Primary research interests focus on knee and soft tissue biomechanics and biomedical instrumentation. Recent projects include the in vivo strain measurements of the human anterior cruciate ligament (ACL), the development and application of an experimental model to investigate ligament and graft healing, the progression of osteoarthritis following ACL injury/reconstruction, the biotribology of articular cartilage, and enhanced healing in ACL repair and reconstruction.

Biography

Dr. Fleming joined the Department of Orthopaedics at Brown University in June 2003. He received his doctorate in Mechanical Engineering from the University of Vermont in 1996 and then served on the faculty of the Department of Orthopaedics & Rehabilitation at the University of Vermont. His primary research interests focus on the lower extremity and spine with a particular interest in knee and soft tissue biomechanics, and biomedical instrumentation. Recent projects include the in vivo strain measurements of the human anterior cruciate ligament, the development of an experimental model to investigate graft healing and the progression of osteoarthritis following ACL injury and reconstruction, tissue engineering methods to stimulate ligament healing, and the in vivo measurement of the forces and motion of spinal implants. He has received several awards for his research including the ACL Study Group Traveling Fellowship (2010); The Cabaud Research Award (2009) and the O'Donogue Research Award (2005) of the American Orthopaedics Society of Sports Medicine; the Bruce Selya Research Award of Lifespan (2005), GOTS-Beiersdorf Research Award (2000), the American Society of Biomechanics Post-doctoral Young Scientist Award (1999), the Albert Trillat Young Investigator Award (1997), and the Kappa Delta Award of the American Academy of Orthopaedic Surgeons (1994).

Institutions

RIH

Research Description

Dr. Fleming's primary research interests focus on the biomechanics of the lower extremity and biomedical instrumentation. Recent projects include the in vivo strain measurements of the human anterior cruciate ligament (ACL), the development of an experimental model to investigate anterior cruciate ligament ligament and graft healing, the progression of osteoarthritis following ACL injury and reconstruction. He currently has funding from the National Institutes of Health (NIH), Department of Defense (DoD) and the National Football League Charities to evaluate the relationships between ACL injury, ACL reconstruction surgery, and degenerative joint disease. Rupture of the ACL is a common debilitating injury that leads to the onset and progression of osteoarthritis (OA). Surgical reconstruction of the ligament is necessary in many patients to restore joint function, and to stop, or possibly delay, the progression of OA that follows ACL injury. Biomechanical factors, such as altered knee displacements and rotations (kinematics) and contact stress are thought to be responsible, but the relationships between kinematics and the progression of OA are unclear. Furthermore, our studies are finding that the inflammatory response at the time of injury (and/or) surgery also play a significant role. The progression of osteoarthritis following ACL injury and reconstruction is being evaluated in an experimental model. In this study, the mechanical properties of articular cartilage are being assessed and compared between control, sham, ACL-deficient, and ACL-reconstructed knees. Biochemical markers of articular cartilage metabolism and structural changes to the menisci are also being measured and compared. This work is being performed in parallel with a clinical study evaluating the effects of initial graft tension on the articular cartilage following ACL reconstruction in a prospective, double-blinded, randomized, controlled trial. Articular cartilage status is being assessed by measuring changes in the joint space width and cartilage volume of the tibiofemoral joint using radiographic and magnetic resonance techniques. Secondary outcomes include the changes that occur in joint kinematics, strength, and patient-oriented outcomes following treatment. These studies were designed to explore the mechanistic relationships between the initial contact conditions, knee kinematics, articular cartilage metabolism, and degenerative joint disease following ACL injury and its treatment.

Awards

1. Kappa Delta Ann Doner Vaughn Award, Presented by the American Academy of Orthopaedic Surgeons, March 2013.
2. BREG/ACL Study Group Traveling Fellowship, Presented by the ACL Study Group, 2010 to 2012.
3. Cabaud Research Award: American Orthopaedic Society of Sports Medicine, 07/2009
4. Mimics Innovation Research Award: Materialize, 05/2008
5. Hughston Award: American Orthopaedic Society of Sports Medicine, 07/2006
6. Bruce Selya Research Award: Lifespan/Brown Medical School, 09/2005
7. O'Donoghue Sports Injury Research Award: American Orthopaedic Society of Sports Medicine, 02/2005
8. GOTS-Beiersdorf Research Award: Gesellschaft fur Orthopadisch Traumatologische Sportmedizin, 06/2000
9. Postdoctoral Young Scientist Award: American Society of Biomechanics, 10/1999
10. Albert Trillat Young Investigator Award: International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, 05/1997
11. O'Donoghue Sports Medicine Award: American Society of Orthopaedic Sports Medicine, 06/1996
12. Excellence in Research Award: Department of Orthopaedics, University of Vermont, 06/1995
13. Kappa Delta Elizabeth Winston Lanier Award: American Academy of Orthopaedic Surgeons, 02/1994
14. Excellence in Research Award: Department of Orthopaedics, University of Vermont, 06/1994
15. Bio-engineering Student Paper Competition: NASA, 03/1994
16. Albert Trillat Young Investigator Award: International Knee Society, 06/1993
17. Predoctoral Young Scientist Award: American Society of Biomechanics, 08/1992

