By replacing all or a portion of the meniscus with donor cartilage, the patient can regain the natural “shock absorber” in the knee and experience many additional years of activity, even in the presence of arthritis. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using meniscus transplant alone or in combination with any of the Biologic Knee Replacement procedures.
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Can read freely here
https://sethiortho.blogspot.com/
Fracture Healing and
Mechanical stability
Perren`s strain theory
Fracture healing
Indirect Healing
Direct healing
Fixation techniques and stability
Nonunion and Management
Fracture healing
Biological environment
Age
Nutritional status
Blood supply
Metabolic
Mechanical stability
Absolute
Relative
Surgical procedure
Alters biological environment
Selection of fixation
Alters mechanical environment
Mechanical Stability
Parren's strain theory
Strain
Relative deformation of a material when a given force is applied
Relative changes in the fracture gap divided by original fracture gap = L / L
Stability determines the Strain at the fracture site
Stable fixation – less strain
Unstable fixation – high strain
Large gap fracture – less strain
Cross section of the fracture-
Fracture gap strain VS cells response
The degree of inter fragmentary strain appears to govern the cellular response.
Each of these tissues is able to tolerate a different amount of strain:
Perren's strain theory….
When the inter fragmentary strain is <2% bone repair occurs by direct healing
While for intermediate amount of IFS (5–10%) the fracture heals by indirect healing.
Stain theory of healing –Indirect healing
Indirect Healing
Indirect Healing…
Hard callus formation
Indirect Healing
Remodeling Stage
Months to years
Conversion of woven bone into lamellar bone
Formation of Medullary cavity
Return of biomechanical property
Influenced by wolf law – Remodeling based on stress
Stain theory of healing…pseudo arthrosis
Complete instability
Callus is unable to form because the strain is too much for it to tolerate.
The more strain-tolerant fibrous tissue forms
Bone ends are sealed over with cortical bone
Formation of false joint with synovial fluid in the gap
Hypertrophic nonunion
Unstable fracture
Excess callus formation unable to reduce the IFS
Creates a hypertrophic non union
Direct Healing
Anatomically reduced rigid fixed fractures
Formation of cutting cones
>100,000 remodeling units work at time
Direct osteonal remodeling
Without callous
Activation
resorption by osteoclasts
osteoid formation by osteoclasts
Primary osteons
Mineralization
Direct Healing….
Fixation techniques and stability
Relative stability
Intramedullary nailing
Load sharing device
Inter fragmentary micro motion
Fracture gap strain is usually 2-10%
Body responds by forming more soft callus to try and decrease the strain
Fixation of diaphyseal fractures – strength and less duration
Relative stability
Absolute stability
Absolute stability
TBW
Lag screw fixation
Interfragmentary strain,
Nonunion and Management
Nonunion ….
Fracture is fixed rigidly but a gap is present
Direct healing may not be able to bridge the gap
The lack of strain may inhibit callus formation and secondary healing
Predispose to non-union
Management –
Biologic Knee Replacement (BKR) is our approach to treating knee injuries, from trauma to arthritis, and is designed to help people delay, or even avoid, artificial knee replacement. BKR is a scientifically-proven collection of our out-patient surgical techniques and procedures and consists of any combination of meniscus transplantation, articular cartilage paste grafting, ligament replacement as explained in further detail below. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using Biologic Knee Replacement.
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Can read freely here
https://sethiortho.blogspot.com/
Fracture Healing and
Mechanical stability
Perren`s strain theory
Fracture healing
Indirect Healing
Direct healing
Fixation techniques and stability
Nonunion and Management
Fracture healing
Biological environment
Age
Nutritional status
Blood supply
Metabolic
Mechanical stability
Absolute
Relative
Surgical procedure
Alters biological environment
Selection of fixation
Alters mechanical environment
Mechanical Stability
Parren's strain theory
Strain
Relative deformation of a material when a given force is applied
Relative changes in the fracture gap divided by original fracture gap = L / L
Stability determines the Strain at the fracture site
Stable fixation – less strain
Unstable fixation – high strain
Large gap fracture – less strain
Cross section of the fracture-
Fracture gap strain VS cells response
The degree of inter fragmentary strain appears to govern the cellular response.
Each of these tissues is able to tolerate a different amount of strain:
Perren's strain theory….
When the inter fragmentary strain is <2% bone repair occurs by direct healing
While for intermediate amount of IFS (5–10%) the fracture heals by indirect healing.
Stain theory of healing –Indirect healing
Indirect Healing
Indirect Healing…
Hard callus formation
Indirect Healing
Remodeling Stage
Months to years
Conversion of woven bone into lamellar bone
Formation of Medullary cavity
Return of biomechanical property
Influenced by wolf law – Remodeling based on stress
Stain theory of healing…pseudo arthrosis
Complete instability
Callus is unable to form because the strain is too much for it to tolerate.
