The Division of Orthopaedic Surgery and Sports Medicine is engaged in many research studies to improve the bone health of children, prevent injuries and the need for unnecessary surgeries, and address health disparities in children's orthopedic care.
Knee Injury Prevention Program (KIPP) for High School Girls
Female athletes are 4-6 times more likely to tear their ACL than male athletes participating in the same sports. Research has demonstrated that there are neuromuscular differences between males and females that explain this disparity in ACL injury rates. This study is being done to determine whether a specially designed exercise program (KIPP) can lower a female teenager’s chances of having a knee injury or knee pain while playing sports. The study is also being done to see if the exercise program can improve a teenager’s fitness or athletic performance.
Anterior cruciate ligament (ACL) rupture is an increasingly common diagnosis in the pediatric and adolescent population due to an increased participation in sports and improved physician awareness and ability to diagnose. Historically, non-operative management with physical therapy, bracing, and activity modification was used to manage ACL rupture in very young patients to allow time for growth before surgery. More recently, improved ACL reconstruction techniques and technology have made ACL reconstruction with autograft the gold standard for treating ACL rupture in young patients. The purpose of this study is to investigate the outcomes of autograft in adolescent patients by creating a database of prospectively identified patients who undergo ACL repair or ACL reconstruction. This research study will help us better understand graft survival rate, complication rates, and other factors associated with patient outcomes.
The Pediatric ALL Evaluation and Trial (PALLET): A Randomized, Controlled Trial
Studies have shown the rising incidence of anterior cruciate ligament (ACL) injuries in children and adolescents. Pediatric patients are at a higher risk of graft failure than adults (3-4% compared to 12-19%) after ACL reconstruction. In the adult population, a growing number of studies have suggested that concomitant reconstruction of the anterolateral ligament (ALL) with the ACL may help lower this risk. However, this has never been studied in adolescent populations. The goal of this randomized, controlled study is to evaluate whether concomitant ALL reconstruction in children undergoing ACL reconstruction will result in a lower rate of graft failure than ACL reconstruction alone.
Fractures in Childhood and Adolescence: a Risk Factor for Decreased Peak Bone Mass?
This study will examine whether fractures during childhood are related to low bone mass, or bone strength, and if children with a lower bone mass are at risk for lower peak bone mass. Bones are strongest, or reach peak bone strength, between the ages of 16 and 25 years. People with weaker bones have a higher risk of fractures. This becomes clearest during later adulthood when people develop a thinning and weakening of bones called osteoporosis. After people reach peak bone strength, their bones get weaker over time. New research is showing that children who do not achieve normal peak bone strength may be at risk for fractures at a younger adult age. If we identify children with lower bone mass or strength now, we may be able to improve their bone strength during adulthood and decrease their fracture risk.
Vitamin D & Fracture Risk in the Pediatric Population
This study compares vitamin D levels in patients with a metaphyseal fracture (broken bone in the area of the bone’s growth plate) to patients with a non-metaphyseal fracture (broken bone in the non-growth plate area) by collecting blood samples from all study participants to measure vitamin D, calcium and parathyroid hormone (PTH) levels. This study will help researchers determine if there is a correlation (connection) between low vitamin D and broken bone location.
The goal of this prospective study is to assess the efficacy of pre-operative surgical site drug injection in pediatric patients with cerebral palsy undergoing hip surgery. Patients will be randomly assigned to the 2 treatment groups: surgical-site injection with ropivacaine, ketorolac, and epinephrine, or surgical-site injection with normal saline. The primary outcome measure will be total narcotic consumption in the first 48 hours after surgery. Pain scores during inpatient hospitalization following the surgical procedure, total narcotic consumption following hospital discharge, length of stay, parent satisfaction scores, and complications will also be analyzed.
Longitudinal study of children with concussions: 3-year follow-up of cognitive and emotional function, return to sports, and risk of re-injury
In recent years, concern has increased regarding the prolonged effects of concussions in children and adolescents. Prior research shows that while most youth athletes with concussion recover within 2 weeks, about one-quarter of patients exhibit signs and symptoms lasting greater than 4 weeks. Families frequently ask about the effects of concussion on neuropsychological function, school performance, and risk for subsequent injuries, especially when a patient has had prolonged recovery. This study aims to longitudinally monitor these outcomes in children and adolescents to better inform clinicians, patients, and families about the long-term effects of concussions.
