An update on stem cell technologies, prp and orthobiologics. Nuffield Health, The Grosvenor Hospital Chester and Chester Knee Clinic GP Seminar, Ewloe, Wales, UK 6th May 2017
Regenerative medicine is now an recognized specialty which has evolved from degerative diseases of Orthopaedic Surgery.Orthobiologics is a current terminology for the application of various cells, cytokines, growth factors.Busy people find it to update and this is an update.
Bone and Cartilage regeneration with cells and tissue engineering products - ...Enric Caceres
Bone and Cartilage regeneration with cells and tissue engineering products - Dr. Enric Cáceres - B-Debate 17/02/2015 http://www.bdebate.org/en/forum/advanced-therapies-and-regenerative-medicine-promise-21st-century
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"
Cartilage Repair using Stem cell & OrthobiologicsVaibhav Bagaria
Regenerating Cartilage is a challenge. What's new in this field of cartilage regeneration and the current status of the stem cell use in this field is described.
An update on stem cell technologies, prp and orthobiologics. Nuffield Health, The Grosvenor Hospital Chester and Chester Knee Clinic GP Seminar, Ewloe, Wales, UK 6th May 2017
Regenerative medicine is now an recognized specialty which has evolved from degerative diseases of Orthopaedic Surgery.Orthobiologics is a current terminology for the application of various cells, cytokines, growth factors.Busy people find it to update and this is an update.
Bone and Cartilage regeneration with cells and tissue engineering products - ...Enric Caceres
Bone and Cartilage regeneration with cells and tissue engineering products - Dr. Enric Cáceres - B-Debate 17/02/2015 http://www.bdebate.org/en/forum/advanced-therapies-and-regenerative-medicine-promise-21st-century
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"
Cartilage Repair using Stem cell & OrthobiologicsVaibhav Bagaria
Regenerating Cartilage is a challenge. What's new in this field of cartilage regeneration and the current status of the stem cell use in this field is described.
Bone tissue engineering challenges in oral and maxillofacial surgerySeyed Mohammad Zargar
In this presentation, I talked about maxillofacial deformities, Different Reconstruction methods and at tissue engineering approach.
S.Mohammad Zargar
Biomedical Engineering Student at University of Isfahan, Iran
Autologous Mesenchymal Stem Cells in OrthopaedicsVladimir Bobic
Nuffield Health, The Grosvenor Hospital Chester, UK
27 June 2013. GP and Physiotherapy Seminar: Autologous Stem Cell Therapies in Orthopaedics. Moderator and Presenter: Vladimir Bobic, Chester Knee Clinic
There are a lot of orthopedic conditions and injuries that presently have limited treatment options available.
Here regenerative technologies comes up as a ray of hope among surgeons for the treatment by functionally repairing the tissues and organs using growth factors, stem cells and products developed by genetic engineering with the advancement in the stem cells research field .
The purpose of this presentation is to first provide idea about the orthopedic conditions along with the therapeutic potential of stem cells to treat these diseases.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Vladimir Bobić: 2019 update on the management of knee OA - Nuffield 180519Vladimir Bobic
A review of orthopaedic and orthobiologic treatment options, with emphasis on the difference between osteoarthritis and osteoarthrosis (PTOA), the role of osteochondral unit, subchondral bone, etc.
il dottor Spoliti Ortopedico illustra come curare con le Cellule mesenchimali, difetto condrale Ricostruzione con Acido Ialuronico e midollo osseo autologo Aspirare Concentrate
Bone tissue engineering challenges in oral and maxillofacial surgerySeyed Mohammad Zargar
In this presentation, I talked about maxillofacial deformities, Different Reconstruction methods and at tissue engineering approach.
S.Mohammad Zargar
Biomedical Engineering Student at University of Isfahan, Iran
Autologous Mesenchymal Stem Cells in OrthopaedicsVladimir Bobic
Nuffield Health, The Grosvenor Hospital Chester, UK
27 June 2013. GP and Physiotherapy Seminar: Autologous Stem Cell Therapies in Orthopaedics. Moderator and Presenter: Vladimir Bobic, Chester Knee Clinic
There are a lot of orthopedic conditions and injuries that presently have limited treatment options available.
