In his latest Easy Reider episode, Orthopaedic Journal of Sports Medicine Editor-in-Chief Bruce Reider, MD, had the pleasure of speaking with Frank R. Noyes, MD, a board-certified orthopaedic surgeon specializing in knee surgery and sports medicine and an internationally recognized authority on the diagnosis and treatment of complex knee problems. Founder of Sportsmetrics, a non-profit injury prevention program that has reduced anterior cruciate ligament (ACL) injuries in female athletes, Dr. Noyes and his wife Joanne established the $10,000 Award of Excellence through Sports Health to recognize scientific advances for female athlete health and injury prevention.
The inaugural Frank and Joanne Noyes Award for Excellence will be presented at the Annual Meeting this July in Seattle—you won’t want to miss it!
This article highlights just a brief excerpt from the full conversation. To hear the complete story, deeper insights, and behind-the-scenes perspective, be sure to listen to the full episode—available wherever you download your podcasts.
Clinical Studies
REIDER: What are two or three of your most important or impactful clinical studies?
NOYES: As a tertiary center, we saw many failures and my practice was about 75% revision surgery. We published studies like 122 revision cases where the ligament was a vertical graft with a residual pivot shift but negative Lachman test. We also published on 200 red-white meniscus repairs, as we were doing meniscus repair very early and achieved 70% to 80% success rates.
Our second major contribution was immediate motion after surgery. In 1981, we wrote the first paper stating "motion is lotion"—you must move the knee immediately after surgery. We published an article on 440 ACLs (primary and chronic, with 50% having other ligament surgery) with zero arthrofibrosis rate. We emphasized that if a patient doesn't have 90 degrees of motion, you need to perform an early manipulation at four to five weeks before scar tissue matures, not at 12 weeks as literature often suggests.
Challenging Cases
REIDER: Please share one or two of the most challenging cases you have treated.
NOYES: I remember a Navy captain from Greece who came to our center using a cane. He had undergone three prior posterolateral ligament surgeries but remained unstable with varus angulation when walking. We discovered he had underlying varus geometry (alignment). This led us to study primary varus, double varus (increased varus angulation with lateral posterolateral injury), and triple varus (which adds knee hyperextension from involving the entire posterolateral complex). We coined the phrase "thou shalt not varus"—any soft tissue operation cannot withstand the forces of malalignment. One-third of humans have varus-aligned knees, and when they have ACL and lateral ligament surgery, the failure rate is 60-70% for lateral posterolateral ligament surgery. This led us to develop tibial osteotomy techniques and received the [Orthopaedic Research and Education Foundation, OREF] Award for that research.
Education Contributions
REIDER: As chair of the AOSSM Curriculum Committee, you created the first definitive fellowship curriculum. What led you to assume that position, and how did you create that first curriculum?
NOYES: I was involved with the Biomechanics and Bioengineering Committees at [The American Academy of Orthopaedic Surgeons], where we developed a curriculum for bioengineering. I met James Farmer, a PhD student who worked with the Academy's educator's course. At that time, I had trained about 100 fellows but there was no curriculum—fellowships were unstructured preceptorships.
With Jim Farmer's assistance and a group of fellowship directors, we developed an “ABC criteria” system: "A" represented what fellows must know, "B" was what should be introduced but might not be mastered during fellowship, and "C" was nice to know but not essential. Chris Harner later used this curriculum to help establish board certification for sports medicine.
REIDER: You were also one of the first and most long-serving chairs of the AOSSM Research Committee. What were some of the most important achievements during your seven years as chair?
NOYES: We established the first research awards, which continue today. With John Albright's help, we secured funding from OREF to establish the first epidemiological studies in sports medicine. Participants needed PhD epidemiologists at their institutions. Fred Sims took hockey, John Albright took gymnastics, Jim Andrews took football, and we took soccer (as I was involved with Olympic soccer as medical director).
We had our epidemiologist write guidelines on conducting epidemiological studies, and Jack Houston agreed to dedicate an entire issue of [The American Journal of Sports Medicine] to epidemiology around 1987 to 1990—the only time the entire journal was devoted to one subject.
Sportsmetrics
REIDER: You founded Sportsmetrics, a sports injury prevention program. Please tell us about its creation and growth.
NOYES: As team physician for the University of Cincinnati, I noticed I operated on more females than males for ACLs. We coined the term "wiggle-wobble knee"—when females jumped, they lacked good landing position, core control, and hip strength. After observing Olympic volleyball players doing plyometrics with perfect landing control, we developed a program combining plyometrics, strength training, endurance training, and flexibility.
We tested it in our gait laboratory with force plate analysis for three years and proved we could eliminate the "wiggle-wobble" after just four weeks of training. We then conducted an epidemiology study with 11 schools, over 43,000 exposures in basketball, volleyball, and soccer. This randomized controlled trial proved that plyometric jump training with strength could reduce ACL injuries in females (who have 4-8 times higher injury rates than males).
Today, Sportsmetrics is non-profit and used in 2,000 cities across 18 countries. We train people virtually and license the program for free. The program can reduce ACL re-injury rates from 22-25% to just 4%. I believe neuromuscular training for female athletes should be bundled with ACL surgery and provided free as a philanthropic contribution.
Awards and Contributions
REIDER: Recently you and your wife Joanne endowed an important award for the journal Sports Health. Please tell our listeners about that award.
NOYES: We proposed a $10,000 award that recognizes outstanding scientific advances for the health, fitness, and prevention of injuries in the female athlete. It's presented at the AOSSM Annual Meeting. Our goal is to promote necessary research for female athletes, recognizing that "a female athlete is not a small man." The award has a strong suggestion for an MD/PT/ATC team approach, particularly encouraging PTs to conduct research for female athletes.
