Dr. Ralph Gambardella

A much sought after sports medicine specialist at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles, Dr. Ralph Gambardella says his beginnings were far from “to the manor born.”

“My friends and I were more likely to steal hubcaps than go to an Ivy League school, ” says Dr. Gambardella with a smile.

A self-described “townie, ” Ralph Gambardella was born and raised in a little hamlet near New Haven, Connecticut. “My parents were first generation Italian with a smattering of Polish thrown in. We had a meager lifestyle, with my dad holding down two jobs and rushing home for a quick dinner before heading out for his evening work. No one in my family or extended family had ever attended college. My dad and mom stressed education, saying, ‘We don’t want you to have to be a cafeteria worker or custodian like we did.’ My brother and I listened—he worked his way to a Ph.D., and I found my way through a number of interests, including music and government, and ended up at the top of my high school class.”

Eager to look beyond the borders of his adolescent experience, Ralph Gambardella stepped out of his past and into the wider world. “I didn’t want to go to college close to home, in particular because I had never been west or south of New York City. I chose Bowdoin College, a small school in Maine that opened my eyes to the fact that the rest of the world existed. In my sophomore year I was confronted with four choices: the draft, the ROTC, a premed track…or Montreal. I knew I wanted to work with people, but wasn’t sure which path to take.”

“One summer during college I went to Southern California and worked for a phone company. Taken with ‘The Golden State, ’ I signed up for a summer dental program at the University of Southern California (USC) and met people who were instrumental in my getting accepted to medical school at that institution.”

Dr. Gambardella, who says he was never known for his prowess on the field, would nonetheless shake the hand of fate and end up linked to a top sports medicine program. “During my first year of medical school I got to know Robert Kerlan Jr., son of the famous Dr. Robert Kerlan, co-founder of the Kerlan-Jobe Orthopaedic Clinic for sports medicine.”

Dr. Gambardella wasn’t inspired to join a sports team, but his friendship with the son of the famed doctor did help him find his true calling. “We remained friends throughout school, and I eventually realized that I had an interest in working with my hands. It was also appealing that orthopedics generally offered fast results, meaning that I could see something accomplished as a result of what I did. Also, I wanted to work with younger patients and those who wanted to ‘get on with things.’ Cardiology, one of my other interests, was too slow for me.”

A walk down the aisle would then lead to a flight back across the country. “My wife and I were married in 1976, my last year of medical school. She was a native Angeleno and wanted to experience the East Coast, so I selected Boston for my next step of the training process. ‘Back east’ they were doing two years of general surgery and three years of orthopedics, different from out west where it was one year of internship and four years of orthopedics. So when I went to Boston, I realized that I wasn’t quite up for two years of general surgery with the accompanying ER call schedule every other night. I changed my mind, and we returned to the west coast where I began an orthopedic residency at USC.”

There was something not only familiar about USC, but about one of his rotations. “During this time I rotated at Kerlan-Jobe as part of an elective, where I was impressed by all the associates working there, especially Dr. Jobe. The clinical portion of my residency was largely at the Los Angeles County Hospital, where I saw a lot of patients with gunshot wounds, knife injuries and trauma. On the supervisory front things were rather thin…you learned as you went and were not spoonfed. The rest was also up to you, meaning that we were very motivated to read the literature because at the end of the day we still needed to know the academic end of things.”

At some hospitals, people see unusual things during a full moon. Dr. Gambardella and his residency cohorts, however, thought they were experiencing lunacy on a daily basis. “We had a love/hate relationship with our Chair, Dr. Paul Harvey, who had earned a reputation as a crazy guy. He would make us come in at odd hours of the morning to round. And if someone ever presented a case and didn’t include the person’s entire background (social history, family history, etc.), he lost it. At the time we thought, ‘What difference does it make if the person’s got xyz in his past?’”

“Over time, of course, I came to see that a patient’s social or work history is very important and may define how you treat their injury. Dr. Harvey was also meticulous about how physicians should present themselves, never allowing us to do grand rounds dressed in scrubs. The day one of our group showed up in scrubs, Dr. Harvey made us wait until the guy went home, showered, put some cologne on, and donned his best suit.”

The Kerlan-Jobe thread would again be picked up in 1982 when Dr. Gambardella entered their sports medicine fellowship. “The entire year was filled with new learning about sports medicine, new techniques, research and especially information on how to interact with all different types of athletes and people. I then decided to look for a practice on the East Coast, in part because my family was there, but also because we had enjoyed our time in Boston. We ended up on Long Island where I joined a private practice as the first sports medicine trained orthopedic surgeon on the island. A year and a half later I received a call from Dr. Kerlan, who said that one of their senior partners had decided to move on and asked if I would like to join the group. I couldn’t pass up the chance to join the greatest sports group in the country—really the opportunity of a lifetime.”

