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Ongoing Research Studies

Clinical Outcomes Following Arthroscopic Knee Surgery (COFAKS)

Intramurally funded through the UT Department of Orthopedic Surgery & Memorial Hermann Health System. COFAKS is a prospective cohort study currently containing over 1,000 patients following ACL reconstruction with and without concomitant injuries. The primary goals of this study are to determine the most appropriate treatment pathways for individuals recovering from ACL injury; and to lower the risk of subsequent ACL injuries by utilizing objective return to activity testing criteria. To date, patients participating within this trial have exhibited a much lower ACL reinjury rate (2.3%) when compared to documented national averages (7.0-12.5%) at 2-years after surgery. Additionally, this cohort of patients serves as a normative benchmark for functional recovery throughout the course of rehabilitation after ACL surgery, allowing for a more objective assessment of patient progress.

Surgical Timing And Rehabilitation after Multi-Ligament Knee Injury (STaR) Trial

Funded by the U.S. Department of Defense – University of Pittsburgh – The overall purpose of this multicenter clinical trial is to investigate the effects of timing of surgery and rehabilitation to optimize clinical outcome and return to duty/activity for military personnel and civilians with a MLKI. We hypothesize that early surgery and early initiation of post-operative rehabilitation will lead to improved outcomes in terms of: 1) return to duty/work and sports, 2) patient-reported and performance-based measures of physical function and health-related quality of life; 3) restoration of normal laxity and range of motion with 4) no increased risk of complications. Individuals with an injury pattern or associated injuries that preclude randomization will be enrolled in a parallel prospective observational cohort to determine injury, surgical and rehabilitation factors that influence the outcome of subjects with a MLKI.

Rehabilitation Enhanced by Partial Arterial Inflow Restriction (REPAIR) Trial

Funded by the U.S. Department of Defense – W81XWH-15-2-0067: The overall purpose of this multicenter randomized clinical trial is to test the effectiveness of the REPAIR intervention (physical therapy (PT) plus blood flow restricted (BFR) training) when compared to usual care PT alone for active military-aged individuals recovering from lower extremity injury. We hypothesize that REPAIR will lead to improved long-term functional outcomes, largely through its effect on increasing muscle strength and muscle volume. The application of this novel treatment approach is theorized to expedite rehabilitation, reduce re-injury risk, and improve long-term clinical outcomes.

Longitudinal Characterization of Anterior Cruciate Ligament Graft Healing with Advanced Magnetic Resonance Imaging Technology

Funded by the University of Texas Health Science Center at Houston – The purposes of this study are to utilize advanced magnetic resonance imaging (MRI) technology (specifically, ultra-short time-to-echo [UTE] sequences) to (1) develop a protocol for objective evaluation of ACL graft incorporation over time, and (2) to develop a protocol for objective evaluation of meniscus healing after repair. We also plan correlate the findings obtained from imaging studies with clinical and functional outcomes. We hypothesize that (1) there will be early progressive changes in UTE-T2 relaxation times of ACL grafts and meniscal repairs that will stabilize as the repair/remodeling process nears completion; and (2) UTE-T2 relaxation times will be related to patient-specific functional performance.

The Effect of a Larger Football Helmet On Cervical Spine Alignment in the Supine Position

Funded by the University of Texas Health Science Center at Houston – The purpose of this study is to evaluate cervical spine alignment with standard football shoulder pads with and without a standard football helmet and a new larger helmet using lateral cervical spine x-ray imaging. When compared to a traditional football helmet, we hypothesize that, with the subject supine, the larger helmet will (1) place the cervical spine in increased flexion before helmet removal and (2) will result in an increased arc of extension from the time the helmet is in place until it is removed. The results of this study will be used to evaluate and/or supplement the recommendations for the management of athletes with acute cervical spine injuries wearing these larger helmets.

The Role of Trochlear Dysplasia in Failure of Medial Patellofemoral Ligament (MPFL) Reconstruction

Funded by the University of Texas Health Science Center at Houston –The purposes of this study are to (1) identify critical radiographic angles of the trochlear groove in which MPFL reconstruction alone is likely to result in recurrent patellar instability and (2) to determine if tibial tubercle osteotomy protects against recurrent patellar instability in the setting of a predisposing critical angle. Successful completion of this study will provide objective radiographic criteria to assess the risk of failure of MPFL reconstruction before the procedure is performed.

The Risk of ACL Injury on Synthetic Playing Surfaces: A Prospective Study

Funded by the University of Texas Health Science Center at Houston – The purpose of this study is to identify characteristics of turf fields that may predispose to ACL injury. Variables such as age, generation, and brand of turf in addition to shoe types and mechanisms of injury will be evaluated. We hypothesize that turf fields that are older and with the greatest overall day-to-day foot traffic will be associated with more ACL injuries.

Can We Improve Meniscal Healing in the Avascular Zone? Fibrin Clot Augmentation with Stem Cells

Funded by the Musculoskeletal Transplant Foundation (MTF) – The purpose of this study is to evaluate ex vivo meniscal healing after augmentation of fibrin clots with stem cells. We hypothesize that (1) the resulting reparative meniscal tissue following repair with stem cell-seeded fibrin clots will be significantly improved relative to that resulting from non-seeded fibrin clots with respect to macroscopic evaluation, histologic analyses, and immunohistochemical analyses up to 12 weeks after repair.

Recent Research Studies

Adductor Canal Nerve versus Femoral Nerve Blockade for Pain Control & Quadriceps Function Following ACL Reconstruction: A Randomized Clinical Trial

Intramurally funded through the UT Department of Orthopedic Surgery & Memorial Hermann Health System. The purpose of this randomized clinical trial was to compare adductor canal blockade (ACB) and femoral nerve blockade (FNB) for pain control and quadriceps muscle function in patients undergoing ACL reconstruction. We hypothesized that ACB will provide superior quadriceps function with similar pain control when compared to FNB. Study Results; Patients receiving ACB demonstrated better quadriceps muscle activation and ambulation rates with similar postoperative pain control. No functional differences were observed between ACB and FNB at 6-months, however, the incidence of postoperative knee extension loss was higher in the FNB group. The overall findings of this study support the use of ACB over FNB for postoperative pain control for ACL reconstruction.

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