Carr Group | Regenerative Medicine
Our research aims to improve evidence for the effectiveness of surgery generally and to translate new surgical techniques and implants into the clinic.
We are based in the Botnar Research Centre, the University of Oxford Institute of Musculoskeletal Sciences and in the clinics and operating theatres of the Nuffield Orthopaedic Centre, which is part of Oxford University Hospitals NHS Trust.
We have published in high impact journals, including the BMJ, the Lancet and the Nature and Science families of journals.
Post-graduate students come from both a clinical and scientific background. Any prospective students are welcome to contact Andy Carr directly.
Our work is divided in two main areas:
Improving outcomes of surgery
A major component of our work is in randomised clinical trials of surgery.
We have pioneered the involvement of patients in assessing surgical outcomes and, with colleagues in Oxford, have developed a range of patient reported outcome measures (PROMs) for orthopaedic surgery. The Oxford Scores have been translated into 20 languages and are now used worldwide in clinical trials.
We have contributed to the BMJ's "Too Much Medicine" campaign and the debate regarding the value of knee arthroscopy based on the results of placebo controlled trials.
The group has systematically reviewed the benefits and harms of placebo controls in surgical trials. We are leading an Arthritis Research UK funded national randomised trial investigating the role of arthroscopic acromioplasty surgery using a placebo control (the CSAW trial). We use fMRI brain imaging and quantitative sensory testing, to assess the physiological effect of placebo or sham surgery.
Understanding mechanisms of inflammation, healing and fibrosis in tendon and the development and translation of biomaterials to augment rotator cuff repair
The effects of ageing, wear and tear, genetic pre-disposition and inflammation are known factors contributing to the development of pathology within a tendon (tendinopathy) or at the tendon bone interface (enthesopathy). These injuries cause pain, loss of limb function and stop activities of daily living. Injured tendons heal by fibrotic repair and are highly prone to re-injury. Our main research goal is to understand the molecular mechanisms causing inflammation and fibrosis in tendinopathy and enthesopathy.
We have led large multicentre randomised trials of tendon surgery.
- The NIHR HTA funded UKUFF trial compared traditional open surgery with arthroscopic surgery and revealed high rates of repair failure with both surgical approaches.
- The NIHR funded PaRot trial demonstrated that there is no benefit from the co-application of platelet rich plasma (PRP) with surgery and potentially harmful effects of PRP on tendon cells
The group has developed biomaterials that aim to enhance endogenous tissue repair using biophysical cues. We are interested in how biodegradable elastomers fabricated into complex geometries can provide cues for cells. We use electrospinning to manufacture novel suture materials (Bioyarn) and surgical meshes (Biopatch).
The materials are constructed of biodegradable polymeric nanofibres and are designed to mimic the hierarchical architecture of normal tissues. We have expertise in the development of in vitro models to understand how cells and materials interact in both healthy ageing and disease. We use cells derived from patients rather than animal models. We also investigate the co-application of these scaffolds with growth factors and endogenous cells. This work was initiated in the NIHR Oxford Biomedical Research Unit and from 2015 is also funded by the Wellcome Trust for phased clinical trials. We undertake manufacturing to GMP standards within the academic environment. This will be the first use in man of these novel materials.
You may find the following article on BBC News interesting.