The new single-blind, randomized, pilot, clinical trial, part of the Arthritis Foundation 2023 FastOA Interventional Pilot Studies, will harness the expertise of surgeons, radiologists, biostatisticians, and cellular and molecular biologists to determine whether cBMA may prevent the chronic inflammation that can lead to pain and stiffness following surgery, and can also contribute to post-traumatic osteoarthritis. Previous studies have suggested that cBMA injections may improve surgical outcomes, but this approach has not yet been evaluated in rigorous clinical trials in patients undergoing ACL revision surgery.

The cBMA used in these procedures is the patient’s own and is collected from the pelvic bones. The participating patients will be randomized to receive either cBMA injections at the time of revision surgery or standard care.

The goal of the trial is not only to establish whether the addition of cBMA reduces the risk of PTOA, but also to understand the underlying mechanisms of cBMA therapy and to look for biomarkers in the joint microenvironment that might help to refine the approach and further improve outcomes. Given the lack of effective non-surgical interventions for the prevention and treatment of PTOA, this study is expected to provide valuable insights that could guide care in the future.

To determine whether any differences observed between the two arms of the trial are clinically meaningful, the primary measure of the treatment’s success will be the patients' self-reported pain levels 12 months after surgery. This will be determined by using the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain. As a secondary measure, the investigators will deploy advanced, quantitative MRI scans to look for changes in the cartilage. “We will leverage clinical outcomes and imaging to evaluate the efficacy of adding cBMA to standard treatment,” said co-primary investigator Miguel Otero, PhD, scientist in the Orthopedic Soft Tissue Research Program, co-director of the Derfner Foundation Precision Medicine Laboratory, and of the HSS Research Institute Histopathology Service.

“Depending on what we learn about whether cBMA reduces the risk of PTOA, the results generated by this study may have the potential to change clinical practice,” added co-primary investigator Scott Rodeo, MD, Vice Chair of Orthopaedic Research, co-director of the Orthopaedic Soft Tissue Research Program, and director of the Center for Regenerative Medicine at HSS.

By analyzing the cellular and molecular make-up of the cBMA as well as synovial fluids collected during and after the ACL revision surgery, the investigators also hope to gain insight into the populations of immune cells present within the joint microenvironment and the link between certain immune components and clinical outcomes. The researchers hypothesize that cBMA’s functionally relevant immune-modulatory and disease-modifying effects depend on the fluid’s cellular and molecular composition. They expect that these biospecimens may yield clues about how to further improve patient outcomes.

The FastOA2023 trial will harness strength of two Arthritis Foundation OACTN Clinical Trial Units that are also participating in the Post-Injury Knee Arthritis Severity Outcomes (PIKASO) Study and will use parallel instruments and dataset management. PIKASO is an ongoing, multicenter, randomized phase II clinical trial examining the use of metformin in patients who are at high-risk for developing PTOA in the knee after ACL reconstruction.

To learn more about the study and when enrollment opens in FastOA2023 visit clinicaltrials.gov. 

During his many months of cancer treatment at a Long Island hospital, Brandt had two goals: to get well and to play football again. If he was a champion on the football field prior to his diagnosis, he would later prove that his courage and determination knew no bounds.

As soon as he could, he resumed training while receiving chemotherapy treatment, setting up a makeshift gym in his hospital room. Side effects of the grueling treatment weren’t Brandt’s only challenge. At one point, he had to overcome neuropathy in his legs that made walking difficult. He dealt with listeria and appendicitis that required another four-week hospitalization.

Brandt faced every challenge head on, and in September 2022, he was in remission and returned to the football field as QB-1 quarterback to play again. Many who know him call him a hero, including his mom Abby, who was with him every step of the way. “He’s a warrior, he’s my rock star,” she said. “I’m the proudest mom in the world.”

For his outstanding character and determination, Brandt received the USA Football “Heart of a Giant” award presented by Hospital for Special Surgery (HSS) and the New York Giants. The award recognizes high school football players in the tri-state area who demonstrate an unparalleled work ethic, extraordinary dedication and a passion for the game.

In late 2022, Brandt, who will turn 18 in April, faced another challenge that brought him to HSS. The cancer treatment, which included steroids, had contributed to the development of a condition called osteonecrosis in his right knee. Resulting damage to the cartilage and bone made it difficult for him to engage in weight-bearing activities such as running and climbing stairs. His best bet to repair the damage was a cartilage transplant.

