The document discusses meniscus transplants, including:
1) Meniscus transplantation can help reduce pain and improve function by restoring a biomechanically favorable environment in the knee.
2) A long-term study of 119 meniscus transplant cases found a 79% success rate, with the main factors affecting survival being increased age and number of previous surgeries.
3) Case studies demonstrate that meniscus transplantation, combined with cartilage repair procedures, can provide long-term benefits for patients with meniscus injuries and cartilage damage.
1. Periprosthetic fractures are fractures that occur near a joint replacement prosthesis. They can occur in the femur, patella, or tibia.
2. Risk factors include increasing age, female sex, osteoporosis, revision arthroplasty, rheumatoid arthritis, steroid use, and neurological diseases.
3. Surgical treatment depends on the fracture classification and stability of the prosthesis. Options include open reduction internal fixation with a locking plate, intramedullary nailing, or revision arthroplasty.
Current Concepts in High Tibial osteotomy and Unicondylar knee replacementPaudel Sushil
This document discusses current concepts in unicondylar knee arthroplasty and high tibial osteotomy for the management of unicompartmental osteoarthritis of the knee. It provides an overview of the procedures, including types of osteotomies for high tibial osteotomy, indications and contraindications for each procedure, long-term results, and risks of converting between the two procedures. The document also reviews principles and considerations for each technique as well as selected implant designs for unicondylar knee arthroplasty.
Poller screws, also known as blocking screws, are non-interlocking screws placed outside an intramedullary nail to improve fracture reduction and fixation. They provide a more rigid construct by serving as a surrogate cortex where nail-cortex contact is insufficient. Their placement helps centralize the guidewire in the medullary canal and maintains reduction through a blocking effect. While there is no consensus on their exact placement, they are generally inserted on the concave side of expected deformities to prevent malalignment during nailing.
Chondral Injuries - Current Concepts in Management & Cartilage RegenerationVaibhav Bagaria
Chondral Injuries are one of the technically challenging cases for sports injury surgeons. There are various techniques described including lavage, abrasion chondroplasty, micro fracture, Mosaicplasty, ACI - various generations and newly developed Bioprinting
Primary Total Knee Arthroplasty has evolved since the 19th century with various prosthetic designs introduced over time. Prosthetic design considerations include femoral rollback, modularity, constraint, and whether to retain or sacrifice the cruciate ligaments. Radiographs are important for preoperative planning to assess alignment and bone defects. Surgical goals include restoring mechanical alignment, joint line, balanced soft tissues, and normal patellofemoral tracking. Key steps include femoral and tibial cuts, balancing the knee in flexion and extension, and addressing any flexion contractures or deformities. Complications can include nerve palsies, vascular issues, stiffness, infections, and loosening. With careful patient selection, planning and technique, total knee
This document discusses implant selection considerations for revision total knee replacement (TKR) surgery. It begins by outlining common causes for revision TKR such as aseptic loosening and polyethylene wear. Key challenges in revision TKR are managing bone defects from osteolysis, compromised soft tissues, and restoring proper limb alignment. Implant options discussed include metaphyseal sleeves and stems to provide fixation in bone defect zones, as well as augmentations. Constraint levels from unconstrained to fully constrained implants are reviewed. Clinical cases demonstrate approaches for addressing instability, significant bone loss, and peri-prosthetic fractures in revision TKR.
1) HTO and UKA are surgical options for isolated medial compartment osteoarthritis of the knee. HTO aims to redistribute mechanical forces while UKA resurfaces the damaged compartment.
2) Traditionally, HTO was recommended for younger, active patients while UKA criteria included older age and lower BMI. However, criteria have expanded given improved techniques and implant designs.
3) When performed according to indications at high-volume centers, both procedures show good-to-excellent outcomes and survivorship rates over 10 years, though UKA survivorship may be higher. Global trends show a shift toward more UKAs being performed.
Tips, tricks and pitfalls of proximal femoral nailing (PFN)Puneeth Pai
1. Proximal femoral nailing (PFN) requires thorough pre-operative planning including imaging and assessment of fracture pattern and patient comorbidities.
2. It is important to reduce the fracture before making the entry point, as the entry point will determine surgical success.
3. Factors such as varus reduction, medializing the shaft, high tip-apex distance, and penetration of the femoral head can lead to poor outcomes like nonunion.
This document summarizes recent advances in the management of periprosthetic infection. It discusses the definition and criteria for diagnosis of prosthetic joint infection (PJI), challenges in diagnosis, and diagnostic markers including serum markers like CRP, ESR, D-dimer, and synovial markers like alpha-defensin and synovial fluid IL-6 and IL-8 levels. Molecular diagnostic methods like polymerase chain reaction and next-generation sequencing are also discussed as culture-independent techniques to aid diagnosis. The conclusion emphasizes that PJI diagnosis remains challenging due to the complex nature of implant-related infections.
