Dr. James Knight's death in 1887 resulted in a change of course for the Hospital for the Ruptured and Crippled (renamed the Hospital for Special Surgery in 1940). The Board of Managers appointed Dr. Virgil Pendleton Gibney as the second Surgeon-in-Chief. The hospital's professional staff was expanded with introduction of surgical procedures. Gibney, raised in Kentucky, was trained under Lewis H. Sayre, M.D., a prominent orthopaedic surgeon at Bellevue Hospital. Dr. Gibney introduced the first residency training, expanded the physical plant, and continued to care for the disabled children in the hospital while maintaining a private practice outside the hospital. He was one of the founding members of the American Orthopaedic Association and served as its first president. He was the only member ever to serve as president twice, the second time in 1912.