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Becker’s Healthcare Podcast
The Future of Sports Medicine and Orthopedics With Dr. Frank A. Cordasco
00:19:47
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- [00:00]
A
This is Carly Beam with the Becker Spine and Orthopedics Podcast, and I'm thrilled to be joined today by Dr. Frank Cordasco with Hospital for Special Surgery out in New York. Dr. Cordasco, thank you so much for being here today.
- [00:13]
B
It's my pleasure, Carly. I'll give you a little brief background on my history. So, again, Frank Cordasco. I received my orthopedic surgery residency training at Columbia Presbyterian Medical Center, New York Orthopedic Hospital, and my shoulder and elbow surgery fellowship training thereafter with Dr. Charles near, also at Columbia and NYOH. I've spent the majority of my career in New York City, initially as a faculty member at Columbia, and then I was recruited to the Hospital for special surgery by Dr. Russell Warren, where I've been for nearly three decades. Now I'm an attending orthopedic surgeon at the Sports Medicine Institute at hss, as well as a senior research scientist at HSS and a professor of orthopedic surgery at Weill Cornell Medicine, which is part of Cornell University. And I've served as the 35th president of the American Shoulder and Elbow Surgeons from 2018 to 2019. And I'm currently an ex officio member of the ASCS executive committee, as well as the ninth chair of the Journal of Shoulder and Elbow Surgery family of journals.
- [01:20]
A
Thank you. And Dr. Cordasco, I want to start with you. What are the top three trends that you're following in health, whether it's specific to orthopedics or just kind of looking overall at the healthcare system as a whole?
- [01:37]
B
Yeah, I think that's an important question, Carly, and I think it's pretty clear to anybody who follows healthcare and innovation. It's really threefold. And I'll start by just being specific to healthcare overall. And then perhaps we could delve into sports medicine and orthopedics. But first off, AI and automation and care, I think, has had a huge impact already on a number of facets of human endeavor, specifically medicine. And so AI and automation and care is rapidly moving into diagnostics, risk prediction, clinical documentation, and administrative workflow automation. A lot of this has been present now for a few years. It's certainly an evolution and we would expect, you know, fairly rapid change soon, meaning in the next one, two to five years. It's being used to read images, flag high risk patients, support triage, and reduce paperwork so clinicians can spend more time with patients on the virtual care and remote monitoring and wearables. This is, again, amazing technology. Obviously, telemedicine is now a mainstream access point since the pandemic it's especially useful for primary care and behavioral health and it reduces the need for many in person visits for these individuals. Remote patient monitoring, consumer wearables can feed continuous data to clinicians and it enables early detection of deterioration or more proactive chronic disease management at home on the healthcare delivery system. It's really personalized and value based care is becoming kind of a transition. So I think many health systems around the country, perhaps New York as an outlier, are shifting from fee for service toward value based models that reward outcomes with coordinated whole person care. I think that's specific to healthcare overall. Using genomics, biomarkers and individual care plans is becoming more and more common, particularly in areas like oncology and condition specific pathologies and programs. As it relates to what I do, my wheelhouse is I practice as an orthopedic and sports medicine surgeon. The three big trends that I just mentioned translate into very practical shifts in how I diagnose, operate upon and follow athletes back to return to sport at their prior level of performance. And it's an exciting time. And again, a lot of this is not new. We tend to focus on what we've been hearing from the media and from our financial colleagues over the last year or two, but AI and imaging pathology and even instrumentation in the OR has been present already in orthopedics for the last several years, even predating Covid. I'll start with the imaging side. You know, AI and imaging planning and outcomes as it relates to imaging. AI tools are getting very good at detecting fractures, implant loosening, osteoarthritis severity and sports injuries such as ACL tears, meniscus tears and rotator cuff injuries, both with respect to radiographs as well as MRI with very good accuracy and some would say approaching MSK radiologists. As you probably know, in our field, orthopedic surgeons and sports medicine, surgeons are often reading their own films and acting upon these patients within 24 hours with respect to treatment modalities, counseling them even before we get a report from the radiology service. AI is helping in those cases where perhaps more information is necessary to be accurate and manage the athlete effectively. So for sports this means faster reads on knee and shoulder MRIs, automated measurements and decision support on whether we proceed with operative or non operative care. As it relates to planning and intraoperative support. I think AI driven templating can predict implant sizes, alignment and patient specific plans and is being integrated, as I mentioned earlier, into augmented and virtual components within navigation, robotics for joint reconstruction and complex reconstructive work. I think the low hanging fruit in orthopedics has been anything that involves bone. So total joint replacements, spine surgery with pedicle screw instrumentation. It's a bit easier to manage those patients with preoperative imaging like 3D CT scans where you can then utilize your intraoperative devices with robotics and computer