Dr. John P. Fulkerson

You could say that the knee has its own private eye. Dr. John Fulkerson, an orthopedic surgeon with Orthopedic Associates of Hartford in Farmington, Connecticut, is particularly taken with problems of the patellofemoral joint. Was there a car accident? What is the family’s knee history? How is the patella tracking?

This sense of scientific inquiry runs in the family. Dr. Fulkerson: “I grew up in Levittown, New York in a diverse working class neighborhood. My dad was a general practitioner who sometimes let me tag along on house calls. He was a wonderful, kind man with an impeccable ethic of scientific inquiry, honesty, hard work, humor, study and athleticism. My grandfather and great grandfather were physicians as well, so I grew up with a strong sense that medicine was where I belonged.”

Medical School

Like many students who poured over textbooks in the late ‘60s, John Fulkerson had the Vietnam War in the back of his mind. “While at Williams College in Massachusetts, I worked hard to get into medical school. My thought was that if I were to go to Vietnam, it would be as a doctor. I studied very hard and played varsity tennis and squash, while also working as a DJ on the college radio station. While working as a YMCA camp counselor after sophomore year, I met my wife to be, Lynn; we are still married. During those years, I was influenced by Paul Tillich’s ‘The Courage to Be, ’ a book that emphasized the importance of a purposeful, positive life.”

“Athletics played an incredibly important part in my life, ” continues Dr. Fulkerson. “After winning shotput and high jump in the Gardiner’s Avenue School Olympics, feats which gave me great confidence, I thought I was ready for any challenge. So I went on to high school football, wrestling and tennis. But it was tennis that got hold of me, and I managed to make the Williams College tennis team, working my way up from number 27 to number 2 on the freshman tennis ladder…then on to the varsity squad as a sophomore. Tennis continued to be good to me and brought me many friends and opportunities over the years.”

John Fulkerson also had the opportunity to meet new friends and mentors when he entered Yale Medical School in 1968. “I worked with Dr. Robert Handschumacher, a professor of pharmacology, who was really inspirational. A friendly person and great scientist, ‘Dr. H’ emphasized meticulous honesty about data and its analysis. In my senior year, I did an orthopedic surgery rotation, and really liked the positive, reconstructive nature of the field. I worked with Dr. Peter Jokl, the head of sports medicine, who had an exemplary lifestyle and stressed the same values that I was raised with, namely honesty, hard work, athleticism and integrity. Peter has been a career-long mentor and friend.”

His life imbued with a sense of service, Dr. Fulkerson had no problem signing on the dotted line. “I had received a grant from the U.S. Public Health Service for medical school, so it came time to honor that obligation. After a general surgery internship at Yale New Haven Hospital, I went into the Indian Health Service as a general medical officer and ran the surgical service under the direction of Dr. Jim Ritter at Fort Defiance, Arizona. Having never worked outside the northeastern U.S., this was an exciting experience for me, and one which entailed treating people with a lot of health needs.”

I also learned quite a bit about Native American spirituality, ” adds Dr. Fulkerson. “One patient had a cyst the size of a grapefruit in his chest, and, as we were preparing to operate, his family decided that he should have three days of treatment by a medicine man first. They held a ceremony in his room during which time the medicine man drained the cyst and it went away; I never had to operate. I really don’t know exactly what went on, but I was impressed by the power of Native American spirituality in this and many other instances.

Real-World Training

Armed with real world experience, Dr. Fulkerson was more prepared than many to get the most out of a residency program. “I began my orthopedic surgery residency at Yale in 1975, during which time I got to know Dr. Wayne Southwick, the Chairman of the department. He had an incredible intellect, a terrific breadth of knowledge, and took such joy in his job. The venerable Dr. Augustus White taught me the wonders of research. For a while, he had us read about 10 articles a week and then reviewed them with us. He imparted an appreciation for the critical understanding of orthopedic literature. Dr. Donald Chrisman also impacted my career. He was a true scholar who took a day each week out of his private practice to drive from Northampton, Massachusetts to New Haven to do research.”

He taught me that there is a close relationship between basic science research and clinical practice; I began to seriously consider an academic career. I was drawn in by the blend of science and medical practice, and fascinated by the way things work—especially cells. At this point in time, I was also very influenced by Lewis Thomas’s book, ‘The Lives of a Cell.’

Dr. Fulkerson then followed his residency with a travelling feast of orthopedic study. “In 1979 I did a traveling fellowship sponsored by the Orthopaedic Research and Education Foundation. This enabled me to learn from many ‘greats’ in orthopedic surgery, such as Dr. John Marshall at Hospital for Special Surgery, Sir John Charnley, inventor of the total hip replacement, in England, and Dr. Jack McGinty in Boston. I also travelled to Sweden to study with Drs. Lars Peterson, Per Renstrom, Ejnar Eriksson and Jan Gillqvist. Sweden has a strong heritage of ACL reconstruction going back to Dr. Ivar Palmer in the early ‘30s.”

Professional Success

His travels ultimately helped him find his focus: “I had been searching for an area of interest that needed study and better understanding. It was the traveling fellowship that helped me settle on the patellofemoral joint as something I wanted to pursue. I had begun a full time faculty position at the University of Connecticut in 1978, then in the early ‘80s, I devised an operation known as an anteromedial tibial tubercle transfer.”