Scott Rodeo, MD, vice chair of Orthopaedic Research, co-director of the Orthopaedic Soft Tissue Research Program at HSS, and Head Team Physician for the New York Giants performed a surgery known as OATS - osteochondral autograft transfer surgery. “The procedure consisted of taking a piece of cartilage and bone from a non-weightbearing portion of his right knee and transplanting it to the area of the lesion,” Dr. Rodeo explained. “Because of the size of the area to be treated, I used a similar graft from his left knee as well. We also used some bone graft from the iliac crest near the hip.” 

Abby Morgan said she was grateful that the procedure could be scheduled quickly. “Dr. Rodeo made magic happen, and Brandt had the surgery on December 29. I wanted to expedite it because Brandt had some big milestones ahead and the recovery would take time,” she explained. “On March 23, he will receive his last maintenance cancer treatment and ring a bell at the hospital to mark the occasion, and he didn’t want to be on crutches. Later that evening, he will receive the “Honored Hero” award from the Leukemia & Lymphoma Society. Spring break is in April, and he wants to enjoy it, something he hasn’t been able to do in the past two and a half years.”

HSS staff who got to know Brandt, even briefly, were impressed and inspired by his positive attitude and perseverance. Dr. Rodeo said he was struck by Brandt’s unwavering commitment to achieve his goal to play football again.

Stephen Melancon, PA-C, a certified physician assistant who works with Dr. Rodeo, said he was impressed by the way Brandt confronted a challenge that many adults would have trouble grappling with emotionally and physically. Now Brandt has a social media presence to help other young people diagnosed with cancer.

“For someone his age, with all that he’s gone through, not only to still be able to participate in sports, which is great, but to put himself out there and make himself a resource for other people – it proves he’s an exceptional young individual with incredible drive and outstanding character,” Melancon said.

“Brandt is truly the definition of exceptional. I don’t know anyone quite like him,” said Robbie Tran, senior director of Global Sports Marketing at HSS. “When faced with adversity, he set his mind on a goal and despite multiple setbacks fought until he accomplished what he set out to. He is an inspiration to many,” added Tran, who met Brandt when he received the Heart of a Giant award.

“He really has the heart of a giant,” said Samuel Taylor, MD, a sports medicine surgeon at HSS and Associate Team Physician for the New York Giants, who presented the award to Brandt. “He refused to let cancer stop him. In the process he inspired his friends, family, teammates, and his community.”

Brandt, who went home from HSS on New Years Eve, continues to make progress following his knee surgery. He is still in physical therapy, which is expected to last 4 to 6 months, and the prognosis is good. At this time, no additional surgery is planned, and he should be able to return to most activities, Dr. Rodeo said.  

Although football may no longer be in his future, Brandt still has dreams and goals. He’s looking forward to college and a possible career in sports management. In the meantime, he is dedicated to helping other young people with cancer who contact him on social media or via a website he has created called “Comeback Kids.”

The site was born out of the kindness and generosity of a teenager who has been through a lot, as he seeks to encourage others, candidly describing his long journey from the moment he was diagnosed with cancer. He provides heartfelt advice on ways to cope and maintain a positive attitude. He communicates sincere empathy to comfort young people facing similar challenges.   

“When I was undergoing treatment, it was helpful to talk to someone who had been in that situation and who would be honest with me,” Brandt explained. “Being able to help others makes me feel like a better person. They ask me the same questions that I specifically remember asking.”

“Your life can change in a heartbeat, like mine did,” he added. “I think this happened to me for a reason – that I was meant to help other people.”

Steven Arnoczky, DVM, a veterinary surgeon and renowned scientist started his illustrious career in orthopaedic translational research at HSS over 45 years ago and was the founding Director of the Laboratory for Comparative Orthopaedic Research. Mentored by pioneers in orthopedic research at HSS, John L. Marshall, DVM, MD, Philip D. Wilson, Jr, MD, Russell F. Warren, MD, and Peter A. Torzilli, PhD. Dr. Arnoczky established one of the very first research programs in the U.S. focusing on soft tissues, and he was an early innovator in establishing collaborations between scientists and clinicians. His approach laid the foundation for his transformative research on preserving knee and shoulder joints after injury. Dr. Arnoczky brought the unique combined perspectives of a clinician-scientist, an individual who had a deep understanding of the clinical problems physicians face, and the scientific expertise to design novel laboratory studies to answer these questions. His approach led to many seminal discoveries that have advanced patient care. His research has been recognized by over 30 national and international awards, culminating in his election to the American Orthopaedic Society for Sports Medicine Hall of Fame, the highest honor in sports medicine research. Embodying the HSS philosophy of supporting the next generation of surgeons and scientists, Dr. Arnoczky supported numerous trainees, including HSS faculty, Scott A. Rodeo, MD, sports medicine surgeon and vice chair of Orthopedic Research and co-director of the Orthopedic Soft Tissue Research Program at HSS, and Jo A. Hannafin, MD ,PhD, through mentorship and collaboration as they developed federally funded research programs.