instrumentation to really support that. I'd have to say that my field, sports medicine, meaning soft tissue work in terms of ligaments and tendons, has probably been a little bit behind for a number of reasons. First off, as I mentioned bone. But there are some exciting, you know, interests in the future and facets that I think we can touch on in a little bit. Moving from imaging to planning and interoperative support. I've mentioned that complex work and I think arthroscopy and sports procedures will over the short term in the next year to five years. We can expect more automated recognition of anatomy and pathology in arthroscopic video and the use of augmented reality guidance over the next few years. Then I think the predictive analysis models with outcomes in logistics is another exciting aspect of this where we can forecast again on the arthroplasty side, length of stay, complications and readmissions. But similar tools are emerging now in my areas of acl, meniscus and shoulder surgeries. On the soft tissue side, obviously on the practical side for clinic notes, et cetera, AI is already used for example at my hospital at HSS and starting to auto draft clinic notes, op notes and pre op plans which can cut documentation time and help with burnout for many physicians and physicians physician extenders. So if we move from there to remote monitoring apps and data rich rehab again this is really exciting and it has already been implemented and executed in the last several years. But there's more, more to so virtual follow up now is a stable part of my post op care, particularly as a sports surgeon who sees athletes from all over the country and in some cases all over the world. So historically prior to the pandemic it would be difficult to have those patients return to New York and to my office to seek consultation. Typically with an ACL reconstruction, for example, we would see patients at 10 days for wound check, one month, two months, three months, four and a half months, six months, nine months and 12 months post op and then a two year follow up. And when you're dealing with patients who are both domestic and international distances from New York, this has just been a game changer for us. So now myself, my own athletic trainer and my PA can meet in a room, so to speak Virtually with an athlete in Seattle or Los Angeles and their entire group of local physical therapists, trainers and even the team physicians in their own training facility. And that has been a game changer for younger mobile patients and long distance athletes.
- [09:25]
A
Yeah, I can imagine it's especially helpful even like this week when we are recording in January in the middle of one of the biggest cold front storms.
- [09:33]
B
In the U.S. absolutely, without question. And it also enables you to see patients seven days a week. You know, if you're away at a conference during the middle of the week, you can then extend hours for these types of post op visits into the weekends. Not that you know, we can get into, you know, work life and healthy wellness aspects later on in the discussion if you'd like. But I think that this provides the surgeon and the patient with a lot of flexibility in terms of when to meet. And again, these are most helpful I think post operatively and during the rehabilitation and return to sport phases where it's so intensive in sports. You know, my arthroplasty colleagues don't often require the need to see patients as frequently as we do in soft tissue surgery for the obvious reasons. So I think it's been, as I said initially a game changer as it relates to wearables and sensors. This is an exciting area in healthcare overall, as I mentioned earlier. So whether you're managing a cardiac patient postoperatively or more specifically in my field athletes we're now using and again we're just touching on this at this point from a practicality standpoint, but I think the future is going to be very exciting as it relates to so called IMU based systems. These are inertial measurement units which include accelerometers, gyroscopes and often magnetometers to create these systems. They can track range of motion, step counts, limb loading, return to play metrics after the types of surgeries I've discussed. So ACL reconstructions, meniscus surgeries, shoulder procedures, et cetera. And some of these platforms combine sensor data with AI to flag patients who for example, may be lagging in rehab or importantly overloading too early, prompting earlier intervention from the surgeon and their therapists and or athletic trainer colleagues.
- [11:41]
A
Yeah, and Dr. Cordesco, I want to ask you also just kind of touching in on some of the biggest innovations that you think will kind of explode in 2026, especially as it relates to sports medicine and these types of surgeries that you've been doing, talking about.
- [12:00]
B
Well, I think the wearable piece will continue to work. You know, very effectively in the coming, in the coming 12 months. We, you know, as I mentioned, these are available. The, the issue related to practicality and actually utilizing them in a cost effective manner has yet to be fully ascertained. I think by, and that's mostly by us. So the surgeons have to buy into these technologies and I think most of us will. The, the issue is logistically how to implement it, how to organize it. We haven't really gotten into the costs associated with monitoring this data and utilizing the technology. So I think as we, as it's clear we would benefit from these. Regarding the clinical need, the real questions remain again, as it relates to major healthcare delivery systems as to how we implement it, how we implement and execute. So I think that's a big piece of. Over the next 12 to 24 months. But technology is there. We, we didn't talk about digital rehab as part of this. Again, with respect to return to sport. So there are. Did I answer your question, Carly? I want to make.