Here regenerative technologies comes up as a ray of hope among surgeons for the treatment by functionally repairing the tissues and organs using growth factors, stem cells and products developed by genetic engineering with the advancement in the stem cells research field .
The purpose of this presentation is to first provide idea about the orthopedic conditions along with the therapeutic potential of stem cells to treat these diseases.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Vladimir Bobić: 2019 update on the management of knee OA - Nuffield 180519Vladimir Bobic
A review of orthopaedic and orthobiologic treatment options, with emphasis on the difference between osteoarthritis and osteoarthrosis (PTOA), the role of osteochondral unit, subchondral bone, etc.
il dottor Spoliti Ortopedico illustra come curare con le Cellule mesenchimali, difetto condrale Ricostruzione con Acido Ialuronico e midollo osseo autologo Aspirare Concentrate
-often suffer from cartilage injuries. Cartilage surgery is available in India to cure cartilage problems and prevent them from developing knee osteoarthritis. Autologous cartilage cell implantation is being done by Madras Joint replacement center at an affordable cost. This biological intervention will hopefully avoid a knee replacement in young individuals.
Introduction
Anatomy and Physiology of bone
Bone Tissue Engineering
Recent studies related to bone tissue engineering
Commercialized products and ongoing clinical trials
Biomedical start-ups
Concluding remarks
Introduction
Anatomy and Physiology of bone
Bone Tissue Engineering
Recent studies related to bone tissue engineering
Commercialized products and ongoing clinical trials
Biomedical start-ups
Concluding remarks
Introduction
Anatomy and Physiology of bone
Bone Tissue Engineering
Recent studies related to bone tissue engineering
Commercialized products and ongoing clinical trials
Biomedical start-ups
Concluding remarks
Craniomaxillofac trauma reconstruction bone graft in cranifacial surgery/oral...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Craniomaxillofac trauma reconstr bone graft in cranifacial surgeryIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Tissue reaction to dentofacial orthopedic appliances /certified fixed orthodo...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Distraction osteogenesis /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Bobic Vladimir - Osteochondral Unit - SEEFORT Dubrovnik - 25 april 2019Vladimir Bobic
The importance of OsteoChondral unit. A review of over 20 years of personal clinical, surgical and imaging journey through numerous osteochondral and subchondral issues. Still more questions than answers!
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Bone Grafts /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Bobic Vladimir - ACL Injuries - Chester Uni MSc Sports Medicine 140324.pdfVladimir Bobic
Presentation for University of Chester MSc Sports Medicine Students. A review of knee ligament injuries, with emphasis on ACL injury, prevention, treatment and rehabilitation and inevitable PTOA in the long run.
A review of personal experience with articular cartilage and osteochondral repair and imaging. An attempt to explain the lack of correlation between symptoms, clinical findings, arthroscopic findings, biopsy and MR imaging.
Vladimir Bobić - Subchondroplasty - ICRS Focus Meeting Rome 7th June 2019Vladimir Bobic
We may have embraced the entirely new treatment concept which is possibly based on some assumptions. Subchondroplasty is probably indicated mainly for the treatment of subchondral cysts and cavities, rather than various bone marrow oedema conditions, most of which do not seem to need surgical treatment, as they get better given time.
The aetiology of various conditions, known generically as “bone marrow oedema” (or perhaps more correctly “bone marrow lesions”), is very different and it is still poorly understood and therefore it is difficult to decide when the surgical treatment is necessary and what is the most appropriate treatment.
Bone marrow oedema, as a metabolic (possibly vascular remodelling rather than degenerative) process does not seem to lack bone, and therefore injecting bone substitute is probably not the best ingredient. To the contrary, injecting bone paste may clog subchondral microtrabecular bone spaces and may slow down or prevent subchondral repair and remodelling by blocking neurovascular pathways. It is difficult to accept that patients "should expect 3 days of severe pain" postoperatively, but even if we do this is probably not acceptable, because injected and cured bone substitute may increase intra-osseous pressure (which is already higher than normal, especially in SONK-like conditions, which are very painful to start with) and block metabolic (vascular) pathways. Unsurprisingly, in some cases, biopsy of the subchondroplasty area treated with on calcium phosphate paste has shown necrotic or nonviable bone a few years postoperatively.
