Orthopaedic innovations come to market in a variety of ways. Sometimes, a researcher will uncover a clue to a new treatment. Then, orthopaedic surgeons will conduct clinical trials to see whether the treatment works. Other times, a clinician will notice a similarity among patients and turn to a researcher to find the reason. And sometimes, the researcher and the clinician are one and the same: the elusive orthopaedic surgeon-scientist.
Martha M. Murray, MD, is an award-winning pediatric sports medicine orthopaedic surgeon and research scientist at Boston Children's Hospital. She recommends that orthopaedic surgeons interested in combining clinical and research work find a question that "gets you up in the morning," and then seek a path to answering that question. But she also warns of the need to be resilient to rejection.
For Dr. Murray, the compelling question was, "Why doesn't the anterior cruciate ligament (ACL) heal after injury and how can we change that? To answer that question, Dr. Murray left her engineering PhD program and went to medical school, with the goal of becoming an orthopaedic surgeon-scientist. To accomplish that goal, Dr. Murray did her ACL research on the side during medical school, residency, and fellowship.
According to Dr. Murray, three key factors are necessary for an orthopaedist to do both clinical work and research science: department leadership, a great research partner, and dedicated teams on both sides (clinical and research).
For Dr. Murray, her chairmen—first, James R. Kasser, MD, and now Peter M. Waters, MD—and her division chief, Lyle J. Micheli, MD, have been instrumental in enabling her to have 50 percent protected research time, including entire days each week dedicated to lab work. Her primary collaborator, Braden Fleming, PhD, at Rhode Island Hospital, does the "heavy lifting" around project design, grant writing, manuscript editing, and research management for their collaborative projects.
In addition, her partners in her sports medicine practice, as well as the physician assistants and fellows, are willing to help manage patient questions that arise when she is in the lab. Conversely, the postdoctoral students and administrative staff in the lab are able to manage most research and administrative issues that come up when she is in the office and operating room.
This frees Dr. Murray and enables her to concentrate on the job she is doing each day. As a result, she can be productive in both places. Dr. Murray notes that although it may take a village to raise a child, it takes a city to support a surgeon-scientist.
Repairing the ACL
Dr. Murray's path as a surgeon-scientist started with benchtop research, in which she developed a scaffold for ACL repair. When the ACL tears, it is unable to clot because the ends bleed but the blood is dissolved by the fluid in the joint. Dr. Murray developed a scaffold that works by stimulating the blood to clot and holding the clot between the torn ACL ends to use as a bridge and grow back together. The next step was preclinical work, during which she and her team brought the scaffold through the Food and Drug Administration (FDA) regulatory process. The final step is clinical trials for her team's technology, the Bridge-Enhanced™ ACL Repair (BEAR) procedure.
The BEAR procedure uses a scaffold and sutures to stimulate repair of the ACL. In preclinical models, the procedure has been shown to result in a healed ACL with strength similar to an ACL graft. Additionally, in pig studies, the knees treated with BEAR had less osteoarthritis (OA) than those treated with ACL reconstruction.
Based on those results, Dr. Murray and her team approached the FDA to learn what they would need to do to move toward human studies. Because the FDA and Dr. Murray's clinical care team had the same goals—namely, to make sure the procedure was as safe and effective as possible before proceeding to human studies—the agency was a great resource and provided excellent guidance through the process.
Currently, her primary research is focused on clinical studies, while she continues to collaborate with Dr. Fleming on understanding the mechanisms of posttraumatic OA and developing new therapeutics to treat early and midstage OA.
One of Dr. Murray's key mentors as a surgeon-scientist has been Kurt P. Spindler, MD, a surgeon-scientist at the Cleveland Clinic. Drs. Murray and Spindler have collaborated on several research efforts focused on ACL repair. Although they are at different institutions, their common research interests make Dr. Spindler a logical and helpful mentor. In turn, Dr. Murray has mentored more than 30 clinical and research fellows during the past 10 years, many of whom have gone on to become successful surgeon-scientists.
Orthopaedic surgeon-scientists add greatly to the orthopaedic profession and the enhancement of patient care. For this reason, the AAOS, the Orthopaedic Research and Education Foundation, and the Orthopaedic Research Society sponsor an annual Clinician-Scientist Development Program (CSDP). This year's program was held Sept. 15–17, 2016, in Rosemont, Ill. For more information, visit www.aaos.org/csdp
Roxanne E. Wallace, MD, is a practicing orthopaedist in Green Bay, Wisc. She is a member of the AAOS Council on Research, the AAOS Communications Cabinet, and Quality, and a member of the AAOS Now editorial board.