The Kappa Delta Sorority and the Orthopaedic Research and Education Foundation (OREF) presented four awards today to scientists who are conducting outstanding clinical research related directly to musculoskeletal disease or injury, with the ultimate goal of advancing patient treatment and care. Honored at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), these award winners have made recent discoveries in the following areas of musculoskeletal health:
- Inflammation and post-traumatic arthritis
- Tissue engineering for cartilage repair in the knee and spine
- Adolescent idiopathic scoliosis diagnosis and treatment
- Osteochondral allograft transplantation for cartilage damage
Preventing post-traumatic arthritis
The 2015 Kappa Delta Ann Doner Vaughn Award was presented to Steven A. Olson, MD, professor of orthopaedic surgery at the Duke University School of Medicine, for his research on the use of cytokines--proteins that facilitate cell communication--to prevent post-traumatic arthritis.
Arthritis caused by joint injury, also called post-traumatic arthritis (PTA), contributes significantly to the prevalence of osteoarthritis, a progressive disease of the joints causing pain and disability. Dr. Olson and his team "developed a novel model that allowed observation of the events involved as arthritis develops after joint fracture" in mice. The team also identified a unique strain of mice, with enhanced tissue-healing properties, protected from PTA development.
A careful, more detailed analysis between the two groups of mice showed that reduced levels of early pro-inflammatory cytokines, as well as reduction in synovitis (inflammation), were associated with protection from the development of PTA.
"This is the first intervention shown to reduce PTA after joint fracture," said Dr. Olson. "We believe these findings are important in that they provide direction for future development of therapies to prevent PTA in humans."
Reproducing the structural, functional aspects of complex connective tissue
Robert L. Mauck, PhD, of the University of Pennsylvania, received the 2015 Kappa Delta Young Investigator Award for his research on developing and optimizing nanofibrous (incredibly small) scaffolds to repair or replace complex connective tissue, such as that found in the meniscus of the knee joint or intervertebral disc of the spinal column.
Complex connective tissues do not heal well, primarily because of their dense makeup with few cells and blood vessels. The challenge, says Dr. Mauck, a researcher at the McKay Orthopaedic Research Laboratory, is to find or create a regenerative treatment to restore the fiber arrangement of the tissue and the mechanical integrity of the structure.
"An ideal regenerative solution would be one where the scaffolds biodegrade over time, after cells colonize the scaffold and produce organized and functional tissue," said Dr. Mauck.
Dr. Mauck and his team utilized a process known as electrospinning to produce nanofibrous, mesh scaffolding, using a variety of synthetic and natural polymers (high weight molecular compounds), to provide an organized healing framework for cell recruitment and formation in damaged tissue.
"These technologies have matured over the years in such a way that enables us to reproduce the structural and functional aspects of these native tissues" in large animal models, said Dr. Mauck. "Pending the success of these ongoing preclinical trials, the next step will be human translation."
Improving outcomes for patients with adolescent idiopathic scoliosis
Stuart Weinstein, MD, and his team were awarded the 2015 OREF Clinical Research Award for their research in defining the natural history of adolescent idiopathic scoliosis (AIS) and for proving the effectiveness of bracing for the treatment and prevention of surgery for AIS.
Adolescent idiopathic scoliosis is a curvature of the spine with no clear underlying cause. In mild cases, monitoring over time by a physician may be sufficient. In more severe cases--especially when the child is still growing--the use of a brace, or in more severe cases, surgery has been recommended, although there was little evidence to support the effectiveness of bracing.
Dr. Weinstein, the Ignacio V. Ponseti chair and professor of orthopaedic surgery and pediatrics at the University of Iowa Children's Hospital, first determined the lifetime nature history of AIS by differentiating it from early onset scoliosis and scoliosis from other causes/etiologies. He then reviewed the outcomes of patients initially treated with a Milwaukee Brace, a body brace with attached vertical bars and a neck ring, and subsequently with the less confining thoracic-lumbar sacral orthosis (TLSO) brace, to determine whether or not the braces prevented further curve progression and the need for surgery.