However, long-lasting symptomatic bone marrow oedema and SONK-like lesions, may benefit biologically and structurally from the surgical treatment with more biologically desirable ingredient, such as autologous bone marrow aspirate, delivered directly to the intra-osseous area affected with bone marrow oedema. This is where subchondroplasty, using autologous bone marrow aspirate, autologous stem cells or even autologous PRP gets entirely new biological meaning and possibly becomes more useful therapeutically.
Presented at ACL Study Group meeting in Åre, Sweden.
Mucoid ACL degeneration and ACL "cysts" and “ganglions” are relatively frequent incidental MRI diagnosis in our practice. The correlation is still poorly understood but seems to be associated with progressive structural ACL degeneration, formation of ACL ganglions and local femoral or tibial subchondral marrow oedema and intraosseous cysts.
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
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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!
- 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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
V Bobic - Stem Cells - BKS Cardiff 030217
1. Autologous Stem Cell Therapies
in Knee Orthopaedics
New developments which may delay or avoid more invasive surgical treatments?
The future of orthopaedics? Less carpentry, more biology?
Prof. Vladimir Bobić
Chester Knee Clinic www.kneeclinic.info office@kneeclinic.info @ChesterKnee
The 3rd Meeting of the Biological Knee Society
Cardiff 3 February 2017
6. What are Mesenchymal Stem Cells?
• Adult stem cells can help
regenerate many tissues
• The best source is the
autologous tissue
• Many different tissues can be
used to process biologically
powerful stem cells
• It seems that the best tissue to
extract MSC is SVF (stromal
vascular fraction) adipose
tissue, which is the best source of
cells and regenerative factors
12. Stem Cells No Better Than Placebo … So Far
(Editor of Arthroscopy Journal re JBJSA September 2016 Article)
13.
14.
15.
16.
17. 1st Orthopaedic
Stem Cell Seminar in
the UK:
Guest Speaker:
Dr Fabio Valerio Sciarretta
Head of Department of Orthopeadic Surgery at
Mercede Clinic, Rome, Italy.
A specialist knee surgeon and arthroscopist, whose
special interests are articular cartilage repair in the
knee and the ankle, ligament reconstruction,
meniscal repair/transplantation and minimally-
invasive knee replacement.
Dr Sciarretta is a member of numerous national and
international orthopaedic associations, the editor of
Italian editions of numerous american and
international textbooks and has published over 50
articles.
www.fabiosciarretta.it
18.
19.
20. In adults, stem cells act as a repair system for
the body. They allow replacement of ageing
and damaged cells in organs.
In adults, damaged tissue is usually replaced
with scar tissue which loses most of its original
function. Stem cell therapy has the potential to
restore the original structure and function of
the damaged tissue.
Researchers believe that stem cell therapy could
dramatically improve medical treatment, espe-
cially in the field of regenerative medicine.
Adult Stem Cells
KLSMC STEM CELLS
Stem Cells
KUALA LUMPUR SPORTS
MEDICINE CENTRE
INFORMATION FOR
PATIENTS
7th Floor, Wisma Perintis,
47 Jalan Dungun, Damansara Heights,
50490 Kuala Lumpur, Malaysia.
Tel: +603 2096 1033
Fax: +603 2096 1500
Stem Cell Enquiry: +603 2089 5239
E-mail: enquiry@klsmc.com
Website: www.klsmc.com
Outpatient Clinic Hours
Monday to Friday ( 9am to 5pm )
Saturday ( 9am to 1pm )
KUALA LUMPUR SPORTS MEDICINE CENTRE
Location Map
Parking is available in the basementP
21. From Chondral Damage to Advanced OA
... to Advanced Medial OA?From Small MFC Chondral Lesion ...