This document discusses outcomes of treating distal tibia fractures using minimally invasive plate osteosynthesis (MIPO) technique. It provides an overview of the MIPO surgical procedure and reviews several studies comparing MIPO to traditional open reduction and internal fixation. The studies found MIPO resulted in high union rates, shorter healing times, and fewer complications like infection compared to open reduction. MIPO preserves the fracture site's blood supply and limits soft tissue damage, allowing for better callus formation and healing.
This document discusses protrusio acetabuli, a hip joint deformity where the medial wall of the acetabulum invades into the pelvic cavity. It can be caused by primary or secondary factors like infections, tumors, inflammation, trauma or genetics. The first case was described in 1824. Diagnosis involves clinical exams and radiological imaging. Treatment depends on the patient's age and bone maturity, and may include surgical closure of growth plates in children, bone grafting in adolescents, or total hip arthroplasty in older adults. Placement of the hip prosthesis component is important to avoid loosening.
High tibial osteotomy (HTO) is a realignment procedure that unloads the diseased knee joint surface and corrects angular deformities. It has regained popularity for treating medial compartment osteoarthritis in young, active patients. The goals of HTO are to redistribute weight bearing forces across the knee joint. It is commonly performed using either a closing or opening wedge technique. Patient factors like age, activity level, and alignment/deformity guide whether HTO or knee replacement is most appropriate. Long term studies show HTO effectiveness declines over 7-10 years.
Otto Pelvis, also known as primary protrusio acetabuli, was first described by German pathologist Otto in 1824. It is characterized by medial protrusion of the acetabulum. There are two types: primary, which remains a diagnosis of exclusion, and secondary. Clinical features include a marked female predilection and bilateral involvement. Radiographs can identify protrusio using Kohler's line or central edge angle. Management depends on age and degeneration, ranging from valgus osteotomy in younger patients to total hip arthroplasty with grafting in older patients. Surgical techniques aim to restore the hip center through lateralization and reconstruction of bone defects.
This document discusses the treatment of unstable intertrochanteric fractures using cephalomedullary nails like the proximal femoral nail (PFN) or trochanteric femoral nail (TFN). It provides a simpler classification system for surgeons to identify stable versus unstable fractures. Unstable fractures are more difficult to treat and have a risk of gradual collapse if the lateral wall or lesser trochanter is broken. The PFN provides advantages over dynamic hip screws by acting like a dynamic hip screw, trochanteric stabilizing plate, Medoff sliding plate and including a derotational screw for improved stability and prevention of medialization in unstable fractures.
This document provides an overview of ankle arthrodesis, including:
- Indications for the procedure include pain, deformity, and instability from conditions like trauma, infection, arthritis.
- Surgical options include open arthrodesis with internal or external fixation, arthroscopic arthrodesis, and mini-open techniques.
- The goals of fusion are to relieve pain, create a stable foot, and position the ankle in 5 degrees of valgus and 5-10 degrees of external rotation.
- Potential complications include non-union, infection, nerve injury, and malunion. Outcomes studies found relief of pain but activity limitations remain.
Damage control orthopaedics (DCO) is an approach that temporarily stabilizes orthopaedic injuries in severely injured trauma patients to avoid worsening their condition. It focuses on controlling hemorrhage, managing soft tissue injury, and achieving provisional fracture stability through temporary stabilization methods like external fixation. This allows time for the patient's physiology to stabilize before definitive repair and reduces the risks of complications from a major orthopaedic procedure when the patient is still unstable. DCO has evolved from traditional approaches as an understanding has grown of the body's inflammatory response to trauma and risks of multiple hits.
Unicondylar knee replacement (UKA) is a less invasive procedure than total knee replacement that replaces only the damaged or arthritic parts of one compartment of the knee. UKA aims to resurface the diseased compartment without altering knee joint kinematics by preserving the cruciate ligaments. UKA is indicated for isolated uni-compartmental osteoarthritis with pain localized to one side and intact ligaments. Contraindications include osteoarthritis in both compartments and an absent ACL. Proper technique during UKA involves avoiding overcorrection and preventing tibial spine impingement. Advantages include preserving normal knee function while allowing for quicker recovery, but disadvantages include potential secondary degeneration and loosening requiring conversion to total
This document discusses locking plate technology for fracture fixation. Some key points include:
- Locking plates provide fixed-angle stability between screws and plate through threaded screw holes.
- They allow for angular stability, increased pullout strength, and preservation of blood supply compared to conventional plates.
- Indications include osteoporotic, periarticular, and comminuted fractures. Plates can be used in compression, neutralization, bridging, or combination modes.
- Proper surgical planning, screw placement, and technique are important to avoid complications like loss of reduction, screw protrusion, or plate/screw failure.
This document discusses several common causes of hip pain in adolescents, including transient synovitis, Perthes disease, slipped capital femoral epiphysis, septic arthritis, tuberculous arthritis, and idiopathic chondrolysis. For each condition, the document outlines typical presenting symptoms, potential causes, diagnostic methods like x-rays and blood tests, and treatment approaches such as rest, traction, surgery, or antibiotics. Common complications are also listed. The goal of treatment for many of these hip disorders is to relieve pain, prevent deformity, and restore hip function in adolescent patients.
