L. Andrew Koman, MD, recognized by AAOS for 30 years of botulinum toxin and cerebral palsy research

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American Academy of Orthopaedic Surgeons

Mar 14, 2019, 03:01 ET

LAS VEGAS, March 14, 2019 /PRNewswire/ -- The Orthopaedic Research and Education Foundation (OREF) Clinical Research Award, which recognizes outstanding clinical research related to musculoskeletal disease or injury, was presented to L. Andrew Koman, MD, at the 2019 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Dr. Koman, along with co-authors Beth Paterson Smith, PhD, and Thomas L. Smith, PhD, studied the impact of botulinum toxins on the musculoskeletal system over the course of 30 years, defining its pharmacologic properties and documenting its positive value in patients with cerebral palsy. The use of this powerful toxin improved function, enhanced mobility, decreased painful spasticity and increased their quality of life.

Botulinum toxins, which are naturally-occurring poisonous substances, bind to the point where a nerve joins a muscle, preventing the muscle from contracting and resulting in paralysisⁱ. Botulinum A toxin had been used to balance eye muscle forces in children, but, in 1988, Dr. Koman and Dr. B. Smith were the first to inject botulinum A toxin to stabilize muscle imbalance in children with cerebral palsy. Botulinum toxins improved function for cerebral palsy patients, making daily activities more manageable.

"For severe patients, it facilitates their care and makes it easier for their caregivers to help them," said Dr. Koman, professor and chair of the Department of Orthopaedic Surgery at Wake Forest School of Medicine, Winston-Salem, North Carolina. "For patients with upper body functional impairment and mobility challenges, it was easier to get their clothes on and off, to raise their arms, and to get them in and out of wheelchairs. For less severe patients, it was easier for them to walk and it decreased pain. Using botulinum toxin delayed surgery a significant amount of time, decreased hospitalizations, improved the quality of life for patients, and it is cost effective."

In patients with cerebral palsy, the research demonstrated that the use of botulinum toxin could delay surgery for two years in patients who have an equinus (toe walking) deformity of the foot and ankle. Patients without fixed contractures–a deformity that results from constriction of the connective tissues–who continued to respond at nine months were often able to successfully use botulinum toxin for five to 20 years.

Dr. Koman and his colleagues built a multidisciplinary team of clinicians, therapists, scientists, engineers and public health researchers. The team performed over 110 pre-clinical and clinical trials, which established botulinum toxin as a safe and effective treatment for use in children and adults with cerebral palsy. A database that contains more than 25,000 patient years of data was created and allowed researchers to look at such factors as the cost impact of botulinum use and caregiver stress associated with the level of severity of cerebral palsy.

The research also confirmed the use of botulinum toxins as safe and effective for the management of habitual toe walking, joint contractures from lower-body paralysis, tetraplegia—a form of quadriplegia—spasticity, and Raynaud's phenomenon.

The team at Wake Forest has performed over 30,000 injections without any incidents of infection, systemic complications or injury. Predictable side effects may include occasional dry mouth and bruising.

"If used appropriately with the right dilution and the right number of units, it is a very safe drug," said Dr. Koman. "In the randomized, controlled trials, the patients who received placebo had more pain than the patients who had toxins. We found that by increasing the volume, we can decrease the amount of toxin, which makes it safer and less expensive, but we get the same efficacy."

Dr. Koman is also a professor of pediatrics and vascular surgery at Wake Forest School of Medicine and director of the Musculoskeletal Service Line. His practice is dedicated to pediatric orthopaedics and hand surgery with an emphasis on congenital deformity, cerebral palsy, microsurgery and peripheral nerve surgery. His focus is on clinical research in new musculoskeletal treatment modalities. He previously won the OREF Clinical Research Award in 1999 for his work in microvascular physiology.

Headshots and award ceremony photos are available upon request.

About the OREF Clinical Research Award.

The OREF Clinical Research Award was established in 1995 to recognize outstanding clinical research related directly to musculoskeletal disease or injury. All submitted manuscripts are reviewed, graded, and selected by the AAOS Research Development Committee. The award provides $20,000 to recipients. For more information about the manuscript submission process, please visit aaos.org/kappadelta.

About OREF

The Orthopaedic Research and Education Foundation (OREF) is an independent, 501(c)3 non-profit organization that raises funds to support research on diseases and injuries of bones, nerves and muscles and to enhance clinical care leading to improved health, increased activity and a better quality of life for patients. To further its mission, OREF is committed to exploring ways to partner with others to move the field of musculoskeletal research forward. For more information, visit www.oref.org and follow us on Twitter.

About the AAOS

With more than 38,000 members, the American Academy of Orthopaedic Surgeons is the world's largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues and it leads the health care discussion on advancing quality.

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ⁱ Medicine Net. Medical Definition of Botulinum Toxin. https://www.medicinenet.com/script/main/art.asp?articlekey=25769 Accessed 1/21/19.

SOURCE American Academy of Orthopaedic Surgeons