22. Osteochondral Repair and OA: Current Treatment Options
ACI BioPoly
TKR
OATS
Microfracture
Chondroplasty
24. The Subchondral Unit: A New Frontier
re-drawn from Imhof et al. 1999
Henning Madry, Saarland University, Homburg/Saar, Germany
Imhof H, Breitenseher M, Kainberger F, Rand T, Trattnig S. (1999): Importance of subchondral
bone to articular cartilage in health and disease. Top Magn Reson Imaging 10:180–192
25. The Structure of Subchondral Bone
Redrawn from: Imhof H, Breitenseher M, Kainberger F, Rand T, Trattnig S. (1999): Importance of subchondral bone to
articular cartilage in health and disease. Top Magn Reson Imaging 10:180–192
A surprisingly high number of arterial and venous vessels, as well
as nerves, can be seen in the subchondral region sending tiny
branches into the calcified cartilage …
26. The Structure of Subchondral Bone
• This is extremely important for cartilage repair: the
tidemark is crossed by collagen fibrils extending
from the articular cartilage into the calcified
cartilage, while no collagen fibrils connect the
calcified cartilage to the subchondral bone plate.
• Blood vessels from the subchondral region can extend into
the overlying calcified cartilage through canals in the
subchondral bone plate.
• Therefore, nutrients can reach chondrocytes in the
calcified zone via these perforations.
• Unsurprisingly, the perforations are grouped
together in the regions of subchondral plate where
the stress is greatest.
CKC UK
27. The Structure of Subchondral Bone
The changes in the thickness of the subchondral bone plate depend on the
location and mechanical loads
Henning Madry, Saarland University, Homburg/Saar, Germany
33. “Vladimir, give me a brief summary …”
From: Vladimir Bobic
Sent: 27 March 2011 10:33
To: Fares Haddad
Subject: Re: cartilage
Hi Fares,
There is not much new on the horizon. There are quite a few scaffolds/implants, etc, but nothing really exciting. We ("the cartilage people")
seem to be too focused on repairing only one layer (articular cartilage), while we have much bigger structural (and metabolic) problems with an
osteochondral unit. Better understanding of subchondral activity and more 3D approach to repairing the whole (osteochondral) unit rather than just
damaged articulating surface is what we need if we really want to make this work functionally.
As you know from my previous email, there is still a huge unmet need in treating symptomatic chondral and osteochondral lesions as many
articular cartilage procedures fail functionally even with non-impact high-level pro sports. In that respect, and looking honestly at our functional outcomes
of ACI/MACI surgery the best we can do is just to plug the hole (literally) with so-called "functional repair tissue", at enormous expense (over £16,000 for
Genzyme ACI/MACI and over £26,000 for TiGenix CCI!) and reduce athletic population to tears and despair with months of slow and restrictive
rehabilitation. We are definitely not very successful with ACI technology when it comes to anticipated functional outcomes at almost any athletic levels,
although we don't know if this technology helps biologically in the long run.
I don't think that TruFit works in the long run, although the concept is good, but the biological response to biphasic materials is not.
OATS is generally good in the long run, but mainly for smaller lesions and with single 10mm grafts. The surrounding cartilage often fails
(years later) and things get worse circumferentially, often associated with increased subchondral activity (bone marrow oedema) and subchondral cysts
(failed subchondral remodelling), which is probably a consequence of very slow but much wider osteochondral problem at the outset.
I often use deep subchondral decompression through the recipient socket and implant autologous bone marrow aspirate, all of
which seems to work better that OATS on its own. I saw an excellent vet paper in the JBJSA last year, looking at the same combo in horses,
and they confirm that OATS + ABM is better than OATS alone.
I hope this is of some help.
Regards, Vladimir
London Knee Meeting 2011
London, 13 October 2011.
Articular Cartilage Repair
one step forward, two steps back … (in 7 minutes)
34. • Mainly because we still do not seem to understand
complex biological and mechanical interaction of
articulating surface and subchondral bone.
• This is probably the reason why all mainstream
cartilage repair technologies suffer from two major
problems:
• insufficient peripheral chondral integration
(biomechanical problem?)
• insufficient longitudinal subchondral integration
(nutritional and biomechanical problem?).
• We may have to accept that this is as good as it
gets, at this point in time.
• However, finding a biological solution for cartilage
regeneration is one of the fastest growing areas of
research and development in orthopaedics and
regenerative medicine in general.
So, Why is Cartilage Repair Still a Problem?
35.
