Buford, Don, and Scott Sigman. 2020. “The Ortho Show Podscript: An Interview with Don Buford on Orthobiologics.” Journal of Orthopaedic Experience & Innovation, July.

PodScripts The Ortho Show Podscript: An Interview with Don Buford on Orthobiologics Don Buford a, Scott Sigman b Keywords: orthobiologics, prp, bmac, laser

Journal of Orthopaedic Experience & Innovation

We have an awesome guest, an iconic leader in orthopedic surgery and orthobiologics, Dr. Don Buford. We’re thrilled to have him. Don is a sports medicine orthopedic surgeon, founder of the director of the Texas Orthobiologic Institute

a Dr. Don Buford founded The Texas Orthobiologics Institute as a research institute where patients can benefit from the latest vidence e based orthobiologic orthopedic treatments. The most common conditions treated are arthritis pain, back pain, tendon injuries, and sports injuries. Our Institute’s goal is to maximize our patients’ quality of life and minimize their disability from any musculoskeletal condition without surgery whenever possible. We typically perform our orthobiologic therapies in an office based procedures that takes less than an 1 hour. In some cases, we use these PRP and bone marrow concentrate/stem cell injections to assist, accelerate or augment the healing response after a surgical procedure. Dr. Buford has been in an established orthopedic surgery practice in Dallas for over 20 years and has been voted multiple times by Dallas area physicians as one of the best orthopedic surgeons. He has been board certified yb the American Board Of Orthopedic Surgery twice and is a sought after lecturer nationally and internationally on orthopedic surgery and regenerative medicine subjects. Dr. Buford attended Stanford University for the first half of his ollegec career. While at Stanford, he was a member of the team and had a double major in economics and Human Biology. He then transferred to USC where he continued to play baseball and study eco- nomics and the pre-med curriculum. In 1988 he received the Woody Hayes NCAA Division I Academic All-American Award for being the single most outstanding NCAA Divi- sion I male student-athlete. After graduation from USC, he signed his first professional baseball contract with the and also enrolled at UCLA Med- ical School. Dr. Buford played professional baseball as a and in the Baltimore Orioles professional organization for 4 years. Dr. Buford’s father, Don Sr., played for the ('63 -'68) and the Baltimore Orioles ('68-'72) and played in 3 , winning in 1970 over the . Don Sr. is in the Orioles Hall of Fame. Dr. Buford’s younger brother, Damon, had an 8 year ma- jor league career which included 2 years as the starting center fielder orf the . After graduating from the UCLA School of Medicine, Dr. Buford completed a 5 year orthopaedic surgery residency at the University of Texas, Southwestern in Dallas. Dr. Buford also completed a one year sports medicine fellowship at the prestigious Southern California Or- thopaedic Institute (SCOI) in 1999 where he learned advanced arthroscopy techniques. Dr. Buford’s interest in orthobiologics was a natural outgrowth of his training in minimally invasive surgery…..both are designed to help patients in the simplest, safest way possible. Since 2008, Dr. Buford has been training clinicians on MSK ultrasound and now orthobiologics as the Director of the MSK Ultrasound and Orthobiologics Course. The course is held twice a year in various locations. Dr. Buford and his course faculty have trained over 1600 clini- cians in MSK ultrasound.

