AAOS/ORS symposium examines pathways from novel idea to improvements in standard of care

Despite the wealth of innovation in the orthopaedic sciences, seemingly few technologies translate to clinical use. Federally funded research efforts are largely focused on understanding the mechanisms behind the development and progression of debilitating musculoskeletal diseases. There is a pressing need for researchers and surgeons to figure out how to connect mechanistic knowledge to improved clinical outcomes.

From May 11–13, 2017, the AAOS and the Orthopaedic Research Society (ORS) held a collaborative event—the AAOS/ORS Translating Orthopaedic Technologies into Clinical Practice: Pathways from Novel Idea to Improvements in Standard of Care Research Symposium.

The focus of the event was to examine pathways to commercialization that can be used by surgeons and scientists who work with companies, entrepreneurs, and funding sources in the field of orthopaedics. The economic burden of musculoskeletal injuries and degeneration is staggering, exceeding $874 billion in the United States alone, equivalent to 4.9 percent of the nation's gross domestic product.

In addition, new and novel ways to improve efficiency, ease, or outcome of an orthopaedic procedure are abundant. But most of these ideas are abandoned due to a lack of clarity about "what to do next." To improve the quality of life of patients with musculoskeletal diseases, a more focused effort on understanding how to translate ideas into clinical care is required. Transparent pathways to commercialization specific to the orthopaedic sciences are needed.

The symposium provided a forum for the exchange of ideas on best practices for commercialization as applied to the field of orthopaedics. Faculty included the following:

• surgeons who have experience balancing academic and corporate roles
• scientists and entrepreneurs who have translated research into clinical care via start-up companies
• industry representatives who have collaborated with surgeons
• legal representatives who have protected orthopaedic ideas and structured contracts
• directors and managers of funding sources that span the early stage, angel investors to local government-private partnerships and the federal level

The symposium elucidated the process of commercializing technology by educating attendees about various pathways to commercialization. It provided guidance to participants on finding ethical common ground—the physician's Hippocratic oath and our industry colleagues fiduciary responsibilities to their stakeholders—and developing contracts, managing conflict of interest, the industry-clinician relationship, entrepreneurial pathways, and forming/leading life sciences start-up companies.

Protecting intellectual property while recognizing the need to collaborate and publish was also a focus.

The highlight of the symposium was "The Pitch"—five young orthopaedic entrepreneurs were selected from a highly competitive applicant pool to present their ideas to a panel of experts, including venture capitalists, angel and private equity investors, lawyers, and clinician-scientists.

Panelists asked tough questions and provided feedback with input from the general audience, who later voted for the best presentation. The five innovators selected to pitch their products were as follows:

• Amr Abdelgawad, MD, Texas Tech University Health Sciences Center, pitched "Development of Internal Bone Lengthener"
• Justin Barad, MD, Osso VR, pitched "Osso VR: Realizing Surgical Skill Through Virtual Training"
• Kevin Campbell, MD, Rush University Medical Center, pitched StreaMD
• Venkata Mantripragada, PhD, Cleveland Clinic, pitched "CellXTM and ColonyzeTM - A Resource Tool for Cell Source Management and Quality Control"
• Gadi Pelled, PhD, DMD, Cedars-Sinai Medical Center, pitched "SonoHeal: A Novel Personalized Therapy for Accelerated Tissue Regeneration"

Dr. Campbell, chief executive officer and cofounder of StreaMD, was presented with the 2017 Orthopaedic Innovator Award.

The future of translational research
The environment to enable pathways from a novel idea to improvements in the standard of care within orthopaedics should be nurtured.

Residents, fellows, and surgeons need to be educated about commercialization pathways as parts of their training and career development. Networking with surgeons and scientists who have successfully translated ideas into clinical use can help provide real-world guidance on commercialization approaches.

Finally, those in attendance recognized that not all ideas should result in the formation of a start-up company. More careful vetting of concepts is required to help identify if a pathway toward commercialization is feasible and, if so, what mechanisms can best enable the commercialization vision.

Additional information on the symposium is available at www.aaos.org/pathways

Suzanne Maher, PhD, is associate director of the Biomechanics Department and Co-Director of the Orthopaedic Soft Tissue Research Program at Hospital for Special Surgery. She is a board member of the Orthopaedic Research Society. She can be reached at mahers@hss.edu

Michael Yaszemski, MD, PhD, is the John and Posy Krehbiel Endowed Professor of Orthopedic Surgery and Biomedical Engineering at the Mayo Clinic and director of its Polymeric Biomaterials and Tissue Engineering Laboratory. He can be reached at yaszemski.michael@mayo.edu

Erin Lynn Ransford is the manager, Research Advocacy, in the AAOS Department of Research, Quality, and Scientific Affairs. She can be reached at ransford@aaos.org