The Institute was founded in 2000 for the purposes of promoting and supporting clinical and basic science research on all human related knee disorders, traumatic and athletic knee injuries, complex knee ligament instabilities, limb alignment problems, tissue transplantation and cartilage restoration research. The Institute functions within the Foundation and Center on numerous programs. A patient registry, now active for over 25 years, tracks patients in over 20 prospective clinical studies. Full time researchers contact patients to return from all over the United States for follow up examinations using the Cincinnati Knee Rating system. This provides the basis for clinical presentations and publications with up to date research data on many surgical procedures including ACL, PCL, MCL and Posterolateral reconstructions; meniscus transplants, tibial and femoral osteotomies, cartilage restoration techniques, patellofemoral realignment and complex meniscus repairs.

The Institute has established national collaborations with scientists, universities and industry to address specific knee related research problems that require a multi-disciplinary approach using novel or innovative solutions. This includes collaboration of scientists and clinicians from different disciplines which include orthopaedics, rehabilitation, bioengineering, epidemiology, collagen biochemistry and basic science. The research projects are designed to address specific needs determined in the prospective clinical studies to improve patient surgery and treatment results.

A major emphasis is underway on the healing and remodeling of meniscus transplants with studies designed to improve clinical success for the next generation of meniscus allografts. This involves chemical stabilization techniques to retain the meniscus collagen microanatomy to use as a scaffold for tissue engineering studies. Loss of meniscus function in the knee joint with the subsequent development of tibiofemoral arthrosis is recognized as one of the foremost unsolved orthopaedic and sports medicine problems. Every year over 500,000 meniscus surgical procedures are preformed with a majority requiring partial or complete removal due to trauma or degeneration. The progression of osteoarthritis in the menisectomized knee depends on the amount of meniscus function retained, limb alignment, concurrent cartilage or ligament damage, body mass and patient genetics. A number of these factors are under study in the concurrent clinical studies.

Current meniscus transplants provide only a temporary and often less than ideal solution. The Institute has collaborated for the past four years in a multi-disciplinary program with biochemists, bioengineers and orthopedists on this problem. Future funding of basic science and clinical research will be required at major levels to address the novel approaches which have been selected in preliminary studies that have been presented at the Orthopedic Research Society and published in the Journal of Orthopedic Research.

A major program is underway to study the role of computerized navigation in patients requiring tibial or femoral osteotomy. Our Center has experience with computerized navigation in total knee joint replacements and initiated this project to transfer three dimensional motion measurements and digital imaging techniques to lower limb malalignment operative procedures. Studies are currently underway in cadavers and in clinical cases to analyze and develop navigation techniques. A second study has a focus to determine the role of computerized navigation for ACL and PCL reconstructions. There currently exists a great deal of enthusiasm in terms of transferring the three dimensional and digital technologies to improve ACL and PCL knee ligament surgical techniques. It should be noted that Edward S. Grood PhD, professor of biomechanical engineering at the University of Cincinnati, developed one of the first successful three dimensional motion and digitizing knee systems over twenty years ago which provided the basis of many published studies from our Foundation on the diagnosis of ligament injuries and biomechanics of knee ligament function. We are pleased that Dr. Grood will be continuing this research with the study of current computer navigation software and surgical techniques.

Another project underway involves studies to map three dimensional ACL fiber function under different loading conditions. Traditionally the ACL has been represented as consisting of two fiber bundles which incorrectly oversimplifies fiber function and has been proven in our studies and in other laboratories to be scientifically incorrect. An example of the complexity of this analysis is shown in the three-dimensional anterior cruciate ligament illustration above which demonstrates fiber separation distances under flexion and rotation loading conditions. Advances in ACL and PCL reconstruction will require surgical techniques to better replicate ligament function and provide normal joint stability.

The Institute was founded by Frank R. Noyes MD who has authored over 225 published works, and lectured throughout the United States, Europe and Middle East. Patients from around the world travel to the Institute to be evaluated and treated and receive information on the latest knee treatment advances available. Dr. Noyes has received many national and international honors including the Kappa Delta Research Award, Orthopedic Research and Education Clinical Scientist Award and is a past member of the American Academy of Orthopedic Surgery Board of Directors, National Institutes of Health Arthritis Advisory Committee, past chairman Olympic Medical Advisory Committee Soccer and past chairman of the Research Committee for the American Orthopedic Society for Sports Medicine. Dr. Noyes provided the initial research funding of the Institute with the goal to receive matching funding from national granting organizations. The Institute is a tax-exempt, non-profit foundation. All contributions are directly applied to research projects and all physicians donate their time without compensation.

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