b Dr. Scott A. Sigman is a board-certified orthopaedic surgeon providing comprehensive care to patients at Orthopedic Surgical Associates of Lowell since 1996. Specializing in Sports Medicine, Dr. Sigman possesses the skills and experience to diagnose and treat sports injuries and conditions affecting the knee and shoulder. In addition to his practice duties, he has served as the Team Physician for the US Ski Jump Team, and serves for the last 20 years as the Team Physician at UMASS Lowell, and is the past Chief of Orthopaedics at Lowell Gen- eral Hospital. Dr. Sigman graduated cum laude with his Bachelor’s degree in Biology from Tufts University, where he played varsity lacrosse and was President of the Alpha Epsilon Pi fraternity. He then received his medical degree as a cum laude graduate of the University of Maryland School of Medicine and member of the prestigious Alpha Omega Alpha medical honor society. Upon graduating with his medical degree, Dr. Sigman completed his postgraduate internship in General Surgery at St. Agnes Hospital, followed by a residency in Orthopaedic Surgery at Tufts Medical Center. Dedicated to furthering his training, Dr. Sigman also completed a fellowship in Sports Medicine at the prestigious Kerlan-Jobe Orthopaedic Clinic, during which he was responsible for the orthopaedic care of the Los Angeles Lakers, Los Angeles Dodgers, LA Angels, LA Kings, Anaheim Mighty Ducks, LA Galaxy and USC football. In addition to his extensive training and practice experience, Dr. Sigman has also contributed to numerous publications and research studies regarding advances in the field of orthopaedic surgery. He takes great pride in remaining informed of the latest state-of-the-art arthroscopic techniques for both knee and shoulder surgery. He also gives presentations and lectures and instructional courses to fellow surgeons throughout the world in new shoulder and knee surgery techniques. In 2019, Dr. Sigman was elected as a Fellow of the Royal College of Physicians of Ireland, Faculty of Sports & Sports Medicine. This cer- tificate is a culmination of his ongoing efforts to change the paradigm of postoperative pain management. Memberships: The Ortho Show Podscript: An Interview with Don Buford on Orthobiologics

THE ORTHO SHOW then, Mark Marquess and Dean Staats. And just the luck of the draw was a year behind a fantastic, All-American mid- INTERVIEW WITH DON BUFORD, MD dle infield where I wasn’t about to break in until those guys were graduated and gone. So, after my sophomore year, I Dr. Sigman: Hello world. Dr. Scott Sigman, your favorite did something that was rarely done at the time, which was I opioid-sparing orthopedic surgeon back here for another went to both athletic directors and got a release to transfer episode of The Ortho Show podcast. We’re excited to roll where I wouldn’t lose a year of eligibility because I trans- back into orthopedics at this point post-pandemic. We have ferred within Division 1. So, I transferred from Stanford an awesome guest, an iconic leader in orthopedic surgery down to USC which my parents somehow, I convinced them and orthobiologics, Dr. Don Buford. We’re thrilled to have to do that and transferred back to USC and finished my him. Don is a sports medicine orthopedic surgeon, founder last two years and played under another two great coaches, of the director of the Texas Orthobiologic Institute as well Rod Dado and Coach Mike Gillespie. as a director of Orthotalk where he’s one of the leading edu- Dr. Sigman: That’s awesome. So, what a great couple of cators on ultrasound news and orthopedics. It’s a real plea- good schools there you got going on there Don. You did sure to have you on down. It can’t thank you enough. pretty good for yourself too. So, let’s move into orthopedics Dr. Don Buford: Well, thank you for the invitation. I’m here a little bit now. So, one of the things that I find pretty happy to be here. I’m looking forward to it. amazing about you is that you have a complex named after Dr. Sigman: Yes, it’s my pleasure. So, before we roll it or- you, the Buford Complex. I mean I think of people that get thopedics, I want to talk about a little bit of our shared his- things named after, they’re either dead or they’re really old. tory. What year were you born? I mean you got to tell us about the story because I think it’s Dr. Buford: I was born in 66. really cool. Dr. Sigman: So, I was born in 64 and I think your father Dr. Buford: So, I know some of the listeners have heard got traded to the Orioles probably in 67 if I’m not mistaken. it before, but I went to high school in Southern California, Dr. Buford: I think I think that’s right, yes. North Hollywood. And as a senior at this private high Dr. Sigman: Yes, so bottom line is that you and I grew up school, we had the opportunity to do kind of extracurricular together in