Steven Arnoczky, DVM, a veterinary surgeon and renowned scientist started his illustrious career in orthopaedic translational research at HSS over 45 years ago and was the founding Director of the Laboratory for Comparative Orthopaedic Research. Mentored by pioneers in orthopedic research at HSS, John L. Marshall, DVM, MD, Philip D. Wilson, Jr, MD, Russell F. Warren, MD, and Peter A. Torzilli, PhD. Dr. Arnoczky established one of the very first research programs in the U.S. focusing on soft tissues, and he was an early innovator in establishing collaborations between scientists and clinicians. His approach laid the foundation for his transformative research on preserving knee and shoulder joints after injury. Dr. Arnoczky brought the unique combined perspectives of a clinician-scientist, an individual who had a deep understanding of the clinical problems physicians face, and the scientific expertise to design novel laboratory studies to answer these questions. His approach led to many seminal discoveries that have advanced patient care. His research has been recognized by over 30 national and international awards, culminating in his election to the American Orthopaedic Society for Sports Medicine Hall of Fame, the highest honor in sports medicine research. Embodying the HSS philosophy of supporting the next generation of surgeons and scientists, Dr. Arnoczky supported numerous trainees, including HSS faculty, Scott A. Rodeo, MD, sports medicine surgeon and vice chair of Orthopedic Research and co-director of the Orthopedic Soft Tissue Research Program at HSS, and Jo A. Hannafin, MD ,PhD, through mentorship and collaboration as they developed federally funded research programs.

During his tenure at HSS, Dr. Arnoczky met his wife, Brenda, who was head nurse on the neurology/neurosurgery floor at New York Hospital (now New York-Presbyterian Hospital). This gift memorializes the role that HSS played in their lives. “HSS started me on an orthopaedic research career that would change my life. Like so many others whose lives have been enhanced by their time at HSS, Brenda and I are so very grateful for what HSS has meant to us. We are happy to be able to pay it forward with this enduring support,” said Dr. Arnoczky. 

As the No. 1 hospital in orthopedics for 13 straight years by U.S. News & World Report (2022-2023), HSS is a leader in research aimed at improving the lives of patients suffering from debilitating orthopedic and rheumatic conditions such as arthritis, bone and soft tissue injuries, autoimmune diseases, and musculoskeletal pain and deformities.

“This exceptional gift will help to ensure that there is sustained funding for leading-edge investigations taking place at HSS. We are pleased that Steven is building upon his past contributions to HSS as a scientist and mentor to many trainees with this gift, made with his wife, Brenda, to make a lasting difference for HSS and the field of orthopedics,” said Louis A. Shapiro, CEO at HSS.

“HSS is committed to delivering unsurpassed care and improving the field. The Arnoczkys’ gift will help us to continue developing treatments and explore emerging research topics to best improve clinical outcomes as grants will be awarded annually to projects and initiatives aimed at having a clear and measurable impact on patients,” said Dr. Rodeo. 

Through a competitive process, medical students, residents, and fellows collaborating with physicians and scientists on pilot translational orthopedic research projects will be invited to apply for a grant. A selection committee comprising of leading HSS physicians and scientists will evaluate applications. Grants will cover the cost of personnel, equipment, supplies, and other key research resources specific to investigators and their projects.

“We are deeply grateful for Steven and Brenda’s generosity which will enable talented medical students, residents, and fellows to accelerate breakthroughs that change people’s lives,” said Bryan T. Kelly, MD, MBA, president, surgeon-in-chief and medical director at HSS. 

The Arnoczky Endowment for Translational Orthopedic Research will build on HSS’s leadership position as the largest musculoskeletal research facility in the world.

“To see Steven give back to HSS in this way is deeply meaningful to those of us who worked with him early in his career. We join the entire HSS community in thanking the Arnoczkys and celebrating this visionary gift,” said Drs. Warren, Torzilli, and Hannafin, co-founders of the HSS Soft Tissue Research Laboratory.

Reconstruction is the current standard of care surgical treatment for tears of the anterior cruciate ligament (ACL). This procedure typically uses a graft, or a piece of tissue, placed in the knee minimally invasively, using small incisions. About 300,000 ACL reconstructions are performed annually in the United States with well documented rates of success.

