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Osteochondritis dissecans

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Salvage of Large OCD Lesions: Articular Cartilage Paste Grafting Kevin R. Stone, MD CPMC Grand Rounds 2/13/2009 Stone Research Foundation
What to do when OCD fixation fails?
Patient Example: JL ,[object Object],[object Object],[object Object],[object Object],[object Object],Pre-op Xray
JL: Preoperative MRI Age 25: Pre-Hardware Removal
Morselized Lesion Paste Graft to MFC Extraction of Herbert Screws OCD Lesion 35X 40 X 30 mm JL: Failed Herbert Screws
Articular Cartilage Paste Graft Technique Step 1 Step 5 Step 4 Step 3 Step 2
Biopsy of Paste Graft JL: 8 Mo Post-Paste Graft Histology
A 6 X 6 mm central portion required a second Paste Graft. JL: 8 Mo Post Paste Graft
Hypertrophy of the medial OCD lesion JL: 11 Mo Post Paste Graft Pre-Op 11 Mo Post-Op
JL: 7 Years Post Paste Graft 7 Years Post Op ,[object Object],[object Object],[object Object]
JL: 7 Years Post Paste Graft ,[object Object],[object Object],[object Object],A B C
JL: 7 Year Post Op MRI
JL: 8 Year Post Op Xray PA Flexion AP
JL: 8 Year Post Op MRI ,[object Object],[object Object],[object Object],[object Object]
JL: 10 Year Post Op Xray
JL: 10 Year Post Op MRI
JL: 10 Year Post Op MRI
JL: 10 Year Function ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient Example: HV ,[object Object],[object Object],[object Object],[object Object]
HV 12/97 Art Cart Surgery ,[object Object],[object Object],[object Object]
HV 12/97 Art Cart Surgery ,[object Object]
HV 10 Month Post
HV 10 Month Post Paste Graft
HV 10 Month Post Paste Graft Biopsy
HV 10 Month Post Histology
HV 10 Month Post Histology
HV 11 Year Post MRI
HV 11 Year Post MRI
HV 11 Year Post Function ,[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Does the Paste Contain Live Cells?
[object Object],[object Object],[object Object],Art Cart Paste Graft Characterization Study
Preliminary Results ,[object Object],[object Object],[object Object],The cells have the ability to express collagen I, collagen II and aggrecan genes. Paste Core *DMEM: Dulbecco/Vogt modified Eagle's minimal essential medium DMEM Chondrogenic media DMEM Chondrogenic media
Study Conclusions ,[object Object],[object Object],[object Object],[object Object]
Thank You Stone Research Foundation

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Osteochondritis dissecans

Editor's Notes

  1. Jason Lovett
  2. First picture: One Herbert screw removed the second one slightly removed. Picture #2: After the screws were removed. Picture #3: The remaining OCD lesion. Picture #4: After the paste graft has been placed.
  3. The procedure step by step.
  4. ( Dulbecco/Vogt modified Eagle's minimal essential medium ), which contains approximately four times as much of the vitamins and amino acids present in the original formula and two to four times as much glucose .
  5. Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004