From a Clinical Question to Clinical Research: The Impact of an ISAKOS Research Grant

Nicolas Valladares, MD, MEXICO

ISAKOS eNewsletters   eNewsletter Article 2026   rating

Introduction

Many meaningful research projects begin with a simple question encountered during everyday clinical practice.

As orthopaedic surgeons, we continuously face clinical situations in which established treatments provide good results, yet important questions remain unanswered. These questions are often the starting point for innovation. However, transforming a clinical observation into a structured research project is a very different challenge.

A good scientific question is only the beginning.

Clinical research requires methodology, ethical oversight, patient recruitment, long-term follow-up, data collection, financial resources, a committed research team, and, perhaps most importantly, perseverance.

Receiving an ISAKOS Research Grant represented an important milestone for our research team in Guadalajara, Mexico. The grant has supported our ongoing clinical investigation evaluating the potential role of placenta-derived mesenchymal stromal cells (P-MSCs) in patients with partial-thickness supraspinatus tears.

The experience has reinforced my belief that supporting investigator-driven research is essential, particularly when innovative clinical questions arise directly from the challenges we encounter while treating our patients.

The Clinical Question

Partial-thickness tears of the supraspinatus tendon are commonly encountered in orthopaedic and sports medicine practice. Their clinical presentation and natural history can vary considerably, and treatment decisions are influenced by factors including symptoms, tear characteristics, patient age, functional expectations, and response to conservative treatment.

While many patients respond satisfactorily to nonoperative management, others continue to experience pain and functional limitations.

At the same time, interest in biologic therapies within orthopaedics has expanded considerably. Regenerative medicine has generated important scientific questions regarding whether biological interventions may influence the environment of injured musculoskeletal tissues and potentially contribute to healing or symptomatic improvement.

However, enthusiasm for emerging biologic treatments must be accompanied by rigorous clinical investigation.

For our research team, this led to a fundamental question: could placenta-derived mesenchymal stromal cells have a meaningful role in the treatment of patients with partial-thickness supraspinatus tears?

Rather than relying on theoretical biological potential or anecdotal clinical experience, we believed that this question should be evaluated through a prospective clinical study with appropriate methodology, comparison groups, patient follow-up, and objective outcome assessment.

That clinical question ultimately became the foundation of our research project.

From an Idea to a Clinical Trial

Moving from a research question to an actual clinical trial is rarely straightforward.

Designing the protocol was only the first step. The project required regulatory and ethical considerations, organization of treatment groups, coordination of biological products and study materials, patient recruitment, clinical evaluations, imaging, follow-up visits, outcome measurement, data management, and continued participation from multiple members of the research team.

One of the most important lessons from this experience has been that clinical research is not a single event; it is a sustained process.

A surgical procedure may take hours. A clinical research project may take years.

Patients must be recruited appropriately and followed according to protocol. Data must be collected consistently. Members of the research team must remain engaged. Unexpected logistical and financial difficulties inevitably appear.

This becomes particularly relevant in investigator-initiated research, where many of the resources and infrastructure available to large industry-sponsored trials may not be present.

Our study has therefore required not only scientific planning, but also a substantial personal and institutional commitment to keep the project moving forward.

The Challenge of Independent Clinical Research

Independent clinical research can be particularly demanding when studying innovative biological treatments.

There are direct costs associated with study materials, clinical evaluations, follow-up, research personnel, and the multiple logistical requirements necessary to maintain a clinical trial over time.

Funding limitations can slow recruitment or extend the duration of a study. Importantly, however, these difficulties should never result in compromising methodology simply to finish a project more quickly.

When resources are limited, perseverance becomes part of the research process.

Our team remained committed to the original scientific question and to completing the study responsibly. This required adapting to practical challenges while maintaining the fundamental principles of the research protocol.

For me, this has been one of the most valuable aspects of the experience. Research teaches us not only how to investigate a hypothesis, but also how to remain committed to a question when the answer requires considerably more time and effort than originally anticipated.

The Impact of the ISAKOS Research Grant

Receiving the ISAKOS Research Grant was therefore important to our project in several ways.

The most immediate impact was financial. The grant provided resources that helped us continue the study and address some of the costs associated with maintaining the research project.

However, its significance extended beyond financial support.

For our research team in Mexico, receiving support from ISAKOS also represented recognition from an international scientific community dedicated to arthroscopy, knee surgery, orthopaedics, and sports medicine.

That recognition matters.

When an investigator-driven project encounters difficulties, external scientific support provides additional motivation to continue. It reinforces the idea that the research question is worth pursuing and that the work being performed locally can potentially contribute to a much larger international conversation.

Science is increasingly global. Important clinical questions are not restricted to the largest academic centers or to a particular country.