- [13:15]
A
Yes, yes, this is great.
- [13:17]
B
Okay. As it relates to app based protocols, you know, clearly if you follow any software apps, whether you're, whether you utilize Peloton or other platforms like that, it's pretty clear that we can push exercise videos as well as other aspects like pain and function scores and proms directly to dashboards that the, the athlete and their surgeon and the team can review. And this can support more standardized pathways for common procedures and also generate outcomes with respect to registries and our own research and quality work. Yeah.
- [13:57]
A
And then Dr. Cordesco, one other topic that I really wanted to touch base with you on is biologics in orthopedics. What's your perspective on the state of biologics and orthopedic here now and what are your predictions for the next two to three years?
- [14:16]
B
Well, again, this has been going on for over two decades. If we think back to athletes like Kobe Bryant traveling to Dusseldorf to obtain injection treatments, it's, you know, this goes back a couple of decades. It's become much more prominent in the states due to regulatory reforms. And you know, I view biologics in, in a couple of different ways. So as it relates to things that we do in the office to either enhance healing for patients we deem to be non operative or to promote healing in patients who are postoperative. I think most surgeons like myself utilize these on a daily basis in our offices and sometimes in our operating rooms. So, you know, biologics I think of in three basic ways. Bloodborne bone marrow derived and adipose tissue and so, for example, if I'm treating a younger athlete who has early osteoarthritis, that is not a surgical problem, I might utilize a biologic to enhance pain relief and symptom relief. And I think I'll, before getting into details, I'll sort of qualify this by saying we wish we had more data than we do. And I think that's going to explode with the help of AI over the next two years. So historically we believe that these products can help and we have patient data that suggests that it will help, but we don't necessarily have the numbers for evidence based assessment that will, that would allow healthcare delivery systems to feel comfort, comfortable reimbursing for it. So as you know now most of these techniques are not reimbursable upon rather by healthcare delivery systems. So the onus is on the patient to sort of establish these resource allocations, which is hard. So as a surgeon, as a clinical practitioner, it's hard for me to recommend a technology that requires the patient to expend a resource allocation. Having said that, there is data available for for example, PRP to manage the use of these techniques for early osteoarthritis. So there are lots of systematic reviews and meta analyses that will allow us to definitively say PRP is better than for example, Visco supplementation for the management of early osteoarthritis. And I think that's, that's an easy lift for most of us because the data is there. So I mentioned the management of early OA in young athletes. There are other aspects and a lot of this, Carly, honestly is joint and disease specific. So we know, for example, and we've published on this at hss, that some joints are more responsive and some tendon groups are more responsive to the application of PRP short of surgery. So many of these are non operative treatments. So for example ECRB tendinosis, ECRB is the extensor carpi radialis brevis. It's an elbow extensor tendon, otherwise known as tennis elbow. The same can be said of the common flexor tendon group, so called golfer's elbow. These treatments, like platelet rich plasma, have been shown to be helpful in our own research and the research of others. And if you contrast that for example with rotator cuff tears or tendinosis, the application of PRP has probably been less useful in that setting. So without getting into the weeds, so to speak, I want to make it clear that there are differences among tendon groups within the human body and there are also differences in the host response. So what may work for me with the same problem that you might have may not work for you. And this is across many, many numbers of people. And we don't know the details of this, and I'm certainly no expert in regenerative medicine, but it's very clear that what you bring to the table, based upon your own genetics and your own composition, if you will, without once again getting into the nuances of what types of factors we're talking about, it's clear that the differences between humans have an impact on the responses to these biologics, which makes it that much more difficult. So I know it's an exciting area and we're all interested in it, but I think we don't have a lot of the data that we need to promote it on a regular basis. Having said that, is it used in most sports medicine practices around the US and around the world? Absolutely. But we just don't have the data that a purist would like to have to implement this across all patient populations.
- [19:29]
A
Thank you for breaking all of that down. We are coming to about time. Dr. Cordasco, I want to thank you again for joining us on today's podcast. It was great chatting. I look forward to connecting again in the future.
- [19:44]
B
Perfect.