So, my name is Dr. Harris Sloan. I have the honor and privilege to interview Dr. Steve Snyder for the Anna Oral History Project. A few weeks ago, when we were presented with the list of influential Anna members, I jumped at the opportunity to interview Dr. Snyder. I got to know him on my Anna Traveling Fellowship in 2022, as SCOE was one of our stops. And I just really enjoyed speaking with him. I enjoyed learning from him in the OR and outside of the OR, getting to know him and his family. And so, thank you very much for taking some time to meet with us today, Dr. Snyder. I really appreciate it. Well, I'm glad to be here, Harris. I mean, this is one of my favorite topics in the world. And so, I'm glad to be able to share some of my thoughts with current and previous and new Anna members. All right, Dr. Snyder, I'm going to get right into it. I've got some questions here for you, but if there's anything you want to talk about or elaborate on, please feel free to hijack the interview. I guess I'll start with, what is your favorite aspect of being an Anna member? You know, the camaraderie, the fellowship, the brotherhood, all those warm and friendly words are all true to me and my heart. I had a bit of an unusual introduction to Anna. And that was back in 1982 when Bob Metcalf, one of the original founders of Anna, called me up and asked if he could come out and visit. And I was, of course, honored. I'd only been in practice for one year. My senior partner, Jim Fox, was an Anna member, and I talked to him about it. And why would Dr. Metcalf want to come out and talk to me? And so I told him, sure, I'd love to, you know, we'll go out to dinner or something. He says, no, I'm just going to fly in and talk and then fly out. So OK, fine. So yeah, Dr. Metcalf came out and I picked him up at the airport and we went to the office and sat down and talked. And he said that the board of directors of Anna was a little concerned because they noticed that I had started a association of my own. I called it the Arthroscopic Shoulder Surgeon Society. And the reason I did that was because there was no shoulder arthroscopy in Anna. And he said, well, would you be interested in doing this with our organization rather than on your own? Of course, I'd love to. And my plan was to join Anna anyway when I think I had to be in practice a year or two or something like that, have a certain number of cases. But I didn't want to be without having connections in the shoulder, important shoulder part of arthroscopy. So that's the whole reason he came out. And I agreed. We shook hands and he said, well, I'm going to make you the head of the shoulder section. And then a year after that, the head of the education committee. So Doug Jackson then took over as president shortly after that. And we started actually having labs at what was our fall meeting. We'd actually have cadaver labs. And so that's how I got ushered into the Arthroscopy Association, kind of because I was a little bit of a rebel, but not on purpose and certainly not to challenge them, but just was so enamored of shoulder arthroscopy that I wanted to be sure we included that. So that was, you know, that was always a kind of a funny thing for me. I mean, we could have handled it on a phone call, but it was important enough to the board that they sent, or Bob came out. We had a nice dinner and he went That's great. What do you think was the most impact? You know, you're an innovator. You've innovated on so many products and techniques and really revolutionized the way, really, we all do shoulder arthroscopy. If you had to pick one thing that was the most impactful innovation to orthopedics during your time in practice, what would that be? Well, you know, there are different things for different parts of the surgery, but the number one thing I think would be suture anchors. You know, again, I don't like to say I invent things. What I do is I struggle to do good surgery. And if I'm struggling, I figure other folks will too. And so I take, try to make it a little better. And that's true with suture anchors, the first suture anchor guy, but what his idea was, was to use the metal staples. And Lanny is a very good friend of mine, almost like a big brother and a lot of ideas on things. He generally had him first. He, he didn't like it one bit, but it was when the MyTech company came out with their, why don't we make a screw-in anchor? Because we can do the same thing, because we can do the same kind of surgery, you know, put the anchor in, use the sutures to tighten the labrum at the time, not the cuff. And then if we make a mistake or break the suture, which we were apt to do quite often in slight amounts, we're just doing so screw it out. And we had a whole system that we made with one of the companies that actually had a reverse thread vows to take the mini screw out and in the, it's pretty limited there. And so we couldn't afford to put anchors in and not use the whole system for that. And I think that was for me and my fellows. And then here's from that, you know, little anchors for the glenoid, bigger anchors for the rotator cuff, sort of built one on the other. And then materials for shoulder arthroscopy, better than mine. Oh, materials. I always, combination. And those were really helpful and never liked to put metal in the glenoid. There's just not enough room and you get in too much trouble if it happens to fail. But I don't mind putting metal in the rotator cuff because it's non-articular and I like to be