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Dr. Rafael Inigo Pavlovich

Dr. Rafael Iñigo Pavlovich: Pioneering New Innovations in Meniscal Repair


June 25, 2003

Dr. Pavlovich is the recipient of national honors from several countries, including Mexico, his homeland, and the United States; the author of many influential articles published in prestigious journals as well as member of the editorial board of several major Journals such as J. of Arthroscopy, International Orthopedics, Archives of Orthopedics and trauma surgery, J. of Knee surgery, Orthopedics, Acta Orthop Mexicana, etc.; and the winner of several research prizes, including a National Science and Technology award. In addition to his accomplishments as a scientist, Dr. Pavlovich speaks five languages and has traveled and practiced in Europe, the Americas, and the Middle East. He continues to initiate cutting-edge developments in orthopedic surgery, most recently in his work with radiofrequency pulses, which he discussed with Knee1 in a recent interview.

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Audio Resources:
Dr. Pavlovich shares his thoughts on important aspects of knee care:

Radiofrequency and Classical Treatments for Meniscal Repair

Advantages of Radiofrequency for Meniscal Repair

Helping Surgeons Become Better

Synovial Tissue Ignored by Orthopedists

The Magic of Medicine

Knee1: Years ago you initiated some interesting and promising research in meniscal repair with radiofrequency pulses. Can you tell us more about how the meniscus is repaired with radiofrequency?

Dr. Pavlovich: It’s quite new, a new approach. We biologically awaken the meniscal tissue. It’s a little like rebooting a computer: you reboot the tissue, a fresh start.

Knee1: What are some of more traditional treatments for a torn meniscus?

Dr. Pavlovich: Regarding meniscal repair, the classical techniques utilize sutures; now bioabsorbable implants can also be used for fixation. Radiofrequency, on the other hand, is biological awakening. We promote blood vessel ingrowth in the area of injury to be repaired. There is an interesting potential of applying this to complement the primary stabilizing techniques such as the ones formerly described.

Knee1: When might this new treatment be available to the public?

Dr. Pavlovich: I’ve done some experimental trials, and results are very promising; we’re still carrying on some mechanical studies. I’m very excited!

Knee1: So this new treatment has been your focus for the last three years.

Dr. Pavlovich: Actually, for the last five or six years. Others have described the use of radiofrequency for ablation of the meniscus, but none have described the use of radiofrequency to promote healing and repair.

Knee1: You also mentioned that you were currently "working in new ways to teach doctors to be not only better surgeons but better human beings”. Can you tell us more about these "new ways"?

Dr. Pavlovich: I’m trying to make surgeons take a new approach and become better people. We have forgotten many things from the past. We are too focused, too commercial, too "superior"; that’s the way we think. We don’t focus on the family or the friends of the patient. I’ve been preparing some lectures about keeping one’s life in balance. An imbalanced surgeon is not likely to succeed at the highest level.

I’m also trying to develop tests so that people will discover if they have a gift for surgery or if they lack the skills. Many people are bright, but not gifted in the operating room. When we train a surgeon, that person may never achieve his or her potential because book knowledge is one thing while neuromuscular or motor skills are another. How do we choose between surgeons who are competing for a single position at a hospital? In addition to considering a resume, a test for motor skills could help.

This theory has to be validated. In the military, evaluation of pilots, for example, are advanced in this regard. We need incorporate this type of knowledge: a team of researchers, like pedagogists, could investigate this problem and develop spatial intelligence tests. Is an individual’s brain able to cope with surgical challenges or not? This is what I’m trying to find out.

We have a test for intelligence, but up to now we haven’t had a valid test for surgical motor skills, for spatial intelligence. People are supposed to have seven kinds of intelligence: musical, mathematical and so on; one of them is spatial. This is according to Dr. Gardner, at Harvard University. We have to acquire data and find out who has a gift for surgery.

Knee1: You are currently focused on making devices and surgical techniques simpler yet equally effective, so more doctors can apply them to more people. How does repairing the meniscus with radiofrequency help you meet this goal?

Dr. Pavlovich: By achieving better outcomes or results. Radiofrequency was a curiosity for me years ago. Now it’s a passion. I can foresee many applications beyond orthopedic surgery. I am investigating some very interesting concepts that are still in testing. All my life I’ve been trying to create. I don’t like conventional limited thinking. The electromagnetic field is a tool for the new millennium. This is a very promising area of investigation.

Knee1: What do you foresee as the most important new trends in orthopedic care?

Dr. Pavlovich: As we have discussed, I am most interested in applications of radiofrequency to arthroscopy. I’m working with prestigious colleagues including Dr. James H. Lubowitz (a previous Knee1 Hero on this site) to review the literature regarding radiofrequency for the journal, Arthroscopy. I have reviewed current concepts regarding application of computers to arthroscopy for the journal as well.

Another major interest is the joint lining or synovium. In my opinion, the significance of synovial tissue pathology has been neglected by the orthopedic surgeon. When you go to a Congress or a Meeting, you barely hear about synovial tissue (which I believe is responsible for more than 90% of pain in the knee). In association with colleagues from Israel, Mexico, and the United States, I organized a symposium which was called "Synovial Tissue: The Forgotten One." Published in the J of Knee Surgery 2001.

Knee1: Dr. Pavlovich, you speak five languages, and spent your postgraduate years in many different parts of the world. Has your international background had an impact on your view of medicine? If so, how?

Dr. Pavlovich: I’ve lived in and traveled to many places. I practiced and studied for four years in the Middle East, then France and then I came back to Mexico. Currently, I very much love where I live. It’s a small, lovely city not far from the sea of Cortez...Hermosillo.

Travel has expanded my vision and perspective. I feel like a citizen of the world. I have 360-degree vision. Before travel, I saw things in two-dimensions; now I feel like I’m at an IMAX movie. And I have learned to discover the best in everyone, every place I go. Every single person seems to have something to give. One might think that some people are not so brilliant, but when you meet them, they often are. Life is a big puzzle made up of little pieces. This is what I have learned.

Knee1: How do you think that this international experience has increased your desire to see medicine go "back to basics"?

Dr. Pavlovich: Some surgeons do great work but may lose "contact" with the patient. Some may be out of touch with the patient as an individual person who happens to have a problem. These surgeons may just see another knee or another shoulder in front of them. These surgeons have lost perspective.

Medicine is an art and it’s magic. We have to be more compassionate and relate to our patients as people. Sometimes a patient feels much better if you just smile, and we don’t understand why. There is a mystical way of being with your patient, which we shouldn’t forget, even though we don’t know exactly how it works. We have to go back to basics, I think. A lot can be done with touch, with a look, with instillation of a confident attitude that things are going to be much better; this is in many ways what heals, and healing is our goal.

 

Last updated: 25-Jun-03

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