I'll just give a quick history of the group. Back about 13 years ago, we were at the academy meeting. Ted Ganley, Eric Wallman, Coker and I were talking about the clinical practice guideline that was being developed, and there was almost no evidence to help make decisions for care. The guideline was subsequently published in 2011, and although it didn't have much evidence, it did clearly outline the important clinical questions and areas in which we needed more research. It basically was an outline for future research for a group, and the group basically started that. The ORF gave us a grant to start a group with Christy Weber's support, and we had a two-day meeting in the fall of 2010, and that launched the group. Some of the key recommendations within the guideline include the importance of inter and intra-observer reliability studies for both radiographs, MRI, and arthroscopy classification, prospective cohort studies to identify independent predictors of healing and to measure your outcomes, and then RCTs to establish optimal surgical and non-surgical treatment strategies. We got started, we started by talking to some really smart, talented people. Kurt's already been mentioned several times today, but he gave us remarkable recommendations and advice, and probably most importantly, he connected the group to Jim Carey at its beginning, and he shared many of the lessons they had learned about 10 years ahead of us. We also met with Rick, and once again, great encouragement. He attended most of our meetings. He actually helped us develop the ROC acronym, and he also shared many of the lessons learned from ours about running these groups. The group put forth a definition, which has actually evolved a bit over the last 10 years, and we've had superb input with four veterinary colleague researchers and some MSK radiology experts to help us clearly define this condition, which also occurs in animals. It's a focal idiopathic alteration of subchondral bone and or its precursors with risk for adjacent instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis. ROC members more than 50 people currently, and it's predominantly orthopedic surgeons, but significant number of MSK radiologists, physical therapists, veterinary partners, and some PhD researchers as well. The classification reliability work has all been published over the last six years, one for both arthroscopy, healing sequence, x-ray classification, MRI classification, all published in the AJSM over this timeframe. The prospective cohort was launched prior to launching it. We identified all our key research questions before putting the first patient in the cohort. We now have approximately 1,700 patients in the cohort, 25 centers, and Henry Ellis and Phil Wilson at TSRH have been our leading enrollers and done remarkable work there. With the support of AOSSM getting a research grant, Ben Hayworth led the RCT drilling, comparing transarticular to retarticular drilling. This was presented last year at AOSSM and at PASNA, showed fairly comparable results between the two techniques, and this was nominated for best paper award at PASNA last year. Multiple x-ray, MRI, even CT imaging papers with our MSK and clinical colleagues, so this is a limited number of the publications trying to better understand how imaging improves our diagnostic capabilities. Our veterinary colleagues have continued their line of investigation, looking at as vascular failure, is that the primary cause of OCD? It may be in some cases, but research continues there to clearly find out what the fundamental underlying cause of OCD is. A number of the groups are also doing animal model work, both in goats, pigs, and rabbits to give us more insight into this condition. Ted Ganley and others have led some of the rock genetic work, including GWAS studies, the University of Utah has a population databank that we're working to access to better understand familial and genetic associations for OCD. The group has also had access to some very large data sets, including our own, and they've published four studies now, three knee, ankle, elbow on large medical system databases, and the rock cohort was just published this last year with Carl Nissen's hard work outlining the entire cohort and the demographics of OCD. From 2015 to 2019, you can see the rock members, both individually and collectively on the far right, as of 2019, there were 75 joint publications with rock members on OCD topics. The prospective cohort has a number of projects ongoing right now, a healing prediction algorithm where we can look at x-rays, MR, clinical demographic sex factors to predict who's gonna heal with non-operative treatment, which still is an option for younger skeletal immature patients. This is being led by a data scientist and statistician from the Naval Academy who's now a medical student at Stanford, along with Carl, Mark Tompkins, and Matt Malusky. Our throstomy findings prediction where you can actually predict what stage of disease you'll find based on clinical and imaging factors. That's being done by Matt Malusky, Greg Myers, and others. We're also looking at the fairly significant psychosocial impact of OCD. This has a huge impact on young athletes because of prolonged time away from sports like ACL and other problems, and Henry Ellis and Phil Wilson are leading that work. We have over 200 large unstable OCDs that have been treated surgically, and we're looking at those outcomes. And Jeff Nepple, Matt Malusky, and Ben Hayworth are leading that work and got a positive directed grant to continue that project. The group is expanding to elbow and eventually to the talus. Don Bay and Carl Nissen have led the elbow expansion into rocket, and we've also had the privilege of working with Masa Murahama in Japan with his expertise on use of ultrasound for screening these athletes. Lots of things in our future. I think the prospective study cohort group is gonna provide a lot of information going forward. I think biologics and the role in treatment of OCD will continue to expand. Genetics clearly is an important factor we need to better understand, and the factors related to etiology, both loading conditions and vascular etiology are important. We think surgical technique development is gonna be a big thing that ROC does in the future, and we really wanna try to drive variation reduction across our centers and across treatment areas. ROC Mission and Culture, I think, has been a big part of its success. Eric kind of started us off, and he said, we want to determine optimal treatments and cure for this condition in 25 years. John says this is the best thing that's ever happened to him professionally to participate with this group. And Ted says you get to know people in a really amazing way, both friendship, leadership, and creativity. Jim Curries told me that after years of aspiring to be a successful musician, he said he's finally part of a successful ROC group, so we're happy we could provide that for Jim. And I'll also say to be successful in any multistandard group, you have to have a capable MPH and statistician, and ideally, you get a comedian. Unfortunately, Jim does all three of those for us very well. Carl summarized things very well. To me, a couple of days ago, he said, this has been the most invigorating and enjoyable aspect of his professional life. And what makes me smile is the group has really no attrition. The group is welcoming and encouraging. And hence, once people join, they stay involved and engaged. We really have tried to model ourselves after Adam Grant. He talks about give and take within cultures and how helping others really drives success. We filled the group with givers and matchers. We've tried to create this giving culture where it's really critical for everyone's success, but also for your personal and professional happiness. I'll just conclude with a quote by Margaret Mead. Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has. And some acknowledgments, first to the remarkable rock group. There's over 50 members who work a lot, and it's remarkable what they've been able to accomplish. Alan Anderson, who we all lost too early, was a remarkable friend, mentor, and colleague to me and so many others in this audience. And also like to talk about, you just mentioned Lucas Murnaham. It was with our group who passed too young and was an amazing human. So thank you.

osteochondritis dissecans

clinical practice guideline

imaging

surgical outcomes

expanding focus