorabilia imaginable in the clinic - success rate for surgery. We can tell them including a new initiative to combatsigned footballs, photos and jerseys from it’s a success rate that we have, not some- arthritis.athletes like David Beckham, Martina thing available in literature,” said Dr. There is a Basic Science DepartmentNavratilova, and Greg Norman. Steadman, who opened the Vail clinic in that looks at healing from the cellular But this isn’t some kind of memora- 1990. “That’s given us a leg up.” level, a Biomechanics Lab loaded withbilia museum. It’s actually a world- The key to the foundation’s success Batman-like gadgets to analyze motionrenowned sports medicine clinic and starts with Steadman’s creative mind. He and the retrospective look at the clinicalresearch center called the was one of the first doctors to advocate research to verify what they’re doing onSteadman◆Hawkins Research Foundation. aggressive rehab, which means mobilizing the operating table. This is the most-published sports patients as quickly as possible after sur- “It’s the best of both worlds to havemedicine institute in the world, the place gery, working on their range-of-motion so these two entities — the clinic, which isthat made aggressive rehab popular, the they’ll heal faster. Dr. Steadman also totally devoted to the research side, andorigination of the microfracture proce- developed numerous innovations for sur- the research side, which is totally commit-dure for regrowing knee cartilage, and gical techniques. But his most famous con- ted to either proving or disproving the tribution to the orthopedic world is a pro- procedures as we develop them,” Dr. cedure called microfracture. Steadman said. John Marshall is AP’s sports writer based in Denver. [68]
  • AssociatesT he Steadman◆Hawkins Research Foundation is proud to recognize its team of associates, who carry out the Foundation’s research and educational mission in Vail. The staff has been internationally selected for itsdiverse training and background in biomechanics, engineering, clinical research, veterinary science, and computerscience. Together, the staff members take a multidisciplinary approach to their work in solving orthopaedicsports medicine problems.ADMINISTRATION CLINICAL RESEARCH BIOMECHANICS RESEARCH LABORATORYJ. Michael Egan K a r e n K . B r i g g s , M . B . A . , M . P. H .Chief Executive Officer and President Director M i c h a e l To r r y, P h . D .Marc Prisant Director Marilee HoranExecutive Vice President and Chief Financial Research Associate Kevin B. Shelburne, Ph.D.Officer Senior Staff Scientist Lauren MathenyAmy Ruther Research Associate J. Erik Giphart, Ph.D.Human Resources Manager Staff Scientist/Motion Laboratory Director Sarah Kelley-SpearingRachele Palmer Research Assistant Ta k a s h i Ya n a g a w a , M . A .Administration Staff Scientist/Senior Programmer James BennettDEVELOPMENT Research Intern John Brunkhorst Research InternJ o h n G . M c M u r t r y, M . A . , M . B . A . Rebeccca GlassmanVice President for Program Advancement Research Intern Nils Horn Research InternPaige Prill David KuppersmithVice President for Development and Te d O ’ L e a r y Research InternCommunications Research Intern Dustin ManchesterBASIC SCIENCE EDUCATION Research InternW i l l i a m G . R o d k e y, D . V. M . Greta Campanale Ti f f a n y Te l l oDirector Coordinator Research Intern VISUAL SERVICES Jennifer Thorne Research Intern Joe Kania Coordinator [69]
  • Meet Our Staff Greta Campanale Erik Giphart, Ph.D. Greta Campanale joined the Erik Giphart joined the Steadman◆ Steadman◆Hawkins Research Foundation Hawkins Research Foundation staff in in September of 2000 as Educational January of 2004 as an Intern and currently Program Coordinator and has remained in holds the position of Motion Analysis that role ever since. Her main responsibil- Laboratory Director. His primary focus ity is to organize the Steadman◆Hawkins is on designing and building a second-in- Sports Medicine Fellowship Program, in the-world, high-speed biplane fluoroscopy which six orthopaedic surgeons spend one system in the Biomechanics Research year under the tutelage of the physicians Laboratory. With this sophisticated x-ray in the