Presidential Address of the American Orthopaedic Society for Sports Medicine: AOSSM – A Championship Team

It is truly a great honor and privilege to represent you in our 50th celebratory year. What a world-class team AOSSM has become in a half a century. I’d like to honor personally all of the past presidents that have helped me, guided me, and led me over the last few years. Thank you so much. We have a special guest here. I want to honor all of the 69 founding members, but Major Gladden is here, one of our founding members, in the audience. Thank you Major Gladden for being here, we wouldn’t be here without you. An organization that is 50 years old unfortunately has members that have departed our ranks. So I would like to have a moment of reflection and silence for those that have left us.

We have a special honor, a surprise honor, for Bruce Reider. 20 years of service. And so we are honoring him by an annual scholarship selected to an individual international/national as the Bruce Reider Scholarship to attend the AOSSM meeting. Thank you Dr. Reider for your 20 years of service as a master editor of our journal.

Before I begin my address, there are some people to thank. First, my wife and family. Second, we have an awesome Presidential Line that works as a team. The Board of Directors, the Committee Chairs, and the Professional Team. This meeting doesn’t take place without that group. I want to thank my partners at Cleveland Clinic for the greatest job. Thank my colleagues at Vanderbilt Sports Medicine Orthopaedics for the first 20 years of my career. I have to thank all of the multi-center teams I have participated in and worked with. It has truly been one of the most fun things I have ever done in life. There are countless colleagues and friends in my career and certainly you have molded me and helped me, and I am appreciative. And to all the fellows, residents, and medical students I have learned from and had the pleasure to educate, thank you so much.

Now, let’s celebrate 50 years. That’s a long time, 1972 to 2022. I don’t think any of the founders early on thought it would grow to this. A half century ago they started this, but it is the member engagement of each of you that make AOSSM what it is. And truly the engagement makes us where we are. It’s the collective talents for over 50 years that have developed into a championship team, a world leader in sports medicine and research. But in the future, things will change. We will still be a team, but the team will be more inclusive, more diverse, and that will be our key to success.

I want to look back over the last 50 years and think about what some of the greatest athletes said about teams. You may disagree with them, but these are some of the athletes I thought were great athletes. First, I am going to start in the 70s. One of my favorite players when I was young, Dallas Cowboys quarterback, Roger Stauback, and he was quoted as saying “Have the right people, in the right places, working together.” Michael Jordan dominated basketball and perhaps is one of the greatest athletes of all time, not just in the 80s, and he was quoted as saying “Talent wins games, but teamwork and intelligence wins championships.” Mia Hamm was a star, a media darling and a soccer star, and she definitely revolutionized some of the aspects of women playing soccer and she was quoted as saying “I am a member of a team, I rely on the team, I defer to it, sacrifice for it, because the team, not the individual, is the ultimate champion.” Certainly, she helped popularize women’s soccer, but there is something else that helped all women’s sports that is also 50 years old, and that is Title IX. Certainly a huge impact on our field and on women’s athletics. And Title IX’s other aspect is its huge impact on education. Serena Williams dominates women’s singles tennis, but she was also an outstanding and dominate doubles player, with career slam wins, and she is quoted as saying “Every woman’s success should be an inspiration to another. We are strongest when we work together and cheer each other on.” And finally, how could anyone who watched the Olympics in 2016 forget this face? Simone Biles, commenting on being a team member stated “The teams comes first.” She is the most highly decorated gymnast.

So, what do the greatest athletes of all time think? They don’t think about themselves. They all recognize that their success is team success. And it depends on players, coaches, medical staff, strengthening and conditioning staff, and equipment. So now I would like to switch gears. I want to look at some of the highlights from the last 50 years, certainly not all of them because we would be here a long, long time, but some that I thought were most relevant. We will start with our founding fathers, our past presidents, growth of fellowships, journals, and research funding, and the intangibles that make up the AOSSM culture. Our founding members, really quite bold, they separated from the Academy and said “we need to do something, we need to have our own society in sports medicine, we need to have our own meeting in sports medicine.” They created the annual meeting, which is basically the art and science of medicine. The same way it is today. They created a forum for education. What initiative they had, very very bold. And also at this time, in 1972, independently, several members began a scientific journal we know today as AJSM, which also celebrates its 50th anniversary.

I want to thank our Past Presidents. Each past president has left an indelible mark on AOSSM and has shepherded our society through 50 years of change. If you think about what has changed in society and healthcare, it’s incredible. Through the advent of arthroscopy, MRI, electronic medical records, internet, iphone, CAQs, and many many more. Orthopaedic specialization is something that has rapidly evolved over time. In 1990, almost 50% of orthopaedic surgeons considered themselves a generalist; now it is down to about 20%. If you look at orthopaedists who consider themselves a generalist with a special interest, that has also declined. So obviously specialization is taking off. In 2016, the last time it was measured by Academy, 60%, and it continues to grow. Most orthopaedic surgeons now consider themselves specialists, and this will have huge implications on how we education, what meetings they go to, and what they attend. Our Fellowships, one of the crown jewels of what we do, have doubled in 20 years from 58 sites to 90 sites, and from 128 fellows to 225 fellows.

