Integration of Science into Orthopaedic Practice: Implications for Solving the Problem of Articular Cartilage Repair*

Abstract

President Peterson, thank you for the honor of presenting the Fourth International Cartilage Repair Symposium Presidential Guest Lecture. I appreciate the opportunity to address the fascinating subject of integrating science into orthopaedic practice, a subject that should be the primary concern of surgeons and scientists seeking to restore damaged and diseased articular cartilage. It took more than 2000 years for a few thoughtful practitioners of the art of orthopaedics to value and apply principles and observations derived from basic research 1. Yet, in the short time since this occurred, the understanding that optimal patient care depends on science as well as art has transformed orthopaedic practice from a disparate array of manipulations and operations, best characterized as well-intentioned savagery, to a range of treatments that, in many instances, can be considered civilized. Equally important, we live in a time when the integration of knowledge from new basic research into orthopaedic practice has the potential to solve the most daunting clinical problems, including the pain and loss of mobility caused by the limited capacity of human joints to repair themselves. Individuals with varying experience and qualifications have practiced orthopaedics for more than twenty-five centuries 1,2. It would be reasonable to expect that, over this period of time, orthopaedic treatments would have become generally safe and effective. Yet, only 250 years ago, John Hunter (1728-1793), the individual regarded as the father of scientific surgery 3, noted that "surgery, namely operations, is like an armed savage that attempts to get by force that which civilized men would get by stratagem." 2 Orthopaedic operations in Hunter's day were painful, bloody, brutal, and extremely dangerous: the typical results, for patients who survived the operations, were disappointing and disabling 1. It was a situation that led to Hunter's comment that …