Dan Guttmann, M.D., is Associate Director of the Taos Orthopaedic Institute, and currently is Chief of Upper Extremity Surgery and the Hip Arthritis Service. He is also Co-Director of the Taos Orthopaedic Institute Research Foundation Annual Sports Medicine Fellowship. He is a Clinical Instructor in the Department of Orthopaedic Surgery at the University of New Mexico. Dr. Guttmann is Orthopaedic Consultant for New Mexico Highlands University Department of Athletics and Taos High School Department of Athletics. Additionally, he serves as Orthopaedic Consultant to the Taos Ski Patrol, Red River Ski Patrol and Angel Fire Ski Patrol. Dr. Guttmann received his medical degree from Temple University in Philadelphia, and has completed a Fellowship in Adult Reconstructive Surgery at the Joint Replacement Institute in Los Angeles, and the Shoulder and Elbow Fellowship at the New York University/Hospital for Joint Diseases in New York City.
Shoulder1: Why did you become a doctor, and why did you choose orthopaedic surgery?
Dr. Guttmann: I became a doctor because I enjoy interacting with people and helping to take care of patients. I was mentored by my father, who is also an orthopaedic surgeon. He is a great role model in terms of being a classic physician who serves a community. My father introduced me to not only taking care of fractures and injuries but to forming a relationship with patients and their families that may last a lifetime. Additionally, I’ve always been interested in sports. As an athlete, I understand what it means to sustain an injury, and I bring this perspective to my patients on a personal level.
Shoulder1: What do you love about it?
Dr. Guttmann: Orthopaedics is a very positive specialty. You can make a dramatic improvement in someone’s life by fixing a fracture or reconstructing a joint or muscle. Whether this is operative or non-operative treatment, it allows them to function better and allows them to walk, run, throw or participate in an activity or sport that they were unable to do. You can really make a difference in someone’s quality of life.
It’s exciting especially today because there’s so much technology that’s been developed to allow us to do reconstructive surgery in a minimally invasive way. One of the things I’ve focused on is using arthroscopy to treat problems that used to be treated in an open manner. This has dramatically changed patients’ ability to rehabilitate. Their pain after surgery is decreased, complications associated with surgery have been reduced significantly, and the patients’ rehabilitation and subsequent return to activities, sports or work has been greatly accelerated.
Shoulder1: Can you think of a specific patient whose recovery demonstrated the success of arthroscopy?
Dr. Guttmann: Last year an athlete from the women’s high school varsity basketball team dislocated her shoulder twice during the summer before her senior year. She happened to be the star player on the team, and hoped to earn a scholarship to college and play competitively beyond that.
Shoulder instability is one of those injuries that in young people, especially young athletes, there is a very high likelihood of recurrence of instability, meaning repeat dislocations. Even if the athlete does not actually re-dislocate, the quality of their life must change. The non-operative approach to shoulder instability is a sling for several weeks and then a rehabilitation program. But the problem is, even after one dislocation, tissue gets damaged and does not heal properly. So if you have patients that have not been treated with surgery, even if they do not re-dislocate, often it’s because they stop participating in sports. But if patients are athletes or active people and really want to participate, there’s a 60-90 percent chance that their shoulders will come out again.
There was a lot of discussion about how aggressive we should be in terms of treating this problem, but it was clear that she was likely to re-dislocate if she was going to continue playing basketball. As I stated, this young woman was someone who really had potential to play in college and even beyond. She and her family and I decided that early intervention with minimally invasive surgery would be the best option for her.
We performed the surgery arthroscopically, which is important to understand in terms of the historical perspective. In the past, traditional open surgery to treat instability could be very painful as you have to cut through normal structures and tissue in order to get to the problem. Although athletes may have a stable shoulder, they weren’t always able to get back to the same level of competition. In addition, the rehabilitation could take six months or more before return to competition. Athletes have a small time window of opportunity to excel, and this may force them to miss their chance to succeed.
We were able to fix her shoulder, and she returned to play in three months. She made the All-State team and got a scholarship to college. She and I developed a strong relationship, and I attended all the games. She was really the star of the team and recovered sufficiently to play at the same level if not better than she ever played before. It was great to see her play to her full potential.
Since I began my practice I have almost exclusively performed arthroscopic treatment for rotator cuff and instability problems. I also been training Orthopaedic Sports Medicine Fellows; it is fulfilling to be able to share this minimally invasive process with other doctors.
Shoulder1: What research have you been involved in?
Dr. Guttmann: One of my research projects is an investigation of the learning curve for new arthroscopic surgical procedures for shoulder problems. My co-investigators include my associate, James H. Lubowitz, MD. What we’ve looked at is how many cases are required to learn to do a complete arthroscopic repair of a rotator cuff. This is valuable information for me personally as well as other surgeons who are considering the transition from open to arthroscopic surgery. A lot of surgeons are comfortable with a certain way of treating rotator cuff problems and could be hesitant to change to a difficult technique if they believe it’s going to take them too long to learn. What we’ve demonstrated is that there is a learning curve, but for a surgeon who has some arthroscopic experience, the learning curve can drop dramatically even after the first ten cases.
Shoulder1: What are some exciting upcoming developments in shoulder surgery?
Dr. Guttmann: I think there’s going to be a lot of new developments regarding the relationship of genetics to orthopedic treatment. For example, in the rotator cuff we’re looking at biologic factors that can modify our surgery to help speed up or improve the quality of healing. We’re trying to understand the biochemicals involved in the healing process and utilize genetic information to enhance our technology.