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A Conversation with President Freddie H. Fu, MD

Founded in 1972, the American Orthopaedic Society for Sports Medicine (AOSSM) is an association of orthopaedic surgeons dedicated to helping everyone who is active, from the professional athlete to the weekend warrior. In addition to research into the biomechanics of injury and honing techniques for repair, the membership is very focused on preventing sports injuries through educating the public –– including young athletes, parents and coaches –– about the best ways to keep healthy and stay in the game.

On July 12, during the annual meeting in Orlando, renowned surgeon Freddie H. Fu, MD, was installed as the association's 37th president. As the David Silver Professor and Chair of the Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine, Fu is internationally renowned for pioneering surgical techniques of the shoulder and knee. He is a "go to" expert on a number of topics, particularly double-bundle anterior cruciate ligament reconstruction (see box), about which he is passionate. To date, Fu has made nearly 750 national and international presentations, edited 28 major orthopaedic textbooks and authored or co-authored almost 300 peer-reviewed articles and 88 book chapters on the management of sports injuries.

In addition, Fu has served as the head team physician for the University of Pittsburgh's Athletic Department for the past two decades. He is quick to say that he has a lot of help in caring for the 500 athletes who look to his team to keep them in top performance shape.

"In sports, the surgeons spend time with the teams and understand not just the injury itself but also the total aspect of the sport," he pointed out. Fu added that to be a "total" team sports medicine professional, it's important to understand prevention and training techniques, nutrition and psychology, in addition to how to fix what gets broken. "It's more than just the end result. Better understanding leads to better care."

During the coming year, Fu is eager to harness both his personal passion and that of the AOSSM's membership to continue to improve safety, outreach, communication, research and opportunities for young surgeons.

Fu said the AOSSM is preparing to launch an Injury Prevention Initiative in the spring of 2009 that will focus on tips to minimize athletic overuse injuries, especially related to baseball throwing. The multi-platform approach will include outreach to parents, coaches and children. Fu described the sports world as a pyramid with tens of thousands of young athletes forming the base and a very small percentage of world-class athletes at the top.

"Everyone wants to move up. There's a lot of pressure, but many people aren't meant to move up," he noted, adding that sometimes everyone involved needs a little perspective that there are other things in life after sports.

One concerning example of increasing need for injury repair is "Tommy John" elbow reconstruction surgery. Co-author E. Lyle Cain, MD, fellowship director of the American Sports Medicine Institute in Birmingham, Ala. presented study findings during the AOSSM annual meeting in July that indicated a significant increase in the number of surgeries performed on minors. He said only 12 percent of patients receiving this surgery in 1997 were under 18 (12 of 97 patients). By 2005, that figure jumped to 33 percent with 62 of the 188 operations occurring on high school athletes.

Fu said there is a mixture of misperception and impatience fueling such increases.

"Young pitchers believe that by the surgery they'll become stronger, which is not necessarily true," he said, adding that although the surgery has excellent outcomes, it would be preferable for pitchers to take time off and rehabilitate or better yet to focus on mechanics and limiting numbers of pitches to avoid the need for surgery in the first place.

In addition to expanded communication with the community through the Youth Sports Injury Prevention Initiative, Fu is also excited about improving cross-discipline communication through a new journal – Sports Health: An Interdisciplinary Approach— which is launching in January 2009. A joint effort of the National Athletic Trainers' Association, the Sports Physical Therapy Section, American Medical Society for Sports Medicine and the AOSSM, the journal is slated to cover a broad range of best practices and emerging sports medicine science related to prevention, protection, treatment and hot topics.

Also launching in January is a match program for fellowships in sports medicine.

"Every year in this country, about 700 complete an orthopaedic residency," noted Fu. "About 200 of them would like to spend one extra year to specialize in sports medicine."

Unfortunately, he said, the process has become disorganized throughout the past five-to-ten years. Prospective fellows have been unsure exactly what programs are available and have sometimes felt pressured to make an immediate decision on an offer. In an effort to rectify the situation, the AOSSM has been instrumental in structuring a program where interviews between programs and prospective fellows are set between January and March with all involved parties entering their rankings into a commercial matching program at the end of the time period.

"The match process is for the benefit of the trainees," Fu explained. "It lets them look at the whole country to see where they want to go."

Fu is also excited about AOSSM research work.

"We are pooling the membership together to collect data and have now supported, outcome-based, multicenter studies for ACL surgery and are working on a study of pediatric injuries. In December 2008, our society will work with the National Institutes of Health to put on a post-injury osteoarthritis conference," Dr. Fu added.

Beginning with his term, the AOSSM is launching a three-year funding cycle for ligament and tendon repair. In addition to sponsoring workshops, Fu said the Society would have some grant money available for foundational work.

"The idea is to have members be able to get some basic work done so that they can apply for bigger grants through the NIH," he explained.

The end goal, he continued, is to better understand various sports injuries, look for biological markers that might offer clues to risk factors or early warning signs and ultimately improved techniques.

Finally, he noted, every AOSSM president is given the opportunity to select a speaker for the annual meeting that marks the end of the elected term. Fu has already chosen his speaker for next summer – Pittsburgh native William E. Strickland, Jr, who has made it his life's work to bring career-oriented training to adults in transition, as well as an arts and learning center to the urban community.

A great admirer of Strickland, Fu said he wants the AOSSM membership to embody that same spirit of making their communities viable and vibrant.

"I want the membership to have a feeling of giving back to the community … not just with money but in other ways, too," he said of taking a hands-on approach, such as staffing medical sports clinics for the underprivileged.
After all, a love of the game often transcends cultural differences and provides a great starting point for reaching out to those in need within a community. What better place to find common ground than on the playing field?

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