Australia and a member of the Anna Communications and Technology Committee. As part of Anna's 40th year anniversary and oral history program, it's my honor to interview Dr. Gary Poehling. While Dr. Gary Poehling would no doubt be considered a legend in our field, I personally feel the term pioneer would be the best way to state his contributions to the art of arthroscopy. After bringing one of the first arthroscopes to the U.S. from Japan, Dr. Poehling has been instrumental in developing techniques to safely perform minimally invasive surgery in the wrist and elbow. He is a professor at Atrium Wake Forest School of Medicine, where he previously served as the department chair of orthopedics. He assumed the position of the second president of ISCOS and held the esteemed role of editor-in-chief of the Arthroscopy Journal. In this capacity, he's played a pivotal and instrumental role in evolving the journal and transforming it into the influential monthly publication it is currently. Dr. Poehling, thank you for joining me today. Thank you, Ian. Dr. Poehling, what is your favorite aspect of being an Anna member? Well, Anna has been really the organization that made arthroscopy really expand. They were dynamic. When I was early in my career, it was the people in Anna. Originally, it was the International Arthroscopy Association, which really started things. Just to give a little bit of a history of how all of that really occurred for me, I was in Japan during the Vietnam War as in the military. I brought back an arthroscope, a model number 26 arthroscope from Japan for my chairman, Dr. Len Goldner at Duke. When I came back, I gave him the arthroscope and he said, well, we've had arthroscopy here at Duke for a couple of years and nobody's been able to make it work. You as a first-year resident are going to be put in charge of developing arthroscopy. That was how I got initiated as a very junior person. He made sure that I went to the first arthroscopy course, which was put on by John Joyce in Philadelphia. I got to meet all of the people that came together and developed. I was fortunate. I was by 15 years younger than anybody else that was at that meeting. The youngest person in this group of people that were really changing medicine. Of course, it started out as the International Arthroscopy Association. As it developed, it was clear that the people in the United States were doing 95% of all of the development. That's where all the action really was. The Arthroscopy started at that point because the IAA was 95% American at that time. As that developed, it was, I happened to be at that time. I was a youngster for sure, but was able to develop with them and was able to move along with the journal. Dr. Ward Cassell was very instrumental in number one, getting me to that first meeting. Then he is also the person that taught me my first mentor on how to do arthroscopy. I went to him and we did 10 cases together. Then he taught me about editing. That's how I got involved with the journal. Bob Metcalfe said, well, we really not only have to have our organization and we're doing all these new things, but we need to have a journal. He did all the pre-programming and then decided at the last minute that he really didn't feel that he could be the editor. Ward Cassell was. Ward and Jack McGinty asked me if I would be an associate editor of the journal. I became Ward's assistant. Then in 1989, he decided that he was going to retire. That's, of course, when I had the opportunity to become the editor. The real great thing about all of that, as far as I was concerned, was the people that I had around me. When we started that, it was clear to me that we needed voices of all kinds. The idea was that we wanted to have high quality work. We didn't want just big names up there. We wanted it to be secondary to the quality of the work. I felt like we needed to have people around. The first people that were there, the first four, were Brian Day, who was from Canada, Peter Jokul, John Fulkerson, and Craig Morgan. Those were the very first guys. We got together and said, we have got to make this good. It needs to be standardized. Magazines or journals in the past, they varied a great deal. We decided that we needed to have a standard format. We worked on that. We put those kinds of things together. These guys really did. Now, after that, one of the first ones after that was Alan Barber. What I can say, and there were many, many that followed, as associate editors, as the 25 years that I was editor, I guess it was actually 24 and a half or something. Anyway, it was the people that were part of that were just terrific. They just put so much energy into it. That's what really built it. It was the people that we dealt with. Of course, there's all the meetings that we had. In the beginning, everybody was just so thirsty for this and nobody had it in training. The meetings were very well attended and very necessary for just even the knee arthroscopy. Then when the shoulder came along, that was next. Then, of course, the elbow and the wrist and the ankle, and probably at the end was the hip. It seems like now we are moving towards the spine. We're going to finally take over, I think. Yeah, that's a great summary of just everything. Dr. Poehling, you being involved with truly the society arthroscopy and the journal in its embryonic stages, a very unique perspective on where things have come about. What's one thing that you were surprised, looking back at yourself when you first went to Japan and these early stages of learning what arthroscopy is and its utility? What's one thing that has surprised you of where we've transformed from a minimally invasive specialty that you did not see so long ago? Well, that really summarizes