UNC Sports Medicine Institute

Letter From the Director

The UNC Sports Medicine Institute (SMI) is a multidisciplinary research and clinical project with an aim to keep active people active. We intend to improve on how we deliver care to our community and beyond and continue to focus on a tight collaboration between clinicians and researchers. The SMI is data-driven, collaborative, and patient-focused.

Since its inception in 2019, the SMI has steadily grown. The formation of an Operations and Leadership team as well as a Core Advisory Board with representation from multiple School of Medicine departments as well as Exercise and Sports Science, School of Public Health and others has provided an infrastructure for success. The SMI’s first half-time hire, Carla Hill, PT, runs our day-to-day operations and helps maintain focus on expansion.

Since its inception as a virtual institute, the SMI has successfully raised $150,000 and continues to pursue opportunities for further growth and development. Clinically, we have incorporated SMI documentation into our discharge paperwork, created improved patient materials and further developed partnerships with other UNC groups. We have focused on program building within the SMI and hope to have an even larger clinical impact this upcoming year. On the research front, we now have more than 12 funded studies that fall under the SMI purview and a growing research team to support their ongoing success.

Lastly, we are hosting the first annual SMI conference with speakers from all over the country coming to share their knowledge and join us for this inaugural meeting. This is a CME course which will cover rehabilitation, prevention, surgical and non-surgical interventions all related to the knee. It stacks up to be a great meeting that attendees of all backgrounds can benefit from.

David J. Berkoff, MD Vice Chair of Clinical Operations Director, SMI

SMI Collaborates to Keep Active People Active

At the UNC Sports Medicine Institute (SMI), a dedicated, inter-disciplinary team of medical providers and clinical researchers uses stateof-the-art tools, technology and novel techniques to help community and University members preserve and return to active lifestyles.

Launched in February 2020, the SMI was conceptualized by individuals within UNC Orthopaedics, UNC Exercise and Sport Science and other University sports science leaders as an entity that would close a gap by optimizing collaborative care and inter-disciplinary research. Through enhanced clinician-researcher collaborations, the SMI provides innovative, comprehensive care pathways that focus on prevention, performance, and recovery from a broad patient-centered approach.

Federal, foundation, and industry-funded clinical trials developed and led by the SMI’s clinical research scientists and medical providers offer patients treated at the SMI with an opportunity to participate in studies that may enhance their outcomes and benefit the treatment of future patients. The fruits of innovative clinical trials in turn enable clinicians to help patients return to active lifestyles and reduce potential longterm disability via cutting-edge patient care. SMI Co-Directors David Berkoff, MD (Vice Chair of Clinical Operations and Division Chief of the NonOperative Sports and Musculoskeletal Medicine) and Brian Pietrosimone, PhD (Director - UNC EXSS MOTION Science Institute) and their respective UNC Department Chairs (James Sanders, MD – UNC Orthopaedics / Darin Padua, PhD – UNC EXSS), as well as faculty from other departments within UNC’s School of Medicine (SOM) and Gillings School of Public Health, were instrumental to the SMI’s inter-disciplinary development.

Dr. Berkoff noted: “No sports injury is treated by a single discipline. The SMI’s mission is to enable UNC Health providers to apply novel investigative approaches to individualized clinical care in order to help patients accelerate their recovery and return to active lives. We focus on keeping active patients active as our primary clinical mission, whether we’re working with youth, weekend warriors or professional athletes. Sports medicine doesn’t stop at treatment. Our clinical and research teams invest themselves in helping patients understand the treatment, rehabilitation, and prevention tenets of holistic injury recovery that lead to better outcomes.”

Dr. Pietrosimone stated: “The patient population treated by our sports medicine disciplines drives the SMI’s investigative work and comprises the core of the Institute’s clinical trial enrollment. It’s exciting to watch individuals treated and rehabilitated for athletic injuries witness how participating in [SMI-sponsored] trials helps uphold clinical research that leads to innovative sports medicine practice at UNC Health.” The SMI leadership team meets regularly to discuss and develop ideas and initiatives. Both University and regional partners who join the core team members are critical to enhancing the SMI’s evidence-driven, wide-reaching clinical science activities. Collaborators include UNC’s Athletic Department; UNC Gillings School of Global Public Health; UNC Medical Center Rehabilitation Services therapists; UNC Thurston Arthritis Research Center; UNC Injury Prevention Research Center; the UNC/NCSU Joint Department of Biomedical Engineering; and North Carolina State University’s College of Veterinary Medicine.

Across wide-ranging clinical trials, the SMI tracks and analyzes injury outcomes and indicators among research participants. In 2022, clinical investigations included: tracking post-operative outcomes via repeated measures; motion analysis and movement retraining; exploring medication application; novel interventions to optimize post-operative outcomes; injury prevention program implementation; identifying biomarkers correlated with medical conditions; and investigation of post-injury tissue quality. Additional SMI initiatives include integrating nutritional information into patient care, developing patient resources, and expanding clinical research opportunities.