During his tenure at HSS, Dr. Arnoczky met his wife, Brenda, who was head nurse on the neurology/neurosurgery floor at New York Hospital (now New York-Presbyterian Hospital). This gift memorializes the role that HSS played in their lives. “HSS started me on an orthopaedic research career that would change my life. Like so many others whose lives have been enhanced by their time at HSS, Brenda and I are so very grateful for what HSS has meant to us. We are happy to be able to pay it forward with this enduring support,” said Dr. Arnoczky. 

As the No. 1 hospital in orthopedics for 13 straight years by U.S. News & World Report (2022-2023), HSS is a leader in research aimed at improving the lives of patients suffering from debilitating orthopedic and rheumatic conditions such as arthritis, bone and soft tissue injuries, autoimmune diseases, and musculoskeletal pain and deformities.

“This exceptional gift will help to ensure that there is sustained funding for leading-edge investigations taking place at HSS. We are pleased that Steven is building upon his past contributions to HSS as a scientist and mentor to many trainees with this gift, made with his wife, Brenda, to make a lasting difference for HSS and the field of orthopedics,” said Louis A. Shapiro, CEO at HSS.

“HSS is committed to delivering unsurpassed care and improving the field. The Arnoczkys’ gift will help us to continue developing treatments and explore emerging research topics to best improve clinical outcomes as grants will be awarded annually to projects and initiatives aimed at having a clear and measurable impact on patients,” said Dr. Rodeo. 

Through a competitive process, medical students, residents, and fellows collaborating with physicians and scientists on pilot translational orthopedic research projects will be invited to apply for a grant. A selection committee comprising of leading HSS physicians and scientists will evaluate applications. Grants will cover the cost of personnel, equipment, supplies, and other key research resources specific to investigators and their projects.

“We are deeply grateful for Steven and Brenda’s generosity which will enable talented medical students, residents, and fellows to accelerate breakthroughs that change people’s lives,” said Bryan T. Kelly, MD, MBA, president, surgeon-in-chief and medical director at HSS. 

The Arnoczky Endowment for Translational Orthopedic Research will build on HSS’s leadership position as the largest musculoskeletal research facility in the world.

“To see Steven give back to HSS in this way is deeply meaningful to those of us who worked with him early in his career. We join the entire HSS community in thanking the Arnoczkys and celebrating this visionary gift,” said Drs. Warren, Torzilli, and Hannafin, co-founders of the HSS Soft Tissue Research Laboratory.

HSS is the world’s largest academic medical center specialized in musculoskeletal health, spanning orthopedics, rheumatology and related disciplines. The HSS Research Institute maintains 20 laboratories dedicated to solving debilitating orthopedic and rheumatic conditions such as arthritis, bone and soft tissue injuries, autoimmune diseases, and musculoskeletal pain and deformities. There, more than 300 dedicated personnel focus on tissue repair, improving surgical outcomes, autoimmunity and inflammation, genomics, new treatments, and precision medicine.

“HSS has a long history of contributing to the collective base of clinical and basic science knowledge and finding healthcare solutions for complex conditions,” said Louis A. Shapiro, President and CEO, HSS. “We’re proud that through the joint efforts of our institution and philanthropic support, we will have the ability to make a strong impact on this growing and vital area of research.”

