Orthopaedics

A core strength of the Division of Orthopaedic Surgery’s basic and applied science is biomechanics. A crucial difference between pediatric and adult orthopaedic biomechanics is skeletal growth, and applied mechanobiology of growth is a primary research interest. We have aided quantification of the “Hueter-Volkmann principle,” which relates the physical, or mechanical, state of the growth plate to its growth rate by determining the compressive strength of the growth plate in long bones of patients treated for limb angular deformities.  Based on these principles, we designed and fabricated a spinal implant based on the premise that some types of scoliosis may be surgically arrested or corrected much less invasively than current standards of care by slowing growth on the convex side of the curve. We have determined that the implant and surgical procedures as they are now defined are capable of consistently altering spine growth. The regulatory pathway for the device has been defined in consultation with the FDA.

More recently, spatial and temporal maps of major cell signaling pathways in the mouse tibial and vertebral growth plates have begun to be defined. This basic science collaboration with our Division of Developmental Biology is expected to greatly improve our understanding of normal and abnormal skeletal growth and development, and lead to more biologically based approaches to treatment of bone deformities.

Prevention of injuries is a primary focus of interdivisional collaboration with the Sports Medicine Biodynamics Center laboratory and training facility. Research is aimed at improving diagnosis of athletes at risk for knee injuries, as well as at designing and testing training programs for reducing those injury risks. Knee injury diagnosis is also a research interest for divisional collaboration with our Department of Radiology, in particular improvements in articular cartilage and meniscal and ligament injury diagnosis using quantitative MRI.  

Sports medicine research within the division focuses on knee injuries. We have pioneered new surgical techniques in the pediatric reconstruction of the anterior cruciate ligament, the medial patellofemoral ligament and juvenile osteochondritis dissecans (JOCD) lesions.

While ACL injuries are heavily researched, juvenile osteochondritis dissecans orthopaedic literature remains scant, and the etiology of the condition is unknown. With the assistance of the orthopaedics mechanobiology lab, a team of investigators from the Divisions of Orthopaedics, Pathology and Developmental Biology and the Department of Radiology (link) have developed a novel repetitive stress animal model of JOCD. We will investigate the effects of injury to the secondary growth plate of the distal femur epiphysis and its role in the etiology of juvenile osteochondritis dissecans.

A clinic dedicated to juvenile osteochondritis dissecans (JOCD) has been initiated in the division, with an outcomes research component to track patient progress to operative and non-operative treatment.  The Division of Orthopaedics is a founding member of the multisite Jupitoor Project study group, dedicated to advancing research in JOCD. Read more about the project. 

Eric Wall, MD, is the principal investigator in the first study initiated by the study group, to investigate the staging of JOCD lesions in X-rays, MRIs and arthroscopy videos. The study group will develop and validate a new staging system for JOCD lesions.

The Division of Orthopaedics at Cincinnati Children's Hospital Medical Center has been among the primary investigators using the Orthofix device for limb lengthening for callostasis, i.e., corticotomy followed by regenerate bone and callous formation.

Leg lengthening and deformity correction have met with renewed interest and improved success in the past two decades. Particular techniques of distraction osteogenesis are now standards for limb reconstruction. However, the invasiveness of the procedures and months of treatment time lead to high risk of infections, significant rehabilitation time and many clinic visits and X-ray exposures. Therefore, the goals for our new research in bone lengthening and reconstruction include determining how changes in surgical treatment processes may increase the rate at which new bone forms and matures. Changes in treatment protocol may then be expected to significantly decrease treatment time.

Fracture fixation is a major activity in the Division of Orthopaedics at Cincinnati Children's Hospital Medical Center. Research centers on improving methods of diagnosis and treatment for fractures, including defining evidence-based standards of clinical care. For example, among children with forearm shaft fractures, does surgical treatment improve range of motion and function as compared to traditional cast treatment? How do different treatment processes affect the stiffness and stability of repaired limbs?

 A painless injection technology was developed in the Division of Orthopaedic Surgery at Cincinnati Children's Hospital Medical Center and has three patents pending. We are engaged in technology transfer, product development and manufacture. A posture-sensing device has also been designed. Both devices are under negotiation for licensing and development.

Other areas of research at the Division of Orthopaedics at Cincinnati Children's Hospital Medical Center include orthopaedic tumors and neurological and muscular disorders.