Dr. Chris Tucker:
Welcome to the Arthroscopy Journal Podcast. I'm Dr. Chris Tucker from TSAOG Orthopedics in San Antonio, Texas, and the podcast founding editor. Today on the podcast, we are celebrating the 40th anniversary of the Arthroscopy Journal. I'm honored to welcome to the podcast Arthroscopy Journal, Editor-in-Chief Emeritus Dr. Gary Poehling from Wake Forest in Winston-Salem, North Carolina. Dr. Poehling is a professor of orthopedic surgery at Wake Forest University School of Medicine and a professor at Wake Forest Institute for Regenerative Medicine. His research interests include arthroscopic surgery, cellular treatment for arthritis, and robotic knee surgery. Dr. Poehling received his bachelor's degree from Marquette University, his medical degree at the Medical College of Wisconsin, and he completed orthopedic residency at Duke University. Gary, congratulations on your entire career and most notably to our discussion today, your contributions to the development of the Arthroscopy Journal, and welcome to our podcast.
Dr. Gary Poehling:
Thank you.
Dr. Chris Tucker:
Well, we're here in January 2025 to celebrate the 40th anniversary of the Arthroscopy Journal, which published its inaugural issue in 1985. When it was a quarterly publication, and as you humbly commented in your final editorial in 2014, it published only a grand total of 275 pages in its entire first year. Since then, arthroscopy has seen consistent growth and increased influence in the field of orthopedics. And in 1994, the Journal expanded to six issues per year to keep up with the growing demand. Now published monthly, Arthroscopy is a leader at the forefront of orthopedic research and education, and under the guidance and leadership of current Editor in Chief, Dr. James Lubowitz, it's also expanded the Arthroscopy family to include two additional journal offerings, Arthroscopy Techniques and Arthroscopy, Sports Medicine, and Rehabilitation.
As for your personal history, you began your journey with the Journal as the founding member of the editorial board from 1985 to 1987. Then you rose to be the associate editor to Dr. Ward Casscells' from 1988 to 1990, and then you succeeded him in 1991 as the editor in chief, a position you held for the next 23 years until your retirement in May 2014 when you handed the reins over to our current Editor in Chief, Dr. Jim Lubowitz. What an amazing story in history. I really feel blessed to have known you for the last five years or so through my personal involvement as an editor for the Journal, and it's really a pleasure to be able to interview you today. Going back to the very beginning, even maybe before the beginning, can you tell us how you originally became involved with the Journal, and what it was like in the development years before the publication ever even came to press?
Dr. Gary Poehling:
It's exciting, and I'm really happy to share that with everyone. And it all started back in 1983. In those days it was a very small meeting, the Arthroscopy Association was just beginning, and in 1983, Bob Metcalf came to a meeting and suggested that we really needed to have a journal to put out the publications that we need, because people weren't really accepting articles concerning arthroscopy, because it was not considered first-rate, and so that many of the journals would not publish our things because we didn't have long follow-ups and all of that problem. So, Bob in 1983 suggested that and he said, "Well, let me think about it and work with this." And so he did.
And he did a lot of the planning work, and who is going to publish it, where they're going to buy the paper. All of these things were done, and he actually did most of the first journal's articles. But Bob, in 1985, just before we were going to start publishing it, he came and he had a very busy practice. He was the president of AANA and he had 10 children, and he decided that he was a little overloaded, so decided not to have that done. So, what happened is Ward Casscells was appointed the editor, and we had Raven Press. And Raven Press was the publisher, with Mary Rogers. Jack McGinty, who had been president of AANA in 1982 became the head of the board of trustees. And I was on the editorial board, and that's how I was involved right from the very beginning.