Baltimore for most of our lives which is really work if we had kept up with our class work. So basically, I pretty cool. I know that Terry Blair who was ’s had enough credits to graduate high school. So, I was grant- son was a good friend of mine went to high school with ed the opportunity to spend afternoons off campus three me. One of ’s daughters was running around in days a week. And there were parents of students who had our circles. You and I never really got to meet but I have their names on a list where you could pick from these op- such fond memories of those days for the Baltimore Orioles portunities. And a lot of them were music business, movie when just to let everybody know Don’s father’s Don Buford business because these were the parents of the students in Sr. who was one of the iconic Baltimore Orioles baseball this North Hollywood school. And farther down on the list players in the dynasty era of the Baltimore Orioles when were the attorneys and the sports medicine docs and I want- we were growing up. And so, names like , ed to be a doc from that early age. And I found a sports they’re probably your uncle’s, right? Like medicine guy who was Jim Fox who was one of the founders and . I mean Boog, what a great guy. And you of SCOI and when I showed up at the doorstep day one, know were hanging out and you got to spend time with he did what all good senior orthopedic practice people do those guys in the locker room and all that, how cool was is he found his junior partner and said, “I forgot I signed that? up for this. Here’s Don Buford. He’s a senior in high school Dr. Buford: Oh, yes. Those are my earliest memories, and he’s going to hang out with you for six months.” And honestly like in 70 being on the field. They used to have fa- the junior partner was Steve Schneider. So, I met Steve at ther-son games like once a year on the field orf all the 5 to 17 years old. And this is back when they had the carousels 12-year-old kids of the players. And I remember being on and I made a sound slide carousel about the shoulder. And the field and running around and thinking I had made it. over the course of time developed a relationship such that Dr. Sigman: Yes, Memorial Stadium, I mean such amaz- when I first saw that anatomy called theord Buf Complex ing memories for us. We would go to all those games and now, I was just a curious kid in the operating room and said then Sabatino’s for dinner and in Little Italy and all those “Hey, what’s that? I haven’t seen that before.” And he said, great memories. And I guess all of your brothers play base- “I don’t know, why don’t you look it up?” And so, I looked at ball too, right? You guys all went to the professional level videotapes from the SCOI docs, which was their early genius and or no? Talk to me about that. was recording everything they did arthroscopically. And so Dr. Buford: So, I’m the oldest. I’ve got two younger I was able to come up with some stats and some data and brothers. We’re all within about four years. So now the age we tried to correlate it as you know with some pathology or difference doesn’t seem as great as it was, but my youngest not and he in his dry sense of humor named it that because I brother Damon played for eight years in the big leagues for didn’t have anything to do with that part of it. But and then a bunch of different teams, including the Red Sox, includ- in true fellowship fashion, one of the fellows wrote it up and ing the Orioles, including Texas Rangers. My middle brother submitted it and we all got our names on it. Darryl who’s the smartest one in the family became an at- Dr. Sigman: That’s unbelievable. I mean for everybody torney and became a sports agent. that’s out there listening, Steve Schneider is one of the few Dr. Sigman: Awesome. That’s awesome. guys that I still call Dr. Schneider. I mean, he’s just one Dr. Buford: – He picked a profession, yes. He doesn’t age of these guys that has really revolutionized arthroscopic out of his profession. shoulder surgery and all the things that we do that. That Dr. Sigman: That’s exactly right. is just an awesome story from beginning to end. Then you Dr. Buford: So, he’s an attorney back in LA. Yes. were SCOI fellow, right? Then you went back, and you com- Dr. Sigman: That’s awesome. And then you spent some pleted the circle. time at Stanford and USC playing ball too, right? Dr. Buford: Yes, they scared me because I interviewed for Dr. Buford: I did. After high school, I went to Stanford for the fellowship and Dr. Furcal was the fellowship director two years and had a chance to play under a great coach back

