Under The Knife: Top surgeons blend research, track records

These are the names no player wants to hear. While a visit to Dr. James Andrews in Birmingham or Gulf Breeze isn't a bad thing in and of itself -- Andrews estimates he only operates on about 40 percent of the athletes that visit him -- these surgeons have become shorthand in baseball. The rise of the "super surgeon" in sports is understandable. Star players want star doctors. Teams want to protect their investments.

The first super surgeons came about more than 50 years ago. Dr. Robert Kerlan and his protege Dr. Frank Jobe helped the Los Angeles Dodgers stay at the forefront of sports medicine, while Dr. Jack Hughston opened his facility in southern Georgia just before Kerlan-Jobe in Los Angeles. The lineage of many of the current super surgeons can be traced to these three "founding fathers."

As that first generation retired -- only Jobe is still alive -- the work they did lived on through education. Andrews left the Hughston Clinic, went a bit west to Birmingham, and replicated the success. Between the three centers, almost all of the orthopedists working in sports have some connection, often doing fellowships at one or more of the facilities. Even athletic trainers and physical therapists consider themselves as one or the other, referring to themselves as "Andrews guys" or "Jobe guys."

I put together the first rankings of the super surgeons in 2010 and since there's a powerful gravity to these surgeons, it's not surprising that other laws of physics, like inertia, hold as well. Eight of the 10 are the same, with the changes coming more from the research and technique side than the more normal emerging apprentice path. (Of course, Andrews pioneered that as well with his early shift to the then-new arthroscope as he left Hughston's orbit.)

The research side is becoming more influential, especially with an explosion of stem cell-based techniques becoming common. When Andrews stood in front of a conference in Birmingham and said he'd do PRP injections on all his elbow patients as a matter of course, that was a tipping point. As more advanced techniques arise, advances are sure to come, such as that by Walt Lowe in Houston, who's been working with meniscal transplants.

Some I spoke with in compiling these rankings even suggested that some doctors who fall just shy of the list are working in fields as diverse as joint replacement, cybernetics and radiology. While it's easy to think of this as pie-in-the-sky work being done to support rich physical freaks, so much translates to the medical care available to the rest of us, that it's clear how much sports medicine leads the way in many other fields. These men -- indeed, they are all men -- are the leaders. Players may not want to hear their names, but when they do, there are no more powerful allies.

1. Dr. James AndrewsTeam: Tampa Bay RaysBase: ASMOC (Birmingham AL), Andrews Institute (Gulf Breeze FL)Med School: LSUSpecialty: ElbowNotables: Brian Wilson (2012), Brett Anderson (2011)

It should be no surprise that Andrews holds at No. 1, though how he's doing it remains a singular achievement. Andrews splits his time between two separate facilities with two separate staffs and administrations, and even two separate research facilities, though AREI hasn't developed the same reputation as ASMI. It's a bit of a dilemma for traveling secretaries, who have to check where Andrews will be rather than having a standing flight booked to Birmingham. Andrews was supposed to slow down after a heart attack, but there's no evidence that has been the case. He's seeing more patients than before, doing as many surgeries, putting his name on as many studies, and is still shorthand for a pitcher's arm injury among fans who probably couldn't tell you who their own team doctor is. Andrews is likely to be the No. 1 on this list as long as he chooses to continue practicing -- and that's part of the problem. Andrews' primacy makes it tough for even very solid doctors to step out of his shadow and harder for those doctors to establish himself as super surgeons in their own right.

2. Dr. Tim KremchekTeam: Cincinnati RedsBase: Beacon Orthopedic (Cincinnati OH)Med School: University of CincinnatiSpecialty: ElbowNotables: Ryan Dempster (2003), Adam Dunn (2007)

What gets "Doc Hollywood" this high on the list? The two "Rs": results and recommendations. Kremchek's patients not only come back successfully, they come back fast. A former ASMI fellow, Kremchek's technique isn't significantly different than Andrews', but he does use a much larger graft, often from the hamstring, which increases the early tensile strength and allows for a quicker rehab. There's a grace to the way he works, an economy of motion you don't expect from a gregarious man. Kremchek isn't just focused on top level athletes. His passion is, like Andrews, reducing the number of youth injuries. A recent pair of Tommy John surgeries done on two Little League stars in the Cincinnati area allowed him to once again ask the community at what price glory? Kremchek's medical palace at Beacon Orthopedic, outside Cincinnati, allows him to have everything from imaging to therapy on hand. Kremchek has also been pushing for a form of MLB Combine for draftees, something that could easily take place close to his Cincy base.

