The Sports Medicine Services, consisting of Drs. Sherwin Ho, Martin Leland, and Richard Kang, has been intensively investigating the biological processes in articular cartilage regeneration, anterior cruciate ligament repair, and rotator cuff tear repair. Articular cartilage has little intrinsic capacity to repair itself after injury, prompting many researchers to explore new methods to facilitate and augment cartilage regeneration. Currently, a variety of approaches have been developed, including chondroplasty, osteochondral transfer procedures (autologous and allograft procedure), microfracture and autologous cultured chondrocyte implant (ACCI). Each of these techniques is useful when utilized in appropriate conditions; however, a significant cohort of patients still fail to achieve good to excellent results even when surgical, pharmacologic and physical therapy are optimal by current standards. These clinical failures suggest that new biologic strategies, including gene therapy, may be a useful adjunct to current treatments to further improve clinical outcome.
Drs. Sherwin Ho, Martin Leland and Richard Kang are investigating the possible use of Sox9 and/or other biofactors to facilitate articular cartilage regeneration. Previously, Drs. T.-C. He and Rex Haydon successfully transduced intervertebral disc cells with Sox9, a transcription factor necessary for chondrogenesis and Type II collagen synthesis. They observed that human degenerative intervertebral disc cells transfected with Sox9 genes led to chondrocyte proliferation with increased production of Type II collagen (Spine 28: 755-763). Currently, Drs. Ho, Leland and Kang are investigating whether exogenous expression of Sox9 in articular cartilage cells or in mesenchymal stem cells will augment articular cartilage repair in a rabbit model. This research has included experiments comparing different man-made scaffolds that can be used to implant these genetically altered cartilage cells back into the host knee defects (J Biomed Mater Res A. 2013, 101(12):3542-50). In addition, Drs.Ho, Leland, and Kang are investigating the potential use of BMP-13 and/or PRP (platelet-rich plasma) for rotator cuff tears using a rat model, as possible treatment options for patellar tendonitis, and a unique approach to rehabilitation following ACL reconstruction surgery.
The Sports Medicine Service has developed a surgical skills laboratory for medical students, residents, and fellows to develop their arthroscopic and minimally-invasive surgical skills using a state-of-the-art virtual reality arthroscopy simulator (MIST) developed by the Spanish aerospace company, GMV based in Madrid, as well as with cadavers. Such virtual and simulated surgery represents important new educational tools for training medical students, residents and fellows. A study to quantitate the learning of these skills was presented at the Arthroscopy Association of North America’s Annual Meeting in San Francisco this year, as well as at the Mid-America Orthopaedic Society’s Annual Meeting in Marcos Island, Florida and has been submitted for publication.
Dr. Reider is also engaged in an ongoing clinical prospective cohort study of possible links between knee proprioception in collegiate soccer and basketball players. Dr. Reider’s previous research has shown that athletes with ACL tears have abnormal proprioception of the knee that returns to normal after ACL reconstruction. The current project prospectively measures proprioception in a large number of healthy athletes to see if those who go on to tear their ACL’s have deficient proprioception prior to the injury. Dr. Reider has also completed a study of degenerative meniscal tears, which has been submitted for publication.