By: Knee1 Staff
Dr. Nancy Cummings is the Director of Orthopedic Surgery at Franklin Orthopedics in Farmington, Maine, and is the Director of the Carrabassett Clinic at Sugarloaf, USA, which has hosted several elite racing events. Dr. Cummings has served on many advisory boards and committees, and is the recipient of the New York Orthopedic Hospital Award. In this article, she discusses her interests in women’s knee injuries and her expectations for the future of orthopedics.
Body1: At what point in your life did you know you wanted to be a doctor?
Dr. Cummings: I was about twelve years old and had hip trouble and needed orthopedic surgery, and was treated by a doctor who was a great role model.
|ACL Injuries in Young Women
1) ACL injuries in women are quickly becoming epidemic
2) A female basketball player has four times the risk of her male counterpart of tearing her ACL
3) The majority of women who tear their ACLs do so in a non-contact fashion, usually by landing awkwardly after jumping
For a description of an ACL tear Click here
To learn more about ACL reconstruction Click here
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Body1: So if you weren’t an orthopedic surgeon, you wouldn’t have gone into medicine?
Dr. Cummings: Yes, that’s right.
Body1: What do you feel is your greatest contribution to orthopedics?
Dr. Cummings: I have a unique perspective for an orthopedic surgeon. I have had six operations on my hip. I know what it is like to be on the other side of the knife so to speak. The other thing I feel I bring is that I spent my first six years of practice in academic medicine, and then had my children, and decided to find an environment where it was going to be easier to balance raising a family and being a surgeon. So I bring an academic sports medicine attitude, experience and skills to a community based practice.
Body1: Could you differentiate between academic medicine and community practice for our readers?
Dr. Cummings: [The difference is in] the things you are exposed to in a big academic center. I did complicated level 1 trauma for the six years and I was in academics, and it gives you a certain way of looking at things. It’s not to say that it’s that different from the community orthopedist. But I had an opportunity to do a number of injuries that you don’t routinely treat at the community hospital. For instance while in academics I treated a number of knee dislocations—(that’s the queen mother of knee injuries) and it taught me a great deal about the complexity of the knee.
Body1: You’re also the Director of Orthopedic Surgery at your hospital; is that correct?
Dr. Cummings: Yes. I’m at a small hospital, and there are three orthopedic surgeons here, so it’s not like running a big department; but I’m also the Director up at Sugarloaf, and the physician for Carrabassett Valley Academy (a school that Bodie Miller attended) and the University of Maine Farmington, which allows me to combine high-level sports medicine and community practice. [Body1: the Sugarloaf U.S.A. has hosted several elite ski racing events, including the U.S. Alpine Nationals, the U.S. Freestyle Nationals, and the Junior Olympics.] I get the best of both worlds here in Farmington.
Body1: When you went through your residency, in the 1980s, was it difficult to be a woman in a sports medicine program?
Dr. Cummings: I started in 1987 and finished my residency in 1992. I was the first female chief resident in orthopedic surgery at The Brigham & Women’s Hospital. I felt like I was treated very fairly, as “Nancy,” not as a representative for all womankind. There were a number of women in my residency group, so you didn’t feel like you were the token female. During my sports medicine fellowship, we went to spring training for the Red Sox, and the ball players were very accepting as well. I thought it might have been an issue, and it really wasn’t. They just care that you know what you’re supposed to know. About 4% of all orthopedic surgeons are women. I’m in a new society called The Forum, and it’s a great academic group of fellowship trained female orthopedist surgeons. We have members that cover athletes of all levels e.g. Division I football teams, NHL hockey teams, and at least one member who covered the Olympics this summer.
Body1: Your CV mentions ACL injuries in young female athletes as one of your major research interests. Can you tell us more about this topic?
Dr. Cummings: A female basketball player has four times the risk of her male counterpart of tearing her ACL and it tends to happen in a non-contact type fashion. I’m interested in the factors that make it so much more common in young women, and have worked with local basketball teams to improve jumping and landing techniques.
A few years ago, I heard at the AOSSM (the American Orthopedic Society for Sports Medicine) about how men and women land differently when they jump. So I asked my four-year-old and six-year-old to jump, and my daughter landed with stiff knees and my son landed with flexed knees. Our neuromuscular wiring may make us that way. . . So we’ve been training young female athletes [to land better] in hopes of preventing the injury. If you start at the 5th and 6th grade level, hopefully, by the time the athletes are starting college, you won’t see all five starters with scars on their knees from reconstructive ACL surgery.
Body1: Can you tell us about some of your other interests in patient care or research?
Dr. Cummings: I have a big interest in ski equipment, because I see a lot of ski trauma. I hope to get involved in tracking the injuries that we’ve seen through the clinic, and get more involved with the ski equipment companies.
Body1: So most of your focus at this point is on prevention?
Dr. Cummings: I think it’s important. I love doing ACL reconstruction, but [ACL injuries are] really an epidemic.
Body1: What do you see as the most important new trends in orthopedics?
Dr. Cummings: I think the most exciting stuff is the tissue engineering and the gene therapy. We have pretty good reconstructions, but they are not as good as the original ligament and I think that before too long we’ll have the scaffolding to recreate the complexity of the original ACL. Gene therapy, being able to manipulate certain genetic material, is very exciting. I think maybe we’ll be able to grow ligaments, something closer to the original part, rather than borrowing the patellar tendon or hamstrings to try and recreate it. I think maybe we’ll see a decrease in arthritis and total joint replacement.
Body1: How do you expect your practice to be different in five years?
Dr. Cummings: I probably will be doing more arthritis-preventing procedures; I expect I’ll be doing more osteotomies, rather than joint replacements; I hope to do more cartilage-sparing procedures like autologous cartilage transplant. I don’t know whether the number of ACL reconstructions I do will decrease, but I hope with the current jump training and ongoing research I will see fewer torn ACLs.
I think we’re at a very exciting time in orthopedics. . . Basic science, technology and manual skills are all coming together to better define the injuries to joints and improve their treatments and outcomes. The arthroscope was a wonderful invention to start us on that path. It is a minimally invasive way to examine and treat knee injuries that was first developed in Japan. The arthroscope has led [us] to being able to affect the course of knee treatment without causing a lot of morbidity, and that has carried over to the shoulder, to the elbow and even the smaller joints. And we’re getting less invasive all around. They’re now doing minimally invasive joint replacements.
Body1: Are there specific advances or changes in your field which you hope to see in the next five or ten years?
Dr. Cummings: I would hope for more durable joint replacements. Even better, it would be great to be able to re-engineer the articular cartilage. I would also hope for further understanding of the molecular and genetic causes of joint degeneration i.e. osteoarthritis and treatments to prevent or reverse it.
Body1: For our readers who may be looking for a orthopedist or an orthopedic surgeon, how would you recommend they find a good one?
Dr. Cummings: I think word of mouth is probably the best. I find that it’s one of my strongest referral sources: a patient who’s had a good experience will tell a relative or a friend. I think that’s probable the most valuable resource for someone in need of an Orthopedic Surgeon
To learn more about Franklin Orthopedics and Dr. Nancy Cummings, please visit the Franklin Community Health Network