The more strain-tolerant fibrous tissue forms
Bone ends are sealed over with cortical bone
Formation of false joint with synovial fluid in the gap
Hypertrophic nonunion
Unstable fracture
Excess callus formation unable to reduce the IFS
Creates a hypertrophic non union
Direct Healing
Anatomically reduced rigid fixed fractures
Formation of cutting cones
>100,000 remodeling units work at time
Direct osteonal remodeling
Without callous
Activation
resorption by osteoclasts
osteoid formation by osteoclasts
Primary osteons
Mineralization
Direct Healing….
Fixation techniques and stability
Relative stability
Intramedullary nailing
Load sharing device
Inter fragmentary micro motion
Fracture gap strain is usually 2-10%
Body responds by forming more soft callus to try and decrease the strain
Fixation of diaphyseal fractures – strength and less duration
Relative stability
Absolute stability
Absolute stability
TBW
Lag screw fixation
Interfragmentary strain,
Nonunion and Management
Nonunion ….
Fracture is fixed rigidly but a gap is present
Direct healing may not be able to bridge the gap
The lack of strain may inhibit callus formation and secondary healing
Predispose to non-union
Management –
Biologic Knee Replacement (BKR) is our approach to treating knee injuries, from trauma to arthritis, and is designed to help people delay, or even avoid, artificial knee replacement. BKR is a scientifically-proven collection of our out-patient surgical techniques and procedures and consists of any combination of meniscus transplantation, articular cartilage paste grafting, ligament replacement as explained in further detail below. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using Biologic Knee Replacement.
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
Adult Stem cells in Orthopaedics present and future perspectives.
Παρουσίαση του Δρ. Σταύρου Αλευρογιάννη που έγινε στο ξενοδοχείο Χίλτον, στις 12/06/15 στα πλαίσια Ημερίδας της Ελληνικής Εταιρείας Αναγεννητικής Ιατρικής, Αντιγήρανσης και Βιοτεχνολογίας, στο 41ο Πανελλήνιο Ιατρικό Συνέδριο.
"H θέση της αναγεννητική Ιατρικής στις παθήσεις Οστών και Αρθρώσεων"
Achilles tendon repair at the Stone Clinic is often performed percutaneously following a torn achilles tendon injury. This method has proven to be as effective as an open surgical technique while reducing recovery time.
The Stone Clinic is a sports medicine clinic in San Francisco, California, offering orthopaedic surgery and medical care, physical therapy and rehabilitation, and radiology imaging services. The Stone Clinic was founded by Kevin R. Stone, M.D., an orthopaedic surgeon, combining himself with a team of nurses, physical therapists, imaging specialists, and patient coordinators, in 1988 to focus on caring for injured athletes and people experiencing arthritis pain.
The Stone Clinic is founded on the goal of rehabilitating all patients to an operating level higher than before they were injured. The Stone Clinic specializes in sports medicine and injury treatment of knee, shoulder, and ankle joints. Stone has lectured and is recognized internationally as an authority on cartilage and meniscal growth, replacement, and repair. Stone and the Stone Clinic are known for the development of the paste grafting surgical technique in 1991, combined with meniscus replacement, which are biologic joint replacement procedures for the regeneration of the knee joint. Surgical procedures were subjected to rigorous outcomes analysis with the results reported in peer reviewed journals. The surgical techniques have been taught to surgeons in the US and worldwide, through lectures and videos.
Nursing students, medical students, residents, fellows, and other physicians from various institutions around the world, rotate through The Stone Clinic and mentor with Stone. The Stone Clinic hosts the annual Meniscus Transplantation Study Group Meeting as well as the annual Professional Women Athlete's Career Conference.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
Meniscus Transplant and Replacement
1. Meniscus Allograft: State of the Art Kevin R. Stone, MD Ann W. Walgenbach, RNNP Wendy S. Adelson, MS Jonathan R. Pelsis, MHS Meniskus – Ersatz: Collagen Meniskus & Allograft 15. Janur 2010 Stone Research Foundation San Francisco
9. Outerbridge Grading System For Cartilaginous Degeneration Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br, 1961;43: 752-7. Grade I Soft discolored superficial fibrillation Grade II Fragmentation < 1.3 cm 2 Grade III Fragmentation > 1.3 cm 2 Grade IV Erosion to subchondral bone (eburnation)
10.
11.
12.
13.
14. The Three-Tunnel Technique Replacing the Meniscus Stone KR, Walgenbach AW. “Meniscal Allografting: the Three-Tunnel Technique.” Arthroscopy – The Journal of Arthroscopic and Related Surgery. 2003, 19(4):426-30.
102. TA: Meniscus Allograft Placement Preparation of medial meniscal allograft Placement of medial meniscal allograft Relationship of lesion to meniscus A B Movie
103.