Our journals, another crown jewel of what we have. We are fortunate to have these journals, and if you look at the evolution of journals, AJSM started in 1972, then in 2009 we had Sports Health, 2013 OJSM, and then VJSM. So if we look at AJSM, in 2021 on an annual basis, 1.4 million downloads. If we look at Sports Health, 2 million downloads on an annual basis. And now you can see the impact of what an open journal allows, that’s 2.5 million downloads per month. And finally, as we have evolved, VJSM was started, and VJSM in 2021 has 27,000 views of its videos. So our journals have been tremendous. We have been very fortunate, we have only had 3 editors of AJSM: Dr. Hughston, Dr. Leach, and Dr. Reider. And when you have that kind of sound leadership and stability, it is no wonder AJSM is the premier journal.

Research grant funding, near and dear to my heart, AOSSM has invested and is one of the first societies to promote research growth and funding. In our first year, we looked at it from 1988 to 1992, 5 grants for $75,000, but if you look at our last 4 years, 2018 to 2022, $2,075,000. How did that happen? It happened with industry support, it also happened with the million dollar drive, which we will talk about more. One of the crown jewels of our research has been the IKDC, IKDC-CAT, and the MARS study. And it is the fact that we can have this kind of support, that leads us to our historic sports medicine research grant, which I will tell you about later. There are intangible member values, part of the culture of what we have. From fun events at the meeting, to gathering of team physicians for collaboration and discussion, to fellowship training, to being a mentor, to being mentored, and friendships. For indelible friendships that we have from meeting people and finally surgical training.

So, where is AOSSM in the present? Our logo from 1972, our logo from 50 years later. Our professional team is outstanding. This meeting and what goes on at this meeting is largely the responsibility of the professional team led by our CEO, Greg Dummer. It is truly outstanding, they have done a great job. So if you see them outside and you meet them, thank them if you enjoyed the meeting. It is really their hard work that puts on such an outstanding program. We have a new website, from new technology, an entirely new platform. I hope you have seen it. There are some unique features on that. This is version 1.0, so it will get better with time. And one of the things is a one place where you can click in as a member and find all of the articles that appear in our journals over the last 50 years.

AOSSM runs by leadership engagement. It runs by you all that are there and participate in this society. Big committees with many members are research, education, and self assessment. There is the Presidential line, Board of Directors, and a Medical Publishing Board. All told, there are 198 people engaged on an annual basis in having the society promote education and research. If you look at our members’ engagement in journals, if you just look at our editors, assistant and associate editors, and editorial boards: 448 people. If you look at the reviewers, there are several thousand reviewers. So, everyone who has reviewed an article has contributed to the society, and we can’t run a journal, we can’t thank you enough for your efforts in reviewing the articles. And our medical publishing team, with Bruce Reider as editor, is seen there in the picture on the right. What about members’ participation in the meeting? There are 503 members here, there are 50 reviewers for the abstracts, which is a tremendous number, 155 posters, 54 moderators, 176 podium presentations, and I have to thank the program committee, that this year was headed by Rick Wright and Casandra Lee, for such an outstanding program. We are truly indebted. Now, if we put all of the people who are engaged in the society together, if we take the leadership, the journals, and the people participating, that is over 1000 people. So if you look to your right and look to your left, that person is engaged with the society. We want to engage you all because the engagement of each member makes our society strong.

Our research portfolio is significant. We have research awards for the O’Donoghue, Cabaud, and Excellence in Research that are manuscript based. The clinical studies, the MARS seed funding from this society engaged 23 of our members, 55% in private practice, at 52 sites. This was an NIH funded study that was led by Rick Wright, funded twice, and it has had multiple publications. And finally, we did the original IKDC, which was very forward thinking. And now we have invested in the Computer Adapted IKDC. We also do annual and sponsored grants and think tanks. And this is only possible, and growing in the future, because of the philanthropic funding that was spearheaded by Neal ElAttrache and the 2 to 1 match from Stanley Druckenmilller and Kenneth Langone, called “The million dollar drive”. And for everyone who contributed to that and matched that, we are very grateful. Pictured on the right, is the ad hoc review committee for the multi-center award. And what we wanted to do in a multi-center award, which is patterned off MARS, was to take an established multi-center group and give them funding so that they can continue on and get external funding, like the DOD and the NIH. We had 4 outstanding presentations, and our review committee consisted of people from the Academy, from OREF, and from AOSSM. And the winner is Jupiter 4.0: Risk factors for failure of isolated medial patellofemoral reconstruction by Dr. Shubin-Stein and Dr. Parook. This combination is a collaboration that was with the AOSSM, AAOS, OREF, and Aircast. It is a novel collaboration, in fact it works so well, the Academy now is using this model to give out grant awards in support and in matching with other subspecialties in the future. So, congratulations to the Jupiter team. The next award we want to give out is the Emerging Leaders Multi-center Award. What we wanted to do here was take a group that wasn’t established and provide them seed funding to get together, to work together, and to build up an infrastructure. And this gets awarded to Eric Baumann for the management of UCL injuries in throwers: a prospective multi-center cohort. This was Jim Bradley’s idea and shows how the presidential line works. On a call, he had a great idea and then we put it together and awarded this grant. So congratulations to this group and Eric Baumann, who will lead it.

