ISTM

While an Orthopaedic Consultant Surgeon at the University Hospital of North Staffordshire, Professor Maffulli held the Keele chair of Trauma and Orthopaedic Surgery until 2008, and developed a close relationship with basic and clinical scientists, notably collaboration with Prof Alicia El Haj, Dr Ying Yang and other members of ISTM's tissue engineering group. He has been involved in projects such as genetic analysis of protusio acetabuli and developmental dysplasia of the hip, and tissue engineering of tendons. 

He has been involved in a range of multi-diciplinary research within the musculo-skeletal field, which can be grouped under:
1. Tissue engineering
2. Genetics studies
3. Sports medicine and sports trauma
4. Randomised controlled trials in Trauma and Orthopaedics

Prof Maffulli has developed a wide network of collaborations with colleagues in the UK and abroad, and, through this network, has set up and taken part in multi-centre trials. In 2008 he moved to a new post in London at the Centre for Sports & Exercise Medicine, but retains a Keele honorary research position and involvement in ongoing translational projects at the university.

Other Visiting Professorships:

• Visiting Professor in Orthopaedics and Traumatology, Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong (since February 1999).
• Visiting Professor in Orthopaedics and Traumatology, Department of Orthopaedics and Traumatology, University of Napoli Federico II, Italy (since November 2002).

ISTM Research theme: 1. Bioengineering & Therapeutics

Research interests:

• Molecular biology, tissue engineering and genetics studies

1. Molecular biology of the thyroglobulin gene

2. A genetic analysis of congenital talipes equinovarus in Great Britain - collaborative study with the Department of Genetics, University of Aberdeen Medical School, and the Departments of Orthopaedics of the Hospital for Sick Children, London, and of the Doncaster Royal Infirmary, Doncaster.

3. A genetic analysis of protusio acetabuli and developmental dysplasia of the hip - collaborative study

4. Mechanical strains and musculoskeletal system cell function - magnetic fields applied to musculoskeletal system cells (bone, tendon, intervertebral disc) aimed at upregulation of cellular function. This is the preliminary phase of a tissue engineering endeavour in the musculoskeletal system.

• Sports medicine and sports trauma

1. Imaging - high resolution real time ultrasonography to the study of soft tissues traumatic lesions and to the process of bone healing in long bone fractures and following callotasis lengthening. Fine ultrasonographic characteristics of tendinopathy in athletic and non-athletic patients.

2. Clinical and basic sciences studies on tendinopathy - in collaboration with some Italian centres and with Hong Kong. Efforts are being made to find an effective alternative to corticosteroids for local injections, and to perform less invasive surgery, especially in the early phases of the condition. Aprotinin is a promising drug in this respect, and percutaneous longitudinal tenotomy has proved to relieve pain in chronic tendinopathy. In the Department of Orthopaedics of the Chinese University of Hong Kong, an in vitro model of tendon injury has been characterised. Preliminary data on the influence of bFGF have been obtained. Further studies at cellular and molecular level are in progress. Also in process is a study of the application of collagen gels to deliver growth factors in tendon injuries.

3. Knee arthroscopy - data on approximately 3000 arthroscopies have been collected. In athletes, an acute haemarthrosis implies a serious knee derangement, and necessitates arthroscopic assessment by an experienced surgeon. In neglected anterior cruciate ligament tears, there is a high incidence of degenerative meniscal changes. A longitudinal data collection study is in progress in collaboration with the Prince of Wales Hospital, Hong Kong.

4. Effects of intensive training on the musculo-skeletal system of elite young athletes (TOYA) study - a multidisciplinary team of eight scientists have followed 543 elite young athletes, practising either football, gymnastics, swimming, and tennis in a longitudinal project. The data collected in the first two years of the study have been analysed, with special reference to the effect of strength and flexibility as factors determining sports injuries. Follow-up studies of this unique sample of young athletes are being performed.

5. Immobilization and destabilization in experimental osteoar­thritis of the knee in rabbit - in collaboration with the Department of Orthopaedics at the Chinese University of Hong Kong, an experimental model in the rabbit knee is being used to study osteoarthritis.

• Correction of limb deformities and external fixation

1. Studies on limb lengthening - physiological studies focused on isometric strength expression by normal and shortened or lengthened limbs. The radiological appearance of bones during and after lengthening has been studied. Further studies are in progress with some of the Italian centres where Ilizarov techniques have been used for more than a decade, and involve both prospective and retrospective projects, mainly of a clinical nature.

2. Intra-epiphyseal human recombinant growth hormone for limb lengthening - basic science and clinical study for correction of limb length discrepancy and short stature, currently focussed on the effects of growth hormone on the cells of the growth plate using cell and molecular biology techniques.

3. Biomechanics of external fixation in limb lengthening - computer-modelling of the musculo-skeletal system by finite element analysis method to determine how changes in fixator configuration would affect the biomechanical environment of the osteotomy.

• Trauma

1. Hip fractures - planning an intervention study of the influence of nutrition on the outcome of surgery for fractures of the proximal femur.

2. The effects of mental imagery on recovery from lower limb trauma - in collaboration with the Department of Mental Health in Aberdeen, applying ideas drawn from mental imagery of cancer patients, to the recovery following lower limb trauma. It is hoped to conduct a prospective randomised trial.