This document discusses the examination of the hip joint. It outlines the traditional steps in examining the hip, including taking a history, inspecting for deformities, palpating for tenderness, and measuring range of motion. Special tests are also described, such as the Trendelenberg test to assess abduction weakness. A variety of hip conditions can be evaluated through clinical examination, including developmental dysplasia of the hip, Perthes disease, tuberculosis, and traumatic injuries. Proper examination of gait, identification of fixed deformities, and use of special tests remains an important orthopedic skill.
The document discusses the throwing motion and prevention of injuries in throwing athletes. It describes the phases of the throwing motion including wind-up, early cocking, late cocking, acceleration, deceleration, and follow through. It provides details on proper mechanics and positioning of the body and extremities in each phase. Warning signs for injury and adaptations in throwing athletes like glenohumeral internal rotation deficit and humeral retroversion are explained. Soft tissue adaptations from repetitive overhead motion are also mentioned.
Orthotic Management of Charcot Marie Toothorthotist
Orthotic treatment for Charcot-Marie-Tooth disease aims to improve stability, balance, and function by addressing muscle weakness through externally applied devices like ankle braces, ankle-foot orthoses, and footwear modifications that are custom-designed based on a thorough biomechanical assessment and tailored to meet each patient's individual needs. Regular review is important to ensure the orthotic treatment continues to achieve its objectives as the condition progresses.
TB spine with neurological deficit can present with varying symptoms depending on the location and severity of involvement. On examination, patients may have spinal tenderness and deformity as well as neurological deficits. Investigations like ESR, Mantoux test, imaging and microbiology can help confirm the diagnosis of TB spine. Treatment involves anti-tubercular medications alongside surgical intervention if needed to address neurological deficits, deformity or abscesses.
High tibial osteotomy (HTO) is a surgical procedure that involves correcting angular deformities of the tibia. It has been used to treat conditions like osteoarthritis, osteochondritis dissecans, and malalignment. There are several techniques for HTO including lateral closing wedge osteotomy, medial opening wedge osteotomy, and dome osteotomy. HTO can help relieve pain from unicompartmental osteoarthritis and delay the need for knee replacement in young, active patients. Potential complications include fracture, nonunion, nerve palsy, and issues that can make later knee replacement more difficult. Precise surgical planning and fixation are important for achieving good outcomes from HTO.
This document discusses repair versus biceps tenodesis for SLAP tears. It provides a brief history of SLAP tears, reviews anatomy and biomechanics, mechanisms of injury, clinical tests for diagnosis, classification systems, and results of studies on surgical management. For treatment decision making, it suggests considering factors like history of injury, age, symptoms, clinical exam findings, and presence of other shoulder pathology to determine whether SLAP repair or biceps tenodesis is most appropriate in a given case. The author's experience shows slightly better outcomes with SLAP repair compared to conversion to tenodesis for failed repairs.
The document provides information on spinal cord and cervical spine anatomy, mechanisms of spinal cord injury, clinical assessment of spinal cord injury patients, imaging for spinal cord injuries, classification of spinal cord injuries, and management principles for spinal cord injuries. Key points covered include the incidence of spinal cord injuries, common mechanisms and levels of injury, assessment of motor and sensory function, classification systems for incomplete versus complete injuries, and guidelines for cervical spine clearance in trauma patients.
This document discusses arthroscopic rotator cuff repair. It begins with the anatomy of the rotator cuff and classifications of tears. It then discusses techniques for arthroscopic repair including single versus double row repairs and different types of sutures and anchors. It summarizes studies comparing biomechanical properties and retear rates of different repair methods. The document concludes with long term follow up of repairs showing rerupture rates increase with larger tear size and age.
This document summarizes research on the treatment of femoroacetabular impingement (FAI) with manual therapy. It discusses the anatomy and causes of FAI, as well as diagnosis using imaging and clinical exams. While evidence directly comparing manual therapy to exercise for FAI is limited, manual therapy techniques used successfully for hip osteoarthritis may also benefit FAI by increasing range of motion and reducing pain. Case reports show positive outcomes with manual therapy including traction, mobilization, and soft tissue techniques for FAI patients. More research is still needed on rehabilitation approaches for FAI.
Reflex Sympathetic Dystrophy (RSD), now known as Complex Regional Pain Syndrome (CRPS), is a chronic pain condition that usually affects an extremity like an arm or leg following an injury. It causes ongoing pain that is out of proportion to the original injury and involves changes in skin, bone, and blood vessels in the affected area. CRPS is classified into two types depending on whether there is confirmed nerve damage present. Treatment involves a multidisciplinary approach including medications, physical therapy, sympathetic nerve blocks, and in severe cases, surgical sympathectomy to relieve pain.
- A 17-year-old female presented with 2 months of lower back pain and 1 month of intermittent fever. On examination, she had tenderness over the sacral region and sacroiliac joints. Tests indicated sacroiliitis.
- Imaging and biopsy results suggested tuberculous infection of the sacroiliac joints. The patient was started on anti-tuberculosis treatment and showed improvement of symptoms.
