LTC DeBerardino, MD is the Chief of Orthopedic Surgery at Keller Army Community Hospital, located at West Point Military Academy. Graduating from the Academy with the class of 1985, Dr. DeBerardino continued his medical education at New York Medical College and later completed orthopedic rotations at Keller Army Hospital and residency training at Tripler Army Medical Center in Honolulu. Dr. DeBerardino’s areas of expertise include posterior cruciate ligament (PCL) reconstruction and meniscal allograft transplantation. He is currently researching PCL reconstruction at Keller Army Hospital, and is also the Research Director of the Joint and Soft Tissue Fellowship collocated at West Point and at the Institute of Surgical Research at Fort Sam Houston in Texas. Currently, he is stationed in Kuwait, where he was deployed to care for troops in the Middle East.
Knee1: Dr. DeBerardino, most of your patients are members of a military elite. What challenges have you encountered when treating cadets at West Point?
Dr. DeBerardino: The injuries sustained by our Cadets run the full spectrum of collegiate-level sports injuries. Because they are continually driven to excel by competitions and testing, they really do not have the benefit of an off-season. We see ankle sprains, shoulder injuries and dislocations, with resultant instability and knee injuries. Besides the ever-present strains and sprains, meniscal injuries are quite common, along with ACL tears. We also see a fair number of PCL injuries.
We tend to be aggressive in both our non-surgical and surgical treatment of these injuries, since the cadets really only have 48 months once they begin at the Academy to complete their Cadet curriculum and graduate as officers in the United States Army. Our goal in treating them is to return them to full function so they can continue their athletic curriculum where they left off and graduate on time.
Knee1: In 1997, you completed the U.S. Army Joint and Soft Tissue Fellowship. Can you tell us more about the focus of the fellowship?
Dr. DeBerardino: Soldiers and athletes sustain numerous shoulder, knee, and ankle injuries in training. The surgical management and rehabilitation of these injuries have implications for their continued athletic participation, their quality of life, and their combat readiness. The mission of the fellowship is to develop a field expert: an expert devoted to innovation in rehabilitative and surgical care, to research, and to the care of soldiers.
The idea of a joint and soft tissue trauma fellowship started with Dr. John Feagin, the United States Military Academy Team Physician and Chief of Orthopedics in 1970. Dr. Feagin recognized the enormous volume of soft tissue injuries in cadets due to the curriculum’s physical demands. The idea continued to be nurtured, and slowly West Point began to develop a name within the U.S. Orthopedic community for having expertise in sports medicine.
The fellowship is the culmination of a long education process: five years of orthopedic surgery training, one year of basic science research at the Institute of Surgical Research at Fort Sam Houston in Texas, and one year of intensive exposure in complex joint injuries at Keller Army Community Hospital at West Point.
Knee1: Dr. DeBerardino, could you please expand on your research in PCL care, and the developments you’ve made?
Dr. DeBerardino: In recent years, a growing body of literature has suggested that the best PCL reconstruction technique is to replicate the anatomy of the PCL closely. In pursuit of this concept, I developed a unique graft construct for performing a dual femoral tunnel PCL reconstruction technique in 1997 called a split-stacked Achilles tendon allograft.
Knee1: Who are the best candidates for PCL reconstruction, and in particular for the split-stacked Achilles procedure?
Dr. DeBerardino: PCL tears can often be managed non-surgically. PCL reconstruction is appropriate for individuals who do not do well with non-operative treatment, who continue to complain of PCL-related instability and giving way of the knee. PCL injuries combined with tears in the ACL and the collateral ligaments (that is, the LCL and MCL) more commonly require reconstruction. I believe that in this case, the reconstruction technique that most closely replicates normal PCL anatomy is the best procedure. Patients with a lack of full range of knee motion, a history of knee infection, or significant degenerative joint disease are not good candidates for PCL reconstruction.
Knee1: What new trends do you foresee in orthopedic care?
Dr. DeBerardino: By the end of this decade, ‘active healing’ will become the norm. We will be augmenting almost all our current reconstructive procedures for the knee and shoulder with site-specific time-released growth factors (HA-TCPs and scaffolds) to increase the rate of graft incorporation, and the healing of soft tissues to bone. [Body1: HA-TCP polymers are synthetic composites that, when used as bone grafts, can promote the healing process.] ‘Active healing’ also includes gene therapy.
Knee1: What challenges have you encountered being stationed in Kuwait as an orthopedic surgeon? Do you find that your work being stationed abroad is different from your work in the States?
Dr. DeBerardino: Being deployed with a Combat Support Hospital as an orthopedic surgeon is challenging. The simple logistics of managing complex orthopedic trauma are more daunting when you are an ocean away from your usual operating environment, people and supplies. The Army always deploys with multiple contingencies in mind and does a good job of providing the wherewithal to manage such circumstances. We are fortunate to be located within a fixed facility and have access to more of the orthopedic amenities than most deployed medical units. Nonetheless, we rely heavily on Tri-service (Army, Navy, Air Force) medical support. The Army deploys on the ground with the largest medical contingent of the three services. The Navy has provided high-level care on their hospital ships, such as the USS Comfort. And the Air Force provides the aeromedical assets required to safely and efficiently transport our injured soldiers back to medical centers in the United States. An understanding of the capabilities and limitations of each integral part of our combined medical system is probably the most important piece of knowledge a surgeon can develop while deployed.