Affiliations

ACADEMIC APPOINTMENTS
Lucy Lippitt Professor of Orthopaedics, Warren Alpert Medical School of Brown University
Adjunct Professor of Engineering, Brown University

HOSPITAL APPOINTMENTS
Senior Investigator: Rhode Island Hospital

HOSPITAL COMMITTEES
Institutional Review Board, Rhode Island Hospital; 11/2005–present

OTHER APPOINTMENTS
Orthopaedic Research Society; Nomination Committee - Bioengineer, 02/09 – 02/12.
National Institutes of Health; "Skeletal Biology Structure and Regeneration Study Section" (Member); 02/2004–06/2008
Journal of Applied Biomechanics: Editorial Board; 09/2002–present
American Journal of Sports Medicine: Editorial Board; 04/2004–present
Journal of Bone & Joint Surgery: Review board; 1994–present
Clinical Orthopaedics & Related Research: Review board; 1996–present
American Journal of Sports Medicine: Review board; 1996–2004
Journal of Orthopaedic Research: Review board; 1995–present
Journal of Biomechanics: Review board; 1997–present
Exercise & Sport Science Review: Review board; 2002–present
Annals of Biomedical Engineering: Review board; 2003–present
Knee Surgery, Sports Traumatology & Arthroscopy: Review board; 2004–present

MEMBERSHIP IN SOCIETIES
Orthopaedic Research Society; 1987–present
American Society of Mechanical Engineers: 1988–present
American Society of Biomechanics; 1992–present
International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; 2000–present
American Orthopaedic Society for Sports Medicine (Affiliate member); 2004–present

Funded Research

1. Cervical Spine Research Society: Pin force measurement in a halo-vest orthosis. $10,000 (direct), 12/96-11/97, Co-investigator (PI –M.H. Krag).

2. Orthopaedic Research and Education Foundation (Institutional Grant): Pin force measurement in a halo-vest orthosis. $14,465 (direct), 12/96-11/97, Principal Investigator.

3. National Institutes of Health (R03-AR45027): An experimental model to evaluate ACL graft healing. $150,000 (direct), 09/97-09/00, Principal Investigator.

4. AO/ASIF Foundation: Development of a Telemetered Implant to Measure Spine Loads In vivo. $72,785 (direct), 10/97-09/98, Co-investigator (PI – M.H. Krag).

5. Fletcher Allen Health Care Patient Oriented Research Grant: A prospective, randomized study of anterior cruciate ligament reconstruction: A pilot study. $15,000 (direct), 12/97-11/98, Principal Investigator.

6. Orthopaedic Research and Education Foundation (Institutional Grant): Validation of a combined model of the tibiofemoral and patellofemoral joints. $14,850 (direct), 06/98-05/99, Principal Investigator.

7. National Football League Charities Medical Research Grant: In vivo measurement of anterior cruciate ligament strain during rehabilitation exercises. $85,000 (direct), 02/99-03/01, Principal Investigator.

8. AO/ASIF Foundation: "Development of a telemetered implant to measure spine loads In vivo" (Competitive Renewal). $50,000 (direct), 1/2000-12/2001, Co-investigator (PI – M.H. Krag).

9. National Football League Charities Medical Research Grant: In vivo measurement of anterior cruciate ligament strain during rehabilitation exercises in vivo (Competitive Renewal), $79,100 (direct), 1/2001-12/2001, Principal Investigator.

10. GOTS-Beiersdorf Research Award: In vivo measurement of Achilles tendon strain, $15,000, 01/01-12/01, Principal Investigator.
11. Arthritis Foundation Biomedical Science Grant: Prospective randomized investigation of rehabilitation following anterior cruciate ligament reconstruction. $243,000, 07/98-09/02. Co-investigator (PI – R.J. Johnson).