104. TA: Revision C A Movie Revision: 8 Months Post-allograft
105. TA: Revision: Operative Images Insertion of Meniscus Allograft with Articular Cartilage Paste Grafting Joint Arthroplasty 3/2006 (38 Mo. Post Op) A B C D
Kevin R. Stone, MD Rath = severe arthritis excluded
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD The procedure step by step.
Kevin R. Stone, MD
Examine the coefficients for each explanatory variable. Positive Coefficient means that the hazard is higher WORSE PROGNOSIS Negative Coefficient implies a lower hazard BETTER PROGNOSIS
Kevin R. Stone, MD Bryan Kelly
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD A= MRI confirming articular cartilage loss of the MFC B= Long leg x-ray demonstrating varus deformity of (L-knee??? I think it should be the Right knee: see x-rays and chart notes ) of about 5-7 degrees C= PA Flexion view demonstrating medial joint space narrowing bialterally L worse than R (nearly bone on bone on the Left). 51 yo ♂ real estate broker both knees w/ problems L worse than R. He has a long hx/o degenerative changes in the medial compartment, loss of the medial meniscus and previous efforts at surgical debridement in order to relieve his medial compartment pain. Pre-operative x-rays revealed medial joint space narrowing and loss of articular cartilage. Pre-operative MRI confirmed loss of the medial meniscus and loss of the artircular cartilage of the medial compartment. He stood in varus. In view of his young age and atheletic activities he requested an effort at biological reconstruction of the medial compartment. 03/10/1999 L-med-Allo/ ArtCart-MFC & MTP/ Open high tib med wedge opening osteotomy using BionX implants and allograft bone/ chon-LFC/ debridement/ Sx: developed a “clicking soreness” on upper MFC thought to be scar tissue requested an effort at operative debridement 03/20/2002 L-knee arthros/ chon-troch/ partial (M)ectomy of Allo where at the posterior 1/3 there was a small flap tear
Kevin R. Stone, MD A= Kissing lesion, MFC, MTP w/ loss of medial meniscus B= Morcellation of the MFC & MTP lesions and loss of medial meniscus
Kevin R. Stone, MD A= Placement of medial meniscal allograft B&C= Articular cartilage paste grafting MFC.
Kevin R. Stone, MD
Kevin R. Stone, MD A= MRI (03/18/02) documenting site of medial meniscus allograft and cartilage paste graft B= Long-leg x-ray (03/14/02) demonstrating post-op alignment C= PA Flexion view (03/14/02) documenting previous osteotomy and preservation of some joint space. 03/14/02 Patient seen 3 years post-op. He noted that before surgery he was unable to do certain activities that he would like to do, and he noted that the knee just pops w/ squatting. He is otherwise quite happy. Px: He had 2 prominent bumps at the medial side of his femoral condyle that he is complaining about. He had patellofemoral crepitus. His pain level is minimal, and his activity level is high. Dx: Arthrofibrosis and bursitis of L-knee. Sx: developed a “clicking soreness” on upper MFC thought to be scar tissue requested an effort at operative debridement 03/20/2002 L-knee arthroscopy/ chond-troch/ partial (M)ectomy of Allo where at the posterior 1/3 there was a small flap tear
Kevin R. Stone, MD
Kevin R. Stone, MD A= Medial meniscus allograft 3 years S/P transplantation B= Medial meniscus allograft 3 years S/P transplantation C= Biopsy MFC 3 years S/P ArtCart
Kevin R. Stone, MD 11-06-2000 R-leg = 4 o varus L leg = 2 o varus Steve Cousins 04-23-2002 R-leg = 5 o varus L leg = 2.5 o varus 39 yo ♂ owner of a “Spicy Sports” company with a long history of injuries playing hockey and lacrosse. Symptoms since 1977 w/ knee locking on one occasion (1982) but spontaneously released without surgery. Eventually came to surgery 1999 but after skiing for 4 months pain recurred. Symptoms at time of xam: R-knee pain, swelling, instability. 11/07/2000 R-med-Allo/ ArtCart- MFC/ Mfx-MTP/ removal bucket-handle tear Developed intermittent anterior knee catching and pain for which HE requested a repeat arthroscopic evaluation and again requested that osteotomy be delayed. Physical exam: lacked final few degrees of extension – excellent flexion and stability. MRI – intact meniscus, damage on the articular cartilage surface, and anterior arthrofibrosis. X-rays- well preserved joint space. 04/02/2002 R-partial med-meniscus/ chondroplasty – trochlea/ debridement
Kevin R. Stone, MD
Kevin R. Stone, MD A= Bucket-handle tear medial meniscus, displacing into the intercondylar notch. B= Bucket-handle tear medial meniscus, displacing into the intercondylar notch.