it. As I started in my orthopedic career, small incisions were for small surgeons and large incisions were for the big guys. That was just reversed. I can say I've been on both sides of that issue. The minimally invasive has, for the most part, continued to be engineered, if you would, with the technology that everyone has put into it. There's been tremendous things just in the tools that we have, not only the tools but the implants that we have and that we are able to use now. It's amazing to me as I look at it. I'm a few years past my surgery business now and I can see that things continue to improve as far as what people are able to do. The real catalyst for it was the ability to be able to see inside joints or not even inside joints. Now, we're operating on and we're doing hamstring repairs endoscopically. It's unbelievable the kinds of things that are being done and being done successfully. Like you were implying before, I think even 20 years ago, people would have never thought that we would put a scope in a hip. Now, it's probably one of the most growing techniques throughout the world. We're still developing things at such a fascinating and high rate. It's going to be very interesting to see what the next 40 to 50 years brings upon the field of arthroscopy. Dr. Poehling, going back to your tenure as editor-in-chief of the Arthroscopy Journal, what do you think you're most proud of regarding the footprint that arthroscopy has in the field of orthopedics overall? I would argue that your time in arthroscopy is extremely influential to make it one of the most powerful and must-read journals in orthopedics. What are you most proud of over your 25-year tenure as editor-in-chief? Well, the things that I really feel strongly about was the way that first group, the first four or five people, we put a lot of time in thinking. We didn't have that many articles to review at that time. Oh, how things have changed. Yeah, well, it hasn't ever changed, but we had more time to talk about how we're going to put this thing all together. That's what I'm really proud of, the system that Jim Lubowitz has taken over, and Jeff Brand, and Michael Rossi, and all of the people that have put energy and effort into this. They have continued, and they've made it even better than it was. The structure was there, the idea, the whole idea that it doesn't matter who wrote this or where did it come from. Is it good science? Let's give it every bit a chance, as much as possible, to make it as good as possible. That was the idea that we had, and there were many journals that weren't doing that, particularly when we first started. They only had certain authors, and particularly the new things that were coming up. Some people thought that they were very edgy, and really, should we even publish this sort of thing, because this may be dangerous, or people are going to, they don't know what they're doing, and all this kind of stuff. We just decided that, no, we're going to go for straight science, and we're not going to go just for somebody's name. We're going to go for quality. If we think this is something that is, it may be edgy that other people really haven't done, and it's going against the open theory, we published it anyway. It turns out that in the end, it was a very positive thing, and I'm happy that we did it that way. Yeah, that's some great perspective. Dr. Poehling, if you had to give, looking back at yourself as a young surgeon, what piece of advice would you look back, give yourself when you were first starting off in this career that you've obviously been so successful in? Well, the thing I think I would say is, it's going to be different for every single person. As I look back at my career, the things that happened to me, I don't know, did I deserve it? When I came back from the military, I was a first-year resident. I didn't know anything because I bought the arthroscope in Japan for my chairman, and I brought it back. I mean, that's all I did, and all of a sudden, I was in charge, and I can't imagine any chairman putting a first-year resident in charge of developing anything, but that's what happened. What I tell people is that it's not prescribed. There isn't something that you can just say, all right, this is the cookbook, and this is how you do it because everybody has different family kinds of situations and living situation. What are you doing and where are you? What kind of responsibilities do you have? Obviously, all of those things have to be taken into consideration, but there's going to be opportunities that are open to you. What I say is, you've got to be not afraid. If you have what you consider a good opportunity, don't be afraid to walk through that door. You know, when I had the opportunity, well, first of all, I had the opportunity to do arthroscopy, to be the arthroscopist at Duke, you know, as a first-year resident. I've never even been in an orthopedic operation yet, you know. I mean, that's just it, and but I said, we're going to do the very best thing I did. A little bit of a funny story here. When I did that, when it first came to me, and he said, you're going to be in charge, I said, oh my God, I don't even know what the arthroscope looks like, you know, at this point. This was when I just came back, and I said, well, I better go and look at it. He said, well, it's all sterilized and everything, and it's all wrapped up, and I said, well, we're going to get it out, and we'll sterilize it again, but I got to get a look at it. So I went and I did it, and Bob Jackson had been there at Duke and had done two arthroscopies at Duke demonstrating how it was, and they used the thing, and the camera had those pictures were still in the camera, and then I took the scope out, and I looked out the