“When I returned in 1985, ” says Dr. Gambardella, “the practice was beginning to grow, expanding over the next few years by adding numerous people in different specialties. My primary function at the time was to assist Dr. Jobe with the Dodgers. This evolved from Dr. Kerlan’s philosophy that it was important that as we doctors aged, we have backup coverage within the group. It was an exciting time that led to my having a different level of interaction with Dr. Jobe, meaning that we spent many hours together and I had a teacher, business partner, surrogate father and friend all rolled into one. As is typical of young orthopedic surgeons, however, I was a little frustrated because I wanted to do everything on my own right away. We evolved into a great team, though, and as he got older I took on more responsibility. To this day he is still active in the group and involved with educating the fellows.”

Putting on new hats means that what goes on under the hats must be stellar and adaptable. Dr. Gambardella: “In the mid to late ‘80s I became involved in a leadership role for the clinic, taking up the mantle of Chair of the Executive Committee. By the late ‘90s I was President of the group, particularly challenging because I had my other ‘hats’ as surgeon and educator. I learned to juggle, though, and went on to see the fruits of my labor. The most exciting day yet was in 1998 when we moved into our new facility, something that was three years in the making. It was one of the first integrated medical plaza buildings in the country where offices, diagnostic imaging, PT, a surgery center, pharmacy and internal medicine doctors were all under one roof.”

Not all of Dr. Gambardella’s patients have a trophy case or golden bat to their names. Some are workaday people whose sports involve lifting their grandkids or teeing off without pain. “Beyond the sports icons and celebrities, there is one patient I recall very well. She had a difficult shoulder problem, and despite many surgeries and our best care, she has always continued to have a shoulder that doesn’t stay in place. Regardless of her many personal difficulties, each year she brings me homemade Christmas cookies and blackberry brandy, as well as gifts for my family. It is really very touching that although we were unable to fully cure her, she still appreciates our efforts.”

“Some of the best moments for all doctors are, for example, when you receive a letter from someone saying, ‘You may not remember me, but you fixed my knee. I just wanted to let you know that because of you I got a scholarship and was able to graduate from college.’”

Teaching what you practice then helps your interests and passions come alive in others. “I am proud to have helped develop the Kerlan-Jobe Foundation, which houses our fellowship training program. We work with industry to help teach fellows the newest techniques and innovations available in our field. Much of what they learn applies to my particular interest, namely, articular cartilage problems. I try to deepen their understanding of articular cartilage injuries, as well as teach them the innovations that are coming down the road.”

“I especially want to stimulate their desire to pursue a research career. The primary challenges are, as you can guess, time and money. While young people may have a desire to do research, there may be no dollars tied to that. So if you’re not seeing patients or doing surgery, then you’re not earning a living.”

He continues, “This gets into the areas of time management and philosophy. I try to impart to the fellows an understanding that life is short and that they better make sure to stop and smell the roses. I tell them, ‘Look, your little girl will someday be 22 and you will have never attended her choir performances. Go.’ They will leave here with superior surgical skills but they should strive to be more than a physician. Divorce is a very real issue in doctors’ marriages, so a work/family balance is critical. I came to find this out as I was divorced and then remarried 10 years ago. And given where medicine is headed, there will be a continuing shortage of doctors. There won’t, however, be a shortage of work…there will always be another patient to see.”

But when wearing his research, as opposed to his family man, hat, Dr. Gambardella is focused on the complexities of the hard, white surface that covers the ends of bones. “Articular cartilage research, something that has been slow to gain attention in the U.S., has been moving at a good pace elsewhere in the world. Because of this, I have been afforded the opportunity to work with people from an array of different countries and gain insight into their treatment processes and philosophies. In the U.S., however, the FDA approval process has really been an issue (they require that the product be based on research done in the U.S.). This is true in all areas, but it especially seems to be the case with articular cartilage work.”

“For example, there are people in other countries who are growing articular cartilage cells and putting them back into the knee to grow. In the U.S. these cells were initially delivered as a liquid. We had to make a tissue patch, sew it into the defect and then add the liquid cells…a long, tedious operation. Now other countries have developed membranes that you can put cells in and materials made like paste that you can more easily put onto the defect, but none of these newer generation techniques and products are available in the U.S. There are now clinical trials in the U.S. with different types of materials that are similar to what is available elsewhere in the world. Unfortunately, it will be five, seven, or ten years before FDA approval.”

He continues, “I’m also involved in studies to make those second generation products, including one with J & J. For this particular product there is a preliminary human study underway at four or five centers, including Kerlan-Jobe. The investigation, which will be expanded to 20 centers across the U.S., involves an implant and a single step operation that uses the patient’s own cells placed in a membrane. This could be attached someday with an arthroscopic surgery. The goal, to provide ingrowth for cells, will be awhile in coming as we have no data as of yet.”

On the personal front, Dr. Gambardella, who once stepped from his small town into the wider world and never looked back…is a traveler at heart. “I have a great wife, two daughters, and two step-daughters. One of my favorite pastimes, wine collecting, began when I realized that I should subscribe to something other than orthopedic journals. I also make time for cycling, skiing, and international travel. My journeys are based on the book, ‘One Thousand Places to See Before You Die: A Traveler’s Life List.’ I haven’t checked off most of the list, of course, but it has been fun chipping away at it with my wife!”

Dr. Ralph Gambardella…providing growth for students and ingrowth for cells.