Dr. Janicki is a member of the CORTICES study group which is a collaboration of pediatric orthopedic surgeons dedicated to improving the Quality, Safety and Value in the management of emergent orthopedic conditions through education, research and development of optimal care guidelines.
Evaluation the Necessity of Operative Irrigation and Debridement: Pediatric Randomized trial of type One Open Fractures (PROOF)
Fractures in which bone has been exposed to the outside world through an associated skin injury, known as open fractures, are frequently encountered in orthopaedics. An open fracture usually calls for a formal, operative treatment in which the bone is exposed, foreign tissue is removed and the wound is washed out. While surgery is the current standard of care for all open fractures, not all open fractures are equal in severity and therefore may not all require surgery.
The “PROOF” trial is necessary to compare operative and non-operative treatments for type one open fractures. The advantages of non-operative (emergency room only) treatment include shorter hospital stays, avoiding the risk of general anesthesia, lower costs and lack of a larger incision. Results from this clinical trial may support the hypothesis that minor open fractures in children can be safely treated non-operatively without an increased risk of infection or an increased time to healing.
This study will examine children diagnosed with a fracture that occurred while using a playground slide in order to understand the causes of these injuries. In our orthopaedic clinics we have observed a high volume of fractures occurring on slides and have noted that many occur while the child is going down the slide with the parent. Previous studies have observed that parent supervision has decreased incidence of playground injuries but in the case of slide injuries the presence of the parent on the slide with the child may increase the risk of fracture. Results from this study may improve the understanding of fracture risks involving slides. It may help us understand whether fractures are more common when children are accompanied down the slide by an adult or when they go down the slide on their own.
Multicenter Prospective Cohort Study on Current Treatments of Legg-Calvé-Perthes Disease
Legg-Calvé-Perthes disease is a childhood hip disorder which is common enough to be a significant public health problem (affects 1 in 740 boys between ages 0—14), but uncommon enough to have a sufficient number of patients from a single institution to perform a definitive prospective study comparing the results of current treatments. The present study will establish a database of prospectively identified patients with Legg-Calvé-Perthes (LCP) Disease and collect information regarding their presentation, treatment, and outcomes in the course of receiving currently available treatments. This study seeks to compare the outcomes of current treatments in the management of three age groups (ages 6—8, 8—11, >11) of patients with Perthes disease at two- and five-year followup. For each age group, two to three common treatment regimens currently used by practicing pediatric orthopaedic surgeons will be compared. The intervention a patient receives is determined through physician preference. Physicians pick an intervention for each age group and treat each patient with the same intervention.
Developmental dysplasia of the hip (DDH) consists of a spectrum of conditions where there is abnormal development of the hip joint. The American Academy of Pediatrics (AAP) recommends physical examination screening for DDH for all newborns at birth and again periodically at well baby visits every 2 months for the first 6 months of life. Despite these recommendations, dislocated hips still go undiagnosed past 6 months of age at which time treatment becomes more complex and challenging with additional operative procedures.
We recognized that children from predominantly Spanish speaking families or children on public insurance were not getting diagnosed in infancy. We will be examining patient and family factors such as primary language and insurance status to determine if there is increased risk for late presentation associated with certain social and economic groups. This study may provide support for DDH screening to be considered a public health issue similar to asthma management and lead exposure detection, improve adherence to AAP guidelines, and support education and policy initiatives to address this health disparity.
SLIP (SCFE Longitudinal International Prospective) Registry
Slipped Capital Femoral Epiphysis (or SCFE) is the most common hip problem in teenagers, and it is one of the most commonly missed diagnoses in children. The rare nature of this condition and the broad number of surgical options available has made it difficult to decide what form of treatment might be best. Treatment outcome for a patient has been linked to how severe their initial slip is, making early diagnosis and treatment important. However, there are multiple different surgical treatment options, and there are wide variations across surgeons and hospitals in the methods and reasoning behind those methods used for management of SCFE. There remains a demand for insight regarding preferable surgical treatments and ongoing care of children affected by SCFE. This research study will help us better understand SCFE and effectiveness of treatments, which we hope will lead to a better standard of treatment for future children with the condition.
