Med Scholars Research
With rising healthcare costs and a transition to value-based care, it is important to understand what drives the cost in high-volume surgical procedures, such as anterior cruciate ligament (ACL) reconstructions. Under the guidance of Dr. Shea, I am performing a cost analysis to document the degree of cost variation in pediatric ACL reconstruction and ACL reconstruction with meniscus repairs at Stanford’s Lucile Packard Children’s Hospital. We also aim to identify variables that currently drive-up costs with ACL reconstruction and ACL reconstruction with meniscus repair.
Furthermore, I’ll be studying osteochondritis dissecans (OCD) of the capitellum and developing a better approach for graft matching. This is particularly important because an increase in youth sports participation has led to an increase in overuse elbow injuries in pediatric patients.
Faculty Advisor: Dr. Kevin Shea, MD
For my MedScholars project, I am working with Dr. Shea and Dr. Sherman in learning and testing the biomechanical properties of hamstring tendons used in Anterior Cruciate Ligament reconstruction at the biomechanics lab. The choice of grafts for ACL reconstruction (ACLR) is a critical factor that can be individualized based on patient characteristics and needs. By comparing the properties of constructs with different numbers of strands and types of tendons, we want to determine what constructs may have better biomechanical features for ACLR.
Faculty Advisor: Kevin Shea, MD and Seth Sherman, MD
Maike van Niekerk
Dr. Kali Tileston and I are working together to develop (a) a new biopsychosocial model of care for pediatric spine patients and (b) guidelines for pediatric orthopedic surgeons on how to improve quality, safety, and value (QSV) in their institutions. Detailed descriptions of both research projects are provided below.
1. Biopsychosocial model of care
Importance: Spine disorders can alter a child or adolescent’s daily life for years. Chronic spine disorders require holistic, integrated, and coordinated care throughout patients' illness trajectories. Despite this, there is limited evidence on interventions to improve the biopsychosocial care delivered to pediatric patients with these conditions.
Aims: We are therefore developing and implementing a new biopsychosocial model of care for pediatric patients with spine conditions that uses a social worker: Social work for Pediatric INtegrated spine carE (SPINE). Its design will be informed by published literature and clinical experience, through the use of a systematic review of relevant literature and an expert consultation meeting. We plan to test the model after its development as a randomized controlled trial.
Supervisors: Dr. Kali Tileston MD (primary) & Dr. John Vorhies
2. Quality, safety, and value guidelines
Importance: Discussions with orthopedic leaders in POSNA (Pediatric Orthopaedic Society of North America) have revealed important opportunities for improving quality, safety, and value in the field, including addressing burnout in orthopedics and equipping pediatric orthopedists with tools on how to do quality improvement projects.
Aims: We are therefore developing (a) evidence-based guidelines that define burnout, describe its prevalence and associations, and outline interventions for addressing burnout on an individual- and institutional-level, as well as (b) a step-by-step quality improvement toolkit that pediatric orthopedists can use to develop and implement quality improvement initiatives in their institutions.
Supervisors: Dr. Kali Tileston MD (primary) & POSNA Wellness Leaders
Under the guidance of Dr. Shea, I am working on designing and training an algorithm to determine whether a patient with osteochondritis dissecans of the knee will heal with non-operative treatment by using baseline characteristics present in the Research on Osteochondritis Dissecans of the Knee (ROCK) cohort. I plan to validate the classification model’s performance and implement it in clinical settings.
Additionally, I am studying the biomechanical properties of different fixation constructs for tibial eminence fractures. We hope to determine the biomechanically optimal fixation technique within pediatric tissue.
