Ever Curious Robert LaPrade, M.D., Ph.D., Publishes His 500th Research Study

Can orthopedic researchers reach rock star or even hip hop status?

The answer, if you are the ever curious Robert LaPrade, M.D., Ph.D., who is one of the most prolific research scientists to ever grace an orthopedic laboratory as well as one of the world’s leading complex knee and orthopedic sports medicine surgeons is…yes, you can.

We caught up with Dr. LaPrade on the occasion of his 500th published study in Minnesota, at the offices of Twin Cities Orthopedics, where he’s recently moved from the Steadman Clinic in Colorado.

His landmark 500th published study, the culmination of more than 20 years of research, and a lifetime of asking questions and designing scientifically robust ways of answering them, is “Single-Stage Multiple-Ligament Knee Reconstructions for Sports-Related Injuries: Outcomes in 194 Patients.”

Of course, we review his 500th study, but that comes later in this article.

First, inquiring minds want to know, what makes Curious LaPrade such a research machine?

Presenting Robert LaPrade, M.D., Ph.D.

In his own words, Dr. LaPrade credits a burning desire to learn, a great team and the unique nature of his clinical practice for his amazing research productivity.

“I strongly believe that I have learned a great deal from each and every research project that we have completed, and I have always surrounded myself with an eager and bright research team which makes it easy to juggle our research program with a full clinical schedule.”

“Due to my complex knee referral practice, many pathologies that may be rare in other’s practices are quite common in my practice and it has been fulfilling to develop bench-to-bedside research solutions which solve many of these pathologies and improve patient outcomes.”

Given his unique position atop the research mountain, what does Dr. LaPrade think are the hottest areas of research for knee injuries right now?

“I feel that the most important thing to highlight is that the anatomic-based reconstructions that we have developed enable a quicker initiation of postoperative rehabilitation so that their ability to return to high level full activities after complex knee injuries is enhanced.”

“Our recent publications have validated that double bundle PCL [posterior cruciate ligament] reconstructions can have postoperative outcomes similar to ACL [anterior cruciate ligament] reconstructions and that athletes with multiple ligament knee reconstructions, including professional athletes, can have excellent outcomes and return to the highest levels of sport with these techniques.”

“Additionally, we have validated that we can successfully repair meniscal tears that were previously considered to be ‘non-repairable,’ such as radial tears of the meniscus.”

So, we asked, out of all the surgical techniques you have developed, which are the most important to highlight? We almost stumped him.

“That’s a tough question. If you asked me last year, I would say the diagnosis and treatment of meniscal root tears. However, my and other groups have validated that one’s age doesn’t matter for repairing these tears and it is more about the status of the patient’s articular cartilage that should be assessed when deciding to repair a root tear.”

“The latest hot topic over the past 12-18 months is probably recognizing the role of tibial slope on cruciate ligament reconstructions.”

“A significant amount of new research has recently been published on this topic which helps us to better understand the role of bony geometry on both cruciate ligament primary tears and also for reconstruction graft tears.”

“I believe the role of slope changing tibial osteotomies will increase a lot in the near future due to this new research on tibial slope.”

And, most important, what studies are you working on now? And can you describe your bench-to-bedside program?

“We are working on studies on knee bony geometry to help us understand which patients are most at risk for injury and to determine how to best address revision cruciate ligament reconstructions.”

“Our bench-to-bedside program is centered around focused and clinically relevant research. We describe our program as the research pyramid.”

“The base of the pyramid is quantitative anatomy studies and biomechanical studies which use the new findings from the quantitative anatomy studies.”

“The next layer of the pyramid is developing improved diagnostic tests for that particular pathology based upon the new information learned from the biomechanical studies.”

“From there, the next layer of the pyramid is to develop anatomic-based reconstructions (or repairs for structures like the meniscus).”

“Finally, the top of the pyramid is clinical outcome studies to validate the anatomic-based reconstructions and essentially all of the previous studies.”

“Every step, or layer, along the pyramid provides new elucidations of the pathology being studied which ultimately helps us to improve understanding, diagnosis, and treatment of many complex knee injuries.”

LaPrade’s advice to new orthopedic surgeons is to really understand the anatomy involved. He said that when he was first starting out he was surprised at how poorly defined it was in the past.

Before and After LaPrade

The true measure of LaPrade’s influence is the extent to which he has advanced clinical care for other physicians. Among his colleagues, he is known as a “doctor’s doctor.” LaPrade’s anatomic-based reconstruction techniques are considered standard care both nationally and internationally.

Indeed, one of LaPrade’s colleagues told OTW “there is a before and after the LaPrade era.”

