STEADMAN PHILIPPON Research institute

2013 Annual Report

An International Center For Research and Education — Keeping People Active SM MISSION

The Institute is dedicated to keeping people of all ages physically active through orthopaedic research and education in the areas of arthritis, healing, rehabilitation, and injury.

HISTORY

Founded in 1988 by orthopaedic surgeon Dr. J. Richard Steadman, the Steadman Philippon Research Institute is an independent, tax-exempt (IRS code 501(c)(3)) charitable organization employing scientists, researchers, fellows, visiting scholars, and interns. Dr. Steadman moved to Vail in 1990 with one researcher. Today, there are almost 30 employees (scientists, researchers, medical fellows, visiting scholars, administration, and interns). In 2010, Dr. Marc Philippon’s name was added to mark the succession of the Institute and recognize his research efforts and contributions to the field of hip arthroscopy.

Funding for research and education programs comes primarily from public donations and fundraising events (grateful patients and the physicians of The Steadman Clinic), corporations, and competitive grants.

CONTENTS The Institute wishes to express again deep appreciation to John P. Kelly, who 2 The Year in Review donated many of the stock photos in this year’s Annual Report and contributed 4 Governing Boards his time to photograph the many Institute and operating room subjects. 12 Awards and Recognition 18 Scientific Advisory Committee John Kelly first picked up a camera while serving as an infantry lieutenant 20 Friends of the Institute in the Air Cavalry in Vietnam. He quickly developed a love for photography 32 Corporate and Institutional Friends that he took home with him to Colorado. By combining his new craft with 33 Research and Education his passion for sports and adventure, Kelly created a successful career. 35  Center for Translational and Regenerative Medicine Research His diverse photo assignments have taken him from Wimbledon to trekking the 38  Center for Outcomes-Based Himalayas, the Winter Olympics to sailing the Caribbean. He was the official Orthopaedic Research photographer for the U.S. Open Golf Championships for 10 years, and the 50 BioMedical Engineering only American among the official photographers at the Lillehammer Winter 52 Surgical Skills Laboratory Olympic Games. When Robert Redford needed the defining shot to promote 53 Imaging Research his film “A River Runs Through It,” he called on Kelly. Subsequently, Kelly 56 Education and Fellowship also provided the still photography for Redford’s “The Horse Whisperer.” 64 Presentations and Publications 81 Events Although he has traveled all over the world, many of his favorite 84 Associates photo shoots have taken place at his beloved End of the Road Ranch 86 Audited 2013 Financial Statements in western Colorado, where clients such as Polo/Ralph Lauren have come to work and play with Kelly and his friends and animals. The Institute is known throughout the world for its research into the causes, prevention, and treatment of orthopaedic disorders. We are committed to solving orthopaedic problems that limit an individual’s ability to maintain an active life.

Our research perspective is based on clinical relevance, with a goal of improving the care of the patient. Recognizing that the body’s innate healing powers can be harnessed and manipulated to improve the healing process has led to exciting advances in surgical techniques developed by Dr. Richard Steadman and validated at our Institute. Today, the Institute is recognized worldwide for Dr. Marc Philippon’s pioneering research in the treatment of sports-related injuries to the hip.

Athletes are becoming bigger, faster, and stronger. Unfortunately, their connective tissue does not. Therefore, injuries are becoming more complex. Our research into the anatomy and mechanisms of the complex knee, hip, and shoulder is being recognized worldwide.

We collect data and publish clinical research results on knees, hips, shoulders, spines, feet and ankles, and hands and wrists, and work to improve imaging techniques. Through these efforts, SPRI has become one of the most published and innovative organizations in sports medicine research and education. We publish our findings in relevant peer-reviewed scientific and medical journals, and present our research results at medical meetings worldwide.

Philanthropic gifts are used to advance scientific research and to support scholarly academic programs that train physicians for the future. Through our fellowship and visiting scholar programs, the Institute has now built a network of more than 200 fellows and visiting scholars worldwide who share the advanced ideas and communicate the concepts they learned in Vail to their patient base.

Our primary areas of research and education are:

• Department of BioMedical Engineering – advances patient care by focusing on injury mechanisms and prevention, develops and validates novel surgical treatments and rehabilitation techniques, and teaches advanced research protocols using state-of-the-art biomedical research techniques and technologies.

• Center for Outcomes-Based Orthopaedic Research – conducts evidence- or outcomes-based research using actual clinical data that aids both physicians and patients in making better and more informed treatment decisions.

• Center for Translational and Regenerative Medicine Research – undertakes biological studies at the cellular level to investigate the causes and effects of degenerative arthritis, techniques of cartilage regeneration, and basic biological healing processes.

• Imaging Research – develops and evaluates noninvasive imaging techniques of the joints for the purpose of directing and monitoring clinical treatment and outcomes, and to enhance the clinical relevance of biomechanics research.

• Surgical Skills Laboratory – implements new surgical technologies and trains surgeons in new techniques using state- of-the-art equipment.

• Education and Fellowship Program – administers and coordinates the physicians-in-residence fellowships and visiting scholars programs, hosts conferences and international medical meetings, produces and distributes publications and educational media, and organizes educational outreach programs in partnership with the local school district.

1 The Year In Review

Dear Friends,

On behalf of all of us at the a world leader in sports medicine Arthroscopy (pg. 13) at its annual Steadman Philippon Research education and research, during their scientific meeting. The Richard N. Institute, we wish to thank you annual meeting in Seattle. This is Villar Trainee Excellence in Clinical for your continued support, which the first time that this award has Research Award was presented to Dr. helped to make 2013 a year of been won by the Institute since Nepple for his research titled, “The accomplishment and significant the award was established. The Effect of an Acetabular Labral Tear, international recognition. Your award is presented for the best Repair, Resection, and Reconstruction commitment makes it possible for us paper submitted in any category. on the Hip Fluid Seal.” This award to carry out our mission of “Keeping was created to recognize young People Active” and educating the Since the opening of the new researchers who contribute high- worldwide orthopaedic community. BioMedical Engineering Laboratories quality research and information. in 2011, two fellowship classes Philanthropy from patients, grateful have had the opportunity to In July 2014, the United States families, and others who have perform quality research benefitting Olympic Committee designated us benefitted from our work has been patients worldwide. Each of these as one of only two U.S. Olympic the basis for all our advances since two fellowship classes has won National Medical Centers in the SPRI’s founding in 1988. SPRI’s major international awards. country. That is quite an honor and regenerative medicine and biomedical one that we take very seriously. The engineering research on the anatomy Earlier in 2013, Dr. Jeff Padalecki, USOC would not have bestowed that and mechanisms of knees, hips, one of our 2011-2012 SPRI fellows, honor, the Olympic Rings, and the spines, shoulders, and ankles—and was presented with the Albert Trillat National Medical Center emblem the outcomes-based orthopaedic Young Investigator’s Award by the without The Steadman Clinic and therapies they have yielded—are International Society of Arthroscopy, the Steadman Philippon Research now recognized worldwide. Knee Surgery, and Orthopaedic Institute being mentioned side-by- Sports Medicine at its biennial side. The U.S. Olympic Committee Because of the commitment from congress. This award recognizes makes it clear that these two our many donors, your team at SPRI his research team’s contributions entities—The Clinic and SPRI—are has been recognized internationally to the understanding, care, and essentially important as a team. at the highest levels for the quality prevention of injuries to the knee. and excellence in research. In July Looking forward, we have submitted 2014, the Steadman Philippon Dr. Jeff Nepple, a 2012-2013 fellow, our application to the International Research Institute received the was honored in October of 2013 in Olympic Committee to become the 2014 Excellence in Research Award Munich, Germany, with an important first U.S.–based research center for from the American Orthopaedic international award presented by the IOC. That designation would Society for Sports Medicine (pg. 12), the International Society for Hip be another significant honor and is

2 something about which we are very our donors, corporate sponsors, and hopeful. The IOC is very interested foundations, for your commitment. in basic research regarding all We look forward to your continued athletes’ health, injury prevention, support and to updating you on and improved performance. exciting advances from the Steadman Philippon Research Institute. For more than 25 years, the Steadman Philippon Research With your help, we are able Institute has devoted time and to make a difference. resources to the training and J. Richard Steadman, M.D. education of physicians and scientists Respectfully yours, from all over the world. SPRI staff members have been involved in the Vail Valley community since the Institute moved to Vail in 1990. On page 62, you will read about a new J. Richard Steadman, M.D. level of commitment achieved when Co-Chairman the Institute’s Education and Public Co-Chief Scientific Officer Outreach Committee—EPOC—began a program to inspire elementary, middle, and high school students Marc J. Philippon, M.D. in Eagle County to become more involved in the fields of science, Marc J. Philippon, M.D. technology, engineering, and Co-Chairman mathematics. During the 2013– Co-Chief Scientific Officer 2014 school year, EPOC’s program involved more than 500 students from local schools, beginning with those in the fifth grade. Gary A. Peterson President and Chief Executive Officer Our life-changing research would not exist without the visionary Gary A. Peterson support of individuals like you. On behalf of our dedicated trustees and researchers, we wish to thank you,

3 Board of Directors and Officers

J. Richard Steadman, M.D. Doris J. Kirchner Cynthia S. Piper Founder President and Chief Executive Officer Trustee Co-Chairman Vail Valley Medical Center Hazelden Foundation Co-Chief Scientific Officer Vail Colo. Hamel, Minn. Steadman Philippon Research Institute Frank Krauser Steven Read Vail, Colo. President and Co-Chairman Chief Executive Officer (retired) Read Investments Marc J. Philippon, M.D. NFL Alumni and Pro Legends, Inc. Orinda, Calif. Co-Chairman Ft. Lauderdale, Fla. Co-Chief Scientific Officer Gary S. Rosenbach Steadman Philippon Greg Lewis Financial Advisor (retired) Research Institute President Vail, Colo. Vail, Colo. Greg Lewis Communications Basalt, Colo. Kenneth Schanzer Gary A. Peterson President President and Chief Executive Officer John G. McMillian NBC Sports (retired) The Steadman Clinic Chairman and Avon, Colo. Steadman Philippon Chief Executive Officer (retired) Research Institute Allegheny & Western Damaris Skouras Vail, Colo. Energy Corporation Founder and Chief Executive Officer Coral Gables, Fla. Global Reach Management Company Adam Aron New York, N.Y. Philadelphia, Pa. Peter Millett, M.D., M.Sc. Partner Gay L. Steadman Howard Berkowitz The Steadman Clinic Vail, Colo. Chairman and Chief Executive Officer Vail, Colo. BlackRock HPB Stewart Turley New York, N.Y. Larry Mullen, Jr. Chairman and Founder, Partner, and Drummer Chief Executive Officer (retired) Robert A. Bourne U2 Eckerd Corporation Vice Chairman Dublin, Ireland Bellaire, Fla. CNL Financial Group, Inc. Orlando, Fla. Cynthia L. Nelson Norm Waite Co-Owner Vail, Colo. George Gillett Here 2 Help Chairman Vail, Colo. Booth Creek Management Corporation HONORARY TRUSTEE: Vail, Colo. Mary K. Noyes Freeport, Maine H.M. King Juan Carlos I of Spain Earl G. Graves, Sr. Chairman and Publisher Al Perkins Earl G. Graves, Ltd. Chairman Emeritus IN MEMORIAM: New York, N.Y. RevGen Partners Denver, Colo. J. Michael Egan Ted Hartley President and Chief Executive Officer Chairman and Chief Executive Officer Senenne Philippon The Steadman Philippon RKO Pictures, Inc. Vail, Colo. Research Institute Los Angeles, Calif. Vail, Colo.

4 The Honorable Jack Kemp Chairman and Founder Kemp Partners Washington, D.C.

EMERITUS:

Harris Barton Managing Member Hbam Palo Alto, Calif.

Jack Ferguson Founder and President Jack Ferguson Associates Washington, D.C.

H. Michael Immel Executive Director (retired) Alabama Sports Medicine and Orthopaedic Center Lafayette, La.

Arch J. McGill President (retired) AIS American Bell Scottsdale, Ariz.

Betsy Nagelsen-McCormack Professional Tennis Player (retired) Orlando, Fla.

Officers:

J. Richard Steadman, M.D. Co-Chairman

Marc Phillipon, M.D. Co-Chairman

Gary Peterson President and Chief Executive Officer

Greg Paschke Chief Financial Officer

Monica White, CPA, CGMA Controller/Treasurer

5 Philanthropy

L-R, Jorge Paulo Lemann, and Leonardo Metsavaht, M.D.

The Brazilian Visiting Scholar Program Benefits Two Countries, a Growing Number of Orthopaedic Surgeons, and Millions of Patients

The Jorge Paulo Lemann Mentored Scientific Award turned an idea into an internationally recognized educational program

It started with a house call, but orthopaedic surgeon. The winner of physicians at The Steadman Clinic, not your typical house call. When that award participates in the Brazilian he attended a meeting we arranged Damaris Skouras, a long-time Visiting Scholar Program at the in which Drs. Steadman, Philippon, SPRI Board member, learned that Steadman Philippon Research Institute. Millett, and Rodkey, and other SPRI Dr. Richard Steadman would be staff members described the mission, speaking at a conference in Rio de In just six years, the award and work, and goals of the Research Janeiro, Ms. Skouras asked Jorge program have provided advanced Institute. Dr. Philippon presented a Paulo Lemann if he would like to training for eight orthopaedic five-year plan to advance knowledge meet Dr. Steadman and ask him surgeons, produced more than 40 of hip biomechanics and arthroscopy.” to check on a knee Mr. Lemann publications in scientific journals, had injured in a skiing accident. benefitted two research institutes, “By the end of that presentation,” and had a significant impact on says Dr. Metsavaht, “Jorge was Dr. Steadman agreed and the three medical practice in two countries. impressed with The Clinic and the of them spent Easter weekend educational opportunities being at Mr. Lemann’s home in Angra Jorge Paulo Lemann is one of the provided by SPRI. He looked at me dos Reis, where the seeds of Mr. world’s most accomplished and and said, ‘Leo, I am willing to help Lemann’s vision to recognize the successful businessmen, as well Dr. Steadman and Dr. Philippon Steadman Philippon Research as one of the world’s most active through annual donations. Any idea Institute as an entity that could have philanthropists. Leonardo Metsavaht, of how we could make it better?’ ” an impact in Brazil were planted. M.D., is an internationally respected orthopaedic surgeon and chief “I suggested that we could provide Mr. Lemann’s friend and physician, scientific officer of the Institute Brazil one Brazilian physician/scholar Dr. Leonardo Metsavaht, had known of Health Technologies, which is the for the SPRI research team every of Dr. Steadman’s work and was well official administrator of the Jorge Paulo year and that person would be aware that Steadman’s thinking was Lemann Mentored Scientific Award. able to return to Brazil and spread clearly ahead of its time. From that this knowledge in our country.” first visit, friendships developed and A Great Day expanded, an idea was born, and “And that was it,” says Dr. that idea resulted in an award and a “A year after Dr. Steadman’s house call, Metsavaht. “It was a great day.” program: The Jorge Paulo Lemann the four of us met in Vail, Colorado,” Mentored Scientific Award, which is recalls Ms. Skouras. “After Jorge given to an outstanding young Brazilian had been checked out by a team of

6 Six Years Later Demanding Qualifications The Results

The Brazilian Visiting Scholar Candidates must meet seven Former award winners have performed Program is now an ongoing, standards before they can be highly technical surgery in towns that expanding, and productive initiative. considered as candidates for previously had no access to advanced It has brought eight outstanding the award. They must: medical practices. They have also orthopaedic surgeons to SPRI. They made presentations, described their spend one year in Vail, observing 1) be highly skilled research at national and international and working with SPRI physicians orthopaedic surgeons conferences, published studies, won and scientists, conducting research, scientific awards, and participated in making presentations, and 2) be familiar with arthroscopic Brazilian national scientific events. writing articles for international surgery and biomechanics medical and scientific journals. “The return to the Brazilian medical and 3) be fluent in English scientific communities has exceeded The selection process is rigorous, our expectations,” says Dr. Metsavaht. according to Dr. Metsavaht. “Jorge 4) have written peer-reviewed Lemann and Dr. Steadman want to scientific papers Medicine, Education, identify good people and competent and Philanthropy physicians who are deserving of 5) be willing to spend a year away advanced orthopaedic training. from their homes and jobs “Jorge’s vision is on education, not For the past 20 years, Jorge has science,” says Dr. Metsavaht. “He participated in the selection process 6) have the capability to apply believes the most effective way of a program that sponsors students what they learn at SPRI to to build a better world is through who have been accepted to top their daily duties in Brazil education because you don’t merely universities in the U.S., but who can’t help the person, you offer a network afford all of the expenses. My duty is 7) be able to spread their knowledge of opportunities. There are other to do the same with the Jorge Paulo throughout the Brazilian medical exchange programs, but Lemann Mentored Scientific Award.” orthopaedic community our goal is focused on improving Brazilian orthopaedic education and scientific inquiry. The best way to do that is through scientific research.”

Brazilian Orthopaedic Surgeon Dr. Bruno Nogueira Joins Steadman Philippon as Visiting Scholar 7 Philanthropy (cont’d)

Doubling the Program A Win-Win Program was a great and unexpected honor. I’m a much better physician now “The only change we have made to the “We are proud to work with these than I was before my experience program was to double our investment,” young visiting scholars,” says Dr. at SPRI. Just one year changed my says Dr. Metsavaht. “In 2012, Jorge LaPrade, director of the International life, and I’m not the only one. I saw told me that he was happy with Scholars Program at SPRI. “They are others who came to Vail as young the program and asked me what I already making an impact in Brazil, doctors and left as experienced thought of sponsoring two scholars.” and we expect them to become practitioners and researchers.” the leaders of a new generation “His suggestion coincided with the of sports medicine scientists.” Damaris Skouras says it best, “On addition of Dr. Robert LaPrade to The behalf of the SPRI Board of Directors Steadman Clinic and the Research Bruno Nogueira, M.D., was an award and SPRI community at large, we Institute. I have the highest regard winner in 2011. About his experience are deeply grateful to you, Jorge for Dr. LaPrade because I had been he says, “Being named a Visiting Paulo Lemann, for the results we following his state-of-the-art work Scholar at Steadman Philippon is have achieved for the U.S. and in researching knee instability. I the best award I’ve won in my life. I Brazil. Muito obrigado, Jorge Paulo!” suggested that we sponsor one really wanted to go to Vail and SPRI, scholar in hip and a second in knee and couldn’t believe it when I was biomechanics and arthroscopic surgery.” told I had been accepted into the program. I knew it would allow me After sending award winners and visiting to learn from the world’s best sports scholars to Vail in 2009, 2010, 2011, medicine surgeons and scientists.” and 2012, Mr. Lemann has funded and Dr. Metsavaht has administered A 2012 Visiting Scholar, Dr. Lourenco the selection process for two scholars Peixoto says, “The Jorge Paul in 2013 and two more in 2014. Lemann Mentored Scientific Award

Jorge Paulo Lemann, Dr. Leonardo Metsavaht, and the Institute Brazil of Health Technologies

“I met Jorge Paulo Lemann in national tennis champion in Brazil “Today, our main research efforts are 2007,” says Leonardo Metsavaht, and played on the Davis Cup teams 1) identifying predictive factors of M.D., M.Sc., C.S.O, a renowned of both Brazil and Switzerland. injuries in sports and 2) measuring orthopaedic surgeon and researcher the risks, as well as identifying in Rio de Janeiro. “He had a skiing “Jorge asked me how we could risk factors, of falls through accident and had been unable to play improve orthopaedics as a whole biomechanics and motion analysis.” tennis for five months. I suggested a in Brazil, other than by building conservative treatment protocol and another hospital,” recalls Dr. “IBTS has produced meaningful he was able to return to tennis in Metsavaht. “We decided to create results sooner than we expected. six weeks. We started playing tennis an institute to improve thinking In four years, the Institute has once a week, which was enough on medical conditions. It is called produced high-impact research time to see that we had similar core the Brazil Institute of Health published in professional journals, values, and we became friends.” Technologies (IBTS), a not-for- and in 2013 it was awarded the profit research institution focused top research award by the World Mr. Lemann’s interest in tennis, on the prevention of orthopaedic Biomechanics Congress.” sports medicine, and orthopaedics injuries and conditions.” is not surprising. He was a five-time

8 2013 a Record Year for Steadman Philippon Research Institute Production How your contributions enable SPRI to maintain its position as one of the world leaders in orthopaedic sports medicine research

The Steadman Philippon Research conducted at SPRI were made at director of Development. “We Institute has nine physicians, conferences in the U.S., Europe, appreciate that support, which has 20 research scientists, and six Canada, South America, and Africa. helped SPRI’s vision become a reality.” administrative professionals. Yet this relatively small group continues Physicians and scientists at INTANGIBLES to position SPRI as one of the Steadman Philippon were honored most productive institutions in the by the American Academy of Dr. William Rodkey, D.V.M., director world as measured by publications, Orthopaedic Surgeons, the of SPRI’s Center for Translational presentations, and awards. International Society for Hip and Regenerative Medicine Arthroscopy, and the International Research, adds that two intangible In 2013, SPRI’s doctors and Society of Arthroscopy, Knee Surgery factors have allowed things to come researchers had 58 articles published and Orthopaedic Sports Medicine. together that provide the impetus in scientific and medical journals for so much productivity in 2013. such as The American Journal of HOW DO THEY DO IT? Sports Medicine, the Journal of “The first is Dr. Steadman’s overall Orthopaedic Research, and the Journal The answer begins with you. leadership. He has always seen this of Bone and Joint Surgery. Each Institute as an important means to publication was cited in the National “All of our achievements are made validate and self-enforce a grade Library of Medicine (PubMed). possible through the support of card as to how we are doing. The generous individual donors and our way he communicates and thinks More than 40 presentations corporate and institutional friends,” with people serves as a stimulus describing the outcomes of studies says John McMurtry, M.A., M.B.A., for the physicians and scientists. It

9 really gives us some guidance and EFFICIENCY “Our production is having an impact food for thought in our everyday on the scientific and medical approach to these research problems. “One of the reasons we are more communities,” he continues. “The That kind of thinking yields studies, efficient than ever is because of American Journal of Sports Medicine publications, and presentations.” our data software system,” says Ms. (AJSM), for example, is the number Briggs. “Our software incorporates a one orthopaedic journal (out of “The second intangible,” says Dr. system that allows the data to check 65) in terms of impact factor. This Rodkey, “is that the attending itself. Ninety percent of patient-based metric, according to the editors, surgeons at SPRI are truly interested verifications (related to procedures shows that authors around the world in and dedicated to research. They that have been performed) are done pay attention. If a person looked share Dr. Steadman’s philosophy by email. Instead of sending 900+ at any 2013 edition of the AJSM, and as a result, they really want to messages a month by regular mail the Steadman Philippon Research know how they are doing and what’s and hoping for a response, patients Institute name was probably in it.” coming next. They are willing to now receive email questionnaires. support the research financially, They are very responsive and the new Dr. Philippon’s landmark article philosophically, and intellectually.” system has made our communication on labrum reconstruction of the with patients much easier.” hip was the lead article in the A third underlying factor contributing August 2013 issue of the AJSM. In to productivity is not intangible, Ms. Briggs also credits the staff’s the December issue of the same according to Dr. Rodkey, “It’s experience as a factor in improving publication, four of the articles were technology,” he says, emphatically. efficiency. “Knowing and working written by SPRI’s staff members. “Clearly, the technological advances with this database for 21 years we’ve made at Steadman Philippon allows us to be thorough and faster,” “Peer-reviewed publications that represent a gigantic step toward she explains. “When doctors and incorporate relevant research provide efficiency, reliability, and accuracy.” fellows come to us with a question, a significant, credible resource we can do a better job of answering among peers,” says Dr. Wijdicks. Coen Wijdicks, Ph.D., senior that question, responding more “Because it is published in such a staff scientist and director of quickly, and helping them get large forum, the result is high impact BioMedical Engineering, and Karen their findings published sooner.” and captures a large audience.” Briggs, M.B.A, M.P.H., director of the Center for Outcomes-Based Individuals and institutions can often ACCOUNTABILITY Orthopaedic Research (COOR), see the results of their contributions provide a closer look at how SPRI’s in a matter of months, not years. The Whether a person contributes $100, advanced technology translates average time required for a research $1,000, or $100,000, that money into high-impact productivity. initiative at Steadman Philippon is is carefully managed so that 77 six to eight months. When a project percent goes directly to research FOCUS takes longer, those who make the programs, while only 23 percent is effort possible are given periodic spent on overhead. The percentage “We have clearly defined goals and updates by the principal researchers. of contributions dedicated solely outcomes,” explains Dr. Wijdicks. to research is one of the highest, “Once you know where you are IMPACT if not the highest, in the world. going, you can have the greatest impact. We know how to optimize Focus and efficiency are impressive, Some of the money is spent on items, our processes. Our focus is sports but the impact of SPRI research supplies, and equipment that might medicine and we concentrate on our is even more important. be scientific-but-less-than-glamorous. strengths. That makes the Steadman Philippon Research Institute one of “We are not trying to break records “We would not be able to collect the best in the world at what it does.” or beat the number of the previous data as we do if we did not keep year’s publications or presentations,” our software updated and moving Dr. Wijdicks adds that now that says Dr. Wijdicks. “Our goal is to forward as medicine advances,” says SPRI’s expertise has been established, maintain the quality of production Ms. Briggs. “We have to know what corporations, institutions, and the regardless of external factors is in the professional literature, and medical/scientific communities look that are out of our control.” it costs money to have access to to SPRI to develop and validate new that literature. We’ve hired some products, techniques, and procedures. of the best minds in the country to

10 manage high-level statistical programs. has directly affected patient care recognized as the “Orthopaedic Then we have to buy programs that by changing the method of treating Nobel Prize” in the medical and will help our doctors make their hip conditions and injuries.” scientific communities. Dr. LaPrade presentations and present our research presented his paper at the combined at meetings around the world.” Dr. Steadman developed an annual meetings of the Orthopaedic arthroscopic procedure for injured Research Society and the American “We know the benefit of every surgical knees called “The Package.” Patients Academy of Orthopaedic Surgeons. screw that gets donated,” adds who underwent the procedure were Dr. Wijdicks, “and we appreciate understandably worried about if ONGOING INITIATIVES the gift and the giver that make and when they might have to return it possible. We want donors to for another procedure—or possibly “Your contributions are already at know that their donations go to even need knee replacement. work and supporting new research something necessary and good.” initiatives,” concludes Dr. Wijdicks. Dr. Steadman’s team conducted long- “Investigations involving the hips, CARE term monitoring of the repaired knees’ shoulders, knees, feet, and ankles are “survivorship.” They found that many growing exponentially. The metrics Contributions also result in life- patients were able to delay total used to define successful outcomes changing, patient-centered care. knee replacement for up to 10 years, are becoming more demanding People are able to go about their allowing them to make informed and more precisely defined.” normal daily activities, postpone or choices about their future health care. avoid joint replacement, participate “In the coming years, the Steadman in sports at every level, prevent For his landmark study, Dr. Steadman Philippon Research Institute will injuries, and remain physically active was honored with the Richard continue to solidify its role as a throughout their lives because of O’Connor Research Award given by leader in sports medicine research. procedures developed or refined at the Arthroscopy Association of North That research will impact the SPRI. Here are three examples: America. The study was published in lives of those who contribute to the February 2013 issue of Arthroscopy. SPRI, as well as those of patients “The research for Dr. Philippon’s throughout the U.S. and abroad.” labral reconstruction procedure Robert F. LaPrade M.D., Ph.D., began in 2005 when he came to received the 2013 Orthopaedic Why was 2013 an especially SPRI,” says Ms. Briggs. “We’ve Research and Education Foundation productive year for SPRI? Because been keeping track of patients for (OREF) Clinical Research Award your support made it possible. seven years and have now validated for his paper on “Improving that the procedure will last for an Outcomes for Posterolateral Knee extended period of time. His research Injuries.” The award is unofficially

11 Awards and Recognition

Nick Kennedy receiving the Excellence in Research award from Robert F. LaPrade M.D., Ph.D., Research Committee Chair of the American Orthopaedic Society for Sports Medicine. American Orthopaedic Society for Sports Medicine Presents the 2014 Excellence in Research Award to SPRI

The Steadman Philippon Research Institute was TITLE OF SUBMISSION: awarded the 2014 Excellence in Research Award Posterior Cruciate Ligament Graft Fixation from The American Orthopaedic Society for Sports Angles: Biomecha nical Evaluation for Single- Medicine (AOSSM) during the annual AOSSM and Double-Bundle Reconstruction Meeting in Seattle this past July. This is the first time that this award has been won by the Institute AUTHORS: since the award was established in 1988. Nicholas I. Kennedy, B.S., Mary T. Goldsmith, M.Sc., Scott C. Faucett, M.D., Matthew T. Rasmussen, This recognition is given to the best paper submitted B.S., M.Sc., Garrett A. Coatney, Lars Engebretsen, in any category to the AOSSM Awards Committee, a M.D., Ph.D., Coen A. Wijdicks, Ph.D. world leader in sports medicine education, research, communication, and fellowship. The award is a This study was partially funded by the Norwegian symbol of quality and research excellence. It is Health South-East (Helse Sør-Øst) Regional Health also a symbol of international collaboration. Authority Founded in 1972, AOSSM is an international organization of orthopaedic surgeons and other allied The award-winning research was conducted in health professionals dedicated to sports medicine. This partnership with Lars Engebretsen, Ph.D., from award is a symbol of quality and research excellence. the Oslo Sports Trauma Research Center in Norway and Robert LaPrade, M.D., Ph.D., of the Steadman Philippon Research Institute in Vail.

12 International Society for Hip Arthroscopy (ISHA) Recognizes Dr. Jeff Nepple for Excellence in Clinical Research

Dr. Jeff Nepple, a Sports Medicine Fellow (class of 2012– “Since the opening of the new SPRI Laboratories in 2011, 2013) at the Steadman Philippon Research Institute, there have been two fellowship classes that have had the was honored October 12–13, 2013 in Munich, Germany, opportunity to perform quality research within BioMedical with a major international award presented by ISHA at its Engineering, and Jeff’s year represents the second fellowship annual scientific meeting. He was one of eight finalists. class with a member to win an international award.”

The Richard N. Villar Trainee Excellence in Clinical Earlier this year, Dr. Jeff Padalecki won the Albert Trillat Research Award was presented to Dr. Nepple for his Young Investigator’s Award presented by the International presentation of research conducted during his fellowship Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports year at SPRI titled “The Effect of an Acetabular Labral Medicine at its biennial congress. The award was based on Tear, Repair, Resection, and Reconstruction on the his research on the effects of radial root tears and repairs Hip Fluid Seal.” The award was created to recognize on medial compartment joint loads and contact areas. young researchers who contribute high-quality research and information. Residents and fellows with a study The ISHA Awards Program is committed to related to hip arthroscopy were encouraged to apply. recognizing and honoring young researchers whose work has contributed to better understanding and SPRI Sports Medicine Fellowship Deputy Director and communication within the field of hip arthroscopy. Chief Medical Officer Robert F. LaPrade, M.D., Ph.D., commented, “It is my pleasure to announce that an SPRI ISHA was established in 2008 to further the development, Sports Medicine Fellow was recognized with an international through education and research, of arthroscopic hip research award this past Saturday in Munich, Germany.” surgery. Dr. Marc Philippon is a founding member.

13 L-R, Drs. Marc J. Philippon and J. Richard Steadman, and Dr. Bill Moreau, Managing Director Sports Medicine, United States Olympic Committee.

Steadman Philippon Research Institute and The Steadman Clinic Designated a National Medical Center Within the U.S. Olympic Committee’s National Medical Network

The Steadman Philippon Research “Our goal is to contribute to Team Through its fellowship program, Institute and The Steadman USA by delivering the highest the Institute has graduated Clinic announced their official standard of evidence-based 196 orthopaedic surgeons now designation as a National Medical orthopaedic care and personal practicing in multiple locations in Center within the United States attention to Team USA athletes,” the United States and abroad. Olympic Committee’s National says Dr. Marc J. Philippon, co- Medical Network, one of only two chairman of the Steadman Philippon “The Steadman Philippon Research such centers since the network was Research Institute and managing Institute and The Steadman Clinic first announced in August 2013. partner of The Steadman Clinic. are highly honored to be designated a USOC National Medical Center, “The Institute has one of the largest The Institute’s commitment to serving the athletes of the western orthopaedic patient databases research and the Clinic’s philosophy of United States,” says Dr. Philippon. in existence, and its research is providing evidence-based care to elite published worldwide in peer-reviewed athletes as well as people who just “We are pleased to have the Steadman professional journals. The patient want to live an active lifestyle have Philippon Research Institute and The treatment protocols developed produced countless success stories Steadman Clinic join the USOC’s and used by the physicians at The both on and off the awards podium. National Medical Network as a Steadman Clinic are validated national partner,” says Alan Ashley, through this research. The quality of “We are pleased to have the chance USOC chief of sport performance. SPRI’s research and the outcomes to give back to the athletes who have “The variety and value of services that of patients at The Clinic have led to worked so hard to become Olympians this collaborative project will provide several of the physicians becoming and Paralympians, and we look is a great resource for Team USA, and thought leaders in the field of sports forward to working with Team USA for we are excited to see the expansion medicine orthopaedics,” says Karen many years to come,” says Dr. Richard of the National Medical Network, Briggs, SPRI director for Outcomes- Steadman, who founded the nonprofit which now includes two national Based Orthopaedic Research. entity now known as the Steadman and five regional medical centers.” Philippon Research Institute.

14 I was born. We later learned that ‘kikkan’ is the Swedish expression for little girl, which gets me a few extra cheers when I race in Scandinavia.”

“Teammates over the years have used variations of Kikkan, not all of which I can mention here, but in high school they started calling me ‘Kikkanimal’ because I was always pushing to do more, work harder. They said I was like an animal they had never seen before, and ‘Kikkanimal’ stuck. I like the attitude that the nickname embodies.”

Multiple Sports

Weibrecht and Randall have more in common than unusual nicknames. Both played multiple sports as kids and both had early Patients in the News success in their skiing careers. Olympic Skiers Andrew Weibrecht and Kikkan Randall Made Stops at “I played soccer, lacrosse, and a lot The Steadman Clinic and SPRI en Route to the 2014 Games in Sochi of tennis,” says Weibrecht, “but skiing was my best sport. By the time I was 12 or 13, I was beginning

United States’Andrew Weibrecht approaches a gate in the men’s super G at the Sochi 2014 Winter to stand out. At 15, I won the Olympics, Sunday, February 16, 2014 in Krasnaya Polyana, Russia (AP Photo/Charles Krupa). children’s world championship

Kikkan Randall from the U.S. competes during the qualification of the Women’s World Cup Cross called the Trofeo Topolino Games in Country Ski 1.5km Sprint Free event in Szklarska Poreba, Poland, Saturday, Jan. 18, 2014. (AP Italy, and I was third at the Junior Photo/Alik Keplicz). World Championships in 2006. That sort of showed me that I could Athletes with nicknames like “The Cross-country skier Kikkan Randall is compete at the international level.” War Horse” and “Kikkanimal” are a four-time Olympian. She has won expected to be different, perhaps three consecutive World Cup Sprint Kikkan Alpine-raced seriously for a special. You get both with Andrew titles and is the most decorated few years and thought it might be Weibrecht and Kikkan Randall. cross-country skier in American her sport, but she also ran track and history. In her career, she has won 17 played soccer. It wasn’t until she Andrew “The War Horse” Weibrecht U.S. Championships and 21 World was 16 that she went into cross- has overcome devastating injuries Cup podiums, and her 2013 and country skiing fulltime. She got a top and near-impossible odds to win 2014 sprint titles placed her third ten in her first junior championship medals in the 2010 and 2014 overall in the World Cup standings— event and by the age of 19 was a Olympic Super G competition—the both records for the U.S. women. member of the U.S. Ski Team. Super Giant Slalom. He got his nickname because of the way he How do you explain a first name Family History, attacks the course. Nobody comes like Kikkan and a nickname like Education Emphasis out of the gate like The War Horse. “Kikkanimal”? You can’t. Only Kikkan (pronounced Keek’ an) can. “My Both Randall and Weibrecht come A coach used to shout at him parents came up with a combination from families with a sports and before the start of a race, “Let the of Kikki (inspired by Christine “Kiki” education background. Kikkan wombat out of the cage!” One of his Cutter, the first American to win a has an aunt and uncle who were competitors said, “If there is one guy World Cup title) and Megan, which Olympic cross-country skiers. who risks everything, it’s Andrew.” was a popular name about the time Andrew’s dad was a football player

15 and his mom was on the U.S. luge “My foot injury was worse,” she “One of the great things about The team. His two brothers were ski says. “Pain in my right foot started Steadman Clinic is that I could go racers and competed in college. developing during the 2012 season. I right downstairs to Howard Head managed to train through it and then Sports Medicine to get started Kikkan and Andrew are both tried to ignore it, but by August my on my rehab program. Working students—Andrew at Dartmouth, coach told me we were going to have with Ana Robinson Jeronimus, my Kikkan at Alaska Pacific University. to do something about it before it got physical therapist, I was able to Andrew’s wife, Denja, has two even more serious. He recommended improve my balance, strength, and degrees and teaches in the Lake that I see Dr. Thomas Clanton at The stability, and to take pressure off Placid area. Kikkan’s husband, Jeff Steadman Clinic and the Steadman my foot. I still do the exercises Ana Ellis, is a former Canadian athlete Philippon Research Institute.” showed me.” (Ana also worked with in two sports and now the marketing Andrew when he was in Vail.) and media coordinator for the During the past four years, Andrew FIS Cross-Country World Cup. had more surgeries than top ten Andrew’s Broken Ankle finishes. Right shoulder, left shoulder, “When I win a race, he gets to right ankle, and left ankle—all since Andrew had two surgical procedures interview me,” says Kikkan. the Olympics in Vancouver in 2010. for his broken ankle with Dr. Clanton. His Olympic silver medal and Memorable Olympic “There were lots of internal struggles. performance during the 2013-2014 Experiences I didn’t tell anyone, but if it had not season reflect the success of those gone well in 2014, I was going to operations. He says he feels better “Every Olympic experience has been be done with it. I loved the sport, now than at any time since 2010. unique and memorable for me,” says but I don’t think I could have gone Kikkan. “The first one was in Salt through that cycle of injuries again.” “There are very few orthopaedic Lake, where I was born. I felt very hospitals in the world that can match much at home. Four years later, The Clanton Connection the reputation of The Steadman Turino was exciting because I had Clinic,” says Andrew. “It made sense my first top ten Olympic finish. By Dr. Clanton has now treated both for me to go somewhere that can the time we went to Vancouver, I Kikkan and Andrew successfully. provide the best care. I prefer to have was consistently among the top He is an internationally recognized a physician like Dr. Clanton, who does finishers and it was cool to be back orthopaedic surgeon who joined The 300 foot and ankle operations a year.” and racing in Canada. Sochi was Steadman Clinic and SPRI in August my first real chance to get to the 2009 as the director for foot and Kikkan adds that Steadman is Games with medal potential.” ankle sports medicine. He specializes really unique in that the physicians in injuries to the lower extremities and understand the athlete’s perspective. 2010 was a breakout year for Andrew. the foot and ankle, and has treated “It’s important to have a doctor “I had been getting better every year many professional and collegiate who can appreciate the different and was getting great results. Then athletes, including former NBA player components of elite training and I went to the Olympics and won a Yao Ming, NFL star and Heisman racing, and design a treatment bronze medal. Everything was going Trophy winner Eddie George, and plan that gets you back to your perfectly. Four years later, after so World Champion hurdler Liu Xiang. sport as soon as possible.” many injuries, I decided to give it one more shot. Winning another medal Kikkan’s Stress Fracture On the Agenda (silver) made everything worth it.” “Dr. Clanton diagnosed my injury Andrew and Kikkan are training Injuries as a stress fracture and gave me for the 2014-2015 season and the advice I really needed to hear,” hope to be teammates again in Athletes suffer injuries, and skiers says Kikkan. “First, I didn’t need the 2018 Winter Games in South seem to get more than their fair surgery. I backed off my training Korea. Watch “The War Horse” to share. Kikkan had a “massive” blood schedule, took time to recover, and see how he attacks courses and goes clot in her leg that threatened her he set me up with orthotics after after his third medal. And follow career, but it happened at the end discovering that my skis were not “Kikkanimal” on her quest to become of the 2008 season and she had supporting my feet in the right way.” one of the rare athletes who will have time to recover from the ordeal. participated in five Olympic Games.