36. Articular Cartilage Regeneration
• Regenerated cartilage can be derived from various cell types,
including chondrocytes, pluripotent stem cells, and
mesenchymal stem cells.
• Common scaffolding materials include proteins, carbohydrates,
synthetic materials, and composite polymers.
• Scaffolds may be woven, spun into nanofibers, or configured
as hydrogels.
• Chondrogenesis may be enhanced with the application of
chondroinductive growth factors.
• Bioreactors are being developed to enhance nutrient
delivery and provide mechanical stimulation to tissue-
engineered cartilage ex vivo.
48. •Adipose tissue derived MSCs?
•Stem cells isolated from fat are being considered as an option for
treating tissue damage and diseases because of their accessibility and
lack of rejection.
•New research published in BioMed Central's open access journal Stem Cell
Research & Therapy shows that this is not as straightforward as previously
believed, and that fat-derived stem cells secrete VEGF (Vascular
Endothelial Growth Factor) and other factors, which can inhibit cartilage
regeneration.
•However pre-treating the cells with antibodies against VEGF and growing
them in nutrients specifically designed to promote chondrocytes can
neutralize these effects.
The Best Source of
Autologous Stem
Cells?
49.
50.
51.
52.
53.
54. MSC Clinical Trials: IMPACT
•Currently, UMC Utrecht (Holland) researchers are conducting
the first human trial of an instant mesenchymal stem cell
(MSC) product for use with ACI in what they call the IMPACT
study. In treating focal articular knee cartilage lesions in that
study, the investigators will assess the safety and feasibility of
the MSC construct.
•“In one surgical procedure, we will use the patient’s own
cartilage and mix it with bone marrow from the stem
cell bank,” Saris said. “You use bone-derived stem cells that
can still become whatever they want and you use
chondrocytes that you do not have to culture.
•“We are capable of doing this within one surgical procedure,
which means that you get rid of all the logistics and the costs
of culturing” he said. “This is the next frontier in cell therapy.”
55. Lateral Femoral Trochlea:
a reliable source of good cancellous bone and bone marrow, even in advanced OA
CKC UK
MFC AVN
59. Autologous Bone Marrow
• Red marrow has significant haematopoietic stem cell potential
and still persists in adults in certain areas such as the iliac
crests.
• The anterolateral trochlea (the usual OATS donor site) is often
spared even in advanced OA and seems to contain reasonably
good bone marrow, which can be aspirated through the donor
site.
• Pluripotent haematopoietic stem cells can differentiate into any and all
of the cells of circulating blood and the immune system.
• MRI studies have indicated that the conversion of red to fatty marrow
occurs prematurely in some patients with avascular necrosis.
• Osteonecrosis is associated with a decrease in progenitor cells in the
proximal femur. Bone marrow also contains osteogenic progenitors,
with a potential for effective bone regeneration.
• It seems sensible to use core decompression but also to deliver
better “biologic fuel” with pluripotent cells to the affected area.
• The quantity and quality of good autologous bone marrow is
questionable, but as it seems that stem cells do not to do the
actual work (they seem to go around and boss other cells and
tell them where to go and what to do) a few mils of bone
marrow aspirate may be good enough to kick-start the process.
CKC UK
62. SONK Before and After Subchondral Decompression
• 15/12/08: subarticular insufficiency
fracture and slight flattening of the
MFC and prominent subarticular
marrow oedema more marked on the
femoral side. Since 04/04/08,
significant deterioration in the medial
compartment with SONK-like
process, progressive degenerative
changes …
• 11/09/09: Comparison is made with
the previous scan 15/12/2008. In the
medial compartment, following the
subchondral decompression, there
is now evidence of articular
irregularity, deficiency and
thinning of articular cartilage,
slight increase in the subarticular
marrow oedema and early
subarticular cyst formation in the
outer aspect of the MFC …
63. SONK: sudden onset,
severe knee pain
MRI: “In the outer weight-
bearing portion of the medial
femoral condyle, there is an
osteochondral lesion (22mm ant-
post x 10mm med-lat x 2mm
deep), with fluid at the interface
with parent bone, mild reactive
marrow oedema and a cortical
break peripherally in keeping
with instability. Degenerative
changes in the medial
compartment with spontaneous
osteonecrosis of the medial
femoral condyle (SONK) and
unstable fragment.”