Journal of Orthopaedic Experience & Innovation 2 The Ortho Show Podscript: An Interview with Don Buford on Orthobiologics and he was sitting there with me in the interview and said, based is key and we’re going to come back to that at the “Well, what other places have you applied?” And I’d already end because I absolutely love one of your posts. You made had– at this point I already had maybe almost a decade of it probably about eight or nine months ago. But I think that hanging out with them. And so I was kind of hanging my hat evidence-based is key and the problem that I have within here guys, you guys are four blocks from my house. the biologic space is that you get a lot of people that are Dr. Sigman: Don’t make me go, I want to stay here. way to the right and say, “Orthobiologics are the only thing Dr. Buford: Yes, don’t make me go. I don’t want to go that we should be doing. Surgery is obsolete. There should across town. The traffic’s terrible. So, I did the fellowship be no orthopedic surgery. It should only be injections and and it’s funny, we’ll get into it. But Dr. Schneider’s also re- biologics.” And if you take a look at patients that have dis- ally one of the first regenerative medicine orthopedic docs locating shoulders or hip labral tears or full thickness tear at least around the shoulder. of the rotator cuff or a complete tear of the ACL, it seems Dr. Sigman: So, one of the reasons that you’re my go-to to me that it would be difficult to imagine that orthobio- guy Donnie iswe’re both on LinkedIn a lot. We have a lot of logics alone would be able to get those things to heal. So, I similar friends across the industry. And in this day and age think surgery is still– we’re still here. We still got a job. At with regenerative medicine, it’s the Wild Wild West. And least we’re hoping after the pandemic obviously, but I com- there’s just a lot of publications of things that are happen- pletely agree with you. I think the orthobiologics and the ing or statements that people are making, false claims. etc. augmentation of surgery in particular I think is really where But what I really respect about you the most is that you are we’re many people are leading. So, we thank you for being an established outstanding orthopedic surgeon that clini- the watchdog of LinkedIn in particular. So, talk to me. Why cally operates on patients and stays state-of-the-art and yet is the FDA so bad at being able to monitor this stuff and why you also cross over into the orthobiologic space and you are can’t they police better? a leader in that orthobiologic space. You understand it and Dr. Buford: Yes, the FDA, which is the regulatory body in you can interpret it. So, the good news is for guys like my- the US that’s charged with regulating these orthobiologics self because then I don’t have to do any of that. I just look is admittedly in a tough spot because you’ve got essentially for your post and then when I know whatever Don is say- no barrier to entry for these procedures. Anybody can call ing that’s what I’m going to do. So, how did you get there? I it anything and now we’re in a social media age where peo- mean because it really is pretty cool. ple can advertise and have these seminars and say things Dr. Buford: It’s an interesting story. Part of it even goes with very few repercussions. And so, as a federal entity the back to fellowship, just being inquisitive and having a men- FDA does the best they can setting up guidelines and regu- tor who forced you to continue to ask why. Why, why, why? lations. And they even have reporting mechanisms if some- Why do we do it this way? How can we do it better? And I thing seems to afoul of that, but they’re not an en- should spend about 12 years now since that first little pro- forcement body and I think that’s the problem they really ject I did using PRP or platelet-rich plasma for partial thick- have. They can send out the untitled letters, the warning ness cuffs. And the thought behind it was even at that point letters, but if somebody really needs to be stopped from do- 15 years ago, we had pretty good anchors. We had pretty ing something, they have to go to FBI or justice department good mechanical repairs and the issue even at that point or some other entity. So, when you think about even if it was seemed to be biologic. These things take a long time to heal. just an orthopedic surgeon issue, that would still be a ton We’re telling people six months back to work. Man, there’s of us that they would have to regulate. Now you open that so much room to get better there. How do we do it? And we up to anybody with an MD or even worse than that, I should use biologics in orthopedics and other areas with bone heal- say worse than that, but anybody who has a medical back- ing and things and isn’t there some way to help this? And so ground because you have naturopathic doctors, chiroprac- that’s where the thought process initially came from. And tors, nurse practitioners, all of these people in some lev- after some early actual failures clinically and some clini- el can have a stake in doing