Faculty Advisor: Dr. Kevin Shea, MD
Willemijn van Duersen
My project studies the biomechanics properties of the menisco-tibial ligament complex (MTCL) in pediatric knees. Our objective is to evaluate the anatomy and biomechanical strength of the MTLC of the medial and lateral meniscus, which has not previously been studied in pediatric tissue. Since inclusion of the MTLC in some meniscus repair constructs may produce more normal anatomy than repair to the menisci-capsular complex, these findings will inform possible applications of MTCL-based meniscus repairs for meniscal ramp lesions, postero-lateral tears, and meniscus transplants.
From the Allosource specimen dissection conference in Colorado to the biomechanics lab, research with Dr. Shea’s team has been hands-on and collaborative. It has given me insights into how to approach research from the mindset of a surgeon. In particular, I feel motivated by the direct applications of our research findings to surgical practice. I am grateful for Dr. Shea’s mentorship and efforts in celebrating science and diversity in orthopedics.
Faculty Advisor: Dr. Kevin Shea, MD
My name is Wills, and I am an MS2 doing MedScholars research under the mentorship of Dr. Kevin Shea, MD in Pediatric Orthopedics. My MedScholars project is a biomechanical analysis of meniscus repair constructs. My project has two aims:
1) Assess and compare the biomechanical properties of four different all-inside (inside the capsule) repair techniques for radial tears in human cadaveric menisci, including one novel repair we designed.
2) Evaluate the impact of reinforced, or “rebar,” suture patterns on the strength of repairs.
All-inside, meniscal-based suture repairs have shorter operating times, minimize risk of nerve injury, and are increasingly possible with new devices. Currently, no study focuses on all-inside repairs to radial tears. Our study will add useful data for surgeons to consider when deciding which repair technique to use, which may improve outcomes in meniscus surgery patients.
I am working full-time in the Biomechanics Lab during the summer 2022. In June, I attended the annual cadaver dissection lab at Allosource in Centennial, Colorado along with several dozen attendings, fellows, residents, and medical students. I helped dissect pediatric knees, learned arthropscopic techniques from some of the nation’s leading pediatric orthopedic surgeons, and received advice on my project and career. I have received mentorship at all stages of my research from attendings and residents throughout the department. My research experience is a tremendous opportunity for learning and professional development that will form a base for my future career.
Faculty Advisor: Dr. Kevin Shea, MD
My Medscholars project is looking at the use of cannabidiol (CBD) as a therapeutic agent in children with cerebral palsy.
The study aims are:
(1) To assess the relationship between CBD use and quality of life for children with cerebral palsy.
(2) To describe current CBD use patterns including frequency, duration, dosage, and modality, as well as opinions about CBD use in children with cerebral palsy.
To do this I will be using a disease-specific and caregiver-proxy survey that measures health-related quality of life (HRQOL) and a CBD-specific survey. I have been working on contacting and recruiting patients for the study and distributing surveys. Our goal is to enroll 150 patients by the end of 2020. I look forward to analyzing the data and writing up the findings for conferences and journals. This prospective observational study will help lay the groundwork for future interventional trials on this topic.
Faculty Advisor: Dr. John Vorhies, MD
Yousi (Josey) Oquendo
My name is Josey and I am an MS4 on a research year under the mentorship of Dr. Michael Gardner in Orthopaedic Trauma, Dr. Serena Hu in Orthopaedic Spine, and Dr. John Vorhies in Pediatric Orthopaedics. In the Pediatric Orthopaedic group, my primary research project is a prospective cohort study evaluating the validity of 3D topographical scanning in Adolescent Idiopathic Scoliosis. We are using a 3D camera called a Structure Sensor that is able to create a 3D rendering of the torso for measurement and analysis. In the adult Orthopaedic Trauma Research Group, we recently validated the use of this device for evaluation of shoulder ptosis and surface deformity in clavicle fracture. In this scoliosis study, the measurements obtained from the 3D scan will be correlated to scoliometer and radiographic measurements, and patients who undergo repeat scan will have their scans compared over time. Our primary aims for this project are the following:
- Validation of 3D topographical scanning for monitoring of Adolescent Idiopathic Scoliosis.