Steadman-Hawkins Clinic, refining system, which creates movies of movingGreta Campanale their surgical and clinical skills in sports bones, joint motion can be tracked with medicine and contributing to the research sub-millimeter accuracy. This allows for of the Foundation. Greta also plans edu- the measurement of ligament lengthen- cational conferences hosted by the ing and perhaps even cartilage indenta- Foundation, such as the Vail Cartilage tion during activities such as walking, run- Symposium and the Steadman-Hawkins ning, and throwing a ball. Not only are Fellows Meeting, as well as the weekly these measurements currently unknown, and monthly academic lectures presented they are critical in understanding ligament by our physicians and guest lecturers. and cartilage function and their surgical Born and raised a faculty child at The reconstruction or repair, as well as their Taft School, a prep school in Connecticut, contribution to the development and Greta attended Taft and then earned her progression of osteoarthritis. This project bachelor’s degree in English at will open entirely new avenues of Georgetown University in Washington, research for the Foundation, as well asErik Giphart D.C. While enrolled in a post-baccalaure- greatly improve ongoing research projects. ate pre-med program in Bryn Mawr, Erik, a Dutch citizen, earned his Pennsylvania, Greta met her husband master of science degree in electrical Mike, a Philadelphia native, and decided engineering from Delft University of to pursue a path other than medicine. Technology in 1994 with a focus on com- The couple happily transplanted them- puter science and information theory. As selves to Colorado, where Mike had lived part of his M.S. program he was required and gone to college, to new jobs and to complete a three-month internship married life. Although they assured their outside of the university. He found an East Coast families that they would return internship at the Neuro Muscular Research upon having children, Greta and Mike Center (NMRC) in Boston and has been in find that their roots have grown deeply in the United States ever since. Vail since Sofia, age 3, and Stella, 2, were “You have to be flexible to take born. For the foreseeable future, their advantage of great opportunities. I was families have a beautiful Rocky Mountain going to visit the U.S. for three months destination when visiting Greta, Mike, plus a vacation. That was 12 years ago.” and the girls. In 2001 Eric received his Ph.D. in biomed- ical engineering at Boston University after completing his dissertation work on pos- tural control at the NMRC. After gradua- tion, he created a virtual reality laborato- ry at Sargent College of Health and Rehabilitation Sciences, Boston University, to study how perceptual deficits modify [70]
  • locomotion in patients who suffer fromvarious diseases. “I feel that with my newposition I have essentially come full circlewith my training. I almost completed myM.S. thesis in medical image processing inthe Netherlands, but decided to stay andcomplete my thesis work at the NMRC inBoston instead. This got me involved withhuman movement studies and biomechan-ics. After working with 3D VR environ-ments for three years and furthering myskills in motion analysis, I found out aboutthe great work the Biomechanics groupdoes at the Foundation. With theadvanced image processing and 3D mod-eling, as well as cutting-edge biomechan-ics required to analyze the fluoroscopydata, I feel I have found my home.” Applying his engineering skills tomedical and orthopedic problems is veryfulfilling for Erik and is inspired by hisfamily. Erik’s mother, Johanna, suffersfrom post-polio syndrome, and she hadher ankle fused many years ago. He clear-ly remembers her suffering after countlesssurgeries on her ankle and foot. Beingable to understand her limitations and togive her some advice based on his currentknowledge is satisfying for him. Erik’s sis-ter, Anja, is an M.D.-M.P.H. who has livedand worked in Africa for most of the past14 years. After being the only Westerndoctor in small regional hospitals inZambia and Mozambique, saving livesevery day, she now lives in Dar es Salaam,Tanzania, with her husband and adoptedchildren, and works for the ElizabethGlaser Pediatric AIDS Foundation to pre-vent transmission of the HIV virus frommother to child. Erik draws a lot of inspi-ration from his sister’s work. Erik and his wife, Courtney, an archi-tect for Morter Architects in Vail, movedto Courtney’s home state of Colorado inthe summer of 2003 after deciding it wastime to start a family. They currently livein Edwards with their two children. Theyenjoy skiing, hiking, and snowshoeingwith their dog Brooke, and all other activ-ities the mountains bring. [71]