"These studies highlighted the low quality of evidence and the conflicting studies on bracing effectiveness upon which treatment decisions were being made," said Dr. Weinstein. The findings were the basis for a more in-depth, multi-center phase 1 clinical trial which found that "bracing is effective in preventing curves from reaching the surgical threshold of 50, and also that there is a dose effect with this treatment: wearing the brace more than 13 hours a day increases the chance of success to more than 90 percent."
The research "has profoundly changed clinical practice for the physicians treating patients with AIS and has given patients and parents a solid evidence base upon which to make informed patient-centered choices," said Dr. Weinstein. "Our early work disputed the notion that all types of scoliosis had a grim prognosis. We were able to let parents and patients know that AIS is a unique entity. They now know that untreated, AIS does not lead to early disability or death or the inability to have a normal life. They can now make informed decisions knowing that untreated scoliosis may lead to increased back pain, cosmetic concerns, and in patients with large upper back (thoracic) cures, pulmonary symptoms.
"As we now know that curves over 50 degrees at skeletal maturity have a tendency to progress throughout life, this degree of curvature has become the standard threshold for recommending instrumentation and fusion to prevent complications."
Optimizing the use of allograft transplantation in cartilage repair
The 2015 Kappa Delta Elizabeth Winston Lanier Award went to William D. Bugbee, MD, an orthopaedic surgeon Scripps Green Hospital and Scripps Clinic, both in La Jolla, Calif., for his team's 15 years of research on optimizing the process and effectiveness of osteochondral allograft transplantation for cartilage repair.
Articular cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints. Healthy joint cartilage makes it easier for the body to move, by allowing bones to glide over each other with very little friction. Articular cartilage can be damaged by injury or normal wear and tear. Because cartilage does not heal well, doctors have developed surgical techniques to stimulate the growth of new cartilage. Restoring articular cartilage can relieve pain, improve function and delay or prevent the onset of arthritis.
Dr. Bugbee conducted a series of basic scientific and clinical studies with the goal of improving the process, indications and outcomes associated with allograft transplantation in cartilage repair: from optimizing the viability and delivery of tissue for surgical use, to improving the understanding of cartilage and bone remodeling following the procedure.
"Our research efforts in the field of osteochondral allograft transplantation have led to innovations in tissue banking, new insights into the biology of osteochondral allografts, improvements in surgical techniques and a better understanding of the clinical indications and outcomes related to this procedure," said Dr. Bugbee. "As a result of these endeavors, osteochondral allograft transplantation has been widely adopted in the orthopaedic community and has emerged as an important treatment option for patients with articular cartilage injury."
About the Kappa Delta Awards
In 1947, at its golden anniversary, the Kappa Delta Sorority established the Kappa Delta Research Fellowship in Orthopaedics, the first award ever created to honor achievements in the field of orthopaedic research. The first annual award, a single stipend of $1,000, was made available to the Academy in 1949 and presented at the AAOS meeting in 1950. The Kappa Delta Awards have been presented by the Academy to persons who have performed research in orthopaedic surgery that is of high significance and impact.
The sorority has since added two more awards and increased the award amounts to $20,000 each. Two awards are named for the sorority national past presidents who were instrumental in the creation of the awards: Elizabeth Winston Lanier and Ann Doner Vaughn. The third is known as the Young Investigator Award.
The fourth award, also providing $20,000, is the OREF Clinical Research Award. Established in 1995, the award recognizes outstanding clinical research related directly to musculoskeletal disease or injury. All submitted manuscripts are reviewed, graded, and selected by the American Academy of Orthopaedic Surgeons Research Development Committee. For more information about the manuscript submission process, please visit aaos.org/kappadelta.
In 1994, the OREF Board of Trustees determined the need to encourage clinical research in orthopaedics, and created the OREF Clinical Research Award with approved funding of $20,000 annually, beginning the following year. This award recognizes outstanding clinical research related directly to musculoskeletal disease or injury.