- The case report describes an unusual presentation of sacroiliac joint tuberculosis in a young female patient, initially diagnosed as non-tuberculous sacroiliitis.
Avascular necrosis femoral head by DR RAJAT MALOT (MS,DNB,Fellowship paediatr...chitrapandey
This document discusses avascular necrosis of the femoral head. It begins by outlining how to approach a patient with hip pain, including taking a detailed history and examining pain characteristics and range of motion. It then describes the blood supply of the femoral head and discusses how avascular necrosis develops when this blood supply is disrupted. The document covers clinical presentation, risk factors like corticosteroid use and trauma, sequelae including mechanical failure and degenerative changes, and various investigation methods.
The document provides information on performing a physical examination of the shoulder, including:
An overview of the anatomy of the shoulder joint and surrounding structures. Descriptions of various tests to assess range of motion, impingement, rotator cuff integrity, labral disorders, and instability. Special tests include Neer's impingement sign, Hawkins' test, relocation test, and others. A thorough shoulder exam evaluates history, inspection, palpation, range of motion, and results of special tests to identify potential pathology.
Evaluating medical evidence for journalistsIvan Oransky
This document provides tips for journalists on evaluating medical evidence from studies. It discusses issues like the reliability of peer review and publication bias. It also covers challenges like overreliance on embargoed studies, how often studies are later found to be wrong, and the rise in retractions. The document provides advice on getting studies, assessing study quality, considering benefits and harms, and maintaining objectivity. It emphasizes the importance of reading full studies rather than just press releases or abstracts. Overall, the document aims to help journalists critically evaluate medical studies and provide accurate reporting to readers.
Posterior glenohumeral instability accounts for 2-12% of shoulder instability cases and can be overlooked due to mild symptoms. It can be congenital or acquired from repetitive stress injury or trauma. Examination involves tests like the posterior drawer test and posterior apprehension test. Treatment begins with physiotherapy but surgery is indicated for recurrent instability. Surgical options include arthroscopic capsular shift or open techniques like posterior capsulorrhaphy. Post-operative rehabilitation involves restricted motion initially and a gradual return to sport over 3-6 months. Complications can include loss of motion or nerve injuries.
Arthroscopic Stablization Cherry Blossom Test 2009haydenmac
1. Arthroscopic stabilization has become the standard treatment for anterior shoulder instability with improved outcomes likely due to better indications, management of contributing pathology, instrumentation, and surgical skill.
2. Contraindications for arthroscopic stabilization include significant bony defects of the glenoid or humerus, poor quality soft tissue, revision surgery, and high-level contact athletes.
3. Successful arthroscopic stabilization requires thorough evaluation of all pathology, anatomic repair of the labrum and capsule, and addressing any capsular laxity.
1. The document discusses radiographic anatomy and classification of supracondylar fractures in children, which are most commonly caused by a fall on an outstretched hand and involve extension of the elbow.
2. Supracondylar fractures are classified using the Gartland system as Type 1 (non-displaced), Type 2 (angulated or displaced with posterior cortex contact), or Type 3 (completely displaced).
3. Treatment depends on the type, ranging from splint immobilization for Type 1 to closed or open reduction with percutaneous pinning for Types 2 and 3 to stabilize the fracture.
Lateral condyle fractures of the elbow are common in children between ages 6-10 years. They occur when a varus force is applied to an extended elbow. These fractures are prone to displacement and nonunion due to pull from forearm extensors and being bathed in synovial fluid. Treatment depends on the amount of displacement, with undisplaced fractures often treated non-operatively and displaced fractures requiring closed or open reduction and internal fixation. Complications can include ulnar nerve palsy, osteonecrosis, nonunion, and cubitus deformities.
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.
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.
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).
This document summarizes current management of anterior cruciate ligament (ACL) injuries, including anatomy, treatment options, surgical techniques, graft types, and rehabilitation. Key points include: ACL tears are common sports injuries; reconstruction is preferred over conservative treatment to prevent further damage; anatomic single- or double-bundle reconstruction aims to restore the native footprint; fixation and graft choices depend on patient factors; and rehabilitation focuses on regaining strength and function over 6-12 months before returning to sport. Surgical techniques and understanding continue to evolve based on research into knee biomechanics, healing, and failure rates.
This study reviewed the long-term outcomes of total knee arthroplasty (TKA) in patients with severe valgus knee deformity (variant-III). 32 patients (37 knees) underwent TKA with an average follow up of 10 years. The mean preoperative valgus alignment of 33 degrees was corrected to nearly neutral alignment postoperatively. Clinical and functional outcomes significantly improved based on HSS knee scores and range of motion. No revisions were required. Complications included 3 transient peroneal nerve palsies and 2 DVTs, but no infections or loosening. TKA can successfully treat severe valgus deformity with proper soft tissue balancing and implant selection.