And the fun story that I have about that is, that Ward came after we published the first Journal in the meeting in 1986, and he entered the meeting and said, "Well, guys, we published articles on chondromalacia on removal of loose bodies and knee cartilage, and if you guys don't publish anything or write any papers, we're not going to have anything to publish." Of course, it didn't really turn out that way. So, at any rate, we were involved, and Ann Farley was the managing editor from 1985 to 1992, and that was in Wilmington, Delaware. And when I was appointed to be the associate editor, I went to visit her, and I remember going to Wilmington and going up on the third floor of a 1800s building. It was a very old building and she was up in a little office up there, and she showed me how things were taken care of. And basically, they were on four-by-six note cards kept in a shoebox. That was the method of keeping track of our Journal articles. At any rate, she was wonderful, and it was the beginning, and we all were learning.
And so after that, in 1990, that's when Ward decided that he was going to stop the editing and turn things over to me. So, at that point, Anne Skulskie became the managing editor, and what we first did at that time was to check, to see exactly how much did it really cost, and we didn't feel like we were getting a good deal at all from Raven Press. We weren't losing money, but we weren't making any money either. So, we figured out how much it did cost to actually publish this and then what our return was, and we didn't feel that it was very good. So, what we did was made a complete request for a proposal for about 10 publishers. And we were at the academy meeting in 1992, and that was in San Francisco. And we met with each one of these people and they presented to us what it was going to cost for paper and for this and for that and all of that, and then told us what we could earn from that.
And all of the publishers suggested, even Raven Press increased their amount, but the person that really made a huge difference was a guy by the name of Lou Rines. Lou Rines was a publishing guru, and he had been publisher of almost all of the different publishers, but he came in and he gave us a contract more than double of what we were getting with Raven Press. And so that in 1995 is when we started publishing with Saunders at the time. Now Saunders was actually part of Hardcore Brace at the time, and ultimately they were bought out by Elsevier, and that's how we became involved with Elsevier. Bought the contract and the negotiations. The other person that was very important in this whole thing was a girl by the name of Carol Wolfe, and she was our first managing publisher from the Saunders, and she really believed in us and said that we could really go. The other interesting person that was involved in all of that was Hank Hackett, and he was our production manager from 1995 to 2006, and he happened to move to Greensboro, which is right near Winston-Salem.
So, those were the, at that time, the real possibility of where this is going. We weren't sure that most people did see it, but Elsevier did allow us and did say, "This is not only going to be important in this country, it's going to be worldwide." And so, that's another whole aspect of what we tried to do, and that is to try to get international articles. Very complicated at the time. It's become much, much easier now, and we get articles from all over the world in perfect English and all, but it wasn't true in 1992 when we started all of that. And I remember getting a series of French articles that we had to translate from French into English, which was a huge problem in itself. And then we had to send it back to them, and was our translation all right, and all of this. But the fact of that matter was, is those people that we did that for became very good friends of us, and published in our journal on a regular basis. So, it was very good.
Dr. Chris Tucker:
That logistical backstory is really exciting to hear, just where it was real grassroots start and then what it's grown into. Those of us who are involved in the Journal know that although you were formally involved since its inception for the first 29 years, you really still remain involved intimately, even until now for all 40 years of the Journal history. So you really have a unique perspective on the development of the practice of orthopedics over that time span, because you've witnessed and reviewed the research and the development and evolution of so many treatments. I just wanted to hear from you what you think some of the most noteworthy and remarkable changes in how we practice orthopedics has evolved over that last 40 year time span.
Dr. Gary Poehling:
Well, the thing that strikes me is that there's going to be a change. The only constant is change. And if I look back to what my practice was when I was first, when I went as an intern back in 1968, and think about what we did then and how we did it, it seems so primitive, and even the things that are being done now. Now I stopped operating a few years ago, but I continue seeing patients, and I see what is being done now. And the things that are being done now, like root repairs and things of that nature, we didn't even consider that. We thought it was a success if we got all of the loose pieces out in the back, and that was a great success. And now we have the tools to be able to do so many of these things.
