'The greatest laboratory in the world': Q&A with Dr. Thomas Graham on caring for pro athletes

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Lehigh Valley Orthopedic Institute in Allentown, Pa., appointed Thomas Graham, MD, as its first physician in chief in April.

He recently connected with Becker's about his decades of experience treating professional athletes and emerging orthopedic trends. 

Note: Responses were lightly edited for clarity and length.

Question: What unique challenges do surgeons face when they are treating professional athletes compared to general patient populations?

Dr. Thomas Graham: Many people have a little bit of a misconception about the way that information has flowed to extend surgical science with those of us who've been privileged to be involved in the care of professional athletes. They're the greatest laboratory in the world, so first and foremost they require 100th percentile outcomes. If you throw it 96 you go to Cooperstown, you throw it 86 you do something else for a living. So we get a better reflection or barometer of what our treatments can truly deliver by being engaged in the care of the professional athlete. The greatest thing is we've identified a lot of things in that laboratory that we then brought back into the daily practice in each of our specialties and subspecialties, and that's really rewarding. I think we've actually transported more learnings from taking care of elite athletes into our daily practice than going the other way, and I'm really proud of that. I think anybody who wants to pursue an active lifestyle and improve performance is an athlete. It's not just the people with numbers on their back and a lot of numbers on their check that people read about us taking care of. I did the Peloton this morning: I'm an executive-athlete. The folks who are on the assembly line or lifting boxes for FedEx are industrial-athletes. The people defending our freedom are warrior-athletes. I think that we can't limit our thinking about those who are desirous and pursuing improvement, performance, comfort or effectiveness in their life to just the folks that we see on ESPN.

Q: How do you determine appropriate care for professional athletes when they're in the middle of the season and they want to get back on the field?

TG: We're pretty logical and systematic about it. First of all, they are people; that day, our patients; and, oh yes, they're players, and that's what they do for a living. You can't lose sight of that, and I think that's where we've had some success is understanding those criteria. Then I think about three phases: short, medium and long. Short term is the season, medium term is their career and long term is them playing with their grandkids. You have to align your decision-making to make sure that you're not doing anything that might jeopardize one versus the other, and that's why we've worked so hard in developing and pioneering the kind of care that optimizes safety, comfort and effectiveness. As for the temporal consideration, that's why we developed a lot of things that returned athletes in season, or if you've operated on at the end of the season, they were ready for training camp or spring training. We looked at the temporal aspects of rehabilitation and returning to play a little differently. We said listen — can you get this individual back before the All-Star break, or can you get them back for the playoffs, safely, comfortably and effectively? Communication and trust with the athlete and the team has been so critical, and again I'm really honored that we've been able to earn that.

Q: Are there any emerging trends in sports medicine or orthopedics that you are keeping an eye on?

TG: Orthopedics has always been on the cutting edge as far as implementing the newest techniques and technology, and I think Lehigh Valley Orthopedic Institute is a great cauldron of innovation. The ones that I foresee that are right around the corner or presently being implemented and touching patients revolve around biologics. I think that we are going to be thinking highly about how we are literally touching things at the molecular and cellular level and not always traditionally with our hammers and saws and chisels for what orthopedists are known for. I also think partnering with our data is important, and that could have a couple manifestations. As we move into a brand new realm of having a way to turn information into insight, this could help us render better care at the right time and monitor patient-reported outcomes. We in orthopedics have long prided ourselves of being the technocrats and the early adopters, developers and pioneers when it comes to bringing innovation. 

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