Abstract
Two decades ago, I had the honor of volunteering to support colleagues in Nepal. I accompanied Dr. David Spiegel, Dr. Ashok Banskota, and colleagues to Banapa at what was the only hospital in the country exclusively dedicated to caring for children with musculoskeletal problems. Here we supported the surgeons, therapists, and prosthetists at a location remote enough that on a clear day, patients and their caregivers could see Mount Everest. I left the US with prepared lectures, studied the topics to be discussed, and brought journals to share. The majority of the patients cared for were disadvantaged, often from remote areas and often traveled for days by foot and/or any available means of transport to the facility. The pathology was impressive and patients were frequently delayed in their presentation due to various barriers in health service delivery including physical barriers of distance and terrain, lack of available services in their communities, inability to finance care, and sometimes cultural factors. Common challenges included upper and/or lower extremity fracture nonunions, ligament injuries, recurrent dislocations, and deformities. Our local hosts presented an intra-articular Salter fracture of the knee and a severely comminuted Leopard fracture of the forearm. I was familiar with the Salter-Harris Classification but not the Leopard Classification, which I soon learned was not a true classification. The presenter quietly informed me while holding his wrists extended and fingers clenched that the injury was the result of an encounter with the “large cat” called a leopard. At the hospital in Kathmandu, I worked with the surgeons who carefully planned the steps of stabilizing multiple ligaments of the knee, including the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), of an active teenager who had been struck by a passing vehicle on one of their very busy streets. The Nepalese surgeons who successfully performed that multiligament reconstruction have been key members in the development and leadership of the Arthroscopy Society of Nepal.
While underresourced financially, Nepal has a wealth of talented, dedicated, and skilled surgeons. Their understanding of local injury patterns, optimal utilization of the resources available, and level of care coinciding with their honorable social and cultural customs made me understand I would be learning more than I could possibly teach. While I brought hard copies of journals and certain texts, our colleagues in Nepal were more focused on digital material. At a time when online journal review was not commonplace throughout the world and few were proficient with online medical searches, they used the medium exceedingly well. The effects were apparent in their practice and outcomes: unique, complex cases were treated with state-of-the-art techniques tailored to their patients’ needs, and their sometimes-limited resources were utilized to the fullest. Over the past 2 decades, members of this academic group in Nepal have been hosted at our institution, and our relationship continues to flourish.
Fast-forward a decade later and my journey took me to Singapore—an impressive backdrop that provided a vastly distinct practice environment with unrestrained resources. Yet, within this contrasting setting, there exists the same unwavering enthusiasm, energy, and remarkable proficiency that I had encountered years before. Additionally, I was very much impressed with the research infrastructure I encountered. It was an intricate network of support—brimming with collaborative efforts, mentorship, and dedication—that continues to fortify the foundation upon which research thrives. I witnessed a synergy among scientists and surgeons who were diligently collaborating in basic and clinical research, propelling the boundaries of sports surgery. This concerted effort stood as a testament to the commitment to advancing their field and ushering in novel breakthroughs.
Beneath the surface of these ostensibly disparate circumstances lies a common thread: an intrinsic bond forged by commitment to evidence-based medicine, and an unyielding dedication to advancing the field for the betterment of children. Papers published in the American Journal of Sports Medicine (AJSM) occupy a special position in this space. In unique and varied regions of the world, AJSM is a revered orthopaedic journal that provides free access to regions with limited resources and access.
As AJSM reviewers, you provide critical analysis that raises the quality and, consequently, the impact that the articles have on the readership throughout the world. You get something in return for your work, including continuing medical education credit, the ability to critically review and analyze articles on topics of interest before they are published, and the ability to see the reviews of other reviewers after a decision has been made. You also hone and refine your analytic skills with each manuscript that you review. You solve interesting puzzles as to how to best improve a manuscript. You raise the bar on the quality of evidence. You also support your colleagues while advancing your profession. Since those things are not readily apparent to those around you, I would also like to address your family, friends, and trusted colleagues directly.
Thank you for supporting the person that you care about so much. As they sit quietly somewhere reading or typing away at a computer, you might not know that they are doing noble and heroic deeds on behalf of children and their families throughout the world. Individually and collectively, they have an elite knowledge of surgical, medical, rehabilitation, and basic science topics, and they help all of orthopaedics in a peer review process.
The manuscripts that our reviewers spend time on become more accurate, more precise, more legible, and impactful. Some of those manuscripts helped the most by reviewers report on injuries that are vastly complex, located in some of the least ideal and most anatomically treacherous places around the body. This research makes life safer and better for some of the youngest, sometimes smallest, and most vulnerable people on the planet.
