The evolution of my philosophy of knee care began to take shape during my residency, when I was exposed to the ideas of Dr. Ernst Dehne, a surgeon whose work I greatly respected. Dr. Dehne’s radical (at that time) proposal advocated that treatment of tibial fractures with a cast combined with early ambulation and weightbearing not only resulted in a healed tibia, but produced well-nourished and healthy joints above and below the fracture when the cast came off. Encouraged by the improvement I had seen in the joints that had been treated that way, I decided to treat tibial fractures with motion and early weightbearing whenever possible. This prevented the permanent adverse changes in joints that occur with prolonged immobilization and no weightbearing.

When I first started practicing orthopaedics, these as well as other techniques helped to shape the development of my treatment protocol. The AO group provided me with another revolutionary concept that I took to heart. Their idea was that if a fractured extremity was mobilized after rigid fixation, the joints above and below the fracture could tolerate later immobilization with no ill effects.

It was obvious that cast immobilization without weightbearing created problems. Sometimes there was no other choice, but by 1973–1974, I was convinced that the injury site itself was only one component of the treatment protocol, and consequently I developed a strategy to include joint mobilization whenever possible.

At the same time, I noticed that if the injured area could be protected, aerobic exercise could be done safely, and that this not only affected the fitness level, it gave a psychological boost to the injured patient’s attitude. As time went on, I came to realize that exercising the injured limb (as long as there was no deformation) actually enhanced healing. The additional discovery that exercising the uninjured extremity resulted in strength gains on the injured side also became part of my rehabilitation philosophy. This was first employed in the medial collateral ligament, and then later applied to the anterior cruciate ligament and the ankle.