12. Arthritis Foundation Biomedical Science Grant: An in vivo model for load induced articular cartilage degeneration. $243,000, 01/01-12/03. Co-investigator (PI – B.D. Beynnon).

13. National Football League Charities Medical Research Grant: The effects of initial graft tension on articular cartilage following anterior cruciate ligament reconstruction. $184,000 (direct), 09/03 – 08/05, Principal Investigator.

14. National Institutes of Health (RO1-AR047910): Effects of initial graft tension on ACL reconstruction: A prospective, randomized clinical study comparing two tensioning techniques. $1,244,000 (direct), 09/03-08/09, Principal Investigator.

15. National Institutes of Health (RO1-AR049199): "Osteoarthritis following ACL reconstruction". $1,245,000 (direct), 09/03-08/09, Principal Investigator.

16. Arthroscopy Association of North America Research Grant: Effect of initial graft tension on tibiofemoral contact pressures. $20,000, 07/04-06/05. Co-investigator/mentor (PI – M. Bradley).

17. National Institutes of Health (RO1-AR047910S1): Effects of initial graft tension on ACL reconstruction (Supplement). $600,000 (direct), 12/05-08/09, Principal Investigator.

18. Brown University – Office of the Vice President for Research (Research Seed Grant)" Development and verification of CTX imaging for musculoskeletal biomechanics research. $82,269, 7/06 – 6/07, Co-investigator (PI – B. Brainerd).

19. National Institutes of Health (RO1-AR053684): Prognosis and Predictors of ACL Reconstruction: A Multicenter Cohort Study. 12/06-11/10, Co-Investigator (PI – K. Spindler, Vanderbilt University).

20. Keck Foundation: Proposal to Design and Build a Dynamic 3D Skeletal Imaging System. $1,800,000 (direct), 2/07 – 1/10, Co-investigator (PI – B. Brainerd).

21. Orthopaedic Research & Education Foundation Resident-Clinician Scientist Training Grant: Tibiofemoral Contact Pressures: Comparison of Single-Bundle and Double-Bundle Reconstructive Techniques. $20,000 (direct), 7/07 – 6/08, Mentor/Co-investigator (PI – M. Plante).

22. National Institutes of Health COBRE Center of Excellence (P20RR024484-01): Skeletal Health and Repair. $6,000,000 (direct), 10/07-09/12, Project Mentor/Core Co-Director (PI - Q Chen).

23. Brown University/Women & Infants Hospital National Center of Excellence in Women's Health (Innovations in Women's Health Research Seed Grant): Biomechanical response of the cervix to compression. $50,000, 01/08-12/09, Co-investigator (PI – E. Chien).

24. National Institutes of Health (R21 AR055937-01): Restitution of Lubrication in ACL Deficient Joints Preventing Wear. $275,000, 04/08-03/10, Co-investigator (PI – G. Jay).

25. National Institutes of Health (1R01AR056834-01) Biologically Enhanced Healing of Autograft ACL Reconstruction.. $1,480,000 (direct); 04/09-03/13, Co-Principal Investigator.

26. National Institutes of Health (2R01AR047910-06) Effects of Initial Graft Tension on ACL Reconstruction. $1,250,000 (direct); 07/09-06/14, Principal Investigator.

28. National Institutes of Health (1R01 AR056834-01S1; Biologically Enhanced Healing of Autograft ACL Reconstruction (Supplement). $878,468 (direct); 09/30/09-08/31/11, Co-Principal Investigator.

29. National Institutes of Health (1R41 AR057276-01; Jay) Tribosupplementation of Injured Joints. $234,545 (direct); 09/30/09-08/31/11, Subcontract PI.

30. National Institutes of Health (2R01 AR054099-04; Murray) The Effect of Age on Functional ACL Healing. $554,850 (Subcontract direct); 09/30/09-08/31/11, Co-Investigator (Subcontract PI).

31. D31. Department of Defense (Peer Reviewed Medical Research Program Investigator Initiated Research Award - PR110746; Jay/Fleming) Tribosupplementation with Lubricin in Prevention of Post-Traumatic Arthritis. $2,219,221; 10/1/2012-09/30/2015, Co-Principal Investigator.