SMI Post-Doctoral Research Associate Caroline Lisee, PhD, ATC, noted: “Being part of a unique, collaborative clinical-research community has prepared me for an exciting career. Both mission and mentoring at the SMI builds confidence that my own clinical studies will produce meaningful findings that enable

sports medicine practitioners to offer injured patients the best in treatment, rehabilitative and preventive care.”

SMI Assistant Director Carla Hill, PT, DPT, OCS, is a vital leader, organizer and promoter of the Institute’s mission and development. Hill highlights SMI activities on social media, leads event planning, participates in research project implementation, and assists in growing its network of collaborators to achieve goals. She joins fellow leadership team members who are driven to improve patient care through integrating clinical research and connecting patients to providers and resources that best meet their needs.

Hill stated: “In less than a year with the SMI, I’ve witnessed how collaboration among related disciplines can foster new ideas for treatment and research that enhance our patients’ return to active lives after injury.”

On September 30th, the first UNC Sports Medicine Institute Annual Conference will be held at UNC’s Friday Conference Center. Keynote presentations will be given by sports medicine leaders from around the country and feature a kick-off talk from Former Hall of Fame Coach Roy Williams. The day-long conference will feature panel discussions dedicated to surgery, nonoperative management, rehabilitation and recovery, and teamwork in sports medicine.

In its third year, the SMI will focus on the growth of their clinical and research enterprise.

Dr. Pietrosimone noted: “One of our biggest aims is to grow study enrollment within the SMI. Patients, clinicians, and researchers working together will lead to high level discoveries that will in turn improve future clinical care.”

Dr. Berkoff concluded: “Our achievements continue to grow thanks to the enthusiastic contributions of our clinical and research partners. The SMI will grow fueled by the enthusiasm and contributions of this entire collaborative team. We endeavor to provide care in a different way and impact research on a new level.”

UNC Adds EOS Scanner at ACC Location

This year, UNC added an EOS low-dose radiation scanner at the Ambulatory Care Center in Chapel Hill. This new system is safer for children and teenagers as it reduces radiation exposure at a rate one-third of conventional x-ray. For patients needing frequent imaging for conditions like scoliosis, limb-lengthening deficiency, and hip dysplasia this machine can make a significant difference. UNC is one of only a hand full of hospitals in the state offering this diagnostic option for pediatric orthopaedic patients.

“EOS, which uses slot scanning technology, is a powerful tool to both decrease radiation for many spine and extremity studies, also provides tools for 3D rendering which is very helpful in surgical and non-surgical planning. We are also planning to use it to improve our research and understanding of spinal deformity.” - Dr James Sanders

Key Statistics

Clinical Sites

UNC Orthopaedic Clinic at Weaver Crossing 1181 Weaver Dairy Road Chapel Hill, NC 27514

UNC Orthopaedic Clinic at Carolina Pointe II 6011 Farrington Road Chapel Hill, NC 27517 UNC Orthopaedic Clinic at the Ambulatory Care Center (ACC) 102 Mason Farm Road 2nd Floor Chapel Hill, NC 27514

UNC Imaging and Spine Center 1350 Raleigh Road Chapel Hill, NC 27517

UNC Specialty Clinic at Pittsboro 75 Freedom Parkway Pittsboro, NC 27312 UNC Orthopaedics at Panther Creek 6715 McCrimmon Parkway Suite 205A Cary, NC 27519

UNC Children’s Specialty Clinic of Raleigh 2801 Blue Ridge Road Raleigh, NC 27607

New Faculty Profiles

Daniel Bracey,

MD, PhD joined the department in September 2020 as a Clinical Assistant Professor of Adult Reconstruction. Dr. Bracey received a BA in Economics from the University of Virginia before pursuing a Certificate of Graduate Study in Cell & Molecular Biology from Villanova University. He graduated with his MD from Wake Forest University, where he also completed his PhD in Molecular Medicine and Translational Science. He went on to complete his residency at Wake Forest, and Adult Reconstruction Fellowship at Colorado Joint Replacement. Dr. Bracey’s research interests include joint replacement outcomes, bone graft materials, origins of osteoarthritis, and periprosthetic joint infections.

Joseph Hart, PhD,

ATC joined the department in February 2022 as the NorfleetRaney Vice Chair of Research. Dr. Hart received his BS in Sports Medicine from Marietta College. He went on to receive a Master of Science in Physical Education; Emphasis on Athletic Training from West Virginia University. He received his PhD from the University of Virginia in Kinesology. Prior to moving to UNC, Dr. Hart was the Director of Clinical Research at the University of Virginia Department of Orthopaedic Surgery, as well as a Professor of Kinesology since 2014. His vast research interests include ACL injuries, chronic ankle instability, image-based skeletal muscle analytics modeling, and home based physical therapy.