Kevin R. Stone, MD
Kevin R. Stone, MD Placement of the medial meniscal allograft in relation to ArtCart of MFC The only other picture of this meniscus is washed out and less distinct in demonstrating the implanted meniscus.
Kevin R. Stone, MD R-lat R-med L-med L-lat 11-6-2000 8.31 mm 0.70 mm 3.89 mm 6.91 mm 04-23-2002 7.28 mm 1.83 mm 4.85 mm 6.85 mm
Kevin R. Stone, MD A= Torn posterior medial meniscus B= S/P partial medial meniscectomy Slide “C” is a movie slide – demonstrating the allograft in relation to the healed MFC ArtCart 1.5 years post-op. Developed intermittent anterior knee catching and pain for which HE requested a repeat arthroscopic evaluation and again requested that osteotomy be delayed. Px: lacked final few degrees of extension – excellent flexion and stability. MRI – intact meniscus/ damage on the articular cartilage surface, and anterior arthrofibrosis. X-rays- well preserved joint space. 04/02/2002 R-partial medial meniscectomy/ chondroplasty – trochlea/ debride
Kevin R. Stone, MD A= Torn posterior medial meniscus B= S/P partial medial meniscectomy Slide “C” is a movie slide – demonstrating the allograft in relation to the healed MFC ArtCart 1.5 years post-op. Developed intermittent anterior knee catching and pain for which HE requested a repeat arthroscopic evaluation and again requested that osteotomy be delayed. Px: lacked final few degrees of extension – excellent flexion and stability. MRI – intact meniscus/ damage on the articular cartilage surface, and anterior arthrofibrosis. X-rays- well preserved joint space. 04/02/2002 R-partial medial meniscectomy/ chondroplasty – trochlea/ debride
Kevin R. Stone, MD A= Torn posterior medial meniscus B= S/P partial medial meniscectomy Slide “C” is a movie slide – demonstrating the allograft in relation to the healed MFC ArtCart 1.5 years post-op. Developed intermittent anterior knee catching and pain for which HE requested a repeat arthroscopic evaluation and again requested that osteotomy be delayed. Px: lacked final few degrees of extension – excellent flexion and stability. MRI – intact meniscus/ damage on the articular cartilage surface, and anterior arthrofibrosis. X-rays- well preserved joint space. 04/02/2002 R-partial medial meniscectomy/ chondroplasty – trochlea/ debride
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
Kevin R. Stone, MD Rhonda Topple
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
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Kevin R. Stone, MD Test
Kevin R. Stone, MD TEST
Kevin R. Stone, MD Tracy Achiles A= MRI demonstrating full-thickness MFC defect B= MRI demonstrating loss of medial meniscus C= MRI demonstrating loss of articular cartilage 48 yo ♀ fitness manager and triathlon/ iron-man competitor who tripped over her dog while walking it down the driveway landing on both knees. Subsequently saw local orthop surgeon who found a R-med meniscal tear and she underwent partial (M)ectomy Apr 27, 2001. Able to return to running but Sx pain/ swelling recurred. 2 nd Surgery Jan 2002 04/02/2002 – Right knee Surg: R-med-Allo/ R-MFC-ArtCart/ R-MFC|MTP|-Mfx/ Chon – troch Two weeks post-op she swam in a pool for two hours with her legs kicking and developed immediate swelling. It was presumed that she most likely had re-torn her meniscus allograft. However, she was treated conservatively to see whether or not it would heal on its own. It failed to do so. She had recurrent swelling w/ activities and not responsive to a single effort of cortisone injection . 06/26/2002 - Right knee Surg: R- med-Allo repair/ Mfx-MFC /Chon -MTP
Kevin R. Stone, MD
Kevin R. Stone, MD A= Full thickness chondral defect MFC and loss of medial meniscus B= Full thickness chondral defect MFC and loss of medial meniscus
Kevin R. Stone, MD A= Preparation and placement of medial meniscal allograft B= Placement of medial meniscal allograft Slide “C” is a movie clip – demonstrates relationship of lesion to meniscus
Kevin R. Stone, MD A= Retained medial meniscal allograft. C= Refixation of medial meniscal allograft. Repair of the “unstable junction of meniscal capsule w/ medial meniscus allograft. Slide “B*” is a movie - demonstrates the instability of the junction of the junction of the capsule w/ the allograft
Kevin R. Stone, MD A= Retained medial meniscal allograft. C= Refixation of medial meniscal allograft. Repair of the “unstable junction of meniscal capsule w/ medial meniscus allograft. Slide “B*” is a movie - demonstrates the instability of the junction of the junction of the capsule w/ the allograft
Kevin R. Stone, MD A= Retained medial meniscal allograft. C= Refixation of medial meniscal allograft. Repair of the “unstable junction of meniscal capsule w/ medial meniscus allograft. Slide “B*” is a movie - demonstrates the instability of the junction of the junction of the capsule w/ the allograft