Again, remember when posterior cruciate ligament reconstruction was way out on the very far edge of routine practice, and now it's relatively routine. And the results, I remember the results of what we tried to do when I was an intern, and those and the posterior cruciate ligaments were terrible. Another thing that really dramatically changed is the patella femoral joint, and dislocating patella and the way we treated them, they were not successful, they just didn't have it early on. And arthroscopic treatment has allowed us to be able to see exactly what is going on. And as you know, I was involved in the beginning of wrist arthroscopy, and that's another one. And I never forget, there's Dr. Bill Bowers, who is a great anatomist who was at UNC, and I showed him a wrist arthroscopy and he said, "This is not fair." He says, "I've been doing this for 10 years and I haven't been able to see that."
But that's the difference of what really allowed us to be able to see the intricacies of what is going on and then design things that will allow things to improve. So, that's what I've seen over the time, and I believe that's not going to change. You mentioned that I'm involved with Regenerative Medicine Institute here, and I see the changes are going to be coming, and they're going to be associated with our treatments. And so how can we use these cellular treatments? And we have struggled with them for a long time, but I am very confident that there'll be major changes that will allow the integration of our surgery with the cellular things to get even better results than we're getting right now.
Dr. Chris Tucker:
Sure. I look forward to touching on that a little bit more in a minute. Stepping away from your clinician hat a little and putting your editor in chief hat back on, notably, in the most recent release of the Journal Impact Factor results, which was in July '24, "Arthroscopy remains in the top 10 ranked journals in the orthopedic category now tied for 8th place amongst 136 journals. Current impact factor 4.4." This number I think underscores the journal's exceptional quality and clinical relevance, especially given very specialized focus compared to other more broad orthopedic and sports medicine publications.
Now, as the current Editor in Chief, Jim Lubowitz has always championed in our annual editors meeting. When guiding the direction and focus of the journal, we've never chased the impact factor nor altered the approach to the publication because of it. I think we all feel that quality will be recognized for what it is. What are your thoughts, and how do you feel the impact factor as a grade can be both helpful or harmful in the medical publication field?
Dr. Gary Poehling:
Well, certainly you see, there's some things that are so contracted like cartilage, that always has a very high impact factor, but it's all the people that are working in that particular field published in that journal and they quote each other and all of that. So, it's a very small group. Our group is not huge, huge, but is much larger than that small research group. And the difficulty that we have is that things are turning over all the time. There's almost never a journal that there isn't some new idea that's in there that people have made progress on and how things should change in your practice.
And so the impact factor, while actually, we, I think are doing quite spectacularly well, I should say, considering that we don't have this huge broad thing with physical therapy and all of those kinds of things, and total joints and all are not really included in our field, it's more focused. And of course, for the people that are doing this, that's what they really would like. And I think you're right, is that the quality is what people are looking for and expect, and we'll let the impact factor, we'll celebrate when we win, but we're not going to cry if we lose.
Dr. Chris Tucker:
Fair enough. So, obviously we've evolved into a digital workforce, and as you acknowledged earlier, the Journal evolved with that trend. Moving from what you said was once this completely paper-driven index card peer review process in a print journal to now this digital process with online publications full of media and videos, social media, and digital promotions. And even just last year, in 2024, we appointed our first associate editor for digital in emerging technologies, Dr. Prem Ramkumar. Could you ever have foreseen this growth in the early days, and what do you make of it now?
Dr. Gary Poehling:
Well, I have to congratulate Jim Lubowitz, who I recognized as an extraordinary reviewer and editor, and he has been wonderful. When I was coming along, I saw that this journal was destined to be an international journal, and most people didn't see that, but certainly the people that were involved, we talked about it. It was the editors that got together, and it was all of them that got the idea that this is really something. But to say that we're going to have all of these additional things that have come on and become more and more and more successful, and more and more often quoted, beyond what I expected.