window, and there was a big crack right through. The lens was broken, so we had to send it back to Japan to get it fixed, and you know, it came back, and we went on by then, but you know, so you have to have a positive attitude, and you have to look at it and say, yes, I can do it, you know, and even if there is some question, and I certainly had many questions I had, I said, what am I getting myself into, but the more I got into it, the more fun it was, and the more interesting it was. So I don't know, maybe the first couple of arthroscopies that we did convinced me it was all right, but so what I tell people is, you don't know what's going to open up to you, what opportunity is going to come, and don't be afraid to walk through the door and say, yeah, I can do this, even if you haven't done it before, but if you find it interesting and challenging, that's a good thing. Something's never changed, the bane of all orthopedic surgeons' existence, a crackscope, it still is a problem now. So that's some fantastic insight, maybe going a bit more, you know, in your kind of international exchanges that you've experienced, because it's been so, you know, it's very apparent that it's been a large role of your career and has had great influence. How important to you has just international exchange of ideas, how much have they influenced your thinking and your practice today? Well, it's tremendous. You know, I can't say enough, and I think you hit it right on the head. When I first started with the journal, I was on the editorial board right from the very beginning, but when I became an associate editor, my job was, well, what I said that I would do, because Ward Cassells was the editor, I said, well, what I will do is that I think we need to develop the international group to start producing articles about arthroscopy. Now, arthroscopy was not nearly as common, it was much more common in the United States than it was, but there was some in Europe, there wasn't much in, or there was a fair amount in Japan, but there was almost, there wasn't any in China at the time, and so in South America was just beginning. So, what I said is my job was to develop the international market. So, this is something that I thought we needed to focus on. If we're going to have an international journal, I think you need to do that. So one of the first things we did is we talked to the French arthroscopy because they were one of the leaders in Europe. And so the first thing we did is we we had 10 articles that were all in French. So we had to translate those. Oh, I struggled so hard, so hard. And I got several people to help me with translating because I don't know French at all. And trying to put those things together, then you're dealing with not not only the science of it, but also the, the, the language of it. It was, it was a big struggle. But what I found out is that if, if you try, and people see that you're trying to help them to be successful in this thing, though, they'll bend over backwards doing that. So it was, it was really the beginning of the whole thing. And my whole time that I was editor, I felt like the that traveling and seeing the other countries and exactly the things that they're up against. What I found is that there's different influences everywhere. And I remember a great example of when the medial patella femoral ligament was just come out, and we had put together a good number of those. And, and I remember, I went to India, and I said, this is the best thing since sliced bread, you just put three anchors in, you know, two up in the patella, and one in the, in the femoral condyle. And they said, No, we, we don't use anchors here, you know, because people have to pay for their whole thing. But we've been able to do this operation with no anchors, and their results were every bit as good as mine. They showed me three different techniques to be able to do that same operation. And I felt really kind of foolish, we're spending, you know, $4,500 on anchors when they were doing it for nothing, you know, and, and, but those are many, you know, it doesn't matter everywhere you go, you see things like that. And, and obviously, you learn from it. Yeah, that's my experience, as well as every surgeon in the world has their own challenges, and they all deal with them differently. And we can learn, you know, from those challenges and apply them to our patient population that we personally deal with. You know, Dr. Palin, getting back to, you know, some of the innovations that you've have given the arthroscopy community. Could you tell us what sparked your interest in putting in, you know, a scope in the wrist and the elbow? And how at that time, when you first think, thinking of these techniques, you know, how, how did they how at that time, did you think that an arthroscopy scope could help your patients at that time with wrist and elbow issues? Well, it all happened. It all happened at a meeting that was the International Society of the Knee, ISK. And that was an international group and they had a meeting in Salzburg, Austria. And it was in 1985. And so it was basically a knee meeting and it was in a lovely thing. And so I went to dinner one night with with Terry Whipple, and Jim Roth, and and myself and we began Jim Roth, and and myself and we began talking at the table that Jim Roth had already done some arthroscopy of the wrist of the wrist. He had used a regular scope. And he said he could really see inside the joint. Terry Whipple had done some actual arthroscopy of the wrist on cadavers. And I had done some dissection around the wrist and and hadn't come to any conclusion. I was definitely the furthest behind in that group. But we got together and we said, you know, this knee thing didn't go so well, you