Research Proposal

Sarah Sweet
Intern/Mentor
2016
Research Title: Repairing a Torn Anterior Cruciate Ligament Through Bio-enhanced Methods

Overview of Research
This research will investigate and follow the clinical progression of a new form of
anterior cruciate ligament repair surgery: Bridge-enhanced ACL Repair Technique. The research
provides background information regarding the idea behind the technique and prospected results,
along with conclusive data pulled from published research. The research will follow the
technique through its clinical trial and compare the results to the expected benefits. The problem
that the Bridge-enhanced ACL Repair Technique is looking to resolve is how to reduce the
occurrence of early-onset post-traumatic osteoarthritis of the knee.

Background and History of the Issue

The anterior cruciate ligament (ACL) is a band of tough and flexible connective tissue
that runs diagonally through the anterior of the knee joint and stabilizes the motions of the knee.
Every year approximately 150,000 athletes in the United States tear their ACL during activities
that require motions involving a rapid change in direction, stopping suddenly, or landing
incorrectly. A torn ACL requires between six to nine months of recovery time before a full
recovery is reached and is traditionally treated with either a surgical or a nonsurgical approach.
A majority of patients will surgically repair a torn ACL because it is the only method that
restores full function. The ACL repair surgery is performed by resecting the stump of the ACL
and replacing it with the chosen graft which is conventionally an achilles tendon, patellar tendon,
or hamstring tendon. Dr. Martha Murray of the Boston Childrens Hospital is challenging this
traditional repair by introducing the Bridge-enhanced Repair Technique (BEAR). Dr. Murray
began her graduate education as an engineering student until she met a man that tore his ACL
and became intrigued by the ACLs inability to self heal. Her interest in torn ACLs eventually
led to her switching into medical school and since then she has been determined to develop a
technique to repair ACLs that is less.
When the ACL is torn it is not able to heal itself due to the synovial fluid that it lives in.
The synovial fluid that surrounds the ACL has circulating plasma that prematurely breaks down
the fibrin-platelet clot, thus preventing the formation of a scaffold for the two ends of the
ligament to join together and repair. The BEAR technique is an attempt to form this scaffold by
using a specialized protein sponge injected with the patient's blood to form a bridge between the
two ends of the torn ACL and provide a space for it to heal itself. This clot will provide
structural support along with growth factors and cytokines. These growth factors are important
to stimulate collagen production. A primary focus of the BEAR technique is to prevent
post-traumatic osteoarthritis which is at an increased risk due to the impact damage and the
inflammatory response.

Problem Statement and Rationale

Ideas and methods developed from the Bridge-enhanced ACL technique can benefit both
doctors and patients. The patients may benefit from the technique by reducing the risk of
osteoarthritis and thus improving their quality of life. The patient may also benefit from the
surgery being less invasive due to not requiring a graft harvest. Doctors may benefit from this
research by emphasising the idea of finding ways for the body to repair using its own biology.
The BEAR technique is a starting place for doctors to build future ideas off of that can
potentially one day enhance medicine.

Research Methodology

Research Question and Hypothesis

How can the Bridge-enhanced ACL Repair technique prevent the occurrence of
early-onset post-traumatic osteoarthritis of the knee?
The Bridge-Enhanced Anterior Cruciate Ligament Repair technique will advance
the repair of torn anterior cruciate ligaments by reducing the occurrence of early
onset osteoarthritis of the knee through its use of a collagen-platelet composite.

Basis of Hypothesis
My hypothesis is focused on how the BEAR technique can be used to reduce the
common risk of post-traumatic and premature osteoarthritis in patients following their
treatment for a torn ACL. The literature that I have studied thus far suggests that the
approximately fifty percent of patients who tear their ACL develop osteoarthritis
within ten to twenty years after the initial trauma. The BEAR technique has shown
that it will potentially reduce this risk by reducing the catabolic effect of enzymes on
the cartilage in the knee.

Research Design
I hope to conduct causal-comparative research. I plan on studying the results of
several scientific studies and experiments regarding the BEAR technique and how it
functions to improve the traditional ACL repair. Causal-comparative research will
also be used to follow the technique through its future clinical trials and progression.
The primary research data collection method that I plan on using is primary data
analysis. Primary data analysis will be conducted using data from published
experiments and articles. The data collected will both be quantitative and qualitative.
 Operational Definitions
Osteoarthritis- the degeneration of cartilage in the knee causing pain and stiffness.
Post-traumatic- after the patient has torn his or her ACL.
Bridge-enhance- a protein sponge injected with blood and used as a scaffold.

Product Overview
I hope to create research that can be presented and evaluated by doctors or medical
professionals. The audience will be doctors and students that have not been presented with the
idea of the Bridge-enhanced ACL Repair technique that can potentially use the ideas in their
practice or research. In order to distribute the product, I will publish an article on an online
journal or contest.

Logistical Considerations
A special consideration of my project is finding a group of doctors to review my research.
I will manage this by asking if the doctors at my internship would be interested in evaluating the
final product. Another consideration is how to get more information regarding the stage that the
BEAR technique is in right now and maintaining up-to-date information. I can manage this by
trying to come in contact with Dr. Murray or people that work with her to see if they will provide
any insight for me.