  • Philanthropic Highlights in 2006 2006 New Gifts Steadman◆Hawkins Research Foundation, supporters — individuals, corporations and founda- tions — increased their philanthropy in 2006. Total: $2,950,574 Foundations and Grants $ 370,000 Corporations $ 834,500 Family and Friends $ 1,746,290 Increasing Generosity Five years of support. Individuals, corporations ($ Millions and foundations con- 3.5 tributed $2,950,574 in 2006, breaking the record for 3.0 total giving. 2.5 2.0 1.5 1.0 0.5 0 02 03 04 05 06 Annual Giving ($ Millions The generosity of our 2.0 friends making annual gifts 1.8 to the Foundation between 1.6 2002 and 2006 has shown a 1.4 positive trend. In 2006, con- tributions, including special 1.2 events, totaled $1,723,124. 1.0 0.8 0.6 0.4 0.2 0 02 03 04 05 06 Our Future The Steadman◆Hawkins Research Foundation has carefully managed its invest- ment portfolio to reduce risk. The investments of the carefully structured portfo- lio are diversified in asset allocation and exposure. Total investment portfolio: $4,037,657. Fixed Income 5% Alternative Investments 33% Cash 4% Equity 57%[72]
  • Independent Accountant’s ReportBoard of DirectorsSteadman◆Hawkins Research FoundationVail, ColoradoWe have audited the accompanying statements of financial position of Steadman◆Hawkins Research Foundation (the Foundation) as of December 31, 2006 and 2005,and the related statements of activities, cash flows and functional expenses for theyears then ended. These financial statements are the responsibility of theFoundation’s management. Our responsibility is to express an opinion on thesefinancial statements based on our audits.We conducted our audits in accordance with auditing standards generally acceptedin the United States of America. Those standards require that we plan andperform the audit to obtain reasonable assurance about whether the financialstatements are free of material misstatement. An audit includes examining, ona test basis, evidence supporting the amounts and disclosures in the financialstatements. An audit also includes assessing the accounting principles used andsignificant estimates made by management as well as evaluating the overallfinancial statement presentation. We believe that our audits provide a reasonablebasis for our opinion.In our opinion, the financial statements referred to above present fairly, in allmaterial respects, the financial position of Steadman◆Hawkins ResearchFoundation as of December 31, 2006 and 2005, and the changes in its net assetsand its cash flows for the years then ended in conformity with accountingprinciples generally accepted in the United States of America.s BKD, LLPJune 19, 2007Colorado Springs, Colorado 80903 [73]
  • S T E A D M A N ◆H AW K I N S R E S E A R C H F O U N D AT I O NS TAT E M E N T S O F F I N A N C I A L P O S I T I O NDECEMBER 31, 2006 AND 2005ASSETS 2006 2005Cash $ 585,011 $ 915,096Accounts receivable 128,167 149,965Accounts receivable, related party 2,836 1,633Investments 4,130,879 3,119,858Contributions receivable 279,893 291,054Contributions receivable, related party 750 5,750Prepaid expenses and other assets 65,609 56,740Property and equipment, net 328,583 214,577Total assets $ 5,521,728 $ 4,754,673LIABILITIES AND NET ASSETSLiabilities Accounts payable $ 72,594 $ 108,358 Accrued expenses 96,148 88,936 Deferred revenue 18,000 134,500Total liabilities 186,742 331,794Net Assets Unrestricted 4,561,769 3,835,466 Temporarily restricted 773,217 587,413Total net assets 5,334,986 4,422,879 Total liabilities and net assets $ 5,521,728 $ 4,754,673See Notes to Financial Statements [74]
