From wartime to game time, Dr. Neal ElAttrache operates at the forefront of surgical advancement

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A decade from now, one defining aspect of orthopedic surgery in 2024 will have been the speed at which new techniques are adopted, Neal ElAttrache, MD, said.

Dr. ElAttrache, head team physician for the Los Angeles Dodgers, spoke with Becker's about his perspective on changes in orthopedics.

Note: This conversation was lightly edited for clarity and length.

Question: How do you think orthopedic surgeons in 10 years will look back at how sports medicine and orthopedic surgeries are being done today?

Dr. Neal ElAttrache: When you look at the amount of time it takes for a new technique to become adopted worldwide, the time now is probably half of what it was when I started. As a general rule of thumb when I started, if you came up with a significant change in the way that something was done in surgery, it would take about a good decade for that to catch on with the mainstream.

These days technological advances have made it so that changes in surgery are easier to do by more surgeons. Exposure through the media and equipment companies really spread the word. With the way that communication exists now, the adoption time for a procedure is half of that might be five years now. I learned that when we developed a novel way to fix rotator cuff tears and with some of the new instruments that we devised that made doing that operation easier.

So the way they're going to look back on what we're doing now is I think that technology is changing so much faster than it was, and it's going to make things easier to do. I don't think that the overall surgical talent may not be much better than it is now. I trained guys that many of whom have never done an open shoulder operation; they just do it arthroscopically. There are some skills that are sort of falling by the wayside that won't be as good as they are now. But overall the technology is changing the way that things are going to be done. I think that they'll look back on this as and say, well they had to be a bit more invasive. They had to do this with a little bit more surgical exposure and maybe the recovery times were longer.

The other thing that's advancing is biologic knowledge. How do you get tissue to heal faster? How do you get the tissue to mature from a tendon that has structural properties that are well developed? And how do you get that to happen more predictably and sooner than what's sort of on the frontier right now? There probably will be biologic ways to enhance or heal tissue without us going in and mechanically putting stitches in and replacing it with other tissue. Those are things that are evolving rapidly, and if you look at the scientific knowledge of DNA and how you can actually manufacture living tissue? How can you clone cells? All this stuff is being done in other fields, but none of that is just in a vacuum. All of that knowledge ends up percolating through the way we treat so many other things.

So the long answer to a simple question is orthopedic surgeons will look back on the field and probably be doing procedures with a greater degree of difference. If you look at how I'm doing it now compared to how Frank Jobe, MD, taught me over 30 years from now, there will be a much bigger difference 30 years from now than there was 30 years ago, and it's all because of technology and biologic knowledge.

Q: And when it comes to biologics and regenerative medicine, what do you think it will take to really push all of that forward in orthopedics?

NE: It's interesting when you look at how procedures got passed into the mainstream. Let's look back on the 20th century. The biggest driving forces for advancement in the 20th century in medicine were the experiences and knowledge we got out of war. That's where we got antibiotics. Many of the surgical techniques that we have came out of wartime needs. We would have these techniques and medicines that were developed on the masses of people, and we would take that knowledge and then operate on these athletes. We don't have as much of that driving force now in the 21st century. There are some techniques in rehab that still had their birth out of the Wounded Warrior Project, and there's some really great advances that are done in physical therapy that now are being applied to our athletes. But by and large, we were taking procedures and medicines and things that were advancing medicine from war to the general population.

Now the huge driving force, at least in orthopedic surgery and sports medicine, is how to help this population of people heal more predictably and enhance their body so that they can move on in life and rely on their physical ability. And the advances we're getting from these athletes, we're then putting it to the general population. So we've gone the opposite direction. You would think that you would only do something on an athlete that's been researched in the general population. But the needs of this athletic population are so unique and so demanding that we have the drive for us to be able to accomplish that.

We're coming up with advances that we now know work, and we're taking it to the active population that is otherwise injured. I think that's a very rewarding way to look at what I do. Rather than just saying, "Well, I'm wasting my life just operating on rich athletes." I see the number of patients in the general population that are benefiting from the techniques that I do for athletes, and I'm able to give that to somebody that wants to be able to walk comfortably or wants to be able to ski with his kids. I get a more fulfilling feeling than otherwise.

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