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Making a Difference May Include Being Different

3/7/2018: I was invited to write this short manuscript by the editor in chief of the Journal of Bone and Joint Surgery. What’s Important: Making a Difference May Include Being Different Johnson, Lanny L. MD JBJS: March 7, 2018 – Volume 100 – Issue 5 – p 443–444 doi: 10.2106/JBJS.18.00011 The Orthopaedic Forum I probably made a difference in orthopaedic surgery as one of the pioneers of arthroscopy and the inventor of the motorized shaver and other instruments. However, a recent review of the biographies of those chosen for the American Orthopaedic Association’s (AOA’s) Distinguished Contributions to Orthopaedics Award made it clear that my career path was very different from those who are acknowledged by organized medicine. Many of the AOA luminaries came from families with medical genealogies. There were no doctors in my family. We only knew our family doctor, E.E. Woods, MD, who removed my tonsils in his office under ether anesthesia in 1938. He was way ahead of his time in doing outpatient surgery. I had been an athlete in high school and had wanted to become a coach, but my high school coach thought that I should be a surgeon based on results from the Kuder Preference Test. I had rejected that idea, thinking I was not smart enough—my IQ was 112. Plus, my family had no money. Most of those chosen by the AOA for the Distinguished Contributions to Orthopaedics Award had attended elite private colleges. I had attended a state school (called Michigan State College at the time) on an athletic scholarship. My high school coach had convinced me to try veterinary science, which I did for 1 year, and then I changed my major to premed. My application to the prestigious University of Michigan Medical School was rejected. I graduated from Wayne State University Medical School in Detroit—without honors. Perhaps my only likeness with the AOA honorees was my residency at Barnes Hospital in St. Louis, which was then, and still is, a prestigious program. My mentors there were H. Relton McCarroll, MD, and Fred C. Reynolds, MD, who were both American Academy of Orthopaedic Surgeons (AAOS) presidents. Those chosen for honors by the AOA typically came from large university academic groups. I had a desire for academic medicine and had been offered opportunities right out of residency to head a program at Syracuse and a new program in Shreveport, Louisiana. However, I accepted a family member’s advice that I was not a good fit for academic medicine and declined. By contrast, I started a solo private practice in East Lansing, Michigan, where there was no medical school at the time. I was interested in sports medicine and went to all of the relevant continuing education courses, where I learned that the experts of the day were 100% correct in their clinical diagnoses, personally confirmed by them during surgery. I was not that good, and was looking for ways to improve. I heard a lecture by Bob Jackson, MD, in 1969 about arthroscopy with a large Watanabe scope. Then, at an AAOS technical exhibit, I saw a needle scope. I popularized the use of this scope in an outpatient setting using local anesthesia at a time when arthrograms were the diagnostic standard. Subsequently, I saw that hand debridement by arthroscopy was primitive, and I invented motorized instrumentation, including a shaver. Most of those honored by the AOA belong to multiple prestigious orthopaedic organizations, most of which initially rejected my applications for membership. The rejections arose partly because the orthopaedic surgeons in my community said I was performing an unethical and immoral operation. Today, those purportedly inappropriate procedures are among the most common and successful orthopaedic procedures that are performed. I was rejected from membership in the Michigan Orthopaedic Society for 11 years. Five years ago, I received that society’s inaugural Lifetime Achievement Award. I was a candidate for AOA membership on 4 occasions before finally being admitted at 60 years of age. Each application was sponsored by a different AAOS president. My practice received a site visit by the American Orthopaedic Society for Sports Medicine (AOSSM) president, Les Bodner, MD, and secretary, Royer Collins, MD. After their visit, they voluntarily submitted my application for membership, but I was blackballed. Three years later, I was asked to give a 2-hour program on arthroscopy at the AOSSM national meeting, and was then granted membership. From all of these initial rejections and subsequent recognitions, I learned that I must accept, weigh, be thankful for, and respond to legitimate criticism. Unlike those typically honored by the AOA, I was never a traveling fellow, nor do I have a long list of academic appointments or awards. I had published in The Journal of Bone & Joint Surgery while I was a resident, but had only 1 publication thereafter. Noting that, the former JBJS Editor-in-Chief, Paul Curtiss, MD, invited me to submit. The submissions were all rejected. Dr. Curtiss was kind enough to tell me why: a prominent Harvard professor who reviewed for JBJS said I was a known liar. I was never elected to a leadership position in organized medicine. To be fair, I was offered several opportunities to serve as president of large national orthopaedic associations, but the same family member mentioned above directed me to decline. I have never been named a “distinguished” anything. I have received no National Institutes of Health (NIH) or other prestigious grants; I have always funded my own research. So, with all of these differences from the mainstream orthopaedic leadership, how can someone like me make a difference? I was influenced by the 1958 AAOS presidential address by H. Relton McCarroll, MD, entitled, “What Good Thing Could Come Out of Nazareth?” The message was that an orthopaedic surgeon can make a contribution no matter where he or she practices. I practiced in a remodeled student-rental house across from an 80-acre cornfield. In the early days, there were no traffic lights between my home and my office. Without the usual academic