Patients throughout the world present us with unanswered questions every day.

Creating mechanisms that allow clinicians from different regions to investigate those questions strengthens orthopaedic research as a whole.

More Than Financial Support

Research grants are naturally discussed in terms of funding, but their influence can be considerably broader.

A grant can provide momentum.

It can encourage a research team during difficult stages of a project. It can provide validation for young investigators participating in their first clinical studies. It can facilitate collaboration and can connect local clinical research with an international scientific community.

In our case, the ISAKOS Research Grant became part of the journey of the project itself.

It reminded our team that independent clinical research does not have to occur in isolation.

International scientific societies can play an important role in connecting investigators, supporting innovative ideas, encouraging appropriate methodology, and creating opportunities for research originating in different healthcare environments to become part of global scientific discussion.

For investigators working outside traditionally large research institutions, that message can be particularly powerful.

A Message to Young Investigators

I would strongly encourage young ISAKOS members and clinicians interested in research to apply for opportunities such as the ISAKOS Research Grants.

It is easy to believe that research must begin with a sophisticated laboratory, a large academic department, or substantial financial resources.

In my experience, it often begins somewhere much simpler: with curiosity during clinical practice.

Why did this patient respond differently?

Can this treatment be improved?

Is there another biological or surgical approach worth investigating?

Can we objectively demonstrate that what we believe works actually benefits our patients?

Those questions are the beginning of research.

The next step is to transform curiosity into a clearly defined hypothesis and then surround that hypothesis with appropriate methodology.

Young investigators should also understand that research rarely progresses exactly according to the original timeline. Recruitment can be difficult. Resources can become limited. Follow-up can take longer than anticipated. Protocols require discipline.

These challenges should not necessarily be interpreted as failure. They are often simply part of conducting meaningful clinical research.

A strong research team, appropriate mentorship, collaboration, and persistence can be as important as the original idea.

The Importance of International Scientific Communities

One of the great strengths of organizations such as ISAKOS is their ability to connect orthopaedic surgeons and researchers across geographical boundaries.

Clinical practice varies around the world. Healthcare systems differ, resources differ, and patient populations differ. These differences should not be viewed only as limitations; they also create opportunities to ask different questions and contribute different perspectives.

Supporting research internationally helps broaden the scientific evidence available to our profession.

For researchers in Latin America and other regions where investigator-driven clinical research may face financial or infrastructural limitations, international collaboration and grant opportunities can help reduce some of the barriers between a promising clinical question and a scientifically meaningful study.

This ultimately benefits more than investigators.

The final objective of clinical research remains the same regardless of where it is conducted: to improve the care we provide to our patients.

What This Experience Has Taught Us

Our research project continues to teach us lessons that extend beyond the specific biological treatment being investigated.

It has reinforced the importance of asking clinically relevant questions, designing studies capable of answering those questions, and maintaining scientific discipline throughout a prolonged research process.

It has also demonstrated the importance of teamwork.

Clinical trials depend on far more than the principal investigator. They require physicians, research collaborators, clinical personnel, patients, and institutions willing to remain committed over time.

Most importantly, the experience has reinforced the value of perseverance.

Not every research question produces the result we expect. In fact, the purpose of research is not to confirm what we hope to find, but to determine as objectively as possible what the evidence demonstrates.

Regardless of the eventual findings of our clinical trial, completing the study with methodological integrity will be the most important measure of its scientific value.

Future Perspectives

Biological therapies represent one of the most rapidly evolving areas in orthopaedics and sports medicine. Their potential is exciting, but their future must be guided by rigorous clinical evidence rather than enthusiasm alone.

Further research will be necessary to determine which biological products may provide meaningful clinical benefits, which patients are most likely to benefit, what doses and treatment protocols are appropriate, and whether improvements are sustained over time.

Well-designed prospective and randomized clinical trials will be essential to answer these questions.

Our ongoing investigation into placenta-derived mesenchymal stromal cells and partial-thickness supraspinatus tears represents one contribution to this broader scientific effort.

Looking forward, we hope that the experience gained from this project will allow our team to continue developing collaborative clinical research in orthopaedics and sports medicine and to strengthen connections between investigators in Mexico, Latin America, and the international ISAKOS community.

Perhaps the most important future perspective, however, is not related to any individual technology or biological treatment.

It is the continued support of clinical curiosity.

Every day, somewhere in the world, an orthopaedic surgeon encounters a patient who generates an unanswered question.

When that question is combined with sound methodology, collaboration, perseverance, and appropriate scientific support, it can become meaningful research.

And meaningful research has the potential to improve the way we care for our patients.

I am sincerely grateful to ISAKOS for supporting our research and for continuing to create opportunities for investigators around the world to transform clinical questions into scientific contributions.