know, and people were complaining about all of it. And we said, we ought to. We've we all felt that there was a lot of opportunity in the wrist. And so he said, Well, let's let's put our things together. Let's work together as a team and Jim Roth will write a paper and Terry Whipple will devise a model for us to be able to show people and then I would organize a meeting. And so I organized the meeting and I went to Jim urbanic, who was head at Duke, and I said, we want to have a closed meeting invitation only meeting and we're only going to invite the not the people that are going to be doing the arthroscopy piece, but all of the all of the upper level people invite them, not that we particularly wanted only those people. But what happened with the knee is that the people that really ran things and were in charge, were left behind and the young guys who are coming up with all of these ideas, and it caused a lot of conflict. So we invited and the people that came were many of them were presidents of the hand society and people that were chairman and all of that sort of thing. And they all came. I'm quite sure that none of them really did arthroscopy of the rest. But they we had another meeting that when had them send the people that they thought would be the people that would be doing this and they were many of the younger people that were interested in this. And, and so we put that meeting on and what happened was that it's it's pretty much the way wrist arthroscopy is still done today. And, and our ability to be able to see things. Bill Bowers, who was who was a big anatomist from the UNC at the time, came over and when he saw what we saw on the inside, he says, Gary, this just is not fair. Since I've been trying to see that for 10 years with my dissections, and I could never do it, you just stick a scope in there and you can see everything. And so, so he, he affirmed that this was something that was really good. And so it kind of went from there. And it was amazing the number of cases that that that were being done, you know, as far as the the wrist and, and then a little bit later was 1989. I think when we wrote the article about the elbow and, and doing it in the more prone position. So, and those those two really, really allowed us to be able to start to see many, many things and and all of the things as far as the wrist is concerned are getting better and better and people are more informed about what is what can be done as far as preserving risk function, because in the early days of my residency, you know, risks were kind of well, you kind of let them whatever, whatever was broken in there, it either will heal or it won't. And, and you'll either like it, or you'll fuse it. And that was kind of the alternatives, you know, and, of course, now the reconstructive things in both the wrist and the elbow are, are pretty extensive. Yeah, that's, that's some great insight into, you know, two procedures that, you know, definitely revolutionize what we can do and just make better clinical decision making while also being less morbid, looking at the smaller joints of the upper extremity. Yeah, look, you know, obviously, Dr. Pehling, you were part of ANA in its infancy. What are your favorite memories of being a member of ANA? Oh, I still remember going to the laboratory and, and developing all of that. We've gone through, I don't know how many things but the the lab in in the early days was over and over and over again. I mean, we still do a lot of it. It's been a while since I've done that sort of thing. But my early days, remember the excitement that people had when they come and oh my gosh, you can actually see these things. And in the lab and the camaraderie that we had, I mean, was a relatively small group to start with. And, and, and I certainly had the opportunity was given the opportunity again, did I really deserve it? I don't think so. But But nonetheless, I had the opportunity, you know, as a as a third year resident to be giving national talks around the country, you know. But that was because I was helped by the older members of the of the organization that were, were were just wonderful to me, you know, and it's wonderful what what it has done for me, they were very supportive of what I was doing and happy that then I was part of it. And, you know, I, I can't, can't say enough about the, the personal relationships that, that we developed in the early days. And, you know, it's great. Yeah, what do you think overall, the most important role Anna has played in your career and in the role of its promotion or education or mission of supporting minimally invasive surgery? Well, that's it. And education was everything, you know, I mean, that was the whole reason for it is to, to be able to get the word out about what is best and what can affect it. And now, so it really has changed. You know, it's changed our patients lives tremendously. You know, when when it all first started, there were those that were really on the top of the heap as far as sports medicine, and they were saying, well, this is the tool of the devil and all this kind of stuff. But patients voted, you know, patients really, really, and athletes in particular, saw that there are some athletes that have an arthroscopy and they're back on the field in a very short period of time. You know, it depended on what the what the problem was. But they didn't want to go in and have an arthrotomy done and know that it's going to be eight or 10 weeks until they can even get back on the field. Instead of a couple of weeks, you know, that, that they were seeing other people get back and rehabbing so much faster. So that's a, it's a powerful situation. And it's one of those things that really, we continue to push the limits of what