16 avoiding high-risk situations, using bracing and taping (plus orthoses), and complete rehabilitation of minor injuries to prevent more serious ones.”

The Most Common Mistakes

The most common mistake Dr. Clanton sees is failure to fully engage and complete the rehab process. He says it is important to recognize that injuries or surgery take a certain amount of time in order for the healing process to be complete. Dr. Thomas Clanton Keeps “In addition, the resumption of sports Olympians on Their Feet requires that the injured area (which could mean the entire leg or kinetic chain that has been affected) must be brought back gradually to accept Among the things Olympic skiers his ability to compete at the highest the same loads that part of the body Andrew Weibrecht and Kikkan Randall level. Surgery was necessary to correct was accepting before the injury. This have in common is that they both the problem. Not only was it important may require a pragmatic approach worked through serious injuries, both to be able to explain to Andrew what of walking first, running second, and were treated successfully at The the surgery would do, but he also more aggressive maneuvers later, Steadman Clinic by Dr. Thomas needed to know the proper course of before returning to competition.” Clanton, and both benefitted from rehabilitation and the timeline for a ongoing research conducted by Dr. return to high level competition.” Ongoing Foot and Ankle Clanton and his colleagues at the Research at SPRI Steadman Philippon Research Institute. Dr. Clanton adds that for these two great athletes, as well as others Dr. Clanton and his colleagues “Regardless of the injury or the level who face similar injuries, it is an recently completed a series of of the athlete, it is never easy to deal indomitable attitude and a spirit of research projects and resulting with an injury,” says Dr. Clanton. “It perseverance that leads to success. publications on lateral ankle sprains represents a setback and a roadblock and instability, looking at normal to one’s goals. That is why it is The Most Common Injuries ligaments and their strength and essential to have a physician, along stiffness compared with various with others on the healthcare team, Foot and ankle injuries are among methods of repair, reconstruction, who understand sports and can the most common seen in sports, and reinforcement surgically. guide the athlete to successfully according to Dr. Clanton. Ankle surmount such roadblocks.” injuries alone are the most common “We have compared our patients’ in terms of time lost from training results with these methods and “In Kikkan’s case, this was primarily and competition. Other common discovered important information through recognizing the incredibly injuries include tendon tears such as that will guide the way we treat such stressful training schedule through those of the Achilles, sprains such as injuries in the future,” he concludes. which she had put herself, analyzing those to the midfoot or big toe (turf the causes of her stress-related injury, toe), and various fractures such as Other projects have included research and prescribing a course of calculated traumatic breaks in the ankle or foot on turf toe injuries, high ankle rest and resumption of training that bones, as well as fatigue fractures. sprains, and osteochondral injuries still enabled her to heal and reach (tears or fractures in the cartilage her goals,” explains Dr. Clanton. “Prevention is better than having covering a bone in the ankle joint). to miss time treating one of these Future projects include testing “In Andrew’s situation, the problem injuries,” advises Dr. Clanton. “This various methods for Achilles repair was a structural issue that had can include proper training programs, and evaluating the motion involved reached the point of interfering with developing strength and flexibility, after total ankle replacements.

17 SCIENTIFIC ADVISORY COMMITTEE Dr. John Feagin The scientific advisory committee Robert F. LaPrade, M.D., Ph.D. Inducted consists of distinguished research Chief Medical Officer scientists who represent the institute Steadman Philippon into Army and serve as advisors in our research Research Institute Sports Hall and educational efforts, in our Vail, Colo. of Fame fellowship program, and to our professional staff. C. Wayne McIlwraith, D.V.M., Ph.D. Dr. John Feagin, a West Point graduate and Director former West Point team physician, was inducted Steven P. Arnoczky, D.V.M. Orthopaedic Research Center and into the Army Hall of Fame October 10, 2014. Dr. Feagin has been a close advisor and mentor Director Orthopaedic Bioengineering to the Institute for more than 25 years. Laboratory for Comparative Research Laboratory Orthopaedic Research Colorado State University “This Hall of Fame is a testament to the great Michigan State University Fort Collins, Colo. tradition of athletics, Army and West Point,” said Army Director of Intercollegiate Athletics Boo East Lansing, Mich. Corrigan. “National champions, All-Americans Peter J. Millett, M.D., M.Sc. and incredible athletes are being honored.” Stephen S. Burkhart, M.D. Chief Shoulder Surgery Service The San Antonio Orthopaedic Group The Steadman Clinic Dr. Feagin graduated in 1955 and earned two varsity letters as a member of the swimming San Antonio, Texas Vail, Colo. and diving team. He was commissioned into the Artillery Branch of the U.S. Army and graduated Lars Engebretsen, M.D., Ph.D. Gary A. Peterson from Duke University School of Medicine in Professor President and Chief Executive Officer 1961. Feagin served as an orthopaedic surgical resident at Walter Reed Army Medical Center Orthopaedic Center Ullevål University The Steadman Clinic for four years and then as chief of orthopaedic Hospital and Faculty of Medicine Steadman Philippon services at the 85th Evac Hospital in Vietnam. University of Oslo and Oslo Sports Research Institute

He returned to West Point as team physician in Trauma Research Center Vail, Colo. 1967 and worked closely with assistant football Oslo, Norway coach Bill Parcells and head basketball coach Marc J. Philippon, M.D. Bob Knight. Feagin is a founding member of John A. Feagin, M.D. Managing Partner the American Orthopaedic Society of Sports Medicine, the International Society of Knee Emeritus Professor of Orthopaedics The Steadman Clinic Surgery and Arthroscopy, the Society of Military Duke University Vail, Colo. Orthopaedic Surgeons, and the American Durham, N.C./Vail, Colo. Orthopaedic Society for Sports Medicine. William G. Rodkey, D.V.M.

An extensive author and lecturer, Feagin wrote Troy Flanagan, Ph.D. Chairman “The Crucial Ligaments,” which helped revise the High Performance Director Scientific Advisory Committee treatment of anterior cruciate ligament injuries. U.S. Ski and Snowboard Association Director His book and papers are still used today in (USSA) Center of Excellence Center for Translational and treating this common sports knee injury as well as in educating young orthopaedic surgeons. Park City, Utah Regenerative Medicine Research The Steadman Philippon Dr. Feagin served as the team physician for the Charles P. Ho, Ph.D., M.D. Research Institute U.S. Ski Team during the 1992 Winter Olympics Director Vail, Colo. after moving to Durham, N.C., to become an associate professor at the Duke University School Imaging Research of Medicine and chief of orthopaedic services The Steadman Philippon J. Richard Steadman, M.D. in the Durham Veterans Administration Medical Research Institute Founder Center. He worked as team physician of the Duke basketball team under West Point graduate Vail, Colo. The Steadman Clinic Mike Krzyzewski and helped found the Coach Vail, Colo. Krzyzewski -Nike Human Performance Laboratory. Bryan T. Kelly, M.D. Co-Director John JP Warner, M.D. Dr. Feagin was presented the Mueller International Knee Prize for a Lifetime of Center for Hip Preservation Chief Contributions to the Sciences and Practices Hospital for Special Surgery Shoulder Surgery Service of Knee Surgery and was inducted into the New York, N.Y. Harvard Medical School American Orthopaedic Society of Sports Boston, Mass. Medicine Hall of Fame. He is an honorary member of the Army Football Letterman’s Mininder S. Kocher, M.D., M.P.H. Club and as a U.S. Military Academy Professor Savio Lau-Yuen Woo, Ph.D., D.Sc. (Hon.) graduate, he established the John A. Feagin Orthopaedic Surgery Ferguson Professor and Director West Point Sports Medicine Fellowship. Harvard Medical School Musculoskeletal Research Center Harvard School of Public Health University of Pittsburgh Children’s Hospital Pittsburgh, Pa. 18 Boston, Mass. Steven Arnoczky, D.V.M., Inducted into the American Orthopaedic Society for Sports Medicine’s Hall of Fame

Scientific Advisory Committee Member Only the second non-physician Steven Arnoczky, D.V.M., was inducted to receive this honor, Arnoczky is into the American Orthopaedic being recognized for basic science Society for Sports Medicine’s contributions to the advancement of (AOSSM) Hall of Fame at its annual ligament reconstruction of the knee meeting in Seattle July 11, 2014. and meniscal repair and replacement.

Dr. Arnoczky is a sports medicine The AOSSM established the Hall of researcher from the Michigan State Fame in 2001 to honor members University College of Veterinary of the orthopaedic sports medicine Medicine. He has conducted basic community who have made original science orthopaedic research and significant contributions to the for 40 years and has served on specialty. Induction is the highest the SPRI Board for 24 years. honor given to a society member. There are currently 58 members from 11 countries in the Hall of Fame.

Kennedy Lectureship Honors SPRI Advisor Lars Engebretsen, M.D., Ph.D.

Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS)

One of the highlights of each year’s Sports Trauma Research Center; Sports Medicine Specialty Day, held and head of Medical Sciences, on March 15 in 2014, is the John International Olympic Committee. C. Kennedy Memorial Lectureship. Dr. Lars Engebretsen, a member of In 2001, Dr. John Feagin, also the Institute’s Scientific Advisory a member of the Scientific Committee, was honored as the Advisory Committee and professor Distinguished Lecturer for 2014. emeritus of orthopaedic surgery An internationally recognized at Duke University, was honored authority in orthopaedic sports as the Distinguished Lecturer. medicine, Dr. Engebretsen serves in many capacities, including This lectureship is named in honor of professor and chair, University of John C. Kennedy, M.D., F.R.C.S., a past Oslo; professor in Sports Medicine, president of the American Orthopaedic Norwegian School of Sports Science; Society for Sports Medicine. professor in Sports Medicine, Oslo

19 Friends of the Institute

In 2013, SPRI received 1,196 separate gifts and support from individuals, foundations, and corporations. This combined support, including special events, amounted to $4,385,518.

The Institute is grateful to the following individuals, corporations, and foundations for their support of the Institute in 2013. Their vision ensures the advancement of evidence-based medical research and joint preservation research, science, and care, as well as the education of physicians for the future. We extend our gratitude to these supporters for their generous contributions.

20 1988 Society | Lifetime Giving

On November 9, 1988, the Institute was incorporated as a not-for-profit educational and research organization dedicated to advancing modern medical science and the education of young physicians. The Institute is deeply grateful to the following members of the distinguished 1988 Society, whose cumulative giving totals more than $1 million.

Mr. Herbert Allen; Arthrex, Inc.; Mr. and Mrs. George N. Gillett, Jr.; Mr. Kenneth C. Griffin; Linvatec; Össur Americas, Inc.; Smith & Nephew Endoscopy; Dr. and Mrs. J. Richard Steadman; Vail Valley Medical Center

2013 FRIENDS

$100,000 - $499,999

Anonymous Mr. Kenneth C. Griffin Dr. and Mrs. Marc Philippon Mr. Herbert Allen Mr. Jorge Paulo Lemann Mr. and Mrs. Gary S. Rosenbach Arthrex, Inc. Oslo University Smith & Nephew Endoscopy Dr. Donald S. Corenman Össur Americas, Inc. Vail Valley Medical Center

$25,000 - $99,999 Medequip, Inc. Mr. and Mrs. James Gordon Dr. and Mrs. Peter J. Millett Hellman Family Foundation Mr. Thomas H. Bailey Mr. and Mrs. Stanley S. Shuman Fred & Elli Iselin Foundation Mr. and Mrs. Howard Berkowitz Dr. and Mrs. J. R. Steadman Ms. Mary H. Jaffe Mr. and Mrs. Peter L. Briger, Jr. The Steadman Clinic JP’s Peace, Love & Happiness Foundation Mr. and Mrs. James R. Cargill II The Trailsend Foundation KSL Capital Partners Dr. and Mrs. Thomas Clanton Dr. Randy Viola Ms. Alexandra Mastriana-Solal Mr. James S. Crown Mr. and Mrs. Patrick Welsh Messner Reeves, LLP Mr. and Mrs. Lawrence Flinn Ms. Mary Noyes Mrs. Peggy Fossett Mr. and Mrs. Jay A. Precourt Dr. Tom Hackett $10,000 - $24,999 Mr. Michael Price Dr. and Mrs. Russell Hirsch Ms. Karen Rainwater Mr. and Mrs. Peter R. Kellogg Mr. and Mrs. Herbert Bank Mr. Evan M. Rayman Dr. and Mrs. Robert F. LaPrade Mr. Lim Chee-Wah Mr. and Mrs. Arthur Rock The Liniger Family Foundation Ms. Caryn Clayman Ms. Sandee N. Sander Mr. and Mrs. Thomas A. Mars Mr. and Mrs. Claiborne P. Deming Mr. Edward D. Scott

21 Mr. and Mrs. Michael S. Shannon Mr. Paul Gordon Ms. Damaris Skouras Greyledge Technologies, LLC The Spiritus Gladius Foundation Mr. Blake A. Helm Synthes USA Products, LLC Mr. and Mrs. Frank C. Herringer Mr. and Mrs. Richard F. Teerlink Ms. Lyda Hill Mr. and Mrs. Stewart Turley Mr. and Mrs. David C. Hoff Mr. Norm Waite Dr. Thomas G. Hopkins Mr. and Mrs. Preston Hotchkis Mr. and Mrs. Charles Huether $1,000 - $9,999 Mr. and Mrs. George H. Hume Mr. and Mrs. Walter Hussman Alpine Bank Admiral and Mrs. Bobby Inman Arthroscopy Association of North America Mr. and Mrs. Bud Isaacs Mr. and Mrs. Paul Baker Mr. and Mrs. John V. Jaggers Mr. and Mrs. Ronald P. Baker Dr. Arlon Jahnke, Jr. Mr. Foster Bam Mr. and Mrs. Charles Johnson Mr. and Mrs. James N. Benedict Mr. Jerry R. Johnson Education and Michael J Zamkow & Sue E Berman Mr. and Mrs. Michael O. Johnson Research Grants Charitable Foundation Mr. Tait Johnson Bledsoe Brace Systems Mr. and Mrs. Daniel S. Jones Mr. and Mrs. Bruce A. Blakemore Mr. and Mrs. John W. Jordan II Mr. and Mrs. Bill Blanchard Mr. and Mrs. Jerome F. Jurschak Sharing our research findings Mr. and Mrs. Erik Borgen Dr. and Mrs. David Karli throughout the world is a vital part of Mr. and Mrs. Robert Bowers Mr. Jeff Kassal our educational and research mission. Mr. and Mrs. Christopher W. Brody Mr. and Mrs. John Kirchner We wish to thank the following donors Ms. Dorothy W. Browning Mr. F. Ryan Krauser and sponsors for their support: Ms. Margaret Buckman Mr. and Mrs. Carl Kreitler Mr. and Mrs. John L. Bucksbaum Mr. and Mrs. Bob Krohn European Visiting Scholar, Mr. Harry Burn Mr. and Mrs. Gary Leeds sponsored by Arthrex, Inc. Mr. and Mrs. Preston Butcher Mrs. Marie Lemos Mr. and Mrs. Donald R. Chappel Linvatec Brazilian Visiting Scholar, Mr. and Mrs. John Cole Mr. and Mrs. Kent Logan sponsored by Instituto Brazil Simon & Eve Colin Foundation, Inc. Mr. Michael Lyons de Tecnologias da Saúde Dr. and Mrs. Kenneth H. Cooper Mr. and Mrs. John W. Mabee Mr. and Mrs. Robert J. Darretta Ms. Marilyn W. Martin Griffin Visiting Scholar General and Mrs. Peter Dawkins Mr. Ron Mastriana Program for Clinical Sports Mr. and Mrs. Sam Decker Mrs. Betsy McCormack Medicine MRI Mr. and Mrs. Thomas C. Dillenberg MedSynergies-Surgical Division Diversified Radiology Mr. Michael A. Merriman Sports Medicine Imaging The Doctors Company Mr. Richard Michaux Research Fellowship, Ms. Connie K. Duckworth Mr. Ron Miller sponsored by Siemens Mr. Stephen Eisen Dr. James Montgomery EKS&H, LLP Mr. and Mrs. Bruce A. Montoya Bioskills Research and Dr. Gail Ellis Mr. V. Michael Morgenstern Education Grant, sponsored Dr. and Mrs. Frederick Ewald Mr. James H. and by Smith & Nephew Endoscopy Dr. John A. Feagin and Mrs. Marty Head Mrs. Katherine R. Mutchnik Mr. and Mrs. Herbert Fitz Ms. Barbara A. Nelson The Flora Foundation Mr. and Mrs. Don H. Nelson Ms. Sue Fogel Pedro Vital Netto Dr. Joe Fogel and Caroline Elliott Mr. and Mrs. Michael Noell Mr. Christopher B. Galvin Mr. Donald A. Nyman Mr. Jose Garcia Cantera Mr. and Mrs. John Oltman Mr. and Mrs. Christopher Garvin Opedix Labs Mr. and Mrs. Herb Glaser Mr. and Mrs. Paul Oreffice Mr. and Mrs. Matthew A. Gobec ORP Hanger

22 Mr. and Mrs. Preston S. Parish $500 - $999 Ms. Mary D. Sauve Dr. Richard Parker Shell Oil Company Foundation Ms. Jan Rymer Pickens Mr. John T. Acklen Matching Gifts Mr. and Mrs. Addison Piper Anonymous Mr. George A. Skouras Pivot Medical, Inc. Mrs. Mary L. Asplundh The Patricia M. and Mr. and Mrs. Paul Raether Mr. and Mrs. Ronald L. Baker H. William Smith, Jr. Foundation Razoo Foundation Ms. Joni Beal Dr. and Mrs. H. Douglas Teague William Rodkey, D.V.M. Mr. Brent Berge Mr. and Mrs. Brett Tolly Mr. and Mrs. Michael D. Rose Mr. and Mrs. David R. Brewer, Jr. Mr. and Mrs. Arthur W. Vietze Mr. and Mrs. Ken Schanzer Mr. Daryn Miller and Dr. and Mrs. William R. Weaver Mr. and Mrs. Brad Seaman Mrs. Karen K. Briggs Mr. Charles Weaver Mr. O. Griffith Sexton Mr. and Mrs. T. Anthony Brooks Mrs. Thea Z. Weilbaecher Mr. and Mrs. John Simon Mr. and Mrs. Ronald J. Byrne Ms. Luanne C. Wells The Joseph & Rosalyn Sinclair Mr. and Mrs. Steven C. Coyer Mr. and Mrs. Richard Wenninger Foundation, Inc. Mr. Craig A. Davis Ms. Betty Wohl Dr. and Mrs. Steve B. Singleton Mr. and Mrs. John W. Dayton Mr. and Mrs. Dave Wolfe Mr. Michael Byram and Mr. and Mrs. Jeff Dorsey Mrs. Heather Yakely Mrs. Ann B. Smead Mr. Dan Drawbaugh Mr. Joseph D. Zimmerman Dr. and Mrs. W. Sean Smith Dr. and Mrs. Jack Eck Sonnenalp of Vail Foundation Mr. and Mrs. Henry B. Ellis Sonoma Orthopedic Products Mr. and Mrs. William T. Esrey $100 - $499 Spectra Energy Foundation Mr. D. B. Frye Mr. and Mrs. Lyon Steadman Mr. John Gallagher Mr. Kelly Adair Mr. Hans Storr Mr. and Mrs. Paul Gassner Mr. and Mrs. Stephen L. Anderson Dr. and Mrs. Barry S. Strauch Mr. and Mrs. George N. Gillett, Jr. Mr. Collins A. Andrews III Stryker Imaging Mr. and Mrs. Gary Gillis Ms. Connie L. Auran Stryker Trauma Mr. and Mrs. Michael Gordon Mr. John R. Bagley Mr. and Mrs. Mark Tache Mr. John H. Gorman Mr. Jaime Balas Tang Family Foundation Ms. Marcy R. Gross Mr. and Mrs. Ronald C. Ball Mr. Oscar L. Tang and Gustafson Family Foundation Mr. Robert Barrow Dr. Agnes Hsu-Tang Mr. Bill and Mrs. Leelee Harriman Ms. Elizabeth D. Baubigny Mr. Barry Teeters Ms. Beverly Hay De Chevrieux Mr. and Mrs. Donald W. Baumgartner Mr. Arthur Temple III Mr. and Mrs. Peter S. Hearst Mr. and Mrs. Jack Beal Mr. and Mrs. Fred Teshinsky Mr. Charles Hirschler Mr. and Mrs. Thomas Beat Mr. and Mrs. Paul Testwuide Dr. and Mrs. Malvin Keller Mr. Robert P. Beattie Mr. and Mrs. Jere W. Thompson Mr. Gary Koenig Mr. John J. Beaupre Mr. and Mrs. James Tiampo Mrs. Nancy A. Kotite Dr. and Mrs. Quinn H. Becker Mr. and Mrs. William R. Timken Mr. and Mrs. Michael J. Mahoney Mr. Clifford A. Bender Mr. and Mrs. Jeffrey Townsend Mr. and Mrs. Charles McAdam Mr. Mortimer Berkowitz Mr. Steve Tucker Mr. and Mrs. Arch McGill Mr. Jeremy M. Bernstein Mr. Mark Tymchenko Mr. and Mrs. John G. McMurtry Mr. and Mrs. Philip M. Bethke Dr. and Mrs. Luis H. Urrea II Mr. and Mrs. George Middlemas Ms. Susan Biddle US Bank Mr. and Mrs. Kirk Mielenz Mr. Craig M. Bingham US Ski and Snowboard Team Foundation Mr. Peter Mindock Mr. and Mrs. Paul T. Birkeland Vail Resorts Mr. Alan D. Moore Dr. and Mrs. Edward Blender Mr. and Mrs. Bronson Van Wyck Mr. William and Mrs. Kay Morton Mr. and Mrs. Albert W. Bluemle Ms. Marjorie R. Vickers Mr. and Mrs. Trygve E. Myhren Ms. Penny Bortz Mr. and Mrs. Joseph Vijuk Ms. Cindy L. Nelson Mr. Thomas H. Bradbury Mr. and Mrs. George Vonderlinden Mr. and Mrs. Larry Nisonoff Mr. Gabriel Braun Ms. Valerie Weber Mr. and Mrs. Warren S. Nix Mr. Michael J. Brown Mr. and Mrs. Stephen D. Wehrle Pearlstone Family Fund, Inc. Ms. Jennifer Bruno Mr. and Mrs. George Wiegers Mr. and Mrs. John Purchase Ms. Megan Bryant Ms. Barbara G. Williams Ms. Jane Roehrig Mr. George R. Bunn Mr. Rodney Wimmer Mr. and Mrs. Michael Rothman Mr. Kurt Burghardt Mr. Chapman Young III Mr. and Mrs. Peter F. Sampson Mr. Bill Burns

23 Mr. and Mrs. Robert L. Bush Mr. and Mrs. Verlin W. Fisher Mr. Steven Kahl Mr. Steve Busick Mr. Joseph Flagge Mr. and Mrs. John Karoly Mr. Jeff M. Butler Mr. and Mrs. Troy Flanagan Mr. and Mrs. Richard Kaufman Mr. Rodger W. Bybee Mr. John Fleming Mr. and Mrs. Robert E. Kavanagh Mr. and Mrs. Tom Caccia Mr. Robert Foster Mr. and Mrs. Desmond P. Kearns Ms. Julia Cahill Mr. Fred Frailey Ms. Margaret W. Kell Mr. Harold E. Cahoy Mr. Agustin Franco Macias Ms. Mary Ann Kempf-Koch Dr. and Mrs. J. Marc Carpenter Mr. Michael Freund Mr. and Mrs. Robert W. Kern Ms. Marilyn M. Carr The Gould-Shenfeld Mr. and Mrs. Dirk J. Kokmeyer Mr. Stephen Catlin Family Foundation Ms. Karen Korfanta Mr. and Mrs. Giuseppe Cecchi Ms. Ligia Garcia Mr. and Mrs. Nic Korte Ms. Linda C. Chase Mrs. Arlene C. Gerety Mr. William J. Kourbage Mr. Joe Chess Mr. Cameron P. Giebler Mr. Frank W. Krauser Mrs. Annemette Clausen Ms. Deborah Gierach Mr. and Mrs. Kevin J. Kroll Mr. and Mrs. Collins G. Clyburn Lieutenant Colonel and Mr. David M. Kuhl Mr. Ned C. Cochran Mrs. Daniel J. Gilliland Mr. and Mrs. Dylan Kunkel Mr. Mark Cooley Ms. Mary Goldsmith Mr. James Kurtz Mr. and Mrs. Steven R. Corneillier Dr. and Mrs. Harvey M. Goldstein Mr. John LaConte Mr. and Mrs. Spencer Cornett Mr. and Mrs. Frank Gould Mr. and Mrs. James W. Larson Dr. and Mrs. Shannon Cox Mr. and Mrs. George T. Graff Mr. Chester A. Latcham Mr. and Mrs. David S. Crawford Ms. Cornelia Greaves Mr. Kenneth C. Laumann Mr. Charlie Crevling Mr. and Mrs. Michael Greene Mr. and Mrs. William A. Lederer Dr. Richard V. Crisera Mr. A. Wayne Griffith Mr. John E. Leipprandt Mr. and Mrs. Donald W. Crocker Mr. Gary F. Grillo Mr. and Mrs. Charlie L’Esperance Ms. D. E. Elizabeth Cronin Ms. Joyce L. Gruenberg Mr. Burton Levy Ms. Kristi Cumming Mr. and Mrs. Robert B. Gwyn Ms. Amanda Leyrer Mr. James L. Cunningham Mr. Robert W. Haight Dr. Bert A. Lies, Jr. Mr. Richard B. Cunningham Dr. and Mrs. Ralph Halbert Mr. and Mrs. Soren Lind John M. Cunningham, D.V.M. Mr. Ivan Hass Mr. W. C. Lockwood Dr. and Dr. Mark A. Curzan Mr. and Mrs. Harry L. Hathaway Mr. Richard Lubin Mr. Joseph Cygan Mr. and Mrs. Brian L. Hayungs Mr. Timothy Mague Ms. Lenore M. Dahl Dr. Justin L. Hazen Mr. and Mrs. James Mahaffey Ms. Susan Daniels Mr. Thomas A. Head Mr. and Mrs. Phil Mahre Mr. Bill Davis Mr. Peter W. Heitman Mr. and Mrs. Anthony J. Manatt Dr. and Mrs. Kenneth E. DeHaven Mr. Corey P. Helm Ms. Kristin Mapstone Ms. Renee M. Desnoyers Mr. Mark Herron Mr. and Mrs. Michael Marsh Mr. and Mrs. Robert T. DeYoung Mr. Derek Heys Mr. and Mrs. Rocco J. Martino Mr. Frederick A. Dick Mr. and Mrs. Rob Hill Ms. Lou Adele May Dr. Frederick W. Distelhorst Dr. and Mrs. Norwood O. Hill Mr. Thomas R. McArthur Mr. and Mrs. Wayne B. Dondelinger Ms. Anne Hintz Mr. William C. McClean III Mr. John Dorrier Mr. A. Barry Hirschfeld Ms. Patricia A. McGivern Mr. and Mrs. Morgan Douglas Mr. and Mrs. William H. Hobart Mr. Robert L. McGrath Mr. and Mrs. Jamie Duke Mr. James E. Holland Mr. Ed McKenna Mr. Jack Durliat Mr. Trent Howard Mr. and Mrs. James M. McPhetres Ms. June E. Dutton Mr. and Mrs. Jay C. Huffard Mrs. Peggy L. McWilliams Mr. Barry Eckhaus Dr. Steve and Dr. Mary Hunt Mr. and Mrs. Frank N. Mehling Mr. Alfred M. Ellerby Mr. Torrence M. Hunt, Jr. Dr. Stephen B. Meisel Ms. Slavica Esnault-Pelterie Dr. and Mrs. John Hutto Ms. and Mr. Allyson Metz Mr. and Mrs. Ricardo Mr. and Mrs. Paul H. Huzzard General George Miller Espirito Santo Silva Mrs. Josephine O. Jackson Mr. James I. Mitchell Ms. Gretchen Evans Mr. Evan James Mr. and Mrs. Evan Moody Mr. Herbert Feinzig and Dr. K.W. Mr. and Mrs. Stuart Jennings Mr. Robert E. Moore McGinniss-Feinzig Mr. and Mrs. Bill Jensen Mr. and Mrs. William J. Morse Mr. Larry S. Fields Mr. Donald W. Jones Mr. Richard M. Moss Ms. Sistie Fischer Mr. James Jones Mr. Aubert J. Mowry Mr. Mark Fischer and Dr. and Mrs. Thomas A. Joseph Dr. and Mrs. R. Deva Nathan Ms. Lari Goode

24 Mr. and Mrs. Larry W. Nettles Mr. Howard F. Sklar The Founders’ Dr. Todd Neugent Mr. Edmond W. Smathers Legacy Society Dr. Myron Nevins Mr. and Mrs. James S. Smith Mr. and Mrs. Andy Newberry Ms. Pam Smith Over the years, the Institute Ms. Raissa Nicol Mr. Rick Smith has been privileged to receive Ms. Monica Nisonoff Mr. Bradley Smith generous and thoughtful gifts Mr. and Mrs. Timothy P. O’Hara Mr. John W. Snow from friends and supporters who Mr. Jon E. Oppenheimer Mr. Jean-Louis Solal remembered the Institute in their Mr. Larry O’Reilly Ms. Barbara A. Sosaya estate plans. In fact, many of Dr. William H. Overholt Dr. Susan Spencer our friends—strong believers and Mr. Shaun Oveson Dr. Bob Stanton supporters of our work today—want Ms. Diann Papp Ms. Mary Steadman to continue their support after their Mr. Tim Parker Mr. James Steiert lifetimes. Through the creation of Mr. and Mrs. Mandy Patinkin Mr. Larry S. Stewart bequests, charitable trusts, and Dr. and Mrs. Maurie Pelto Mr. and Mrs. Daniel W. Stock other creative gifts that benefit both Mr. and Mrs. Robert A. Perkins Mr. John R. Stokley our donors and the Institute, our Mr. and Mrs. William C. Perlitz Dr. John A. Strache supporters have become visible Ms. Ruth W. Perotin Mr. and Mrs. Roland Straten partners with us in our mission Mr. and Mrs. Duwayne J. Peterson, Jr. Mr. and Mrs. Eric Strauch to keep people physically active Mr. William J. Phelan Mr. and Mrs. B. A. Street through orthopaedic research and Mr. John B. Phillips Mr. and Mrs. Bruce C. Stuart education in arthritis, healing, Mr. and Mrs. Paul E. Prenoveau Mr. Robert L. Stubing rehabilitation, and injury prevention. Mr. James A. Progin and Mrs. Rachel Surowiec Ms. Judy Holmes Dr. William Swetlik To honor and thank these friends, Mr. Wolfgang W. Raffalsky Mr. Gary Tanner the Founders’ Legacy Society was Mr. and Mrs. David Rahn Mr. and Mrs. Brent Tatman created, recognizing those individuals Mr. Carl Rand Mr. Irving H. Teper who have invested not only in our Mr. and Mrs. Gary B. Rappaport Ms. Dava Thomas tomorrow, but also in the health and Mr. Matt Rasmussen Mr. John R. Thomas vitality of tomorrow’s generations. Mr. and Mrs. Ronald Rasnic Mr. Kenneth R. Thomasma Ms. Beverly B. Rauch Ms. Eleanor Torre Our future in accomplishing Mr. Walter G. Regal Mrs. Nancy S. Traylor great strides, from understanding Mr. Karl A. Reuther, Sr. Mr. William B. Tutt degenerative joint disease, joint Mr. and Mrs. Ted Reynolds Mr. Nicholas Viens biomechanics, and osteoarthritis Mr. and Mrs. Donald W. Rhodes Mr. Daniel E. Virnich to providing education and training Mr. and Mrs. Wayne A. Robins Mr. Franklin K. Vought programs, is ensured by the vision Mr. Emerson B. Robinson, Jr. Mr. and Mrs. Andy Wallace and forethought of friends and Mr. Daniel G. Roig Dr. Dale A. Waters supporters who include us in their Mr. Alejandro Rojas Mr. and Mrs. Robert P. Watson estate plans. The Institute’s planned Mr. and Mrs. Robert M. Rosen Mr. and Mrs. Iain Waugh giving program was established Ms. Jolanthe Saks Dr. and Mrs. Wayne Wenzel to help donors explore a variety of Mr. Larry M. Saliterman Mr. and Mrs. Bernard West ways to remember the Institute. Mr. and Mrs. Steve Sanger Mrs. Monica White We are most grateful to these Mr. Steven Schenbeck Mr. William Wilkerson individuals for their support in Mr. and Mrs. Marvin Schilling Mr. Ted J. Winninger becoming founding members of the Dr. David Schneider Mr. and Mrs. Joel A. Wissing Founders’ Legacy Society: Mr. and Mrs. Keith Schneider Ms. and Mr. Pam Wolfe Mr. William J. Schneiderman Ms. Lourae Woody Mr. and Mrs. Robert M. Fisher Mr. Bobby S. Shackouls Mr. Julian Yao Ms. Margo Garms Mr. George Shenk Mr. Craig Yates, Sr. Mr. Albert Hartnagle Mrs. Susie Sheridan Mr. Richard B. and Mr. and Mrs. John McMurtry Mr. and Mrs. Jeffry S. Shinn Mrs. Vickie T. Zellmer Mr. and Mrs. Edward J. Osmers Mr. and Mrs. Jeffrey J. Shuster Dr. and Mrs. Paul Zizza Mr. Al Perkins Dr. David Silken and Ms. Mary Jane J. Zuccaro Mr. Robert E. Repp Dr. Maura Levine Mr. Warren Sheridan Mr. Chuck Simmons

25 Patient and Researcher in the News

Perseverance Plus Perspective Equals Success for Dawn Ommen, M.D.

By Jim Brown, Ph.D.

