New Study Validates Suspensory ACL Technique
When it comes to ACL (anterior cruciate ligament) tears, researchers at the University of Missouri School of Medicine decided to aim for a completely integrated repair. James Cook, D.V.M., Ph.D., director of the Division of Research at MU Health Care’s Missouri Orthopaedic Institute is senior author of the study. Dr. Cook told OTW, “It’s common for dogs to experience ACL tears—in fact, it’s more common than with people. With our study, we were able to employ Mizzou Advantage’s One Health, One Medicine concept, which is a multidisciplinary approach to develop a valid and clinically applicable model that benefits both species at the same time. Additionally, it is not possible to fully assess graft healing in a human patient, so our research team at the University of Missouri School of Medicine developed a model to scientifically assess ACL grafting techniques in order to ‘put the science behind the surgery.’ The development of our canine model allowed us for the first time to compare outcomes at the cell and tissue levels in order to precisely determine how well the grafts performed. This gave us the opportunity to fully assess graft healing, and validate the proposed clinical benefits of the newer suspensory technique over the traditional repair method.”
Dr. Cook, the William C. Allen Endowed Professor for Orthopaedic Surgery at the MU School of Medicine and director of the Mizzou BioJoint Center, noted, “The suspensory technique has been reported to have excellent clinical success in patients, and our study provided scientific validation of that success, as well as cell and tissue mechanistic explanations for the benefits. Results of the study also suggest that the suspensory method provides the most reliable option for achieving natural graft-to-bone integration, and may allow patients to return to a more active lifestyle with a new ACL that is less likely to fail. We are now focused on enhancing the grafts used for the suspensory technique to make them even stronger and more ‘biologically friendly’ to the joint so that outcomes can be further improved. We have also discovered that reinnervation of the grafts is critical for function and re-injury prevention, so we are working on ways to improve this process now, using this same model.”
“I would just like to emphasis how important the approach we take at the University of Missouri is―which is a One Health, One Medicine multidisciplinary team approach to solving clinical problems. For our study, this included a research team comprised of physicians, veterinarians, engineers and a molecular biologist to make these critical advancements possible.”
Balloon for Irreparable Rotator Cuffs!
Balloon as spacer/re-educator…Joseph A. Abboud, M.D., an orthopedic surgeon at the Rothman Institute in Philadelphia, is helping patients who have suffered massive irreparable rotator cuff (RC) tears. Dr. Abboud tells OTW, “There are many patients with these types of tears who have been told that they cannot be helped arthroscopically. An FDA IDE [investigational device exemption] study is now underway in the U.S. at several centers, including The Rothman Institute in Philadelphia, Pennsylvania, to evaluate a new device called InSpace. This device, is manufactured by an Israeli company named OrthoSpace and has been approved and available in Europe for over five years with encouraging data reported.”
“With difficult RC tears you may not be able to bring the tissue of the rotator cuff back to the bone effectively thus impacting the healing cascade. One way to circumvent this problem is to use reverse shoulder arthroplasty (RSA); which is a fairly invasive procedure. The InSpace technology, which works in the subacromial space, involves inserting a saline-filled biodegradable balloon that is inflated to the precise amount needed for the shoulder in question. The procedure, unlike RSA, is done arthroscopically in 10-15 minutes.”
“The balloon sits between the humeral head and the acromion and helps to re-center the humeral head relative to the glenoid. The thought is that by helping to re-center the humeral head, you are redirecting some of the muscle forces across the joint. Therefore the net vector of forces around the joint are closer to what we have in the native normal joint than the decompensated chronic rotator cuff deficient shoulder. We also know that patients who have chronic progressive rotator cuff tears often develop the ability to compensate for their deficient rotator cuff without even being aware of this learned behavior. By inserting this biodegradable balloon we are providing the shoulder the opportunity to potentially learn this compensatory behavior in the hopes that the patient develops a chronic compensated and asymptomatic rotator cuff tear type shoulder. In essence we are not fixing the irreparable rotator cuff, rather we are re-educating the shoulder so that it learns to compensate better. Within three months the biodegradable material loses its ‘balloon’ state and is fully resorbed by twelve months.”
“The potential benefits of this type of procedure are substantial, including the ability to have it done arthroscopically with a short anesthesia time, reduction in pain and a potential for increase in function. And theoretically, depending on the study outcome, there is the potential in the future that if over time symptoms recur, we could repeat the procedure with few downsides. As with any FDA IDE study, we have to see what the final data analysis shows to be sure this will be an efficacious intervention for our patients in the future.”
Hip Preservation: Detailed Website Now Available
A hip patient would be relieved to stumble upon the website of Omer Mei-Dan, M.D., associate professor of orthopedics and sports medicine at the University of Colorado (CU)—yes, folks, this is the B.A.S.E. jumping orthopedic surgeon we profiled in 2015. Not content to give his patients run-of-the-mill informational blurbs, Dr. Mei-Dan decided to put his all into an expansive website. He tells OTW, “Hip preservation is a relatively new subspecialty, and there are only a few designated fellowships in the U.S. Hip preservation combines the hip pathologies of adolescents and adults from FAI (femoroacetabular impingement) to hip dysplasia and instability. There are two types of training that surgeons go through in order to acquire the skill set covering both arthroscopic and open procedure, but these typically do not cross paths. One is a sports medicine fellowship where someone learns how to be a good arthroscopist. The other is a pediatric or trauma/tumor surgery fellowship, which qualifies one for the large open procedures. Our CU Hip Preservation fellowship combines both training regimen into one program.”
Dr. Mei-Dan, who has completed four fellowships within this space, works holistically and aims to understand and treat the full spectrum of hip pathologies. “I love educating my patients. I spend an average of 70 minutes with each new patient, in part because the physical exam is very comprehensive and there are many patients with hip pain who have been misdiagnosed or treated incorrectly for years, developing a tough-to-break vicious cycle. I think it is critical to give patients enough data regarding options. Patients go online and search for information regarding pathologies, but this can be even more confusing to the common person as the internet is so cumbersome and search results don’t usually lay things out the right way.
“With our CU Hip Preservation website, patients don’t have to dig through dozens of websites attempting to differentiate between what is valid and what is not. Everything on our site is supported by research and validated strategies and protocols. There are easy to download documents informing them on how to prepare for surgery, postoperative instructions, and the entire hip arthroscopy rehab protocol, among other things.”
To see Dr. Mei-Dan’s CU Hip Preservation website, please visit: www.cuhipclinic.com.
