A Career Comes Full Circle: Dr. William Clancy and ACL Reconstruction
Madison, Wisconsin - In many ways the career of UW Health Sports Medicine division chair William Clancy, Jr., MD, can be defined by the anterior cruciate ligament (ACL).
And like the ACL reconstruction surgery he pioneered, Dr. Clancy has come full circle and is back where it all began.
The Dark Ages
Dr. Clancy's interest in sports medicine predates the profession. As it often is, necessity was the mother of invention, and in this case necessity took the form of injuries. A gold and bronze medalist at the United States Track and Field Championships during his undergraduate years at Manhattan College, Dr. Clancy's athletic accomplishments were accompanied by a litany of strains and sprains and other running maladies.
With medical school in his future, Dr. Clancy investigated the possibility of wedding interest to profession. But there was one problem.
"There was no such thing as sports medicine," he says. "Nobody knew anything about sports injuries. It was the dark ages. I was interested in sports-related injuries, so I said, ‘Where do they fit?'"
The answer was orthopedics, in which Dr. Clancy accepted a residency at Columbia-St. Luke's in New York City. His interest bloomed after attending a Rhode Island seminar that focused on sports injuries, and a two-year stint at the United States Naval Academy, where cadets participated in mandatory, year-round athletics programs, convinced him the ACL would become the focal point of a soon-to-be-burgeoning field.
"At the Naval Academy we recognized the most important injury was the ACL," Dr. Clancy says.
The ACL: A Brief History
The ACL is one of the four major ligaments in the knee that connect the tibia to the femur. Its primary function is to prevent the tibia from shifting forward and to control the amount of rotation in the knee joint. Basically, the ACL stabilizes the knee during activity.
Numbering 95,000 per year in the United State alone, ACL tears are common to sports that involve rapid acceleration/deceleration and planting of the feet to cut, such as basketball, football and soccer. Today ACL reconstruction is a common procedure with impressive success rates. But early in Dr. Clancy's career that was not the case. In 1974, when Dr. Clancy founded the Sports Medicine program at the University of Wisconsin, a torn ACL likely meant the end of an athlete's competitive days.
But in Madison, with its active, athletic populace and Big Ten affiliation, Dr. Clancy saw possibility.
"This was a fertile opportunity," he says. "I would be the head team physician and head orthopedic surgeon, which meant I would see every injury in every sport. That would allow me to look at things that hadn't been written up, think about them and develop treatment programs."
ACL work had evolved considerably since 1903, when a German physician attempted the first ACL replacement using braided silk. (The assessment of his efforts in the informal journals of the day was brief and blunt: "His surgery was not successful.") But surgical attempts to restore a functional stability to torn ACLs had largely failed.
Inspiration found Dr. Clancy shortly after his relocation to Madison when he attended a lecture by Swedish physician Enjar Eriksson. Dr. Eriksson's work involved using the patellar tendon to stabilize the knee. But Dr. Eriksson left the patellar tendon attached to the lower leg, which Dr. Clancy saw as logistically problematic for the ACL.
Building on Dr. Eriksson's premise, Dr. Clancy invented what would become known as the "Clancy procedure" by drilling holes in the femur and tibia and securing a patellar tendon graft to effectively replace the torn ACL.
The results were so encouraging, the Clancy procedure quickly became widely used for ACL reconstruction.
"We published all of the data and had a 95 percent success rate," says Dr. Clancy, and his success bred rampant imitation. "Everybody in the world did our procedure."
Small Steps, Significant Gains
Since the initial inception of the Clancy procedure, ACL reconstruction techniques have undergone a number of progressive ebbs and flows.
"History is nothing more than taking two steps forward and one step back," Dr. Clancy says. "That has been the total history of the ACL."
The advance of arthroscopic instruments allowed for more precise, less-invasive work and quicker recovery times. Surgeons tried double-tunneling, wherein two anchor tunnels were drilled to secure grafts. Experimentation with synthetic grafts made of Gore-Tex gave way to the use of hamstring grafts and allografts (grafts from cadavers).
What hasn't changed, however, is the fundamental approach to the Clancy procedure, which is still used on the vast majority of NBA, NFL and NHL athletes who tear their ACLs.
"My success rate is exactly the same today as it was in 1975," Dr. Clancy says. "The procedure has not changed in 35 years. It was correct then and it is still correct now. It all comes back to the same procedure - anatomic graft placement. That's the whole key."
And Dr. Clancy is again heading up the University of Wisconsin Sports Medicine division, having returned after 20 years at the renowned Andrews Sports Medicine and Orthopaedic Center in Birmingham, Alabama.
His career includes many landmarks: team orthopedist for the 1980 U.S Olympic hockey team and the 1984 U.S. ski team; head team physician for the 1994 U.S hockey team; medical director for the U.S. ski jumping team from 1976-1989; chief medical officer for U.S.A. Hockey from 1989-1994.
But now his place is in Madison, refining what he once invented.
"We were in a void, a universe that didn't even have a telescope," he says when talking about his early days at UW. "Now so much has been discovered. We have to work harder to take smaller steps. The gains aren't huge gains, but they're very important."
Those small gains, which translate into better patient care, sustain Dr. Clancy, as does his vision of the Sports Medicine division's future.
"All of our people have an incredible amount of energy," he says. "You feed off the person next to you, and it enhances both of you. We're growing into a world-class place. It's going to be incredible."
Date Published: 08/24/2011