David Ritchie, Glasgow
CKC MRI 060506
64. FU MRI: “In the medial
compartment, the graft over the
central weight-bearing portion of
the medial femoral condyle has
incorporated with adjacent
bone and the overlying
articular cartilage is flush
with adjacent native
cartilage. A small focus of
marrow oedema is noted directly
beneath the graft but overall
there has been a reduction in
marrow oedema around the
graft. A small trace of
subcortical fluid in the peripheral
portion of the medial femoral
condyle is similar to the pre-
operative scan - presumably not
included in the repair.”
Dr David Ritchie, Glasgow
CKC MRI 030307
68. An alternative approach to the treatment of
femoral and tibial Osteonecrosis, Chronic SONK
and Secondary OA:
• The knee is often not too bad (all 3 compartments) or it is too early
for a partial or a full knee replacement.
• Classic Microfracture and Core Decompression are probably not deep
enough.
• Looking at most MRIs it seems that we need to reach at least 15 to 20
mm deep into subchondral bone, which is where any cylindrical
osteochondral harvesters are very handy.
• Effectively, this is a combination of OAT and deep core (subchondral)
decompression, with a hand driven K-wire, through the bottom of the
recipient socket, with
• a mixture of autologous blood + bone marrow injected into the
recipient socket,
• and capped with 10 mm OATS plug, which was soaked in the same
mixture of bone marrow and blood.
• This “integrated” subchondral repair concept makes sense, it gives
most people quick and durable pain relief and better knee function,
but it is based on huge assumptions.
• The main question is weather unprocessed (and not concentrated)
autologous bone marrow, is powerful enough biologically?
CKC UK
69. • Conclusions: Delivery of bone
marrow concentrate can result
in healing of acute full-thickness
cartilage defects that is superior
to that after microfracture
alone in an equine model.
• If this is the case, looking at
osteochondral defects, is this
combination working better
because microfracture (multiple
perforations and tunnelling) of
subchondral bone is making it less
stiff but also allows “biologic
fuel” (bone marrow, blood and
who knows what else) to reach
deeper areas, re-establish
nutrition and facilitate local
osteochondral repair?
ABMA: An Essential Ingredient for Octeochondral Repair?
JBJS A August 2010
70. Dear Mr Bobic,
I am writing to you to give an update of my progress and to say thanks. You carried out a Medial Subchondral
Decompression, Autologous Bone Marrow Transplant and Autologous Osteochondral Grafting for me on the
7th of January 2009. I found the standard of care you supplied to be excellent. I have had numerous surgeries
over the past twenty years following very poor care provided to me when I was eighteen years old. Yours was the
last procedure I had. Following this my pain has been greatly reduced and my function significantly improved.
To compliment your work, I have worked with a biomechanist to balance and strengthen my body with particular
focus on my legs.
Last September, I completed the Yorkshire Three Peaks Challenge which, in case you are not aware, involves
walking a twenty five mile circuit and climbing the highest peaks in Yorkshire. This has to be completed in less
than twelve hours which basically means only two ten to fifteen minute stops. My knee was strong and pain
free for the whole event and the next day provided me with only a small amount of low level aching. There
were plenty of others with no surgical history who were worse off.
I would like to thank you very much for making this possible for me. I undertake regular walks in the Lake
District, Yorkshire Dales and Wales and this would not of been even considered before your help.
I do understand that I will need a knee replacement in the future and I will not hesitate in coming to see you
for this procedure. Of the many surgeons I have seen I feel the standard of care and expertise you provided was,
by far, the best which has been born out by the excellent result I have had.
Thanks again and see you in the future
Yours sincerely
From: R... L... <...@btinternet.com>
Subject: UPDATE AND THANKS
Date: 12 April 2013 16:08:18 BST
To: Vladimir Bobic <vbobic@kneeclinic.info>
71. This applies both to stem cell
technologies and our attitudes …
"There are only two ways to live your life:
One is as though nothing is a miracle.
The other is as though everything is a miracle."
Albert Einstein