able to see my anchors. Not many people agree with me on that because I ask this every time I'm on a panel at arthroscopy or some other meeting and it always comes up, well, why do you still use metal anchors? And I turn that around and ask the moderator or the guy asking the question, why would you not use metal anchors? They essentially never come out except when they do. And when they do, if you don't, if you can't see them, we call them invisible anchors, they're still out and they'll catch and they'll rub and they'll be miserable until you do an MRI scan and see where the plastic or the absorbable anchor is. So I haven't been talked out of using metal anchors in the rotator cuff position for forever. And I don't think I ever will until we get some kind of a biologic anchor, then that'll be the best. My next question was going to be, what do you think if you had a crystal ball and you were able to sort of see the next era of change, what do you envision is going to be the sort of most impactful or innovative thing that we're going to see in the next decade? Well, I kind of hinted about it there. I think we're going to continue to use anchors for quite a while and the biologics that the smart guys are developing to stimulate and enhance rotator cuff healing, that's going to be huge. And then for the anchors, I think a biologic anchor is in the offing. I've actually suggested this to several companies. I'm kind of out of the development business now, you know, when it comes to anchors and stuff like that, because I'm retired. But I've suggested to my buddy Donnie Buford and several others that are very into biologics that why can't we develop an anchor that's like a soft anchor, you know, like soft anchors are wonderful for the glenoid and even some for the cuff, but why not use a biologic material, synthetic or otherwise, to make an anchor that will then incorporate in the body and go away. And so biologics, I'm just really, really anticipating a huge improvement in our success rate as those move forward. We had a little technical difficulties, which cut part one a little bit short. So picking right back up, Dr. Snyder, what is the best piece of career advice that anyone has ever given you? Oh, that's easy. And I might have mentioned this, but I was laying in the hospital bed after surgery on Christmas Eve, when I was 18 years old and just had my knee operated on. And a real, real wonderful man is had operated on me down in Eugene, Oregon. And his name was Don Slocum, one of the original sports medicine doctors in the country. And, you know, I'm not very big, I'm like a 5'9", 5'10", and weighed about 180 pounds, and not big enough to really play football, but I was trying. And he asked me, you know, he came in, I was all alone, and my folks couldn't get down because the road had frozen over coming from Idaho. So anyway, he asked me, he says, Well, what are you going to do now? And I says, Well, I got to get back and play football. And he says, Well, I got a got something I got to talk to you about. He says, You know, your knee was pretty messed up. The cartilage was all torn up. And one of the menisci were gone and the ACLs gone. He said, We did a Slocum procedure, which is something that most you guys probably don't know about that it was one of the early operations to correct rotational instability. You transfer the PEZ tendons on the medial side, but I said, Well, what's that mean? And he says, Well, you're, you're not going to be able to run and cut very well. And I said, What am I going to do? He says, Are you smart? And I said, Well, high average. And he said, You can be an orthopedist. And I was a freshman. And I swear to God, that was the first time I'd ever thought about being a doctor. And I never really got back to playing football. I redshirted a year and and pretended like I was getting back but I couldn't. That was my second ACL. So anyway, best advice, be an orthopedist. That was actually my next question was, tell me about your decision, how you got in orthopedics. So you just killed two birds with one stone. So that's, yeah, well, it was probably I don't know, really, there was, of course, along the way, once I got into orthopedics, my gosh, I had 1000 wonderful advisors and people to look up to and, and learn from, but that was that was the alpha. So I guess one of my questions is, you know, we all have, hopefully most of the time when everything goes perfectly right in the OR, but it doesn't always happen. And so, you know, what advice do you have for younger orthopedic surgeons on how to manage that? Or, you know, what did you do in the OR when sort of things just didn't seem to be going your way? Yeah, when the bone soft and the anchor pulls out? Yeah, yeah. Honestly, I, I never stopped as far as I can remember. I don't think I've ever stopped doing an operation because of misdirection or something. But I sure, like everybody did have some trying situations. You know, the whole thing is just keeping cool. When things start going crazy, we had an earthquake once in the operating room. And, you know, it took about 10 seconds before the emergency lights came on and, and the respirator was working. So we were okay, we were able to actually finish the case. There's always the case of that blood vessel that's not supposed to be there. I was called to another room by one of my partners who was learning how to do the subscap and he put a shaver down the front on the wrong side of the subscap and got the vein and that was