3. Dr. Neal ElAttracheTeam: Los Angeles DodgersBase: Kerlan-Jobe Orthopedic Clinic (Los Angeles CA)Med School: University of PittsburghSpecialty: ShoulderNotables: Andre Ethier (2011), Georges St. Pierre (2011)

Like most of the surgeons on this list, Neal ElAttrache does more than just baseball injuries. He's a go-to knee doctor in multiple sports, including the NFL, where he famously operated on Tom Brady. Also, he's considered among the world's best shoulder doctors and even consults on shoulder injuries for other doctors on this list. "The first thing I do when I get a new shoulder case," said Jim Andrews a few years back, "is call Neal ElAttrache." Along with Lew Yocum, ElAttrache is keeping the Kerlan-Jobe clinic a top destination for injured athletes, as well as one of the top sports medical training and research facilities. Understanding ElAttrache's brilliance goes beyond his work with a scalpel; his empathy is cited by many of his patients and colleagues.

4. Dr. David AltchekTeam: New York MetsBase: Hospital for Special Surgery (New York NY)Med School: Cornell UniversitySpecialty: ElbowNotables: Joe Nathan (2010), Johan Santana (2008)

Does it surprise you that there's only one Ivy League guy on this list? David Altchek is perhaps best known for his adjustment to the original Jobe-created Tommy John technique, called docking. That technique has led many to consult with Altchek and his confident manner and location have led many to decide to use his services. A second generation physician, Altchek is also one of the lead consultants to the NBA for medical services in addition to his work with the Mets. His basketball work has led him to focus much of his recent research on ACL reconstructions. He's also the top doctor for many tennis professionals, working with both the local U.S. Open and the Davis Cup teams. Just how well-rounded is Altchek? I couldn't confirm this, but I'm pretty sure he's the only doctor to appear in a Ralph Lauren fashion ad. Yes, Lauren is one of his patients as well.

5. Dr. Lewis YocumTeam: Los Angeles AngelsBase: Kerlan-Jobe Orthopedic Clinic (Los Angeles CA)Med School: University of Illinois, ChicagoSpecialty: ElbowNotable Surgeries: Ryan Madson (2012), Stephen Strasburg (2010)

For years, there was almost an "East Coast/West Coast" vibe to elbow injuries. The East Coast normally went to Andrews, while the West went to Yocum. It still works that way in many cases, though Yocum has slowed his pace a bit in recent years. He's used that time to develop a series of young doctors, both at Kerlan-Jobe and around the country, that will continue his work. Yocum doesn't mind being low-key, as he's avoided the press for decades, preferring to quietly influence the profession through education and training. Don't take this slower pace and re-focus as any drop in his workload or sign of imminent retirement. Yocum's passion for sports, especially baseball, is likely to keep him the go-to guy on the West Coast for decades.

6. Dr. Richard SteadmanTeam: UnattachedMed School: University of Texas, SouthwesternSpecialty: KneeNotable Surgeries: Carlos Beltran (2010), Victor Martinez (2012)

If Dick Steadman had wanted, he could have named microfracture surgery after himself. It was his development of the procedure that's allowed it to go from a last-chance fix to something that can allow an athlete in many sports to continue or prolong his career. Much of Steadman's work is based on his most numerous patients at his Vail clinic -- skiers. But don't mistake Steadman for a ski bunny; his athletic bona fides stretch to his time at Texas A&M, where he played for Bear Bryant. Along with his partner Marc Phillipon, whose work with hips is as groundbreaking as Steadman's with knees, Steadman has focused on knee and hip issues. Steadman's work with microfracture is thought to be an intermediate step toward actual regeneration of knee cartilage, and naturally, Steadman's at the forefront there as well.