these procedures. And so, the cal research I just stayed on the sidelines for a while until regulatory field is xtremelye broad. And so I think we need we started to understand more and more about the nature a few landmark enforcement decisions which have started of healing and how to enhance it. So, through the whole to happen actually, actually accelerated by COVID interest- process, I’ve tried to stay evidence-based. But part of be- ingly enough, that will, I think, reign back in some of these ing in clinical practice as a surgeon is we kind of know clinicians, procedures, things like that, that are being done where the defects are. We kind of know the areas where we without really any evidence or basic science background be- do things that don’t have that 95% success rate. And we hind them. know the area’s now for example with degenerative menis- Dr. Sigman: Yes. I mean we got Donnie Buford on the cal tears, just to throw out a common example. Now, we case, man, we don’t got to worry about it. I’m like, I see know that just taking those people to surgery to do a partial these posts these people put up. The Wild Wild West, drink meniscectomy really doesn’t give them any long-term ben- this potion and life’s going to be good with you’re exosomes. efit, vo er a PRP injection if we can get their pain under con- You’re all over it. I mean have you ever got in trouble? Is trol. So, I think just knowing where there’s room to improve there anybody like called you out on it? and using biologics if it makes sense, and we have some Dr. Buford: I have a wall of honor in my office, literally evidence in those areas, first, is how we push the edge of in my pod where I see patients where I post my cease-and- the envelope forward. Along with that there’s areas where desist letters. Because you’re not in trouble if you’re telling surgery’s still required but man if we can kickstart that heal- the truth. So, if somebody saying that you can use this prod- ing process or enhance it then we can use orthobiologics in uct to cure dementia. And I say, “No you can’t, there’s no conjunction with surgery too. So, I think having a foot in evidence for it. You can’t do that.” And I get a cease and de- both areas helps because I can tell people. “Yes, I’ve seen sist. I politely always respond and say, “It’s great to point that. It doesn’t do great. This may be a chance to enhance out what I said that wasn’t factual and I will retract that part your healing.” Or, “I’ve seen that. It doesn’t do great. You of it.” And usually, they want to go away because their inter- may not need surgery. Let’s try this first.” est is not in being regulatory compliant. So, I’ve had several Dr. Sigman: Yes, I mean, I think your point of evidence- of those letters. I think I’m up to a hundred percent where

Journal of Orthopaedic Experience & Innovation 3 The Ortho Show Podscript: An Interview with Don Buford on Orthobiologics every company that sent me a cease and desist has now re- ing to make it work, but for now, this is what we have.” So, ceived a letter from the FDA saying stop. I think we really need some really good basic science to fig- Dr. Sigman: You got a job man. You’re going to go to work ure out what is in that BMAC that’s really making the differ- for the FDA. ence. So, talk to it. Can you give us some examples of what Dr. Buford: Well, there’s a bunch of us. It’s not just me. you think and how that’s working for us? But again, the barrier to entry is so low unfortunately and Dr. Buford: Sure, there’s some things that are reasonably people can advertise so quickly and throw up a website and well known and well-studied, especially BMAC at this point disappear just as fast so. So, kudos to the FDA for what and to a lesser extent they exist in PRP. Some of them are they can do. They have been accelerating. It’s interesting known very anti-inflammatory proteins or cytokines like with this pandemic. There’s been a lot of regenerative medi- IRAP is one, I-R-A-P. It’s an interleukin receptor antagonist cine advertising specifically towards pandemic illnesses like protein. It’s a very well-known powerful anti-inflammatory. ARDS. And the FDA has been extremely rapid to respond And that’s something that’s in very high concentration in and very aggressive in responding. And it’s been fantastic bone marrow concentrate versus to start regular bone mar- just to see them be this active in the field. row or versus our blood or in PRP for example. There are Dr. Sigman: So, you and I have some common ground other growth factors that have known effects in our bodies in laser. I’ll tell you, we’ll roll into this story for the FDA like vascular endothelial growth factor, fibroblast growth and that I decided that I thought it would be a good idea factor, a whole litany of things that we come across in res- to maybe repurpose the Laser