Trapper Lalli, MD

joined the department in July 2020 as a Clinical Assistant Professor of Foot and Ankle. Dr. Lalli received a BS in Biology from West Virginia University, where he also graduated with his MD. He completed his residency in orthopaedic surgery at West Virginia School of Medicine, and Foot and Ankle Fellowship at UPMC. He practiced for four years as an Assistant Professor of Orthopaedic Surgery at University of Texas Southwestern Medical Center in Frisco, TX before moving to Chapel Hill. Dr. Lalli’s research interests include foot and ankle trauma, biomaterials, hallux valgus, and diabetic foot disease.

Stuart Mitchell, MD

joined the department in October 2021 as a Clinical Assistant Professor of Pediatric Orthopaedics. Dr. Mitchell graduated with a BS in Engineering Science and Biological Sciences from Vanderbilt University in 2010. He received his MD from Johns Hopkins University. He completed his residency, including a year as an NIH T32 Research Fellow, at Johns Hopkins University and went on to complete a Pediatric Orthopaedic Surgery Clinical Fellowship at Children’s Hospital of Philadelphia. Dr. Mitchell’s research interests include patient reported outcomes, adolescent idiopathic scoliosis, and pediatric fracture management.

Michael Seifert, MD

joined the department in April 2020 as a Clinical Assistant Professor of Orthopaedics. Dr. Mitchell graduated with a BS in Computer Science Engineering from University of Florida. He received his MD from University of South Florida Morsani College of Medicine and went on to complete a residency in Internal Medicine at Virginia Commonwealth University Health System. He completed a Primary Care Sports Medicine Fellowship at Maine Medical Center in Portland, ME. He spent three years as an Assistant Professor of Sports and Internal Medicine at UCF College of Medicine in Orlando, FL. He has research interests in biologics and joint injections.

Judith (Jodi)

Siegel, MD joined the department in December 2020 as a Clinical Assistant Professor of Orthopaedic Traumatology. Dr. Siegel graduated with a BS in Sports Medicine from Marietta College and went on to get a Master of Science in Physiology of Exercise from Ohio University. She received her MD from Temple University, completed a residency in orthopaedic surgery at Boston University before completing an Orthopaedic Trauma Fellowship at Hennepin County Medical Center in Minneapolis, MN. Dr. Siegel was an Assistant Professor of Orthopaedics at University of Massachusetts for 12 years before making the move to UNC. Her research interests include medical education and fracture management.

Gregory Summerville,

MD joined the department in February 2022 as a Clinical Assistant Professor of Orthopaedics. Dr. Summerville graduated from UNC with a BS in Public Health before receiving his MD from Wake Forest University. He completed a residency in Internal Medicine from University of California, San Francisco and a fellowship in Pediatric Sports Medicine from Children’s Hospital of Philadelphia. Dr. Summerville practiced for five years as a Sports Medicine senior physician with The Permanente Medical Group in San Francisco before returning to Chapel Hill. He has research interests in concussion management and patient reported outcomes.

Douglas Weinberg,

MD joined the department in September 2020 as a Clinical Assistant Professor of Orthopaedic Spine Surgery. Dr. Weinberg graduated with a BA in Chemistry from Cornell University, after which he received his MD from Tulane University. He went on to complete his orthopaedic residency at Case Western Reserve University and an Orthopaedic Spine Surgery Fellowship at Emory University. Dr. Weinberg’s research interests include adult spinal deformities and spinal trauma.

Photographs courtesy of PCRF

Pediatric Limb Differences Program Grows Globally

For infants born with limb deficiencies or deformities, early intervention can be important for optimal development. However, many families learn of the congenital anomaly at birth and need time to process their own emotions regarding the limb loss/difference. For many families, this grieving process can take up to a year, which can delay making important treatment decisions that affect development. Early detection and counseling, even as early as the 2nd trimester when the anomaly is first discovered, can allow the family enough time to prepare for the decisions ahead. This is the message that UNC Pediatric Orthopaedics Division Chief and Associate Professor Anna Vergun, MD, promotes with each family she sees whose developing child needs limb correction, reconstruction, or rehabilitation.

Pediatric orthopaedists can outline with parents the corrective surgical and/or prosthetic options that will enable their child to have a better life. The critical action step for families is to bring their infant to see our team as soon as possible. To this end, Dr. Vergun is collaborating with Dr. Weili Lin in the Department of Radiology to investigate the use of fetal MRI to better understand the anatomy of the musculoskeletal system as early as the 2nd trimester. Dr. Vergun explains that “fetal ultrasound is an important screening tool, but fetal MRI can give much better detail if an anomaly is detected on ultrasound. It can also help unravel how the neonatal brain and limbs develop together.” The sooner we understand the anatomy of how the limb is different, the sooner we can work together to find a treatment plan that makes sense for that child and family. Also, understanding how the brain responds to a missing or partial limb could lead to innovative therapies.