  • S T E A D M A N ◆H AW K I N S R E S E A R C H F O U N D AT I O N S TAT E M E N T S O F A C T I V I T I E S YEAR ENDED DECEMBER 31, 2006 Temporarily Unrestricted Restricted Total REVENUES, GAINS AND OTHER SUPPORT Corporate partner support $ 572,500 $ 262,000 $ 834,500 Contributions 893,699 460,578 1,354,277 Grants 15,000 354,937 369,937 Fundraising events, net of $156,720 of expenses 368,847 — 368,847 Fellows and other meetings — 3,400 3,400 Video income 4,100 — 4,100 Other income 15,513 — 15,513 Net assets released from restrictions 895,111 (895,111) 0 Total revenues, gains and other support 2,764,770 185,804 2,950,574 EXPENSES Biomechanics research program 531,758 — 531,758 Basic science program 69,057 — 69,057 Bioskills 54,839 — 54,839 Clinical research program 442,830 — 442,830 Education program 266,354 — 266,354 Office of Information Services 173,015 — 173,015 Management and general 407,269 — 407,269 Fundraising 513,534 — 513,534 Total expenses 2,458,656 — 2,458,656 OTHER INCOME (EXPENSE) Investment income 479,372 — 479,372 Other (59,183) — (59,183) Total other income (expense) 420,189 — 420,189 CHANGE IN NET ASSETS 726,303 185,804 912,107 NET ASSETS, BEGINNING OF YEAR 3,835,466 587,413 4,422,879 NET ASSETS, END OF YEAR $ 4,561,769 $ 773,217 $ 5,334,986See Notes to Financial Statements [75]
  • S T E A D M A N ◆H AW K I N S R E S E A R C H F O U N D AT I O NS TAT E M E N T S O F A C T I V I T I E SYEAR ENDED DECEMBER 31, 2005 Temporarily Unrestricted Restricted TotalREVENUES, GAINS AND OTHER SUPPORT Corporate partner support $ 520,000 $ — $ 520,000 Contributions 832,853 386,881 1,219,734 Grants 5,000 768,554 773,554 Fundraising events, net of $136,052 of expenses 335,768 — 335,768 Fellows and other meetings 10,050 — 10,050 Video income 11,915 — 11,915 Other income 28,815 — 28,815 Net assets released from restrictions 764,955 (764,955) 0 Total revenues, gains and other support 2,509,356 390,480 2,899,836EXPENSES Biomechanics research program 443,245 — 443,245 Basic science program 114,704 — 114,704 Bioskills 50,918 — 50,918 Clinical research program 319,967 — 319,967 Education program 438,099 — 438,099 Office of Information Services 171,755 — 171,755 Management and general 415,810 — 415,810 Fundraising 431,440 — 431,440 Total expenses 2,385,938 — 2,385,938OTHER INCOME Investment income 265,387 — 265,387CHANGE IN NET ASSETS 388,805 390,480 779,285NET ASSETS, BEGINNING OF YEAR 3,446,661 196,933 3,643,594NET ASSETS, END OF YEAR $ 3,835,466 $ 587,413 $ 4,422,879See Notes to Financial Statements [76]
  • S T E A D M A N ◆H AW K I N S R E S E A R C H F O U N D AT I O NS TAT E M E N T S O F C A S H F L O W SYEARS ENDED DECEMBER 31, 2006 AND 2005 2006 2005OPERATING ACTIVITIES Change in net assets $ 912,107 $ 779,285 Items not requiring (providing) cash Depreciation 119,457 93,470 Realized and unrealized gains on investments (381,618) (203,739) Loss on disposal of fixed assets 59,183 — In-kind contributions of investments (109,204) (43,717) Changes in Accounts receivable 20,595 (50,125) Contributions receivable 16,161 (294,904) Prepaid expenses and other assets (8,869) (30,073) Accounts payable (35,764) 60,839 Accrued expenses 7,212 (2,110) Deferred revenue (116,500) 134,500 Net cash provided by operating activities 482,760 443,426INVESTING ACTIVITIES Purchase of property and equipment (292,646) (65,828) Purchases of investments (1,750,686) (1,055,100) Sales of investments 1,230,487 700,000 Net cash used in investing activities (812,845) (420,928)INCREASE (DECREASE) IN CASH (330,085) 22,498CASH, BEGINNING OF YEAR 915,096 892,598CASH, END OF YEAR $ 585,011 $ 915,096See Notes to Financial Statements [77]
  • Programs Office of Management Biomechanics Basic Clinical Information and Research Bioskills Science Research Education Services Total General Fundraising Total Salary and benefits $361,758 $ — $25,372 $331,421 $117,097 $ 62,989 $ 898,637 $264,183 $194,613 $1,357,433 Payroll taxes 20,679 — 1,845 20,833 7,711 4,516 55,584 17,348 11,514 84,446 Travel 15,356 2,479 367 9,782 35,447 2,668 66,099 15,974 2,725 84,798 Utilities 4,196 — 1,501 3,248 2,784 5,104 16,833 8,352 2,088 27,273 YEAR ENDED DECEMBER 31, 2006 Telephone 2,892 — 248 2,460 548 1,696 7,844 4,653 1,574 14,071 S T E A D M A N ◆H AW K I N S R E S E A R C H F O U N D AT I O N