Dr. Chris Tucker:
You mentioned change earlier. In your final editorial in 2014, you opened with a quote from President John F. Kennedy, who you quoted once saying, "Change is the law of life, and those who look only to the past or the present are certain to miss the future." I enjoyed reading that and re-reviewing your editorial. So along those lines, I think we all see many changes. Most recently in the practice of medicine it only seems to be accelerating, some good and some bad. What do you think are some of the biggest challenges facing our profession right now that potentially threaten the change how we care for our patients, and what do you think we need to do as surgeons to potentially mitigate those threats?
Dr. Gary Poehling:
Well, medicine is definitely changing, and one of the problems is the expense of medicine and how we as a society can provide healthcare to the masses, the people that are really need that. And that's a difficult and a problem that we haven't really solved, and just pointed out that as far as wealthy countries are concerned, we're not really at the top. But I think that has more to do with the politics of it than it has do with our healthcare system. Our healthcare system is really good. The problems that we have are taking care of the underserved, and I'm not sure that we as arthroscopists can solve that problem, because that's more of a political problem, but we have to pay attention to it and we have to do everything we can.
And I think that we're spreading our field to a more diverse group, and I think we have become more sensitive to that whole issue of diversity. Well, I think that's good. I still think that meritorious promotion is what is most important, but what we do have to do is look and make sure that we're not excluding people from the capability of doing it if they are capable, to give everybody a chance. And I think that's all important.
I think we need to also continue as we become more and more, less and less invasive, are we going to be able to make this the treatment less expensive in a more efficient way? And I think we, particularly in the United States here, have not paid attention to the cost of what it takes. If it's a good operation, we go for it. And we don't look at the cost. Now, many other places in the world, they do look at the cost, and they figure out ways to be able to make it less expensive. As a focus we need to be able to do that, and focus more on that. And I think that would be important for us.
Dr. Chris Tucker:
I think it's a gross understatement to say that you've been a mentor, a leader, an educator, colleague and friend to countless people over your career. I had the fortune to interact with you regularly through the Journal, but less frequently than I would like. Yet each time I listen to your stories and hear your thought, it really is quite impactful. I wanted to hear first, who was one of your most important mentors, and what was one of the most impactful lessons you took away from that person?
Dr. Gary Poehling:
Well, that's kind of you to ask. And of course, being the editor is a tremendous privilege. I know you as doing your work, gives you an opportunity to meet so many people and so many diverse kind of people. But I have to look back at how did I get to this place, and how did it really happen? Well, I was drafted into the military, and that was after my internship, and so I was assigned and went to Japan. And I took care of people that were, because I only had an internship, and so I wasn't allowed to touch any of the soldiers or anything, but I took care of the people that were taking care of the soldiers that were in the hospitals there.
And so, I called the guy that I was coming back to, I was coming back to Duke and it was Leonard Goldner, and I asked him if there's anything I could bring back from Japan. And he said, "Yes, you can bring back a model number 26 Arthroscope." Which was a scope that Masaki Watanabe had made. And so, I figured out how to get that, and went down, and saw him and got the arthroscope, and brought that back with me when I came back and started my residency. So, I got back and I gave the arthroscope to Dr. Goldner, and he looked at me. Understand I'm a first-year resident now just starting. I haven't had any experience at all. And he looked at me and he says, "We've had this model number 21 Arthroscope for four years and nobody's been able to make it work. I'm putting you in charge of developing arthroscopy." This is the first day I walk in the door.
And he said, "You tell me whatever equipment that you need, I'll get it for you. And there's going to be the first arthroscopy meeting. It's going to be held in Philadelphia, and it's by invite only, and I'll make sure that you have an invite." I go there as a first-year orthopedic. Everybody else that was there at the meeting was a minimum of 10 years older than me. And so, I was the little baby in the meeting, and that's where the arthroscopy business all started. And after that, he also said that, and that's where I first met Ward Casscells, and he is the one that taught me how to do the arthroscopy. Goldner sent me up to him. He had published 150 cases, so he had 10 cases on over two days. He did the first five and I did the second five, and that was it. And so, Ward Casscells certainly has to be up there, but the real champion, the guy that really trusted me, I have no idea why you would take a first-year resident and tell him. So that was Leonard Goldner.
