28
February
2022
|
06:00 AM
America/New_York

Action Figure

Summary

A sports medicine physician has translated his passion for helping injured athletes get back in the game into an innovation that marries the fields of medicine, engineering, and design.

ActionFigure_Tuttle

 

John Tuttle, M.D., didn’t intend to transform orthopaedic surgery.

The sports medicine physician was simply trying to solve a niggling problem he often encountered in practice: fixing soft tissue to bone when repairing an injury. While it’s a common procedure for those in orthopaedics and sports medicine, the technique can be challenging, and success depends on a variety of factors. “I knew there had to be a better way to do it,” he says.

Now, thanks to an inspired collaboration with Prachi Joshi, who leads invention development with a background in biomedical engineering, and the rest of the team at Carilion Clinic Innovation, Dr. Tuttle is moving a surgical “what if” closer to a game-changing reality. Known as the soft-tissue fixation button, the invention, says Joshi, “is different from anything else that’s currently out there.”

 

Identifying a Surgical Challenge

 

Dr. Tuttle has spent his career helping injured athletes—from weekend warriors to professionals—get back in the game.

A childhood love of basketball, baseball, and football while growing up in Ohio eventually led him to a fellowship in sports medicine at Northwestern University, where he helped provide care to players on teams such as the Chicago Cubs, Bears, and Blackhawks. Since joining Carilion Clinic in 2017, he’s worked with some local teams, including those from the Virginia Military Institute, Southern Virginia University, and Washington and Lee University.

“I’ve always felt really at home on the sidelines and in the locker room,” he says. “I enjoy working with this patient population because they’re so motivated to get back to a high level of functioning.”

In treating athletes, Dr. Tuttle has become intimately familiar with sports injuries and their repair. One such repair involves reattaching tendon to bone following a tear. This can occur with the biceps tendon, particularly the long head of the biceps tendon, which connects the biceps muscle to the shoulder socket. Unexpected force—falling on an outstretched arm or lifting a heavy weight, for instance—can damage the tendon, as can repetitive motions and long-term overuse.

Minor tears don’t always need treatment, but people who especially depend on the strength and function of their biceps tendons, such as athletes and manual laborers, often require surgical intervention.

These days, surgeons usually repair such ruptures and tears arthroscopically; both physicians and patients tend to prefer this minimally invasive approach. The challenge, says Dr. Tuttle, comes in successfully fastening the tendon to the bone. When repairing a long head of the biceps tendon, the tendon can either be cut and released or, preferably, cut and then attached to the humerus bone in the upper arm.

The problem: “Each patient has a natural tension relationship between the tendon and bone,” says Dr. Tuttle. “It can be difficult to determine how much tendon to cut so we can reestablish and maintain that tension once the tendon is reattached.”

Dr. Tuttle knew what he and his colleagues wanted: a way to fix the tendon to the bone before they cut it. But creating that solution would take more than just wishful thinking. There was much to consider.

“It would mean coming up with something that offered secure fixation, minimized the amount of tendon to be removed, maintained the force coupling of tendon to bone, was reliable, and—most important—was achievable technically,” he says. “I kept thinking about it, going through many trial-and-error scenarios in my head.”

Then, just a few years ago, the solution began to crystallize when a new knotless anchor hit the market. This innovative surgical device allows physicians to drill into bone, attach a suture, and lasso soft tissues to the area without tying knots.

“I had a lightbulb moment,” Dr. Tuttle says. “It occurred to me I could use this anchor as a springboard for a new type of soft-tissue fixation. My wheels started turning.”

 

Back-of-the-Napkin Idea

 

Around the same time, Joshi was transitioning from the National Institutes of Health’s Pitt Clinical and Translational Science Institute to a new role as innovation manager at Carilion Clinic Innovation. Under the leadership of Troy Keyser, she manages the department’s proof-of-concept program, guiding early- to mid-stage innovation projects from ideation to possible commercialization—all with the ultimate goal of improving patient care.

For Dr. Tuttle, it was perfect timing. He had finally devised what he thought was a viable solution to the challenges of tendon repair: a button that could be secured to the new knotless anchor. As with a button on a shirt, this approach would allow surgeons to affix soft tissue onto bone, where, over time, that tissue would eventually establish itself. “It was one of those back-of-the-napkin ideas,” he says, referencing the classic brainstorm sketched roughly onto a cocktail napkin.

“I’m not sure if we even had a sketch when we started,” Joshi says. “But Dr. Tuttle had an idea, and the way he was able to articulate that idea and its potential clinical impact really drew us in.” Intrigued, she and the team told Dr. Tuttle they were on board.

What happened next was the ultimate collaboration between the fields of medicine, engineering, and design. Working with one of the team’s engineers, Dr. Tuttle refined his idea based on computer-aided design models, which were 3D-printed as prototypes in Carilion Clinic Innovation’s makerspace, tested, and refined yet again—a process that took about eight months. Now, working with a final prototype, 
Dr. Tuttle has begun testing both the button and the procedure itself.

“We believe that it’s an easier, faster, and more reliable approach to soft- tissue fixation,” he says. “But the biggest question remains: How strong is that fixation?”

To learn more, Kendall Carter, a student at the Virginia Tech Carilion School of Medicine, is leading a project that compares Dr. Tuttle’s prototype to a commercially available button and explores alternative techniques that test the approach from a biomechanical standpoint. Together, they are conducting in-vitro testing in tissue-based models to determine the clinical relevancy and biomechanical properties of the latest prototype.

Austin Petty, an undergraduate at the Virginia Tech College of Engineering, and his mentor, Vincent Wang, Ph.D., an associate professor of biomedical engineering and mechanics, will analyze the study samples using a biomedical apparatus they’ve designed. They expect to have preliminary results later this year.

 

prachi joshi

A Dream Almost Realized

 

Meanwhile, Dr. Tuttle has filed a patent for his innovation. The goal, he says, is to get a working product on the market that expands surgical options and provides physicians with a new way to help patients. “I’ve never tried anything like this before,” he admits. “I have many ideas and ‘wouldn’t it be nice’ notions, but now this is more than just a whimsical thought. It’s starting to become a concrete product and a real option.”

It’s a dream almost realized—and one
he believes wouldn’t be possible without Joshi and Carilion Clinic Innovation.

“I don’t have the time, resources, or expertise to create something like this on my own,” says Dr. Tuttle, who joined Carilion because he wanted the opportunity to teach, conduct research, and explore innovation in addition to providing patient care. “Prachi and her team have been ready to help me every step of the way, and that’s allowed me to focus on my clinical practice while really getting this innovation moving.”

For Joshi, it’s a prime example of why she, too, landed at Carilion. “Our vision is to help develop inventions that have a real clinical impact and that can be realized broadly through commercialization,” she says. “We provide the resources and give inventors everything they need to create and play.
Dr. Tuttle is the clinical expert. My job is to enable him to do what he loves.”

And Dr. Tuttle has no plans of stopping. Although it’s too early to share the details, he’s working with Joshi and Carilion Clinic Innovation on several other projects, too—all stemming from the challenges and questions that occur during clinical care.

“My patients inspire me to keep searching for new answers to issues that arise,” he says. “I’m full of ideas for the future.” 

 

Written by Jessica Cerretani