James Bradley, M.D., Pittsburgh Steeler Team Physician, Honored With Leadership Award
James Bradley, M.D., team orthopedic surgeon for the Pittsburgh Steelers, has been honored with the Ralph C. Wilde Leadership Award. The award is presented by Allegheny County Medical Society Foundation (ACMSF), and, according to their website, “Recognizes a physician who demonstrates exceptional skill in their clinical care of patients and dedication to the ideals of the medical profession as a teacher or profession leader.”
For 26 years Dr. Bradley has been on the sidelines as the Steelers’ orthopedic surgeon. He is a past president of the National Football League Physicians Society, and is currently chairman of the NFL’s Medical Research Peer Review Committee and also serves on the NFL Injury and Safety Panel Committee.
Dr. Bradley told OTW, “It’s hard to say what has been my ‘standout’ moment with the Steelers because it’s been an entire compendium of experiences. Overall, working with this team has made me much a better person. I am more patient and more focused. I am also more compassionate…I know what feels like to be cut from an NFL team…because I was. And I am a better physician because I am not going to give up and am going to keep our team on the cutting edge.”
“So there was this moment in Superbowl XL. During the preceding week, one of the players was hurt on the practice field. His prognosis was unclear—and we knew that if he didn’t play then we would lose 40% of the defensive calls. He wanted to play, so we improvised and got lucky. And guess what? We won!”
Cartilage Restoration Viable Option in Those 40+
New research from Hospital for Special Surgery (HSS) has found that patients over 40 whose knee cartilage is damaged may find relief with cartilage restoration procedures. One study included 35 patients whose damaged cartilage was under their kneecap. The second study included 61 patients whose cartilage damage was at the end of their femur bone in the knee. The researchers found that the majority of patients reported higher activity levels and decreased pain, as well as a high degree of satisfaction with the procedure.
Riley J. Williams, III, M.D. is senior study author and director of the Institute for Cartilage Repair at HSS. Dr. Williams told OTW, “As our cartilage repair strategies have expanded over the past decade, physicians now have more options for patients. More patients are interested in leading an active lifestyle later in life. As such, many patients are unwilling to undergo replacement-type procedures, which may limit their activity options. Thus, our group sought to examine the functional outcomes of patients treated for symptomatic cartilage damage who were older than prior groups who had been studied.”
“The most interesting finding was that we were able to improve the functional outcomes of this group of patients using a multitude of surgical options. This is a novel finding. It was also interesting to see that many patients in their 40s and 50s derived benefit from whole tissue graft options as well. We believe that these are the first studies to show a durable functional outcome in patients well into their 50s that did not focus on the use of knee osteotomy or joint replacement surgery to achieve good results.”
“We will continue to expand the number of patients examined, as well as the duration of the follow-up. Many new cartilage methods continue to come to market and it is our goal to study these new technologies in this group as well.”
Femoroacetabular Impingement: Cartilage Assessment Is Critical
A new review article published in Nature Reviews Rheumatology takes a look at the latest on femoroacetabular impingement (FAI), saying that it is a condition increasingly recognized as a source of pre-arthritic pain in young adults. To deepen our understanding of the condition, the additional studies that are underway will shed further light on the subject. Moin Khan M.D., M.Sc., FRCSC is an orthopedic surgeon at McMaster University in Ontario, Canada. Asked what remains misunderstood by some in the orthopedic community, Dr. Khan told OTW, “A careful history and physical examination is essential to identify the source of the pain as there are many potential sources of hip pain other than FAI. The importance of cartilage assessment is critical to successful outcome. And although short term results are promising, further research is required to clarify the long term implications of arthroscopic management on joint health (and if it does in fact delay the development of osteoarthritis).”
“Identifying patients who have some degree of dysplasia who may not be candidates for FAI surgery is important—inappropriate arthroscopic intervention may in fact worsen symptoms. FAI is the result of dynamic impingement…not everyone with FAI morphology will be symptomatic. The most common cause of failure after arthroscopic FAI management is inadequate resection of bony pathology. At present, the quality of available evidence guiding treatment decisions is low and clinical trials are underway to provide high quality information on the diagnosis, management and prognosis of patients affected by FAI.”
The authors point to several ongoing randomized controlled trials, including the Femoroacetabular Impingement Trial (FAIT) and the Femoroacetabular Impingement Randomized Controlled Trial (FIRST), which will improve our understanding of issues regarding the diagnosis, management and prognosis of patients undergoing arthroscopic management of FAI.
Commenting on the research aimed at improving cartilage assessment, Dr. Khan said, “Various MRI techniques are being investigated including delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T2 mapping and glycosaminoglycan chemical exchange saturation transfer (gagCEST) among others. These techniques potentially will improve clinician’s ability to assess cartilage status and provide prognostic information.”
“In addition to MRI techniques, research is ongoing into evaluating the potential use of biochemical markers of cartilage breakdown and inflammation. This research is in its early phase however in the future biomarkers may play a role in the assessment and management of the pre-arthritic hip.”
The co-authors on this paper are: Asheesh Bedi, M.D., Freddie Fu, M.D., Jon Karlsson, M.D., Ph.D., Olufemi R. Ayeni, M.D., Mohit Bhandari, M.D., Ph.D.