Dr. Dawn Ommen, a Nebraska native coach. She coached for one year That’s when she heard about Dr. and current SPRI research assistant, at the University of Nebraska- Philippon, who was then at the has brought a perspective to her work Kearney and two years at the University of Pittsburgh—not exactly with Dr. Marc Philippon that may be University of North Florida. down the street from her home in unmatched. Who else can say she Nebraska. “As the pain became more has been an NCAA Division I athlete, Her interest in sports and medicine and more debilitating, I talked to a a college coach, a certified physical led to graduate school and earning a friend who had similar symptoms and therapist, a hip surgery patient, a Master of Physical Therapy degree at who had been successfully treated physician, and a medical researcher? St. Ambrose University in Davenport, by Dr. Philippon, and I was able Iowa. “At the time, I thought about to get an appointment with him.” Dr. Ommen will tell you that none of med school, but physical therapy her achievements have been easy. In seemed to be a natural way to go.” Dr. Philippon eventually performed fact, that’s exactly what she recently surgery on both of Dr. Ommen’s told a group of young student-athletes Dr. Ommen worked as a certified hips, including the world’s first ever in Colorado. Her never-ever-give-up physical therapist for five years, ligamentum teres reconstruction attitude has put her in a position to part of that time as a wellness via an iliotibial band. Since then, make major contributions as a sports director of a program that won a she has been able to return to medicine physician and to inspire national wellness award. She also a high level of competition and others to strive for ambitious goals. helped the company decrease the is an avid triathlete, snow skier, bottom line on health insurance. water skier, and weight lifter. First Big Goal First Big Obstacle First Big Failure “My first big goal coming out of high school was to play Division I Being a physical therapist added to Dr. Ommen continued to be a college basketball,” she recalls. “I her growing body of expertise and patient of Dr. Philippon after he didn’t have a lot of scholarship experience, but it led to what she moved to The Steadman Clinic and offers, perhaps because I was describes as her first big obstacle. the Steadman Philippon Research short and slow. But I walked on at She suffered a hip injury while Institute. She was inspired by the Kansas State and played for two teaching a physical therapy student. cutting-edge medicine she received. years before transferring to the The injury was misdiagnosed and University of Nebraska to graduate.” mistreated for almost five years “As a patient, it amazed me that and included a procedure in which every time I had an appointment Her experience as a college athlete four screws were placed in her or a procedure, there was always opened the door to be a college lower back. They didn’t work. something new—whether it was

26 a surgical technique, an anti- taken from her own hip surgery coagulation regimen, or a change in procedures. Yet another perspective. rehabilitation exercises,” she says. “It’s obvious that Dr. Philippon is “I feel like I live and work continually seeking to improve his at Disneyland out here in world-leading surgical outcomes.” Vail,” says Dr. Ommen.

Her experience with The Clinic and her The Driving Force awareness of the Research Institute motivated her to go to medical A person cannot achieve what school, with the goal of becoming a Dr. Dawn Ommen is achieving sports medicine physician. “Not so without tremendous support. That fast,” she tells her audience. “I had support, she says, has come from to take the MCAT to get into school Kevin, her husband of 11 years. and I didn’t score well enough.” “He has been the driving force. He’s “Should I try again?” she asked been with me through injuries, herself and her husband, Kevin, numerous surgeries, travel to get a high school math teacher and treatment, and getting me through robotics coach in Nebraska. school. He was the one who said you have to go back to medical school.” Chairs support “Yes,” they both answered. Institute Work On the Agenda So she did take the MCAT again, scored well, was accepted, and graduated Dr. Ommen’s medical training is from the University of Nebraska not complete. She will soon learn The education of orthopaedic College of Medicine in May of 2013. where she will spend the next three surgeons is a critically important years as a resident, and then there mission of the Institute. Becoming Part of will be an additional year as a sports Academic Chairs provide the the SPRI Team medicine fellow. Her long-term goal continuity of funding necessary is to establish a sports medicine to train physicians for the future, During one visit to see Dr. Philippon, center that will address the surgical, thus ensuring the continued Dr. Ommen asked about the possibility rehabilitational, nutritional, and advancement of medical research. of a research assistantship at SPRI. psychological needs of women athletes. He liked the idea and arrangements Currently, more than 190 SPRI were made for Dr. Ommen to spend a It sounds like a monumental task, fellows practice around the world. year working with Dr. Philippon on a but don’t tell Dr. Ommen she can’t We wish to express our gratitude variety of research projects, including do it. She has a well-documented and appreciation to the following what she thinks could become a record in the field of perseverance. individuals and foundations that landmark study on the effects of have made a five-year, $125,000 prehabilitation on hip arthroscopy. And now she can look at things from commitment to the fellowship yet another perspective: that of a program to support medical “There is a phenomenal relationship parent. Kevin and Dawn Ommen research and education. In 2013, between The Clinic and the delivered their first child in April. four chairs provided important Research Institute,” says Dr. Ommen. funding for the Institute’s research “There is no wasted data here. Dr. and educational mission. We are Philippon and his colleagues are most grateful for the support from using that data to change what the following individuals: is going on in hip arthroscopy.” Mr. and Mrs. Lawrence Flinn Dr. Ommen’s medical records are Mr. and Mrs. Peter Kellogg part of SPRI’s famous database. As a Mr. and Mrs. Al Perkins research assistant and former patient, Mr. and Mrs. Steven Read she may be analyzing information

27 Visionaries Medical research and education programs are supported by gifts to the Institute’s annual fund. Visionaries are those patients and their families, trustees, staff, corporations, and foundations whose lifetime cumulative giving totals $10,000 or more.

Donors at this level support many programs, including the Institute’s research to validate the success of new treatments for degenerative arthritis and identify factors that influence treatment success. For example, as youth sports injuries rise to epidemic proportions due to early specialization and extensive practicing, the Institute is researching conditions and injuries commonly associated with specific sports, such as hip impingement in young hockey players, to determine how to prevent and treat them. Injuries in growing children may cause unforeseen complications during adulthood, such as an early onset of osteoarthritis.

Visionaries’ gifts ensure the advancement of evidence-based medical research, joint preservation research, science, and care, as well as the education of physicians for the future. We extend our gratitude to these individuals for their lifetime of support:

American Orthopaedic Mr. and Mrs. Herbert Bank The Cliffs Communities Foot & Ankle Society, Inc. Helen S. & Merrill L. Mr. Bruce R. Cohn American Airlines Bank Foundation, Inc. Compass Bank Aarhus University Hospital Ms. Susan Barnett Mr. and Mrs. Jonathan Coon Mr. and Mrs. Edward C. Abraham Ms. Nancy Bechtle Dr. and Mrs. Kenneth H. Cooper Mr. and Mrs. Don Ackerman Mr. and Mrs. Melvyn Bergstein Dr. Donald S. Corenman Aetna Foundation Mr. and Mrs. Howard Berkowitz Ms. Joanne Corzine Aircast, Inc. Biomet, Inc. Mr. Jim Covert Mr. and Mrs. John Alfond Bionicare Medical Technologies, Inc. Mr. Archibald Cox, Jr. The Alix Foundation Ms. Lyndall Boal Arie and Ida Crown Memorial Mr. Herbert Allen Mr. George Boedecker Mr. James S. Crown Mr. and Mrs. James C. Allen Mr. and Mrs. John A. Boll Henry Crown and Company Alpine Bank Mr. and Mrs. Erik Borgen Mr. and Mrs. Lester Crown Mr. Ronald Alvarez and Dr. and Mrs. Martin Boublik Mr. Douglas N. Daft Ms. Alice Ruth Mr. and Mrs. Robert A. Bourne Mr. Franco D’Agostino and Smith & Nephew Endoscopy Dr. Dennis D. Bowman Ms. Alicia Ziegert American Express Mr. Jack Boyle III Mr. and Mrs. Andrew P. Daly American Academy of Ms. Maria Brabb Darwin Partners Orthopaedic Surgeons Lord Brabourne Mr. Norris Darrell, Jr. Mr. and Mrs. Harold Anderson Mr. and Mrs. Bernard A. Mr. and Mrs. Ronald V. Davis Mr. and Mrs. John M. Angelo Bridgewater, Jr. General and Mrs. Peter Dawkins Anonymous Mr. and Mrs. Peter L. Briger, Jr. Mr. and Mrs. Michael S. Dell Anonymous Mr. and Mrs. Michael C. Brooks Mr. and Mrs. Claiborne P. Anonymous Mr. and Mrs. Preston Butcher Deming Mr. and Mrs. David B. Arnold, Jr. Mr. Richard T. Butera DePuy Mitek Mr. and Mrs. Adam Aron Butterfield & Robinson Mr. and Mrs. Thomas C. Dillenberg Arthrex, Inc. Dr. and Mrs. R. David Calvo Dr. and Mrs. Charles J. Dillman ArthroCare Corporation Mr. and Mrs. James R. Cargill II Diversified Radiology His Royal Highness Bin Mr. and Mrs. Russell L. Carson Dr. Michelle and Mr. Neil Donaldson Majid Abdul Aziz Mr. and Mrs. Jim Castillo Mr. and Mrs. Jeff Dorsey Mr. John M. Bader Mr. and Mrs. Pedro Cerisola Mr. and Mrs. Edward C. Dowling Mr. Thomas H. Bailey Mr. Lim Chee-Wah EBI Medical Systems Mr. and Mrs. Paul Baker Mr. Jim Cimino Mr. and Mrs. John M. Egan Mr. and Mrs. Ronald P. Baker Dr. and Mrs. Thomas Clanton Mr. J. Michael Egan Mr. Foster Bam Ms. Caryn Clayman EKS&H, LLP

28 Mr. and Mrs. Phillip D. Elder Mrs. Martha Head Charles G. Koch Mr. and Mrs. Henry B. Ellis Howard Head Sports Medicine Center Charitable Foundation Dr. and Mrs. Steve Ellstrom HealthOne, LLC Mr. and Mrs. Henry Kravis Encore Mr. and Mrs. Peter S. Hearst Mr. and Mrs. Bob Krohn Energy Corp. Allegheny & Western Hellman Family Foundation Anthony H. Kruse Foundation Mr. and Mrs. Robert Engleby Mr. Blake A. Helm KSL Capital Partners Mr. and Mrs. Floyd English Mr. and Mrs. Frank C. Herringer Mr. and Mrs. J.B. Ladd Mr. and Mrs. William T. Esrey The William and Mary Lanning Memorial Hospital Dr. and Mrs. Frederick Ewald Flora Hewlett Foundation Dr. and Mrs. Robert F. LaPrade Dr. John A. Feagin and Mr. and Mrs. Walter Hewlett Mr. Jorge Paulo Lemann Mrs. Marty Head Highline Sports & Entertainment Mrs. Marie Lemos Mr. Jack Ferguson and Mr. and Mrs. Stephen Hilbert Mr. and Mrs. S. Robert Levine Mrs. Veronica Slajer Ms. Lyda Hill Linvatec Mr. and Mrs. Chad Fleischer Audrey Hillman Fisher Foundation The Liniger Family Foundation Mr. and Mrs. Lawrence Flinn Hilliard Family Fund Mr. and Mrs. Soren Lind Ms. Sue Fogel Mr. Hayne Hipp Mr. and Mrs. Walter Loewenstern Mrs. Peggy Fossett Dr. and Mrs. Russell Hirsch Mr. and Mrs. Kent Logan Mr. Nic Frangos Mr. Charles Hirschler Mr. and Mrs. Frank J. Lynch Frito Lay, Inc. Charles P. Ho, Ph.D., M.D. Mr. and Mrs. Buck Lyon Mr. and Mrs. James Gaither Hockey Equipment W.L. Lyons Brown Mr. and Mrs. Robert Galvin Certification Council Charitable Foundation, Inc. Mr. Christopher B. Galvin Mr. and Mrs. David C. Hoff Mr. and Mrs. John W. Mabee G.E. Johnson Construction Mr. and Mrs. Preston Hotchkis Mr. and Mrs. Douglas Mackenzie Company, Inc. Mr. and Mrs. Charles Huether Mr. and Mrs. John Madden III Genzyme Biosurgery Hugoton Foundation Mr. David Maher Mr. and Mrs. Bradley Ghent Mr. and Mrs. George H. Hume Mr. and Mrs. John Maher Mr. Ephraim Gildor Mr. and Mrs. Walter Hussman Maher Foundation Mr. and Mrs. George N. Gillett, Jr. Mr. and Mrs. Roy Igersheim The Mailman Foundation, Inc. Dr. James P. Gills Dr. and Mrs. Frederick Ilfeld Mr. Theodore Mallon Ms. Donna M. Giordano Mr. and Mrs. Michael Immel Mr. John Manner Mr. C. Brody Glenn Admiral and Mrs. Bobby Inman The House of Remy Martin Mr. Richard Goodman Fred & Elli Iselin Foundation Mr. Herbert E. Marks Mr. and Mrs. James Gordon Mr. and Mrs. Douglas E. Jackson Mr. and Mrs. Thomas A. Mars Mr. and Mrs. David W. Graebel Mr. Brice Jackson Ernst & Wilma Martens Foundation Ms. Jean C. Graham Ms. Mary H. Jaffe Jack C. Massey Foundation Mr. Earl G. Graves Mr. and Mrs. John V. Jaggers Ms. Alexandra Mastriana-Solal Mr. and Mrs. Trevor Gray Mr. and Mrs. Bill Jensen Mr. and Mrs. Roy May Mr. and Mrs. Stephen Greenberg Mr. and Mrs. Charles Johnson Mr. and Mrs. Frederick R. Mayer Mr. Kenneth C. Griffin Mr. and Mrs. Michael O. Johnson Mr. and Mrs. David Mazer Mr. Neal C. Groff Mr. and Mrs. Charles Johnson Mr. and Mrs. Charles McAdam Mr. and Mrs. James Grosfeld Mr. and Mrs. Evan Jones Mr. and Mrs. John P. McBride Mr. and Mrs. Martin D. Gruss Mr. and Mrs. John W. Jordan II Mrs. Betsy McCormack Gumbo Foundation JP’s Peace, Love & The McCormack Foundation Mr. Donald W. Gustafson Happiness Foundation Mr. Rick McGarrey Mr. Kim Gustafson Dr. and Mrs. Jay Kaiser Mr. and Mrs. Arch McGill Halliburton Foundation, Inc. Dr. and Mrs. David Karli Mr. and Mrs. John McMillian Mr. and Mrs. Ron Haan Mr. Jeff Kassal Meadowood Napa Valley Mr. and Mrs. Steve Haber Ms. Beth Kasser MedSynergies-Surgical Division Dr. Tom Hackett Mr. and Mrs. Peter R. Kellogg Medequip, Inc. Dr. and Mrs. Topper Hagerman Mrs. Connie Kemmerer Mr. and Mrs. Eugene Mercy, Jr. Dr. and Mrs. Gaines Hammond Mr. and Mrs. Jack Kemp Mr. Michael A. Merriman Harlan Estate Key Bank Messner Reeves, LLP Mr. and Mrs. Milledge A. Hart III Key Foundation Mr. and Mrs. George Middlemas Mr. and Mrs. Ted Hartley Mr. and Mrs. John Kirchner Mr. Ron Miller Dr. and Mrs. Richard J. Hawkins Steven and Michele Dr. and Mrs. Peter J. Millett Kirsch Foundation

29 The Minneapolis Foundation Mr. and Mrs. Jay A. Precourt Mr. and Mrs. Rod Slifer MJP Innovations Mr. Michael Price Small Bone Innovations Dr. James Montgomery Mr. Marc Prisant Mr. Michael Byram and Mr. and Mrs. Bruce A. Montoya Mr. and Mrs. Tom Quinn Mrs. Ann B. Smead Mr. and Mrs. Mike A. Myers Mr. and Mrs. Paul Raether Mr. Michael Smith Mr. and Mrs. Trygve E. Myhren The Rainforth Foundation Mr. Thomas W. Smith Dr. and Mrs. Glen D. Nelson Ms. Karen Rainwater Mr. and Mrs. Jack Smith Mr. and Mrs. Don H. Nelson Mr. and Mrs. Felix D. Rappaport Sonnenalp of Vail Foundation Ms. Cindy L. Nelson Mr. and Mrs. George Rathman Sonoma Orthopedic Products Mr. and Mrs. Paul L. Newman Mr. Evan M. Rayman Spectra Energy Foundation Mr. and Mrs. Tradd Newton RE/MAX International, Inc. Mr. and Mrs. Erich Spangenberg NFL Charities Red Bull North America, Inc. Mr. and Mrs. Howard Specter Nippon Sigmax Mr. and Mrs. Steven Read The Spiritus Gladius Foundation Mr. and Mrs. Larry Nisonoff ReGen Biologics Steadman Philippon Mr. and Mrs. Michael Noell RJG Foundation Research Institute Dr. and Mrs. Thomas Noonan The Robbins Foundation Stavros S. Niarchos Foundation Mr. Greg Norman Mr. George R. Roberts Dr. and Mrs. J. R. Steadman Norman M. Morris Foundation Mr. and Mrs. Sanford Robertson The Steadman Clinic Norman Family Charitable Foundation Mr. and Mrs. Wayne A. Robins Mr. and Mrs. Lyon Steadman Mr. Robert Norris Mr. and Mrs. Arthur Rock Steadman Hawkins Clinic Denver Ms. Mary Noyes William Rodkey, D.V.M. Mr. and Mrs. Charles L. Stephens Mr. Edward D. O’Brien Mr. and Mrs. Michael D. Rose Dr. William I. Sterett Mr. and Mrs. John Oltman Mr. and Mrs. Gary S. Rosenbach Stocker & Yale, Inc. Opedix Labs Mrs. Nancy H. Russell Mr. Bram Stolk Opus Medical, Inc. Mr. and Mrs. Larry W. Ruvo Mr. Hans Storr Oratec Interventions, Inc. Mr. Jack Saltz Mr. James E. Stowers III Mr. and Mrs. Paul Oreffice Ms. Sandee N. Sander Mr. and Mrs. Steve Stratton Ormed GmbH & Co. KG Saucony, Inc. Dr. and Mrs. Barry S. Strauch ORP Hanger Mr. and Mrs. Kenneth T. Schiciano Stryker Trauma Ortho Rehab Mr. Craig Schiffer Stryker Imaging OrthoLogic Dr. and Mrs. Theodore Schlegel Surgical Dynamics, Inc. Ortholink Physicians Corp. Mr. and Mrs. Paul Schmidt Synthes USA Products, LLC Ortho Supply, Inc. Mr. William J. Schneiderman Mr. and Mrs. Mark Tache Oslo University Mr. Robert Schroeder Mr. Oscar L. Tang and Össur Americas, Inc. Mr. and Mrs. Charles Schwab Dr. Agnes Hsu-Tang Mr. John Osterweis Mr. Edward D. Scott Tang Family Foundation Mr. and Mrs. Preston S. Parish Seabourn Cruise Line Mr. Vernon Taylor, Jr. Ms. Uta Ortiz Patino Julius Seaman Family Foundation Team 1 Orthopaedics, Inc. Mr. and Mrs. Robert L. Patton Jr. Mr. and Mrs. Brad Seaman Mr. and Mrs. Richard F. Teerlink Perry Golf Mr. and Mrs. Gordon I. Segal Mr. Tim Tenney Mr. Nelson Peltz Ms. Monica Seles Mr. and Mrs. Fred Teshinsky Mr. and Mrs. Bob Penkhus Mr. and Mrs. Michael S. Shannon Mr. and Mrs. James Tiampo Pepsi Cola Ms. Mary Sue Shannon Mr. and Mrs. William R. Timken The Perot Foundation Shark Shootout Charities Mr. and Mrs. John C. Tlapek Mr. Alan W. Perkins Mr. and Mrs. O.B. Shelburne Mr. and Mrs. John Tolleson Mr. James Petersen, Sr. Mr. and Mrs. Stanley S. Shuman The Trailsend Foundation Pfizer, Inc. Siemens Medical Solutions Mr. and Mrs. Stewart Turley Philips Medical Dr. David Silken and Dr. and Mrs. Luis H. Urrea II Dr. and Mrs. Marc Philippon Dr. Maura Levine US Bank Mr. and Mrs. Addison Piper Dr. and Mrs. James F. Silliman U.S. Ortho Corporation Piper Jaffray & Co. Mr. and Mrs. Brian Simmons US Ski and Snowboard University of Pittsburgh Mr. and Mrs. John Simon Team Foundation Dr. and Mrs. Kevin D. Plancher Dr. and Mrs. Steve B. Singleton Vail Valley Medical Center Mrs. Andrew Pollet Mr. and Mrs. Gary Sitzmann Vail Valley Foundation Mr. David S. Pottruck Ms. Damaris Skouras Mr. Jack Van Valkenburgh

30 Vail Resorts Mr. and Mrs. Leo A. Vecellio, Jr. The Face of Philanthropy in 2013 Verizon Communications, Inc. Mr. and Mrs. Arthur W. Vietze Dr. Randy Viola Ms. Beatrice Busch Von Gontard Mr. and Mrs. George Vonderlinden Mr. Norm Waite Mrs. Alice Walton Ms. Lucinda Watson Mr. Mark E. Watson, Jr. Mrs. Olive C. Watson Ms. Valerie Weber Mr. and Mrs. Stephen D. Wehrle Mr. and Mrs. Patrick Welsh Dr. and Mrs. Wayne Wenzel Mr. and Mrs. George Wiegers The Williams Family Foundation Mr. Rodney Wimmer Ms. Mary Wolf Dr. and Mrs. Savio L.Y. Woo Wyeth Pharmaceuticals Mr. Craig Yates, Sr. Zimmer, Inc. MRI and Other Revenue: $964,647 Family and Friends: $2,483,692 Corporate Support: $1,901,826

Supporting Orthopaedic Research and Education In 2013, individuals, corporations and foundations contributed $5,350,165 to support the Institute’s research and education programs.

NINE years of support Total Revenue ($ millions) Total Revenue Less In-Kind

9.0

8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

0 2005 2006 2007 2008 2009 2010 2011 2012 2013

31 Corporate and Institutional Friends

Corporate support helps fund our Institute’s research and education programs in Vail, Colorado, and at six university sites. As we continue to deliver efficiencies, corporate funding has allowed us to direct more dollars into research. This year, 77 cents of every dollar raised went into research. The Institute is grateful for the generous support of our corporate partners. In 2013, we received $1,790,755 in corporate support. This work will benefit patients and physicians for generations to come.

American Academy of Foundations Orthopaedic Surgeons The Paul Galvin Memorial Foundation Fellowship Arthrex, Inc. The Gumbo Foundation Benefactors Arthroscopy Association of The Hellman Family Foundation North America The William and Flora Biomet, Inc. Hewlett Foundation Centrix Orthopaedics Fred & Elli Iselin Foundation Fellowship Benefactors fund the Istituto Brasil de Tecnologias The Liniger Family Foundation research of one fellow for one de Saúde The Pfizer Foundation year at a level of $10,000. As are Linvatec Precourt Foundation other contributions to the Institute, Össur Americas, Inc. The Sexton Family Foundation this is a fully tax-deductible OsteoMed The Patricia M. and contribution that provides an Pivot Medical H. William Smith, Jr. Foundation opportunity for the benefactor Smith & Nephew Enoscopy The Sonnenalp of Vail Foundation to participate in a philanthropic The Steadman Clinic The Spiritus Gladius Foundation endeavor by not only making Stryker Trauma The Tang Foundation a financial contribution to the Synthes USA Products, LLC The Trailsend Foundation educational and research year, University of Oslo and Oslo Sports US Ski and Snowboard but also by getting to know the Trauma Research Center Team Foundation designated fellow. Each benefactor Vail Valley Medical Center is assigned a fellow, who provides Wright Medical written reports and updates of his or her work. We extend our gratitude to the following individuals and foundation for their generous support:

Mr. and Mrs. Mitch Hart The Fred and Elli Iselin Foundation Ms. Mary Noyes Mr. and Mrs. Jay Precourt Mr. and Mrs. Stewart Turley

32 THE YEAR IN RESEARCH AND EDUCATION

33 Based on the mixed results for ACL and other ligaments, it is difficult to project whether PRP would have a beneficial effect on injured MCLs.

Most Commonly Injured Ligament

The MCL is the most commonly injured ligament of those supporting the knee, and the incidence of the injury is twice as high in males as in females. MCL tears or ruptures may SPRI Study Looks at Platelet-Rich not heal without intervention. One of those interventions is surgery, which Plasma for Ligament Healing has been shown to accelerate healing and hasten the return to performance. However, surgery is expensive, does not always allow the athlete to return A team of physicians and scientists worldwide in elite and recreational to full performance, and may be in the Department of BioMedical athletes adds up to thousands of associated with painful complications. Engineering at SPRI led by Dr. Marc injections performed in the United Philippon, Dr. Robert LaPrade, and States and Europe. This could The surgeons and scientists at SPRI, Coen Wijdicks, Ph.D., is conducting translate into millions of dollars spent working with the Colorado State preliminary studies to determine if per year on an unproven treatment. University Orthopaedic Research injections of platelet-rich plasma Center, are proposing tests using (PRP) can hasten the healing According to SPRI’s Dr. Robert biological models to determine if process in injured knee ligaments. LaPrade, “Science has progressed the effects of PRP can accelerate greatly in the past decade, offering MCL healing. The BioMedical PRP is derived by taking blood from significant promise in the area Engineering team has extensive a patient, subjecting it to a process of PRP, stem cells, and growth experience in studying growth factor that separates the blood into various factors. However, future studies effects on musculoskeletal healing. components, then harvesting the PRP and additional research are needed component and re-injecting it into so that we can take what we are The specific aims of the study the same patient. The concentration learning at the scientific level and will be 1) to determine if a single of platelets is thought to supply turn these into realistic, credible dose of PRP at different platelet important growth factors that promote treatment recommendations for concentrations can accelerate healing. The process is relatively easy patients who are under the care healing when compared with a to perform and surprisingly inexpensive. of their orthopaedic physician.” saline placebo, and 2) to determine if the highest PRP concentration Increased Attention With all of the publicity, it is not can accelerate healing when unusual for patients to demand PRP injected at multiple time intervals. PRP is drawing increased attention, treatment from their orthopaedists. If but most of it comes as a result of they don’t get the treatment, many The study, funded by The Kenneth anecdotal reports involving high-profile of them will seek other clinicians and Anne Griffin Foundation, has elite athletes. Among the injuries that who will administer PRP, whether been submitted to the American have been treated using PRP are those its indications are evidence- Orthopaedic Society of Sports involving the collateral ligament (MCL) based or not. These demands put Medicine and has received excellent and anterior cruciate ligament (ACL), tremendous pressure on physicians reviews. A pilot study has been as well as conditions such as patellar to use a treatment for which very completed and the SPRI/Colorado tendinitis and elbow tendinosis. few good basic research studies and State research teams expect to The results have been mixed. randomized clinical trials exist. have preliminary results in 2014.

Despite the lack of scientific No randomized clinical trials have studies proving a beneficial effect, been performed to confirm that PRP the number of injections of PRP specifically accelerates MCL healing.

34 Center for Translational and Regenerative Medicine Research

WILLIAM G. RODKEY, D.V.M., DIPLOMATE, AVCS, DIRECTOR, CENTER FOR TRANSLATIONAL AND REGENERATIVE MEDICINE RESEARCH

The purpose of the Center for Translational and Regenerative Medicine Research (CTRMR), formerly Basic Science Research, is to gain a better comprehension of factors that lead to 1) degenerative joint disease, 2) osteoarthritis, 3) improved healing of soft tissues such as ligaments, tendons, articular cartilage, and meniscus cartilage, and 4) new and untried approaches of treatment modalities.

Our emphasis is on understanding the effects of injuries and then enhancing therapies at the joint, tissue, and even cellular levels. We perform in William G. Rodkey, D.V.M. vitro (laboratory) and translational (animal) studies before human use. Our ACCOMPLISHMENTS GRANTS ultimate goal is to regenerate, not just repair, injured tissues. That is, we focus • Three publications in quality peer- No outside grants or patents were our efforts on regenerative medicine. reviewed books. obtained in 2013. Philanthropic • Twenty-five presentations in eight donations were solicited for and used The relatively new area of regenerative different countries. specifically for some of the CTRMR medicine coupled with biological • Served on two major international research studies. enhancement of tissue healing is an research committees. exciting one that has gained global • Served on the editorial board of COLLABORATIVE EFFORTS attention, especially in the areas of directors of a major knee journal. orthopaedic sports medicine and • Served as a peer reviewer for four major CTRMR continued its very strong in the care of combat casualties orthopaedic sports medicine journals. and extremely well-established from our military services. Many of • Completed important studies and/ collaboration with Colorado State the applications lend themselves or published articles on adult University (CSU). Specifically, we to treatment of posttraumatic autologous stem cells, meniscus worked closely on many projects osteoarthritis. There are many new regeneration, and the microfracture with the CSU Orthopaedic Research and innovative techniques under technique and rehabilitation. Center (ORC) under the direction of investigation by scientists around the Dr. Wayne McIlwraith and his deputy, world, including stem cells, blood PUBLICATIONS Dr. David Frisbie. products, and synthetic materials that exploit new sciences such as In 2013, the department had three Our collaborations have been ongoing nanotechnology and electrospinning. publications in high-quality and for nearly 20 years, and our joint One of the broad goals of this work can leading textbooks, including: efforts have led to many publications be stated simply as joint preservation. and presentations on the subject • The ACL-Deficient Knee. A Problem of cartilage repair and resurfacing. Solving Approach Several of these studies have • Surgical Techniques of the Shoulder, influenced the way that microfracture Elbow, and Knee in Sports Medicine is performed, and other studies have validated the postoperative

35 rehabilitation protocols that have animal resources over traditional live PROJECTIONS been developed by Dr. Steadman. animal studies. A successful model This collaboration with the CSU ORC would also permit more studies to The future looks very bright is truly invaluable to CTRMR and to be done much more quickly, and the for regenerative medicine, and SPRI as an institute. number of test products and testing we believe that the Center for protocols could be significantly Translational and Regenerative One such collaborative study in increased. While this study is ongoing, Medicine Research can truly make a particular is worthy of note. An in the early findings suggest that this difference in this area of biomedical vitro (“test tube”) laboratory study traumatic impact model with the and orthopaedic sports medicine was conducted to assess the effect of addition of interleukin-1 provides a research. Some of the areas we will the timing of administration of stem model that may closely mimic the continue to pursue include: cells to pieces of articular cartilage joint environment in human patients that were subjected to a mechanical following, for example, a ski injury. • Functional tissue engineering injury. This mechanical injury model This finding will help guide our • Synthetic matrices has been validated previously by future studies. The second important • Gene therapy Dr. Frisbie and co-workers at the interim finding is that the timing of • Cellular therapy CSU ORC. In this present study, when stem cells are administered • Stem cells, circulating progenitor we also added interleukin-1 (a seems to have no effect on results. cells, others naturally occurring inflammatory We will continue to use this model • Platelet-rich plasma (PRP) protein that is increased in living and to analyze the specimens from • Mechanisms of action, dose joints following traumatic injury the initial study. optimization, etc. and promotes the degenerative osteoarthritic process) to emulate We, of course, also collaborate with All of these future projects focus the inflammation that accompanies The Steadman Clinic attending staff on improved tissue healing and direct injury in traumatic joint and fellows. This collaboration is regeneration. In other words, we disease. If this laboratory model is always fruitful and helps us assure believe that the discipline of proven successful, its use would save that our work is clinically focused. regenerative medicine is not only the a great deal of money and laboratory future, but it is also right now.

36 Developing Programs to Prevent Hip Injuries in Young Athletes

By Dawn Ommen, M.D.

Editor’s note: Dr. Ommen is currently The clinical exam is similar to the completing a research internship exam that professional and Olympic in the Center for Outcomes-Based athletes experience as one of Dr. Orthopaedic Research department of the Philippon’s patients. The exam Steadman Philippon Research Institute. consists of range of motion, strength testing, and specific hip motion tests. Dr. Philippon and his staff just These clinical results are correlated completed the fourth consecutive with a musculoskeletal radiologist’s year of physical hip screening for pre- reading of the patient’s MRI. adolescent/adolescent athletes. The purpose of the screening is to look for Erin, a mother of one of the study the differences seen in male and any indication of femoroacetabular participants, knew right away that female athletes for the first time this impingement (FAI), an abnormal she wanted her child to participate year. In addition, in the fourth year bone growth in the hip joint that can in the study. “Being involved of the study, we are gaining valuable lead to hip pain and labral tears. in healthcare myself and also longitudinal data as many of the being a lifelong athlete, I realize study’s participants have completed FAI is a common diagnosis in Dr. the importance of these types of the study each of the past four years. Philippon’s patient population and is studies. In addition, my child may seen at a higher rate in the athletic benefit from the knowledge gained This study was accepted to be community as compared with the through this study in the future.” presented as a poster at the general public. Indications of FAI International Olympic Committee are being found in young athletes, Erin indicated that the experience Injury Prevention meeting in April. sometimes even before the onset of that her child had during the study SPRI and Dr. Philippon would symptoms. The goal of the screening was a great learning opportunity into like to expand this screening in is to identify factors related to the world of medicine, experienced cooperation with the United States developing FAI and, ultimately, to in a non-threatening atmosphere. Olympic Committee medical team develop an exercise prevention program and United States Ski and Snowboard that would allow these athletes to The data from the last three years Association Sports Medicine. continue with their sports and be of screening have resulted in active throughout their lifetimes. two manuscripts that have been This unique study is providing published in the American Journal of groundbreaking information in The number of athletes participating Sports Medicine, the premiere sports the young athlete population. in the study has increased every year. medicine journal in the world. One of Through this study, Dr. Philippon This year we were able to more than the manuscripts reported that even and his team are leading the way double our prior participant numbers, at young ages, ice hockey players in identifying causes of an often as 77 athletes completed the study. have a greater bone growth associated debilitating hip condition in the This included 28 hockey players, with FAI than skiers of similar ages. competitive athlete, providing these 42 skiers, and seven figure skaters and future competitors a better between the ages of nine and 17. The other publication identified and chance at an injury-free career analyzed at-risk positions for the hip and continued active lifestyle. Figure skaters were a new addition during specific hockey movements. to the study this year. The study With a significant increase in female This study was partially funded consists of two parts: an abbreviated athlete participation in this year’s by Mr. and Mrs. Paul Schmidt. hip MRI and a clinical hip exam. screening, we are looking to analyze

37 Center for Outcomes-Based Orthopaedic Research (COOR)

Karen K. Briggs, M.B.A., M.P.H., Director; Marilee P. Horan, M.P.H., Upper Extremity Coordinator; Lauren M. Matheny, B.A., Lower Extremity Coordinator; Grant J. Dornan, M.S., Biostatistician; Ashley Darrough, Data Collection Coordinator; Dawn Rossi, Administrative Assistant

Patient-centered outcomes following surgery are those outcomes that are important to patients. More than 20 years ago, Dr. Steadman started developing a sophisticated system to document how patients felt about their surgery in order to improve the quality of orthopaedic care.

In 2013, the Center for Outcomes- Based Orthopaedic Research continued to document outcomes on every knee, hip, shoulder, and ankle patient who visited The Steadman Clinic. In addition, annual follow-up forms are emailed to more than 15,000 patients.

As healthcare evolves, COOR will COOR look forward to continuing age is to keep active to maintain continue to provide physicians and to help patients and physicians health and decrease risk of diseases patients the information on outcomes with improved healthcare. associated with sedentary lifestyles. of orthopaedic surgery to assist Bucking the trend of avoiding ACL with decision-making. Outcomes KNEE STUDIES reconstruction, in the late 1980s provide the tool to help address Dr. Steadman was performing ACL concerns over how the healthcare Anterior Cruciate Ligament reconstruction on patients more dollar is spent and the results Reconstruction in Patients 40 Years than 40 years of age. With the of that expenditure. This type of or Older: 20- to 25-Year Follow-up number of knee replacements in information will be important to adults ages 45 to 65 tripling over policy-makers, payers, and patients Anterior cruciate ligament (ACL) the last 10 years, we were interested as they increasingly seek information injuries are most commonly seen in whether this group of patients about treatments and innovations. in young active patients. The goal had more knee replacements or of ACL reconstruction is to return continued with their active lifestyle. These outcomes are available patients to high-intensity activities for many procedures, including that may include twisting and From 1988 to 1993, 81 ACL microfracture, which was developed cutting maneuvers. In the past, reconstructions were performed by Dr. Steadman in the 1980s, older patients who suffered an ACL in patients 40 years or older. The and labral reconstruction in the injury were encouraged to change average age was 45, with a range hip, which was developed by Dr. their activity level and avoid an ACL from 40 to 60. Twenty years later, Philippon over the past 10 years and reconstruction. However, with the the average age was 68, with a validated by data from our registry. baby boomers staying active later range from 62 to 82. One patient in life, more ACL injuries are being had a reinjury 10 years following As data continues to be collected seen in older patients, and these their reconstruction, and 24 and new procedures are developed, patients have a desire to return percent of patients required a the value of the COOR data registry to activities and some to high- knee replacement at an average continues to grow. SPRI and intensity activities. The goal as we of 19 years following their ACL

38 reconstruction. Patients who did suture repair, only limited studies not have a total knee replacement have compared outcomes following had good-to-excellent outcomes meniscus repair in patients less than scores and are still active. (See 40 years old versus patients over 40 comments from patients in boxes.) years old. Failure rates in patients The median patient satisfaction over 40 have been documented to with outcome at minimum 20 years range from 9 percent to 27 percent. follow-up was 10 on a scale of 1 to However, it is unclear if there is a 10, with 10 being very satisfied. significant difference in subsequent This study showed that patients surgery rate and outcomes following 40 years or older can have an ACL meniscus suture repair. To better reconstruction without increased understand the long-term outcomes risk of knee replacement, and if following meniscus suture repair, they don’t have knee replacement COOR gathered outcomes data at they have good function, are active, 10 to 21 years follow-up in patients and are satisfied with the results. under 40 and 40 years and over.