And the other person that was hugely impactful to me was Terry Whipple. Terry Whipple was a first-year resident when I was a senior resident. And I went to Terry and I said, "Terry, I'm going to be leaving next year. And I've done this arthroscopy and all of that." And I had done, I don't know, probably 180 cases or something like that, at that time. And so, had some experience with it, and I said, "Would you like to do this?" And he said, "Well, let's have a meeting." And so I sat down, and I told him everything that I had learned in about 15 minutes, and he's been helping me ever since. And Terry has been a real important person for me.
And another person from industry that has made a huge impact was Charlie Federico. And Charlie was a, originally when I first met him, was a salesman for Smith & Nephew, or actually it was for Dyonics at the time, and that was before the Smith & Nephew thing. But Charlie was a guy that I could go to. And he is the guy that I came back from China and I introduced arthroscopy to China in 1983, and I came back and I said, "Charlie, they haven't got any equipment over there. All of this stuff we need to put on a course, we need to train them and all of that." He put together the whole thing. We had to change the electricity and all of that, but he put together 13 televisions and telescopes and all the equipment for them to learn. And actually, I just got back from the folks in China, and they were very grateful for that whole thing, and recounted the time that we went there and all the doctors came and learned how to do arthroscopy at that time. So, those are the main people.
Dr. Chris Tucker:
That's really neat to listen to, Gary. Appreciate those thoughts. Lastly, before we close out, I wanted to know what was one of the most important piece of advice you wanted to pass down to our listeners? Keeping in mind, we have surgeons, medical students, product reps, even patients listening to our podcasts now.
Dr. Gary Poehling:
Well, I would say, just do good work and trust in yourself. When you see things that you believe could be developed, don't shy away from that. Believe in what you see and what you think, and be open to new things and to accept them and to examine them. I can say that I've been fortunate in that most things that I have been involved with amounted to doing more minimally invasive kinds of things, and that as we have seen over the time, has been a successful approach and has been one that has worked in almost all the different situations. There are a few things that you tried and they didn't work out as well as you would like, but you can't get disappointed in all of those kinds of things. You got to stay positive.
And the other aspect is be real sensitive to your patients. And we as orthopedics, we can size up problems pretty quickly and go through, and many patients will accept that, but there's a lot of them that are injured by not paying attention, not instructing them, not telling them all that is important and educating them. It takes time, and that's something that we all don't have enough time to do, but it is important, and so I think that's important. The other aspect of it is, our family lives are important also, and so we want to live a complete life and take care of our family, because that's, in the end, really important.
Dr. Chris Tucker:
Excellent advice. Thanks, Gary. I wanted to congratulate you once again on all your work and your decades of service to the orthopedic community as a whole, and especially to our Arthroscopy Journal. You really do embody the principles of humility and service and professionalism that I think we all should celebrate as the Arthroscopy Journal turns 40 this year. So, thanks for taking the time out of your evening to share your thoughts with us.
Dr. Gary Poehling:
Well, thank you and congratulations on all the good work that you guys are doing. It's really tremendous and it is really impactful for everyone to have this as a opportunity for them to be able to be updated. This is really great. Thank you.
Dr. Chris Tucker:
It was our pleasure. Dr. Poehling's final editorial titled, Change: A Constant in Orthopedics, was originally published in the April 2014 issue of the Arthroscopy Journal, which is available online at www.arthroscopyjournal.org. This concludes this edition of the Arthroscopy Journal Podcast. The views expressed in this podcast do not necessarily represent the views of the Arthroscopy Association or the Arthroscopy Journal. Thank you for listening. Please join us again next time.
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