“As experts in inflammatory disorders and in the development of interventions for overactive immune responses, the clinicians and researchers at HSS are well-positioned to investigate many of the adverse effects of COVID-19,” says Lionel B. Ivashkiv, MD, Chief Scientific Officer at the HSS Research Institute. “This includes studying the causes of these adverse effects as well as how to prevent and treat them.”What follows are descriptions of the first group of funded projects in basic/translational research:

Activation of pDCs by SARS-CoV-2 and Its Impact on Macrophage Response

Principal Investigator: Franck Barrat, PhD

Co-Investigator: Marie-Dominique Ah Kioon, PhD

This project will study cell types that are responsible for cytokine storm syndrome — the hyperactive immune response seen in people with COVID-19 — by looking at how certain immune cells are activated by SARS-CoV-2. Research in mice infected with SARS-CoV, a coronavirus similar to the one that causes COVID-19, has suggested that plasmacytoid dendritic cell precursors (pDCs) are key to the immune response to infection. These pDCs activate macrophages, which in turn secrete cytokines. In the SARS-CoV research, depletion of pDCs appeared to protect the mice from lethal lung injury. Using blood samples from donors, the investigators will study the pathway by which pDCs activate macrophages and look at ways to therapeutically block that process.

Inhibiting RNA Polymerase II Transcription Complexes in Macrophages to Target COVID-19–Associated Cytokine Storm

Principal Investigator: Inez Rogatsky, PhD

Co-Investigators: Steven Josefowicz, PhD, and Robert P. Fisher, MD, PhD

This pilot project will dissect the role of macrophages in SARS-CoV-2-induced acute respiratory distress syndrome (ARDS), the main driver of COVID-19-associated mortality. We will test small-molecule inhibitors of RNA Polymerase II (Pol II) transcription complexes for their ability to modulate type I interferon and inflammatory pathways in monocytes/macrophages. This research will be done using cultured macrophages as well as donor blood and blood from COVID-19 patients.

Mechanisms of Cytokine Storm in Patients with COVID-19

Principal Investigator: Mary K. Crow, MD

Co-Investigators: Mikhail Olferiev, MD, and Lionel B. Ivashkiv, MD

The objectives of this study are to describe the process of the cytokine storm in people with COVID-19 and to identify biologic predictors of a favorable outcome in patients with severe cases of the disease. The project aims to characterize immune cell populations seen in COVID-19 patients who experience cytokine storm and compare them to those patients who do not, to compare the immune response before and after patients are given the anti-inflammatory drug anakinra, and to identify measures that suggest patients are more likely to decline and eventually require mechanical ventilation. The research will employ blood samples from HSS patients who are being treated for COVID-19 at New York–Presbyterian Hospital and who meet certain other qualifications.

What follows are descriptions of the first group of funded projects in the areas of clinical and health outcomes research:

Response to and Recovery from TKA in Patients with Antibodies to SARS-CoV-2

Principal Investigator: Miguel Otero, PhD

Co-Investigators: Meghan Kirksey, MD, PhD, and Peter K. Sculco, MD

It is unknown if people who have been exposed to COVID-19 may be at higher risk of experiencing an abnormal immune response following surgery, resulting in poor outcomes. This study will evaluate the response to and recovery from total knee arthroplasty (TKA) in people who have antibodies to COVID-19 — a marker of exposure. This study will include both patients who have COVID-19 antibodies and those who don’t, to act as controls. Patients will be followed for six weeks after surgery and evaluated for the presence of certain immune markers in the blood, as well as symptoms of inflammation including pain and stiffness in the joint.

SARS-CoV-2 Exposure and the Role of Vitamin D Among Hospital Employees

Principal Investigator: Emily M. Stein, MD, MS

Co-Investigators: Theresa T. Lu, MD, PhD; Andy O. Miller, MD; Jeri Nieves, PhD; and Alana Serota, MD

It is unknown if people with vitamin D deficiency may be more likely to become infected with COVID-19. This study will investigate vitamin D status and associated immune markers as risk factors for COVID-19 infection in a cohort of healthcare workers. Healthcare workers are at higher risk of contracting COVID-19 than the general population, making them a good group to study. Vitamin D is critical for immune function and is known to be protective against respiratory-tract infection and tuberculosis. This prospective, observational study will follow healthcare workers at HSS and at other healthcare facilities for one year, to determine whether levels of vitamin D and certain immune cells in the blood make someone more susceptible to COVID-19 infection.

Association of Immunomodulatory Medication Use and Social Determinants of Health with COVID-19 Infection in Systemic Rheumatic Disease Patients in New York City

Principal Investigator: Medha Barbhaiya, MD, MPH

Co-Investigators from HSS: Lisa Mandl, MD, MPH; Catherine MacLean, MD, PhD; Vinicius Antao, MD, PhD; Jane Salmon, MD; and Mayu Sasaki, MPH

Other Co-Investigators: Candace Feldman, MD, MPH (of Brigham and Women’s Hospital); Debra D’Angelo, MS (of Weill Cornell Medicine)

Using data from the INSIGHT Clinical Research Network, a central repository containing longitudinal electronic health data for residents of New York City, investigators will assemble a cohort of patients being treated with immunomodulatory medications for rheumatic disease. This patient population will then be used to study the effect of these medications on COVID-19 incidence and outcomes. Retrospective data will be used to evaluate the incidence and severity of COVID-19 in these patients. Patients will also be studied prospectively to determine whether there’s a relationship between COVID-19 infection and future rheumatic disease as well as to study connections between infection and future psycho-social issues.