• Exercise physiology

1. Muscle physiology - collaborative studies with the University of Chichester to investigate sarcopenia in elderly orthopaedic patients.

2. Endurance and aerobic power - study of the association between endurance performance and sustained aerobic power using mainly non-invasive tests. Adults, older adults and children have been studied, and the anaerobic threshold has been used as a basis to plan training in long distance runners.

3. Sexual hormones metabolism in sedentary and athletic women - studies using radiolabelled sexual hormones to study their metabolic clearance rate during exercise to understand the role of exercise in determining hypo-oestrogenic and hypo-progestinic states. Further investigations concerning the study of the hypothalamus-hypophysis-ovary axis and exercise are in progress.

4. The effects of physical activity in master athletes - a collaborative study with the University of Napoli, to study longitudinally the effects of sports activity (mainly endurance exercise) in athletes older than 60. The initial results show that this group of athletes is still training hard, and benefit greatly from continuing training.

5. The study of exercise and cold adaptation in a rat model - a collaborative study with the University of Napoli, to study the effects of exercise and cold adaptation in rats. This is to be viewed in the broader framework of thermogenic control and nutrition exerted by cold and by exercise.

• Randomised controlled trials in Trauma and Orthopaedics

Current and recent trials:

1. STARS trial: A prospective randomised study for the surgical management of displaced subcapital fractures of the femoral neck.

2. SMAK trial: A randomised controlled trial comparing a standard medial parapatellar approach versus a subvastus approach in total knee replacement. The primary outcome measure is the Knee Society Score, which is collected at baseline and at 1, 6, 12 and 52 weeks post-operatively.

3. MRIA trial: A prospective randomised controlled trial evaluating the impact of magnetic resonance imaging on the rate of arthroscopy for mechanical knee problems. Patients were randomly allocated to one of two management policies after they have had their MRI. The primary outcome measure for the study is the proportion of arthroscopies (diagnostic or therapeutic) carried out in each arm of the study.

Selection of Publications:

P.O. Bagnaninchi, Y. Yang, A.J. El Haj, N. MAFFULLI. Tissue engineering for tendon repair. British Journal of Sports Medicine 41 (8): Art. No. e10 August 2007

S. Bridgman, G. Walley, G. MacKenzie, D. Clement, D. Griffiths, N. MAFFULLI Sub-vastus approach versus the medial parapatellar approach in primary total knee: a randomised controlled trial [ISRCTN44544446] Trials 7: Art. No. 23 July 31 2006

L. Yao, C.S. Bestwick, L.A. Bestwick, N. MAFFULLI, R.M. Aspden. Phenotypic drift in human tenocyte culture. Tissue Engineering 12 (7): 1843-1849 July 2006

N. MAFFULLI, V. Testa, G. Capasso, S.W.B. Ewen, A. Sullo, J.B. King. Similar histopathological picture in males with Achilles and patellar tendinopathy. Medicine and Science in Sports and Exercise 36: 1470-1475, 2004

A.M. Nevill, R. Holder, N. MAFFULLI, J.C.Y. Cheng, S.S.S.F. Leung, W.T.K. Lee, J.T.F. Lau, K.M. Chan. Adjusting bone mass for differences in projected bone area and other confounding variables: an allometric perspective. Journal of Bone and Mineral Research 17: 703-708, 2002

N. MAFFULLI, S.W. Waterston, S.W.B. Ewen. Ruptured Achilles tendons show increased lectin staining ability. Medicine and Science in Sports and Exercise 34:1057-1064, 2002

W. Bruns, M. Bruce, G. Prescott, N. MAFFULLI. Temporal trends in femoral curvature and length in medieval and modern Scotland. American Journal of Physical Anthropology 119: 224-230, 2002

K.M. Khan, J.L. Cook, P. Kannus, N. MAFFULLI, S.F. Bonar. Time to abandon the ‘tendinitis’ myth. British Medical Journal 234: 626-627, 2002

F. Benazzo, G. Stennardo, M. Mosconi, G. Zanon, N. MAFFULLI. Muscle transplant in the rabbit's Achilles tendon. Medicine and Science in Sports and Exercise 33:696-701, 2001.

C. Tallon, N. MAFFULLI, S.W.B. Ewen. Ruptured Achilles tendons are significantly more degenerated than tendinopathic tendons. Medicine and Science in Sports and Exercise 33: 1983-1990, 2001

Since 1988 Prof Maffulli has published over 200 peer-reviewed scientific papers and over 100 review articles.

Research Grants:

• Metastatic disease of the spine. West Midlands Health Authority. February 2002 to present. £22,000

• Quantitative on-line assessment of collagen fibre organisation in connective tissues in vivo and during conditioning in vitro. In collaboration with the Biophotonics Group, Cranfield University. Biotechnology and Biological Sciences Research Council (BBSRC). £179,929

• Early foot changes in young adult Type 1 diabetes – a pilot study. In collaboration with the Clinical Measurements Laboratory, West Midlands Rehabilitation Centre, Birmingham. Diabetes UK £9,246