Constance Chu, MD, believes the next revolution in orthopedics will happen before the first incision is ever made.
A professor and vice chair of research in orthopedic surgery at Stanford (Calif.) University, Dr. Chu leads work at the intersection of imaging, biology and AI — with a goal of predicting, preventing and personalizing musculoskeletal care before surgery becomes necessary.
“I actually think most of the advances are going to be nonsurgical,” Dr. Chu said. “We already do surgery very, very well — to fix fractures and replace joints when they’re damaged beyond repair. But the patient’s biology really determines how they get injured and how they heal.”
To that end, her team is harnessing AI to analyze MRI scans and build 3D models of joints, especially the knee. The technology allows clinicians to detect subtle bone and tissue changes that signal early osteoarthritis — years before symptoms appear.
“With MRI, we have 3D imaging information, and AI has really lent itself to doing three-dimensional modeling of orthopedic tissues,” she said. “Within the first year after an ACL tear, we can already see bone shape changes that move toward osteoarthritis.”
Dr. Chu said those early findings give physicians a window into helping patients modify their habits before damage worsens. When arthritis risk is identified early, patients can adjust activity or movement patterns to slow disease progression.
Her research also explores how AI can illuminate the biology behind healing. By combining imaging with genomic and cellular data, her team studies how individual cells respond to stress or inflammation — information that could one day guide personalized treatment.
“It’s not just genetics — it’s also epigenetics,” Dr. Chu said. “We can measure how single cells in your blood are responding — whether they’re in a more inflammatory or less inflammatory mode — and that takes the computing power and assistance of AI.”
She emphasized that technology alone isn’t enough.
“Our job as physicians and scientists is to work with the AI scientists,” Dr. Chu said. “They know the algorithms, but they don’t know the disease or patient care. If we curate the right data, AI can find patterns we might never see.”
A major focus of Dr. Chu’s work is how aging changes tissue resilience and recovery. She said the biology of aging affects every musculoskeletal system — and that chronological age often tells less than biological age.
“Procedures that work beautifully in children don’t work the same way in older adults,” she said. “You can’t define aging based on age — some people in their 30s heal worse than older people who’ve stayed active.”
That insight is shaping new frontiers in regenerative medicine. Dr. Chu and her collaborators are exploring how to supplement older tissues with the factors they lose over time, improving healing after injury.
“If we can determine what’s missing — what we can apply at the time of repair to make older tissue heal more like a young person’s — that would be a huge step,” she said.
She envisions a future where AI and advanced manufacturing help surgeons create biologic materials tailored to each patient.
“What’s needed for one person will be different for the next,” Dr. Chu said. “Using AI and 3D printing, we could prepare personalized formulations that are ready on the day of surgery, specific to that patient.”
Outside the operating room, AI could also play a quiet but powerful role in prevention. Algorithms could automatically flag early signs of bone loss on routine imaging, prompting intervention before fractures occur. “
If we can get people into care earlier, we can prevent catastrophic fractures — those low-energy breaks that happen from a simple fall,” she said. “That could save so many people from major complications.”
But as technology advances, Dr. Chu worries healthcare is becoming more formulaic — and less personal.
“Most insurance decisions today are based on averages and big databases,” she said. “But patients aren’t average. That approach risks dehumanizing care and leaves people who fall outside the norm without access to what they need.”
Her proposed solution echoes how she approaches innovation in the lab: collaboration.
“Responsible and collaborative use of AI is needed to improve our ability to provide personalized care in a cost-effective way,” she said. “If we can make AI efficient and precise enough, it doesn’t have to make care more expensive — it can make it more personal.”
Dr. Chu also called for sustained federal investment in basic science research that isn’t tied to commercial goals.
“We need federally funded research that is not tied to a product,” she said. “Some of the biggest medical advances came from discovery — people studying something simply because they wanted to understand it.”
For all the complexity of her work, Dr. Chu said the mission of orthopedics remains simple: helping people move.
“The current economic trends in healthcare are the opposite of personalized medicine,” she said. “It’s more important than ever that we not dehumanize people and turn everyone into an average. Orthopedics is about restoring mobility — keeping people active and independent. That’s what we have to protect.”
