Reshaping the field: Orthopedic surgeon makes small cuts that deliver big results for athletes

In orthopedic surgery, millimeters can transform the course of a patient’s life. Alfred A. Mansour III, MD, deals with such critically thin margins every day.

In addition to a clinical practice serving children and young adults, Mansour works extensively with high-level collegiate and professional athletes striving to return to the field after injury. Along the way, he is helping develop the next generation of precision techniques to achieve a new degree of effectiveness for patients—and looking to show other surgeons they can achieve the same results with these methods.

“We’re defining how to do things safer and better,” says Mansour, who serves as Director of the Comprehensive Hip Preservation Program in the Department of Orthopedic Surgery at McGovern Medical School at UTHealth Houston.

Mansour’s research focuses on complex knee and hip surgery, identifying hard-to-spot bone deformities and correcting them with osteotomies (small cuts in the bone). In collaboration with Walter R. Lowe, MD—who repairs anterior cruciate ligament (ACL) tears that often occur with knee injuries—he has restored the abilities of athletes from Division I college football players to members of the Jamaican national soccer team.

Mansour’s hip procedures, which correct hip dysplasia, have a 90% success rate in returning patients to competitive athletics.

“Beyond the immediate effects, we can actually normalize the joint function before it starts to do serious damage,” he says. “Some patients who would otherwise need a total hip replacement later in life may never need one after our procedure.”

One of the secrets lies in the advanced computer modeling and imagery that supports the surgeries. The department’s Center for Orthopedic Research, Innovation, and Training (CORIT) laboratory creates simulations to predict the effect of osteotomies, optimizing preoperative planning for the procedures. After surgery, the BioMotion Lab—one of only three in the United States—uses video motion and enhanced X-ray analysis to show how patients’ hip and knee biomechanics have changed.

Mansour believes emerging technologies such as artificial intelligence (AI) hold the key to even more exact measurements and better patient outcomes. One of the faculty members on his team is gaining invaluable knowledge in this field by completing a master’s degree at McWilliams School of Biomedical Informatics at UTHealth Houston.

“We make a cut in the bone that looks precise to us, but there’s always variability in human judgment,” Mansour says. “AI can help eliminate those variables—and since a person will take millions of steps in their lifetime, how much better does a perfect procedure do over the course of a life than one that’s 98% accurate? We can’t answer that question right now.”

Even with his team’s success in returning competitive athletes to the field, Mansour knows he can only reach a limited number of patients himself. His goal is to create a significant volume of research supporting the effectiveness of these methods to inspire surgeons across the country to adopt them.

So far, Mansour’s team has delivered several presentations at national scientific meetings demonstrating the effectiveness of their work, and they have a robust database of patient-reported outcomes. However, completing more scientific studies comes with significant costs, such as recruiting volunteers, hiring staff, and paying for technical aspects like imaging and analysis.

“If you talk to patients and say you want to cut their bone but their leg looks pretty straight, they are skeptical,” he says. “We want to have a large number of studies that prove it works.”

Philanthropy can help cover these costs and support proof-of-concept studies necessary for large grants from federal agencies like the National Institutes of Health. In so doing, philanthropy can increase the adoption of Mansour’s methods and help patients far beyond his reach.

“As a surgeon, you can only directly affect the patients you treat,” he says. “But if you are conducting research, then you can help thousands of patients. You may not know their names, but you know you are helping them have better lives.”