Assessment of Surgical Outcomes in the COVID-19 Pandemic Era

Principal Investigator: Andy O. Miller, MD

Co-Investigators: Scott A. Rodeo, MD, and Mark Fontana, PhD

Investigators will implement a patient registry to evaluate how COVID-19 affects outcomes and complication rates after orthopedic surgery. This registry, along with COVID-19 screening procedures, will provide the tools to address specific research questions. Among these questions are determining the incidence of current and prior infection among the HSS surgical population, the clinical features associated with current and prior infections in this patient population, and whether COVID-19 status affects short-term complication rates.

What follows is a description of an integrated multidisciplinary study being undertaken jointly by the Adult Reconstruction and Joint Replacement (ARJR) Perioperative Research Group, Anesthesiology and Rheumatology:

Prediction and Prevention of Postoperative Blood Clots in COVID-19 Patients

Principal Investigators: Friedrich Boettner, MD; Kethy M. Jules-Elysee, MD; Lisa A. Mandl, MD, MPH

Co-Investigators: ARJR surgeons: Alejandro Gonzalez Della Valle, MD; Jason Blevins, MD; David J. Mayman, MD; Peter K. Sculco, MD; Geoffrey H. Westrich, MD and Thomas P. Sculco, MD

Medicine/Rheumatology: Medha Barbhaiya, MD, MPH; Doruk Erkan, MD, MPH; Deanna Jannat-Khah, DrPH

Pathology: Thomas W. Bauer, MD, PhD

Anesthesiology: Stavros G. Memtsoudis, MD, PhD, MBA; Alexandra Sideris, PhD

ARJR: Amethia Joseph, MHA; Ethan Krell, MS

Weill Cornell Medicine: Raymond David Pastore, MD

Recent literature suggests that one of the major complications seen in people with COVID-19 is thrombosis (the formation of blood clots) due to endothelial dysfunction, persistent inflammation and potentially antiphospholipid antibodies. As elective surgeries resume, those with prior exposure to SARS-CoV-2 will inevitably present for treatment, and some may have perioperative management considerations related to their risk of deep-vein thrombosis. This project will use, a noninvasive device that can determine clotting risks, to investigate whether people who have had COVID-19 have a more dysfunctional endothelium preoperatively and at 24 hours after surgery. The investigators will measure antiphospholipid antibodies and inflammatory markers, and evaluate the prevalence of asymptomatic post-operative deep-vein thrombosis in people who undergo TKR and have SARS-CoV-2 antibodies.

COVID-19 Translational Research Core at HSS

Principal Investigator: Theresa Lu, MD, PhD

Co-Investigators: Jessica Andrés-Bergós, PhD; Miguel Otero, PhD and Emily M. Stein, MD, MS

The COVID-19 Translational Research Core (TRC) was designed to fill critical gaps in the resources needed to promote the broad range of COVID-19–related clinical and translational research at HSS. The TRC will provide consultation on the design and implementation of COVID-19 research in the areas of orthopedics, rheumatology and metabolic bone disease; support for a COVID-19 biobank; and technical expertise and facilities required for clinical and translational researchers working on COVID-19–related projects. The TRC staff will help to acquire, house, and track biospecimens from investigator-initiated COVID-19–related research studies.

The rotator cuff is a collection of muscles and tendons at the shoulder joint that allows it to move. Overuse from repetitive overhead activities like swimming, tennis, or pitching a baseball, or acute injuries, can cause tears in the muscles or tendons of the rotator cuff.

“Arthroscopic shoulder surgery for rotator cuff tears is effective for relieving pain, restoring function and improving quality of life, but up to 25% of patients show incomplete or failed healing on imaging,” says Dr. Rodeo. “The frequency of incomplete or failed healing is more pronounced in patients over the age of 60. That matters because more people today want to stay active as they age.”