Consulting and contract labor 12,364 63,299 7,493 14,089 18,600 2,173 118,018 30,000 69,750 217,768 Legal and accounting 8,234 654 115 7,524 1,172 1,424 19,123 10,475 3,510 33,108 Postage and freight 3,905 8 404 4,496 1,130 1,282 11,225 3,136 6,211 20,572 Exhibits and meetings 2,620 — — 617 29,605 — 32,842 — — 32,842 Research projects 50,000 — — 3,989 12,439 — 66,428 — — 66,428 S TAT E M E N T S O F F U N C T I O N A L E X P E N S E S Facility rent 5,461 — 1,855 4,365 3,426 6,232 21,339 10,327 3,356 35,022[78] Promotion 1,000 — — — 269 — 1,269 — 42,329 43,598 Repair, maintenance and equipment — — — — — 33,206 33,206 — — 33,206 Board meetings — — — — 1,535 — 1,535 — 20,907 22,442 Dues, subscriptions, books and journals 541 — 11 927 9,108 81 10,668 113 805 11,586 General insurance 960 — 111 1,070 185 221 2,547 14,042 480 17,069 Printing 1,453 403 32 7,529 1,963 63 11,443 190 107,487 119,120 Supplies 16,103 — 6,541 9,942 13,844 9,310 55,740 4,392 8,543 68,675 Program support 57 — 7 63 14 24 165 46 25,488 25,699 Depreciation 23,722 — 8,937 12,352 9,308 41,961 96,280 12,211 10,966 119,457 Other 457 2,214 — 8,123 169 65 11,028 11,827 1,188 24,043 $531,758 $69,057 $54,839 $442,830 $266,354 $173,015 $1,537,853 $407,269 $513,534 $2,458,656 See Notes to Financial Statements
  • Programs Office of Management Biomechanics Basic Clinical Information and Research Bioskills Science Research Education Services Total General Fundraising Total Salary and benefits $301,547 $ — $22,589 $224,553 $110,176 $ 81,860 $ 740,725 $266,348 $187,477 $1,194,550 Payroll taxes 18,911 — 1,610 15,363 7,446 5,858 49,188 18,941 11,378 79,507 Travel 7,858 4,977 — 4,569 36,670 4,487 58,561 12,755 1,846 73,162 Utilities 4,997 — 3,103 3,447 2,955 5,417 19,919 7,006 2,216 29,141 YEAR ENDED DECEMBER 31, 2005 Telephone 2,831 — 202 2,105 472 1,875 7,485 3,441 1,655 12,581 S T E A D M A N ◆H AW K I N S R E S E A R C H F O U N D AT I O N Consulting and contract labor 13,968 108,033 3,336 14,837 250 2,430 142,854 40,301 70,047 253,202 Legal and accounting 8,460 607 145 6,522 1,505 2,259 19,498 4,767 3,970 28,235 Postage and freight 4,405 56 758 5,055 2,789 1,909 14,972 3,549 4,578 23,099 Exhibits and meetings 1,590 — — 1,160 245,725 — 248,475 45 — 248,520 Research projects 50,000 — — 10,457 5,087 — 65,544 — — 65,544 S TAT E M E N T S O F F U N C T I O N A L E X P E N S E S Facility rent 8,323 — 4,226 5,839 4,115 7,435 29,938 9,817 3,872 43,627[79] Promotion 2,000 — — 579 90 219 2,888 750 37,534 41,172 Repair, maintenance and equipment 20 — 3 23 5 11,945 11,996 198 36 12,230 Dues, subscriptions, books and journals 1,327 — 11 91 7,509 32 8,970 67 1,857 10,894 General insurance 693 — 54 668 134 399 1,948 13,217 321 15,486 Printing 3,463 140 276 5,766 679 844 11,168 5,524 75,800 92,492 Supplies 7,241 — 5,646 7,091 2,947 9,156 32,081 5,021 7,352 44,454 Program support 198 — 22 212 47 89 568 146 4,217 4,931 Depreciation 5,282 — 8,937 11,630 9,308 35,541 70,698 10,427 12,345 93,470 Other 131 891 — — 190 — 1,212 13,490 4,939 19,641 $443,245 $114,704 $50,918 $319,967 $438,099 $171,755 $1,538,688 $415,810 $431,440 $2,385,938 See Notes to Financial Statements
  • S T E A D M A N ◆H AW K I N S R E S E A R C H F O U N D AT I O NN O T E S T O F I N A N C I A L S TAT E M E N T S YEARS ENDED DECEMBER 31, 2005 AND 2004NOTE 1: NATURE OF OPERATIONS AND SUMMARY Investments and Investment ReturnOF SIGNIFICANT ACCOUNTING POLICIES Investments in equity securities having a readily determinable fair value and all debt securities are carried at fair value. InvestmentNature of Operations return includes dividend, interest and other investment income andSteadman◆Hawkins Research Foundation (the Foundation) is a not- realized and unrealized gains and losses on investments carried at fairfor-profit foundation located in Vail, Colorado, that is organized for value. Investment return is reflected in the statements of activities aseducational and scientific purposes to advance medical science and unrestricted or temporarily restricted based upon the existence andresearch. The Foundation’s primary sources of support are public nature of any donor or legally imposed restrictions.donations, grants and corporate partners. Use of EstimatesCorporate