This document provides an overview of knee arthritis and cartilage disorders presented by Dr. Christopher Inzerillo. It discusses knee anatomy, the different types of knee arthritis, symptoms, diagnosis through history, physical exam, x-rays and MRI. Treatment options discussed include non-surgical approaches like physical therapy, medications, supplements and bracing as well as surgical options like injections, arthroscopy, cartilage repair procedures, realignment surgeries, knee replacement and new techniques using robotics.

1. Knee Arthritis and
Cartilage Disorders
Presented by:
Christopher Inzerillo, MD,
FAAOS

2. Background:
College: Duke University
Medical School: University of Toledo
Residency: University of Pennsylvania
Fellowship: Sports Medicine NYU/Hospital for
Joint Disease
MBA: Marist College

3. • Knee Anatomy
 Largest joint in the
body
 Most common joint to
have a problem
 Three bones, femur,
tibia, patella
 Four ligaments hold
bones together
 Two menisci, “shock
absorbers”
 Articular cartilage
“cushion”

4. Knee Arthritis
• Greek “Arthros” means Joint
• Greek “itis” means inflammation of
• Symptoms are pain, swelling,
stiffness, loss of function
• Many types: most common
osteoarthritis “wear and tear”
• Rheumatoid, septic, post traumatic,
gouty, psoriatic
• Cost to United States 303.5 Billion!!!

5. Knee History & Physical Exam
• History: acute injury vs slow
gradual onset of pain, history of
prior injury, family history,
• Inspection: alignment “knocked
knee, bow legs”
• Loss of range of motion, effusion
• Tenderness

6. Knee Arthritis
• Cartilage wears away,
normal cushion of the joint.
• Cartilage is avascular, has
minimal healing ability
• Different from Meniscal
cartilage injury

7. Knee Arthritis
• X-ray findings

8. Knee Arthritis
• MRI findings

9. Treatment
Non-surgical always first!
• Non-surgical: Activity
modification, weight loss
• Physical Therapy, including
exercises for strengthening
and flexibility
• Medicines: NSAIDS,
steroids, no narcotics!!
• Supplements: glucosamine,
turmeric, arnica, etc.
• Anti-inflammatory diet,
alkaline diet
• Bracing, unloader, support
brace

10. Injections
• Steroid: (cortisone)
– Mixture of local anesthetic and
steroid
– Can be given 3-4 times per year
– Effective for most but not all
• Gel:
– Orthovisc, Synvisc, euflexxa,
supartz, hymovis, gelsyn,
– Large protein that attracts water

11. Injections
• PRP: (platelet rich plasma)
aggressive marketing, patient
demand, little evidence of
effectiveness, many different
types
• Stem cells: BMAC myth or
miracle? Sounds good in
theory, patient demand,
expensive, not proven, stay
tuned!

12. Platelet-Rich Plasma
• Procedure
 Peripheral blood draw (autologous)
 Blood spun down to isolate concentrate of platelets
 Rich in growth factors

13. Is there a Role for Stem Cells?
• Autologous
 Bone Marrow Aspirate Concentrate
(BMAC)
 Adipose-derived Stem Cells (ASCs)
• Harvested from bone marrow or
adipose tissue
• Injected into injured joint/tissue

14. Knee Arthritis
• Surgical Treatment:
• Knee arthroscopy:
more effective for
meniscal tears, mild
symptoms, loose
bodies, synovectomy
• Cartilage biopsy

15. Cartilage Repair or Restoration
• Surgical
Treatment:
–Cadaveric
Cartilage
transplant
–Scaffolds
–MACI
cartilage
transplant

16. Knee
Realignment
• Surgical Treatment:
– Osteotomy
– Realignment of
deformed limb to
unload the worn area

17. Knee Replacement
• Surgical Treatment:
– Knee replacement
– Partial knee
– Total knee

18. Robotic Surgery
• Preoperative CT scan
• 3D model of the knee
• Pre-operative plan
• In surgery, plan is
carried out using a
robot

19. Knee 3D Virtual Model
Knee CT scan
Total knee 3D model
Partial knee 3D model

21. Advantages of Robotic Surgery
• Precision of the cuts
 Accurate to with 0.5 mm
 Adjust cuts in 1 degree increments
 Allows for press-fit (cementless)
 Greater longevity of replacements
 UKA more accurate/reproducible
• Protect of soft tissues
• Less soft tissue dissection
 Less pain? Faster recovery?
 Decreased hospital stay?
 Lower overall costs?
Cemented Uncemented

22. Thank You!
For more information on me, or to book an appointment
visit: smgortho.com or call 844-SMG-ORTHO, or the
Paramus office direct at 973-437-2615.