and use it in the setting of idency and it’s just to get past the test at that level but COVID because of the really powerful anti-inflammatory ef- it really works clinically when you see that it’s in these fects that lasers can have at the cellular level. And so, I lit- things that are used successfully. Another big one is Alpha2 erally picked up the phone and called the FDA and six hours Macroglobulin or A2M for short. There’s an entire company later somebody called me back and over a six-day window based around just harvesting A2M and using that as a sep- we got permission to use our laser in this field as a non- arate clinical treatment. And we found that that exists in significant risk vic de e. And so, it’s amazing to me in the BMAC in a higher concentration than in just A2M alone, setting of this COVID pandemic how the world has real- most of the time. So, for that example, BMAC seems to be ly changed in the regulatory process in particular. So that enough to give A2M therapy to patients. And you’re right. was a real feel-good story for us out of the FDA. So, how’s How those work in conjunction and the interplay is not your laser doing, and I know we have some common ground something we may ever be able know until we get quantum there. You’ve been using laser in the biologic space too or mechanics and quantum computing. But we can measure what you been doing? the clinical output and we can do that in a reasonably objec- Dr. Buford: I do. I think I’ve got a hot sheet of about 10 tive way. A lot of times there’s really two wings to this in my ideas that I’m always trying to knock off for studies and us- opinion. We have the regenerative side, which is someone’s ing the laser in some aspect either alone or in conjunction got tendinopathy, someone’s post-surgical where we’re try- with the orthobiologic treatments is like 4 of the 10 ideas I ing to accelerate a healing response or create one where have whether prepping somebody or prepping an area or as there wasn’t one before. And then we’ve also got people a post-injection kind of longer-term treatment option. So, that have chronic degenerative conditions like arthritic I’m excited about that. I’ll tell you the truth, the laser that I conditions. And here we’re looking more for palliative types have right now is literally about 10 yards from me. I’ve been of treatment. And so honestly, I use it much more for pal- treating my back. liative care because my number-one patient is a patient Dr. Sigman: We got a believer. We got a believer people. with bilateral knee arthritis closely followed by back pain Dr. Buford: So, I believe in it that strongly. And my son from facets or disc disease closely followed by hip arthritis and my daughter know how to treat my back. or shoulder. And so those indications tend to be palliative. Dr. Sigman: That’s awesome. And then you get into the chronic tendinopathy. These were Dr. Buford: So, I believe in it and it’s just like you said. people who haven’t gotten better with other less invasive There’s a lot of evidence behind it. It works at the cellular modalities and now we try an orthobiologic. level. Gone are the days when a thoughtful clinician should Dr. Sigman: Yes, it makes sense. I mean one of my fa- just say no without looking at the data. vorite Star Trek episodes is when they come back to earth Dr. Sigman: You’re absolutely right. The basic science be- and Bones is walking through the hospital and there’s some hind laser is actually quite strong and I’m right there with woman on a stretcher and he’s like, “Why are you here?” you. I think that it clearly demonstrates at the cellular lev- And she says, “Oh I’m here for a kidney transplant.” He’s el increased metabolism within the cell and increased the like, “Oh that’s just barbaric.” He’s like, “Take one of these.” healing process and reducing inflammatory response. So, And she takes a pill and five minutes later she’s running out the idea of you know a PRP stem cell, augmented with laser of the hospital. “He gave a kidney in a pill. He gave me a to me I think would be very exciting study to sort of demon- kidney in a pill.” We may look back. “Oh my God, you’re re- strate perhaps, improved clinical efficacy with that. So es,y ally going to take that thing and stick that into somebody’s man, go with it for sure. So, let’s talk a little bit more about pelvis and take out the BMAC.” But you know, hopefully, regenerative medicine. I mean, there’s no question the body we’ll be able to figure out the stuff that’s in there and be of literature that’s out there, either pro or con, we’re getting able to hone in on the science of that. But it’s there. I mean, to the point now where we’re really starting to see some lit- you’re absolutely right. I think the clinical outcomes are re- erature that’s really pointing in the direction that orthobio- ally