a mess. But again, you had to open the shoulder and stop the flow. And just by luck, there was a vascular surgeon who was training with one of our hand surgeons and he came in and fixed it. You know, things like that happen, Harris, but advice, just, you know, I think being prepared in advance. I used to, before we had Vumedi and OrthoBullets and those wonderful things, I used to spend a lot of time and get up very early on a surgery day and go over everything in my brain and then driving to work, go through the steps of the operation. And so it's just really built into your reflexes. And I think most conscientious surgeons will do that. What advice would you give to future Anna presidents? Oh, goodness. I think we're on a pretty good trajectory right now, you know, with Larry and Field and Gettleman and JT, you know, those guys are fabulous. And I think what they've been doing now is building for more inclusive organization. When we started, I didn't start it, but I was fairly early on in Anna, you know, we were just trying to educate everybody in the United States and, you know, North America for all practical purposes. But we forgot that a huge and very important part of our wealth in orthopedics is our women and our underprivileged folks and this and that. That's really my favorite thing that Mark Gettleman and, you know, has passed on is this inclusionary thrust that they're doing. Every time I see these women gathered together and a meeting, it just makes me happy. Half of our medical students or more are women and only a small percentage of the orthopedic surgeons are. And in the old days that was necessary because we wouldn't have any power tools, you know. And that goes back to Dr. Slocum, you didn't have to be the high average. Now you gotta be a little brighter. And I think that women are really gonna add to our specialty as a whole. Yeah, I would imagine that's probably a really big change over, you know, the course of your involvement in Anna seeing that. What are the other big changes that you've seen, you know, overall or maybe in the last just five or 10 years? Yeah, well, you know, the embrace, I guess you don't embrace cadavers, but you sure learn from them. And when Doug Jackson, this was way, way back in the 80s, Doug Jackson and the team came up with the idea that we were gonna do cadaver surgery. And actually that was one of my jobs to set up, help set up, you never do it yourself. A cadaver lab, I think we were up in Monterey, yeah. And it was a raging success and it went, you know, really took over. And we had a fall meeting every year where cadaver lab surgery was, you know, a hot item. That slowed down, but now again, I think we mentioned the biologics. I don't know where I stand on it. I really believe in it. I'm a big believer in nature having way more power than we give her credit for. I think we were starting to talk about biologics and I was saying something very erudite, like I don't know that much about why the biologics work. When I started doing allografts a long time ago, 15 years ago or so, I was introduced by Scott Steinman up at Mayo at the time. Scott had done a study on some rabbits where he took a graft jacket, which is a human dermal matrix, and he put it in these little, or they were dogs, and put it in for their rotator cuff. And when they healed, you couldn't tell the difference between where the graft was and the rotator cuff. It had completely morphed into a beautiful tendon. And I happened to be lucky. I went up there to give a talk or something and Scott showed me this stuff and it just fascinated me. And then I was interested in arthroscopy, try to help out the rotator cuff. And I learned about graft jacket, but I didn't trust it. Nobody had ever used it for a rotator cuff as far as I knew. And Scott did it in the dog. So we then worked out a way to do it. And that was my introduction to biologics that, and then Dick Steadman and Lanny Johnson with their, Dick Steadman was the one that did the microfracture to help the ACL heal. And Lanny, he did this light decortication of the subchondral bone and got that velvety clot. I just put a funny name on it and I called it a crimson duvet. But again, that's pure biologics. I didn't come from anywhere else. The problem with it is it doesn't cost anything. So no companies much care about it. They'd rather, and I guess that's the way business works, but they'd rather sell you something that you spin down and inject. And those things certainly could potentially be better. I just haven't proven it to myself yet. What do you think, what has been sort of your mark that you've left on Anna? What's been your biggest contribution? I think my two big friends, Ash and Burkhardt. I get with them, we were just together this weekend down at Ash's meeting in San Diego. And I get with the two of them and we just start thinking about things, ways to get in trouble by making new products. And Ash, he's the consummate teacher and he's always got something. Me personally, big mark, I don't know. I think my fellows, again, I just absolutely love them. And I saw a couple at the Ash meeting that I haven't seen in a long time, had dinner, just had a wonderful time. And I hope it's reciprocal. If it's one way, I guess that's better than none. But I think my life has been enriched by guys like you, Harris. The little time we spent together in the traveling fellowship, but the fellows, that's gotta be right up there. One thing I can assure you of, it's a two-way