Anotomic-Biological Reconstruction of Acromio-Clavicular Joint Injuries-Dr. U...TheRightDoctors
This study evaluated 11 patients who underwent an anatomic reconstruction of the acromio-clavicular joint using a semitendinosus graft. At a minimum follow-up of 6 months, 8 patients had excellent outcomes, 2 had good outcomes, and 1 had a satisfactory outcome based on Constant and ASES scores. Complications included minimal loss of reduction in 1 patient and wound edge necrosis in another. The technique aims to anatomically reconstruct the coracoclavicular and acromioclavicular ligaments. The authors concluded the technique provides stable reconstruction with low complication rates. However, they noted limitations including the small sample size and need for longer-term studies.
The document summarizes a study on arthroscopic remplissage for recurrent anterior shoulder instability. 48 patients underwent remplissage in addition to Bankart repair, with a mean follow-up of 37 months. The failure rate was 6.3%, and 93.7% were satisfied without restrictions. Scores on the ASES, Rowe, and Oxford scales all significantly improved post-operatively without loss of range of motion. The study concludes remplissage enhances Bankart repair for managing instability, with good results and no effect on shoulder movement.
Results of Mini-Open Latarjet Procedure in Failed in Arthroscopic Bankart Rep...TheRightDoctors
The document summarizes a study on the mini-open Latarjet procedure for patients with failed arthroscopic Bankart repair for recurrent shoulder instability. 24 patients underwent the mini-open Latarjet procedure and were followed for a minimum of 2 years. Results found satisfactory range of motion, functional outcomes, and low recurrence rates. Complications were minor. The study concludes the mini-open Latarjet is an effective option for challenging cases of recurrent instability after failed soft tissue repair due to significant bone loss.
Functional outcome of Arthroscopic reconstruction of single bundle anterior c...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
AHSS Registrar Review Course. Scaphoid and carpal fracturesAvanthiMandaleson
- Scaphoid fractures occur most commonly in young males due to falls on an outstretched hand. Location and degree of displacement affect stability and union rates.
- CT imaging with parasagittal views of the scaphoid aids in determining fracture stability and configuration to guide treatment.
- Treatment options include casting for undisplaced fractures or open reduction and internal fixation using a variable-pitch screw for displaced fractures to restore alignment and compression.
- Other carpal bone fractures have specific mechanisms of injury and surgical treatment is indicated for displaced or unstable fractures to address carpal instability or restore joint congruity.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study evaluated the functional outcomes of 15 patients who underwent thoracolumbar burst fracture stabilization using pedicle screw fixation and rods. Most patients were males between 21-30 years old, with falls being the primary cause of injury. The L1 vertebrae was most commonly fractured. Post-operatively, most patients experienced reduced pain and improved mobility, with 86.66% showing excellent or good functional outcomes and a mean hospital stay of 13 days. The results demonstrate pedicle screw fixation to be an effective procedure for stabilizing thoracolumbar burst fractures.
This document discusses the management of midshaft clavicle fractures, specifically whether they should be fixed operatively or treated non-operatively. It notes that while non-operative treatment was traditionally believed to result in good healing, more recent studies have found higher rates of nonunion, malunion, pain, and functional deficits with non-operative care. Specifically, displaced fractures have been shown to have nonunion rates up to 15% with non-operative treatment. The document advocates for operative fixation, especially with plates, for displaced midshaft fractures to improve healing and avoid long-term sequelae. It reviews plate designs and positioning and surgical techniques for plate fixation of these injuries.
Several studies have found that augmenting rotator cuff repair (RCR) with bone marrow aspirate concentrate (BMAC) can improve healing outcomes:
- Two studies found higher healing rates (100% vs 67-70%) and tendon quality with BMAC at 6 months post-op.
- One study found BMAC prevented re-tears in 87% of patients vs 44% without BMAC at 10 years follow-up.
- A multicenter study found significant improvements in pain and function scores with BMAC treatment for rotator cuff tears and osteoarthritis.
Lateral closing isosceles triangular osteotomy for the treatmentsongao
Dr. Sandeep Tripathi presented a new technique for correcting cubitus varus, or gunstock deformity of the elbow, using a lateral closing wedge isosceles triangular osteotomy. The technique was performed on 25 patients aged 6-12 with cubitus varus secondary to malunion of a supracondylar fracture. A lateral incision was made, the osteotomy performed, and fixed with K-wires. Most patients had excellent results with a mean carrying angle of 11.7 degrees. Complications included minor infection and scarring, with one revision for displacement. The author concluded the technique is practical, effective, and reliable for correcting cubitus varus.
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.
The document describes the anatomy and classification of injuries to the clavicle, acromioclavicular joint, and sternoclavicular joint. It discusses the clavicle bone, its joints, ligaments, muscle attachments, mechanisms of injury, physical exam, radiographic evaluation, classification of fractures, and treatment options for fractures and dislocations which can include nonoperative treatment, plate fixation, intramedullary fixation, coracoclavicular screw fixation, and distal clavicle excision.
1. The document discusses treatment options for giant cell tumor of the distal radius, including extended curettage with adjuvant therapies like phenol or bone cement for lower grade tumors, and en bloc resection with reconstruction using osteochondral allograft or arthrodesis for higher grade tumors.