what we need to identify here. We see the same thing in logics is going to help and it’s going to make a difference. I the laser space. There’s no commercial insurance payers or think the problem is for a lot of clinicians and understand- CMS that has any interest in paying for laser therapy at this ing is really how it works. I talk about orthobiologics and I point. I get a sense that they have no desire to pay for any- say, “If you think about it, we’re doing it like you go in, you thing more or new or different despite the fact that there do your BMAC and you put it into the syringe and it’s like is growing evidence that PRP for knee osteoarthritis for ex- a shotgun. You got a thousand pellets in there and maybe ample can really help patients for pain relief and instead of three or four of those pellets are the thing that’s really go- some of the corticosteroids and viscose and the other things

Journal of Orthopaedic Experience & Innovation 4 The Ortho Show Podscript: An Interview with Don Buford on Orthobiologics that are out there. So, it’s a real interesting spot. That’s tal condition without surgery whenever possible. We typi- something that definitely has to be studied more as ew go cally perform our orthobiologic therapies in an office based forward. So, you keep on it, brother. You keep us informed. procedures that takes less than an 1 hour. In some cases, You keep those crazy people off the podium and make sure we use these PRP and bone marrow concentrate/stem cell that we understand what’s going on. One of my favorite injections to assist, accelerate or augment the healing re- posts that you made, I don’t know, it was made six or eight sponse after a surgical procedure. months ago. You went through and looked at all the major Dr. Buford has been in an established orthopedic surgery orthopedic journals and I hear it all the time. “I am only go- practice in Dallas for over 20 years and has been voted mul- ing practice level one randomized control trials. That’s how tiple times by Dallas area physicians as one of the best I practice medicine and that’s the only way I’ll do it.” Right? orthopedic surgeons. He has been board certified y b the So, you took a look at all the five journals, right? You put American Board Of Orthopedic Surgery twice and is a them all together. Tell us about the level of evidence that’s sought after lecturer nationally and internationally on or- really being published out there right now. thopedic surgery and regenerative medicine subjects. Dr. Buford: Yes, so we took we took, I think it ended up Dr. Buford attended Stanford University for the first half being six of the most well-known orthopedic journals, JBJS, of his college career. While at Stanford, he was a member of Arthroscopy Journal, Sports Medicine, basically six of the the baseball team and had a double major in economics and top 10 orthopedic journals as ranked by impact factor and Human Biology. He then transferred to USC where he con- we looked at a full year of every single clinical study in every tinued to play baseball and study economics and the pre- one of those journals and we used either the author or the med curriculum. editor’s identification of the level of evidence which basical- In 1988 he received the Woody Hayes NCAA Division I ly most journals now require us to list that and it’s reviewed. Academic All-American Award for being the single most And we ran that data for all those journals for actually it outstanding NCAA Division I male student-athlete. would have been 13 months and what we found was that the After graduation from USC, he signed his first profes- average level of evidence in orthopedic journals was three. sional baseball contract with the Baltimore Orioles and also And that was independent of journal. So, for every journal enrolled at UCLA Medical School. that was the average. Every issue, that was the average. For Dr. Buford played professional baseball as a second base- every measurable time frame, that was the average. And so, man and outfielder in the Baltimore Orioles professional or- I made the blanket statement, “The average level of evi- ganization for 4 years. Dr. Buford’s father, Don Sr., played dence for Orthopedic Research right now is three.” for the Chicago White Sox ('63 -'68) and the Baltimore Ori- Dr. Sigman: How did you get some feedback on that one? oles ('68-'72) and played in 3 World Series, winning in 1970 How did that rollout? over the Cincinnati Reds. Don Sr. is in the Orioles Hall of Dr. Buford: Yes, I’m still getting feedback. I’ll probably Fame. Dr. Buford’s younger brother, Damon, had an 8 year get more after this. major league career which included 2 years as the starting Dr. Sigman: No cease and desist letter. That’s good. center fielder orf the Texas Rangers. Dr. Buford: Yes, when you think about it, doing clinical After graduating