Bergfeld, Caplan, Derwin, Iannotti, Parker
Our shoulders and knees sustain more injuries than any other joint, and are a major focus of several researchers in the Center.
The American Academy of Orthopaedic Surgeons estimates that about 4 million Americans seek medical care for shoulder problems every year. One of the most common causes of shoulder pain is rotator cuff disease. More than 100,000 Americans have a rotator cuff repaired each year, with more than 600 such procedures performed annually at The Cleveland Clinic.
The knee is the anatomical site most often treated by orthopaedic surgeons, the Academy reports. Knee problems result in 10.8 million visits to doctors’ offices annually. One of the most common knee injuries is the torn ACL, with about 150,000 such injuries in the United States each year. At The Cleveland Clinic, approximately 450 arthroscopically-guided ACL reconstructions are performed annually. Minimally invasive arthroscopic procedures avoid open surgery and shorten recovery.
The wear and tear from years of activity, or from sudden, acute injuries in sports, falls or accidents, play havoc with the tendons and ligaments that hold our joints together, and with the meniscus and cartilage that protect them. In some cases, damaged tissues lose their ability to repair themselves. Members of the Orthopaedic Research Center are determined to improve this situation by investigating innovative concepts to prevent injuries as well as promote better tissue healing of these important tissues.
Sophisticated tissue engineering methods are employed to investigate the use of natural biologic materials, with or without cell augmentation, to enhance healing of torn or damaged tendons and ligaments. Researchers are studying these materials at the cellular and tissue levels using biologic, biomechanical and advanced imaging techniques. The Cleveland Clinic is also identified as a leader in the study of posterior cruciate ligament injuries, having established the state-of-the-art surgical procedures to repair this common injury.
Our sports medicine and bioengineering researchers are also working to improve the healing capacity of the meniscus, the fibrocartilage in the knee that is critical to its function. The researchers are studying how the cells of the meniscus respond to injury and exploring the use of biologic agents to enhance cell migration and other events in the healing process. They study the biomechanics of the knee following excision, repair or replacement of the meniscus to help surgeons choose the best treatment for their patients. Donor meniscal tissue has been transplanted into patients with irreparable knee damage since 1998 at The Cleveland Clinic.
At the Cleveland Clinic, we realize that preventing injuries to soft tissues is as important as improving their healing capacity. Analysis and simulation of complex human movement allows researchers to study tissue loading and the mechanisms of injuries to joints. Through novel application of musculoskeletal biomechanics, materials science and computer modeling of joint function, intervention strategies to prevent injury by controlling movement are being developed and implemented.
Finally, research into current treatment methods is crucial to advance the field of orthopaedic surgery. Known as 'outcomes research', this involves collecting and analyzing patient data. For instance, our ACL database is the largest multicenter patient database of its kind in the country and contains data on about 1,500 patients who have had ACL surgery at The Cleveland Clinic over the last 10 years. By analyzing this information, surgeons will better understand which factors, from the mechanism of injury to rehabilitation, promote or hinder successful outcomes. We will also learn more about how to prevent these common injuries, and how ACL injury is related to the development of arthritis.