2. Studies have found that extended curettage with cement has a high local control rate and good functional outcomes compared to wide resection.
3. Reconstruction options after tumor resection include osteoarticular allograft, vascularized fibular graft, or arthrodesis depending on the extent of bone loss and need to preserve wrist or forearm function.
Strabismus surgeries for cranial nerve palsies. Presented at the 27th Postgraduate Course of the St Luke's International Eye Institute: "Naughty or Neyes: Comparing Old and New Techniques", Henry Sy Auditorium, St Luke's Global City, Taguig, Metro Manila, December 2, 2023
1. Reconstructive surgeries aim to restore skeletal continuity and function after tumor resection through techniques like arthrodesis, bone grafts, and endoprosthetic replacements.
2. Limb salvage surgery is now possible in 90% of cases due to improved chemotherapy, diagnostics, and surgical techniques. The goal is a painless, functional tumor-free limb.
3. Evaluation includes biopsy, imaging to determine tumor extent and involvement of surrounding structures, staging, and psychosocial/functional assessment. Wide local excision with clear margins while preserving neurovascular structures is key.
Mainstreaming #CleanLanguage in healthcare.pptxJudy Rees
In healthcare, every day, millions of conversations fail. They fail to cover what’s really important, fail to resolve key issues, miss the point and lead to misunderstandings and disagreements.
Clean Language is one approach that can improve things. It’s a set of precise questions – and a way of asking them – which help us all get clear on what matters, what we’d like to have happen, and what’s needed.
Around 1000 people working in healthcare have trained in Clean Language skills over the past 20+ years. People are using what they’ve learnt, in their own spheres, and share anecdotes of significant successes. But the various local initiatives have not scaled, nor connected with each other, and learning has not been widely shared.
This project, which emerged from work done by the NHS England South-West End-Of-Life Network, with help from the Q Community and especially Hesham Abdalla, aims to fix that.
Exploring Alternatives- Why Laparoscopy Isn't Always Best for Hydrosalpinx.pptxFFragrant
Not all women with hydrosalpinx should choose laparoscopy. Natural medicine Fuyan Pill can also be a nice option for patients, especially when they have fertility needs.
Coronary Circulation and Ischemic Heart Disease_AntiCopy.pdfMedicoseAcademics
In this lecture, we delve into the intricate anatomy and physiology of the coronary blood supply, a crucial aspect of cardiac function. We begin by examining the physiological anatomy of the coronary arteries, which lie on the heart's surface and penetrate the cardiac muscle mass to supply essential nutrients. Notably, only the innermost layer of the endocardial surface receives direct nourishment from the blood within the cardiac chambers.
We then explore the specifics of coronary circulation, including the dynamics of blood flow at rest and during strenuous activity. The impact of cardiac muscle compression on coronary blood flow, particularly during systole and diastole, is discussed, highlighting why this phenomenon is more pronounced in the left ventricle than the right.
Regulation of coronary circulation is a complex process influenced by autonomic and local metabolic factors. We discuss the roles of sympathetic and parasympathetic nerves, emphasizing the dominance of local metabolic factors such as hypoxia and adenosine in coronary vasodilation. Concepts like autoregulation, active hyperemia, and reactive hyperemia are explained to illustrate how the heart adjusts blood flow to meet varying oxygen demands.
Ischemic heart disease is a major focus, with an exploration of acute coronary artery occlusion, myocardial infarction, and subsequent physiological changes. The lecture covers the progression from acute occlusion to infarction, the body's compensatory mechanisms, and the potential complications leading to death, such as cardiac failure, pulmonary edema, fibrillation, and cardiac rupture.
We also examine coronary steal syndrome, a condition where increased cardiac activity diverts blood flow away from ischemic areas, exacerbating the condition. The long-term impact of myocardial infarction on cardiac reserve is discussed, showing how the heart's capacity to handle increased workloads is significantly reduced.
Angina pectoris, a common manifestation of ischemic heart disease, is analyzed in terms of its causes, presentation, and referred pain patterns. We identify factors that exacerbate anginal pain and discuss both medical and surgical treatment options.
Finally, the lecture includes a case study to apply theoretical knowledge to a practical scenario, helping students understand the real-world implications of coronary circulation and ischemic heart disease. The role of biochemical factors in cardiac pain and the interpretation of ECG changes in myocardial infarction are also covered.
Ventilation Perfusion Ratio, Physiological dead space and physiological shuntMedicoseAcademics
In this insightful lecture, Dr. Faiza, an esteemed Assistant Professor of Physiology, delves into the essential concept of the ventilation-perfusion ratio (V˙/Q˙), which is fundamental to understanding pulmonary physiology. Dr. Faiza brings a wealth of knowledge and experience to the table, with qualifications including MBBS, FCPS in Physiology, and multiple postgraduate degrees in public health and healthcare education.
The lecture begins by laying the groundwork with basic concepts, explaining the definitions of ventilation (V˙) and perfusion (Q˙), and highlighting the significance of the ventilation-perfusion ratio (V˙/Q˙). Dr. Faiza explains the normal value of this ratio and its critical role in ensuring efficient gas exchange in the lungs.