from the UCLA School of Medicine, Dr. studies, it’s very hard to have an RCT. It’s great when we Buford completed a 5 year orthopaedic surgery residency can get them, but it’s an incredibly difficult thing to run and at the University of Texas, Southwestern in Dallas. Dr. Bu- manage and to have it have enough power to be relevant. ford also completed a one year sports medicine fellowship Obviously so much of what we do is based on level three evi- at the prestigious Southern California Orthopaedic Insti- dence, case-control study, or kind of a “look what I did” ret- tute (SCOI) in 1999 where he learned advanced arthroscopy rospective review compared to control. techniques. Dr. Sigman: Yes, and that’s the reality and so especially Dr. Buford’s interest in orthobiologics was a natural out- when you’re in the innovation space as you’re trying new growth of his training in minimally invasive surgery…..both ideas and new things, you always get that same pushback. are designed to help patients in the simplest, safest way You need to show level one evidence before I’m going to possible. make a change and move into something new. At the end Since 2008, Dr. Buford has been training clinicians on of the day, however, most of us are using level three evi- MSK ultrasound and now orthobiologics as the Director of dence to make clinical decisions on a daily basis. So, it’s a the MSK Ultrasound and Orthobiologics Course. The course little bit of a conflict there, but really great stuff. Donnie, I is held twice a year in various locations. Dr. Buford and his can’t thank you enough. As I said, you’re our watchdog, you course faculty have trained over 1600 clinicians in MSK ul- are the police officer out there in the orthobiologic space. trasound. You’re a leader as well as in ultrasound. We can’t thank you enough. And again, innovation within your orthopedic sur- gical space as well. So, we can’t thank you enough for being on the show today. Dr. Scott A. Sigman is a board-certified orthopaedic sur- Dr. Buford: My pleasure. I really appreciate the invita- geon providing comprehensive care to patients at Orthope- tion. dic Surgical Associates of Lowell since 1996. Specializing in Sports Medicine, Dr. Sigman possesses the skills and expe- AUTHOR BIOGRAPHIES rience to diagnose and treat sports injuries and conditions affecting the knee and shoulder. In addition to his practice duties, he has served as the Team Physician for the US Ski Dr. Don Buford founded The Texas Orthobiologics Institute Jump Team, and serves for the last 20 years as the Team as a research institute where patients can benefit from the Physician at UMASS Lowell, and is the past Chief of Or- latest evidence based orthobiologic orthopedic treatments. thopaedics at Lowell General Hospital. The most common conditions treated are arthritis pain, Dr. Sigman graduated cum laude with his Bachelor’s de- back pain, tendon injuries, and sports injuries. gree in Biology from Tufts University, where he played var- Our Institute’s goal is to maximize our patients’ quality sity lacrosse and was President of the Alpha Epsilon Pi fra- of life and minimize their disability from any musculoskele-

Journal of Orthopaedic Experience & Innovation 5 The Ortho Show Podscript: An Interview with Don Buford on Orthobiologics ternity. He then received his medical degree as a cum laude In addition to his extensive training and practice expe- graduate of the University of Maryland School of Medicine rience, Dr. Sigman has also contributed to numerous publi- and member of the prestigious Alpha Omega Alpha medical cations and research studies regarding advances in the field honor society. of orthopaedic surgery. He takes great pride in remaining Upon graduating with his medical degree, Dr. Sigman informed of the latest state-of-the-art arthroscopic tech- completed his postgraduate internship in General Surgery niques for both knee and shoulder surgery. He also gives at St. Agnes Hospital, followed by a residency in Or- presentations and lectures and instructional courses to fel- thopaedic Surgery at Tufts Medical Center. Dedicated to low surgeons throughout the world in new shoulder and furthering his training, Dr. Sigman also completed a fellow- knee surgery techniques. ship in Sports Medicine at the prestigious Kerlan-Jobe Or- In 2019, Dr. Sigman was elected as a Fellow of the Royal thopaedic Clinic, during which he was responsible for the College of Physicians of Ireland, Faculty of Sports & Sports orthopaedic care of the Los Angeles Lakers, Los Angeles Medicine. This certificate is a culmination of his ongoing ef- Dodgers, LA Angels, LA Kings, Anaheim Mighty Ducks, LA forts to change the paradigm of postoperative pain manage- Galaxy and USC football. ment.

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Journal of Orthopaedic Experience & Innovation 6