$1 Million to Rothman From DOD
For those who sustain traumatic combat-related joint injuries there may be new hope. A team from the Rothman Institute, at Thomas Jefferson University in Philadelphia has been awarded a $1.1 million grant from the Department of Defense [DOD] to advance such treatment. Joseph A. Abboud, M.D., an orthopedic shoulder surgeon at the Rothman Institute, is one of the three primary investigators (PI) on the grant. He tells OTW, “This research is occurring in our basic science lab, at Jefferson, which is headed by my co-PI Andrzej Fertala, Ph.D. We are utilizing an antibody engineered in our lab to help inhibit excessive scar formation in a joint injury animal model. In vitro the antibody has demonstrated the ability to down regulate scar formation. In the surgical arm of the study we are utilizing a validated rabbit model to create a post-surgical joint contracture. The rabbits in the treatment arm of the study will be treated with the antibody and eventually we will assess joint stiffness, modulus, ROM [range of motion] as well as histologic characteristics.”
“At this point my co surgical PI Pedro K. Beredjiklian, M.D. and I have finalized the surgical protocol and we are validating the delivery of the antibody through a specialized, subcutaneously implanted programmable delivery system. We expect to complete the surgical arm of the study within the next two years. This is a three year grant, and was the largest project funded by the Department of Defense in this funding cycle.”
“These are very disabling joint injuries, and if we can improve patient impairment by 20-40% then people may lead more normal lives.”
Mohit Bhandari, M.D. Awarded the Order of Ontario
Mohit Bhandari, M.D., M.Sc., FRCSC has been invested with the Order of Ontario by The Honorable David C. Onley, Lieutenant Governor of Ontario. Dr. Bhandari, the Canada Research Chair in Musculoskeletal Trauma and Surgical Outcomes, was one of the 25 new appointees to the Order of Ontario, the province’s highest official honor. The Order of Ontario recognizes residents of Ontario who have demonstrated a high level of individual excellence and achievement in any field benefiting the people of Ontario or anywhere in the world.
Dr. Bhandari conducts research on many topics, including identifying optimal management strategies to improve patient-important outcomes in patients with multiple injuries, lower extremity fractures and severe soft tissue injuries. He has also tackled a subject that not many of his orthopedic colleagues have addressed: raising awareness of intimate partner violence.
Asked what this honor means to him, Dr. Bhandari told OTW, “I’m deeply touched by this honor, particularly because it honors those Ontarians who have been recognized for their contributions to the lives of citizens. The fundamental tenet of the work we have been doing in orthopaedic surgery over the past decade had its vision in helping people and making their lives better. For me, induction into the Order of Ontario is a profound recognition that our research may have transformed the lives of men and women suffering from injuries.”
“The selection committee aims to ‘recognize any current or former long-time resident of Ontario who has demonstrated a high level of individual excellence and achievement in any field benefiting the people of Ontario or anywhere in the world.’ The awardees spanned the sciences to arts and entertainment. I was particularly proud to be among the two surgeons in this year’s inductees. While I have little idea what specific selection criteria led to this award, I am reassured that our efforts to promote evidence in orthopaedics, transform research by large, global clinical trials, ask fundamental questions of importance to all people around the world, and become strong advocates for those causes that demand our action (violence against women, trauma in low and middle income countries, to name a few).”
Robert Talac, M.D., Ph.D. Named Top Orthopedic Surgeon
Robert Talac, M.D., Ph.D., of the Advanced Spine Institute, was recently voted Top Leading Physicians of the World for Top Orthopedic Spine Surgeon in Tennessee and Texas by The International Association of Orthopedic Surgeons. Dr. Talac grew up in Czechoslovakia, came to the U.S. to study at the Mayo Clinic, continued at the University of San Diego and the Center for Spine Heath, Cleveland Clinic, and has focused his considerable intellectual talents and gifted hands on spine related problems. Using a 7-millimeter-wide endoscope with a camera on its tip, Dr. Talac is able to enter the back through that tiny 7-millimeter space while a patient is conscious under local anesthesia without cutting muscles or moving the spinal cord for quick recovery and one-day spine surgery.
30-Year Knee Survivorship: Expect It!
“But I can’t have a knee replacement yet because it will only last 10 years!” That, says a very experienced knee surgeon, just isn’t true. William J. Long, M.D., FRCSC is an orthopedic surgeon at Insall Scott Kelly Institute in New York. He tells OTW, “Our new research, which has just been accepted by the Journal of Bone and Joint Surgery, debunks the myth that a knee replacement isn’t very durable. We have found that a knee replacement—done well with a good component—and it doesn’t have to be state of the art—has an 80-90% chance of attaining 30-year survivorship, when considering aseptic wear or loosening. Our team examined all knee replacements done on patients under 55 that were performed by Drs. John Insall and W. Norman Scott in the late ’70s and ’80s. It was incredible to see that the original IB-I monoblock design that Dr. Insall developed 40 years ago had a 30-year survivorship for wear or loosening of 92%.”
“Additionally, we looked at their activity scores in 1997 and compared them to their scores in 2012. We found that if you didn’t have another joint that went bad and you were not medically comprised then your functional scores were the same at 30 years as at 15 years. Now we know that in a young, active, demanding population we can achieve durable long term outcomes.”
Promising New Stem Cell Suture
When it comes to stem cells the more direct, the better, says new research. Lew Schon, M.D. and colleagues have recently published work on a stem cell suture that improves Achilles tendon healing. Dr. Schon is director of foot and ankle services at MedStar Union Memorial Hospital in Baltimore. He is also founder and director of the Orthobiologic Laboratory at that facility. Dr. Schon, past president of the American Orthopaedic Foot & Ankle Society (AOFAS), tells OTW, “One of the well documented aspects of aging is the decreased level of mesenchymal stem cells in our tissues with the result that we injure more easily and take longer to recover. Augmenting surgery with allogeneic stem cells has the potential to change medicine and be of great benefit to an aging population which wants to stay active. We were aware of studies on direct injection of large quantities of mesenchymal stem cells into tissue for various therapeutic effects, but we were concerned about other studies which showed a tendency for injected cells to migrate from the area of injection and lodge in the microvasculature of the organs. We used a rat model, and found evidence to suggest that the use of stem cells enhances healing after Achilles repair…and that embedding of stem cells directly into suture provides early healing benefits.”
“The concept of our Stem Cell Suture™ was to allow a surgeon to concentrate stem cells in a scaffold-like construct (suture) alongside and within the repaired damaged tissues to provide the desired therapeutic effect using techniques (sewing) already in the surgeon’s skillset. Perhaps the most surprising thing about this study was how well reality correlated with theory.”
“We are preparing a submission to the FDA for the Stem Cell Suture™ now; many more studies for that submission will occur. We had a substantial grant from the Maryland stem cell research fund to help us move through these studies and the process overall.”