Next, the discussion moves to the impact of different V˙/Q˙ ratios on alveolar gas concentrations. Participants will learn how a normal, zero, or infinite V˙/Q˙ ratio affects the partial pressures of oxygen and carbon dioxide in the alveoli. Dr. Faiza provides a detailed comparison of alveolar gas concentrations in these varying scenarios, offering a clear understanding of the physiological changes that occur.
The lecture also covers the concepts of physiological shunt and dead space. Dr. Faiza defines physiological shunt and explains its causes and effects on gas exchange, distinguishing it from anatomical dead space. She also discusses physiological dead space in detail, including how it is calculated using the Bohr equation. The components and significance of the Bohr equation are thoroughly explained, and practical examples of its application are provided.
Further, the lecture examines the variations in V˙/Q˙ ratios in different regions of the lung and under different conditions, such as lying versus supine and resting versus exercise. Dr. Faiza analyzes how these variations affect pulmonary function and discusses the abnormal V˙/Q˙ ratios seen in chronic obstructive lung disease (COPD) and their clinical implications.
Finally, Dr. Faiza explores the clinical implications of abnormal V˙/Q˙ ratios. She identifies clinical conditions associated with these abnormalities, such as COPD and emphysema, and discusses the physiological and clinical consequences on respiratory function. The lecture emphasizes the importance of understanding these concepts for medical professionals and students, highlighting their relevance in diagnosing and managing respiratory conditions.
This comprehensive lecture provides valuable insights for medical students, healthcare professionals, and anyone interested in respiratory physiology. Participants will gain a deep understanding of how ventilation and perfusion work together to optimize gas exchange in the lungs and how deviations from the norm can lead to significant clinical issues.
Causes Of Tooth Loss
PERIODONTAL PROBLEMS ( PERIODONTITIS, GINIGIVITIS)
Systemic Causes Of Tooth Loss
1. Diabetes Mellitus
2. Female Sexual Hormones Condition
3. Hyperpituitarism
4. Hyperthyroidism
5. Primary Hyperparathyroidism
6. Osteoporosis
7. Hypophosphatasia
8. Hypophosphatemia
Causes Of Tooth Loss
CARIES/ TOOTH DECAY
Causes Of Tooth Loss
CAUSES OF TOOTH LOSS
Consequence of tooth loss
Anatomic
Loss of ridge volume both height and width
Bone loss :
mandible > maxilla
Posteriorly > anteriorly
Anatomic consequences
Broader mandibular arch with constricting maxilary arch
Attached gingiva is replaced with less keratinised oral mucosa which is more readily traumatized.
Anatomic consequences
Tipping of the adjacent teeth
Supraeruption of the teeth
Traumatic occlusion
Premature occlusal contact
Anatomic Consequences
Anatomic Consequences
Physiologic consequences
Physiologic Consequences
Decreased lip support
Decreased lower facial height
Physiologic Consequences
Physiologic consequences
Education of Patient
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Support for Distal Extension Denture Bases
Establishment and Verification of Occlusal Relations and Tooth Arrangements
Initial Placement Procedures
Periodic Recall
Education of Patient
Informing a patient about a health matter to
secure informed consent.
Patient education should begin at the initial
contact with the patient and should continue throughout treatment.
The dentist and the patient share responsibility for the ultimate success of a removable partial denture.
This educational procedure is especially important when the treatment plan and prognosis are discussed with the patient.
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Begin with thorough medical and dental histories.
The complete oral examination must include both clinical and radiographic interpretation of:
caries
the condition of existing restorations
periodontal conditions
responses of teeth (especially abutment teeth) and residual ridges to previous stress
The vitality of remaining teeth
Continued…..
Occlusal plan evaluation
Arch form
Evaluation of Occlusal relationship through mounting the diagnostic cast
The dental cast surveyor is an absolute necessity in which patients are being treated with removable partial dentures.
Mouth preparations, in the appropriate sequence, should be oriented toward the goal of
providing adequate support, stability,
retention, and
a harmonious occlusion for the partial denture.
Support for Distal Extension Denture Bases
A base made to fit the anatomic ridge form does not provide adequate support under occlusal loading.
The base may be made to fit the form of the ridge when under function.