Meniscus Suture Repair: 10-Year All patients 18 years or older who Outcomes in Patients over 40 underwent meniscus suture repair Compared with Patients 40 and under by Dr. Steadman were included in this study. Patients were asked Meniscus tears are one of the to complete a questionnaire at a The WOMAC Index is divided into most commonly seen orthopaedic minimum of 10 years following knee three categories: pain, stiffness, injuries. Most tears are treated surgery and each year thereafter. and function. It is validated to with debridement. However, with Outcome measures collected include measure outcomes following new research information showing the Lysholm score to document treatment for osteoarthritis. the importance of preserving function, WOMAC score to document meniscus tissue, the number of pain and function, and the SF-12 The SF-12 survey measures repairs has increased. Removal score to document general health and perceptions about health. This of tissue surrounding the torn patient satisfaction with outcome. information helps keep track meniscus can often result in reduced of feelings of wellbeing and protection of the surrounding There were 191 knees in 187 performance of daily activities. articular cartilage surfaces. Previous patients (125 males, 69 females) studies have also shown that when with an average age of 33 who The Lysholm score (0-100, large amounts of the menisci are underwent meniscus suture repair 100=highest) and Tegner activity level excised, patients are more likely and were included in this study. (0-10, 10 = highest satisfaction) are to develop knee osteoarthritis There were 142 patients 40 years common scoring systems utilized to (OA) at a more rapid rate. or younger, with an average age evaluate outcomes of arthroscopic of 27.5 years, and 49 patients knee surgery. The Lysholm score In the last 10 years, meniscus over 40 years of age, with an measures symptoms and function. repair surgeries have drastically average age of 50 years. Older age The Tegner activity level categorizes increased (Figure 1). Although did not associate with a greater individuals based on the activities multiple studies have documented number of second surgeries. in which they participate. outcomes following meniscus

FIG. 1: Trends over 10 Years - all meniscus repair surgery 20%

15%

10%

5%

0% 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

39 Patients who were older than 40 had these fractures required various similar function and satisfaction with angled picks. Previous work had been outcome compared with patients done with drills, but drills could not 40 years or younger. Patients who reach all areas of the joint and when underwent meniscus suture repair used, they produced heat that could had high function and high patient limit the development of new tissue. satisfaction at an average 16 years A secondary goal was to provide following meniscus suture repair. a situation in which the marrow This study shows that patients clot would stay in place. When a 40 years and older can do just as microfracture was created, the rough well following surgery as patients surface attracted and held the clot. who are younger than 40. Now 30 years later, microfracture Microfracture: 30 Years Later is performed in the knee, hip, shoulder, elbow, ankle, and hand In the early 1980s, Dr. Steadman joints. When done properly with began developing the microfracture the correct postoperative protocol, technique—a relatively quick microfracture has been shown to be and minimally invasive surgical very successful in returning patients technique to stimulate articular to their desired activities. Today, cartilage repair. The goal was to microfracture has its own surgical create a combination of surgery and procedure code (CPT), and over 300 Quotes from rehabilitation that would allow for publications on microfracture in the patients who had knee are referenced in PubMed. ACL reconstruction 20 years ago by In 2012, the paper “Outcomes of microfracture for traumatic chondral Dr. Steadman defects of the knee: Average 11-year follow-up,” by Dr. Steadman and “Dr. Steadman, Can’t believe you others, was named one of the top still follow-up with me.” 25 most cited articles in all of the arthroscopic orthopaedic literature. “I run, ski, play racquetball, Today, microfracture is the most volleyball, help with soccer, hunt, cartilage repair tissue to form. Most common cartilage repair technique fish, backpack, all with abandon.” prior cartilage procedures had little being used in the U.S., and the to no emphasis on the postoperative incidence continues to grow. The “Two weeks ago I finished a 184-mile period. The surgical goal was to following table is a summary of the relay race around the mountains.” create fractures in the subchondral number of cartilage procedures bone perpendicular to the surface performed over several years from “None of what I like to do would and to be able to reach all areas analysis of a large payer database. be possible without Dr. Steadman of the joint. The creation of these fixing my knee in 1987. That is 26 fractures would release blood and Microfracture is performed 60 years of fun.” bone marrow, which would form a to over 100 times more often large clot and produce the cells that than other procedures. This trend can create new cartilage. Creating continued even as new techniques

Procedure 2005 2006 2007 2008 2009 2010 2011 Microfracture 72,887 74,433 79,629 75,436 76,777 84,780 78,456 Arthroscopic autograft 1,181 1,376 1,137 1,074 999 1,155 1,044 Arthroscopic allograft 930 1,202 971 832 719 631 662 ACI 885 630 742 728 767 1,446 1,343 Open osteochondral allograft 660 808 848 663 863 1,351 1,619 Open osteochondral autograft 496 509 653 798

40 developed. Microfracture was another surgery three years following was determined by comparing the developed and proven effective surgery. At an average of four years players’ sport statistics two years and continues to be the treatment after surgery, patients had excellent prior to surgery with those two years of choice for cartilage defects. improvement in their outcome scores following surgery. These statistics and reported high satisfaction with included games played, minutes HIP STUDIES outcome. This study showed that played, goals or points scored, etc. acetabular labral reconstruction is a From Development to Validation: good option to manage patients with Hip Labral Reconstruction labral deficiency who continue to be symptomatic, rather than having In 2005, Dr. Philippon developed to resort to a joint replacement a new technique for hip labral at a significantly young age. reconstruction. This procedure was for patients who had labral damage Following this study, we published a that could not be repaired and if study on labral reconstruction in the removed, would not leave enough professional athlete. Only athletes labrum to do its job. The technique who were on an Olympic team or uses a graft from the patient’s own played sports as their primary job thigh. The graft is made into the were included in the study. There shape of a tube and then placed were professional soccer, hockey, around the acetabulum to replace football, baseball, and basketball the missing labrum. Early results players. In addition, two Olympic of this technique were published skiers were included. Two athletes in 2010; however, it was not required total hip replacement. clear yet if the graft would last. However, they were older and at the end of their playing careers. Of COOR then gathered midterm follow- the rest of the athletes, 86 percent up on the patients. Eighty-seven returned to professional sports percent of patients who did not have and 81 percent returned to their signs of osteoarthritis did not require previous level of play or better. This

is particularly common in hip flexion In both types of impingement, the and internal rotation, a position abnormal contact between the frequently encountered during femoral head and acetabulum during activities of daily living. Difficulty movement causes injury to the labrum with putting on shoes and socks and articular cartilage. Injuries to the and getting into and out of a car acetabular labrum lead to increased are common complaints in patients movement of the femoral head with extensive impingement. within the acetabulum, resulting in an unstable joint. Also, tears of the There are two distinct types of FAI, acetabular labrum result in increased cam and pincer. Most commonly, contact forces between the femoral patients have a combination of head and the acetabulum. With these What is FAI? the two types of impingement. increased forces, damage to the Cam impingement results from articular cartilage may result. Injuries Femoroacetabular impingement (FAI) excess bone located on the femoral to the articular cartilage over time occurs when abnormally shaped neck. Pincer impingement results may increase in size and depth, and bones of the hip repetitively hit from excess bone located on the ultimately result in bone-on-bone each other during movement. As a acetabulum. The precise cause of contact. At this point, the only current result, soft tissue structures of the the impingement is unknown, but solution is a total hip replacement. hip, including the acetabular labrum it likely has both developmental- and the articular cartilage, are often and activity-related (such as in entrapped and injured. Impingement contact in sports) components.

41 These two studies provided clinical limited osteoarthritis. “These cartilage lesions, and it has been validation for the use of the labral results highlight the importance shown to be relatively inexpensive reconstruction in both elite athletes of Dr. Philippon’s preoperative and to produce reliable results. and the recreational population. patient selection criteria, the goal The procedure provided an option of which is to perform arthroscopy We studied 17 male professional for patients who previously had when symptoms are mild in order hockey players who had microfracture. no options for missing labrums. to prevent early conversion to There were four centers, five wings, We will continue to track these arthroplasty and thus ensure excellent five defensemen, and four goalies. patients to determine the long- clinical results for patients.” They played between two and 17 term success of the treatment. seasons prior to microfracture. Eighty- Performance Outcomes in two percent of the players returned to Midterm Outcomes after Professional Hockey Players Following competition at their previous level of Arthroscopic Hip Surgery for Arthroscopic Microfracture of the Hip play. Return to play was dependent Femoroacetabular Impingement on when players had surgery. Players who had surgery in the off-season Few studies have documented or the end of the current season patient-centered outcomes of modern returned to professional play the hip arthroscopy. Most studies upcoming season, and players who are two-year outcome studies. In had surgery at the beginning of the a study that was the largest of season returned to play the same its kind, we published midterm season. The number of games played outcomes on patients following in the preoperative season was on arthroscopy for femoroacetabular average 68, compared with 56 in impingement (FAI). We gathered the postoperative season. Shooting follow-up data on 466 out of 559 percentage in non-goalies was 11 patients who had surgery between Several studies have reported that 2005 and 2008. Before surgery, all professional athletes can return patients had persistent pain and to play following hip arthroscopy. disability due to symptomatic FAI. There are many different causes of In addition, all patients completed hip pain that may lead an athlete a trial of non-operative treatment to arthroscopic surgery. Damage including physical therapy and to the articular cartilage of the hip medication of their pain to allow is common in the high-demand activity, which was ineffective. athlete, especially those who are Patients were between the ages of contact athletes. The number of 18 and 77. Only 16 percent of the professional hockey players requiring patients with no or limited arthritis hip arthroscopy has increased required total hip replacement, at over the last several years. This an average age of 73 years. Patient- has led to the question, “Can percent before surgery and 10 centered outcomes were collected professional hockey players return percent after surgery. The average at a mean of 73 months following to hockey following microfracture number of goals against for goalies arthroscopy. Postoperatively, excellent to treat articular cartilage defects?” was 3.6 before surgery and 3.6 after outcomes were seen in patients Microfracture is the most commonly surgery. When these players were with preserved joint space after accepted treatment method for compared to age-matched players hip arthroscopy for symptomatic who did not have surgery, their FAI at a minimum of five years. statistics were similar. Following surgery, the players averaged 25 This study showed that durable and minutes on ice and the non-surgical successful long-term results are controls averaged 26 minutes on achievable after hip arthroscopy ice. The average number of goals to treat symptomatic FAI. Hip in the treatment group was 11.8 arthroscopy for FAI resulted in and in the control group was significantly better outcomes and 12.6. For goalies in the treatment activity level at a minimum of five group, save percentage was 89 years follow-up in patients with percent, while the control group save percentage was 90 percent.

42 This study showed that professional Microfracture has been shown to be a hockey players with cartilage defects relatively low-cost, low-risk procedure treated with microfracture can return with good to excellent results in to hockey and return to the same both the knee and the ankle. The elite performance level following microfracture technique for cartilage an arthroscopic microfracture defects of the knee was developed procedure when compared with by Dr. J. Richard Steadman in the pre-injury outcomes and controls. 1980s. Microfracture surgery of the knee has been well documented, Outcomes Following Microfracture reporting functional and symptomatic in Grade 3 and 4 Articular improvement in approximately 67 Cartilage Lesions of the Ankle to 95 percent of patients. However, the microfracture technique in the Articular cartilage lesions of the ankle ankle has been less thoroughly joint are common cause of ankle pain studied. We conducted a study and disability. These cartilage defects to document outcomes following are usually the result of trauma, such microfracture of the ankle. as ankle sprains or fractures. Up to 50 percent of acute ankle sprains and All patients 18 years or older who 73 to 80 percent of ankle fractures underwent ankle microfracture will result in some type of cartilage surgery at The Steadman Clinic damage. An untreated articular for the treatment of an articular cartilage defect is a significant cartilage lesion were included in The Lysholm score (0-100, risk factor for the development this study. Forty patients underwent 100=highest) and Tegner activity of ankle osteoarthritis (OA). microfracture for the treatment of level (0-10, 10 = highest an articular cartilage lesion of the satisfaction) are common scoring Various treatment methods have ankle. Detailed surgical data were systems utilized to evaluate been described for articular cartilage documented at the time of surgery. outcomes of arthroscopic knee lesions of the ankle, which have Patients were asked to complete surgery. The Lysholm score a subjective questionnaire at a measures symptoms and function. minimum of one year following ankle The Tegner activity level categorizes surgery and each year thereafter. individuals based on the activities Outcome measures included the in which they participate. Foot and Ankle Disability Index (FADI) to document function, The Foot and Ankle Disability Index the Lysholm score to document (FADI) is a region-specific self-report function, and the Tegner activity of function. This index was designed scale to document activity level and to assess functional limitations patient satisfaction with outcome. related to foot and ankle conditions.

also been commonly referred to as osteochondral lesions of the talus (OLTs) when occurring on the talus. Non-operative treatment options include immobilization with casting; walking boots or braces; non-steroidal anti-inflammatory drug (NSAID) therapy; activity modification; corticosteroid injections; and more recently, hyaluronate and platelet- rich plasma (PRP) injections. Due to poor results with these non- operative treatments, surgical treatment is recommended.

43 Four patients (10.5 percent) required another surgery after the initial microfracture surgery. Ninety-four percent of patients completed a questionnaire. The average Lysholm score was 74 out of 100. The average FADI score was 77 out of 100. Average Tegner activity scale was four out of 10, which demonstrates a recreational athlete. Median patient satisfaction with outcome was eight out of 10.

In our study, 30 percent of patients had previous ankle surgery and more than half of patients who were treated with ankle microfracture FIG. 1 had chronic ankle injuries. Patients FIG. 5 who had previous ankle surgery had lower outcome scores, as did patients who had a longer amount increased risk for injury and have of time from ankle injury to surgery. limitations in normal functional The most important finding in activities. The Dorsiflexion-Lunge this study is that patients were Test is a test of range of motion at highly satisfied with their operative the ankle while the patient has their outcome. This study supports the weight on the ankle. If a patient FIG. 2 use of microfracture for treatment of has restriction in testing, then this articular cartilage lesions of the ankle. implies stiffness in dorsiflexion. This makes squatting and leg press Return to Play in Athletes exercises challenging. To compensate Following Ankle Injuries for this loss of motion, athletes may have exaggerated hip flexion and The decision to allow an athlete inhibition of knee flexion, and the to return-to-play (RTP) following foot will be observed to rise from the an ankle injury is a multifactorial floor. In assessing treatment changes, FIG. 3 process—involving both physical weight-bearing measures are more and psychological parameters. There likely to detect treatment effects is limited research that provides than non-weight-bearing measures guidelines to assist in the decision to allow an athlete to safely RTP. Balance can be defined as the The ankle team at COOR reviewed ability to maintain the body’s the current literature and the center of gravity within the base functional tests that we use in our of support. Balance is a crucial institution. The functional tests used element of most sports, and loss include: The Dorsiflexion-Lunge Test of proprioception is a risk factor for (Figure 1), Star Excursion Balance reinjury. The SEBT examines an Test (SEBT) (Figure 2), Agility athlete’s ability for unilateral balance T-Test (Figure 3), and Sargent/ and dynamic neuromuscular control, Vertical Jump Test (Figure 4). and requires strength, flexibility, and proprioception. The patient Dorsiflexion (Figure 5) of the ankle is is required to maintain a base of necessary for a normal gait, climbing support with one leg while reaching stairs, and rising from a squatting maximally in defined directions with position. Patients who can’t move the contralateral leg. They must reach FIG. 4 their ankle in this motion are at as far as they can while maintaining

44 the balance on the injured leg. The SHOULDER STUDIES SYSTEMATIC REVIEW directions in which they reach form Systematic review is a method of the shape of an eight-point star. Clinical and Structural Outcomes research in which the results from after Arthroscopic Single- Versus multiple similar studies are considered The classical description of agility Double-Row Rotator Cuff together to arrive at an overall is the ability to change direction Repair: A Systematic Review conclusion regarding a particular rapidly. It is an essential component question. This approach is typically of team and field sports for a Rotator cuff tears are a significant used when the results from numerous variety of reasons—neuromuscular source of shoulder pain and disability, existing studies conflict with one control, injury reduction, and overall and account for more than one another, with the goal of condensing performance capabilities. Patients million physician visits per year in all of the available information down who have sustained an ankle injury the United States. As our population to a single study with a more decisive have been shown to demonstrate ages, the frequency of rotator conclusion. In some cases, it may be impairment in agility when compared cuff tears has steadily increased, appropriate to combine all of the actual with uninjured ankles. The Agility which in turn has increased the data points from each study in order T-test measures an athlete’s agility demand for arthroscopic rotator to calculate the overall results (this is by assessing movement in multiple cuff repairs, which have been called a meta-analysis). While a standard directions. The athlete must navigate proven to relieve pain and improve systematic review is appropriate for a course shaped like the letter function. Furthermore, this increased some research questions, a meta- T, where both the horizontal and demand has led to the rapid analysis may be appropriate for others. longitudinal arms are each 10 yards. evolution of repair techniques that often outpace the development of To perform a systematic review, Adequate strength is important not solid clinical data, which are often online medical research databases only for competitive performance, but used to make informed clinical (such as PubMed.gov) and specific also for injury prevention. Athletes decisions. As a result, many studies journal websites are searched using who have decreased strength and that evaluate rotator cuff repair a predefined set of keywords related flexibility are more prone to lower techniques suffer from low patient to the research question. Each record extremity injuries, and neuromuscular numbers and conflicting results. that is retrieved from this search is training programs can prevent injuries. thoroughly evaluated to determine In terms of ankle strength, athletes One controversy in the treatment whether it should be included in the with muscle strength imbalance are of rotator cuff tears is over the study according to certain previously- at an increased risk of ankle injuries. best way to repair the rotator cuff named inclusion criteria. The research The Sargent Jump Test was developed tear. Some surgeons use just one methods, results, and conclusions are in 1921 by Dr. Dudley Sargent in row of repair sutures and some use obtained from each included study, and order test an athlete’s “strength, two rows (Figure 1). Biomechanical this data is managed and presented speed, energy, and dexterity.” The evidence suggests that two-row in an appropriate manner so that test allows us to derive an estimate repairs are stronger. However, only the reader can quickly review all of of the power involved in the jump. few clinical studies have shown that the available literature regarding the the patients have better outcomes original research question. This type of Functional testing provides objective when they have a two-row repair research must be performed using a set measures to gauge an athlete’s compared with a one-row repair. of published rules and guidelines that progression through the rehabilitation ensure that the study was performed process. Testing balance and To evaluate the research that has ‘systematically’ (i.e. using a standard proprioception, strength, range already been done on one-row versus method) to avoid potential sources of of motion, and agility give the two-row repairs, researchers at bias that may alter the overall results. team physician effective measures the Steadman Philippon Research for assessing RTP readiness. Institute recently performed a This, coupled with psychological systematic literature review. High- assessment, can assist in the RTP level studies that compared the decision-making process. If any patient outcomes and imaging results doubt exists, then the physician following arthroscopic rotator cuff should lean toward safety rather than repair using either a one- or two-row expose the athlete to undue risk. technique were chosen for review. Seven studies were identified and included in the review. All reported

Figure 1: (A) One-row repair. (B) Two-row repair. 45 outcomes scores and imaging- improved preoperative education. We than 50 percent of the patients in diagnosed re-tears for both the one- performed a study to evaluate patient this study were over 50 years of age, and two-row groups were documented. expectations prior to arthroscopic indicating that a return to sporting Using the data from each study, shoulder surgery and to correlate activities and living an active lifestyle researchers identified several them with preoperative symptoms, have become increasingly important important clinical characteristics function, and the reasons the patient in the ‘baby boomer’ population. for both one- and two-row repairs. decided to seek treatment. From our data registry, we identified 313 Complications Following Anatomic Although there were no differences patients with completed expectation Fixation and Reconstruction of in patient outcomes scores between questionnaires who went on to the Coracoclavicular Ligaments the two techniques, the one-row arthroscopic shoulder surgery. group demonstrated a significantly The coracoclavicular ligaments connect increased rate of imaging-diagnosed The three most important part of the clavicle (collar bone) to part re-tears after two years. This expectations among all patients of the scapula (shoulder blade). These information may suggest that one-row were the ability to participate in ligaments can become torn when repairs do not hold up as long. In sports, to achieve their pre-injury the shoulder is injured, resulting in addition, these results indicate that level of function, and to improve significant pain and deformity. These the presence of a re-tear may not range of motion. Patients with more types of tears have been fixed surgically always result in increased symptoms expectations were more likely to have for many years. However, most of the or outcomes scores reported by the more symptoms and worse function older techniques resulted in a wide patient. Other studies have shown preoperatively when compared with array of complications following surgery. that rotator cuff tears may only those with fewer expectations. The Newer techniques have been developed become symptomatic more than two study also showed that patients who to fix these tears and to improve patient years after their initial appearance. had shoulder dislocations had a outcomes by minimizing the risks for Taken together, researchers believe different expectation profile than the complications that were seen in the past. that a follow-up period of two years rest of the patients. In addition, more may not be adequate to detect changes in patient symptoms for those who have sustained an imaging- diagnosed re-tear. At the Steadman Philippon Research Institute, we continue to track clinical outcomes in patients who have had rotator cuff tears for many years after their surgery. The data from our registry will help answer these questions in the future as we continue to collect long-term follow-up information.

Patient Expectations prior to Arthroscopic Shoulder Surgery: Correlation with Patients’ Reasons for Seeking Treatment

What a patient expects from his or her treatment has been shown to influence the results of treatment. In other words, worse outcomes and low patient satisfaction can result if patients have expectations that are either too high or too low. Studies have demonstrated increased satisfaction after surgery in patients who had expectations similar to those of their surgeon as a result of

46 On the other hand, new techniques can also introduce new, unique complications. We performed a study to determine which complications were associated with these newer techniques and to evaluate the effect that these complications may have had on patient outcomes. A query of our data registry resulted in a study group of 59 patients. All but three were males and most were injured during snow sports or cycling. About 23 percent of these patients had a complication that required a second surgery. There were no differences in outcomes between those patients who had a complication and those who did not, but patients who had Raising Matthew: Mary Antoine’s a complication were less satisfied. Perspective on an Olympian’s Success

This study emphasizes the importance of both patient-centered outcomes and patient satisfaction on the overall Mary Elise Antoine is an author, would become frustrated, but he treatment results. Although newer cultural historian, and storyteller in would never quit. He later made techniques have been developed to Prairie du Chien, Wisconsin. She recommendations to the USA Bobsled more closely mimic normal anatomy, has three children. The oldest is and Skeleton Federation regarding it is most important to document how Elise, who lives with her husband a new sled being developed.” patients respond to these treatments. on a family farm in Iowa and is a high school social studies Behavior teacher. Nicholas is a government “From an early age, my children relations assistant with a consulting knew what was expected of them group in St. Paul. Matthew is the regarding behavior in the family and youngest—now an Olympic medalist in public. They had responsibilities and a national champion in men’s at home and they knew they were skeleton. Here are Mary Antoine’s expected to help my parents and reflections about raising Matthew. elderly neighbors. The first job all three of my children had was Early signs bussing tables at a local restaurant. “At an early age, Matthew wanted It taught them responsibility, how to go down a sliding hill standing to take orders from others, and how up on his sled. Of course, all I to work with a variety of people.” could envision was Matt falling off and hurting himself, so I tried to The importance of education get him to stop. It didn’t work.” “When Matthew came to me as a senior in high school and told me he Determination wanted to compete in skeleton, I never “What was noticeable in Matthew had a second thought. But I made as a child was his determination. one stipulation. He had to attend He would decide to do or make college while he learned and mastered something. He would plan it out skeleton. (Matt’s brother and sister in his mind how to construct it both have master’s degrees, as does and how it would work. He made Mary.) It took Matthew six years of a three-dimensional model of the classes, assignments, and tests while solar system. He tried to invent an competing at the national level, but he automatic dog-washing machine. He has a degree in sports management.”

47 Patients in the News Matt Antoine Wins Bronze Medal in Sochi Olympics

Wisconsin native follows his win in Sochi by taking the Men’s U.S. National Skeleton Championship at Lake Placid

By Jim Brown, Ph.D.

Who would want to slide on an ice SPRI News: Is your life to be a race car driver, but that track, headfirst more than 1,500 yards back to normal yet? didn’t work out. I liked anything downhill on a 70-pound steel sled “I doubt that it will ever be as normal that went fast and always enjoyed at speeds near 80 miles per hour? as it was before winning the bronze winter sports. Skeleton brought all medal at the Olympics and the of those things together. After my Matthew Antoine of Prairie du Chien, National Championships, but things first run down the track, I knew it Wisconsin, would, and he has been will start to settle down sooner or later.” was something I wanted to do.” doing it for the past 12 years. He capped his best season ever by SPRI News: Why did you SPRI News: When did you start? becoming the first U.S. athlete choose this sport? “I started competing when I was to earn a medal at the Olympics “People often ask us if we are crazy. in high school and continued since 2002 and by setting a track We’re not crazy, but anyone who does while I was in college, but there record in his win at the Nationals. this sport has to have a passion for are only two tracks in the United speed. Growing up, I liked watching States. In college, I tried to stay A few hours after his victory in Lake auto racing with my dad and my close to the one in Lake Placid.” Placid, he spoke with SPRI News brother. I had a go-cart when I was about his life and his career. a kid. I was convinced I was going

48 SPRI News: What is a typical year SPRI News: How did you come the Research Institute to other people of training and competition? into contact with Dr. Peter Millett and other athletes. It is the most “The season lasts from October until at The Steadman Clinic? professional and thorough medical March. We train most of the year. I’m “He was recommended by our team provider I’ve ever experienced.” taking about a two-month break after physician and by a teammate who this past 2013-2014 season and will had been treated by Dr. Millett.” SPRI News: How is your knee now? begin ramping it up again in mid-May. “It feels amazing—better than it did We train like track and field athletes.” [Dr. Millett continues to use techniques two years before surgery. I have no developed and refined at the Steadman restrictions, and my outcomes in “The Skeleton National Team trains at Philippon Research Institute.] skeleton have been great since the U.S. Olympic Training Center in the operation.” Colorado Springs, where we have living SPRI News: What was his diagnosis? quarters and access to the facilities, “My knee was beyond a point where SPRI News: You’ve overcome coaches, sports medicine services, it would heal on its own. The patellar some pretty serious obstacles to and sports nutritionists. It’s a six-day tendon had begun to break down and a become an Olympic athlete and week from 9:00 in the morning to third of it was torn off. I had scar tissue, national champion. What message approximately 4:00 in the afternoon.” damaged cartilage, and a hematoma do you have for young athletes who that had formed under the tendon.” might have Olympic aspirations? “During our summertime training, we “Stay positive and focused. Everyone really focus on the push-start. At SPRI News: Why did you choose who has ever been successful at this level, everyone is experienced. to have the surgery in Vail? this level has hit rock bottom at They all have the equipment, driving “I was looking for a positive prognosis some point. Keep your eye on the ability, and aerodynamics, but the following surgery. It was July and goal and be persistent. Don’t let push-start can make the difference.” the season was going to start in the down times keep you down. October. Eighteen months after Figure out a way to battle back.” (The push-start is when the that, I wanted to be ready for the competitor pushes his or her sled Olympics. Dr. Millett was positive from a standing start as fast as about me being able to compete possible over 30-35 meters—think not only in the upcoming season, of sprinting from the goal line but for the rest of my career.” to the 30-yard line on a football field—before getting onto the sled.) SPRI News: What procedures did he perform? SPRI News: What kinds of injuries “He removed the middle third of typically affect skeleton athletes? my patellar tendon, cleaned out “Our injuries get compared to those scar tissue, repaired the damaged in contact sports. Bumps, bruises, cartilage area, removed the hematoma, contusions, ice burns, and concussions, and drilled two holes through the but I’ve never had a concussion.” patella to increase blood flow.”

SPRI News: What was your SPRI News: How would you most serious injury? describe your overall experience? “During the 2011-2012 season, my “Absolutely amazing. Start to finish, I knee started hurting. It got to the was really impressed with how they point where I was having trouble approach things. They were thorough walking, going up and down stairs, in what they did. They were realistic and even sitting. I knew something about what needed to be done was wrong, but I continued after the surgery, but at the same competing. There really wasn’t much time very aggressive about getting I could do about it at the time. It me back to sports performance.” wasn’t an injury that happened during a skeleton event or training, “I would absolutely, hands-down, but it was a knee overuse injury.” recommend Dr. Millett, The Clinic, and

49 Department of BioMedical Engineering

COEN WIJDICKS, PH.D., DEPARTMENTAL DIRECTOR, SENIOR STAFF SCIENTIST; TRAVIS TURNBULL, PH.D., RESEARCH ENGINEER; MARY GOLDSMITH, M.SC., SENIOR ROBOTICS ENGINEER; MATTHEW RASMUSSEN, B.S., RESEARCH ENGINEER; BRADY WILLIAMS, B.S., RESEARCH ASSISTANT; ADRIANA SAROKI, B. S., RESEARCH ASSISTANT; DAVID CIVITARESE, B.A., RESEARCH ASSISTANT

The Department of BioMedical Engineering aims to help physicians improve their practice of orthopaedic sports medicine by conducting research that can be directly implemented to improve patient care. Our multidisciplinary laboratory utilizes quantitative, analytical, and innovative methods to answer questions that arise from collaboration with clinical care, world-renowned medical doctors, and educational programs.

By promoting and sustaining a highly collaborative environment, we conduct research with direct and immediate applications to orthopaedic care in order to ensure impact, and overall contribution These three AJSM articles, now patients receive evidence-based to the fields of orthopaedic and informally referred to at SPRI as treatment proven to result in superior sports medicine, and 4) community the ‘hat trick’ issue, illustrate that outcomes. By emphasizing bench- outreach programs that support top-ranked journals pay attention to-bedside research, we help active advances in medicine through to the research generated by the people from all walks of life and all innovative teaching and mentorship. Department, allowing our findings to athletes—from elite competitors to reach surgeons around the world. weekend warriors—maintain and ACCOMPLISHMENTS enhance their athletic performance, Additionally during 2013, two health, and quality of life. Since 2009, the yearly number of articles were published in the British publications produced has continued Journal of Sports Medicine, while GOALS AND METRICS to increase. In 2014, the Department others appeared in publications has already set a new record for such as the Journal of Orthopaedic In 2014, the Department of the number of articles accepted Research and the Journal of Bone BioMedical Engineering expanded for publication and submitted for and Joint Surgery and Knee Surgery, its collaboration with physicians, review. In 2013 alone, 22 articles Sports Traumatology, Arthroscopy. academic institutions, and corporate originating from research conducted entities around the world. Along with in the Department of BioMedical During the past year, 12 podium expansion and collaboration, the Engineering at SPRI were published and 17 poster presentations were success of research and education in high-impact factor journals. given at high-impact conferences, within the Department is measured Each publication was cited in the including those of the American by: 1) number of publications in high- prestigious National Library of Academy of Orthopaedic Surgeons, impact, peer-reviewed journals, 2) Medicine (PubMed). Notably, three the International Society for presentations given at both national of those articles were published in Hip Arthroscopy, the American and international conferences a single issue (December 2013) Orthopaedic Foot & Ankle Society, that attract diverse audiences of of American Journal of Sports the American Orthopaedic Society physicians and scientists, 3) awards Medicine—the journal ranked number for Sports Medicine, and the that validate research excellence, one in all of orthopaedic surgery. International Society of Arthroscopy,

50 Knee Surgery & Orthopaedic Sports • DePuy Synthes Trauma Division Medicine. Presentations were of DePuy Orthopaedics, Inc. given by BioMedical Engineering • Instituto Brasil De Tecnologias researchers to audiences around Da Sade in Brazil the world at conferences in the • Colorado State University United States of America, Canada, • Vail Valley Medical Center Europe, Africa, and South America. • Vail Mountain School • Eagle County School District Through a partnership with the • Arthrex, Inc. Department of BioMedical Engineering, • Össur, hf sports medicine fellows conducted • Smith & Nephew, Inc. research and received distinguished awards including the Albert Trillat OUTREACH Young Investigator’s Award (Dr. SPRI Research Featured in Sochi Jeff Padalecki), presented by the The Department of BioMedical Winter Games Issue of the British International Society of Arthroscopy, Engineering, in collaboration with Journal of Sports Medicine and Knee Surgery & Orthopaedic Sports all SPRI departments, participates International Olympic Committee Medicine, and the Richard N. Villar with the Education and Public Injury Prevention & Health Protection. Trainee Excellence in Clinical Outreach Committee (EPOC) (pg. Research Award (Dr. Jeff Nepple), 62) in coordinating SPRI laboratory The two articles are prominently presented by the International visits for students, speaking at displayed in the table of contents: Society for Hip Arthroscopy. Eagle County schools, mentoring “Epidemiology, identification, student projects, participating in treatment and return to play of Additionally, a research assistant school science fairs, and providing musculoskeletal-based ice hockey in the Department received the internships to young members of the injuries,” Robert F. LaPrade, Rachel prestigious Excellence in Research Vail Valley community. In addition, K. Surowiec, Ada N. Sochanska, Award (Nicholas Kennedy), presented through the EPOC Science Club Brandon S. Hentkowski, Brandie by the American Orthopaedic initiative, the Department provides M. Martin, Lars Engebretsen, Society for Sports Medicine. Eagle County high school students and Coen A. Wijdicks; an opportunity to conduct innovative Moreover, our efforts have expanded scientific research under the “Injuries in elite and recreational beyond the research and medical mentorship of science teachers and snowboarders,” Coen A. Wijdicks, realms and resonated throughout professional scientists. Combined, Brandon S. Rosenbach, Troy R. our local community. In January, the SPRI outreach programs reach Flanagan, Gillian E. Bower, Kelly Department Director Coen Wijdicks, an estimated 500 students annually. E. Newman, Thomas O. Clanton, Ph.D., was named a finalist for Young Lars Engebretsen, Robert F. Professional of the Year, sponsored PROJECTIONS LaPrade, and Tom R. Hackett. by the Vail Valley Partnership. The Department will continue to be COLLABORATIVE EFFORTS goal focused and pursue our passion for bench-to-bedside research through The Department collaborates with embodying the SMART model for goal local, national, and international achievement. Research initiatives will institutions, both academic be Specific, Measurable, Achievable, and corporate, including: Relevant, and Time-bound. Expanding collaboration with local, national, and • The United States Olympic Committee international institutions, continuing • American Orthopaedic education that benefits students, Foot & Ankle Society surgeons, and the Institute, and • Arthroscopy Association consistently aiming to align their work of North America with their core values will allow the • Ceterix Orthopaedics, Inc. Department to continue to achieve • University of Oslo, Norway our goals while pursuing and applying • Aarhus University in Denmark our passion for advancing patient • University of Queensland, Australia care through translational research.

51 Award- SURGICAL SKILLS LABORATORY Winning Paper Lead Article KELLY R. ADAIR, DIRECTOR in the Journal of Orthopaedic Research

“Improving Outcomes for Posterolateral Knee Injuries” by Robert F. LaPrade, M.D., Ph.D., is the lead article in the January 4, 2014, online and April print issue of the highly regarded Journal of Orthopaedic Research.

The research and subsequent publication resulted in the competitive and prestigious 2013 Orthopaedic Research and Education Foundation Clinical Research Award, referred as the “Orthopaedic Nobel Prize.”

“This award solidly validates our research strategy of defining the Kelly R. Adair anatomy, developing improved means of diagnosing a problem, redefining An integral part of sports medicine Year-to-date, we’ve hosted over 170 the clinically relevant biomechanics, surgery is mastery of operating labs, which include 28 for various developing improved radiographic abilities. Have you ever wondered medical device companies and the diagnostic measures, developing how an orthopaedic surgeon remaining 142 for our MD fellows, biomechanically validated ligament becomes proficient in his or her ATC fellows, and other internal staff. reconstructions, and then validating expertise of surgery? Just as pilots We can expect hundreds of surgeons these reconstructions in patient may use a flight simulator, imagine to come through our lab annually, outcomes studies,” said Dr. LaPrade. the surgical skills lab as a surgery and as many as 100 surgeons simulator for orthopaedic surgeons in a weekend. We are confident The posterolateral corner of the knee that precisely mimics the operating that increased surgeon training, stabilizes the joint. Posterior cruciate room, with the same equipment particularly as it relates to our current ligament injuries from external and instrumentation. The Surgical research concepts and techniques, trauma or hyperextension are difficult Skills Lab allows surgeons and correlates with improved outcomes for to diagnose and treat and can be other sports medicine professionals the patients in the operating room. debilitating and career-ending for to practice in an environment that gymnasts and other athletes who closely replicates the operating play soccer, basketball, or football. room. Our reputable surgeons and However, patient outcomes following facilities have attracted medical treatment have significantly improved specialists from all over the world to as a result of Dr. LaPrade’s research. train and advance their techniques through hands-on cadaveric specimen Dr. LaPrade’s collaborators on this paper training. We’re applying what we included Lars Engebretsen, M.D., Ph.D. have learned through our inventive (University of Oslo, Norway), Steinar research projects by educating Johansen, M.D. (University of Oslo), Chad surgeons in these new techniques. Griffith, M.D. (University of Minnesota), Benjamin Coobs, M.D. (University of Minnesota), and Andrew Geeslin, M.D. (Western Michigan University).

