Non Surgical Orthopaedics

Over the last four to five years my interest in cartilage regeneration has continued to focus upon new techniques in stimulating cells to self-repair.  Concurrently, biotechnology has rapidly advanced to provide us with new tools in evaluating the genome (our DNA sequences) and to explain much of cell behavior in terms of growth factors- proteins that control how our cells work, produce materials, and eventually become senescent.  Technologies in the offing will be able to make DNA editing a new therapy for many diseases.  Furthermore, the link between aging, cancer, and our immune systems has become increasingly obvious- this is what is driving the marketing of “personalized medicine”.

Although we are not there yet, I feel strongly that this is the (very near)future.  The concept of treating all patients with the ‘same’ ostensible problem  the exact same way, or with the same drug, will be seen to be quite antiquated.  Most of today’s ‘guidelines’ will soon obsolesce.  Both physicians and patients will need to get smarter. Part of this will come from patient empowerment, but this will only be possible if the ‘big data’ are organized into a form that makes decisions actionable and reasonable; for example, not everyone should take up marathon running (stress fractures, heart stress), and some folks would really benefit from weight lifting(to build bone mass) at an early age. The doctor will continue to be in the business of giving advice, but it will be more informed advice.

In orthopaedics, new therapies will result in much less surgery. What if: many ACL tears were made to heal in situ? many cartilage lesions  and tendinopathies healed with injections? Rotator cuffs and torn meniscii could be treated in the office? Much of this is already true today.

In my practice, patients should look forward to receiving the best synthesis of advice derived from some old methods and some new possibilities. This is how progress is made and this is what keeps life interesting.