A Bioinspired Approach to Large Pediatric Osteochondral Injuries (OCIs)

Funded by the POSNA Angela S.M. Kuo Award, 2017-2019

Osteochondral Injuries (OCIs) are common, affecting 900,000 patients in the United States each year. Pediatric hip diseases that are often associated with large OCIs (>2.5cm), such as Legg Calves Perthes disease, slipped capital femoral epiphysis, trauma, avascular necrosis and malignancy currently account for 6-15% of the over 300,000 total hip arthroplasties performed in the United States each year. Treatment of large pediatric and adolescent OCIs remains a major clinical challenge. These injuries often lead to early osteoarthritis and significant patient disability because large OCIs exceed the limitations of current techniques for treatment using micro- fracture, autologous chondrocyte implantation (ACI) and osteochondral autologous transfer (OAT) due to inherent regenerative capacity, tissue availability, rejection, synovitis, and perhaps most importantly, the inability to resist joint forces and remain intact as the size of the injury increases. Similarly, tissue-engineered osteochondral (OC) constructs of clinically relevant size able to withstand physiologically relevant forces remain elusive. What remains lacking is a construct that supports self-population, maintenance, and induction of autologous mesenchymal stem cells into osteochondral tissue under intra-articular forces in large OCIs. There is, therefore, a critical need to develop an effective construct for the treatment of large OCIs. In its absence, the realization of a novel, clinically effective strategy for treating large OCIs remains unlikely. Our current research efforts focus on this goal.

The results of our research are expected to have a significant positive impact upon and benefit to the orthopaedic community because proof of principle will provide strong justification for its continued development, funding and eventual translation to a treatment for large OCIs in pediatric, adolescent and young adult patients.