Partners The preparation of financial statements in conformity with accountingThe Foundation has agreements with several corporations who spon- principles generally accepted in the United States of America requiressor the Foundation’s research. This research is for the general use of management to make estimates and assumptions that affect theand publication by the Foundation. These agreements are recorded reported amounts of assets and liabilities and disclosure of contingentas income in the year payment is due. assets and liabilities at the date of the financial statements and the reported amounts of revenues, expenses, gains, losses and otherContributions changes in net assets during the reporting period. Actual resultsGifts of cash and other assets received without donor stipulations are could differ from those estimates.reported as unrestricted revenue and net assets. Gifts received with adonor stipulation that limits their use are reported as temporarily or I n c o m e Ta x e spermanently restricted revenue and net assets. When a donor-stipu- The Foundation is a qualifying organization under Section 501(c)(3)lated time restriction ends or purpose restriction is accomplished, of the Internal Revenue Code and a similar provision of state law.temporarily restricted net assets are reclassified to unrestricted net Consequently, no provision for income taxes has been made in theassets and reported in the statements of activities as net assets financial statements.released from restrictions. ReclassificationsGifts of land, buildings, equipment and other long-lived assets are Certain reclassifications have been made to the 2005 financial state-reported as unrestricted revenue and net assets unless explicit donor ments to conform to the 2006 financial statement presentation. Thesestipulations specify how such assets must be used, in which case the reclassifications had no effect on the change in net assets.gifts are reported as temporarily or permanently restricted revenueand net assets. Absent explicit donor stipulations for the time long- NOTE 2: INVESTMENTS AND INVESTMENT RETURNlived assets must be held, expirations of restrictions resulting inreclassification of temporarily restricted net assets as unrestricted net Investments at December 31 consist of the following:assets are reported when the long-lived assets are placed in service.Unconditional gifts expected to be collected within one year are 2006 2005reported at their net realizable value. Unconditional gifts expected to Stock and equity funds $ 2,311,208 $ 1,612,089be collected in future years are reported at the present value of esti- Equity securities 51,812 40,137mated future cash flows. The resulting discount is amortized using Fixed income funds 202,696 194,750the level-yield method and is reported as contribution revenue. Money market funds 36,886 111,140 Limited partnerships 1,328,277 1,161,742Cash $ 4,130,879 $ 3,119,858At various times during the year, the Foundation’s cash accountsexceeded federally insured limits. At December 31, 2006 and 2005, approximately 89% and 90%, respectively, of the Foundation’s investments consisted of equity secu-Accounts Receivable rities and equity mutual funds.Accounts receivable are stated at the amount billed to customers. TheFoundation provides an allowance for doubtful accounts, which is Investment income during 2006 and 2005 consists of the following:based upon a review of outstanding receivables, historical collectioninformation and existing economic conditions. Accounts receivable 2006 2005are ordinarily due 30 days after the issuance of the invoice. Accounts Interest and dividend income $ 97,754 $ 61,648past due more than 120 days are considered delinquent. Delinquent Net realized and unrealized gainsreceivables are written off based on individual credit evaluation and on investments 381,618 203,739specific circumstances of the customer. Investment income $ 479,372 $ 265,387Property and EquipmentProperty and equipment are depreciated on a straight-line basis overthe estimated useful life of each asset. Leasehold improvements aredepreciated over the shorter of the lease term plus renewal options orthe estimated useful lives of the improvements. [80]