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Fun to see I am still quoted from 1979 publication

11/29/2017: It was fun to see work I published 38 years ago is still quoted in the medical literature. The original publication was: Johnson LL: Lateral capsular ligament complex: Anatomical and surgical considerations. Am J Sports Med 7:156-160, 1979 This was reference in Oper Tech Orthop by Jorge Chahla as in press 2017 Elsevier Inc. Chahla J, Moatshe G, LaPrade RF. Biomechanical Role of Lateral Structures in Controlling Anterolateral Rotatory Laxity: The Anterolateral Ligament Biomechanical Role of Lateral Structures in Controlling Anterolateral Rotatory Laxity – The Anterolateral Ligament. Available from: www.researchgate.net/publication/314031553_Biomechanical_Role_of_Lateral_Structures_in_Controlling_Anterolateral_Rotatory_Laxity_-_The_Anterolateral_Ligament [accessed Nov 29 2017].

Patent Claims Granted for Skin Wound and Potential Wrinkle Treatment

10/12/2017: I learned that my application U.S. Application No. 15/189,510  Title: “ANTIMICROBIALS AND METHODS OF USE THEREOF” resulted in successfully granted the following claims which I have proof that after cosmetic skin defoliation or dermabrasion that the wound healing will be enhanced showing rapid healing, minimal inflammation and importantly restoration of the skin collagen layer.  This has the potential for wrinkle treatment in combination with skin defoliation and/or dermabrasion. Allowed Claims 1–32. (Cancelled) A method of treating a wound to promote healing consisting essentially of administering a composition of an aqueous solution comprising 2,4,6,trihydroxybenzaldehyde (“246 THBA”) and protocatechuic acid (PCA) both of which are present at a concentration of between 10 to 200 mM, wherein the administration results in: promoting wound healing; reducing at least one microbe selected from the group consisting of L. casei, C. difficile, P. acnes, C. perfringens, L. casei, E. coli, S. aureus 6538, S. aureus 33591,, S. mutans, S. pyogenes, P. aeruginosa, K. pneumonia, and C. albicans; increasing localized IGF-1 expression; and reducing localized TGF-E and EGF expression. 34–35. (Cancelled) The method of claim 33, wherein the composition is in the form of a(n) liquid, solution, cream, ointment, salve, gel, emulsion, suspension, dispersion, or paste. The method of claim 33, wherein the wound is a burn, skin break, bone break, muscle tear, puncture, surgical incision site, microdermabrasion site, skin graft site, a wound associated with diabetes, a bed sore, a pressure sore, or a laceration. The method according to claim 33, wherein the composition is administered in ultradeformable liposomes. The method of claim 33 wherein the PCA and 246THBA are each present at a concentration between 20 to 100 mM. The method of claim 33 wherein the PCA and 246THBA are each present at a concentration between 20-50 mM. The method of claim 33 wherein the PCA and 246THBA are each present at a concentration of about 25 mM. The method of claim 33 wherein the PCA and 246THBA are each present at a concentration at about 50 mM. The method of claim 33 wherein the composition may be administered by any conventional route including, oral, topical, buccal, injection, pulmonary, intravenous, inhalant, subcutaneous, sublingual, or transdermal. The method of claim 33 wherein the treating of the wound is a cosmetic method of treating skin to enhance skin healing, wherein the composition is administered topically, orally or by intradermal or subcutaneous injection to a skin tissue, wherein the composition promotes an effect selected from the group consisting of reducing inflammation, optimizing growth hormone production, and increasing collagen stimulation. 45–52. (Cancelled) The method according to claim 33, wherein said administration further results in reduced scar formation.      

