Scientists honored for orthopedic breakthroughs at 2014 AAOS Annual Meeting

Mar 13 2014

The Kappa Delta Sorority and the Orthopaedic Research and Education Foundation (OREF) presented four research awards today to scientists who are performing research that translates to improvements in patient treatment and care. Honored at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), these award winners have made recent discoveries in the following areas of musculoskeletal health:

• Muscle atrophy
• ACL reconstruction
• Spine surgery effectiveness
• Rotator cuff disease

Understanding the Development of Muscle Atrophy

Brian Feeley, MD, of the University of California, San Francisco, received the 2014 Kappa Delta Young Investigator Award for his research focused on muscle atrophy and fatty infiltration in massive rotator cuff tears. According to Dr. Feeley, rotator cuff tears offer a unique, clinically relevant disease state to study muscle atrophy, which is a "consistent phenomenon of aging, diabetes, and cancer."

To investigate the effects of rotator cuff tears, Dr. Feeley developed various models of rotator cuff tear. Based on his work, Dr. Feeley believes that denervation, or a blocking of the nerve, has an important, "previously undefined role in the development of both atrophy and fatty infiltration." Dr. Feeley also evaluated uncoupling of the rotator cuff and regulation of muscle changes after rotator cuff tears, which he believes could improve the outcomes after rotator cuff repair.

"This has important clinical relevance as well," Dr. Feeley stated, "as our data suggests that the amount of fat seen on MRI and quantified in this technique does accurately represent the amount of fat present within the muscle." Future projects will focus on improving the outcomes after rotator cuff repair and alternative avenues for treatment strategies.

Anatomic Anterior Cruciate Ligament (ACL) Reconstruction

The 2014 Kappa Delta Elizabeth Winston Lanier Award was presented to Freddie Fu, MD, D.Sc. (Hon.), D.Ps. (Hon.), of the University of Pittsburgh. Dr. Fu examined anatomic ACL reconstruction as a method of replicating the knee's normal anatomy and restoring its normal functioning. According to Dr. Fu, research done over the past decade has "changed the paradigm of ACL reconstruction and has renewed the focus of recreating the ACL's normal anatomy as closely as possible to the native knee."

Injury to the ACL is of great interest to orthopaedic scientists because of its possibility to be devastating for the patient and result in both acute and long-term clinical problems. Further, because of the younger age of patients who undergo ACL surgery, Dr. Fu explained it is important to develop new approaches to reconstruct the ACL, aiming to maintain both long-term knee health and quality of life. The research overviewed by Dr. Fu challenged previous assumptions about ACLs and further characterized insertion site anatomy with the goal of improving outcomes for patients after ACL surgery.

Together with prior studies on ACL anatomy and function, an understanding of the double-bundle technique for ACL repair, which incorporates two separate bundles in ACL reconstruction instead of the traditional single cord, has defined the ACL reconstruction technique utilized around the world today, according to Dr. Fu. "[This research] has significantly contributed to the defining ACL anatomy, imaging, biomechanics and knee kinematics after ACL reconstruction, with the primary goal to improve medical care for patients."

History of Rotator Cuff Disease: Relationship to Surgical Indications

The 2014 Kappa Delta Ann Doner Vaughn Award went to Ken Yamaguchi, MD, MBA from the Washington University School of Medicine, who described how the asymptomatic rotator cuff tear can be used as a model to study the natural history of this disease.

"Disorders of the rotator cuff are one of the most common sources of pain and disability among all musculoskeletal disorders," Dr. Yamaguchi wrote. "Without solid evidence on the natural history of rotator cuff disorders, as well as a clear understanding of the limitations of operative treatment, there has been much controversy and little consensus on what are the appropriate indications for repair of rotator cuff tears."

The paper outlined studies performed over the last 15 years related to the natural history of rotator cuff disease and concluded that there were important risks to non-operative treatment that must be considered in addition to risks of operative treatment. Other findings included why tears develop, what factors might be important in why some tears become painful and others do not, as well as considerations in understanding the pathogenesis and treatment of rotator cuff disease.

"Given the lessons learned from our studies on rotator cuff disease, we now have much clearer and consistent surgical indications that have led to our institutional healing rates improving from 50 percent to 90 percent," said Dr. Yamaguchi. "It is anticipated that more uniform accepted criteria for surgical indications will have a significant effect on improving the reliability of good patient outcomes from rotator cuff treatment."

Spine Patient Outcomes Research Trial (SPORT)

James Weinstein, DO, MS, CEO and President of the Dartmouth-Hitchcock Health System, and his team were awarded the 2014 OREF Clinical Research Award for the study, "The Spine Patient Outcomes Research Trial (SPORT)." To test the hypothesis of outcome differences between operative and non-operative spine treatments, SPORT was performed at 13 multidisciplinary spine practices in 11 states across the U.S.

The research evaluated the effectiveness of lumbar spine surgery for Intervertebral Disc Herniation (IDH), Spinal Stenosis (SpS), and Degenerative Spondylolisthesis (DS), which constitute the three most common spinal surgical procedures. Not only did the study demonstrate the significant treatment effect of surgery for the three most common lumbar degenerative disorders, but it found that lumbar spine surgery for patients meeting strict indications for surgery also was cost-effective.

For carefully selected patients with nerve issues or inflammation who have tried non-operative treatment options, but have failed a reasonable trial, "surgery is likely to lead to a greater degree of pain reduction and functional improvement than non-operative treatment," Dr. Weinstein concluded. "The results from SPORT should help patients and their providers make more informed treatment decisions in a shared decision-making process."

Source: American Academy of Orthopaedic Surgeons