52 IMAGING RESEARCH

CHARLES P. HO, PH.D., M.D., DIRECTOR; COLEY GATLIN, M.D., GRIFFIN VISITING SCHOLAR FOR CLINICAL SPORTS MEDICINE; RACHEL SUROWIEC, M.SC., RESEARCH SCIENTIST; NICHOLAS JOHNSON, B.A., RESEARCH ASSISTANT; KATHERINE WILSON, M.SC., CONSULTANT

Imaging Research develops and evaluates noninvasive imaging techniques of the joints for the purpose of directing and monitoring clinical treatment and outcomes, and to enhance the clinical relevance of research conducted in the Center for Outcomes-Based Orthopaedic Research (COOR), the Department of BioMedical Research, and the Center for Translational and Regenerative Medicine Research.

In 2013, collaboration with national, international, public, and private research and academic entities continued to emerge as a focus of Charles P. Ho, Ph.D, M.D. Imaging Research efforts. Colorado State University, Siemens Medical TECHNOLOGY Imaging Research continued its Solutions USA, the University of work to quantify imaging diagnoses Queensland (Australia), and the The Imaging Research data registry of articular and soft tissues. That Commonwealth Scientific and continued to expand in 2013 to investigation has now been Industrial Organization in Brisbane, include approximately 300 new extended to include ligaments and Australia, are among the institutions cases per month. A tablet-based tendons, including the mapping currently coordinating their efforts data collection system developed of tendon properties in the rotator with the work of Imaging Research. by the Center for Outcomes-Based cuff and peroneal tendons in the Orthopaedic Research made the ankle. Imaging personnel have STAFF process less time consuming and also begun the process of mapping more efficient. Collection of MRI posterior the cruciate ligament (PCL) Imaging Research personnel data now includes all knee, shoulder, properties in patients with and and initiatives are supervised hip, and foot/ankle patients. without symptoms of PCL injuries. and directed by Dr. Ho. RESEARCH AND Siemens has continued to collaborate Imaging Research continues COLLABORATIVE EFFORTS with SPRI on quantitative magnetic to include and appreciate the resonance imaging (MRI) of articular contributions of the Griffin Visiting Imaging Research is in its third year cartilage, focusing on the knee and Scholar for Clinical Sports Medicine of screening young hockey players hip. Siemens was scheduled to meet MRI. This fellowship is sponsored with hip injuries, and the initiative with SPRI and Imaging Research by the Kenneth and Anne Griffin now includes skiers. The department personnel in 2014 to discuss Foundation. Coley Gatlin, M.D., is monitoring players and compares the development of new clinical began his service in this capacity the data collected from both groups. quantitative imaging initiatives. in August of 2013 and completed The information could help identify his fellowship in July 2014. movements in both sports that Efforts continued with Colorado State increase the risk of injuries or allow University to obtain histologic data Katherine Wilson, M.Sc., completed her detection of players’ predispositions (of microscopic structure tissue) work as a research engineer and now to certain abnormalities. obtained through studies of the hip. serves as an SPRI research consultant, focusing on Imaging Research.

53 CSU has conducted its research by analyzing specimens of cartilage waste products obtained from hip arthroscopies conducted by Dr. Marc Philippon at The Steadman Clinic. The histologic data obtained in specimens from surgical procedures can be compared with preoperative imaging biomarker values to further the understanding of and validate the noninvasive quantitative MRI of articular cartilage health. One phase of that research has been completed and the findings were to be submitted for publication in 2014. CSU has also collaborated with SPRI on other Visiting Scholars Program Brings imaging and mapping initiatives. German Physician to the Institute 2013 saw an extension of the Dr. Ulrich Spiegl: Destined for a Career in Sports collaboration with the University of Medicine from the Start Queensland and the Commonwealth Scientific and Industrial Research By Jim Brown, Ph.D. Organization (CSIRO) in Australia. Working with the institutions, Imaging Research is examining the role of MRI for modeling bone The series of events that resulted in Multiple Specialties and soft tissues. Bone modeling Ulrich Spiegl becoming a European has traditionally used computer Visiting Scholar at SPRI began two But there’s more. After earning his tomography (CT), but it cannot model generations before he was born. Doctor of Medicine degree from soft tissue and it involves the risk Technical University in Munich, he of exposure to radiation. The goal “My father and my grandfather were also received specialty certification of the new research is to find ways physicians,” says Dr. Spiegl. “I in orthopaedics and traumatology, to conduct bone modeling based on probably began thinking about being emergency medicine, special trauma MRI data that will be comparable and a doctor when I was nine or 10, so surgery, and sports medicine. consistent with CT data, but safer. that was pretty much my goal all of the time. It always seemed to be part Dr. Spiegl has always had a strong PROJECTIONS of the conversation in our family.” interest in research, as evidenced by more than 20 articles already in-press Imaging Research will continue its There were many other factors or published in the world’s leading efforts to expand the SPRI imaging that eventually led him to Vail and orthopaedic journals, including the data registry. It will also expand SPRI, where he began his one-year American Journal of Sports Medicine, its work with other departments at fellowship in January of 2013. He Spine, and the Journal of Elbow Surgery. SPRI, as well as with institutions had played soccer and tennis. He was around the world, to make its findings a mountain biker and skier. Although Arthrex Sponsorship regarding biomarker and other his work now begins before daylight quantitative imaging research more and often ends after dark, he still While participating in a fellowship consistent, more reproducible, and works out four or five days a week. program at the University of more applicable for clinical use. Leipzig, he read about SPRI’s He learned to speak English in European Visiting Scholar Program. Germany and improved his language The program was developed and skills during a two-year exchange sponsored by Arthrex, Inc., an student program at Raytown High orthopaedic medical device company. South, near Kansas City. He traveled Arthrex’s founder and president, to California, New York, and many Reinhold Schmieding, has had a states in-between, including long-time interest in education. Colorado. He loves America.

54 “We are proud to work with these Productive Year young visiting scholars,” says Robert F. LaPrade, M.D., Ph.D., director of the At SPRI, Dr. Spiegl spent approximately International Scholar Program. “These 70 percent of his time on research doctors are already making an impact projects and rotated among the on their respective home countries, various departments, but he worked and we expect them to become very closely with Dr. Millett on the leaders of a new generation investigations related to the shoulder. of sports medicine scientists.” “I was able to be involved with four Bump in the Road case studies, in addition to five or six additional research projects. The Then came a bump in Dr. Spiegl’s year 2013 was very productive for career path. By the time he got the Research Institute and I was the information, another physician fortunate to be a part of that effort.” had already been selected as the 2013 European Visiting Scholar. “One of the most important things I Visiting Scholar observed is the time physicians give No problem. The person selected their patients and the teamwork that had to cancel. Dr. Spiegl, with exists in the Research Institute,” says The European Visiting Scholar, the approval of his supervisor Dr. Spiegl. “If people have questions, developed and sponsored by Arthrex, at the University of Leipzig, they answer them. You don’t get Inc., has become the model for recommendations from prestigious the feeling of being rushed. If one our Visiting Scholars programs. physicians in Germany, and support of the fellows or visiting scholars from the Society for Arthroscopy has an idea, it is easier to move The SPRI Visiting Scholars programs and Joint Surgery, applied for the forward with that initiative than are sponsored by corporate and position. Two weeks later, back on at a bigger university or research individual donors. Our program the fast track, he was notified that he facility. Those are just a couple of the was developed in conjunction had been accepted, and four months many reasons that make Steadman with Arthrex, Inc., an orthopaedic later he began his work in Vail. Philippon such a different place.” medical device company. Arthrex’s founder and president, Reinhold Dr. Spiegl’s host family during his Dr. Spiegl completed his visiting Schmieding, has had a long- exchange student days in Missouri scholar term earlier this year and has time interest in education. Mr. had moved to Denver—close enough returned to the University of Leipzig. His Schmieding approached SPRI with for regular visits. Another sign. goal is to complete the requirements an idea for educating a European for a Ph.D., continue to improve his orthopaedic surgeon with interest “Once accepted, I did more surgical skills, and eventually return in research, committed to funding homework,” recalls Dr. Spiegl. “I to his hometown of Murnau, a city it, and the Visiting Scholars program knew about Dr. Steadman because near the southern border of Germany, was created. Mr.Schmieding of the work he had done with famous to practice sports medicine. commented, “Arthrex is pleased to soccer players and other athletes. contribute annually to the Institute. He is very well known in Europe. Something he was destined to do. The sponsoring of a European But I was equally impressed when I research fellow exemplifies Arthrex’s learned about the other physicians commitment to orthopaedic research and scientists at Steadman Philippon to advance knowledge of the global and the amount of information medical community and to helping provided by their research.” surgeons treat their patients better.” Arthrex, Inc., is annually sponsoring the European Visiting Scholars program, and due to its success, Mr. Jorge Paulo Lemann is supporting our Brazilian Visiting Scholar. “Dr. Spiegl says the research conducted at the These scholars learn new surgical Steadman Philippon Research Institute has had a techniques and conduct research, which is submitted for publication profound effect on the practice of sports medicine in leading orthopaedic journals. in Germany and other European countries.” 55 EDUCATION

WELCOME 2013–2014 Fellows

Front Row from Left to Right: Gregory Sawyer, M.D., Mark Hamming, M.D., Jared Johnson, M.D., Michael Ellman, M.D., Anthony Cerminara, M.D., Jeffrey Jaglowski, M.D., Tommy Haytmanek, M.D., Coley Gatlin, M.D., Second Row: Tom Hackett, M.D., J. Richard Steadman, M.D., Robert LaPrade, M.D., PhD, Peter Millett, M.D., MSc, Back Row: Marc Philippon, M.D., Tom Clanton, M.D.

Eight New Physicians Introduced

Each year, a select group of orthopaedic surgeons is chosen from a field of more than 160 to participate in 12 months of vigorous training in the Steadman Philippon Sports Medicine Fellowship Program. SPRI’s goal is to prepare them to be leaders in the field of orthopaedic sports medicine for the remainder of their careers. Many go on to hold high-level faculty positions at top medical schools.

Fellows and visiting scholars are given a unique opportunity to perform research in their respective areas of interest, including BioMedical Engineering, Outcomes-Based Orthopaedic Research, Imaging Research, and Translational and Regenerative Medicine Research. The Institute currently maintains a network of approximately 200 fellows and visiting scholars in communities around the world who serve in academic positions at leading universities and in private practices.

The following are brief summaries of the accomplishments of this year’s class of eight SPRI fellows.

56 Anthony Cerminara, M.D. team coverage for the Bulls, White and his wife, Nancy, are excited Sox, DePaul men’s and women’s to head back to the mountains. Dr. Cerminara graduated summa soccer teams, and area high school cum laude from Gannon University football teams. His wife, Julie, works Mark Hamming, M.D. in Erie, Pennsylvania. He attended as a pediatric nurse practitioner. Gannon on a football scholarship and Dr. Hamming graduated from was awarded with NCAA Division II Jeffrey R. Jaglowski, M.D. Northwestern University in his home All-Academic honors. He attended city of Chicago, with a B.S. in biology medical school at the State University Born and raised in Erie, Pennsylvania, and a minor in Spanish. While at of New York at Buffalo, where he Dr. Jaglowski attended Mercyhurst Northwestern, he was named MVP graduated first in his class. Dr. College in his hometown, where he and captain of the swim team, Cerminara then traveled to Miami to majored in sports medicine. Clinical received All-American honors, and pursue his residency in orthopaedic experience with collegiate athletics competed at the U.S. Olympic Trials. surgery at the University of Miami/ over those years led him to certification Dr. Hamming obtained his medical Jackson Memorial Hospital. While as an athletic trainer. He pursued degree at Rush Medical College, in Miami, Dr. Cerminara covered graduate studies at Pennsylvania where he discovered his interest the University of Miami football, State University in Hershey, where he in orthopaedics. Upon completing baseball, and basketball teams and received his Master of Science degree medical school, Mark traveled to the Marlins baseball team, and in anatomy and performed basic Duke University for an orthopaedics was team physician for a local high science and clinical cancer research residency. Throughout his residency, school. He also obtained advanced for which he received numerous grants. he provided physician coverage for training in musculoskeletal trauma He began medical school at Penn Duke’s many varsity athletic teams at Miami’s Ryder Trauma Center. Dr. State, where he continued to foster including football, basketball, and Cerminara has moved to Vail with interests in orthopaedic surgery and lacrosse. During residency, Dr. his wife, Sarah, a dermatologist who sports medicine. He was elected a Hamming’s research focused on ACL will be working at Vail Dermatology. member of Alpha Omega Alpha and grafts. Dr. Hamming has been joined graduated with honors. Dr. Jaglowski in Vail by his wife, Lesley, and their Michael B. Ellman, M.D. completed residency training at the eight-month-old son, George. Lesley Harvard Combined Orthopaedic Surgery Hamming, Ph.D., J.D., will start her Raised in Bloomfield Hills, Residency Program and served as chief career in Chicago as a patent attorney. Michigan, Dr. Ellman matriculated resident at the Massachusetts General at the University of Michigan for his Hospital. He looks forward to a great Gregory A. Sawyer, M.D. undergraduate studies and medical year in Vail with his wife, Heather. school training, where he graduated Dr. Sawyer grew up in the foothills with honors at both levels. As an Jared Johnson, M.D. of western Maine and attended undergraduate, he spent six months Colby College, where he double- studying Spanish language and Jared grew up in the mountains and majored in chemistry and biology culture in Seville, Spain. During skiing in Salt Lake City. He attended and graduated summa cum laude. medical school, Dr. Ellman earned the University of Utah, where he He attended Dartmouth Medical the Dean’s Commendation for studied business administration School, where he was inducted into Excellence in Clinical Skills and and finance. He then moved to New the Alpha Omega Alpha honor society. the Art of Medicine, and further York City and medical school at Following medical school, Dr. Sawyer developed his medical Spanish Weill Cornell Medical College, where completed his orthopaedic residency skills through work at a clinic in he was awarded the T. Campbell at Brown in Providence, Rhode Island. Guadalajara. Dr. Ellman completed Thompson Award for excellence in During his time at Brown he served his residency training at Rush orthopaedic surgery from the faculty as an assistant team physician for University Medical Center in Chicago, of The Hospital for Special Surgery. the men’s ice hockey and lacrosse Illinois. He published several research Following medical school, he moved teams, as well as for the Providence studies focused on articular cartilage to Los Angeles and completed his Bruins. While at Brown, he was biology and biochemical pathways residency training at UCLA. During involved in multiple areas of research, involved in osteoarthritis, and was residency, he was involved in including biomechanical analysis awarded the American Academy several research projects and was of different ACL and tibial spine of Orthopaedics Baxter Healthcare published in journals such as The reconstruction techniques, patient Scholarship for his work and interest Journal of Bone and Joint Surgery, outcomes following elbow arthroscopy, in hip cartilage preservation. Dr. Journal of Biomechanics, and the and an epidemiologic evaluation of Ellman also participated in sports Journal of Cellular Biochemistry. He Toradol use in athletes. Following

57 his residency, Dr. Sawyer completed (UTHSCSA), where he obtained his a fellowship in orthopaedic trauma medical degree. Next, he completed Where Are surgery at Rhode Island Hospital. Dr. a UNC-affiliated family medicine Sawyer and his wife, Annah, have a residency and primary care sports They Now? three-month-old daughter, Lylah. medicine fellowship in Greensboro, North Carolina. During his residency Foot and Ankle Fellow and fellowship, Dr. Gatlin provided The graduating class of 2012–2013 sports coverage for several local Steadman Philippon fellows is busy C. Thomas Haytmanek, Jr., M.D. high schools, Elon University, and establishing new careers in orthopaedics. the Burlington Indians (a farm Dr. Haytmanek graduated cum laude team of the Cleveland Indians). Tyler C. Collins, M.D. from Wake Forest University with a Dr. Collins has joined the practice at major in chemistry and a minor in Thinking the medical training was the CORE Institute in Mesa, Colorado. physics. He then attended Jefferson over, he moved to Kerrville, Texas, Medical College in Philadelphia, and joined a family medicine private Christopher Espinoza-Ervin, M.D. closer to his hometown of Bethlehem, practice. He transitioned to full- Dr. Espinoza-Ervin is practicing at Pennsylvania. After graduating cum time emergency room work after the McBride Orthopedic Hospital and laude at Jefferson, he completed realizing he enjoyed acute care Clinic in Oklahoma City, Oklahoma. his orthopaedic surgery residency medicine and sports medicine more at Duke University. During his than the geriatric and hospital- Scott C. Faucett, M.D., M.Sc. training he completed research based internal medicine required of Dr. Faucett is establishing his projects published in The Journal private practice. Dr. Gatlin provided practice at Medical Faculty of Bone and Joint Surgery, Clinical sideline sports coverage for several Associates at George Washington Orthopaedics and Related Research, local high schools and Schreiner University, Washington, D.C. and Foot and Ankle International. University. Also, he worked with one Dr. Haytmanek and his wife, Larisa, of the local orthopaedic surgeons Edmund “Edton” A. Ganal, M.D. have a young daughter, Abigail. to establish a Saturday morning Dr. Ganal has moved to Newport, sports clinic. Dr. Gatlin enjoyed his Rhode Island, and is practicing at the Griffin Visiting Scholar for work as medical director for a rural Naval Health Clinic New England. Clinical Sports Medicine MRI health clinic in Utopia, Texas, for four years. He served one-year terms Jared T. Lee, M.D. Coley Gatlin, M.D. as vice president and then president Dr. Lee is establishing his practice of the Kerr-Bandera Medical Society with the Big Horn Basin Bone and Dr. Coley Gatlin graduated cum in 2005 and 2006. He returned to Joint clinic in Cody, Wyoming. laude from the University of Texas at UTHSCSA for additional residency Austin with a B.A. in biochemistry training in diagnostic radiology and Jeffrey J. Nepple, M.D. and attended the University of Texas completed the training in June 2013. Dr. Nepple is establishing his sports Health Science Center at San Antonio medicine practice at Washington University Orthopaedics in St. Louis, Missouri.

Jack Skendzel, M.D. THANK YOU Dr. Skendzel has moved to Woodbury, Minnesota, and joined A special thank you to our sponsors who make the fellowship program possible. Summit Orthopedics. We’d like to recognize those individuals and foundations that support the entire fellowship class through the sponsorship of Academic Chairs. Nicholas A. Viens, M.D. Dr. Viens has joined the Lexington Chair sponsors of the 2013–2014 Steadman Philippon fellowship class are Mr. Clinic Orthopedics—Sports Medicine and Mrs. Lawrence Flinn, Mr. and Mrs. Peter Kellogg, Mr. and Mrs. Al Perkins, Center in Lexington, Kentucky. and Mr. and Mrs. Steven Read.

W. Sean Smith, M.D. Fellowship Benefactors fund the research of one fellow for one year. Each Dr. Smith is practicing at MedQuest benefactor is assigned a fellow who provides written reports and updates in Greenville, South Carolina. of his or her work. We extend our gratitude to the following individuals for their generous support: Mr. and Mrs. Milledge Hart, the Fred and Elli Iselin Foundation, Mr. and Mrs. Jay Precourt, and Mr. and Mrs. Stewart Turley.

58 EDUCATION

59 Gregory Sawyer, M.D.: First from the Brown University Residency Program to Serve as a Steadman Philippon Sports Medicine Fellow

By Jim Brown, Ph.D.

When growing up in the northeast Rhode Island Hospital. There he met playing and following sports, you his wife, Annah, who was a social are a Red Sox, Celtics, Patriots, and worker at the hospital with degrees Bruins fan. It’s not just a birthright— from Union College and Columbia. it’s a solemn, responsibility. “One of the greatest weeks of my life was Vail “The medical profession was the when the Red Sox beat the Yankees environment in which I was raised,” in the 2004 American League The next big career move for Dr. and says Gregory Sawyer, M.D., who playoffs,” he says. (Editor’s note: He Mrs. Sawyer brought them to Vail, just completed his year as a Sports doesn’t appear to be kidding.) when Greg was accepted into the Medicine Fellow at the Steadman Steadman Philippon Sports Medicine Philippon Research Institute. A Good Match Program. He was one of six chosen out of a highly competitive field of more “We lived in Wilton, Maine, but my Dr. Sawyer’s medicine and sports than 150 applicants, and the first mom was an administrative assistant interest began to merge during graduate of Brown’s residency program at the Franklin Memorial Hospital in medical school at Dartmouth, to be accepted into the program. Farmington, just a few miles away. where he was inducted into the Some of my earliest memories were Alpha Omega Honor Society. “I “I distinctly remember the interview functions at the hospital, and it was waivered a bit between radiology process, and it was very intimidating,” sort of understood that medicine was and orthopaedics, but being an says Dr. Sawyer. “I was sitting what I was going to do.” orthopaedic surgeon specializing in around a table with these giants sports medicine would give me the of orthopaedic medicine whose “The two physicians I was most opportunity to be in the office and the articles I had been reading for several frequently exposed to (because of operating room, as well as to get out years. Now they were asking about broken bones while playing sports) and take care of players and teams. my research, my writing, and my were my family physician and my The energy of orthopaedics plus the experiences, and telling me that they orthopaedic surgeon. The experiences connection with sports was a good would love to have me be a part of with my orthopaedic surgeon really match for me.” their program.” put him on a pedestal in my mind and made me think about taking care After graduating from medical school “When we learned that I had of athletes someday.” at Dartmouth, he began his residency been accepted, Annah and I at Brown University’s Alpert Medical were overwhelmed,” recalls Greg. Sports have also been a big part School. He served as an assistant “Steadman Philippon was our first of Dr. Sawyer’s life. He played team physician for the university’s choice, and we were thrilled with the basketball and soccer in high school, hockey and lacrosse teams and for the opportunity to work at SPRI and live and went on to play soccer at Colby Providence Bruins, a minor league in Vail. We both grew up Maine and College, where he graduated summa affiliate of the Bruins. Vermont, so we feel very much at cum laude with a double major in home in the mountains, although the chemistry and biology. Dr. Sawyer also completed a fellowship mountains there are not exactly the in orthopaedic trauma surgery at Rocky Mountains.”

60 Impressions “There is never a month that goes by of patients at the highest level. And that there is not at least one article finally, I had the opportunity to “I was incredibly impressed with written by doctors and scientists at establish relationships with the best how well things are organized here SPRI in high-impact orthopaedic orthopaedic surgeons in the world. and how much attention is given or sports medicine journals,” says Not just being able to learn from to detail by the entire staff,” says Dr. Sawyer. “Sometimes there are them, but to call them friends. It’s Greg. “You don’t get that at other two or three in the same journal. something that will be with me for a places. Everyone was welcoming and The number of quality research long time.” pleasant. It’s more than a workplace publications that come out of this relationship. They want to get to Institute is incredible.” On supporting SPRI: know you outside of the hospital. We “Donations fund programs and research were invited into the homes of Dr. Looking Back that are changing the way sports Steadman and the other Steadman medicine is being practiced. SPRI Clinic/SPRI physicians.” Dr. Sawyer has observations on other is essentially setting the medical aspects of the Research Institute. community’s guidelines for improving “One of the things that sets SPRI Here are a few of them. patient outcomes. It is impacting apart is the mentorship model,” says orthopaedics like no other institute.” Greg. “Whether in the office or the On the Surgical Skills Laboratory: operating room, you are there with “It is unmatched. You can’t go anywhere Looking Forward some of the best surgeons in the in the country that provides this level world. You get to see exactly how of access to a facility where you can Greg and Annah Sawyer returned Dr. Millett or Dr. Clanton run their practice surgical techniques at almost to New England in August. Their practices and you see them execute any hour of the day. I could call Kelly daughter, Lylah, will have a baby very specific skills in the operating Adair, the Surgical Skills Laboratory brother or sister later this year. room. At times, I had to kind of pinch director, and tell him that I would myself knowing that I was in the like to have a shoulder (for example) Dr. Sawyer has accepted a position at operating room at midnight finishing available the next day at 4:00. He the Maine Medical Center in Portland, up a case with Marc Philippon.” always said yes. And when I got down where he will serve as a sports there, there was a very good chance medicine physician and trauma Dr. Sawyer was one of the last fellows that Dr. LaPrade or one of the other surgeon. His goal is to eventually to complete a one-month rotation SPRI physicians was already there establish the first orthopaedic with Dr. Steadman before he retired working on a new surgical technique.” residency in the state of Maine. from his surgical practice. “I think his lasting legacy will be how he cared On the challenges of an Based on what he’s accomplished for the patient,” observes Greg. “I’ve SPRI Fellowship: as a medical student, resident, never worked at a place where the “It’s the unpredictable nature of orthopaedic surgeon, SPRI fellow, doctors and staff members are more the practice. It’s not just a nine- husband, father, and Red Sox fan, we invested in making patients better. to-five job. The doctors there are expect him to succeed. They take care of people as individuals, taking calls all the time from not just patients, and that is a college and professional coaches, reflection of Dr. Steadman’s influence.” trainers, athletes, and health care professionals. A high-profile athlete Research could be injured somewhere in the world on a Friday and we would be During his fellowship at SPRI, Dr. treating him or her the next day in Sawyer’s primary research was Vail. That’s just the way it works in conducted with Dr. Philippon this field. You have to be flexible.” and focused on different ways to repair the hip’s labrum (the ring of Lessons learned: cartilage around the socket of the “Three things stand out. First, I hip joint). The results of the study learned procedures and techniques in were presented during Dr. Sawyer’s the operating room and labs that are last week as a fellow and have now on the cutting edge of orthopaedics. been submitted to a peer-reviewed Second, I learned how to conduct a professional journal for publication. successful practice that takes care

61 Steadman Philippon’s Education and Public Outreach Program— EPOC—Develops the Next Generation of Home-Grown Scientists

By Jim Brown, Ph.D.

For more than 25 years, the in various EPOC programs. BioMedical Engineering and senior Steadman Philippon Research SPRI’s team of scientists offers tours, staff scientist, Mary Goldsmith, Institute has attracted physicians presentations, projects, science senior robotics engineer, and and scientists from all over the fairs, and internships. Here is how Kelly Adair, director of the world. Now, SPRI is growing EPOC’s program has involved more Surgical Skills Laboratory, with them in its own back yard. than 500 students, beginning the help of other SPRI staff with those in the fifth grade: members,” says Ms. Bryant. SPRI staff members have been involved in the Vail Valley community 5th Grade “The tours are very interactive for the since the Institute moved to Vail • Tours of SPRI laboratories students, who get to handle some of in 1990. That involvement reached the surgical tools and artificial bones a new level when the Institute’s 6th, 7th, 8th Grade as the scientists and physicians Education and Public Outreach • School visits and presentations by direct open discussions about topics Committee—EPOC—began a SPRI staff scientists such as surgical processes and how program to inspire elementary, • Mentored school science fairs research relates to those processes.” middle, and high school students • Classroom and assembly lectures to become more involved in the • Support for science-related projects SPRI Science Club fields of science, technology, (such as robotics competition) engineering, and mathematics. “The SPRI Science Club is an High School excellent gateway to research and SPRI Board member Senenne • SPRI Science Club orthopaedic education, as well Philippon chairs the committee, • Mentored scientific research as a professional experience for which also includes Coen Wijdicks, the students who are interested Mary Goldsmith, Lynda Sampson, SPRI Laboratory Tours in these fields,” says Bryant. John McMurtry, and Megan Bryant, in addition to eight Vail Valley educators. Three SPRI laboratory tour days are Two 9th-12th grade student set aside each year, and as many representatives from each EPOC’s three-tiered program has as 80 fifth graders participate in participating Eagle County school been developed in partnership the tours in a single day, according are selected by their respective with the Eagle County School to Megan Bryant, marketing science teachers. A theme is District, Vail Mountain School, and coordinator for The Steadman Clinic. chosen each year to guide the club’s Vail Christian Academy. During research, and each student team 2013-2014, four high schools, “The children are shown the full defines its own question within three middle schools, and four laboratory experience by Coen the scope of the club’s theme. elementary schools participated Wijdicks, Ph.D., director of

62 “Having world-class research scientists various topics and experiences. It is Who Wins? as a sounding board really gives the very rewarding to mentor the students students a sense of validation and and work with them on ways to better Through EPOC’s variety of activities, pride,” says Gabe Scherzer, a Vail understand the dynamics behind Steadman Philippon physicians and Mountain School science teacher. producing an authentic experiment.” scientists broaden their perspective by interacting with elementary, Students agree to commit a minimum Rachel Ledon, a student at Battle middle, and high school students. of two hours per week to their Mountain High School, has this science projects, and SPRI research to say about her SPRI Science Students get the opportunity to scientists are available throughout Club experiences: “The EPOC meet, question, and work with world the year to mentor the students. Science Club allowed me to further leaders in science, research, and The student teams are required to explore my passion for science and orthopaedic sports medicine. develop research timelines, submit research. With the help of SPRI’s progress reports, and make a final doctors and researchers, I was “We are grateful and appreciative report or presentation. Throughout challenged to explore questions for all The Steadman Clinic and the year, Science Club members and potential problems of skier the Steadman Philippon Research are given the opportunity to attend safety. I practiced the scientific Institute do for our students research lectures at SPRI in order method, incorporating experimental and community,” says Jason to expand their understanding procedures to find answers and Glass, Ed.D., superintendent of the research process. possible solutions to the problem.” of Eagle County Schools.

“Our young scientists hold the key to Through her involvement, Rachel Dr. Glass, other educational the future,” says Coen A Wijdicks, has become inspired to create administrators, and teachers Ph.D., director of the Department a similar program at her school throughout the Vail Valley area display of BioMedical Engineering at SPRI. that allows students to conduct the vision that makes interaction “These experiences allow students to research projects on their own. between the Steadman Philippon use the resources they are taught in Research Institute and future their science classes and to apply “The Science Club has taught scientists, engineers, mathematicians, scientific methods and techniques to me things I couldn’t learn in and physicians possible. a classroom,” she adds. Everyone wins.

63 PRESENTATIONS AND PUBLICATIONS

64 Publications and Presentations

In 2013, principal investigators and fellows published papers in scientific and medical journals and delivered presentations to a variety of professional and lay audiences worldwide.

2013 Publications Buchholz A, Martetschläger Clanton TO, Johnson NS, Matheny F, Siebenlist S, Sandmann G, LM. Outcomes Following Aga C, Rasmussen MT, Smith SD, Hapfelmeier A, Lenich A, Millett PJ, Microfracture in Grade 3 and Jansson KS, LaPrade RF, Engebretsen Stöckle U, Elser F. Biomechanical 4 Articular Cartilage Lesions L, Wijdicks CA. Biomechanical Comparison of Intramedullary of the Ankle. Foot Ankle Int. Comparison of Interference Screws Cortical Button Fixation and 2014;35(8):764-770. and Combination Screw and Sheath Interference Screw Technique for Devices for Soft Tissue Anterior Subpectoral Biceps Tenodesis. Clanton TO, Matheny LM, Jarvis HC, Cruciate Ligament Reconstruction Arthroscopy. 2013;29(5):845-853. Lewis EV, Ambrose CG. Quantitative on the Tibial Side. Am J Sports Analysis of Torsional Stiffness in Med. 2013;41(4):841-848. Brunkhorst JP, Giphart JE, LaPrade Supplemental One-Third Tubular RF, Millett PJ. Coracohumeral Plate Fixation in the Management Ames JB, Horan MP, Van der Distances and Correlation of Isolated Syndesmosis Injuries: Meijden OA, Leake MJ, Millett to Arm Rotation: An In Vivo A Biomechanical Study. Foot PJ. Association Between Acromial Three Dimensional Biplane Ankle Int. 2013;34(2):267-272. Index and Outcomes Following Fluoroscopy Study. Orthopaedic Arthroscopic Repair of Full-Thickness Journal of Sports Medicine. Clanton TO, Campbell KJ, Wilson Rotator Cuff Tears. J Bone Joint Surg 2013;1(2):2325967113496059. KJ, Michalski MP, Goldsmith Am. 2012;94(20):1862-1869. MT, Wijdicks CA, LaPrade RF. Campbell KJ, Michalski MP, Wilson Qualitative and Quantitative Anderson C, Kennedy N, LaPrade KJ, Goldsmith MT, Wijdicks CA, Anatomic Investigation of the RF. Posterolateral Knee. In: LaPrade RF, Clanton TO. The Lateral Ankle Ligaments for Surgical Doral MN, Karlson J, eds. Sports Ligament Anatomy of the Deltoid Reconstruction Procedures. J Bone Injuries: Prevention, Diagnosis, Complex of the Ankle: A Qualitative Joint Surg Am. 2014;96(12):e98. Treatment and Rehabilitation. 2nd and Quantitative Anatomical Study. J Ed. New York, NY: Springer-Verlag; Bone Joint Surg Am. 2014;96(8):e62. Clanton TO, Chacko AK, Matheny Epub ahead of print 2013. LM, Hartline BE, Ho CP. Magnetic Campbell KJ, Boykin RE, Wijdicks CA, Resonance Imaging Findings Boykin RE, Patterson D, Briggs KK, Giphart JE, LaPrade RF, Philippon of Snowboarding Osteochondral Dee A, Philippon MJ. Results of MJ. Treatment of a Hip Capsular Injuries to the Middle Talocalcaneal Arthroscopic Labral Reconstruction of Injury in a Professional Soccer Player Articulation. Sports Health. the Hip in Elite Athletes. Am J Sports with Platelet-Rich Plasma and 2013;5(5):470-475. Med. 2013;41(10):2296-2301. Bone Marrow Aspirate Concentrate Therapy. Knee Surg Sports Traumatol de Meijer PP, Karlsson J, LaPrade Boykin RE, Rodkey WG, Steadman Arthrosc. 2013;21(7):1684-1688. RF, Verhaar JA, Wijdicks CA. A JR. Acute Anterior Cruciate Guideline to Medical Photography: A Ligament Tear Surgery: Repair Clanton TO, Betech AA, Bott AM, Perspective on Digital Photography Versus Reconstruction – When? Matheny LM, Hartline B, Hanson TW, in an Orthopaedic Setting. Knee In: Sanchis-Alfonso V, Monllau JC, McGarvey WC. Complications After Surg Sports Traumatol Arthrosc. eds. The ACL-Deficient Knee. A Tendon Transfers in the Foot and 2012;20(12):2606-2611. Problem Solving Approach. London: Ankle Using Bioabsorbable Screws. Springer-Verlag; 2013:203-210. Foot Ankle Int. 2013;34(4):486-490. Domb BG, Philippon MJ, Giordano BD. Arthroscopic Capsulotomy, Boykin RE, Stull JD, Giphart Clanton TO, Jarvis HC, Matheny Capsular Repair, and Capsular JE, Wijdicks CA, Philippon MJ. LM, Hirose C, Defee J, McGarvey Plication of the Hip: Relation to Femoroacetabular Impingement in W. Evaluation of Incongruity Atraumatic Instability. Arthroscopy. a Professional Soccer Player. Knee of the Talonavicular Joint After 2013;29(1):162-173. Surg Sports Traumatol Arthrosc. Lateral Column Lengthening. Foot 2013;21(5):1203-1211. Ankle Int. 2013. In Press.