Courses Taught

• Directed Research/Independent Study (BIO195)
• Directed Research/Independent Study (BIO196)
• Independent Studies in Engineering (EN0195)
• Independent Studies in Engineering (EN0196)
• Projects in Engineering Design (EN0100)
• Special Projects, Reading, Research and Design (EN0297)
• Special Projects, Reading, Research and Design (EN0298)

View My Full Publication List in pdf format

Selected Publications

• Spindler KP, Murray MM, Carey J, Fleming BC: The Use of Platelets to Affect Functional Healing of an Anterior Cruciate Ligament (ACL) Autograft in a Caprine ACL Reconstruction Model. Journal of Orthopaedic Research 27:631-638, 2009.(2009)
• Murray MM, Palmer M, Abreu E, Spindler KP, Zurakowski D, Fleming BC: Platelet-rich plasma alone is not sufficient to enhance suture repair of the ACL in skeletally immature animals: An in vivo study. Journal of Orthopaedic Research 27: 639-645, 2009.(2009)
• Oksendahl NL, Gomez N, Thomas CS, Badger GJ, Hulstyn MJ, Fadale PD, Fleming BC: Reliability of digital radiographic assessment of early osteoarthritis in the knee. Journal of Knee Surgery, 22:205-212, 2009.(2009)
• Fleming BC, Spindler KP, Palmer M, Magarian E, Murray MM: Collagen-platelet composites improve the biomechanical properties of healing ACL grafts in a porcine model. American Journal of Sports Medicine, 37: 1554-1563, 2009.(2009)
• Drewniak EI, Jay GD, Warman ML, Fleming BC, Crisco JJ: Comparison of two methods for calculating the frictional properties of articular cartilage using a simple pendulum and intact mouse knee joints. Journal of Biomechanics 42: 1996-1999, 2009 [PMID: 19632680].(2009)
• Joshi SM, Mastrangelo AN, Magarian EM, Fleming BC, Murray MM: Collagen-platelet composite enhances histologic healing of the ACL. American Journal of Sports Medicine 37: 2401-2410, 2009 [PMID: 19940313].(2009)
• Elsaid KA; Machan JT; Waller K; Fleming BC; Jay GD: The impact of anterior cruciate ligament injury on lubricin metabolism and the effect of inhibiting TNF- on chondroprotection in an animal model. Arthritis & Rheumatism 60:2997-3006, 2009.(2009)
• Le NA, Fleming BC: Measuring fixed charge density and mechanical properties of goat articular cartilage using indentation methods and biochemical analysis. Journal of Biomechanics 41: 715-720, 2008.(2008)
• Bowers ME, Tung GA, Trihn N, Kimia BB, Leventhal EL, Crisco JJ, Fleming BC: Effects of ACL interference screws on articular cartilage volume and thickness measurements with 1.5 T and 3 T MRI. Osteoarthritis & Cartilage 16: 572-578, 2008.(2008)
• Elsaid KA, Fleming BC, Oksendahl HL, Fadale PD, Hulstyn MJ, Shalvoy RM, Jay GD: Synovial fluid lubricin concentrations are decreased following anterior cruciate ligament injury in humans is associated with increased cartilage damage. Arthritis & Rheumatism 58:1707-1715, 2008.(2008)
• Tocci SL, Tashjian RZ, Leventhal E, Spenciner DB, Green A, Fleming BC: Biomechanical evaluation of single row arthroscopic rotator cuff repair (ARCR) technique. Journal of Shoulder & Elbow Surgery, 17:808-814, 2008.(2008)
• Bowers ME, Trinh N, Tung GA, Crisco JJ, Kimia BB, Fleming BC: Quantitative MR Imaging using "LiveWire" to Measure Tibiofemoral Articular Cartilage Thickness. Osteoarthritis & Cartilage, 16: 1167-1173, 2008.(2008)
• Fleming BC, Carey JL, Spindler KP, Murray MM: Can suture repair of ACL transaction restore normal anteroposterior laxity of the knee? An ex vivo study. Journal of Orthopaedic Research 26: 1500-1505, 2008.(2008)
• Fleming BC, Brady MF, Bradley MP, Banerjee R, Hulstyn MJ, Fadale PD: Tibiofemoral Compression Force Differences using Laxity- and Force-based Initial Graft Tensioning Techniques in the ACL Reconstructed knee. Arthroscopy 24: 1052-1060, 2008.(2008)
• Teeple E, Fleming BC, Elsaid KA, Jay GD, Aslani K, Crisco JJ, Mechrefe AP: Coefficients of friction, lubricin, and cartilage damage in the anterior cruciate ligament-deficient guinea pig knee. Journal of Orthopaedic Research 26: 231-237, 2008.(2008)