A Bioinspired Approach to Large Pediatric Osteochondral Injuries
Dr. Patrick Whitlock, MD, PhD, recently earned the 2017 Angela Kuo Award from the Pediatric Orthopaedic Society of North America for his groundbreaking research in cartilage repair. Traditionally, the only solution for joints with large areas of destroyed cartilage has been to replace the joint with something artificial. For young people, that’s particularly troublesome, since it means multiple replacements over a lifetime, with the accompanying trauma, expense, and limitations that imposes.
His research led to a breakthrough idea for a type of artificial scaffolding that would dispense growth factors and proteins to injured cartilage, helping its regrowth. “It’s a scaffold of biomaterial that can be formed into the shape of the defect,” says Whitlock. “Within the material we put biologic material derived from cartilage, which releases growth factors and proteins that drive the recipient cells to form bone and cartilage to repair the defect into which it’s placed.” Whitlock developed the scaffold material with Dr. James Lin, PhD, a bioengineer at the University of Cincinnati.
Researchers are just beginning studies in an animal model, and Whitlock is optimistic about what they will find. So far, he says, the in vitro data show that the 3D scaffold holds up well, and drives cells to grow cartilage. His hope is to come away with a better solution that he and his orthopaedic colleagues can offer their young patients.
Resorbable Magnesium Nails for Internal Fixation of Upper Extremity Fractures
In June 2016, Dr. Kevin Little, MD, director of the Hand and Upper Extremity Center at Cincinnati Children’s, began working to develop a biomaterial solution to one of the most common problems in pediatric orthopaedic, the placement and subsequent removal of temporary hardware to stabilize fractured bones. The solution–essentially, a type of nail that wouldn’t need removal. Along with his team, he discovered that magnesium is ideal for this purpose because it is biodegradable, and it shown to aid nerve regeneration as it biodegrades. Additional studies, at other institutions, demonstrated that magnesium can promote bone healing.
In order to test the durability of the magnesium nails, his team has been placing them in porcine bone. Part of the National Science Foundation (NSF) grant, under which they work, has studied methods of growing magnesium as a single crystal, which translates to a stronger, more durable material. The work underway is truly a team effort, with staff from orthopaedics, physiology and engineering collaborating to tackle the question of whether magnesium is–or can be made to be–strong enough to use in pediatric orthopaedic surgery.
Clinical use of this technology in children is at least a decade away, says Dr. Little. However, he looks forward to seeing resorbable magnesium nails in widespread use. “They will make a phenomenal impact on our patients’ lives by limiting the amount of surgery they need, by reducing the amount of time missed from school, activities and sports–and they will lower the cost of healthcare delivery as well.”
Justifying Patellar Instability Treatment by Early Results (JUPITER)
Dr. Nehal Parikh, DO, MS, received a combined $50,000 from the Arthroscopy Association of North America and the Pediatric Society of North America for the establishment of a hypothesis-driven, multi-center, multi-armed, prospective research cohort to study pediatric patellar instability. The incidence of patellar instability ranges from 5.8 to 77 per 100,000 population, with the highest risk in females 10 to 17 years age. Patellar instability can lead to significant morbidity, and eventually patellofemoral osteoarthritis.
The objectives of this study are to compare the safety and efficacy of: (1) non-operative treatment, and (2) operative treatment to treat patellar instability and to evaluate long-term outcomes with each treatment approach. Standardized non-operative treatment is in place across all centers. The operative treatment arms include: (Arm 1) isolated medial patellofemoral ligament (MPFL) reconstruction which is increasingly popular, and (Arm 2) ‘à la carte’ surgical approach which involves correction of underlying anatomic abnormalities.
There are currently 12 sites participating in this initiative.