Dr. Fulkerson explains, “This evolved from a concept I learned as a resident from Wayne Southwick, who had described a biplane osteotomy of the hip to treat slipped capital femoral epiphysis. We would literally sit on the floor of Wayne’s office and play like kids with the instruments for doing this complex osteotomy. Wayne Southwick had an uncanny ability to make the complexities of orthopedic surgery fun. I figured, ‘Why not a biplane osteotomy of the knee to help unload and realign the patella?’ This operation has since been called the Fulkerson Procedure by many, and is now a mainstream orthopedic operation that has helped thousands of people with breakdown of the lateral and distal patellofemoral joint.”

Dr. Fulkerson then continued his investigations into the knee with more research. “I wanted to know why patients had pain around the patella so I undertook a study of the lateral patellofemoral retinacular structure. Margaret Grunnet and I discovered that some people with pain had histologic evidence of small nerve injury in the lateral retinaculum of the patellofemoral joint. We reported this in the literature in 1985. Steve Schutzer, Gale Ramsby and I then examined the mechanics of the joint using a new technology at that time–computerized tomography, by which we differentiated the alignment patterns of patella tracking.”

No one is successful without the help of others, says Dr. Fulkerson, who adds that he was fortunate to have been surrounded by the best young people imaginable. “In 1980 I started the Division of Sports Medicine at the University of Connecticut Health Center, and ran the resident education and selection programs in the department of orthopedic surgery there for many years. I worked with some brilliant students and residents who helped me with my studies.”

Dr. Fulkerson’s detailed knowledge of the knee would then benefit athletes who engage in full body contact…hockey players. “I covered Trinity College hockey and football, and received an award from their athletic department for consistently supporting their programs. After that I was asked to be team doctor for the NHL’s Hartford Whalers, which was a lot of fun. We had a terrific medical group there with an extraordinary trainer, Bud Gouveia. I got to know Gordie Howe, Kevin Dineen, Paul Holmgren, Ron Francis, and even Ivan Lendl (who was on the Whalers Board). I exchanged stories with Wayne Gretzky in our training room, reduced Al Macinnis’s dislocated hip, and reconstructed Adam Burt’s knee.”

In 1993, ” adds Dr. Fulkerson, “I was honored to be appointed team doctor to the ‘94 U.S. Olympic ice hockey team, and had the pleasure of traveling through Finland and Sweden on their pre-Olympic tour. Hockey players are exceptional people who often grow up in strong families. As you might imagine, they are tough and don’t let things get them down. Many of the guys are also very down to earth, and most have great senses of humor.

His leadership skills sharpened, Dr. Fulkerson then undertook the creation of a new society in 1994.

Jean Yves-Dupont and I launched the International Patellofemoral Study Group to provide a forum for surgeons worldwide to meet and further our understanding of how this joint works. Then in 2002 I started the Patellofemoral Foundation to raise funds for research and education on this topic. Part of our success has been the ability to link up with some major orthopedic organizations to sponsor traveling fellowships for outstanding academic orthopedic surgeons worldwide. In addition, we present awards for exceptional research on the patellofemoral joint.

Some of my long time friends, including Peter Jokl and Eric Dahlinger, helped me with this from the beginning. Ivan Lendl also lent a hand in the early days.

Having explored every nook of the knee, Dr. Fulkerson wanted to find a more effective method for reconstructing the ACL. “In the mid ‘90s I learned about the central quadriceps tendon from Hans Uli Staubli, a Swiss surgeon. It is thicker and wider than the patellar tendon and is a better alternative for reconstructing the ACL. My primary finding and contribution here is discovering the ‘central quadriceps free tendon graft’ for ACL reconstruction. I did the research to establish that the quadriceps tendon, without bone attached, is a safe, optimal autograft for ACL reconstruction.”

After being elected to a prestigious sports medicine group, the Herodicus Society, Dr. Fulkerson was named President of the organization in 2002. He explains,

The Herodicus Society is an academic sports medicine society that brings together leaders in the field to share new ideas and information in an informal setting. I am proud to say that during my tenure as President, the membership was expanded to incorporate a larger number of young, accomplished surgeons into the group.

A man of the OR and the land, John Fulkerson and his wife live amongst the vines. “We have a full vineyard with over 200 grape vines, enabling us to make our own wine…an area where my science background comes in very handy. Finally I have found the old college organic chemistry useful!”

Dr. Fulkerson: “Given that we’re in Connecticut, we specialize in cold weather varieties, including a number of hybrids such as Saint Croix, Foch, Cayuga, and Vidal Blanc. We exchange it with friends who make different things; I have traded wine for everything from canned goods to manure. Harvesting the grapes and making the wine is a blast with special friends coming over to pick grapes and join in the fun (and work). We make a party out of it with plenty of food and, of course, wine!”

At home in the natural world, Dr. Fulkerson is a committed land preservationist and President of the Litchfield Land Trust, an organization dedicated to preserving quality land in northwest Connecticut. He also enjoys the outdoors while participating in a number of sports: “Skiing, biking, flyfishing and tennis are some of my favorite pastimes. I also love spending time with my wonderful wife of 41 years, Lynn, who has been so helpful and supportive over the years. We are so proud of our two children, Brad the dentist and Phoebe the artist, who have achieved great things in life. Our family has been very fortunate; much of this I attribute to hard work, friends, caring and mutual support.”

Dr. John Fulkerson…expanding scientific inquiry and creating opportunities for future generations.