Reviewers can be seen studying, underlining, circling, and typing responses. From an editorial standpoint, these practices help eliminate bias and weaknesses, enhance statistical significance, and highlight critical clinical findings and surgical techniques. The reviewers are not trekking through an icy crevasse in Nepal or a mountain peak in Argentina to help treat a number of individual patients. They are, however, doing work that is in many ways more impactful by helping surgical, medical, and rehabilitative specialists to help an untold number of patients throughout the world simultaneously.
The manuscripts perfected with the expertise of your loved ones have been instrumental in getting the very best information to people all over the world. That includes people in Nepal, like Drs. Ashok Banskota, Ishor Pradhan, Amit Joshi, and the other skilled surgeons who have been intrumental in developing trauma and sports medecine care in Nepal and who stabilized that teenager with the ACL/MCL injury years ago. They are treating conditions like the young trekker’s forearm fracture and soft tissue injuries after a very unfortunate encounter with a leopard. They are also training medical workers of all levels who travel and stay in hundreds of remote regions of that country to address prevention, early diagnosis, and treatment, thus exponentially increasing the impact of the work published with your help.
Because of the high bar that has been set by your family member, friend, or colleague, the information produced forms the basis of key meetings and interactions helping vast regions throughout the world. In Singapore, Drs. James Hui, Tae-Joon Cho, and Arjandas Mahadev will host clinicians from 18 different nations in Southeast Asia in the Asian Pacific Paediatric Orthopaedic Society Meeting. Drs. Ashok Johari, Alaric Aroojis, and Prabhu Mehta worked with many others from India, including doctors who specialize in pediatric sports and traumatic injuries, at their Silver Jubilee 25th Anniversary Paediatric Orthopedic Society of India Annual Meeting. The membership of that society serves, at this time, more than 1.4 billion people. From a quiet hamlet in Sheffield, England, Drs. Nicolas Nicolaou, Fazal Ali, and Adil Ajuied host experts from their region and around the world at an international conference for children. In the United States the Pediatric Research in Sports Medicine Society established international collaboration during the presidency of Dr. Kevin Shea. International Pediatric Orthopaedic Symposium founding chairs, Drs. Chad Price and Jack Flynn, attracted and included not only attendees but also faculty leaders from all continents. Recent chairs, including Drs. Suken Shah and Derek Kelly, have instituted a system whereby, each year, surgeons from developing countries are sponsored, with their country serving as a co-host. Our American Orthopaedic Society for Sports Medicine, President Dean Taylor, traveling fellowship committee members, and chair Steven Cohen are partnering with societies overseas such that clinicians from other hemispheres and continents travel to this country while our AOSSM members travel there, all sharing unique skills and best practices. Such meetings provide immense educational value to a broad range of clinicians from both higher- and lower-resourced nations who are making sure that somehow broken children are put back together in the safest, most efficient, and most effective way.
Academic journals have an impact factor, which relates to how many times the content of a journal is cited by other scientific articles. Because you and your loved ones work as a team, you have collectively made what has been described possible. You, your loved ones, and medical specialists from around the world have collaborated to make not game-changing plays like professional athletes make, but life-changing, uplifting changes for every child who is found in need of advanced techniques for treating countless types of sports and trauma-related injuries, both acute and chronic. You are the “impact factor” that is making the lives of children better.
Collegiate and professional athletes attract adoring crowds and inspire others by showing what can be accomplished with teamwork, dedication, and a commitment to excellence. Your team’s commitment to excellence, however, yields a favorable impact for our current and future children that the most famous professional athletes can only dream of. Anatomic studies providing new information regarding the relationship of a growth plate relative to adjacent joint cartilage, ligaments, tendons, and muscle provides enduring content in perpetuity such that a limb can be stabilized and cartilage or bone restored, while growth, alignment, and strength are preserved. Combine that with radiographic, surgical, medical rehabilitation, and basic science studies and the impact is enormous.
Your love, support, teamwork, and collective effort with our AJSM reviewer is what has made everything described here possible. You have made children better in your country and all others. You have helped make them more pain-free and stronger with better motion. You have helped them regain agility, balance, and endurance. By helping them get more accurate diagnostic readings from their caregivers, safer treatments, and more complete rehabilitation, I believe you have helped children of all shapes and sizes not just physically, but also mentally and emotionally. You have helped enhance their grit and have instilled in them a tenacious spirit that makes life better, not only so they can walk, jog, and run, but also so they can excel in all things despite life’s many challenges.
I would therefore like to thank not just the AJSM reviewers, but all those in support of their collective effort to help improve the lives of generations of children throughout the world.