My interests have focused upon biomechanical issues related to the anterior cruciate injured knee as well as the biomechanics of patellofemoral stability.
Injury to the anterior cruciate ligament (ACL) of the knee is common in sports participation, occurring an estimated 100,000 times a year in the United States alone. Associated injuries to the meniscus occur in approximately 60% of acute ACL injuries with an incidence approaching 95% over a ten-year period in the untreated ACL deficient knee. The consequence of ACL injury, with or without treatment, is functional disability due to instability and eventual osteoarthritis. Our laboratories are engaged in investigations related to the biology and mechanobiology of ACL and meniscus injury. Drs. Jack Andrish, MD and Cahir McDevitt, PhD are investigating strategies for promotion of cell migration into wounds in ACL repair/reconstruction. Presently I am working with Drs. Van den Bogert and McLean to develop improved methods of assessment of intra-joint loads in the ACL deficient knee as well as the ACL reconstructed knee utilizing movement analysis, computational models, as well as whole joint biomechanics to study in vivo knee joint loading and ACL strains generated during injury events and rehabilitation. We have shown that ACL injury does not occur without out of plane torques on the knee joint, and the focus of research is to identify the neuromuscular and anatomical mechanisms responsible for this type of joint loading.
The Section of Sports Medicine of the Cleveland Clinic Foundation has a prospectively gathered database of patients having undergone repair/reconstruction of knee ligament injuries. Extensive intraoperative documentation of associated injuries to menisci and articular cartilage as well as the type and extent of ligamentous injury is recorded. Over 1000 patients have been registered into this database since 1991 and since 2001, the registry has been expanded into a multicenter database with over 2000 entries to date. Clinical outcomes instruments are included in the prospective data collection. This registry serves as an invaluable resource to conduct outcome investigations of knee ligament and meniscus injury and management.
I am also directing a study of the osteology of the patellofemoral joint with an emphasis upon defining patellofemoral congruence patterns within a large population as well as collaborating with Dr. van den Bogert on the study of neuromotor mechanisms of female runners with anterior knee pain. Anterior knee pain (AKP) is the most common injury in recreational running. AKP is 2-3 times more common in women than in men, and women with AKP are significantly limited in their ability to exercise. When there is no intra- or peri-articular pathology, AKP is typically diagnosed as patellofemoral pain syndrome (PFPS). The role of neuromuscular control in the etiology and treatment of PFPS is important but not well understood. It is our long-term goal to improve the treatment of PFPS through therapeutic interventions that directly target the relevant neuromuscular variables.