Mark R. Hutchinson, M.D., professor of orthopedics and sports medicine, head team physician, University of Illinois Chicago said this about Dr. LaPrade to OTW:

“Dr. LaPrade’s techniques have always followed the ideal sequential plan from cadaver analysis to confirm anatomy, to biomechanical assessment of function, to animal testing assessment and controlled human testing, leading to long term high quality follow up of clinical outcomes…. Congratulations and deepest appreciation to Dr. LaPrade for his thoughtful approach to knee injuries and for this great manuscript…his 500th publication listed in PubMed!!!!

“The latest manuscript: “Single-Stage Multiple-Ligament Knee Reconstructions for Sports-Related Injuries: Outcomes in 194 Patients” published by Dr. Robert F. LaPrade and his exemplary team is an excellent and honest paper coming from one of the world’s greatest if not best multiligament knee surgeons.”

“The manuscript tells us that we can get excellent outcomes from single stage multiple-ligament knee reconstructions if we stay true to the anatomic concepts and techniques that Dr. LaPrade had mastered, developed, and mentored us all over his 25-year career.”

Jorge Chahla, M.D., Ph.D., assistant professor of sports medicine in the department of orthopedic surgery and director of Biomechanics Research at Midwest Orthopaedics at Rush chimed in saying:

“Dr. LaPrade has not only reached an outstanding numeric accomplishment of 500 peer-reviewed publications, but over the past 20 years he has been the world leading expert on complex knee pathology.”

“With his pyramid approach (anatomic based, biomechanically validated techniques, and objective diagnosis), he has shed light onto several prevalent musculoskeletal pathologies. Nobody can deny that there is a before and after the LaPrade era.”

“He is a true leader in the field and an exceptional mentor. Congratulations to the best!”

Tim Spalding, FRSC Orth, knee surgeon and Honorary Associate Professor at the University of Warwick, UK added:

“’Single-Stage Multiple-Ligament Knee Reconstructions for Sports-Related Injuries: Outcomes in 194 Patients’ is the most comprehensive outcome analysis of a personal series of knee reconstructions that I have read.”

“Testament to the dedication to quality care and science-based improvement by Dr. LaPrade, resulting in benefit for patients worldwide as surgeons read and emulate this work.”

Carlos E. Franciozi, M.D., Ph.D., Post-Doc, associate professor, department of Orthopedic Surgery, head of the Orthopedic Surgery Residency Program and head of the Knee Group Research Program at Federal University of Sao Paulo, Sao Paulo, Brazil sent OTW this wonderful accolade for Dr. LaPrade:

“Dr. Robert LaPrade pushes the limits of knee surgery and shows us how to improve our patients’ outcomes, especially the ones involving complex lesions. From the research lab to the operating room, he is a visionary and an example to be followed.”

“We look to him to continue leading the way by sharing his knowledge and expertise. It’s an honor to be involved with his projects and to apply his advanced techniques and philosophies for optimal treatment and understanding of knee injuries here in Brazil.”

The OFFICIAL 500th LaPrade Study!

Published during the summer in the American Journal of Sports Medicine, LaPrade’s 500th study analyzed 276 patients with multiple-ligament knee injuries who’d sustained those injuries from participating in sports between 2010 and 2016.

LaPrade’s team used multiple scoring methods including the Lysholm score, Tegner activity scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-Item Short Form Health Survey Physical Component Summary to measure the enrolled patients before surgery and at a minimum of two-years post treatment.

LaPrade’s team wrote in their study that 194 (70.5%) of the patients had a complete follow-up at a mean 3.5 years (range, 2-8 years) and that, overall, all outcome scores improved as compared with preoperative scores (p < .001 for all scores).

“The median (first and third quartiles) Tegner activity score improved from 1 (0, 2) preoperatively to 6 (4,7) postoperatively. Median Lysholm and WOMAC scores improved from 41 (22, 57) to 90 (78, 95) and 44 (24, 60) to 3 (1, 8), respectively.”

In addition, the team did not find a significant difference between patients treated in the acute and chronic phases for PCL- and ACL-based multiple-ligament knee injuries. A little more than 9% of patients (18) developed arthrofibrosis and were treated with reintervention surgery.

LaPrade and his team concluded, “These results demonstrated that single-stage anatomic-based knee ligament reconstructions with immediate postoperative rehabilitation in the setting of sports-related multiligament injuries yielded significantly improved outcomes irrespective of the ligament injury pattern.”

And, with that, Dr. LaPrade drops the mic and walks off…to his next study.