Current Research
SSC prides itself on its world class surgical and rehabilitative interventions in ACL injury. It is driven to return athletes to optimum performance at their chosen sport and quickly and safely as possible. Throughout this process the SSC ensures that all surgical and rehabilitative interventions are specific to the individual players’ demands and their specific sport. Throughout this process every piece of data is collected for audit and review to ensure that this process is one of constant modification and development improving athlete outcomes on an on-going basis.
The foundation of this process is the SSC ACL registry which records every aspect of an athlete’s ACL from initial injury, surgical intervention, rehabilitation and return to performance. This registry follows the 600+ ACL reconstructions that are carried out in the SSC throughout their rehabilitation and long after their return to sport to monitor their short and long term outcomes. This rehabilitation process is driven by the SSC ACL Rehabilitation Pathway. This pathway individually guides athletes through their progress, reviewing them on a monthly basis. As part of this process athletes partake in 3D biomechanical testing in our Vicon Motion Capture lab at regular intervals to monitor and feedback on the development of their movement efficiency and lower limb power. This allows for the most accurate discussion around rehabilitation deficits return to play decision making.
To complement this we have a comprehensively equipped Performance Rehabilitation Gym staff by expert Physiotherapists and Strength and Conditioning Coaches to provide feedback and assistance to athletes to ensure the best possible outcome.
SSC uses this process to ensure that athletes achieve the highest possible outcome after surgery and upon return to sport. This on-going process of measurement and analysis allows the SSC to continue to lead the way in ACL surgery and rehabilitation and guide athlete from recreational through to elite back the highest level of sport they desire.
Athletic groin pain (AGP) is a common condition accounting for 2-5% of all sport related pain. AGP is most often chronic in nature and is therefore associated with extended absences from participation in sport. Epidemiological studies have found that AGP is only behind fractures and injuries to the anterior and posterior cruciate ligaments in term of time lost from sport. While evidence exists for the implication of abnormal movement biomechanics in AGP, there has been little work to quantify abnormal loading and movement control factors in relevant sporting actions. Three-dimensional motion capture techniques have the potential to provide such an insight.
The UPMC Sports Surgery Clinic, with the aid of its new state of the art 3D biomechanics assessment laboratory, is undertaking pioneering research in the area of athletic groin pain. A series of functional biomechanical tests have been formulated that have been found to be relevant to the examination of groin pain and have excellent test-retest reliability. A cohort study comparing 40 groin pain patients with 40 matched healthy controls has been undertaken with a view to identifying the key biomechanical factors associated with chronic groin pain. In addition, an intervention study has been recently completed which aims to examine if the key factors identified in the initial cohort study can be modified by physio led rehabilitation. A large scale prospective trial is also currently underway in an attempt to comprehensively examine the key biomechanical determinants of groin pain and the optimum rehabilitation interventions to modify these risk factors.
There is a particular interest in the role of tissue engineering and regenerative medicine strategies here in Orthopaedics and Sports Medicine at UPMC Sports Surgery Clinic. The translational focus of this research is facilitated through close links with the Academic Unit of Orthopaedics and Sports Medicine at Trinity College Dublin, headed by Professor Cathal Moran.
Strong emphasis is placed on inter-disciplinary work of clinicians, with established scientists, engineers, imaging specialists and allied health professionals. Our Orthopaedic and Sports Medicine research focuses on the investigation of biological augmentation of traditional surgical options for soft tissue injury, as well as exploring novel treatment strategies for soft tissue, ligament, ACL, cartilage and meniscus injury.
A National Cartilage Repair & Orthobiologics Centre is being established to facilitate sharing of the scientific expertise available at TCD, RCSI, AMBER (and other leading regenerative medicine centre’s in Ireland) with specialised clinical services at UPMC Sports Surgery Clinic and national/international clinical partners. In addition to the traditional exploration of tissue engineered constructs using scaffolds, cells and other biological factors, there is considerable interest in the role of mechanobiology in the healing and repair process, with particular emphasis on how this relates to rehabilitation of tissues following surgical intervention.
Research Sites
The primary laboratory facility for tissue engineering and regenerative medicine research is the Trinity Centre for Bioengineering at Trinity Biomedical Sciences Institute, while related clinical research is performed here at UPMC Sports Surgery Clinic and partners at Cappagh National Orthopaedic Hospital and other partner sites. Large animal studies are carried out in conjunction with the UCD Department of Veterinary Medicine. Investigations involving Diagnostic Imaging include collaborating with the established departments at UCD and TCD. Translational research and clinical trial activities are undertaken with TCD Clinical Research Facility at St. James’ Hospital.
In addition to the above areas, there is also an interest in exploring factors that influence return to sport following injury. This work involves collaboration between both clinical and research staff across various departments and institutes here at UPMC Sports Surgery Clinic, Trinity College Dublin and related hospitals, as well as with individual athletes and teams.
Links to key research partner sites are provided here:
Wellcome Trust HRB, Clinical Research Facility, St James Hospital
Trinity Centre for Bioengineering
TERG – Tissue Engineering Research Group
AMBER – Advanced Materials and BioEngineering Research
REMEDI – The Regenerative Medicine Institute
For further information on Orthopaedic Research at SSC please email info@sportssurgeryclinic.com
Cartilage Repair Centre
Treatment of cartilage and meniscus injury remains one of the most significant challenges in orthopaedic sports medicine.
In order to meet this challenge, Ireland’s first dedicated Cartilage Repair & Translational Orthobiologics Centre is being developed in partnership between SSC, Trinity College Dublin, Royal College of Surgeons in Ireland, and affiliated clinical and research institutes.