7. Dr. Stephen J. O'BrienTeam: UnattachedBase: Hospital for Special Surgery (New York NY)Med School: University of VirginiaSpecialty: ShoulderNotable surgeries: Research on function of labrum and biceps-labral complex

Never heard of O'Brien? You might have heard of ASMI, who gave Dr. O'Brien their Lifetime Achievement award this past year. O'Brien is known as more of a researcher and thinker, but he's also got his hands in a lot of shoulders along the way. O'Brien's recent focus on the function of the labrum and its relation to the biceps has caused many doctors to re-think what they were doing with labrum tears. Long one of baseball's most fearsome injuries, O'Brien's research has indicated that there's a more holistic view that must be taken in order to better return pitchers from this kind of injury. In fact, the way many doctors, trainers and therapists test for a tear is called the O'Brien Test. Shoulders are a long way from being as repairable as elbows, but O'Brien's research and work with other physicians on this list are getting things closer.

8. Dr. William RaaschTeam: Milwaukee BrewersBase: Froedert Hospital (Milwaukee WI)Med School: University of ChicagoSpecialty: Knee, ElbowNotable surgeries: Yovani Gallardo (2008), J.J. Hardy (2006)

Few doctors come from an engineering background, but Bill Raasch's education has led him to be a methodical problem solver. Raasch is known for taking both the long view, including a focus on biomechanical research (which includes his own motion capture lab) and for returning athletes quickly, such as Gallardo's in-season return from ACL reconstruction. Over and over, people inside the game spoke with admiration for Raasch's work and were surprised he's not better known. For the last decade, he's been one of the Brewers' secret weapons, keeping them among the healthiest teams in the league over that period. Raasch's quiet, Midwestern demeanor won't get him quoted in too many magazine stories, but his work is well known, putting him in good position not only to stay on this list for years, but to move up.

9. Dr. Keith MeisterTeam: Texas RangersMed School: Boston UniversitySpecialty: ShoulderNotable surgeries: Brandon Webb (2009), Leonys Martin (2012)

There was a time point when Meister was the golden boy of orthopedics. He'd left the University of Florida to establish his own practice and clinic in the Dallas area. He was going to be the team doctor for both the Rangers and Stars, all while building a world-class orthopedic hospital in the midst of one of the fastest-growing regions of the country. A decade later, Meister has built out the practice and has helped the Rangers stay healthy enough to make the last two World Series. But Meister has seen his gold-star status fall Why? "Webb killed him," said one team official. Meister put his reputation on the line while trying to repair Webb, even championing the Rangers' signing of his patient. Webb, like so many power sinker pitchers, could just never come back from his shoulder injury, and Meister took a hit for that. One doctor thinks the effect is overrated. "They'll forget that in a couple years. It's not like he did something wrong. He was just a bit louder about it than most and there were more than a few that liked seeing him eat crow," he said. This is really more about Meister not moving up the charts rather than falling off it the way several of his generation have already. In an industry in which there's a very small group of top performers with decades-long careers, it's not so bad to plateau.

10. Dr. James BicosTeam: UnattachedBase: St. Vincent Sports Medicine (Indianapolis IN)Med School: Rush Medical CollegeSpecialty: KneeNotables: Research on cartilage regeneration and transplant

Sometimes, surgeons rise to the top of their profession based on need. With the rise of cartilage issues across sports, James Bicos is fast becoming one of the top surgeons in the world when it comes to cartilage regeneration. Think of this as the next generation beyond Steadman's microfracture techniques. Instead of replicating the cushion with the best available replacement, Bicos is working on actually replacing and re-growing the cartilage. Many of his best-known patients are Olympic level athletes in disciplines such as gymnastics and diving. The demands are different, but timing is key. Getting back to competition with a four-year clock on training ticking is a tough go for many. Bicos is at the top of that field, which has led more professional athletes to look his way.

Dan Wade and Stacey Gotsulias were indispensable with their contributions to this piece.