street, just from all the folks that I've talked to. And what's cool for me is just seeing, there really is a SCOE family and the SCOE and Anna are just so intertwined. And I feel like just sort of seeing Dr. Gettleman and his presidency and everything that I saw when I was there for my traveling fellowship, that's just been really cool to see how those two families have really worked together. And I think it's been a really mutually beneficial relationship. So. Well, I can say one thing more. I always say too much, but one thing more about that. When we joined Anna, I'd been in practice two years, but my partner, Mark Friedman and Jim Fox, were both very active in Anna. Early on, especially when it was a small organization, almost, we almost went out of business. You know, finances were a little rough. But, you know, you work through those things and I don't know why, Harris, maybe you can explain it to me, but why some people get such a charge out of educating people. Because, and Anna, that's what I did. I've got that in kind of in my blood. And I think it was because I wasn't the smartest tech in the box. So by teaching, you know, it reinforces what you know or what you should know. And people can give you a little hints on where you miss, but I always felt it was a real good way for me to, I'm never gonna say perfect, but to improve. And then Fox was the same way, Friedman. Then Carzell was always on the board or, you know, doing something to help out Gettleman. Joe Burns, fabulous young man, not so young anymore. But it was just, you know, so much to offer from Anna and it was Anna. And I think the sports guys, the guys that actually do sports medicine don't actually get the same thing from their organizations. I'm a arthroscopy guy, so. Yeah, you know, then you'd look at, you know, Dr. Gettleman is in president, Dr. Ferkel, who got the Lifetime Achievement Award at this past meeting. I mean, you know, it's just, it's really cool to see that sort of legacy and relationship that's been built over time, so. Yeah, it's fun. If you could change anything about your time with Anna, what would you change? Well, we already said the thing about having the women involved. I think that would be important. I don't know what I'd change. You know, I'm a big believer in practicing, you know, to, you know, get close to perfect and never get perfect. And one thing that I loved was the learning center, especially back in the days when we used the, what we called Alex models. You know, I think people can get so much training and built-in mechanics, hand-eye and all that stuff, doing repetitive surgery on a model. And models aren't near as attractive to us as surgeons. We think, you know, cadavers are a real thing. So you get a 75 or 80-year-old specimen and you can't really learn very much. There's generally arthritis. The cuff has got a degenerative tear and this and that. But with a model, you don't have to ever worry about that. And then once you learn the steps, then you go to the cadaver. Yeah. Dr. Schneider, I mean, I really appreciate your time and sorry it took us two attempts here to get it all on tape. I've really enjoyed getting to know you. I've really enjoyed our time in person and I've enjoyed our time here on the Zoom meeting, having the opportunity to interview you. What, you know, do you have any parting words or anything you want to conclude the interview with in terms of, you know, the Anna Oral History Project? Yeah. I would say this, you know, I've got a lady I've been married to for 52 years and she's always been a part of Anna. You know, her best girlfriends are, you know, some of my best buddies and that's been just wonderful. It makes it more family oriented, you know, take the kids along and when it's possible, but when it's not, you know, she comes with me. She said once she would never trust me. That's why she travels. I think she just liked meeting all the other guys and their wives. But no, I just think it's one wonderful organization. I hope it continues to be that and it will continue to be valuable because you can't learn this stuff on your own and you can only get a certain amount of it reading a journal. But if you learn a little bit and you build on it, you learn the people to go visit. I was a big visitor when I was young, except everybody was doing knees. That was a problem. But, you know, you visit people and those are the people you meet and socialize with at Anna. And I think you need to take advantage of that if you're able to and keep your family involved as well as you can too. And I think it will be a good formula for learning from here on. And the other thing is getting involved with Anna on the teaching side. You know, you're doing it. There's so many different things you can do. And every time you do something, even if it's something awful like raising money, you meet the people on the board, you meet their families, you go to nice dinners and whatnot. And what you're doing is building a lifetime of friendship. And boy, that makes the job a lot easier. Thank you very much. Really appreciate it. Send my regards to your family and I hope I catch up with you in person real soon. Okay, thank you.

Dr. Theo

career path

arthroscopic surgery

mentorship

Arthroscopy Association

orthopedic surgery

surgical techniques

minimally invasive spine surgery

continuous learning

work-life balance

Dr. Harris Sloan

Dr. Steve Snyder

Anna Oral History Project

orthopedics

shoulder arthroscopy

suture anchors

biologics