- Set the foundation for use of 3D topographical scanning to be used as a tool in surgical and interventional decision making.
- Determine which patients and which degrees of deformity would be appropriate to scan by 3D topographical scan without need for x-rays and additional radiation.
I was previously involved in the clavicle fracture study on the adult trauma side, and was interested in running this particular sub-study due to previous work I had done in the juvenile scoliosis as part of my undergraduate senior design project. I have been involved in research across a wide variety of disciplines within medicine and engineering, and was a clinical research coordinator at the Children’s Hospital of Philadelphia prior to beginning medical school. Given my engineering background and my previous experience as a research coordinator, this project has been a great opportunity to take full ownership of the research process from the very beginning of a project while also allowing me to combine a number of my skillsets. I look forward to not only continuing my work on this project, but also on seeing where the concept of 3D topographical mapping takes us next within the field of Orthopaedics.
Faculty Advisor: Dr. John Vorhies, MD, Dr. Michael Gardner, MD, & Dr. Serena Hu, MD
The growing number of skeletally immature patients with significant meniscus injury warrants a more thorough understanding of meniscus anatomy, biomechanics, and surgical repair options. This descriptive laboratory study in pediatric cadavers ages 8-12 years aims to:
1) Characterize contact biomechanics (contact area and contact pressures) of the intact lateral meniscus using a six-degrees-of-freedom robot capable of inducing size-appropriate loads at precise degrees of flexion.
2) Characterize contact biomechanics of the lateral meniscus in states of posterior root tear and root repair. Determine the extent to which root repair restores biomechanics of the intact meniscus state.
3) Characterize contact biomechanics of the lateral meniscus in states of meniscectomy and subsequent transplantation. Determine the extent to which meniscus transplantation restores native biomechanics in meniscus-deficient knees.
Our results improve understanding of how surgical repair methodologies impact contact biomechanics of the knee joint in states of meniscus deficiency and repair. Developing techniques that restore maximal contact biomechanics may improve outcomes in pediatric patients.
Faculty Advisors: Dr. Kevin Shea, MD and Dr. Seth Sherman, MD
In the skeletally immature patient population, injuries to the knee that require ligament reconstruction are increasingly common. The process of choosing a graft for surgeries that involve cruciate or collateral ligament reconstruction in pediatric patients is limited by the lack of specific knowledge of the mechanical properties of those ligaments. The specific aims of this project include:
1) describe the mechanical properties of the ACL, PCL, MCL, LCL and
2) describe the microstructural properties of the ACL, PCL, MCL, LCL, using histology, polarized light microscopy, and transmission electron microscopy.
The study proposed in this application will increase our knowledge of the pediatric knee ligaments, which can have a direct impact on the clinical decision-making of surgeons who are performing knee ligament reconstruction. The lack of empirical data about the ligaments in the pediatric knee is currently a limitation in the surgical planning process in pediatric orthopedics and access to pediatric cadaver knees and the ability to explore the mechanical and microstructural properties of the pediatric knee ligaments will grow our knowledge of this important area of medicine.
For this project, I hope to gain experience in planning and conducting research and to do so while learning about an exciting area of research in orthopedic surgery. I also hope to solidify my interest in orthopedic surgery and learn more about the field through research.
Faculty Advisor: Dr. Kevin Shea, MD
Unfortunately, due to the Covid-19 Pandemic, we were unable to support the Med Scholars Research program for the 2020-2021 year.
Emily Phu Tran
My Medscholars project is a biomechanical and histological analysis of a discoid meniscus. My project has two aims:
(1) To perform a biomechanical analysis of the pressure and contact forces experienced on the tibial plateau with an intact lateral discoid meniscus.
(2) To score the surface integrity, cellularity, matrix fiber organization, and collagen alignment of the intact, full-specimen discoid lateral meniscus.
The purpose of the study is to understand the mechanical and structural differences in the discoid meniscus. Findings will potentially inform future treatments and managements for patients with this meniscus variant.