The Cartilage Repair and Translational Orthobiologics Centre brings together internationally trained surgeons, scientists, imaging and rehabilitation specialists to meet this challenge in a multidisciplinary fashion.
Our team is dedicated to providing patients with the most advanced and effective treatments for cartilage and meniscus injury. Our research and clinical care is helping to shape the future of cartilage and meniscus repair and regeneration. Our patients and athletes are the beneficiaries of this effort.
Clinical Trials
As well as providing new surgical options to patients, the creation of the Cartilage Repair & Translational Orthobiologics Centre shall also increase Irish participation in international studies evaluating the role of stem cells, scaffolds and other biological options.
Providing leadership across both clinical and laboratory sites can ensure that the highest international levels of care are available to all patients in Ireland. The long term aim of this unit is to lead Ireland’s recognition as a key translational site for Regenerative Medicine and Tissue Engineering as applied to Orthopaedics and Sports Medicine.
For further information on Cartilage and Knee Orthobiologics Research at SSC please email info@sportssurgeryclinic.com
Here at UPMC Sports Surgery Clinic, we are currently participating in the EU Horizon 2020 stem cell trial for Osteoarthritis.
Osteoarthritis (OA) is an incurable and debilitating disease. It has been identified as the world’s eleventh highest contributor to disability and affects over 70 million Europeans. There is currently no treatment to prevent progression of the disease.
In the absence of effective pharmacological, biological or surgical treatment options, cellular therapies using mesenchymal stem/stromal cells (MSCs) have emerged as potential treatments for this condition. Autologous adipose-derived mesenchymal stromal cells (ASCs) are an attractive option for these cellular therapies because of the abundance of tissue, high frequency of MSCs, and minimally invasive harvest procedure.
The EU consortium ADIPOA has shown in a ‘first in man’ 2-centre Phase I safety study that intraarticular injection of a single dose of autologous ASCs to the knee (18 patients, 12 month follow-up) was well-tolerated, had no adverse effects, and resulted in an improvement in pain score and functional outcome.
The purpose of the project is to design and implement a phase IIb study to assess the safety and efficacy of autologous (patient-derived) ACSs in the treatment of advanced OA of the knee.
The cells will be prepared from samples of adipose tissue harvested from patients by lipoaspiration.
The international ADIPOA-2 clinical team includes clinicians from ten centres across Europe, including France, Germany, Italy, The Netherlands and two in Ireland, including here at UPMC Sports Surgery Clinic and REMEDI in Galway.
The participation of SSC is being leg by Professor Cathal Moran, Professor and Chair of Orthopaedics and Sports Medicine at UPMC Sports Surgery Clinic and Trinity College Dublin.
ADIPOA-2 will carry out a multi-centre, randomized clinical trial comparing the use of culture-expanded, autologous adult ASCs in subjects with knee OA with injected Hyaluronan (another widely used therapeutic approach for knee degeneration). This study will involve two major elements: the production of consistent batches of high-quality autologous ASCs under GMP-compliant conditions and the delivery of these cell doses to patients in a trial which will meet all national and European regulatory and ethical standards and which will provide a definitive demonstration of the safety and efficacy of ASCs as a therapy for osteoarthritis.
Cartilage Regeneration Scaffolds
Clinical Trials are also being developed for the evaluation of novel scaffolds and orthobiologics in patients with symptomatic cartilage injury. This work builds on prior laboratory research at RCSI and Surgacoll and will link laboratory research to clinical care here at UPMC Sports Surgery Clinic and Cappagh National Orthopaedic Hospital.
ChondroColl™ is a biomimetic, bioactive layered scaffold for use in the regeneration and repair of osteochondral defects (cartilage repair), such as those which occur due to trauma or osteoarthritis. ChondroColl™ closely matches the structure and composition of osteochondral tissue.
The scaffold is a highly porous collagen-based construct comprised of a number of distinct but seamlessly integrated layers, designed to closely mimic physiological osteochondral tissue in terms of both composition and structure. Each of the individual layers has a composition tailored to mimic the native tissue with a gradient pore/fibre structure modelled on the superficial to deep zones of articular cartilage and underlying subchondral bone.
This resorbable cartilage graft substitute, with proven in vitro and pre-clinical performance, offers an exciting early intervention option to orthopaedic surgeons in the treatment of damaged articular cartilage and may offer the potential to delay the need for full joint replacement.
For further information on Clinical Trials at SSC please email info@sportssurgeryclinic.com
Hurling is Ireland’s national sport and is among the top 4 sports for competitive participation in the country. Hurling is a sport rooted in Irish history and has been a distinct Irish pastime for at least 2000 years.
Though hurling holds the third highest attendance rate for sporting events in Ireland, little is known on the specific biomechanics unique to the hurling athlete. Much less the movement mechanics specific to the sport which typically characterize end stage rehabilitation programs or performance conditioning. Moreover, documented scientific analysis of such biomechanics may further enhance long-term athlete development within the sport. 3D motion analysis techniques have the potential to provide this insight.
The UPMC Sports Surgery Clinic, with the aid of its new state of the art 3D biomechanics assessment laboratory, is pioneering research in the athletic performance of hurlers. Initial research is underway focusing on the upper body movement involved in two of the most common hurling strikes in the game, a strike on the run and the free strike. This is aimed at establishing movement mechanics of the upper body joints in elite level inter-county hurlers.
Given that shoulder injuries are the most common non-traumatic upper body joint injury in hurling, 6.7% of whole body injuries, this research establishes the range of movement needed in each upper body joint for effective return to play. This analysis discerns the dominant joints for movement during the different hurling strikes. From an athletic development standpoint, is establishes the unique striking technique necessary for elite level hurling performance.
