This is Carly Beam with the Becker Spine
and Orthopedics podcast, and I'm thrilled to be
joined today by doctor Frank Cordesco
with Hospital for Special Surgery out in New
York. Doctor Cordesco, thank you so much for
being here today.
It's my pleasure, Carly.
I'll I'll give you a little brief background
on my,
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 doctor Charles Neer, also at Columbia
n 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 doctor 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 thirty fifth 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.
Thank you. And doctor Cordesco,
I've started wanna start with you. What are
the top three trends that you're following in
health care today, whether it's, you know, specific
to orthopedics
or just kind of looking overall at health
care system as a whole?
Yeah. I think that's an important question, Carly,
and I think it's pretty clear to anybody
who follows health care
and innovation. It's it's really threefold. And I'll
start by just being specific to health care
overall, and then perhaps we could delve into
sports medicine and orthopedics. But, you know, first
off, AI and automation and care, I think,
has had a 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.
And on the health care delivery system, it's
it's really personalized and value based care is
becoming a 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.
Their reward outcomes,
with coordinated whole person care.
So I I think that's, you know, specific
to health care 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.
So as it relates to what I do,
I mean, my wheelhouse is,
I 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, you know, over the last year to
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
m r with MRI with with very good
accuracy and some would say approaching MSK radiologists.
And 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 twenty four
hours with respect to treatment modalities, counseling them
even before we get a report from the
radiology service. And and so AI is
helping in those cases where perhaps more information
is necessary to be 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, you know, whether we
proceed with operative or nonoperative 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,
you know, the low hanging fruit in orthopedics
has been anything that is 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 three d 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 and,
tendons,
has 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 and
facets that I think we can touch on
in a little bit.
Moving from imaging to planning and intraoperative support,
I've 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.
And then I think the predictive analysis
models with outcomes and logistics
are 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.
And, obviously, on the practical side for clinics,
clinic notes, etcetera,
AI has 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 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 to more to follow.
So virtual follow-up now is a a stable
part of my post op care,
particularly as a,
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 to seek consultation.
And, typically,
with an ACL
reconstruction, for example, we would see patients at
ten days for wound check,
one month, two months, three months, four and
a half months, six months, nine months, and
twelve 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 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's that
has been a game changer for younger
mobile patients and long distance athletes.
Yeah. Yeah. Like, 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 in The
US.
Absolutely. Without question.
And it also enables you to to see
patients
seven days a week. You know, if if
they're 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 and
healthy
wellness aspects in a later on in the
discussion if you'd like, but I think 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, postoperatively
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 was as we do in soft
tissue surgery for the obvious reasons.
So I I think it's been a, as
I said initially, a game changer.
As it relates to wearables and sensors, this
is an exciting area,
in health care
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, these 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 as it relates to the
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, etcetera.
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 in, you know, earlier intervention from the
surgeon
and their therapists and or athletic trainer colleagues.
Yeah. And, doctor Kolesko, I wanna ask you
also just kind of touching in on
some of the some of the biggest innovations
that you think will, kind of explode in
2026,
especially as it relates to sports medicine
and, you know, these types of surgeries that
you've been, talking about.
Well, I think the wearable piece will continue
to work, you know, very effectively in the
coming in the coming twelve months.
We
you know, as I mentioned, these are available.
The the issue related to practicality
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 the real questions remain,
again, as it relates to major health care
delivery systems as to
how we implement it, how we implement and
execute. So I think that's a big piece
over the next
twelve to twenty four 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 I wanna make Yes. Yes. This
is great. 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. Mhmm.
Yeah. And then doctor Cortesco,
one other topic that I really wanted to,
touch base with you on is biologics
in orthopedics.
What what's your perspective on the state of
biologics in orthopedic care now, and what are
your predictions for the next two to three
years?
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
nonoperative
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, blood borne,
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 I'll 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 health care delivery
systems
to feel comfort comfortable reimbursing for it. So
as you know now,
most of these techniques are not reimbursable upon,
rather by health care 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 expand 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, viscosupplementation
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 I mentioned the management of
early o a 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
nonoperative 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 these
treatments like platelet rich plasma have been shown
to be helpful
in Mhmm. Our own research and the research
of others.
And if you contrast that, for example, with
rotator cuff
tears or tendinosis,
the the application of PRP has probably been
less useful in that setting.
So without getting into
the weeds, so to speak, I I I
wanna 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 and it's this is across many,
many numbers of people.
And we don't know the details of this,
and I'm certainly no ex 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 I think we don't have a
lot of the data that we need to
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
that a purist would would like to have
to implement this across
all patient populations.
Thank you for, breaking all that down. And
we are coming to,
about time. So doctor Cordesco, I wanna thank
you again for joining us on today's podcast.
It was great chatting, and I look forward
to connecting again in the future.
Perfect.