Football injuries would be reduced by rule changes

11/11/2015: Football injuries could be reduced by 3 rule changes. #1: “Spearing” or leading with the head and helmet to hit another player is technically outlawed. The institution of “targeting” or hitting with helmet to head or neck is now penalized. However the incidence of leading with the head and helmet still is prevalent. This is seen with attempts to cause a fumble. The impact on the players head and neck is still there with this fumble inducing technique. I have long proposed that the rule be more general; No hitting with the head and helmet or in the head or helmet. This should be understood by all parties. #2: No slamming to the ground outside of normal tackling technique. This occurs most often on the quarterback after he has released the pass. The result is the quarterback is forced backward into the ground with his head the last to hit the ground with great acceleration. It is almost like a whip lash injury to the neck but more importantly the potential for brain concussion of some magnitude. #3: Restore the rule on “No assisting the ball carrier”. What happens now is that the ball carrier is upright or nearly so and both teams are pushing on this rugby like scrum, which is short for scrimmage. The result is often an injured player laying on the field after all the pile is cleared. This is the source of knee and ankle injuries especially to the linemen pushing in the scrum.

Nice Award

I received the inaugural President’s Award today from the Arthroscopy Association of North America. It was given the person who, although never president of the organization, made “numerous contributions to the Association and to the advancement of Arthroscopic Education.”

Invited Speaker: AANA April 2015

12/4/2014: I was invited to give a Presidential guest lecture in April 2015 at Arthrocopy Association of North America. So I had to get recent photograph. This is the requested Bio related to the lecture. Dr. Johnson was one of the pioneers in arthroscopic surgery. He was probably the first in the USA to perform arthroscopy of the temporal mandibular joint, the shoulder, the elbow, the wrist, the hip and ankle in the 1970’s. He performed perhaps the first arthroscopic repair for shoulder instability in August 1982. He is holder of more than 60 US patents, most related to arthroscopic surgery and tissue engineering. The most notable was perhaps the motorized instrumentation for arthroscopic surgery. 4,203,444: Surgical Instrument suitable for closed surgery such as of the knee (arthroscopy) 5/20/1980 and 4,274,414: Surgical Instrument (arthroscopic shaver) 6/23/1981. He has a long interest in cartilage repair and healing. He may have been the first to promote such by arthroscopic means, the procedure known as Arthroscopic Abrasion Arthroplasty. Although he concluded his clinical practice in 1995 he continues to do research and publications in the cartilage engineering space. The following two publications are long term follow ups on what previously would not have been expected; repair of articular defects with histological evidence of hyaline cartilage and a clinical benefit. Johnson LL, Delano M, Spector M, Gottschalk A, Pittsley A. The Biological Fate of Autogenous Bone Grafting for Large Volume Osteochondral Defects of the Knee: 13020 years follow-up. Johnson LL, Delano M, Spector M, Gottschalk A, Pittsley A. Long Term Clinical Assessment following Autogenous Bone Grafting for Large Volume Three Dimensional Osteochondral Defects of the Knee. ICRS, May 2009, Miami, FL. The last several years have been devoted to R & D on phytochemicals and their biological effects. He has been issued US patent 8,263,069 Composition including anthocyanins and anthocyanidins for prevention and or treatment of articular cartilage associated conditions. September 11, 2012. His presentation will review his past experience as well as present more recent research concerning the discovery of osteoarthritic disease modifying reagents and novel broad spectrum antibiotic and wound healing promoting reagents. He believes there is a new era coming in orthopedics will be in tissue engineering and disease modification based upon phytochemicals. He predicts that this will have a greater impact on orthopedic surgery than that of arthroscopy.

Late Stage Treatment for Government Run Health Care

11/28/2014 www.msn.com/en-us/news/world/russian-doctor-rebellion-causes-headache-for-putin/ar-BBg5j9J This is an interesting read about a government further down the road than the USA on government run health care.