I will be working with the Biomechanics Lab in the Department of Orthopaedic Surgery, under the mentorship of Dr. Kevin Shea. Over the summer of 2019, I will be participating in the annual cadaver dissection lab hosted by Dr. Shea and Allosource in Colorado, and will have the opportunity to learn surgical techniques and clinical anatomy from various well-known orthopaedic surgeons. With no prior experience in orthopedics, I was able to put this project together with much support from the Pediatric Orthopaedic Surgery division. I have received mentorship and advice for every aspect of my project, which has provided me the opportunity to discover the many resources available within the department. This research experience has been fundamental to my learning and the development of my future career.
Faculty Advsior: Dr. Kevin Shea, MD
I am working on the CARE Study. The Clubfoot Activity & Recurrence Exercise Study (CARES) is a mixed-methods and a prospective cohort study that will analyze activity levels in 40 enrolled patients diagnosed with about half of the participants categorized as non-relapse controls. Participants’ activity levels will be monitored from a wearable Fitbit device, and I will be tracking participants’ data in Fitabase.
I hypothesize that children with recurrent clubfoot have worse physical performance than clubfoot children who have not experienced a relapse. To test this hypothesis, I have two study goals:
(1) To investigate whether clubfoot children who experience a relapse take fewer steps than clubfoot children who have not experienced a relapse, through quantitative measures of 1) daily step count, 2) activity rate (steps/hr), and 3) activity intensity
(2) To determine whether children with recurrent clubfoot exhibit lower activity levels when compared to those with non-recurrent clubfoot, through qualitative parental reporting of their children’s daily activities
I have been working on CARE Study since winter quarter and made a significant effort to finalize study materials. These include participant manual, feedback questionnaire, post-study surveys etc. I also ran a Fitabase trial to monitor activity levels in lab members and make sure the study runs smoothly once we start recruiting patients. This is the first time that I run a study from early steps of design to the actual execution steps of the study, and I cannot wait to recruit patients and analyze their data over the summer!
Faculty Advisor: Dr. Steven Frick, MD
This summer I have the privilege of leading a database study that will look at the treatment and complication rates of patients with spinal epidural abscesses across different exposure groups stratified by race, socioeconomic status, and HIV or Hep C infection status. I’m super excited about working on this project because of its bearing on surgical intervention in medical cases, as well as the potential healthcare disparities it may highlight. Surgical intervention is often the leading intervention, but many patients have medical management attempted. We hypothesize that some of this difference in treatment may stratify across some of our exposure groups which could highlight an area for improvement and further minimization of complication rates. I look forward to working as even more extensively as a team member with the Pediatric Orthopaedics Research Group, an experience that has already taught me a lot in the short time that I’ve dedicated to it.
Faculty Advisor: Dr. Kali Tileston, MD
Ivan Daniel Mayor
My research project is a mixed-methods study that used both surveys and interviews with parents and children in the pediatric sports medicine clinic in order to better understand how our participants view concussions. The project had two aims:
(1) To explore and note the expectations parents bring to a concussion clinical encounter, in order to enhance concussion care and better address parental concerns about their children's health.
(2) To discover the factors that influence concussion education, identification and those that improve engagement and retention of information before concussions happen. Probing both parents and children will allow for the development or improvement of educational modalities that are best suited for this topic and audience.
I had never developed nor ran a research project of my own, but I brought the idea to the Pediatric Orthopedic Department and with their help and the support of the Medical Scholars Research Program we were able to make this project a reality. From day one the department found faculty I could work with, a clinic setting to host the project, and logistical support every step of the way to see it through to the end. This research experience has been invaluable to me, my career development, and I have no doubt that it will be the stepping stone to future projects. I look forward to presenting and publishing the findings to share my excitement about what we have found.
Faculty Advisor: Dr. Emily Kraus, MD