- The effects of anterior cruciate ligament (ACL) graft placement on in vivo knee function and cartilage thickness distributions;
- Targeting innate immune inflammatory pathways in clinical bone disorders;
- Knee function and ACL injury; and
Mechanisms and prevention of ACL injuries.
The 2016 Kappa Delta Young Investigator Award was presented to Louis DeFrate, ScD, the Frank H. Bassett Endowed Chair and associate professor of orthopedic surgery at the Duke University Medical Center in Durham, N.C., for his research on the effects of ACL graft placement on in vivo knee function and cartilage thickness distributions.
The ACL is one of the most commonly injured knee ligaments, with more than 400,000 injuries occurring each year in the United States, half of which are experienced by athletes between the ages of 15 and 25. ACL injuries are associated with pain, instability, damage to the menisci, and early-onset osteoarthritis. Years of study by DeFrate and his team examined the effects of graft placement on the ability to restore normal in vivo joint function.
“We have demonstrated that abnormal graft placement results in altered ACL graft deformation,” said DeFrate. “These altered graft characteristics were associated with abnormal joint motion and focal cartilage thinning. On the other hand, anatomic graft placement was associated with grafts that more closely mimicked ACL function, restored normal knee kinematics, and maintained cartilage thickness distributions.”
DeFrate said the findings suggest that, regardless of surgical technique, achieving anatomic placement of the graft is crucial to reproducing native knee kinematics and might help slow the progression of osteoarthritis following ACL reconstruction.Targeting innate immune inflammatory pathways in clinical bone disorders
Francis Y. Lee, M.D., Ph.D., received the 2016 Kappa Delta Ann Doner Vaughn Award for his research titled “Targeting Innate Immune Inflammatory Pathways in Osteolytic Disorders: Unmasking the Two Faces of Osteoprogenitor Cells.” Lee is the Robert E. Carroll and Jane Chace Carroll Laboratories professor of orthopedic surgery at Columbia University Medical Center in New York, N.Y.
Osteoprogenitor cells have two functions. They are essential for bone formation and also regulate osteoclastogenesis (a complex cellular process) and bone resorption by producing key cytokines and chemokines. Cells of osteogenic lineage, including bone marrow stromal osteoprogenitors and osteoblasts, are at the forefront of facing multiple cellular responses which share inflammatory pathophysiologic processes. This research aimed to shed light on the innate inflammatory immune functions of osteoprogenitor cells in the context of clinical bone disorders which are associated with bone destruction, pathological fractures, soft tissue scarring, and poor wound healing in infection and bone tumors.
“Our research provides ample evidence for a competent innate immune inflammatory function of osteoprogenitors and regulatory pathways in the context of toxins, biomaterial particulate debris, excessive mechanical loading, primary bone tumors, infection, metastatic bone cancers, and osteoclastogenesis,” said Lee. “Further research on pharmacologic or molecular modulation of inflammatory pathways will provide more scientific insights and better clinical outcomes in the aforementioned disorders by protecting bone and soft tissues.”Knee function and ACL injury
Edward Wojtys, M.D., professor of orthopedic surgery and sports medicine at the University of Michigan Health System in Ann Arbor, Mich., received the 2016 Kappa Delta Elizabeth Winston Lanier Award for his research titled “On Knee Function and ACL Injury.” The research was co-authored by James A. Ashton-Miller, Ph.D., director of the Biomechanics Research Laboratory at the University of Michigan.
With annual costs approaching $10 billion, ACL injuries are recognized as a major public health challenge because of the osteoarthritis that develops in up to 70 percent of cases within 10 years. The condition will deprive hundreds of thousands of adults of their ability to exercise and ward off cardiovascular, diabetic and obesity problems. The study examined the neuromuscular function of the normal and abnormal knee as it pertains to ACL injury and the reasons why female athletes have such a high susceptibility to ACL injury than males. This research also provided insight into the mechanisms of ACL injury in an effort to prevent its occurrence, and utilized the newest technology to grow and implant a scaffold-free cell-engineered ACL replacement with promising results.
“This work offers great potential for the clinical care of millions of active people ranging from children to the elderly in what can be a devastating injury,” said Wojtys. “By improving the physical assessment of those at risk, along with a better understanding of the exact mechanisms of injury and by offering improved surgical procedures that better reproduce native anatomy, the short and long-term physical health of many may be improved.”Mechanisms and prevention of ACL injuries
The 2016 OREF Clinical Research Award was presented to Timothy Hewett, PhD, director of the Mayo Clinic Biomechanics Laboratories and of Sports Medicine Research at Mayo Clinic in Rochester and Minneapolis, Minn., for his research titled “Mechanisms and Prevention of ACL injuries: Cutting ACL Injury Risk with Finely Sharpened Tools.” The research was co-authored by Gregory D. Myer, Ph.D. (Cincinnati Children’s Hospital), Kevin R. Ford, Ph.D. (High Point University), Mark Paterno, Ph.D., (Cincinnati Children’s Hospital), and Carmen Quatman, M.D., Ph.D. (Ohio State University).
The team’s research utilized a prospective cohort coupled biomechanical-epidemiologic approach, which allowed for the development of highly effective screening tools for risk profiling and targeted interventions for the prevention of ACL injuries. Utilizing this prevention approach, the multidisciplinary collaborative research team spent two decades working to delineate injury mechanisms, identify injury risk factors, predict which athletes are at-risk for injury, and develop ACL injury prevention programs.
“There is strong, nearly unequivocal evidence that risk screening coupled with targeted neuromuscular training reduces biomechanical risk factors for ACL injury and decreases ACL injury incidence in athletes,” said Hewett. “Neuromuscular training is currently the only effective tool for prevention of osteoarthritis in the injured knee, with or without surgical reconstruction. We have made significant strides toward these goals, but we must continue until strong epidemiological evidence shows that ACL injury risk is unequivocally decreased in young athletes.”In 1947, the Kappa Delta Sorority established the Kappa Delta Research Fellowship in Orthopaedics, the first award ever created to honor achievements in the field of orthopedic 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. 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.