you can do and how quickly you can get things to heal. Now, I mean, there are biologic limits, but you know, I think we've, we've all learned that, you know, for instance, in the ACL, we were hoping to get people back, you know, in three or four months, but, you know, biology needs its time. And I think most people have come to the conclusion now that you need to wait a year, and you'll be much better if you do it that way. So, but you know, those are all very positive kinds of things as far as the impact, not, not only for us as surgeons, doing more and more fun things that, that really wow people that, you know, I see people back in the office now that I operated 30 years ago, and, you know, talk to them about how it's done. And it's, it's really rewarding. And of course, they, they are very appreciative of those kinds of things as well. So yeah, yeah, you know, going back to the educational aspect of Anna, you know, going into an OLC, whether as a instructor or as an attendee, there is some environment there, it's almost like Orthopedic Disney World a bit, where you get such an enriching experience in multiple levels that I think very few can truly compete with. You know, looking back, Dr. Poehling, what was the best career advice that anyone has ever given you? Probably, you know, Dr. Goldner, I was wondering, what was I going to do when I left my residency, you know, and there were multiple kinds of things and very disparate. And probably the most important thing that he shared with me, he told me that I needed to come to Wake Forest, that they really needed to help and all that sort of thing. But then the probably the really important thing that he told me, he says, don't chase the money. You know, because I, my, my first job was one tenth of what my highest offer was. And yet, I couldn't be happier that I came here. And, and I'm glad that I didn't chase the, the, the higher thing. And, and it's, and it's a matter of can you contribute? Can you add value? Can you contribute? Can you add to it and feel, feel in a very positive way? I just feel so fortunate. I mean, here, I've had a career that we've been doing orthopedics for more than 50 years. And I get up, it's excited every morning. What are what are what new good things can we possibly put together and, and I don't know, there's very few careers that, that you can, I feel so lucky that I am in this career. And there's so much things. There's so many things going on. So I think not chasing the money as is, is a positive thing. But you want to do something that you really enjoy doing, you know, and that you want to do, you know, and, and so I just feel that I was extraordinarily lucky to be able to, to have this situation. Lucky that I landed here, even though people looked at me and all of my other resident mates made more money than I did. And I still feel like I got the best job. When I look back on it. Yeah, yeah. Well, I think there's no argument that you definitely made the right, right choice there. We have a lot of arguments about the role of arthroscopy, but there's no question that you going to Winston-Salem was 100% the right choice. You know, the last question, Dr. Poehling, what do you see the future of, of arthroscopy and minimally invasive surgery and orthopedics and, and the role that Anna has in, in, in further progressing the art of arthroscopy? Well, you know, I feel like I've lived through what I call the industrial revolution, you know, which is where, and arthroscopy is part of that for sure. But I feel that we're not far down the line where we're going to have a biologic revolution. We haven't done as much as we had hoped that we would have done by, by this time. We've been playing with stem cells and working with cellular concoctions, and, and we haven't blown it out of the water yet. But, you know, it's only takes one deeper understanding, you know, or, or change in technology, and it changes everything, you know, and, and I don't know when that's going to be for sure. But I know that it's not too far down the line. And then I think there'll be more and more of the minimally invasive surgery, and we'll be able to do things better. You know, right now, we go in and if the meniscus is pretty well torn up, you know, we have to have to remove it and remove a little bit of cartilage, but can we really grow good cartilage yet? And we're not doing that. But, but I think we will be able to do that. And that will make it more important for us to make the earlier diagnosis to, to do this. And doing that with endoscopic means is going to be an important aspect of it. Yeah, that's some further fantastic insight. Dr. Poehling, you know, you're truly represent that, you know, anyone in this field can have impact, whether you're an intern, initially starting your training, starting up a new, completely innovative field, or, you know, developing new techniques, and advanced age and looking into new fields in the latter 30 year career, I think you kind of symbolize that. And, you know, surely, if we have more Gary Poehlings, in, in the field, we're definitely going to make bigger jumps as we go along in our in our further advancement of arthroscopy. So, you know, I really want to thank you for your time. And thank you for, you know, everything that you've done in your career and your time with Anna, as well as the editor in chief of arthroscopy for 25 years, and want to, you know, wish you the best. Thank you. All right. And thank you. And I'm putting you in charge of taking over. We'll have a talk about it. All right. Thank you. Yeah, thank you.

Dr. Gary Poehling

Arthroscopy pioneer

Minimally invasive surgery

Wrist and elbow surgeries

Arthroscopy Journal

International exchanges

Biologic revolution

Orthopedic surgery