65 Ejnisman L, Philippon MJ, Geeslin AG, LaPrade RF. Anatomy Hapa O, Akşahin E, Erduran M, Davul Lertwanich, Pennock AT, Herzog and Biomechanics of the Lateral and S, Havitçioğlu H, LaPrade RF, Bozdağ MM, Briggs KK, Ho CP. Relationship Medial Sides of the Knee and the E, Sünbüloğlu E. The Influence of Between Femoral Anteversion Surgical Implications. In: Fanelli G, ed. Suture Material on the Strength and Findings in Hips with The Multiple Ligament Injured Knee: A of Horizontal Mattress Suture Femoroacetabular Impingement. Practical Guide to Management. New Configuration for Meniscus Repair. Orthopedics. 2013;36(3):e293-300. York, NY: Springer Science+Business Knee. 2013;20(6):577-580. Media; 2013:29-50. Ellman M, LaPrade RF. Posterior Hauer HJ, Boykin RE, Petit CJ, Hardt Cruciate Ligament. In: Doral MN, Geeslin A, LaPrade RF. Multiligament J, Millett PJ. Decision-Making in Karlson J, eds. Sports Injuries: Knee Injuries. In: DeLee JC, Treating Diaphyseal Clavicle Fractures: Prevention, Diagnosis, Treatment Drez D, Miller MD, eds. DeLee Is There Agreement Among Surgeons? and Rehabilitation. 2nd Ed. & Drez’s Orthopaedic Sports Results of a Survey on Surgeons’ New York, NY: Springer-Verlag; Medicine. 4th Ed. Elsevier; 2013. Treatment Preferences. J Shoulder Epub ahead of print 2013. Elbow Surg. 2014;23(2):e23- Geyer MR, Philippon MJ, Fagrelius 33. Epub Jul 6, 2013. Engebretsen L, Kennedy N, TS, Briggs KK. Acetabular Labral LaPrade RF. Ankle Injuries in Reconstruction with an Iliotibial Horan MP, Warth RJ, Briggs KK, Soccer. In: D’Hooghe P, Kerkhoffs Band Autograft: Outcome and Millett PJ. Functional Limitations G, eds. Springer; 2013. Survivorship Analysis at Minimum as Measured by the ASES Score 3-Year Follow-up. Am J Sports for Patients That Present with Engebretsen L, LaPrade RF, Surowiec Med. 2013;41(8):1750-1756. Rotator Cuff Pathology (SS-25). RK, Williams BT. Early Osteoarthritis. Arthroscopy. 2013;29(6) :e12-e13. In: Kon E, Berruto M, Condello V, Geyer MR, Rodkey WG, Steadman Peretti G, Ronga M, eds. Cartilagine JR. Clinical Relevance of Chondral Huleatt JB, Geeslin AG, LaPrade Istruzioni Per L’Uso. eBook; 2013. Lesions in the Treatment of the RF. Special Considerations ACL-Deficient Knee: Microfracture for Multiple Ligament Knee Engebretsen L, Suroweic R, Technique. In: Sanchis-Alfonso Injuries. In: Doral MN, Karlsson LaPrade RF. Surgical Techniques V, Monllau JC, eds. The ACL- J, eds. Sports Injuries: Prevention, in Cartilage Repair Surgery. In: Deficient Knee. A Problem Diagnosis, Treatment and Shetty AA, Kim SJ, Nakamura N, Solving Approach. London, UK: Rehabilitation. 2nd Ed. New Brittberg M, eds. Springer; 2013. Springer-Verlag; 2013:271-280. York, NY: Springer-Verlag; Epub ahead of print 2013. Gaskill T, Millett PJ. Snapping Giphart JE, Brunkhorst JP, Horn NH, Scapula Syndrome: Diagnosis and Shelburne KB, Torry MR, Millett PJ. Huleatt JB, LaPrade RF. The Role Management. J Am Acad Orthop Effect of Plane of Arm Elevation on of Osteotomy for Knee Cartilage, Surg. 2013;21(4):214-224. Glenohumeral Kinematics: A Normative Meniscus, and Ligament Injuries. Biplane Fluoroscopy Study. J Bone In: Doral MN and Karlsson J, eds. Gauger EM, Ludewig PM, Wijdicks Joint Surg. 2013;95(3):238-245. Sports Injuries: Prevention, Diagnosis, CA, Cole PA. Pre- and Postoperative Treatment and Rehabilitation. 2nd Function after Scapula Malunion Goldsmith MT, Jansson KS, Smith Ed. New York, NY: Springer-Verlag. Reconstruction: A Novel Kinematic SD, Engebretsen L, LaPrade Epub ahead of print 2013. Technique. J Orthop Trauma. RF, Wijdicks CA. Biomechanical 2013;27(8):e186-191. Comparison of Anatomic Single- and James EW, Williams BT, LaPrade Double-Bundle Anterior Cruciate RF. Stress Radiography for the Geeslin A, Huleatt J, LaPrade Ligament Reconstructions: An Diagnosis of Knee Ligament Injuries: RF. Multiligament Injuries. In: In Vitro Study. Am J Sports A Systematic Review. Clin Orthop Doral MN, Karlson J, eds. Sports Med. 2013;41(7):1595-1604. Relat Res. 2014;472(9):2644- Injuries: Prevention, Diagnosis, 2657. Epub 2013. Treatment and Rehabilitation. 2nd Griffith CJ, Wijdicks CA, LaPrade Ed. New York, NY: Springer-Verlag; RF. The Lateral Collateral Ligament Jansson KS, Michalski MP, Smith SD, Epub ahead of print 2013. and Posterolateral Corner. In: Bonnin LaPrade RF, Wijdicks CA. Tekscan M, Amendola NA, Bellemans J, Pressure Sensor Output Changes in MacDonald SJ, and Menetre J, eds. the Presence of Liquid Exposure. J The Knee Joint – Surgical Techniques Biomech. 2013;46(3):612-614. and Strategies. Paris, France: Springer-Verlag; 2012:31-42.

66 Jansson KS, Costello KE, O’Brien LaPrade RF, Pierce CM, Bahr R, Martetschläger F, Kraus TM, Hardy P, L, Wijdicks CA, LaPrade RF. A Engebretsen L, Cook J, Arendt E, Millet PJ. Arthroscopic Management Historical Perspective of PCL Mohtadi N. Acute Knee Injuries. of Anterior Shoulder Instability Bracing. Knee Surg Sports Traumatol In: Bahr R, ed. The International with Glenoid Bone Defects. Knee Arthrosc. 2013;21(5):1064-1070. Olympic Committee Manual of Surg Sports Traumatol Arthrosc. Sports Injuries. Hoboken, NJ: 2013;21(12):2867-2876. Johannsen AM, Anderson CJ, Wijdicks Wiley-Blackwell. 2012;357-400. CA, Engebretsen L, LaPrade RF. Martetschläger F, Michalski Radiographic Landmarks for Tunnel LaPrade RF, Devitt BM, Huleatt MP, Jansson KS, Wijdicks Positioning in Posterior Cruciate JB, Nepple JJ. A Novel Posterior CA, Millett PJ. Biomechanical Ligament Reconstructions. Am J Arthrotomy Approach for the Evaluation of Knotless Anterior Sports Med. 2013;41(1):35-42. Treatment of a Large Osteochondral and Posterior Bankart Repairs. Defect of the Posterior Aspect Knee Surg Sports Traumatol Kennedy N, Miller M, LaPrade of the Lateral Femoral Condyle Arthrosc. 2014;22(9):2228- RF. Surgical Approaches to the of the Knee. A Case Report and 2236. Epub Jul 5, 2013. Knee. In: Orthopaedic Surgical Technical Note. J Bone Joint Surg Approaches. Elsevier. 2013. Case Connect. 2013;3(4):e113. Martetschläger F, Padalecki JR, Millett PJ. Modified Arthroscopic Kennedy NI, Wijdicks CA, Goldsmith Martetschläger F, Rios D, Boykin McLaughlin Procedure for MT, Michalski MP, Devitt BM, RE, Millett PJ. Arthroscopic Treatment of Posterior Instability Årøen A, Engebretsen L, LaPrade Assessment of Anterior Glenoid Bone of the Shoulder with an Associated RF. Kinematic Analysis of the Loss and Treatment Options. In: Reverse Hill-Sachs Lesion. Knee Posterior Cruciate Ligament, Part Safran, Mazzocca and Nicholson, Surg Sports Traumatol Arthrosc. 1: The Individual and Collective eds. Rosemont, IL: American 2013;21(7):1642-1646. Function of the Anterolateral and Academy of Orthopaedic Surgeons. Posteromedial Bundles. Am J Sports 2013. ISBN 9780892039555. Matheny LM, Ockuly A, Steadman Med. 2013;41(12):2828-2838. JR, LaPrade RF. Posterior Meniscus Martetschläger F, Horan MP, Warth Root Tears: Associated Pathologies Khan M, Adamich J, Simunovic RJ, Millett PJ. Complications After to Assist as Diagnostic Tools. N, Philippon MJ, Bhandari M, Anatomic Fixation and Reconstruction Knee Surg Sports Traumatol Ayeni OR. Surgical Management of of the Coracoclavicular Arthrosc. Epub May 28, 2014. Internal Snapping Hip Syndrome: Ligaments. Am J Sports Med. A Systematic Review Evaluating 2013;41(12):2896-2903. McCarthy M, Camarda L, Monson Open and Arthroscopic Approaches. J, LaPrade RF. Combined Ligament Arthroscopy. 2013;29(5):942-948. Martetschläger F, Warth RJ, Millett Injuries of the Knee: Anterior Cruciate PJ. Instability and Degenerative Ligament / Posterolateral Corner and LaPrade RF, Surowiec RK, Arthritis of the Sternoclavicular Medial Collateral Ligament/Posterior Sochanska AN, Hentkowski Joint: A Current Concepts Review. Cruiciate Ligament- Diagnosis, BS, Martin BM, Engebretsen Am J Sports Med. 2014;42(4):999- Treatment, and Rehabilitation. In: L, Wijdicks CA. Epidemiology, 1007. Epub Aug 16, 2013. Johnson DH, Amendoloa NA, Barber Identification, Treatment, and F, Field L, Richmond J, Sgaglione Return to Play of Musculoskeletal- Martetschläger F, Gaskill TR, N, eds. Operative Arthroscopy. 4th Based Ice Hockey Injuries. Br J Millett PJ. Management of Clavicle Ed. Philadelphia, PA: Lippincott Sports Med. 2013;48(1):4-10. Nonunion and Malunion. J Shoulder Williams & Wilkins; 2013:856-867. Elbow Surg. 2013;22(6):862-868. Wijdicks CA, Philippon MJ, Civitarese McDonald JE, LaPrade RF. DM, LaPrade RF. A Mandated Change Martetschläger F, Buchholz A, Medial Collateral Ligament and in Goalie Pad Width Has no Effect on Sandmann G, Siebenlist S, Döbele S, Posteromedial Corner Repair and Ice Hockey Goaltender Hip Kinematics. Hapfelmeier A, Stöckle U, Millett PJ, Reconstruction. In: Cole BJ, Sekiya Clin J Sport Med. 2014;24(5):403- Elser F, Lenich A. Acromioclavicular JK, eds. Surgical Techniques of 408. Epub Dec 16, 2013. and Coracoclavicular PDS the Shoulder, Elbow, and Knee Augmentation for Complete AC Joint in Sports Medicine. 2nd Ed. Dislocation Showed Insufficient Philadelphia, PA: Elsevier; 2013. Properties in a Cadaver Model. Knee Surg Sports Traumatol Arthrosc. 2013;21(12):438-444.

67 McDonald JE, Herzog MM, Millett PJ, Schoenhal JY, Register Philippon MJ, Faucet SC, Briggs Philippon MJ. Return to Play B, Gaskill TR, van Deurzen DF, KK. Arthroscopic Hip Labral Repair. Following Hip Arthroscopy with Martetschläger F. Reconstruction Arthrosc Tech. 2013;2(2):e73-76. Microfracture in Elite Athletes. of Posterior Glenoid Deficiency Arthroscopy. 2013;29(2):330-335. Using Distal Tibial Osteoarticular Philippon MJ. Rethinking Allograft. Knee Surg Sports Traumatol Contraindications to Hip Arthroscopy. Millett PJ, Horan MP, Martetschläger Arthrosc. 2013;21(2):445-449. Audio-Digest Orthopaedics. F. The “Bony Bankart Bridge” 2013;36(21). ISSN 0271-132X. Technique for Restoration of Anterior O’Brien L, Kennedy N, LaPrade Shoulder Stability. Am J Sports RF. Beyond Basic Rehabilitation: Philippon MJ, Briggs KK, Carlisle JC, Med. 2013;41(3):608-614. Return to Football After ACL and Patterson DC. Joint Space Predicts MCL Surgery. In: Reider B, Davies THA After Hip Arthroscopy in Patients Millett PJ, Horan MP, Pennock A, G, Provencher M, eds. Orthopaedic 50 Years and Older. Clin Orthop Relat Rios D. Comprehensive Arthroscopic Rehabilitation of the Athlete: Getting Res. 2013;471(8):2492-2496. Management (CAM) Procedure: back in the Game. Elsevier; 2013. Clinical Results of a Joint- Philippon MJ. Labral Repair Preserving Arthroscopic Treatment Ockuly A, O’Brien L, LaPrade RF. and Rim Trimming. In: Sekiya for Young, Active Patients with Rehabilitation for Multiligament J, ed. Hip Arthroscopy and Open Advanced Shoulder Osteoarthritis. Injuries. In: Doral MN, Karlson J, eds. Surgery. Elsevier; 2013. In Press. Arthroscopy. 2013;29(3):440-448. Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation. 2nd Philippon MJ, Field MH, Briggs Millett PJ, Gaskill TR, Horan MP, Ed. New York, NY: Springer-Verlag. KK. Arthroscopy Rim Trimming van der Meijden OA. Technique Epub ahead of print 2013. and Labral Repair. Hip and Outcomes of Arthroscopic International. 2013. In Press. Scapulothoracic Bursectomy and Padalecki JR, Jansson KS, Smith Partial Scapulectomy. Arthroscopy. SD, Dornan GJ, Pierce CM, Wijdicks Philippon MJ, Souza BGS, Briggs KK. 2013;28(12):1776-1783. CA, LaPrade RF. Biomechanical Hip Arthroscopy for Structural Hip Consequences of a Complete Radial Problems. In: Berry DF, Lieberman HR, Millett PJ, Heurer H, Vaishnav S, Tear Adjacent to the Medial Menisucs eds. Surgery of the Hip. Elsevier; 2013. Gaskill TR, van der Meijden OA. ORIF Posterior Root Attachment Site: Mid-Shaft Clavicle: Plate. In: McCann In Situ Pull-Out Repair Restores Philippon MJ, Patterson D, Fagrelius PD, ed. Video Atlas of Shoulder Derangement of Joint Mechanics. Am T, Briggs KK. Hip Arthroscopy: Recent Surgery. Philadelphia, PA: Jaypee J Sports Med. 2014;42(3):699-707. Progress and Future Directions. In: Medical Brothers; 2013:186-187. Haddad FS, ed. The Young Adult Hip Petre BM, Smith SD, Jansson KS, in Sport. Springer; 2014. In Press. Millett PJ, Gaskill TR, Wierks de Meijer PP, Hackett TR, LaPrade C, Van der Meijden OA. Repair RF, Wijdicks CA. Femoral Cortical Philippon MJ, Souza BGS. Capsule Pectoralis Major Tendon. In: McCann Suspension Devices for Soft Pathology in the Hip. International PD, ed. Video Atlas of Shoulder Tissue Anterior Cruciate Ligament Society of Arthroscopy, Knee Surgery Surgery. Philadelphia, PA: Jaypee Reconstruction: A Comparative and Orthopaedic Sports Medicine Medical Brothers; 2013:212-213. Biomechanical Study. Am J Sports (ISAKOS) – European Society of Med. 2013;41(2):416-422. Sports Traumatology, Knee Surgery, Millett PJ, Mandell DB, O’Dell and Arthroscopy (ESSKA) Standard JM. Wealth Protection Planning Philippon MJ, Ho CP, Briggs KK, Terminology. 2013. In Press. for Orthopedic Surgeons & Sports Stull J, LaPrade RF. Prevalence of Medicine Specialists. Guardian Increased Alpha Angles as a Measure Philippon MJ, Patterson DC, Publishing, LLC; 2013. ISBN-13: of Cam-Type Femoroacetabular Briggs KK. Hip Arthroscopy and 978-0989216302. Impingement in Youth Ice Femoroacetabular Impingement Hockey Players. Am J Sports in the Pediatric Patient. J Millett PJ, Schoenahl JY, Allen Med. 2013;41(6):1357-1362. Pediatr Orthop. 2013;July- MJ, Motta T, Gaskill TR. An Aug; 33 Suppl 1:S126-30. Association Between the Inferior Humeral Head Osteophyte and Teres Minor Fatty Infiltration: Evidence for Axillary Nerve Entrapment in Glenohumeral Osteoarthritis. J Bone Joint Surg. 2013;22(2):215-221.

68 Philippon MJ, Briggs KK, Sawyer Rios D, Jansson KS, Martetschläger Smith SD, LaPrade RF, Jansson KS, G, Ommen D. Sports Medicine: F, Boykin RE, Millett PJ, Wijdicks CA. Arøen A, Wijdicks CA. Functional Hip Labral Tears. Online Normal Curvature of Glenoid Surface Bracing of ACL Injuries: Current Educational Training Resource. Can Be Restored When Performing State and Future Directions. Chinese Educational Project an Inlay Osteochondral Allograft: An Knee Surg Sports Traumatol Orthopaedic Website. Sept 2013. Anatomic Computed Tomographic Arthrosc. 2014;22(5):1131- Comparison. Knee Surg Sports 1141. Epub April 27, 2013. Philippon MJ, Garvey S, Patterson Traumatol Arthrosc. 2014;22(2):442- D, Briggs KK. Rehabilitation After 447. Epub Jan 24, 2013. Steadman JR, Briggs KK, Matheny Joint Preservation Surgery. In: LM, Ellis HB. Ten-Year Survivorship Clohisy JC, Della Valle CJ, Parvizi J, Rodkey WG. Meniscus Regeneration After Knee Arthroscopy in Patients eds. The Adult Hip, Volume 3: Hip with Biologic or Synthetic with Kellgren-Lawrence Grade 3 and Preservation Surgery. Philadelphia, Scaffolds. In: Cole BJ, Sekiya Grade 4 Osteoarthritis of the Knee. PA: Wolters Kluwer Health; 2015. JK, eds. Surgical Techniques of Arthroscopy. 2013;29(2):220-225. the Shoulder, Elbow, and Knee Pierce C, LaPrade RF. Standard in Sports Medicine. Philadelphia, Surowiec RK, Lucas EP, Ho CP. Terminology: Acute Muscle Injuries PA: Elsevier; 2013:625-632. Quantitative MRI in the Evaluation – Quadriceps Muscles. In: Kerkhoff of Articular Cartilage Health: G, Servien E, eds. Muscle Injuries, Sethi PM, Rajaram A, Beitzel Reproducibility and Variability Standard Terminology. 2013. K, Hackett TR, Chowaniec DM, with a Focus on T2 Mapping. Mazzocca AD. Biomechanical Knee Surg Sports Traumatol Pierce CM, LaPrade RF. ACL Injuries Performance of Subpectoral Arthrosc. 2014;22(6):1385- Combined with Lateral and Medial Biceps Tenodesis: A Comparison of 1395. Epub Oct 30, 2013. Knee Injuries. Acute Versus Chronic Interference Screw Fixation, Cortical Injury: What to Do. In: Sanchis- Button Fixation, and Interference Surowiec RK, Lucas EP, Fitzcharles Alfonso V, Monllau JC, eds. The Screw Diameter. J Shoulder Elbow EK, Petre BM, Dornan GJ, Giphart ACL-Deficient Knee: A Problem Surg. 2013;22(4):451-457. JE, LaPrade RF, Ho CP. T2 Solving Approach. London, UK: Values of Articular Cartilage in Springer-Verlag; 2013:293-310. Skendzel JG, Philippon MJ. Clinically Relevant Subregions Management of Labral Tears of the of the Asymptomatic Knee. Pierce CM, LaPrade RF, Wahoff M, Hip in Young Patients. Orthop Clin Knee Surg Sports Traumatol O’Brien L, Philippon MJ. Ice Hockey North Am. 2013;44(4):477-487. Arthrosc. 2014;22(6):1404- Goaltender Rehabilitation, Including 1414. Epub Nov 24, 2013. On-Ice Progression, After Arthroscopic Skendzel JG, Goljan P, Philippon MJ. Hip Surgery for Femoroacetabular Update on Hip Instability. Ortopedica Torry MR, Shelburne KB, Myers C, Impingement. J Orthop Sports e Traumatologica. 2013;64:1-13. Giphart JE, Pennington WW, Krong Phys Ther. 2013;43(3):129-141. JP, Peterson DS, Steadman JR, Woo Smith SD, Jansson KS, Philippon SL. High Knee Valgus in Female Pierce CM, O’Brien L, Griffin LW, MJ, LaPrade RF, Wijdicks CA. Subjects Does Not Yield Higher Knee LaPrade RF. Posterior Cruciate Fracture Mechanics of the Femoral Translations During Drop Landings: Ligament Tears: Functional and Neck in a Composite Bone Model: A Biplane Flouroscopic Study. J Postoperative Rehabilitation. Knee Effects of Platen Geometry. J Orthop Res. 2013;31(2):257-267. Surg Sports Traumatol Arthrosc. Biomech. 2014;47(2):602- 2013;21(5):1071-1084. 606. Epub Nov 26, 2013. van der Meijden OA, Wijdicks CA, Gaskill TR, Jansson KS, Millett PJ. Rasmussen M, LaPrade C, LaPrade Smith SD, Wijdicks CA, Jansson Biomechanical Analysis of Two- RF. Posteromedial Knee. In: KS, Boykin RE, Martetschlaeger Tendon Posterosuperior Rotator Doral MN, Karlson J, eds. Sports F, de Meijer PP, Millett PJ, Hackett Cuff Tear Repairs: Extended Linked Injuries: Prevention, Diagnosis, TR. Stability of Mid-Shaft Clavicle Repairs and Augmented Repairs. Treatment and Rehabilitation. 2nd Fractures After Plate Fixation Versus Arthroscopy. 2013;29(1):37-45. Ed. New York, NY: Springer-Verlag; Intramedullary Repair and After Epub ahead of print 2013. Hardware Removal. Knee Surg Sports Traumatol Arthrosc. 2014;22(2)448- 455. Epub Jan 31, 2013.

69 Viens NA, Wijdicks CA, Campbell Wijdicks CA, Kennedy NI, Goldsmith Wijdicks FJ, Houwert RM, Millett PJ, KJ, LaPrade RF, Clanton TO. MT, Devitt BM, Michalski MP, Verleisdonk EJ, Van der Meijden OA. Anterior Talofibular Ligament Årøen A, Engebretsen L, LaPrade Systematic Review of Complications Ruptures, Part 1: Biomechanical RF. Kinematic Analysis of the After Intramedullary Fixation for Comparison of Augmented Broström Posterior Cruciate Ligament, Part Displaced Midshaft Clavicle Fractures. Repair Techniques with the Intact 2: A Comparison of Anatomic Can J Surg. 2013;56(1):58-64. Anterior Talofibular Ligament. Am Single- Versus Double-Bundle J Sports Med. 2014:42(2):405- Reconstruction. Am J Sports 411. Epub Nov 25, 2013. Med. 2013;41(12):2839-2848. 2013 Presentations

Clanton TO, Viens NA, Campbell Wijdicks CA, Michalski MP, Aga C, Rasmussen M, Smith KJ, LaPrade RF, Wijdicks CA. Rasmussen MT, Goldsmith MT, S, Jansson K, Petre B, LaPrade Anterior Talofibular Ligament Kennedy NI, Lind M, Engebretsen R, Engebretsen L, Wijdicks Rupture Part 2: Biomechanical L, LaPrade RF. Superficial Medial C. Biomechanical Comparison Comparison of Anterior Talofibular Collateral Ligament Anatomic of Eight Soft Tissue Devices for Ligament Semitendinosus Allograft Augmented Repair Versus Anatomic Tibial Fixation of Anterior Cruciate Reconstruction to the Intact Reconstruction: An In Vitro Ligament Reconstruction Grafts. Ligament. Am J Sports Med. 2014; Biomechanical Analysis. Am J Sports Poster. Orthopaedic Research 42(2):412-416. Epub Nov 26, 2013. Med. 2013;41(12):2858-2866. Society (ORS) Annual Meeting, San Antonio, TX, January 2013. Waldrop NE 3rd, Zirker CA, Wijdicks CA, Balldin BC, Jansson Wijdicks CA, LaPrade RF, Clanton KS, Stull JD, LaPrade RF, Philippon Aga CA, Rasmussen M, Smith S, TO. Radiographic Evaluation of MJ. Cam Lesion Femoral Osteoplasty: Jansson KS, LaPrade RF, Engebretsen Plantar Plate Injury: An In Vitro In Vitro Biomechanical Evaluation of L, Wijdicks CA. Biomechanical Biomechanical Study. Foot Ankle Iatrogenic Femoral Cortical Notching Comparison of 8 Soft Tissues Int. 2013;34(3):403-408. and Risk of Neck Fracture. Arthroscopy. Devices for Tibial Fixation of Anterior 2013;29(10):1608-1614. Cruciate Ligament Reconstruction Warth RJ, Martetschläger F, Gaskill Grafts. Podium. 9th Biennial TR, Millett PJ. Acromioclavicular Joint Wijdicks CA, Anavian J, Hill BW, International Society of Arthroscopy, Separations. Curr Rev Musculoskelet Armitage BM, Vang S, Cole PA. The Knee Surgery and Orthopaedic Med. 2013;6(1):71-78. Assessment of Scapular Radiographs: Sports Medicine (ISAKOS) Congress, Analysis of Anteroposterior Toronto, Canada, May 2013. Warth RJ, Briggs KK, Dornan Radiographs of the Shoulder and GJ, Horan MP, Millett PJ. Patient the Effect of Rotational Offset on Balldin BC, Wijdicks CA, Stull Expectations Before Arthroscopic the Glenopolar Angle. Bone Joint J, Jansson K, Philippon MJ. Effect Shoulder Surgery: Correlation with J. 2013;95-B(8):1114-1120. of Arthroscopic Notching During Patients’ Reasons for Seeking Osteoplasty of CAM Lesions for Treatment. J Shoulder Elbow Wijdicks CA, Rosenbach BS, the Treatment of Femoroacetabular Surg. 2013;22(12):1676-1681. Flanagan TR, Bower GE, Newman Impingement: A Biomechanical KE, Clanton TO, Engebretsen L, Analysis. Podium. ORS Annual Meeting, Werpy NM, Ho CP, Garcia EB, LaPrade RF, Hackett TR. Injuries in San Antonio, TX, January 2013. Kawcak CE. The Effect of Varying Elite and Recreational Snowboarders. Echo Time Using T2-Weighted FSE Br J Sports Med. 2014;48(1):11- Balldin BC, Wijdicks CA, Stull Sequences on the Magic Angle 17. Epub Nov. 26, 2013. J, Jansson K, Philippon MJ. Effect in the Collateral Ligaments Effect of Arthroscopic Notching of the Distal Interphalangeal Wijdicks CA, Philippon MJ, Civitarese During Osteoplasty of CAM Joint in Horses. Vet Radiol DM, LaPrade RF. A Mandated Change Lesions for the Treatment of Ultrasound. 2013;54(1):31-35. in Goalie Pad Width Has No Effect on Femoroacetabular Impingement: A Ice Hockey Goaltender Hip Kinematics. Biomechanical Analysis. Podium. Clin J Sports Med. 2014;24(5):403- 9th Biennial ISAKOS Congress, 408. Epub Dec 16, 2013. Toronto, Canada, May 2013.

70 Briggs KK, Matheny LM, Rodkey WG, Clanton TO. Internal Brace. 2nd Clanton TO, Waldrop N, Wijdicks CA, Steadman JR. Factors Associated Annual Desert Mountain Medical Jansson KS, LaPrade R. Biomechanical with Repeat Meniscus Surgery in Foot and Ankle Symposium, Strength of Fixation of the Anterior Patients Undergoing Suture Meniscus Vail, CO, January 2013. Talofibular Ligament with Suture Repair. Podium. 9th Biennial ISAKOS Versus Suture Anchor. AAOS Annual Congress, Toronto, Canada, May 2013. Clanton TO. Lateral Ankle Meeting, Chicago, IL, March 2013. Reconstruction. 2nd Annual Desert Briggs KK, Doran G. Measuring Mountain Medical Foot and Ankle Clanton TO, Matheny LM. Outcomes General Health: Conversion of Data Symposium, Vail, CO, January 2013. Following Lateral Ankle Ligament Repair Forms SF-12 to VR12 Scoring. vs. Reconstruction. AAOS Annual ePoster. 9th Biennial ISAKOS Clanton TO, Matheny LM, Briggs Meeting, Chicago, IL, March 2013. Congress, Toronto, Canada, May 2013. KK. Foot Pathologies Associated with Decreased Activity Levels. ePoster. Clanton TO, Waldrop N, Zirker Briggs KK, Philippon MJ, Herzog M, 9th Biennial ISAKOS Congress, C, Wijdicks CA, LaPrade RF. Goljan P. Quality of Life Assessment Toronto, Canada, May 2013. Radiographic Evaluation of for Non-Operative Treatment Versus Plantar Plate Injury: An In Vitro Arthroscopy for Femoroacetabular Clanton TO, Briggs KK, Matheny LM. Biomechanical Study. AAOS Annual Impingement. Podium. 9th Psychometric Properties of Commonly Meeting, Chicago, IL, March 2013. Biennial ISAKOS Congress, Used Outcomes Scores in Patients Toronto, Canada, May 2013. with Foot and Ankle Injuries. ePoster. Clanton TO, Viens NA, Wijdicks 9th Biennial ISAKOS Congress, CA, Campbell KJ, LaPrade Ho CP, Briggs KK. Sensitivity and Toronto, Canada, May 2013. RF. Biomechanical Comparison Specificity of 3T MRI in Detecting of Augmented Broström Repair Tears of the Ligamentum Teres. Clanton TO. ICL: Management of Techniques to the Intact Anterior ePoster. 9th Biennial ISAKOS Complex Foot and Ankle Injuries in Talofibular Ligament. Poster. Congress, Toronto, Canada, May 2013. the Athlete. American Academy of American Orthopaedic Foot & Ankle Orthopaedic Surgeons (AAOS) Annual Society (AOFAS) Annual Meeting, Briggs KK, Philippon MJ, Goljan P, Meeting, Chicago, IL, March 2013. Hollywood, FL, July 2013. Devitt BM, Peixoto LP. Comparison of Radiographic Hip Joint Space Clanton TO. ICL: The Land of Clanton TO, Matheny LM, Briggs in Weight-Bearing and Supine Ligaments: Navigating Sprains, KK. Do Outcome Measures Differ Radiographs in Patients with Hip Strains, and Ruptures About the by Ankle Pathology? ePoster. Pathology. Poster. Osteoarthritis Foot and Ankle. AAOS Annual Arthroscopy Association of North Research Society International Meeting, Chicago, IL, March 2013. America (AANA) Annual Meeting, (OARSI) World Congress, San Antonio, TX, April 2013. Philadelphia, PA, April 2013. Clanton TO. Symposium: Inside Job: The Nuts and Bolts of Sports Clanton TO, Matheny LM, Briggs Briggs KK, Steadman JR, Rodkey Injury Management. AAOS Annual KK. Foot Pathologies Associated WG. Patello-Femoral Cartilage: Meeting, Chicago, IL, March 2013. with Decreased Activity Levels. Patients with Grade IV Chondral ePoster. AANA Annual Meeting, Defects of the Patella Have Increased Clanton TO. Arthroscopic Ankle San Antonio, TX, April 2013. Disability. OARSI World Congress, Fusions. Arthrex Advanced Orthopedic Philadelphia, PA, April 2013. Surgeon Foot and Ankle Arthroscopy Clanton TO, Matheny LM, Hartline BE. Course, Vail, CO, April 2013. Outcomes Following Lateral Ankle Briggs KK, Steadman JR, Rodkey WG. Ligament Repair vs. Reconstruction. The Effect of Lesion Size on Clinical Clanton TO. Cutting Edge Use ePoster. AANA Annual Meeting, Outcomes After Microfracture: 2- to of Arthroscopy in Foot and Ankle San Antonio, TX, April 2013. 8-Year Follow-Up Study. OARSI World Surgery. Arthrex Advanced Orthopedic Congress, Philadelphia, PA, April 2013. Surgeon Foot and Ankle Arthroscopy Clanton TO. Ligamentous Injuries Course, Vail, CO, April 2013. of the Ankle – Lateral: Anatomic Clanton TO. Ankle Arthroscopy. Reconstruction with Tendon 2nd Annual Desert Mountain Clanton TO. Posterior Endoscopy/ Graft. AOFAS Fall Course: Sports Medical Foot and Ankle Symposium, Arthroscopy. Arthrex Advanced Injuries of the Foot and Ankle, Vail, CO, January 2013. Orthopedic Surgeon Foot and Ankle Houston, TX, October 2013. Arthroscopy Course, Vail, CO, April 2013.

71 Clanton TO. Miscellaneous Topics Espinoza-Ervin C, Horan MP, Goldsmith M, Jansson K, Smith S, in Sports Medicine: Ankle Fractures Warth RJ, Millett PJ. Prospective Engebretsen L, LaPrade R, Wijdicks in Athletes – Is There a Difference? Comparison of the Effectiveness C. Functional Equivalence of AOFAS Fall Course: Sports Injuries of an All Knotless Versus Knotted Anatomic Single- and Double-Bundle of the Foot and Ankle, Houston, TX, Transosseous Equivalent Double-Row ACL Reconstructions: An In Vitro October 2013. Repair Technique in the Treatment Study. Poster. ORS Annual Meeting, of Rotator Cuff Tears: A Comparative San Antonio, TX, January 2013. Clanton TO. Arthroscopic Ankle Cohort Study. 30th Annual Congress Fusions: New PowerRasp Technology, of AGA - Society for Arthroscopy and Goldsmith M, Jansson K, Smith S, Hand Instruments, and Precision Joint Surgery, Wiesbaden, Germany, Engebretsen L, LaPrade R, Wijdicks Screw Placement with GPS. Arthrex September 2013. CA. Functional Equivalence of Advanced Foot and Ankle Surgeon Anatomic Single- and Double-Bundle Arthroscopy Course, Vail, CO, Faruqui S, Wijdicks CA, Foad A. The ACL Reconstructions: An In Vitro December 2013. Accuracy of the Physical Exam Versus Study. Podium. 9th Biennial ISAKOS Arthroscopy in the Detection of Congress, Toronto, Canada, May 2013. Clanton TO. Cutting Edge Use Subscapularis Tendon Injury. Poster. of Arthroscopy in Foot and Ankle American Orthopaedic Society for Horan MP, Warth RJ, Briggs KK, Millett Surgery: New Concepts and Sports Medicine (AOSSM) Annual PJ. Association Between Rotator Cuff Challenges. Arthrex Advanced Foot Meeting, Chicago, IL, July 2013. Pathology and the Disabilities of the and Ankle Surgeon Arthroscopy Arm, Shoulder and Hand (Quick-DASH) Course, Vail, CO, December 2013. Fripp J, Surowiec RK, Lucas EP, Score: Preoperative Factors That Engstrom C, Shakes C, Schwarz Influence Subjective Disability. Poster. Clanton TO. ICL Course: Problems of R, Ho CP, Crozier S. Automated 30th Annual Congress of AGA - Society the Foot and Ankle and How to Tackle Cartilage Morphometric and T2 for Arthroscopy and Joint Surgery, Them Using the Scope. AANA Annual Mapping using 3D-FSE MRI at 3T. Wiesbaden, Germany, September 2013. Meeting, San Antonio, TX, April 2013. The International Society for Magnetic Resonance in Medicine (ISMRM), Horan MP, Warth RJ, Briggs KK, Clanton TO. Osteochondral Lesions of Salt Lake City, UT, April 2013. Millett PJ. Association Between the Talus. AANA Annual Meeting, San Rotator Cuff Pathology and the Antonio, TX, April 2013. Giphart JE, Wilson K, Kagnes K, Disabilities of the Arm, Shoulder Millett PJ. Alterations in Glenohumeral and Hand (Quick-Dash) Score: Clanton TO. Anterior Ankle Soft Kinematics in Patients with Rotator Preoperative Factors that Influence Tissue and Bony Impingement. Smith Cuff Tears Using Biplane Fluoroscopy. Subjective Disability. ePoster. 9th and Nephew Master’s Course: Foot Podium. ORS Annual Meeting, San Biennial ISAKOS Congress, Toronto, and Ankle Arthroscopy, Vail, CO, Antonio, TX, January 2013. Canada, May 2013. February 2013. Giphart JE, Wilson K, Kagnes Horan MP, Warth RJ, Briggs KK, Clanton TO. Arthroscopic Treatment K, Millett PJ. Hip and Pelvic Millett PJ. Association Between in Conjunction with Fracture Care Kinematics in Cam and Pincer FAI Rotator Cuff Pathology and of the Ankle. Smith and Nephew Patients During Constrained and QuickDASH Score: Preoperative Master’s Course: Foot and Ankle Unconstrained Squatting. Podium. Factors That Influence Disability. Arthroscopy, Vail, CO, February 2013. 9th Biennial ISAKOS Congress, ePoster. AANA Annual Meeting, San Toronto, Canada, May 2013. Antonio, TX, April 2013. Clanton TO. New Strategies for Foot and Ankle Injuries. Society Giphart JE, Costello K, Decker M, Horan MP, Warth RJ, Briggs KK, of Military Orthopaedic Surgeons Souza B, Philippon MJ. Alterations in Millett PJ. Functional Limitations (SOMOS) Annual Meeting, Vail, CO, Glenohumeral Kinematics in Patients as Measured by the ASES Score for December 2013. with Rotator Cuff Tears Using Biplane Patients That Present with Rotator Fluoroscopy. Podium. 9th Biennial Cuff Pathology. Podium. AANA Clanton TO. The History & ISAKOS Congress, Toronto, Canada, Annual Meeting, San Antonio, TX, Current State of Lateral Ligament May 2013. April 2013. Reconstruction of the Ankle. Steadman Clinic Grand Rounds, Vail, CO, January 2013.

