For more than a century, orthopedic surgeons and investigators at Boston Children's have played a vital role in the field of musculoskeletal research—pioneering treatment approaches and major advances in the care and treatment of trauma to the joint, scoliosis, polio, TB, hip dysplasias and traumas to the hand and upper extremities.
Our advanced research helps answer the most pressing questions in pediatric orthopedics today—providing the children we treat with the most innovative care available.
Research led by Boston Children’s orthopedic surgeon and principal investigator Martha Murray, MD, focuses on stimulating the healing of tissues inside joints—particularly the ACL and meniscus of the knee.
Treating these injuries remains one of the most challenging problems facing orthopedic science today, since damaged ACL ligaments have almost no ability to repair or regenerate. Surgery is typically performed to remove the injured tissue and replace it with healthy graft tissue. But this procedure can lead to a high rate of premature arthritis in the knee (as high as 80 percent 14 years after an ACL tear). Physeal-sparing and transphyseal reconstruction surgeries, performed by experts at Boston Children's, are not widely available. The ACL reconstruction technique used on adults isn't suitable for children who are still growing.
Murray’s Sports Medicine Research Laboratory team is developing a new technique to stimulate natural ACL healing. In animal studies, they’re finding that an enriched collagen gel can stimulate natural healing—creating a “bridge” between the two torn ends that provides a medium for the cells to come back into and heal.
Fig. 1 Fig. 2 Fig. 3 Fig. 4
- Fig. 1 ACL is torn
- Fig. 2 Healing does not occur when blood clot dissolves in joint fluid
- Fig. 3 Collagen and blood plasma mixture is injected
- Fig. 4 ACL heals successfully
Although it will be years before researchers test the technique in patients, it’s already showing promising results in animals, and may help prevent early arthritis by restoring the knee closer to “normal” than grafting. Plus, it’s much less invasive—requiring just two incisions, in contrast to grafting with segments of the patella and/or other tissues. Finally, because the surgical technique is similar to a straightforward fracture repair, most orthopedic surgeons will be able to perform the procedure. Ultimately, this could facilitate broader access to ACL repair for growing children.
Orthopedic basic science laboratories
Working in Boston Children’s orthopedic research labs are some of the nation’s leading musculoskeletal researchers. These labs include:
Ligament and tendon innovations
A series of innovative, age-specific reconstruction techniques for treating the ACL injuries of growing children has been developed by Boston Children’s orthopedic surgeon and director of the Sports Medicine Division, Lyle Micheli, MD. These are classified as physeal sparing procedures—that is, they spare the child’s growth plates (physes) from disruption that would occur in traditional ACL reconstructive surgery.
Originally developed as a temporary procedure until a child reached skeletal maturity, follow-up studies have found that up to five years after their surgeries, 95 percent of children who’d had physeal sparing procedures were doing so well that they no longer required ACL reconstructive surgery.
The Sports Medicine Division is now incorporating the latest in tendon regeneration—the application of platelet-rich plasma. This treatment has been popular in Europe—and now in the United States—for stimulating tissue regeneration in difficult-to-heal areas such as tendons (including the Achilles, elbow and patella) that don’t respond to physical therapy or to limits on activity.
There are normally many healing growth factors in our platelets. The process involves isolating these growth factors in the patient’s blood platelets and then injecting them into the affected areas with ultrasound guidance.
The Sports Medicine Division in the Orthopedic Center at Boston Children's conducts research into:
- the mechanisms of sports injuries
- the techniques of rehabilitation and treatment
- the physiology of exercise and conditioning
Ongoing research includes the study of:
- knee injuries
- running injuries
- injuries to pre-adolescent children
- the psychological impact of sports and sports injuries
- the treatment and prevention of injuries to dancers
Program director Lyle J. Micheli, MD, is one of the world’s leading authorities on sports care. Micheli has treated world-renowned dancers and professional athletes, and is the author of hundreds of published clinical studies, scholarly review articles and books.