Partnership goal is accelerating the pace of regenerative medicine

Improvements in personal body armor and critical care have reduced the percentage of fatal casualties in combat, but raised the number of serious extremity injuries that require limb salvage surgery or amputation to an all-time high. To meet this challenge, the U.S. Department of Defense (DOD) has established the Center for the Intrepid (CFI), a 65,000 sq.ft. state-of-the-art facility at Brooke Army Medical Center, in San Antonio, Texas, dedicated to the care and rehabilitation of wounded soldiers.

The prosthetic technology and physical and occupational therapies available at the CFI have successfully enabled dozens of amputees to return to “normal” life and even to active combat. The CFI also conducts orthopaedic research, primarily in regenerative medicine, which has extraordinary potential to solve major problems in civilian musculoskeletal health care if appropriate collaborations between academic investigators and industry can be established.

ORS and DOD Research
Among the DOD’s funding initiatives are the $85 million Armed Forces Institute of Regenerative Medicine (AFIRM) and the Orthopaedic Extremity Trauma Research Program (OETRP).

The Orthopaedic Research Society (ORS) recently established a more formal relationship with DOD officials to accelerate the pace of discoveries, bridge the gap between basic science research being done by members of ORS and the applied research being conducted at the CFI, and achieve common goals.

“There is tremendous potential for synergies between the National Institutes of Health (NIH) and DOD programs to enhance and accelerate the science and technologies necessary for regenerative medicine,” said ORS President Regis J. O’Keefe, MD, PhD.

“For funding purposes, the DOD categorizes research based on its technology readiness level. Most of the research presented at the ORS annual meeting is early concept to proof-of-principle studies. In contrast, the DOD limits most of its research funding to projects that evaluate mature technologies in large animals and people,” explains Michael Yaszemski, MD, PhD. Given the lack of overlap, a formal relationship between ORS and DOD investigators would help facilitate the application of discoveries to novel therapies.

ORS visits the CFI
Recently, several members of the ORS visited the CFI to learn more about the remarkable achievements in rehabilitation following limb-sparing surgery and/or amputation.

According to Edward Schwarz, PhD, “One of the motivating factors driving the CFI and the soldiers cared for there is the knowledge that thousands of orthopaedic researchers are working on regenerative medicine.”

The tour included several restricted areas for patient care and research, which are not normally open to the public. For example, the gait lab contains 24 cameras and 8 floor force plates, in contrast to academic gait labs, which typically contain 2 to 4 cameras and 1 or 2 floor force plates to record movement. It also includes rocky terrain, staircases, and other common props that allow complete analysis of patient movements as they perform common daily tasks.

In the computer-assisted rehabilitation environment, a patient can experience a controlled virtual environment such as walking on a beach. Motion analysis is coordinated with biofeedback in projected images of the patient in the virtual landscape. With this real-time feedback, patients can see how to adjust their gait or posture.

Although primarily used for physical therapy for amputees and patients with neuromuscular deficits, the new technology is also used for research. According to Lt. Col. Rachael Evans, MD, “Most current research is directed to validating outcome measures. Once this is completed, the information may be able to provide us with new approaches for rehabilitation of less severe orthopaedic injuries common to both military and civilian populations.”

Common problems
The ORS visitors also learned that some of the biggest challenges faced at the CFI are the same ones that plague civilian health care. Maj. Joseph Hsu, MD, an orthopaedic trauma surgeon, stated that methicillin-resistant Staphylococcus aureus (MRSA) is a major problem.

“I have performed multiple operations on MRSA-osteomyelitis patients, with poor success. It is frustrating to note the lack of research being done to find a solution for MRSA. The antibiotics and bone cement that we use today were discovered more than 50 years ago. It is surprising that no advances have been made for products that are imminently marketable.”

Finally, the ORS visitors discussed several potential areas for collaboration, including a workshop at the 2010 ORS annual meeting in New Orleans, to highlight the AFIRM program and the ongoing collaborations between ORS members and researchers in the military.

“Our first joint ORS/AAOS symposium on Orthopaedic War Injuries in 2007 in San Diego was a huge success,” said Col. James R. Ficke, MD, who coordinated the visit. “We look forward to participating in similar collaborative programs in the future.”

AAOS Now will continue to follow and report on these collaborations and the regeneration technologies they develop.