Game Changers: Exciting Forefront Research Will Reinvent Orthopaedics
Research underway at Wake Forest Baptist Medical Center has the potential to change the face of orthopaedics and open up a broad spectrum of life-altering outcomes for patients.
Imagine an orthopaedic practice where patients with peripheral nerve damage can regain full function, where new outcomes for ligament damage include full replacement – with customized tissue bearing zero risk of rejection. Researchers and surgeons at Wake Forest Baptist are translating these techniques into reality.
Regenerating Peripheral Nerves
A vexing problem for orthopaedic surgeons is peripheral nerve damage associated with trauma to the limbs. Where nerve grafts have shown limited to no restoration of normal function, a new, nerve-regeneration technique facilitates renewal of limb function and hope for normal activity.
Orthopaedic surgeon John Li, MD, PhD, Beth Smith, PhD, director of orthopaedic research, and Mike Callahan, PhD, assistant professor of orthopaedic surgery, are working on a game-changing technique for regenerating damaged nerves. Under a $2.2 million grant from the U.S. Department of Defense, the study will look to improve outcomes for war veterans who have peripheral nerve damage. Thomas L. Smith, PhD, professor of orthopaedic surgery, says this development shows great promise in restoring nerve and extremity function where traditional peripheral nerve grafts have been limited at best.
“This technique for regenerating nerves is a way you can improve outcomes, allowing patients to go back to normal daily activities that they might not otherwise be able to,” Smith said.
The revolutionary procedure uses keratin compounds developed by Mark Van Dyke, PhD, assistant professor, Wake Forest Institute for Regenerative Medicine, and made by Winston-Salem company Keranetics. Preliminary studies in mice, rats and monkeys have shown enough success for researches to proceed toward FDA approval for continued development.
Non-Rejectable Menisci, Tendons and Ligaments
Debilitating problems from severely damaged or removed meniscal tissue may soon be a thing of the past, along with tissue-rejection complications presented by allograft tissues. This development can mean avoidance of premature osteoarthritis and knee replacement, and a return to normal function for patients with crippling knee damage.
Adapting a technique also being researched at Wake Forest Baptist for tendon regeneration, orthopaedic surgeon Cristin Ferguson, MD, is developing a new technique for meniscus replacement using donor tissue and stem cells to replicate recipient tissue and restore normal function of the knee.
The process removes all donor-related cellular and immunogenic components from the allograft meniscus, leaving a neutral scaffolding. Once introduced to the neutralized tissue, the recipient’s stem cells recognize the meniscal tissue type and environment and generate a new meniscus bearing the recipient’s immunogenic markers with no concern about rejection.
This type of tissue decellularization is also being researched by orthopaedic surgeon Gary Poehling, MD, and Patrick Whitlock, MD, PhD, senior resident in the orthopaedic surgery physician-scientist program. It is hoped that this process can be used to create implantable ACL ligaments and tendons.
“This is a technology that will be adapted again and again in a lot of different ways for an exciting number of scenarios where people just didn’t have these kinds of choices before. This will change lives,” Smith said.