Many tissues in the body, including muscles and tendons, harbor stem cells that have the ability to form new tissues. The new clinical trial will test whether injecting an experimental cell therapy into both the muscle and the tendon of an injured rotator cuff will stimulate stem cell activity and promote better repair.

The engineered cell therapy product is E-CEL UVEC®, produced by San Diego based Angiocrine Bioscience, Inc. The investigational product consists of endothelial cells derived from the walls of the blood vessels of human umbilical cords that have been genetically modified to maintain their stability and their regenerative properties. The US Food and Drug Administration has granted the cell therapy Investigational New Drug (IND) status.

In a previous basic science study led by Dr. Rodeo, the cell therapy showed accelerated healing and an increase in the strength of the tendon attachment at the repair site, with no observable side effects, compared to surgery alone.

In the new clinical trial, patients with full-thickness rotator cuff tears who undergo arthroscopic surgical repair will receive two injections of the cell therapy: one into the tendon and one into the adjacent muscle. The study is open-label, meaning that all volunteers will know that they received the cell therapy.

The primary objective of the trial is to evaluate the safety of the cell therapy over 12 months. Dr. Rodeo and his research team will use blood tests to check whether the experimental cells have migrated away from the rotator cuff repair site. The investigators will also evaluate patients’ symptoms as well as shoulder strength, motion and healing as measured by MRI, ultrasound and patients’ reports about their progress.

“Improving patients’ symptoms with standard rotator cuff surgery is good, but strength improvements are less predictable,” Dr. Rodeo says. “Identification of new ways to improve healing and muscle function would represent a significant advance in the treatment of rotator cuff tendon tears.”

“We continue to enjoy working with Dr. Rodeo and his team on this long-term collaborative effort and look forward to providing support for this exciting new therapeutic application of E-CEL UVEC cells,” commented Paul Finnegan, MD, Angiocrine’s CEO.

The study opened September 1, 2019, with the goal of recruiting up to 20 patients ages 45 to 70 with full-thickness rotator cuff tears confirmed by physical examination and MRI. Eligible participants must already have tried and failed standard non-operative approaches, including a minimum of three months of physical therapy, oral anti-inflammatory medications, or a steroid injection.

For more information about the clinical trial (NCT04057833), please contact Camila Carballo, PhD, at carballoc@hss.edu or Daniel Edon, MS, at edond@hss.edu.

Reconstruction is the current standard of care surgical treatment for tears of the anterior cruciate ligament (ACL). This procedure typically uses a graft, or a piece of tissue, placed in the knee minimally invasively, using small incisions. About 300,000 ACL reconstructions are performed annually in the United States with well documented rates of success.

ACL repair is an older technique that involved suturing (sewing) torn ACL tissue, not rebuilding it with a graft. ACL repair was performed in the 1970s at select institutions, including Hospital for Special Surgery, but was abandoned due to unacceptably high failure rates of up to 50%.

Today, ACL repair has been modernized and can be performed through a minimally invasive approach. Proponents suggest that modern ACL repair techniques may be performed safely and may lead to a quicker recovery than ACL reconstruction. However, the limited studies to date raise questions that must be discussed in detail with your surgeon.

1. It is critically important to get ACL surgery right the first time.

When ACL surgery fails, surgeons must do a revision procedure to correct or revise the problems that were not fully addressed the first time. Revision requires reconstructive ACL surgery with a graft. (ACL repairs cannot be done as revisions.) Redoing ACL surgery may result in higher rates of failure, lower rates of return to sports, and increased risk of osteoarthritis.

The importance of successful initial ACL surgery holds true for people of all ages, but it is particularly critical for young athletes, for whom a failed surgery can have devastating consequences, including years lost from sport in the short term as well as chronic pain and loss of function in the long term.

2. Failure rates for ACL repair appear to be significantly higher than those for ACL reconstruction in people of all ages.

Current studies suggest that modern ACL repair techniques have a failure rate that may be five to ten times higher than that of ACL reconstruction^1,2,3. One major recent study in a prominent sports medicine journal found that arthroscopic ACL repair has unacceptable outcomes in young athletes, with short-term failure rates of close to 50%².

It has been suggested that ACL repair may be appropriate for older adults who have a type of ACL tear called a proximal avulsion and who do not participate in “cutting and pivoting” sports such as basketball, volleyball, and soccer. For these patients, failure rates in the short term appear to be much higher than ACL reconstruction in this age group^1,2,3.