72 Johannsen A, Anderson C, Wijdicks LaPrade RF. An Approach to Lateral LaPrade RF. Surgical Options for CA, Engebretsen L, LaPrade RF. and Posterolateral Injuries. Arthrex Osteoarthritis. ISAKOS Sports Radiographic Landmarks for Tunnel Symposium, Bergen, Norway, Rehabilitation Course: Global Positioning in PCL Reconstructions. September 2013. Perspectives for the Physical Podium. AAOS Annual Meeting, Therapist and Athletic Trainer, Toronto, Chicago, IL, March 2013. LaPrade RF. Knee Dislocations Canada, May 2013. and Multiligament Injuries. Arthrex LaPrade C, Jansson K, Dornan Symposium, Bergen, Norway, LaPrade RF, Philippon MJ, Nepple G, Smith S, Wijdicks CA, LaPrade September 2013. JJ. The Effect of an Acetabular RF. Biomechanical Comparison of Labral Tear, Repair, Resection, and Lateral Meniscus Posterior Horn LaPrade RF. Meniscal Allograft: Reconstruction on the Hip Fluid Root Avulsions and Radial Tears Who Should Have Graft, Suture, or Seal. International Society for Hip and In Situ Pull-Out Repairs of Root Resection? Arthrex Symposium, Arthtoscopy (ISHA) Annual Meeting, Avulsions and Radial Tears. Poster. Bergen, Norway, September 2013. Munich, Germany, October 2013. ORS Annual Meeting, San Antonio, TX, January 2013. LaPrade RF. Meniscal Root Tears. LaPrade RF. ACL Revisions. Arthrex Symposium, Bergen, Norway, Leddskader og arthroskopisk kirurgi. LaPrade C, Jansson K, Dornan September 2013. Bløtdelsskader, Hafjell, Norway, G, Smith S, Wijdicks CA, LaPrade January 2013. RF. Altered Tibiofemoral Contact LaPrade RF. Outcomes of Acute Mechanics Due to Lateral Meniscus Repairs vs. Reconstructions for LaPrade RF. Meniscal Injuries. Posterior Horn Root Avulsions and PLC Injuries. 9th Biennial ISAKOS Leddskader og arthroskopisk kirurgi. Radial Tears Can Be Restored with Congress: Evidence-Based Treatment Bløtdelsskader, Hafjell, Norway, In Situ Pull-Out Repairs. Poster. 9th of Collateral Ligaments Symposium, January 2013. Biennial ISAKOS Congress, Toronto, Toronto, Canada, May 2013. Canada, May 2013. LaPrade RF. Surgical Treatment of LaPrade RF. Altered Tibiofemoral Acute & Chronic Medial Knee Injuries. LaPrade RF, Padalecki JR, Jansson Contact Mechanics Due to Lateral Leddskader og arthroskopisk kirurgi. KS, Dornan GJ, Smith SD, Wijdicks Meniscus Posterior Horn Root Bløtdelsskader, Hafjell, Norway, CA. Biomechanical Consequences Avulsions and Radial Tears Can January 2013. of a Complete Radial Tear Adjacent Be Restored with In Situ Pull-Out to the Medial Meniscus Posterior Repairs. ePoster. 9th Biennial LaPrade RF. Improving Outcomes Root Attachment Site. AAOS Annual ISAKOS Congress, Toronto, Canada, for Posterolateral Corner Injuries. Meeting, Chicago, IL, March 2013. May 2013. Mississippi Sports Medicine and Orthopaedic Center, Jackson, MS, LaPrade RF, Johannsen AM, Anderson LaPrade RF, Engebretsen L, Levy B, May 2013. CJ, Wijdicks CA, Engebretsen L. Lind M, Wijdicks CA. Evidence-Based Radiographic Landmarks for Tunnel Treatment of Collateral Ligaments. LaPrade RF. Life Lessons I Have Positioning in PCL Reconstructions. 9th Biennial ISAKOS Congress, Learned in Medicine. Mississippi AAOS Annual Meeting, Chicago, IL, Toronto, Canada, May 2013. Sports Medicine and Orthopaedic March 2013. Center, Jackson, MS, May 2013. LaPrade RF. Symposium: Evidence- LaPrade RF. Biologic Arthroplasty Based Treatment of Collateral LaPrade RF. PCL Current Concepts. (Meniscal and Osteochondral Ligaments. Chairperson. 9th Biennial Mississippi Sports Medicine and Transplants). Arthrex Surgical Skills ISAKOS Congress, Toronto, Canada, Orthopaedic Center, Jackson, MS, Master’s Knee Course, Vail, CO, May 2013. May 2013. March 2013. LaPrade RF. Program Chairman. 9th LaPrade RF. How to Build a Focused LaPrade RF. Posterolateral Corner and Biennial ISAKOS Congress, Toronto, Research Program: The Oslo- MCL Reconstruction/Repair. Arthrex Canada, May 2013. Minnesota-Vail Example. Norwegian Surgical Skills Master’s Knee Course, School of Sport Sciences and Vail, CO, March 2013. LaPrade RF. Combined Anatomic PCL Department of Sports Medicine at and PLC Reconstruction. ISAKOS Oslo Sports Trauma Research Center Sports Rehabilitation Course: sponsored Spring Seminar at Kleivstua, Global Perspectives for the Physical Kleivstua, Norway, May 2013. Therapist and Athletic Trainer, Toronto, Canada, May 2013.

73 LaPrade RF. Orthopaedic Research LaPrade RF. Knee Dislocation: Martetschläger F, Rios D, Horan and Education Fountation Clinical Emergency Room Management. Vail MP, Millett PJ. Bony Bankart Bridge Research Award: Improving Outcomes Valley Emergency Room Physicians Technique for Restoration of Anterior for Posterolateral Corner Injuries. Meeting, Vail, CO, January 2013. Shoulder Stability. AAOS Annual ORS Annual Meeting, San Antonio, Meeting, Chicago, IL, March 2013. TX, January 2013. Martetschläger F, Horan MP, Warth RJ, Millett PJ. Tendon Graft Reconstruction Millett PJ. AC Joint: Technique for LaPrade RF. Anatomic Reconstruction for Sternoclavicular Joint Instability Coracoclavicular (CC) Ligament of the Posterolateral Corner. Global – Technique and Short-Term Results. Reconstruction. 14th Annual AAOS/ Insights: The Future of Hip & Knee Poster. 30th Annual Congress of AOSSM Sports Medicine Course: Elite Surgery. Smith & Nephew, Copenhagen, AGA - Society for Arthroscopy and Athletes to Weekend Warriors, Park Denmark, November 2013. Joint Surgery, Wiesbaden, Germany, City, UT, February 2013. September 2013. LaPrade RF. Management of Injuries Millett PJ. Complete the Tear or to the Medial Knee Structures: Martetschläger F, Michalski M, Fix In Situ: Partial Cuff Tears and Current Concepts. Global Insights: Jansson K, Wijdicks C, Millett PJ. PASTA Lesion. 14th Annual AAOS/ The Future of Hip & Knee Surgery. Biomechanical Evaluation of Knotless AOSSM Sports Medicine Course: Elite Smith & Nephew, Copenhagen, Anterior and Posterior Bankart Athletes to Weekend Warriors, Park Denmark, November 2013. Repairs. 40th Annual Meeting of City, UT, February 2013. Japan Shoulder Society, Kyoto, Japan, LaPrade RF. ACL Graft Choices. The September 2013. Millett PJ. Distal Biceps Tendon Norwegian Arthroscopy Association Rupture: Technique and Results. Winter Meeting, Kvitfjell, Norway, Martetschläger F, Horan MP, Rios D, 14th Annual AAOS/AOSSM Sports February 2013. Millett PJ. The Bony Bankart Bridge Medicine Course: Elite Athletes to Technique For Restoration of Anterior Weekend Warriors, Park City, UT, LaPrade RF. ACL Tunnel Positioning. Shoulder Stability. ePoster. 9th February 2013. The Norwegian Arthroscopy Biennial ISAKOS Congress, Toronto, Association Winter Meeting, Kvitfjell, Canada, May 2013. Millett PJ. Full Thickness Rotator Norway, February 2013. Cuff Tears - Arthroscopic Repair: Martetschläger F, Horan MP, Warth Technique, Perils, and Pitfalls. LaPrade RF. MCL Reconstruction. RJ, Millett PJ. Complications After 14th Annual AAOS/AOSSM Sports The Norwegian Arthroscopy Contemporary Acromioclavicular Medicine Course: Elite Athletes to Association Winter Meeting, Kvitfjell, Joint Reconstructive Procedures. Weekend Warriors, Park City, UT, Norway, February 2013. AAOS Annual Meeting, Chicago, IL, February 2013. March 2013. LaPrade RF. Meniscal Root Millett PJ. Subscapularis Tears: When Avulsion. The Norwegian Arthroscopy Martetschläger F, Horan MP, Warth Should I Do Surgery and How Best Association Winter Meeting, Kvitfjell, RJ, Millett PJ. Complications After to Get There? 14th Annual AAOS/ Norway, February 2013. Contemporary Acromioclavicular Joint AOSSM Sports Medicine Course: Elite Reconstructions. ePoster. AANA Athletes to Weekend Warriors, Park LaPrade RF. Meniscal Suture. The Annual Meeting, San Antonio, TX, City, UT, February 2013. Norwegian Arthroscopy Association April 2013. Winter Meeting, Kvitfjell, Norway, Millett PJ. Arthroscopic Treatment of February 2013. Martetschläger F, Horan MP, Warth Osteoarthritis in Young Patients. 30th RJ, Millett PJ. Tendon Graft Annual Congress of AGA - Society LaPrade RF. Current Updates Reconstruction for Sternoclavicular for Arthroscopy and Joint Surgery, on Meniscal Root Tears 2013. Joint Instability – Technique and Wiesbaden, Germany, September 2013. University of Oslo Hospital, Oslo, Short-Term Results. ePoster. AANA Norway, May 2013. Annual Meeting, San Antonio, TX, Millett PJ. Interactive Case April 2013. Discussions Around the Shoulder LaPrade RF. Translational Research: Joint: Instability, Rotator Cuff, AC- From the Laboratory to the Operating Martetschläger F, Horan MP, Rios D, Joint. 30th Annual Congress of Suite and Back. Vail Hip Symposium, Millett PJ. The Bony Bankart Bridge AGA - Society for Arthroscopy and Beaver Creek, CO, January 2013. Technique for Restoration of Anterior Joint Surgery, Wiesbaden, Germany, Shoulder Stability. ePoster. AANA September 2013. Annual Meeting, San Antonio, TX, April 2013.

74 Millett PJ. SpeedBridge Millett PJ. Advancements in Instability Millett PJ. Case Base Learning IV: Transosseous-Equivalent Rotator Cuff Repair. Arthrex Surgical Skills Making a Bad Situation Better. Panel. Repair. How to Get Reproducible Master’s Shoulder Course, Vail, CO, AANA Fall Course, Las Vegas, NV, Results. 30th Annual Congress of August 2013. November 2013. AGA - Society for Arthroscopy and Joint Surgery, Wiesbaden, Germany, Millett PJ. Advancements in Rotator Millett PJ. Glenohumeral Arthritis September 2013. Cuff Repair. Arthrex Surgical Skills in the Young Patient. What to Do? Master’s Shoulder Course, Vail, CO, AANA Fall Course, Las Vegas, NV, Millett PJ. Clavicle Fracture August 2013. November 2013. Fixation. Arthrex 4th Annual Sports Medicine Fellowship Forum, Naples, Millett PJ. SpeedBridge. Surgical Millett PJ. Knotless Biologic Fixation FL, May 2013. Demonstration. Arthrex Medical of Rotator Cuff Tears with Collagen Education Center, Naples, FL, FiberTape Bridging Techniques. Focus Millett PJ. Double vs. Single Row January 2013. Demonstration. AANA Fall Course, Question and Answer. Arthrex 4th Las Vegas, NV, November 2013. Annual Sports Medicine Fellowship Millett PJ. SpeedBridge and SpeedFix Forum, Naples, FL, May 2013. Pearls Update. Arthrex Medical Millett PJ. Shoulder Laboratory Education Center, Naples, FL, Instructor. AANA Fall Course, Las Millett PJ. Instability Solutions. Arthrex January 2013. Vegas, NV, November 2013. 4th Annual Sports Medicine Fellowship Forum, Naples, FL, May 2013. Millett PJ. AC Joint Dislocations and Millett PJ. Arthroscopic Rotator Clavicle Fractures. Arthrex Surgical Cuff Repair: State of the Art Millett PJ. Proximal Humerus Skills Master’s Shoulder Course, Vail, 2013. Asociacion Argentina de Fractures Options. Arthrex 4th Annual CO, March 2013. Traumatologia del Deporte Congreso, Sports Medicine Fellowship Forum, Buenos Aires, Argentina, April 2013. Naples, FL, May 2013. Millett PJ. Advancements in Instability Repair. Arthrex Surgical Millett PJ. SLAP and Biceps. Get Millett PJ, Martetschläger F, Horan Skills Master’s Shoulder Course, Vail, It Right in One Shot. Asociacion MP, Rios D, Millett PJ. Complications CO, March 2013. Argentina de Traumatologia del Following Subpectoral Biceps Deporte Congreso, Buenos Aires, Tenodesis with Interference Screw Millett PJ. Advancements in Rotator Argentina, April 2013. Fixation. ePoster. 9th Biennial Cuff Repair. Arthrex Surgical Skills ISAKOS Congress, Toronto, Canada, Master’s Shoulder Course, Vail, CO, Millett PJ. Rotator Cuff Disorders: May 2013. March 2013. Current Concepts. Grand Rounds Columbia University Medical Center, Millett PJ. AC Joint Injuries. AAOS Millett PJ. Proximal Humeral New York, NY, June 2013. Annual Meeting, Chicago, IL, Fracture. Arthrex Surgical Skills March 2013. Master’s Shoulder Course, Vail, CO, Millett PJ, Martetschläger F, Horan March 2013. MP, Warth RJ. Complications After Millett PJ. Biceps and Subscapularis. Contemporary Acromioclavicular Joint 5SK ICL. AAOS Annual Meeting, Millett PJ. AC Joint Dislocations and Reconstructive Procedures. ePoster. Chicago, IL, March 2013. Clavicle Fractures. Arthrex Vail Shoulder 9th Biennial ISAKOS Congress, Course, Vail, CO, February 2013. Toronto, Canada, May 2013. Millett PJ. Surgical Skill Wet Lab. AAOS Annual Meeting, Chicago, IL, Millett PJ. Advancements in Rotator Millett PJ. The Bony Bankart Bridge March 2013. Cuff Repair. Arthrex Vail Shoulder Technique for Restoration of Anterior Course, Vail, CO, February 2013. Shoulder Stability. ePoster. 9th Millett PJ. Surgical Options for Biennial ISAKOS Congress, Toronto, Recurrent Shoulder Dislocations. Millett PJ. Pearls for Subscapularis Canada, May 2013. SOMOS Annual Meeting, Vail, CO, Repair. Arthrex Vail Shoulder Course, December 2013. Vail, CO, February 2013. Millett PJ. Management of Rotator Cuff Injuries. Percival Pott Rotation - Millett PJ. AC Joint Dislocations and Millett PJ. Total Shoulder Arthroplasty. Annual Day St. Bartholomew’s Hospital, Clavicle Fractures. Arthrex Surgical Arthrex Vail Shoulder Course, Vail, CO, London, England, November 2013. Skills Master’s Shoulder Course, Vail, February 2013. CO, August 2013.

75 Millett PJ. Arthroscopic Treatment of Padalecki J, Jansson K, Smith Philippon MJ. Groin Pain after Open/ Glenohumeral DJD. Rocky Mountain S, Pierce C, Dornan G, Wijdicks Arthroscopic FAI Surgery: The Role Shoulder and Elbow Society 2013 CA, LaPrade RF. Biomechanical and Treatment of Adhesions. 5th Meeting, Avon, CO, March 2013. Consequences of a Complete Radial International Hip Meeting, Santander, Tear Adjacent to the Medial Meniscus Spain, February 2013. Millett PJ. Anatomic Rotator Cuff Posterior Root Attachment Site. Repairs – Single vs. Double Rows. Podium. AAOS Annual Meeting, Philippon MJ. FAI in Athletes. 86th Wrightington Arthroscopy Conference, Chicago, IL, March 2013. Annual Meeting of the Japanese London, England, December 2013. Orthopaedic Association, Hiroshima, Petre BM, Smith SD, Jansson KS, de Japan, May 2013. Millett PJ. DJD in Young Active Meijer PP, Hackett TR, LaPrade RF, Patients - Joint Preserving Options. Wijdicks CA. Biomechanical Evaluation Philippon MJ. FAI Controversies: Wrightington Arthroscopy Conference, of Femoral Soft Tissue Fixation How Young? How Old? AAOS Annual London, England, December 2013. Techniques for ACL Reconstruction. Meeting, Chicago, IL, March 2013. Poster. ORS Annual Meeting, San Millett PJ. Large Subscapularis Antonio, TX, January 2013. Philippon MJ. Hip Arthroscopy: Repair – Tips & Tricks. Wrightington Fundamental Techniques and Arthroscopy Conference, London, Petre BM, Smith SD, Jansson KS, de Foundational Skills ICL: Pincer England, December 2013. Meijer PP, Hackett TR, LaPrade RF, Impingement. AAOS Annual Meeting, Wijdicks CA. Fixed and Variable Loop Chicago, IL, March 2013. Millett PJ. Massive Rotator Cuff Tears Femoral Cortical Suspension Devices of Bridging Repair Technique. Live for Soft Tissue ACL Reconstruction: Philippon MJ. Hip Arthroscopy: Surgical Demonstration. Wrightington A Biomechanical Study. Poster. 9th Fundamental Techniques and Arthroscopy Conference, London, Biennial ISAKOS Congress, Toronto, Foundational Skills ICL: The Modified England, December 2013. Canada, May 2013. Supine Position. AAOS Annual Meeting, Chicago, IL, March 2013. Millett PJ. The Bony Bankart Bridge Philippon MJ. Debate: Teacher vs. Technique. Wrightington Arthroscopy Student: Labral Reconstruction is Philippon MJ. Impact of Conference, London, England, Necessary for a Deficient Labrum. Chondrolabral Dysfunction on the December 2013. Podium. 3rd Annual Emerging Athlete. Smith & Nephew Booth Talk. Techniques in Orthopaedics Conference, AAOS Annual Meeting, Chicago, IL, Nepple J, Campbell K, Wijdicks C, Las Vegas, NV, December 2013. March 2013. Jansson K, LaPrade R, Philippon M. The Effect of an Acetabular Philippon MJ. Labral Deficiency: Philippon MJ. Sports Medicine/ Labral Tear, Repair, Resection, and Primary Debridement vs. Primary Arthroscopy VII: Hip. Co-Moderator. Reconstruction on the Hip Fluid Reconstruction: How Do I Do It? Step AAOS Annual Meeting, Chicago, IL, Seal. Podium. ISHA Annual Meeting, by Step! Podium. 3rd Annual Emerging March 2013. Munich, Germany, October 2013. Techniques in Orthopaedics Conference, Las Vegas, NV, December 2013. Philippon MJ. CAM FAI. AAOS/ Padalecki J, Jansson K, Smith American Association of Hip and S, Pierce C, Dornan G, Wijdicks Philippon MJ. Ligamentum Teres: Why Knee Surgeons (AAHKS)/Pediatric CA, LaPrade RF. Biomechanical I Reconstruct Sometimes? Podium. Orthopaedic Society of North America Consequences of a Complete Radial 3rd Annual Emerging Techniques in (POSNA) Hip Preservation in the Tear Adjacent to the Medial Meniscus Orthopaedics Conference, Las Vegas, Adolescent and Young Adult, Chicago, Posterior Root Attachment Site: NV, December 2013. IL, March 2013. In Situ Pull-Out Repair Restores Derangement of Joint Mechanics. Philippon MJ. Acetabular Labral Tears: Philippon MJ. Case Study: FAI in Poster. ORS Annual Meeting, San Debridement, Repair or Reconstruction. a Young Professional Snowboarder. Antonio, TX, January 2013. 5th International Hip Meeting, AAOS/AAHKS/POSNA Hip Preservation Santander, Spain, February 2013. in the Adolescent and Young Adult, Chicago, IL, March 2013. Philippon MJ. Arthroscopic Osteochondral Mosaicplasty and Philippon MJ. Ligamentous Resurfacing of the Femoral Head. 5th Instability of the Hip: Yes! Podium. International Hip Meeting, Santander, ISHA Annual Meeting, Munich, Spain, February 2013. Germany, October 2013.

76 Philippon MJ, Skendzel J, Goljan Philippon MJ, Devitt P, Peixoto Philippon MJ. Advanced Arthroscopic P, Briggs K. Hip Arthroscopy for FAI: L, Goljan P, Ho CP, Briggs KK. Techniques. Moderator. Harvard 43rd Predictors of Patient Satisfaction and Sensitivity and Specificity of MRI Annual Advances in Arthroscopy Course, Conversion to Total Hip Arthroplasty in Diagnosing Complete LT Tears. Cambridge, MA, October 2013. 5 to 7 Years Following Arthroscopy. ePoster. AANA Annual Meeting, San Podium. AOSSM Annual Meeting, Antonio, TX, April 2013. Philippon MJ. Femoroacetabular Chicago, IL, July 2013. Impingement: Treatment and Results of Philippon MJ. Course 101 Hip Model the Arthroscopic Approach with Labral Philippon MJ. Labral Reconstruction. Laboratory. AANA Fall Course, Las Takedown. Podium. Harvard 43rd Demonstration. AOSSM Annual Vegas, NV, November 2013. Annual Advances in Arthroscopy Course, Meeting, Chicago, IL, July 2013. Cambridge, MA, October 2013. Philippon MJ. Hip Arthroscopy: My Philippon MJ, Skendzel J, Goljan P, Approach to FAI in the Athlete. Surgical Philippon MJ. Labral Debridement Briggs K. Radiographic Evaluation of Demonstration. AANA Fall Course, Las Versus Repair: How to Decide and Pincer-Type FAI: Do Coxa Profunda Vegas, NV, November 2013. Do. Podium. Harvard 43rd Annual and the Crossover Sign Guarantee Advances in Arthroscopy Course, Acetabular Overcoverage? ePoster. Philippon MJ. Labral Cartilage: Cambridge, MA, October 2013. AOSSM Annual Meeting, Chicago, IL, Repair or Reconstruct? Podium. July 2013. AANA Fall Course, Las Vegas, NV, Philippon MJ. The Hip Capsule–Cut November 2013. It with Repair. Podium. Harvard 43rd Philippon MJ. Scientific Session Annual Advances in Arthroscopy Course, - Hip. Moderator. AOSSM Annual Philippon MJ. Mini Fellowship in Hip Cambridge, MA, October 2013. Meeting, Chicago, IL, July 2013. Arthroscopy. Laboratory. AANA Fall Course, Las Vegas, NV, November 2013. Philippon MJ. Treatment Philippon MJ, Geyer M, Fagrelius Algorithmns for NFL Players with T, Briggs KK. Acetabular Labral Philippon MJ. FAI – Overcalled? Hip Injuries. Herodicus Meeting, Reconstruction with Iliotibial Band Undertreatment? When and How to Kohler, WI, July 2013. Autograft: Analysis at Minimum 3 Years Address Hip Impingement. AANA Follow-Up. Podium. AOSSM Specialty Specialty Day, Chicago, IL, March 2013. Philippon MJ. Labral Reconstruction. Day, Chicago, IL, March 2013. 10th Symposium on Joint Preserving Philippon MJ, Ferro FP, Briggs and Minimally Invasive Surgery of the Philippon MJ. Clinical Case Panel: KK. Arthroscopy Provides Relief of Hip, Quebec City, Canada, May 2013. Arthroscopic Treatment of Hip Tendon Symptoms and Functional Good Disorders. Panelist. AANA Annual Results in Patients with Primary Hip Philippon MJ, Devitt B, Michalski Meeting, San Antonio, TX, April 2013. Synovial Chonstomatosis. Podium. M, Goldsmith MT, Wijdicks CA. A Brazilian Congress of Arthroscopy and Qualitative and Quantitative Analysis Philippon MJ, Peixoto L, Goljan B, Sports Traumatology, Fortaleza, Brazil, of the Arthroscopically Relevant Briggs K. Physical Examination and August 2013. Anatomy of the Acetabulum. Poster. Radiographic Findings Insufficient ISHA Annual Meeting, Munich, to Detect Ligamentum Teres Tears Philippon MJ, Ferro FP, Briggs KK. Germany, October 2013. in Patients with Femoroacetabular Return to Sport After Hip Arthroscopy Impingement. ePoster. AANA Annual for Femoroacetabular Impingement in Philippon MJ, Michalski M, Devitt B, Meeting, San Antonio, TX, April 2013. Professional Football Players. Podium. Campbell K, Goldsmith MT, LaPrade Brazilian Congress of Arthroscopy and RF. Clinically Relevant Osseous and Philippon MJ, Goljan P, Briggs Sports Traumatology, Fortaleza, Brazil, Soft Tissue Anatomy of the Proximal KK. Quality of Life Assessment for August 2013. Femur. Poster. ISHA Annual Meeting, Non-Operative Treatment Versus Munich, Germany, October 2013. Arthroscopy for Femoroacetabular Philippon MJ. Professional Soccer Impingement. ePoster. AANA Annual Players and Return to Competitive Philippon MJ. Capsular Meeting, San Antonio, TX, April 2013. Sport After Hip Arthroscopy Due Reconstruction: A Complex Case to Femoroacetabular Impingement. Discussion. Podium. International Philippon MJ. Reconstruction Podium. Brazilian Orthopedic Arthroscopy Meeting: 1st Techniques in Hip Arthroscopy: Surgery Congress, Curitiba, Brazil, International Meeting About What’s on the Horizon? AANA Annual November 2013. Regenerative Medicine Applied Meeting, San Antonio, TX, April 2013. to the Hip. 5th Hip Arthroscopy International Course, Sao Paulo, Brazil, December 2013.

77 Philippon MJ. Hip Arthroscopy Philippon MJ, Balldin BC, Wijdicks Philippon MJ, Peixoto L, Goljan Revision: What Hurts? Podium. CA, Stull J, Jansson KS. Effect P, Devitt B, Briggs K. Prevalence International Arthroscopy Meeting: of Arthroscopic Notching During of Ligamentum Teres Lesions in 1st International Meeting About Osteoplasty of Cam Lesions for the Femoroacetabular Impingement. Regenerative Medicine Applied Treatment of Femoroacetabular ePoster Presentation. 9th Biennial to the Hip. 5th Hip Arthroscopy Impingement: A Biomechanical ISAKOS Congress, Toronto, Canada, International Course, Sao Paulo, Analysis. Podium. 9th Biennial May 2013. Brazil, December 2013. ISAKOS Congress, Toronto, Canada, May 2013. Philippon MJ, Devitt B, Peixoto L, Philippon MJ. Hip Capsule and Hip Goljan P, Ho CP, Briggs KK. Sensitivity Instability: Anatomy and Function. Philippon MJ, Wilson K, Giphart and Specificity of MRI in Diagnosing Podium. International Arthroscopy JE, Costello K, Decker M, Souza Complete LT Tears. ePoster. 9th Meeting: 1st International Meeting B. Hip and Pelvic Kinematics in Biennial ISAKOS Congress, Toronto, About Regenerative Medicine Applied Cam and Pincer FAI Patients During Canada, May 2013. to the Hip. 5th Hip Arthroscopy Constrained and Unconstrained International Course, Sao Paulo, Squatting. Podium. 9th Biennial Philippon MJ. Soft Tissue Brazil, December 2013. ISAKOS Congress, Toronto, Canada, Management in Arthroscopic Hip May 2013. Preservation: What Do We Do with Philippon MJ. History and the Capsule and Labrum in 2013 Development of Femoroacetabular Philippon MJ. Hip Arthroscopy in and Does it Matter for My Patient. Treatment. Podium. International the Athlete. 9th Biennial ISAKOS Lunchtime Workshop. 9th Biennial Arthroscopy Meeting: 1st Congress, Toronto, Canada, May 2013. ISAKOS Congress, Toronto, Canada, International Meeting About May 2013. Regenerative Medicine Applied Philippon MJ, Boykin R, Patterson D, to the Hip. 5th Hip Arthroscopy Briggs K. Hip Flexion Strength and Philippon MJ, Briggs KK, Goljan International Course, Sao Paulo, Torque after Arthroscopic Fractional P, Peixoto L. The Hip Dial Test to Brazil, December 2013. Lengthening of the Iliopsoas Tendon. Diagnose Symptomatic Hip Instability. Podium. 9th Biennial ISAKOS Podium. 9th Biennial ISAKOS Philippon MJ. Labrum: Function, Congress, Toronto, Canada, May 2013. Congress, Toronto, Canada, May 2013. Preservation, and Reconstruction. Podium. International Arthroscopy Philippon MJ. Hip Labral Philippon MJ. Trainee Award Session. Meeting: 1st International Meeting Reconstruction Surgical Moderator. ISHA Annual Meeting, About Regenerative Medicine Applied Demonstration. Live Surgical Munich, Germany, October 2013. to the Hip. 5th Hip Arthroscopy Demonstration. 9th Biennial ISAKOS International Course, Sao Paulo, Congress, Toronto, Canada, May 2013. Philippon MJ. When and Why I Brazil, December 2013. Reconstruct the Labrum. Podium. Philippon MJ. Hip Labral ISHA Annual Meeting, Munich, Philippon MJ. Comprehensive Reconstruction. Surgical Germany, October 2013. Approach to Hip Preservation. Demonstration. 9th Biennial ISAKOS Laboratory. ISHA Annual Meeting, Congress, Toronto, Canada, May 2013. Philippon MJ, Briggs KK. Hip Joint Munich, Germany, October 2013. Space Disability. Poster. OARSI World Philippon MJ, Briggs KK, Herzog M, Congress, Philadelphia, PA, April 2013. Philippon MJ. How to Educate People Goljan P. Quality Of Life Assessment in Hip Arthroscopy. Panel. ISHA for Non-Operative Treatment Versus Philippon MJ. Hip Arthroscopy. The Annual Meeting, Munich, Germany, Arthroscopy for Femoroacetabular 86th Annual Meeting of the Japanese October 2013. Impingement. Podium. 9th Biennial Orthopaedic Association, Hiroshima, ISAKOS Congress, Toronto, Canada, Japan, May 2013. Philippon MJ. Innovations in May 2013. Treatment of Hip Disorders in Philippon MJ. Clinical Presentation of Athletes–Cell Therapies. Podium. Philippon MJ, Peixoto L, Goljan Hip Instability. Vail Hip Symposium, International Stem Cell Meeting, San P, Devitt B, Briggs K. Physical Vail, CO, January 2013. Diego, CA, September 2013. Examination and Radiographic Findings Insufficient to Detect Philippon MJ. Labral Ligamentum Teres Tears in Patients Reconstruction. Vail Hip with Femoroacetabular Impingement. Symposium, Vail, CO, January 2013. ePoster. 9th Biennial ISAKOS Congress, Toronto, Canada, May 2013.

78 Philippon MJ. Radiographic Exam of Rodkey WG, Steadman JR. Patellar Rodkey WG. Autologous Chondrocyte the Hip. Vail Hip Symposium, Vail, Tendinitis: Surgical Approach, The Implantation DEBATE: Why We Don’t CO, January 2013. Vail experience. Barcelona Knee Use It and What the Options Are. 9th Meeting (BKM ’13), Barcelona, Biennial ISAKOS Congress, Toronto, Philippon MJ. Return to Play Spain, February 2013. Canada, May 2013. Following Hip Arthroscopy. Vail Hip Symposium, Vail, CO, January 2013. Rodkey WG, Steadman JR. Return Rodkey WG. Collagen Meniscus to Sports after Meniscectomy or Implants and Other Resorbable Philippon MJ. Arthroscopic Meniscus Replacement. BKM ’13, Meniscus Scaffolds. Société Approach to FAI. Val D’Isere Barcelona, Spain, February 2013. Internationale de Chiurgie International Hip Course, Val d’Isere, Orthopédique et de Traumatologie France, February 2013. Rodkey WG, Steadman JR. The Role (SICOT) Orthopaedic World of Platelet-Rich Plasma (PRP) to Conference, Hyderabad, India, Philippon MJ. Results of Arthroscopic Treat Patellar Tendinitis. BKM ’13, October 2013. Treatment of FAI. Val D’Isere Barcelona, Spain, February 2013. International Hip Course, Val d’Isere, Rodkey WG, Briggs KK, Steadman France, February 2013. Rodkey WG, Steadman JR. What JR. Effect of Lesion Size on Clinical to Do? A Chondral Lesion and a Outcomes After Microfracture: A Rios D, Jansson K, Martetschläger Meniscus Tear at Age 40. BKM ’13, 2- to 8-Year Follow-Up Study. SICOT F, Boykin R, Millett P, Wijdicks Barcelona, Spain, February 2013. Orthopaedic World Conference, C. Restoration of Normal Radius Hyderabad, India, October 2013. of Curvature When Performing Rodkey WG. 25 Years of an Osteochondral Allograft to the Microfracture: What Have We Rodkey WG. Microfracture: The Vail Glenoid Surface: An Anatomic Learned? Dublin Knee Surgery for Experience. Science, Technique, Computed Tomographic Comparison. Sports Injuries, Dublin, Ireland, Lessons Learned, and Results. SICOT Poster. ORS Annual Meeting, San September 2013. Orthopaedic World Conference, Antonio, TX, January 2013. Hyderabad, India, October 2013. Rodkey WG. Biology and Rios D, Martetschläger F, Horan MP, Biomechanics of ACL Reconstruction Rodkey WG, Steadman JR. Meniscus Millett PJ. Complications Following Healing. Dublin Knee Surgery for Replacement with Collagen Meniscus Subpectoral Biceps Tenodesis with Sports Injuries, Dublin, Ireland, Implants (CMI): Techniques, Tips and Interference Screw Fixation. ePoster. September 2013. Tricks. The Meniscus 2013, Versailles, AANA Annual Meeting, San Antonio, France, February 2013. TX, April 2013. Rodkey WG. Meniscus Repair Healing: Biological Enhancement Rodkey WG. Microfracture: The Vail Rios D, Martetschläger F, Horan MP, Techniques. Dublin Knee Surgery Experience. Technique and Lessons Millett PJ. Complication After Biceps for Sports Injuries, Dublin, Ireland, Learned. Vail Hip Symposium, Beaver Tenodesis. American Shoulder and September 2013. Creek, CO, January 2013. Elbow Surgeons Specialty Course, Chicago, IL, March 2013. Rodkey WG. The Role of PRP in Rodkey WG. What’s New in Cartilage Treating Sports Medicine Injuries: Repair. Visiting Professor and Rodkey WG, Briggs KK, Steadman An Update. Dublin Knee Surgery Orthopaedic Grand Rounds. Hospital JR. Grade IV Patellofemoral Chondral for Sports Injuries, Dublin, Ireland, de la Sta Creu I Sant Pau, Barcelona, Defects Result in Increased Patient September 2013. Spain, February 2013. Disability. 11th World Congress of the International Cartilage Repair Society Rodkey WG, Briggs KK, Steadman JR. Rodkey WG. Chondral Regeneration (ICRS), Izmir, Turkey, September 2013. The Effect of Lesion Size on Clinical and Cellular Therapy: Basic Outcomes After Microfracture: A 2- to Science and Animal Model Studies. Rodkey WG, Briggs KK, Steadman 8-Year Follow-Up Study. European Regenerative Cellular Therapy and JR. Microfracture Clinical Outcomes Federation of National Associations Tissue Engineering, Santiago, Chile, Are Not Influenced by Lesion Size: A of Orthopaedics and Traumatology June 2013. 2- to 8-Year Follow-Up Study. 11th (EFORT) 14th Congress, Istanbul, World Congress of the ICRS, Izmir, Turkey, June 2013. Turkey, September 2013.

79 Smith S, Wijdicks CA, Jansson Surowiec RK, Smith WS, Wilson Wijdicks CA. Radiographic Evaluation KS, Boykin R, Martetschlaeger F, KJ, Dornan GD, Philippon MJ, Ho of Plantar Plate Injury. ePoster. 9th de Meijer PP, Millett PJ, Hackett CP. T2 Values of Articular Cartilage in Biennial ISAKOS Congress, Toronto, T. Stability of Mid-Shaft Clavicle the Asymptomatic Hip: Subregional Canada, May 2013. Fractures After Plate Fixation Versus Method for Analysis and Reporting of Intramedullary Repair and After Values. Podium. ISHA Annual Meeting, Wijdicks CA. Stability of Mid-Shaft Hardware Removal. Poster. ORS Munich, Germany, October 2013. Clavicle Fractures After Plate Fixation Annual Meeting, San Antonio, TX, Versus Intramedullary Repair and January 2013. Viens NA, Wijdicks CA, Campbell After Hardware Removal. ePoster. 9th KJ, LaPrade RF, Clanton TO. Biennial ISAKOS Congress, Toronto, Smith S, Wijdicks CA, Jansson Biomechanical Comparison of Canada, May 2013. KS, Boykin R, Martetschlaeger F, Augmented Broström Repair de Meijer PP, Millett PJ, Hackett Techniques to the Intact Anterior Wilson KJ, Giphart JE, Kagnes T. Stability of Mid-Shaft Clavicle Talofibular Ligament. Poster. AOFAS K, Millett PJ. Alterations in Fractures After Plate Fixation Versus Annual Meeting, Hollywood, FL, Glenohumeral Kinematics in Patients Intramedullary Repair and After July 2013. with Rotator Cuff Tears Using Biplane Hardware Removal. Poster. 9th Fluoroscopy. ePoster. AANA Annual Biennial ISAKOS Congress, Toronto, Waldrop N, Zirker C, Wijdicks CA, Meeting, San Antonio, TX, April 2013. Canada, May 2013. LaPrade RF, Clanton T. Radiographic Evaluation of Plantar Plate Injury: Wilson KJ, Giphart JE, Kagnes Spiegl U, Horan MP, Smith S, Ho CP, An In Vitro Biomechanical Study. K, Millett PJ. Alterations in Millett PJ. The Critical Shoulder Angle Podium. AAOS Annual Meeting, Glenohumeral Kinematics in Patients is Predictive of Rotator Cuff Tears and Chicago, IL, March 2013. with Rotator Cuff Rears Using Shoulder Osteoarthritis and Is Better Biplane Fluoroscopy. Podium. 9th Assessed with Radiographs over MRI. Waldrop N, Zirker C, Wijdicks CA, Biennial ISAKOS Congress, Toronto, ePoster. Shoulder and Elbow Surgeons LaPrade R, Clanton T. Radiographic Canada, May 2013. 2013 Closed Meeting, Las Vegas, NV, Evaluation of Plantar Plate Injury. October 2013. Poster. 9th Biennial ISAKOS Congress, Toronto, Canada, May 2013. Steadman JR, Rodkey WG. Chondral Lesions: Microfracture to Treat 2 to Waldrop N, Wijdicks CA, Jansson KS, 4 cm2 Medial Condyle Defects. BKM LaPrade R, Clanton T. Biomechanical ’13, Barcelona, Spain, February 2013. Strength of Fixation of the Anterior Talofibular Ligament with Suture Versus Steadman JR, Rodkey WG. Collagen Suture Anchor. Poster. AAOS Annual Meniscus Implant (CMI) Results: A Meeting, Chicago, IL, March 2013. Developer’s View. The Meniscus 2013, Versailles, France, February 2013. Wijdicks C, Philippon M, Civitarese D, Costello K, Wages J, Giphart E, Steadman JR, Rodkey WG. Future LaPrade R. Hip Kinematics in Ice of Stem Cells and Cartilage Repair Hockey Goaltenders Performing a in a Clinical Practice: Promises and Butterfly Motion and the Effects of Challenges. Vail Hip Symposium, a Mandated Change in Goalie Pad Beaver Creek, CO, January 2013. Width. Poster. ORS Annual Meeting, San Antonio, TX, January 2013. Steadman JR. Microfracture: The Vail Experience – The Science, Wijdicks CA, Goldsmith MT, Jannson Techniques, and Results. Vail Hip KS, Smith S, Engebretsen L, LaPrade Symposium, Beaver Creek, CO, RF. Biomechanical Comparison of January 2013. Anatomic Single- and Double-Bundle ACL Reconstructions: An In Vitro Study. Podium. 9th Biennial ISAKOS Congress, Toronto, Canada, May 2013.