What about the next 50 years? Where are we going and what are we going to do? I think Isaac Newton said it better than anyone else: “If I have seen further than others, it’s by standing upon the shoulders of giants.” What should we do? We should act boldly, like our founders. We should hardwire our core values, we should create a dynamic strategic plan. And now you are wondering about this next slide, what does the Dow-Jones average teach us about this presentation? The Dow-Jones average, as most people know, it affects your portfolio and retirement portfolio and everything you do. It is made up of the 30 largest industrial companies in America. And here is the relevance, in 1972, there were 30 companies in this index. 50 years later how many of those 30 companies are still at the premier level of the largest companies? It is only 3. 27 companies have dropped out. 90% have fallen away in 50 years. So AJSM should really celebrate the fact that during this time they have grown, they have become world class, they have gotten better. And that is tremendous achievement. But we also must be humble. We don’t want to be one of the 90% to fall out in the next 50 years. And that is why you need a strategic plan and to keep your eye on the ball and your eye on changing education. Just like our journals have pivoted and grown, the society needs to pivot and grow into the changing needs of our members of our patients.

The strategic plan was a Board approved year-long process. We set up a steering committee that was diverse and inclusive, and this steering committee, that was commissioned by the Board to do qualitative and quantitative research with an outside consultant, they met virtually, they spent 1 day together in January doing the first draft, met virtually again to hone the draft down and this draft was presented to the Board at their April meeting. The Board looked at it, made modifications, and the Board unanimously approved this at our Spring Board meeting. I am very grateful to all the people who spent extra time on the steering committee to do this. What is our vision for the future? We want to treat athletes and people of all ages and abilities to enjoy active and productive lives. How will we do this? We will facilitate world-leading evidence-based diagnosis and treatment, guiding a safe return to physical activity for all orthopaedic sports medicine surgeons. We will hardwire AOSSM core values that make up the culture of our organization, we will continue to look for life-long learning focused on scientific and practice innovation, we will encourage mentorship and development of the next generation of leaders, we will lead in clinical and research collaborations that team based, patient focused care, we will show compassion for patients, families, and coworkers, and we will be an advocate for personal, professional, and institutional diversity and inclusion. These are our values. These haven’t changed over 50 years, and should never change over the next 50.

We have 2 pillars in the AOSSM. The first is education and the second is research. Our goal in education is to acquire knowledge. We want to learn and apply evidence-based care in treating athletes and all active people. We have a unique website that allows a customization of personalized care for each member to look at their website and to drive the educational content they need at different points in their career. We want to create partnerships. We want to increase the diversity of our educators and instructors. In Research, we want to lead to the discovery of independently vetted techniques and therapies to improve patient outcomes. We want to drive multi-center research. We want to mentor new and emerging sports medicine surgeons and professionals. We want to collaborate with partner institutions like the Academy, maybe the Arthritis Foundation, maybe the NIH. We want to diversify our funding sources.

There is a foundational community by which we work and this community should represent a diverse, inclusive, engaged, and supportive fellowship of peers that are committed to advancing the care of athletes and the profession of orthopaedic sports medicine. And they really come down to 3 buckets: practice or inclusion, AOSSM member value, and the team physician. What we mean by practice or inclusion is that we want to support all orthopaedic surgeons that are treating sports and active lifestyle injuries to know the best care and the best clinical practice. For member value, we want to customize it so that we are the right education for the right point in that member’s time throughout their lifespan of treating and being an orthopaedic sports medicine physician. And for the team physician, we all know that the care of the athlete today, that used to be one physician on the sideline, now is multiple physicians and a lot that people are not physicians, including our partners in physical therapy and athletic training and now exercise coaches. We want to provide a forum so we continue to educate them as they lead teams or participate in teams so we can get the safest return to care and the safest long-term care for the athletes. We are very fortunate and very celebratory, our past accomplishments are significant, our current position is excellent, but this has provided us an outstanding opportunity that should be used to advance us in the care as a world leader of education and research. This will require membership engagement. This will require work from our journals, our industry partners, and philanthropy. I want to give shout out to all of industry partners and a special recognition to our platinum sponsors, who make up our corporate advisory board here. Without industry support we couldn’t do the type of programming that we have at this meeting. And a lot of industry support was the initial grants that established many other grants for our society and our society members that have been funded at the NIH and other higher levels. Finally, the future, it’s bright. We have a very bright future for the next 50 years. Our strategic goals will require teamwork, working as teams. Our society and teams will be inclusive and more diverse. And it will be our members’ talents, active participation within teams, that will enable AOSSM to achieve the best outcomes for athletes and patients. So, get engaged, join a team, lead a team, help a team, contribute to a team. Thank you very much.