3. There is still much we don’t know about ACL repair.

There has been no scientific evidence that shows a difference in postoperative pain between ACL repair and reconstruction. Rehabilitation and return-to-play protocols for ACL repair have not yet been established. Proper guidelines for rehabilitation and return to sports are essential to keep people safe from re-injury.
 

Andrew D. Pearle, MD

Chief, HSS Sports Medicine Institute

Bryan T. Kelly, MD

HSS Surgeon-in-Chief and Medical Director

Answorth A. Allen, MD

David W. Altchek, MD

Struan H. Coleman, MD, PhD

Frank A. Cordasco, MD, MS

David M. Dines, MD

Joshua S. Dines, MD

Stephen Fealy, MD

Andreas H. Gomoll, MD

Lawrence V. Gulotta, MD

Jo A. Hannafin, MD, PhD

Anne M. Kelly, MD

John D. MacGillivray, MD

Robert G. Marx, MD, MSc, FRCSC

Michael J. Maynard, MD

Moira M. McCarthy, MD

Danyal H. Nawabi, MD, FRCS

Stephen J. O’Brien, MD, MBA

Anil S. Ranawat, MD

Scott A. Rodeo, MD

Howard Anthony Rose, MD

Beth E. Shubin Stein, MD

Sabrina M. Strickland, MD

Karen M. Sutton, MD

Samuel A. Taylor, MD

Russell F. Warren, MD

Thomas L. Wickiewicz, MD

Riley J. Williams III, MD

References

1. Jonkergouw A, van der List J, DiFelice G. Arthroscopic primary repair of proximal ACL tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):21-28.

2. Gagliardi AG, Carry PM, Parikh HB, Traver JL, Howell DR, Albright JC. ACL repair with suture ligament augmentation is associated with a high failure rate among adolescent patients. Am J Sports Med. 2019 Mar;47(3):560-566.

3. Wright RW et al. Risk of tearing the intact ACL in the contralateral knee and rupturing the ACL graft during the first 2 years after ACLR: A prospective MOON cohort study. Am J Sports Med. 2007 Jul;35(7):1131-4.

For more information visit https://www.hss.edu/condition-list_torn-acl.asp.

A new basic science study led by Scott A. Rodeo, MD, clinician-scientist at HSS, looked to evaluate the effects of the novel population of muscle-derived activated endothelial cells (mECs) implanted at the repair site to analyze the gene expression comprehensively by means of RNA sequencing. 

Through cell tracking, the researchers found that there were green fluorescent protein (GFP)-positive viable mECs at the repair site of the supraspinatus tendon (SST) at three days with decreasing positive cell numbers at seven days.

This is the first study to show that activated endothelial cells derived from muscle tissue can enhance healing of tendon-to-bone in as early as 14 days.

"This pre-clinical data demonstrates the potential for these cells to stimulate the intrinsic progenitor cells in tendons. Ultimately, umbilical vein endothelial cells can now be used in a clinical trial of patients undergoing rotator cuff repair," said Dr. Rodeo, who adds that further studies are needed to identify the ideal patient, timing of dosing, and best way to deliver the cells to treat various types of tissue injuries.

This paper received the Charles Neer award from the American Shoulder and Elbow Surgeons Society (ASES) and was presented at ASES 2019 Specialty Day as part of the American Academy of Orthopedic Surgeons conference.

Abstract Title: Muscle-Derived Activated Endothelial Cells as A New Cell Source to Enhance Tendon-To-Bone Healing: In Vivo Study In A Murine Rotator Cuff Repair Model

Authors: Scott A. Rodeo, MD; Susumu Wada, MD, PhD; Amir Lebaschi, MD; Yusuke Nakagawa, MD, PhD; Xiang-Hua Deng, MD; Camila Carballo, PhD, PT; Daniel Nemirov, BA; Dean Wang, MD; Zoe Album, BS; Liang Ying

"The EMS crew are an important and integral part of our medical team. They have provided expert input that has aided the creation of our emergency action plan (EAP) for MetLife Stadium. I am always reassured when I see them on the sidelines, knowing that they bring tremendous expertise to our emergency medical response team," said Dr. Rodeo.

Read the full article at giants.com.

HSS sports medicine surgeon Scott A. Rodeo, MD, who did not treat Wentz, noted how coaches and physicians measure a player's benchmarks throughout the rehabilitation process.

"You try to measure function… Running, planting, pivoting, deceleration, change of direction. We do specific tests. A triple-hop test, or how someone lands from a jump. We can do some videotape analysis to look at movement patterns to get some objective information to quantify function," said Dr. Rodeo.