ACL repair is an older technique that involved suturing (sewing) torn ACL tissue, not rebuilding it with a graft. ACL repair was performed in the 1970s at select institutions, including Hospital for Special Surgery, but was abandoned due to unacceptably high failure rates of up to 50%.

Today, ACL repair has been modernized and can be performed through a minimally invasive approach. Proponents suggest that modern ACL repair techniques may be performed safely and may lead to a quicker recovery than ACL reconstruction. However, the limited studies to date raise questions that must be discussed in detail with your surgeon.

1. It is critically important to get ACL surgery right the first time.

When ACL surgery fails, surgeons must do a revision procedure to correct or revise the problems that were not fully addressed the first time. Revision requires reconstructive ACL surgery with a graft. (ACL repairs cannot be done as revisions.) Redoing ACL surgery may result in higher rates of failure, lower rates of return to sports, and increased risk of osteoarthritis.

The importance of successful initial ACL surgery holds true for people of all ages, but it is particularly critical for young athletes, for whom a failed surgery can have devastating consequences, including years lost from sport in the short term as well as chronic pain and loss of function in the long term.

2. Failure rates for ACL repair appear to be significantly higher than those for ACL reconstruction in people of all ages.

Current studies suggest that modern ACL repair techniques have a failure rate that may be five to ten times higher than that of ACL reconstruction^1,2,3. One major recent study in a prominent sports medicine journal found that arthroscopic ACL repair has unacceptable outcomes in young athletes, with short-term failure rates of close to 50%².

It has been suggested that ACL repair may be appropriate for older adults who have a type of ACL tear called a proximal avulsion and who do not participate in “cutting and pivoting” sports such as basketball, volleyball, and soccer. For these patients, failure rates in the short term appear to be much higher than ACL reconstruction in this age group^1,2,3.

3. There is still much we don’t know about ACL repair.

There has been no scientific evidence that shows a difference in postoperative pain between ACL repair and reconstruction. Rehabilitation and return-to-play protocols for ACL repair have not yet been established. Proper guidelines for rehabilitation and return to sports are essential to keep people safe from re-injury.
 

Andrew D. Pearle, MD

Chief, HSS Sports Medicine Institute

Bryan T. Kelly, MD

HSS Surgeon-in-Chief and Medical Director

Answorth A. Allen, MD

David W. Altchek, MD

Struan H. Coleman, MD, PhD

Frank A. Cordasco, MD, MS

David M. Dines, MD

Joshua S. Dines, MD

Stephen Fealy, MD

Andreas H. Gomoll, MD

Lawrence V. Gulotta, MD

Jo A. Hannafin, MD, PhD

Anne M. Kelly, MD

John D. MacGillivray, MD

Robert G. Marx, MD, MSc, FRCSC

Michael J. Maynard, MD

Moira M. McCarthy, MD

Danyal H. Nawabi, MD, FRCS

Stephen J. O’Brien, MD, MBA

Anil S. Ranawat, MD

Scott A. Rodeo, MD

Howard Anthony Rose, MD

Beth E. Shubin Stein, MD

Sabrina M. Strickland, MD

Karen M. Sutton, MD

Samuel A. Taylor, MD

Russell F. Warren, MD

Thomas L. Wickiewicz, MD

Riley J. Williams III, MD

References

1. Jonkergouw A, van der List J, DiFelice G. Arthroscopic primary repair of proximal ACL tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):21-28.

2. Gagliardi AG, Carry PM, Parikh HB, Traver JL, Howell DR, Albright JC. ACL repair with suture ligament augmentation is associated with a high failure rate among adolescent patients. Am J Sports Med. 2019 Mar;47(3):560-566.

3. Wright RW et al. Risk of tearing the intact ACL in the contralateral knee and rupturing the ACL graft during the first 2 years after ACLR: A prospective MOON cohort study. Am J Sports Med. 2007 Jul;35(7):1131-4.

For more information visit https://www.hss.edu/condition-list_torn-acl.asp.