Elucidating the Discoid Meniscus with Proposed New Classification System
Discoid meniscus is an abnormal meniscal variant where the meniscus is thickened and abnormally shaped. Historically, discoid meniscus has been categorized using several proposed classification systems, but that described by Watanabe et al. remains most widely accepted. There are cases however, in which type I, type II, and type III (Wrisberg type) cannot be definitively assigned. This prospective study will aim to serve as a comprehensive classification system to eliminate uncertainty in diagnosis of discoid meniscal types. Additionally, we plan to correlate discoid type to chance of re-tear, re-operation, and/or overall outcome.
Tibial spine fractures are rare yet significant injuries that most commonly occur in children and adolescents. Treatment for this injury is controversial among physicians because there is no consensus on optimal treatment. The aim of this study is to prospectively examine numerous aspects of tibial spine fractures, including current treatment practices and short- and long-term outcomes. Additionally, this study will investigate if there is a genetic component involved in tibial spine injuries.
Comparison of Three Treatments for Lower Extremity Apophysitis
The purpose of this study is to compare three different treatments for these types of lower extremity apophysitis- Osgood-Schlatter syndrome (OSS), Sinding-Larsen and Johansson syndrome (SLJ), or Sever's disease. The investigators hypothesize that adolescents who perform a home exercise program (HEP) consisting of active elongation exercises will have decreased pain and earlier return to sports and activities as compared to those who perform a HEP that consists of static stretching exercises or those who use symptomatic treatment with ice, acetaminophen or NSAIDs and activity modification.
Simple bone cysts (SBCs) are cysts filled with fluid that occur most frequently in the long bones (arms or legs) of children. There are many ways to treat SBCs but it is unclear if one is better than another. The purpose of this research trial is to compare the effectiveness of two common treatments that are used by surgeons today
Many SMA patients demonstrate concomitant hip and spine deformity. Hip instability progressing to dislocation is common in patients with SMA due to the asymmetric weakness of hip gluteal muscles. Traditionally the treatment of SMA has been supportive, focusing on maximizing pulmonary and musculoskeletal function. Recently however, the US FDA approved Nusinersin, the first disease modifying drug treatment for SMA. This study compares hip instability in patients being administered Nusinersin to patients who have not received Nusinersin by measuring neck/shaft angle, migration index, acetabular index, Shenton’s arc, pelvic obliquity, and Cobb angle. This study will help researchers determine if there is a correlation between Nusinersin administration and improvement of hip instability.
Bracing vs Casting in the Treatment of Idiopathic Early-Onset Scoliosis
Idiopathic early onset scoliosis (IEOS) is a rare spinal deformity affecting approximately 40 of 100,000 children. Serial casting has been the most favored treatment, but casts are usually applied with the child under general anesthesia or sedation in the operating room. Although casting is effective at resolving curvature or delaying surgical intervention, it involves risks from anesthesia. Bracing does not require anesthesia, but there are few studies reporting the outcomes and effectiveness of bracing. Therefore, the purpose of this project is to establish the relative short-term effectiveness of casting and bracing in the treatment of IEOS.
The AISE (Adolescent Idiopathic Scoliosis Etiology) Project
Adolescent Idiopathic Scoliosis (AIS) is a common spinal condition, estimated to affect approximately 1.4 million individuals between the ages of 10-17 years old in the United States. Both males and females are affected by the disease but the classic case is an adolescent female during puberty, who is healthy with normal development--until the induction of scoliosis. There has been a great deal of research done on the etiology of AIS, yet the underlying cause of the disease is unknown. Some believe it to be genetic in nature and while there may be a genetic component many recent studies have shifted focus to understanding the biomechanics of the spine and how that relates to the pathomechanism of the disease. In this ongoing discussion the one idea that has consensus is that the etiology of AIS is multifactorial in nature.
The purpose of the AISE Project has been to further our knowledge of the etiology of AIS. By understanding the elements at play during scoliosis progression, we hope to determine the underlying cause and create innovative, non-invasive, patient-friendly treatment options, such as 3D model guided physical therapy or pharmacotherapy. What we knew then to what we know now about scoliosis has changed significantly, so with the AISE project we hope the more we can learn about the etiology, the better quality of life we can provide for our patients.