Experience With Sports Injuries Drives Researcher’s Passion

 

Scott Rodeo, MD, is part of the research team at Hospital for Special Surgery (HSS) in New York City participating in the PIKASO trial (Preventing Injured Knees from Osteoarthritis: Severity Outcomes), the first Arthritis Foundation-directed clinical trial aimed at preventing post-traumatic osteoarthritis (PTOA). The trial brings together top scientists from nine institutions across the country to examine the use of the drug Metformin in people with knee injury who are at high-risk for developing PTOA in the knee after anterior cruciate ligament (ACL) reconstruction. Dr. Rodeo is an orthopedic surgeon at HSS, Professor of Orthopaedic Surgery and Vice Chair of Orthopaedic Research at HSS/Weill Medical College of Cornell University and head team physician for the New York Giants Football.

Q: Tell us about your background.
 
I am from San Jose, California. After completing my undergraduate work at Stanford University in 1985, I came to New York City for medical school at Weill Cornell Medical College. I completed my orthopedic surgical residency at HSS, followed by a two-year fellowship at HSS (one year of basic laboratory research, followed by one year on the Sports Medicine and Shoulder Service). My passion for academics and pursuing a research career in addition to my clinical work comes from my parents, who were schoolteachers. 

A big part of my life during my formative years was my involvement as a competitive swimmer. This sparked interest in exercise physiology and understanding the basic biology of tissue injury and repair, which ultimately led to my interest in medicine.
 
I competed on the swimming team at Stanford University, and similar to many competitive swimmers, I suffered from shoulder pain. I remember going to our local physician, who told me I simply had to take three months off of training. I recall my response to this physician: “Dr., I’m on my way to swim practice right now in 20 minutes. Any other ideas?” I distinctly remember leaving this visit with our local physician saying to myself, “There has to be a better way.” This sparked my interest in understanding sports injuries and led to my passion for exploration of the underlying cellular and molecular events in tissue healing, with the goal of determining methods to improve outcomes and the ability to return to full function for active individuals. 
 
Q: What drew you to the field of science and research, and arthritis research in particular?  What do you hope to accomplish professionally?
 
I have been driven to arthritis research based on my clinical practice in sports medicine. Taking care of athletes with sports injuries has led to the recognition that, although we can often fix a ligament injury or a meniscus injury and return that athlete or individual back to sports, an unsolved problem has been the gradual development of post-traumatic osteoarthritis (OA) following such sports injuries. 

This is an incredibly important clinical problem, because we are seeing these significant sports injuries in children and adolescents in their teens, meaning that there is an increasing burden of early post-traumatic OA in patients in their 20s and 30s. I see many young patients with cartilage injury and early osteoarthritis, which limits their ability to participate in sports and to pursue an active lifestyle. I see a wide range of athletes and active individuals in my practice ranging from adolescents in sports to “weekend warriors,” high-level collegiate and professional athletes, and an expanding population of patients in their 70s and 80s who wish to remain very active. 

This clinical work has further spurred my interest in identifying ways to improve tissue healing and repair, so as to treat painful joints, allow participation in high-level activities, and potentially prevent progressive degenerative joint disease.  
 
My passion for research on sports injuries and early osteoarthritis has also been driven by my work as head team physician for the New York Giants football team as well as team physician for the USA Olympic Swimming Team. Taking care of athletes at this level has further driven home the consequences of sports injuries and early arthritis and how this can impact an individual’s life. Sports injuries for these athletes obviously has both career and financial impacts, further driving my interest to find better solutions in this area.
 
It is this clinical practice that drives my passion for research. The over-arching goal that fuels my clinical and research practice is the desire to explore basic aspects of musculoskeletal tissue injury (cartilage, meniscus, tendon and ligament) in our laboratory, and then translate these findings to our patients. My research program as a clinician-scientist at HSS is “translational research,” linking our basic laboratory research to clinical trials. I am fortunate to be in a very supportive environment at Hospital for Special Surgery, where there is a long history of close collaboration between laboratory scientists and clinicians, leading to tremendous potential to really move the needle in the area of cartilage and arthritis research. 
 
Q: Could you describe what you do with PIKASO?
 
As a sports medicine clinician, I will enroll my patients in the PIKASO trial. I frequently see patients with knee ligament injury, and thus I am well aware of the tremendously important and unsolved problems related to post-traumatic arthritis that occurs in the years following knee ligament injury. This is an area of significant unmet clinical need, which drives my passion for this particular clinical trial.
 
Q: Do you expect PIKASO to affect patients either directly or indirectly?
 
I do think that this trial has the potential to have a direct positive impact on patients. One of the most fundamental aspects of joint biology is inflammation following injury. We are learning that chronic, unresolved inflammation can have a distinctly adverse effect on numerous tissues in the joint, including articular cartilage, leading to progressive post-traumatic osteoarthritis. The pharmacologic agent that will be studied in this clinical trial, Metformin, has well-established effects on the amelioration of inflammation as well as a positive impact on articular cartilage, and thus there is exciting potential for this drug to possibly impact the progression of post-traumatic osteoarthritis. We currently have no good solutions for PTOA progression.
 
Q: What are you excited about in OA?  What should patients be excited about?
 
What really excites me in the area of OA research is our focus on the early events that occur following sports injury, because it is at this time that the process to eventual arthritis is initiated. I think that shifting our focus to early post-traumatic arthritis has a potential to lead to important inroads in our treatment of arthritis overall. 

When we see older patients with established osteoarthritis, there is tremendous heterogeneity in their clinical presentation due to the chronicity of disease. We often have no clue as to when or how the degenerative process began in these older patients. In contrast, in a patient with a sports injury, we know the exact date of onset of injury, we know from our “time zero” imaging studies that this was a normal joint prior to injury, and then we have the ability to prospectively follow these patients. 

This provides a great opportunity to intervene early to potentially prevent progressive post-traumatic osteoarthritis. This patient population is also a perfect “laboratory” to study the early events in the initiation and progression of osteoarthritis.
 
Q: What else would you like to share about your involvement with arthritis research?
 
I would continue to advocate for the development and support of clinician-scientists. As research tools become increasingly technically complex, we rely on our full-time scientists for their expertise. At the same time, the clinician knows the clinical problems and can advise on appropriate ways to plan trials and advance findings from the laboratory to patient care. It is also important for those in leadership to recognize that this all requires substantial resources — scientific, technical and financial. However, this is clearly money well spent!