To determine surgical and/or prosthetic approaches with the most promising outcomes, Dr. Vergun’s team relies on the assistance of a well-coordinated, multi-disciplinary team of UNC School of Medicine (SOM) specialists. This network is comprised of orthopaedists, pediatricians, radiologists, neurologists, prosthetists, orthotists, physiatrists (Physical Medicine & Rehabilitation) and care coordinators. Under Dr. Vergun’s leadership, this SOM team’s work to centralize family outreach and surgical planning protocols has moved it a step closer to opening the UNC Center for Pediatric Limb Differences by August 2022.

Dr. Vergun noted: “If the specialists across the hospital that UNC Pediatric Orthopaedics partners with continue investing their expertise and energies, we will pull off opening the doors to a center that reaches so many.” According to the North Carolina Birth Defects Monitoring Program, about one in 250 infants are born with a limb anomaly. Some may be simple differences that require minimal or no treatment. Others may be severe and require as many as 5-10 major corrective surgeries during childhood to reconstruct the limb. Other limb differences may be best treated with a prosthesis, an artificial limb, and some will need one or two surgeries to allow the prosthesis to fit better. The wide spectrum of limb anomalies and treatment options can be confusing, which is why these families are best treated at centers with a team of providers with subspecialty expertise.

In her early career at Shriner’s Hospital (2010 – 2014), Dr. Vergun found a mentor in Dr. Hugh Watts, considered by many to be a pioneer in pediatric orthopaedics. The renowned orthopaedist guided her through mastering their shared subspecialty and influenced her path in global health service. In partnership with the Palestine Children’s Relief Fund (PCRF), Dr. Watts was growing a network of volunteer orthopaedists to train surgeons from Palestine and across the globe on the fundamentals of correcting musculoskeletal problems in children. After visiting Ramallah in May 2012, Dr. Vergun dedicated herself to the Pediatric Orthopedic Education and Training (POET) Program with PCRF to train local surgeons and provide ongoing mentoring in the West Bank. Over a decade, Dr. Vergun’s leadership and expertise in building pediatric orthopaedic local capacity in an area of the world long affected by gaps in publicly accessible subspecialty care.

As the POET in Ramallah Program Director, Dr. Vergun initially led a comprehensive hands-on / didactics program developed to train residents and practicing surgeons alike in treating common and complex pediatric orthopaedic cases (e.g., clubfeet, congenital hip dislocation, hand surgery). At the Palestine Medical Center Department of Orthopedic Surgery, those in training additionally benefit from daily didactic sessions, visiting specialists, medical equipment instruction, lectures, and workshops.

Dr. Vergun noted: “Instead of focusing on the volume of cases treated during a mission, our team of surgeons and educators developed a curriculum around the fundamentals of musculoskeletal growth and function and taught surgical techniques that could be mastered quickly and have a high impact. Over time, the local and visiting surgeons built both friendship and trust. Intimately understanding each other’s skill sets allowed us to begin addressing increasingly complex orthopedic problems. “ Drawing from the POET program’s success, the PCRF has asked Dr. Vergun to develop a similarly focused surgical training/education program in Gaza. After visiting Gaza first in 2018, Dr. Vergun realized that the needs were quite different. One area Dr. Vergun felt could make a huge impact was the treatment of pediatric limb deficiencies/differences and child amputees. Since the inception of PCRF’s Children’s Gaza Amputee Project in 2019, she has visited twice to onboard specialists who can grow this initiative from the ground up in serving child amputees in Gaza who have suffered psychologically from physical trauma. In 2019, the industry hosted its first summer camp that provides a safe environment for child amputees to receive comprehensive counseling and normalize their lives in the presence of peers.

In domestic and global commitments, Dr. Vergun makes her biggest strides when working with multiple stakeholders toward a common goal. As the 2020 - 2022 (Immediate Past) President of the Association of Children’s Prosthetic-Orthotic Clinics (ACPOC), her ongoing contributions help direct the organization’s aims in networking cross-disciplinary teams of specialists involved in the care of children, adolescents, and young adults with various musculoskeletal differences.

She concluded: “Pediatric orthopaedists must think outside of our expertise to achieve optimized outcomes in corrective, restorative, and rehabilitative surgery. The answer lies in fostering collaboration among highly talented specialists who help shepherd decisionmaking in surgical approaches. My division at UNC Orthopaedics is humbled by the cross-disciplinary knowledge that informs case planning and enables us to drastically improve a child’s quality of life.”