Additionally, Dr. Rodeo explained that they also use GPS to measure information on the volume and speed of an athlete's run.

Read the full article at delawareonline.com. This also appeared in the September 23, 2018 print issue.

Read the full article at beckersspine.com.

The goals of the study, which is now enrolling patients, is to find biomarkers correlated with the development of osteoarthritis of the joint after surgery to fix traumatic tears of the meniscus. This horseshoe-shaped layer of cartilage cushions the bones of the knee during weight-bearing activities like running and jumping.

More than one million Americans annually undergo meniscal surgery, making it among the most common orthopedic procedures performed in the United States. The injuries generally occur in young athletes who experience violent trauma to the knee, although older people can suffer them without such trauma, as well. However, patients who undergo the procedure often develop osteoarthritis of the joint—a painful, degenerative condition that to date has no cure or particularly effective treatment.

"The bottom line is, this is a very common orthopedic surgery and the results are not very good," said David W. Altchek, MD, sports medicine surgeon and co-chief emeritus of HSS Sports Medicine, and medical director for the New York Mets. "It seems like the surgery makes a small number of people better, some have an indifferent response and, unfortunately, a significant number of people get worse."

"We don’t really know much about the biology of how the meniscus heals. We kind of let pain be the guide," added Christopher Mendias, PhD, ATC, associate scientist at HSS, who is helping conduct the study. "We want to be able to say, 'Is it healing well, and is there a correlation between doing poorly clinically and elevated levels of pro-inflammatory biomarkers or that we can detect with advanced imaging?'"

The HSS study will have several components. Drs. Altchek, Mendias and their colleagues will take samples of synovial fluid--a viscous substance that lubricates joints--from 28 patients (14 men and 14 women) aged 18 to 45 undergoing a procedure called partial meniscectomy in which surgeons shave away frayed pieces of the cartilage. Those samples will be screened for the presence of proteins associated with inflammation, molecules such as interleukin 1 beta, which is known to play a role in osteoarthritis, as well as other previously unidentified substances.

The researchers also will use an advanced form of magnetic resonance imaging to track meniscal healing over time, and will match that information with the biomarker activity to look for patterns of protein activity that predict either successful healing or poor outcomes.  

"This whole idea of precision medicine is just kind of catching on in orthopedics now," Dr. Mendias said. Ideally, a biomarker panel could help surgeons determine which patients will be most likely to benefit from particular meniscal procedures, and what kind of rehabilitation--and even prehabilitation--routine they should undergo. "It could also help us identify therapies to block those inflammatory molecules and reduce the risks of osteoarthritis later in life," he said.

"The hypothesis is that there is a degenerative effect afterward, as a result of the injury or the surgery, or both—and that biologic therapy might slow that down," Dr. Altchek said. He added that there is "a tremendous amount of excitement" in the field of orthopedics about new biologic therapies, including platelet rich plasma and stem cells, that are now being used to treat tendon injuries and certain other ailments. Whether they might work to treat or even prevent the development of osteoarthritis after knee surgery is unclear. "This project is an important step in the direction" of answering that question, he said.

Scott A. Rodeo, MD, sports medicine surgeon, co-chief emeritus of HSS Sports Medicine, and co-director of the Tissue Engineering, Regeneration, and Repair Program, will be contributing patients to the study.

"A common clinical observation is that there is tremendous variability in the rate and risk of progressive degenerative changes in patients undergoing surgery for meniscus injury," said Dr. Rodeo, who also is head team physician for the New York Giants. "Some patients will do well for decades with no further problems, while there is a subset of patients who develop relatively rapid progression of degenerative changes. In addition to biomechanical factors, it is likely that the ‘biologic milieu’ in the joint is a major factor accounting for these discrepant outcomes. In this study we will characterize inflammatory mediators, matrix degrading enzymes, and a host of other cytokines that likely play an important role in joint homeostasis. Such information will not only help us gain a better understanding of the underlying mechanism of joint degeneration in patients with meniscus injury, but, importantly, may suggest therapeutic targets to allow development of innovative treatments."

Other HSS physicians involved include HSS sports medicine surgeons Answorth A. Allen, MD, New York Knicks team physician; and Riley J. Williams III, MD, medical director of the Brooklyn Nets.

If you have a meniscus tear and are interested in the study, or would like to serve as a healthy control subject, please contact Daniel Edon (edond@hss.edu).