80 Events

Grammy Award Winner Darius Rucker Headlined “Rock the Research” Fundraising Event for the Steadman Philippon Research Institute

Grammy Award-winning country music superstar As the lead singer of Hootie & the Blowfish, Rucker was Darius Rucker headlined the “Rock the Research” one of the most popular frontmen in mainstream pop/ summer fundraising concert to benefit the Steadman rock during the mid-’90s. The Grammy Award-winning Philippon Research Institute (SPRI). The annual event band charted six Top 40 hits on the Billboard 100. was held Monday, July 14, at the Gerald R. Ford Amphitheater in Vail, Colo. This marked Rucker’s fourth Rucker moved on to a solo recording and performing career, appearance at the SPRI event and first since 2012. focusing primarily on country music. In 2009, he became the first African American to win the New Artist Award Bruce Smith, a National Football League Hall of Fame from the Country Music Association and only the second member, was a special guest of Dr. Richard Steadman. African American to win any award from the association.

“Darius is a fantastic performer who always puts on a great Proceeds from “Rock the Research” and the corresponding show,” said Richard Steadman, M.D., founder of The live auction supported new research related to sports Steadman Clinic and co-chairman of SPRI, “but what injury prevention and innovative treatments for orthopaedic makes his concerts here so special is that he is also a injuries and musculoskeletal conditions. This includes former patient of ours who embraces our mission of helping the prevention and treatment of osteoarthritis, as well people remain active. We are grateful for Darius’ support.” as new initiatives to prevent sports injuries in youth.

81 NFL Legend Bruce Smith SPRI is most grateful to Special Guest at SPRI’s “Rock the Research 2014” the following sponsors

Bruce Smith, a National Football League Hall of Fame member, was a special guest and participants: to honor Dr. Richard Steadman at “Rock the Research 2014” on Monday, July 14, at the Gerald R. Ford Amphitheater. Cutting Edge Sponsor In-Kind Sponsors Smith, one of the most dominant defensive players in NFL history, first met Messner Reeves, LLP Alpine Party Rentals Dr. Steadman as a patient in 1992. ATI Jets “I learned very quickly that there was something B.R. Cohn Winery about Dr. Steadman that exceeds the normal Corporate and Crazy Mountain Brewery doctor-patient relationship,” he says. “He has a Community Sponsors Denver Broncos concern for each patient that is simply special. Four Seasons For me, he was like a ray of sunshine that Mr. Michael and Mrs. Mary Sue Shannon Here 2 Help brightens the moment. He’s an accomplished and remarkable man—unique and humble—and The Steadman Clinic Mr. Jeromey Clary that’s why I wanted to attend this event.” Vail Valley Medical Center Mr. John Egan Mr. Jim Shpall - “He also added at least five years to my career,” Applejack Wine & Spirits adds Smith, who had three microfracture Participating Sponsors John Irwin Entertainment procedures performed by Dr. Steadman. “He protected me. He did not let them rush me Larkspur back onto to the field prematurely. I couldn’t Arthrex Mr. Larry Mullen have been more blessed to have a doctor Institute of Transfusional Medicine Lodge at Vail who took care of me the way he did.” Medequip, Inc. Mountain Spirits Össur Americas Newton Running After graduating from Virginia Tech and being drafted No. 1 in 1985, Smith played in the NFL RevGen Partners Orin Swift 19 years—15 for Buffalo and four for Washington. Slifer Smith & Frampton Real Estate Petals and Pours, LLC During his career, he earned “Defensive Player Smith & Nephew Endoscopy Pink Monkey Solutions of the Year” honors in 1990 and 1996, was AFC U.S. Ski and Snowboard Red Sky Ranch and Golf Club Defensive Player of the Year four times, and was Team Foundation Silent Partner Limousines, LLC chosen to play in 11 Pro Bowls. With the Bills, his team went to four consecutive Super Bowls. Silver Oak Cellars His number, 78, has been retired at Virginia Tech. Southern Wine and Spirits Individual Sponsors Vail Catering Concepts When he was enshrined into the NFL Pro Football Hall of Fame in 2009, he credited Dr. and Mrs. Thomas Clanton Dr. Steadman for preserving his career. Ms. Caryn Clayman “Dr. Steadman and his colleagues at the Mr. and Mrs. Ron Davis Steadman Philippon Research Institute are Dr. Russell Hirsch pioneers and innovators,” says Smith. “They Dr. and Mrs. Robert LaPrade are constantly exploring new techniques that Dr. and Mrs. Peter Millett extend the playing careers of athletes and add to the quality of life of all their patients. For Mr. Al Perkins what they have done for me and thousands Dr. and Mrs. Marc Philippon of others, I will be forever thankful.” The Precourt Foundation Dr. and Mrs. Steven Singleton Smith and his wife, Carmen, live in Virginia Mrs. Ann B. Smead and Beach, Virginia. Bruce is passionate about his alma mater, Virginia Tech, and attends every Mr. Michael M. Byram football game. He is a commercial real estate Dr. and Mrs. Richard Steadman developer and has built a 300-unit apartment Mr. and Mrs. Steve Stratton complex/hotel near the campus. Their son, Alston, Mr. and Mrs. Stewart Turley is a sophomore offensive lineman for the Hokies. Dr. Randall Viola

82 Vail Valley Medical Center 2014 Steadman Philippon Research Institute Golf Classic Presented by RE/MAX, LLC

The Institute was selected by RE/ Presenting sponsor Bronze Sponsors MAX, LLC, the global real estate firm, to organize the 11th annual RE/MAX, LLC Tom Clanton, M.D. Golf Classic at Sanctuary, a premier EKS&H golf resort located south of Denver. Arthur J. Gallagher & Co. Title sponsor Tom Hackett, M.D. Proceeds from the tournament ORP a Hanger Company support the development of new Vail Valley Medical Center The Hussman Foundation procedures and methodology to Messner Reeves, LLP battle degenerative arthritis. The Navigant Healthcare tournament was open to the public Gold Sponsor Össur Americas, Inc. and included grateful patients Mr. Gary Peterson and corporate supporters. The Steadman Clinic Marc Philippon, M.D. Mr. Matt Simi Since 2004, the Institute has Morgan Stanley raised more than $1,460,000 Silver sponsors Richard Steadman, M.D. from this golf tournament to U.S. Bank support its research programs. Arthrex Mr. Norm Waite BBVA Compass Bank Brian White, M.D. The Institute is grateful to Mr. Dave Medequip and Mrs. Gail Liniger, owners and Sonnenalp Resort of Vail Foundation co-founders of RE/MAX, LLC who Individual Sponsors developed Sanctuary and created this unique opportunity for the Institute Bledsoe Brace Company to develop and enhance relationships John Feagin, M.D. with those who support our mission. In addition, we wish to express our sincere appreciation to the following sponsors and participants:

83 Associates The Institute is proud to recognize its team of associates who carry out the research and educational mission in Vail. The staff has been selected for its diverse training and background in biomechanics, engineering, clinical research, veterinary science, and computer science. Together, the staff members take a multidisciplinary approach to their work in solving orthopaedic sports medicine problems.

Administration Ashley Wilson David Civitarese Gary Peterson Data Collection Coordinator Research Assistant President and Chief Executive Officer The Steadman Clinic Grant Dornan Imaging Research Steadman Philippon Statistician Charles P. Ho, Ph.D., M.D. Research Institute Director Marilee Horan, M.P.H. Jen Rogus Coordinator of Upper Rachel Surowiec, M.Sc. Executive Assistant to the CEO Extremity Research Senior Research Scientist The Steadman Clinic Steadman Philippon Lauren Matheny Coley Gatlin, M.D. Research Institute Coordinator of Lower Griffin Visiting Scholar Extremity Research Greg Paschke Elizabeth L. Carpenter, M.D. Chief Financial Officer Dawn Rossi Griffin Visiting Scholar The Steadman Clinic Administrative Assistant Steadman Philippon Education Research Institute Josu Greenspoon Robert F. LaPrade, M.D., Ph.D. Research Assistant Deputy Director, Sports Medicine Amy Ruther Fellowship Program Administration Director Shannon McNamara Director, International Research Assistant Scholar Program Monica White, CPA, CGMA Controller Sam Moulton Kelly Stoycheff Research Assistant Education and Fellowship Coordinator Development John G. McMurtry, M.A., M.B.A. Ryan Warth, M.D. Max Petri, M.D. Director Research Assistant Visiting Research Scholar

Lynda Sampson Nick Johnson, M.D. Fernando Fuso, M.D. Director of External Communications, Research Assistant Visiting Research Scholar Marketing and Communications BioMedical Engineering Christiano Trindade, M.D. Center for Translational Coen A. Wijdicks, Ph.D. Visiting Research Scholar and Regenerative Director and Senior Staff Scientist Medicine Research Department of Technology and William G. Rodkey, D.V.M. Mary Goldsmith, M.Sc. Multimedia Communication Director Senior Robotics Engineer Jason Gregg Director Surgical Skills Laboratory Travis Turnbull, Ph.D. Kelly Adair Research Engineer Barry Eckhaus Director AudioVisual/Multimedia Manager Matt Rasmussen Center for Outcomes-Based Research Engineer Angelica Wedell Orthopaedic Research (COOR) AudioVisual/Multimedia Technician Karen K. Briggs, M.B.A., M.P.H. Brady Williams Director Research Assistant Jim Brown, Ph.D. Executive Editor Adriana Saroki Research Assistant

84 STEADMAN PHILIPPON Research institute

85 INDEPENDENT AUDITORS’ REPORT

To the Board of Directors Steadman Philippon Research Institute and Subsidiary Vail, Colorado

We have audited the accompanying consolidated financial statements of Steadman Philippon Research Institute and Subsidiary, which are comprised of the consolidated statements of financial position as of December 31, 2013 and 2012, and the related consolidated statements of activities, functional expenses, and cash flows for the years then ended, and the related notes to the consolidated financial statements.

MANAGEMENT’S RESPONSIBILITY FOR THE FINANCIAL STATEMENTS

Management is responsible for the preparation and fair presentation of these consolidated financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of consolidated financial statements that are free from material misstatement, whether due to fraud or error.

AUDITORS’ RESPONSIBILITY

Our responsibility is to express an opinion on these consolidated financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the consolidated financial statements. The procedures selected depend on the auditors’ judgment, including the assessment of the risks of material misstatement of the consolidated financial statements, whether due to fraud or error. In making those risk assessments, the auditors consider internal control relevant to the entity’s preparation and fair presentation of the consolidated financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.

OPINION

In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the financial position of Steadman Philippon Research Institute and Subsidiary as of December 31, 2013 and 2012, and the changes in their net assets and their cash flows for the years then ended in accordance with accounting principles generally accepted in the United States of America.

EKS&H LLLP

July 2, 2014 Denver, Colorado

86 Consolidated Statements of Financial Position

Assets December 31, 2013 2012 Current assets Cash and cash equivalents $ 260,739 $ 1,402,658 Accounts receivable 18,921 642 Accounts receivable, related parties 5,451 22,802 Contributions receivable, current portion 136,800 261,800 Prepaid expenses and other assets 27,189 977 Investments 5,175,573 4,606,283 Inventory 144,804 225,182 Total current assets 5,769,477 6,520,344

Contributions receivable, less current portion 92,421 174,342 Property and equipment, net 2,474,880 3,693,322 Investment, other 227,050 227,050 Deferrred tax asset 14,885 - Total assets $ 8,578,713 $ 10,615,058

Liabilities and Net Assets Current liabilities Accounts payable $ 157,686 $ 199,385 Accrued expenses 242,368 336,697 Line‑of‑credit 263,500 - Current portion of long‑term debt - 248,847 Current portion of capital leases 100,790 433,127 Current portion of deferred rent - 153,616 Total current liabilities 764,344 1,371,672

Long‑term liabilities Long‑term debt, net of current portion - 689,325 Capital leases, net of current portion - 100,789 Deferred tax liability - 6,425 Total liabilities 764,344 2,168,211

Commitments

Net assets Unrestricted 7,373,711 7,079,142 Temporarily restricted 440,658 1,367,705 Total net assets 7,814,369 8,446,847 Total liabilities and net assets $ 8,578,713 $ 10,615,058

See notes to consolidated financial statements 87 Consolidated Statements of Activities

For the Years Ended D december 31, 2013 December 31, 2012 T temporarily Temporarily U unrestricted restricted total unrestricted restricted total

Revenues, gains, and other support Contributions $ 955,974 $ 698,898 $ 1,654,872 $ 998,080 $ 457,593 $ 1,455,673 Fundraising events 828,820 - 828,820 885,724 - 885,724 Grants and corporate partners 1,048,142 742,613 1,790,755 1,024,156 1,474,053 2,498,209 MRI income 962,514 - 962,514 962,514 - 962,514 Other income 2,133 - 2,133 3,228 - 3,228 In-kind contributions 111,071 - 111,071 201,835 - 201,835 3,908,654 1,441,511 5,350,165 4,075,537 1,931,646 6,007,183 Net assets released from restrictions 2,368,558 (2,368,558) - 2,162,605 (2,162,605) - Total revenues, gains, and other support 6,277,212 (927,047) 5,350,165 6,238,142 (230,959) 6,007,183

Expenses and losses BioMedical engineering 1,487,659 - 1,487,659 1,537,409 - 1,537,409 Center for translational and regenerative medicine research 241,760 - 241,760 236,647 - 236,647 Surgical skills laboratory 996,620 - 996,620 1,184,788 - 1,184,788 Center for outcomes-based orthopaedic research 851,876 - 851,876 833,904 - 833,904 Education department 577,207 - 577,207 361,025 - 361,025 Department of technology and multimedia communications 304,200 - 304,200 264,393 - 264,393 Imaging research 601,782 - 601,782 767,588 - 767,588 Management and general 625,659 - 625,659 789,462 - 789,462 Development 928,356 - 928,356 720,428 - 720,428 Total expenses and losses 6,615,119 - 6,615,119 6,695,644 - 6,695,644

Other income (expense) Investment return 578,194 - 578,194 471,317 - 471,317 Interest expense (64,657) - (64,657) (71,683) - (71,683) Total other income 513,537 - 513,537 399,634 - 399,634

Rescinded pledge - - - (600,000) - (600,000)

Provision for income tax 118,939 - 118,939 (53,013) - (53,013)

Change in net assets 294,569 (927,047) (632,478) (710,881) (230,959) (941,840)

Net assets at beginning of year 7,079,142 1,367,705 8,446,847 7,790,023 1,598,664 9,388,687

Net assets at end of year $7,373,711 $440,658 $7,814,369 $7,079,142 $1,367,705 $8,446,847

See notes to consolidated financial statements

88 Consolidated Statement of Functional Expenses For the Year Ended December 31, 2013 718

Total 70,407 75,008 77,927 98,164 22,844 12,812 43,794 12,274 24,604 21,515 22,286 508,240 607,369 292,487 177,046 153,713 142,875 5,316,409 1,298,710 $ 2,875,797 $ 6,615,119 - 27,861 - 48,668 - - 103 254 452 475 155 418 5,402 1,091 3,034 2,568 2,949 1,439 30,566 98,164 14,664 162,122 292,487 926,917 $ 312,013 $ 928,356 Development - - - - - 703 814 Support Services 4,275 1,161 3,067 7,056 9,772 1,893 6,010 4,945 3,672 10,538 44,158 12,053 17,371 226,232 621,987 General $ 271,939 $ 625,659 Management and - - 66 718 6,350 6,148 4,497 38,680 70,850 98,614 65,206 27,861 48,668 20,697 42,505 19,659 Services 119,886 597,692 163,474 144,089 3,767,505 1,293,599 Total Program Total $2,291,845 $ 5,061,104 - - - - 314 979 253 250 157 3,232 8,589 5,000 5,326 5,111 5,509 50,376 36,461 400,066 Imaging $ 79,788 Research $ 601,782 ------289 379 179 523 1,512 9,416 1,159 2,332 8,752 3,894 27,174 34,846 Multimedia Department of $ 213,133 $ 304,200 Technology and Technology Communications - - - - 90 - 366 351 632 475 612 371 157 2,462 2,444 5,130 6,170 9,510 25,115 24,549 11,737 24,561 Education 567,697 269,354 201,716 Department $ 394,540 $ 577,207 - - 22,750 - 46,168 - - - 628 Program Services 4,131 6,758 9,494 8,859 2,859 1,517 1,768 4,835 1,673 32,419 20,660 26,171 11,794 18,934 832,942 Research Center for Orthopaedic $ 699,376 $ 851,876 Outcomes-Based ------25 360 451 760 744 636 150 157 1,108 1,045 18,809 26,349 35,011 270,890 439,944 556,676 Laboratory $ 83,449 $ 996,620 Surgical Skills - - - 652 585 157 4,548 5,647 8,242 1,106 2,500 1,266 1,420 2,786 1,041 12,366 24,301 19,659 Center for Regenerative Translational $ 155,314 $ 241,760 Medicine Research ------41 -

3,841 1,104 2,116 170 4,485 1,673 22,487 31,689 34,980 53,219 68,466 16,978 17,429 290,380 272,526 BioMedical Engineering 1,215,133 240,719 $ 1,487,659 $ 666,245 fees card and dues subscriptions

Consulting and contract labor Salaries and benefits See notes to consolidated financial statements Supplies (office, computer, lab) Supplies (office, computer, Events and fundraising Printing Maintenance and supplies Rent and leases and utilities Telephone Travel Legal and accounting Fellows Education meetings/lectures Education Direct mail/planned giving Meals and entertainment Gifts Postage Bank/credit Meetings (Board and SAC) Advertising Depreciation and amortization Total Insurance Meeting fees/registrations

89 Consolidated Statement of Functional Expenses For the Year Ended December 31, 2012 -

7,206 Total 82,573 89,608 59,566 76,733 81,976 46,611 30,426 31,597 18,293 18,489 27,585 15,819 840,122 800,158 235,142 170,919 169,857 104,064 5,339,383 1,356,261 $ 2,392,458 $ 6,695,644 - 40,181 - - - - 250 182 7,362 4,970 2,754 2,884 4,188 1,562 3,787 7,116 1,603 67,322 81,976 21,995 11,083 144,665 235,142 718,825 $ 121,587 $ 720,428 Development ------350 Support Services 1,231 6,456 7,657 5,112 2,777 5,146 3,886 11,399 16,003 20,965 11,772 15,976 18,293 12,589 497,994 785,576 General $ 151,856 $ 789,462 Management and - - - - 90 3,048 14,020 78,182 78,911 70,059 40,181 59,566 12,844 10,663 13,725 30,997 13,343 Services 197,463 781,397 160,508 150,970 3,834,982 1,350,772 Total Program Total $ 2,119,015 $ 5,185,754 - - - 47 467 521 457 254 1,444 9,333 6,425 81,146 17,919 36,923 13,044 24,744 400,280 Imaging Research $ 171,800 $ 767,588 - - - - 408 714 315 254 3,393 7,885 1,532 7,702 2,879 2,941 1,090 26,225 25,484 Multimedia Department of $ 182,516 $ 264,393 Technology and Technology Communications - - - - - 90 - 598 760 304 866 427 221 109 (425) 3,627 4,976 6,353 1,292 1,055 2,784 59,566 - 14,388 10,339 Education 350,686 238,909 367,308 Department $ 223,778 $ 361,025 - - - 33,756 - - - - - (799) Program Services 9,485 5,432 8,636 9,247 3,592 1,991 3,205 1,016 76,829 11,302 25,688 13,005 20,563 813,341 Research Center for Orthopaedic $ 644,712 $ 833,904 Outcomes-Based ------430 526 559 873 414 250 145 4,896 21,350 25,076 35,320 428,181 597,468 587,320 Laboratory $ 79,448 Surgical Skills $ 1,184,788 - - - 78 261 249 145 842 1,770 1,126 7,646 6,716 2,500 3,776 2,928 19,037 16,540 13,343 Center for Regenerative Translational $ 159,690 $ 236,647 Medicine Research ------

6,273 3,895 3,026 4,419 9,454 1,125 16,460 41,332 50,415 74,244 20,659 27,695 315,397 305,944 BioMedical Engineering 1,231,465 235,805 $ 657,071 $ 1,537,409 fees card meetings/lectures grant and dues subscriptions

Salaries and benefits Consulting and contract labor See notes to consolidated financial statements Supplies (office, computer, lab) Supplies (office, computer, Events and fundraising Printing Maintenance and supplies Rent and leases and utilities Telephone Travel Legal and accounting Direct mail/planned giving Fellows Education Meals and entertainment Gifts Postage Bank/credit Meetings (Board and SAC) Research Insurance Meeting fees/registrations Advertising

Depreciation and amortization Total

90 Consolidated Statements of Cash Flows

For the Years Ended December 31 2013 2012

Cash flows from operating activities Change in net assets $ (632,478) $ (941,840) Adjustments to reconcile change in net assets to net cash (used in) provided by operating activities Depreciation and amortization expense 1,298,710 1,356,261 Net gain on investments (615,165) (485,795) Rescinded pledge - 600,000 Amortization of deferred rent (153,616) (153,624) Donated stock (15,933) (32,503) Deferred taxes (21,310) (115,575) Changes in assets and liabilities Accounts receivable (928) (668) Contributions receivable 206,921 (18,691) Prepaid expenses and other assets (26,212) 1,537 Inventory 80,378 276,498 Accounts payable (41,699) 133,932 Accrued expenses (94,329) 152,697 616,817 1,714,069 Net cash (used in) provided by operating activities (15,661) 772,229

Cash flows from investing activities Purchase of investments (581,837) (885,078) Proceeds from sale of investments 643,645 1,461,400 Purchases of property and equipment (80,268) (103,801) Net cash (used in) provided by investing activities (18,460) 472,521

Cash flows from financing activities Payments on capital leases (433,126) (454,437) Payments on long‑term debt (938,172) (258,354) Net borrowing (payments) on line‑of‑credit 263,500 (9,099) Net cash used in financing activities (1,107,798) (721,890)

Net (decrease) increase in cash and cash equivalents (1,141,919) 522,860

Cash and cash equivalents at beginning of year 1,402,658 879,798

Cash and cash equivalents at end of year $ 260,739 $ 1,402,658

Supplemental disclosure of cash flow information: Cash paid for interest was $64,657 and $71,683 for the years ended December 31, 2013 and 2012, respectively. Cash paid for income taxes was $0 and $23,160 for the years ended December 31, 2013 and 2012, respectively.

See notes to consolidated financial statements

91 Notes to Consolidated Financial Statements

Note 1 Accounts and Contributions Receivable Accounts and contributions receivable represent amounts due from individuals Organization and Summary of Significant and organizations in support of the Institute’s programs. Management Accounting Policies considers all amounts collectible; therefore, no allowance has been recorded as of December 31, 2013 and 2012. Organization The Steadman Philippon Research Institute (“SPRI”), a non-profit organization, Unconditional gifts expected to be collected within one year are reported at was incorporated in the state of Colorado on February 22, 1999, was founded in their net realizable value. Unconditional gifts expected to be collected in future 1988, and is a tax-exempt organization under Section 501(c)(3) of the Internal years are reported at the present value of estimated future cash flows. The Revenue Code (“IRC”). SPRI is located in Vail, Colorado, and is dedicated to resulting discount is amortized using the level-yield method and is reported keeping people of all ages physically active through orthopaedic research as contribution revenue. and education in the areas of arthritis, healing, rehabilitation, and injury prevention. SPRI’s primary sources of support are public donations, grants, special events, and corporate partners. Investments The Institute reports investments in equity securities with readily determinable SPRI has agreements with several corporations that sponsor SPRI’s research. fair values and all investments in debt securities at their fair values with This research is for the general use of and publication by SPRI. These unrealized gains and losses included in the consolidated statements of activities. agreements are recorded as income in the year the research is performed and payment is received. The Institute holds alternative investments, which are not readily marketable and are carried at fair value as provided by the investment managers. The SPRI created the SPRI Leasing Corporation (“Subsidiary”), a wholly owned Institute reviews and evaluates the value provided by the investment managers subsidiary, in order to hold the assets, liabilities, revenues, and expenses and agrees with the valuation methods and assumptions used in determining derived from SPRI’s MRI scanner. the fair value of the alternative investments. Those estimated fair values may differ significantly from the values that would have been used had a ready market for these securities existed. Principles of Consolidation The reporting entity referred to as Steadman Philippon Research Institute and Investment return includes dividend, interest, and other investment income; Subsidiary (the “Institute”) includes the accounts of SPRI and SPRI Leasing realized and unrealized gains and losses on investments carried at fair Corporation. All intercompany accounts and transactions have been eliminated value; and realized gains and losses on other investments. Investment return in consolidation. is reflected in the consolidated statements of activities as unrestricted, temporarily restricted, or permanently restricted based upon the existence and nature of any donor or legally imposed restrictions. Basis of Presentation The Institute reports information regarding its financial position and activities according to three classes of net assets: unrestricted net assets, temporarily Inventory restricted net assets, and permanently restricted net assets. Inventory is stated at the lower of cost (first-in, first-out method) or market. Inventory consists of donated medical supplies of medical implants used for Unrestricted amounts are those currently available at the discretion of medical research. the Board of Directors (“Board”) for use in the Institute’s operations, fundraising, and certain programs. Property and Equipment Temporarily restricted amounts are monies restricted by donors specifically Land, buildings and improvements, and equipment purchased by the Institute for certain purposes or programs; these monies are available for use by the are recorded at cost. Donated fixed assets are capitalized at fair value at the Institute for the restricted purpose. date of donation. Depreciation is provided on the straight-line method based upon the estimated useful lives of the assets, which range from three to seven Permanently restricted amounts are assets that must be maintained years. Leasehold improvements are amortized over the shorter of the lease permanently by the Institute as required by the donor, but the Institute is term plus renewal options or the estimated useful lives of the improvements. permitted to use or expend part or all of any income derived from those assets. As of December 31, 2013 and 2012, the Institute did not have any permanently restricted amounts. Other Investments During 2009, the Institute received a contribution of real estate, which was recorded at estimated fair value at the date of donation. The investment is Cash and Cash Equivalents assessed for impairment if events and circumstances warrant such a review. The Institute considers all highly liquid investments with a maturity of three No such impairment was recognized during 2013 or 2012. months or less when purchased to be cash equivalents, unless held for reinvestment as part of the investment portfolio or otherwise encumbered.

92 Deferred Rent liabilities and disclosures of contingent assets and liabilities at the date of Tenant improvement allowances paid by the landlord are recorded as deferred the consolidated financial statements and the reported amounts of revenue, rent and are recognized as a reduction of rent expense over the term of the expenses, gains, losses, and other changes in net assets during the reporting related lease. period. Actual results could differ from those estimates.

Contributions Subsequent Events Gifts of cash and other assets received without donor stipulations are reported The Institute has evaluated all subsequent events through the auditors’ report as unrestricted support. Gifts received with a donor stipulation that limits their date, which is the date the consolidated financial statements were available use are reported as temporarily or permanently restricted support. When a for issuance. donor-stipulated time restriction ends or a purpose restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the consolidated statements of activities as net assets released Note 2 from restrictions. Fair Value Measurements and Investments Gifts of land, buildings, equipment, and other long-lived assets are reported as unrestricted support unless explicit donor stipulations specify how such The Institute values its financial assets and liabilities based on the price that assets must be used, in which case the gifts are reported as temporarily or would be received to sell an asset or paid to transfer a liability in an orderly permanently restricted support. Absent explicit donor stipulations for the time transaction between market participants at the measurement date. In order that long-lived assets must be held, expirations of restrictions resulting in to increase consistency and comparability in fair value measurements, the reclassification of temporarily restricted net assets as unrestricted net assets following fair value hierarchy prioritizes observable inputs used to measure are reported when the long-lived assets are placed in service. fair value into three broad levels, which are described below:

Level 1: Quoted prices in active markets for identical assets or liabilities Revenue Recognition that are accessible at the measurement date. The fair value MRI and other income are recognized at the time the services are provided. hierarchy gives the highest priority to Level 1 inputs.

L evel 2: Other than quoted prices that are observable for the asset or Functional Expenses liability either directly or indirectly. Expenses incurred directly for a program service are charged to such program. Allocations of certain overhead costs are also allocated to programs on a pro Level 3: Unobservable inputs where little or no market data is available, which rata basis of total space occupied by each service or by headcount. requires the reporting entity to develop its own assumptions.

In determining fair value, the Institute utilizes valuation techniques that Rescinded Pledge maximize the use of observable inputs and minimize the use of unobservable During the year ended December 31, 2012, a donor notified the Institute that inputs to the extent possible, as well as considers counterparty credit risk in its they were rescinding the remaining $600,000 of a pledge made in 2010. The assessment of fair value. These classifications (Levels 1, 2, and 3) are intended Institute did not have any rescinded pledges during the year ended December to reflect the observability of inputs used in the valuation of investments and 31, 2013. are not necessarily an indication of risk or liquidity.

Following is a description of the valuation methodologies used for assets Income Taxes measured at fair value: SPRI is exempt from federal income taxes under Section 501(c)(3) of the IRC. SPRI is not a private foundation within the meaning of Section 509(a) of the IRC. Common Stock and Mutual Funds: Valued at the closing price reported on the active market on which the individual securities are traded. SPRI Leasing Corporation is a for-profit corporation that is required to file a corporate income tax return for its operations and recognizes deferred tax Limited Partnerships: Valued based on the net asset value per share of assets and liabilities based upon differences between its basis of assets for the fund. tax and financial reporting purposes. There have been no changes to valuation methodologies during the years The Institute applies a more-likely-than-not measurement methodology ended December 31, 2013 and 2012. to reflect the financial statement impact of uncertain tax positions taken or expected to be taken in a tax return. After evaluating the tax positions Financial assets carried at fair value as of December 31, 2013 are classified in taken, none are considered to be uncertain; therefore, no amounts have the table below in one of the three categories described above. been recognized as of December 31, 2013 and 2012. If incurred, interest and penalties associated with tax positions are recorded in the period assessed Description Level 1 Level 2 Level 3 Total as general and administrative expense. No interest or penalties have been Common stock $ 15,981 - - $ 15,981 assessed as of December 31, 2013 or 2012. Tax years that remain subject Equity mutual funds 785,304 - - 785,304 to examination include 2010 through the current year for federal returns and Limited partnerships - 3,749,666 - 3,749,666 2009 through the current year for state returns. Total $ 801,285 $ 3,749,666 - $ 4,550,951

Use of Estimates Financial assets carried at fair value as of December 31, 2012 are classified in The preparation of consolidated financial statements in conformity with the table below in one of the three categories described above. generally accepted accounting principles requires management to make estimates and assumptions that affect the reported amounts of assets and

93 Description Level 1 Level 2 Level 3 Total Note 5 Common stock $ 25,305 - - $ 25,305 Equity mutual funds 667,240 - - 667,240 Line-of-Credit Limited partnerships - 3,913,315 - 3,913,315 The Institute has an unsecured line-of-credit with a bank available up to Total $ 692,545 $ 3,913,315 - $ 4,605,860 $1,500,000, which bears interest at the prime rate plus 0.50% (3.75% at December 31, 2013) and matures in March 2018. As of December 31, 2013, the outstanding balance was $263,500. As of December 31, 2012, there was Included in investments on the consolidated statements of financial position are no outstanding balance. money market funds in the amount of $624,622 and $423 at December 31, 2013 and 2012, respectively, which are not subject to fair value classification.

Investments in certain entities that calculate net asset value per share are Note 6 as follows: Long-Term Debt

December 31, 2013 December 31, 2012 Unfunded Redemption Redemption Fund Description Fair Value Fair Value Commitments Frequency Notice Period Long-term debt consists of the following: Absolute Return Funds $ 3,749,666 $ 3,913,315 None Quarterly to Annually 30 to 90 Days December 31, 2013 2012 The Absolute Return Funds employ a strategy to achieve consistent positive, Notes payable to a bank paid in full during 2013. - 938,172 absolute returns with low volatility primarily by seeking to exploit pricing Less current portion - (248,847) inefficiencies in equity and debt securities and by using a traditional hedge Long-term portion of debt $ - $ 689,325 fund approach. The fair value of the investments has been calculated using the net asset value per share of the investments.

Investment return consists of the following: Note 7 Capital Lease For the years ended December 31, 2013 2012 The Institute has acquired assets under the provisions of a capital lease. For Dividends and interest - reinvested $ 73 $ 6,364 financial reporting purposes, minimum lease payments relating to the assets Net realized and unrealized gains 615,165 485,795 have been capitalized. The lease expires in March 2014. Amortization of the Fees (37,044) (20,842) leased property is included in depreciation expense. Total return on investments $ 578,194 $ 471,317 The assets under capital lease have cost and accumulated amortization as follows:

Note 3 December 31, 2013 2012 Contributions Equipment $ 1,714,990 $ 2,188,507 Less accumulated amortization (1,236,921) (1,663,474) Contributions receivable consist of the following: $ 478,069 $ 525,033

December 31, Maturities of capital lease obligations are as follows: 2013 2012 Due in less than one year $ 136,800 $ 261,800 For the Year Ending December 31, Due in one to five years 100,000 186,800 2014 $ 101,390 236,800 448,600 Amount representing interest (600) Less unamortized discount (7,579) (12,458) Present value of net minimum lease payments 100,790 $ 229,221 $ 436,142 Less current portion (100,790) Long-term capital lease obligation $ - The discount rate used was 3.25% for 2013 and 2012.

Note 8 Note 4 Retirement Plan Property and Equipment The Institute has a defined contribution retirement plan (the “Plan”) under IRC The Institute’s property and equipment consist of the following: Section 401(k). Employees are eligible to participate in the Plan after one year of service. The Institute’s contributions to the Plan are determined annually. December 31, The Institute contributed $36,477 and $20,852 to the Plan in fiscal years 2013 2013 2012 and 2012, respectively. Equipment $ 554,828 $ 508,974 Furniture and fixtures 137,814 140,043 Leasehold improvements 2,107,558 2,107,558 Machines and video equipment 1,148,087 1,146,156 Medical equipment 4,301,646 4,293,934 8,249,933 8,196,665 Less accumulated depreciation and amortization (5,775,053) (4,503,343) $ 2,474,880 $ 3,693,322 94 Note 9 Note 12 Temporarily Restricted Net Assets Commitments

The temporarily restricted net assets that have been restricted by the donors to Operating Leases be used only for specified purposes and/or are time restricted until payments The Institute leases facilities under non-cancelable operating leases expiring on contributions receivable are received are as follows: between January 2014 and February 2016, which call for both base rent payments and operating expenses. Rent under these leases for the years ended December 31, December 31, 2013 and 2012 was $316,502 and $316,486, respectively. 2013 2012 Assets available for Future minimum lease payments under these leases are approximately as follows: Education $ 211,437 $ 931,563 Assets available in future periods Year Ending December 31, Education 74,213 74,213 2014 126,000 Center for outcomes-based 2015 127,000 orthopaedic research 21,800 42,914 2016 11,000 Imaging - 100,000 $ 264,000 Time restricted only 133,208 219,015 Total contributions receivable 229,221 436,142 $ 440,658 $ 1,367,705

Note 10 Related Party Transactions

During 2013 and 2012, the Institute received approximately $984,000 and $862,000, respectively, in contributions from related parties, including various Board members, employees, and medical staff at The Steadman Clinic (the “Clinic”).

In addition, the Institute received $962,514 from the Clinic during both 2013 and 2012, as a corporate sponsor and for the use of certain equipment.

The Institute owed a Board member $30,000 for contracted management services, which is included in accounts payable as of December 31, 2013.

Note 11 Income Taxes

Income tax (benefit) expense has been computed at the statutory rates applicable during the period. The components of taxes on income are approximately as follows:

For the Years Ended December 31, 2013 2012 Current Federal $ (86,000) $ 82,000 State (12,000) 11,000 (98,000) 93,000 Deferred Federal (19,000) (35,000) State (2,000) (5,000) (21,000) (40,000) $ (119,000) $ 53,000

The Institute’s deferred tax assets and liabilities are a result of the difference in the tax and book basis of depreciable assets.

95 96

A 501(c)(3) nonprofit organization

181 West Meadow Drive, Suite 1000 Vail, Colorado 81657 970-479-9797 fax: 970-479-9753 www.sprivail.org