Evidence-Based Medicine and the Next Frontier in Orthopedics: Q&A With Dr. David Dines of Hospital for Special Surgery

Becker's Orthopedic Review—June 20, 2013

David Dines, MD, is an attending orthopedic surgeon of the sports medicine and shoulder service at Hospital for Special Surgery in New York and at the hospital's Physician Office in Uniondale, Long Island. He currently serves as medical director of the ATP Men's Tennis Tour and team physician of U.S. Davis Cup Tennis. Previously, he served as associate team physician for the New York Mets baseball team and is a past president of the American Shoulder and Elbow Society.

Here he discusses practicing evidence-based medicine in orthopedics, his current research interest in the biomechanics of shoulder and elbow injuries in athletes and the struggle to better understand tendon healing.

Q:  What attracted you to the field of orthopedics?

Dr. David Dines: Although I was a college football player who got hurt frequently, when I went to medical school I never thought I would become an orthopedic surgeon. But on my rotation in orthopedics, ironically, I had the opportunity to take care of two people with dislocated shoulders, and we were able to reduce their shoulders. I knew at that moment I was going to become an orthopedic surgeon and I was going to take care of athletes my whole life.

Q:  What do you think is the best strategy for practicing evidence-based medicine in the field of orthopedics?

DD: The best strategy is to be cognizant of the most current literature that's available in your subspecialty. I think it's important to attend meetings and listen to the speakers. However, be aware of possible conflicts of interest, at the same time recognize the information and use it in a way that best allows you to take care of your patients in the best, most efficient and effective way.

It's a combination of being aware of the literature and being involved in academics, be it through meetings, through the Internet, through webinars and the like. There is so much available to all orthopedic surgeons within each subspecialty discipline.

Q:  What current research developments are you most interested in?

DD: My research interests are both clinical and basic science. The clinical involves treating the overhand athlete's shoulder and elbow problems. It's understanding the biomechanics and treating the recurring injuries we see so often in throwers and tennis players.

In a basic science mode, a number of people at Hospital for Special Surgery, including myself, have been very involved in tendon healing, specifically, the rotator cuff, as well as other body parts, to improve those soft tissue injuries that are prevalent in athletes of all types. The research has been tied to our interest in taking care of both professional and every day athletes.

Q:  What role do you think biologics will play in the future of orthopedic surgery and sports medicine?

DD: We have been very involved in developing strategies to improve soft tissue healing, and that can include growth factors, platelet rich plasma injections and other biologic scaffoldings. I think as time goes on we're going to find the best strategies in each of these areas to get tendons to heal better, quicker and in a more natural way so that both the average person and athletes of all types can return to their activities quicker and with a much better result.

Q:  What are some of the biggest unanswered questions in orthopedics?

DD: I think the biggest unanswered questions are the questions that we've dealt with for years and years: why can't we get tissue to heal the way it was developed in utero or in the embryologic stage?  When rotator cuff tendons are torn, we repair them. The tendon heals as a wad of scar tissue that becomes a primitive tendon, but we never recreate the exact biology that the patient was born with.

These are the processes we need to understand better so we can improve both soft tissue and bone healing, prevent osteoporosis in the future, and even prevent some overuse syndromes by better rehabilitation or by better supplementation, if there are supplements we can use to retard the inflammatory processes caused by overuse. The other big question is how to slow down some of the ravages of aging as they affect the soft tissues. This is going to be the next frontier for us.

Read the full story at beckersspine.com.

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