Support for Distal Extension Denture Bases
This provides support
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A comparative study on uroculturome antimicrobial susceptibility in apparentl...Bhoj Raj Singh
The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract, and it is often required to do a urine culture to find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy (128) and humans with clinical UTIs (161). In urine samples from UTI cases, microbial counts were 1.2×104 ± 6.02×103 colony-forming units (cfu)/ mL, while in urine samples from apparently healthy humans, the average count was 3.33± 1.34×103 cfu/ mL. In eight samples (six from UTI cases and two from apparently healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis 1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI cases. Fungal strains were always detected with one or more types of bacteria. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in urine samples of apparently healthy humans, and Gram -ve bacteria (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases. From urine samples of 161 UTI cases, a total of 90 different types of microbes were detected and, 73 samples had only a single type of bacteria. In contrast, 49, 29, 3, 4, 1, and 2 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most common bacteria detected in urine of UTI cases was Escherichia coli detected in 52 samples, in 20 cases as the single type of bacteria, other 34 types of bacteria were detected in pure form in 53 cases. From 128 urine samples of apparently healthy people, 88 types of microbes were detected either singly or in association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3, 11, 2 and 1 samples yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. In the urine of apparently healthy humans too, E. coli was the most common bacteria, detected in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S. aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. Gram +ve bacteria isolated from urine samples' irrespective of health status were more often (p, <0.01) resistant than Gram -ve bacteria to ajowan oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01). However, for antibiotics, Gram +ve were more often susceptible than Gram -ve bacteria to cephalosporins, doxycycline, and nitrofurantoin. The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.
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1. Meniscus Transplants Kevin R. Stone, MD Ann W. Walgenbach, RNNP Wendy S. Adelson, MS Jonathan R. Pelsis, MHS Stone Research Foundation San Francisco
4. Meniscus Key shock absorber in the knee Torn 1.5M times annually US Minimal healing No spontaneous regeneration template
5. Loss of meniscus cartilage leads to: Increased forces across the knee joint Increased risk of articular cartilage damage Pain and arthritis in many cases Painful arthritic joints: Rough surfaces Harsh, degradative environment The Problem
6. Reduce pain and improve function Preserve the biology of the knee Restore a biomechanically favorable environment Provide a buffer to prevent bone-on-bone contact and pain The Goal
7. Meniscus Transplantation: Indications Traditional thought: Meniscus Transplantation does not work in arthritic knees ( Noyes & Barber-Westin 1995, Stollsteimer 2000, Rath 2001) Current thought: Meniscus Transplantation does work in arthritic knees if damaged articular cartilage is treated as well (van Arkel 2002, Noyes 2004, Verdonk 2005, Cole 2006, Stone 2006, Farr 2007, Rue 2008)
8. Supporting Studies: Sizing 148 heights and weights compared to MRI meniscus size Pearson’s Correlations (r): Height vs Total Tibial Plateau (TTP) r = 0.7194 Weight vs TTP r = 0.5470 TTP vs Medial and Lateral Meniscal Width r = 0.7386, r = 0.7209 TTP vs Medial and Lateral Meniscal Length r = 0.7040, r = 0.7209 Stone KR, Freyer A, Turek T, Walgenbach AW, Wadhwa S, Crues J. Meniscal sizing based on gender, height, and weight. Arthroscopy 2007;23-5:503-8 Meniscal Sizing Based on Gender, Height, and Weight
9. 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.
12. Current Study: Long-Term Survival of Concurrent Meniscus Allograft Transplantation and Articular Cartilage Repair: A Prospective 12-Year Follow-Up Evaluation Pre-Allograft Transplant in place Transplantation OB IV
13. Study Design Study Inclusion Irreparable injury of the meniscus Or Loss of the meniscus More than 50% OB III/IV ROM ≥ 90° Study Exclusion Rheumatoid Arthritis Tri-compartment arthritis Total loss of joint space Simultaneous med/lat meniscus allograft transplantation
14. Patient Selection Young patients with cartilage loss and pain Older patients with cartilage loss and focal pain who want to remain athletic and delay or avoid a knee arthroplasty. “Doc, isn’t there a shock absorber you can put in my knee?”
15. Surgical Technique Medial Meniscus Allograft Transplantation: Performed utilizing periosteum, but not bone blocks, at the meniscus horns. Lateral Meniscus Allograft Transplantation: Preformed by preserving the bony block between the horns and inserting it into a bone trough.
16. 119 Meniscus Allograft Transplant Cases Mean age = 46.9 years (14.1 – 73.2 yrs) Mean follow-up = 5.8 years (2.1 mo – 12.3 yrs) 118 patients ≥ 3 months from injury to time of surgery (Mean = 14.2 years) Patient Population of Study
17. Patient Population (N = 119) Neutral / Varus / Valgus Moderate ( 5 – 7°) / Severe ( > 7°) Grade III / Grade IV Medial / Lateral Male / Female None / Mild–Moderate / Severe (Kellgren-Lawrence)
18. Results Procedure failure: Removal of allograft without revision (N = 7) , or progression to knee arthroplasty [N = 18 (TKA or UNI)]. 94/119 allograft cases successful (79%) Of 25 failures, Mean time-to-failure: 4.65 ± 2.99 years Range: 2.1 months – 10.37 years Kaplan-Meier estimated mean survival time was 9.93 ± 0.40 years [95%CI: 9.14,10.72] 13 patients were lost to follow-up
19. Complications 4 Early Postoperative Infections 3 Deep (1 Staphphylococcus Aures, 2 negative serologies) 1 Superficial (Staphylococcus Epidemis) All cases were treated arthroscopically with irrigation and debridement and IV antibiotics. All cases resolved, but one deep infection case ultimately failed, with the allograft being removed 12.5 months later.
21. Kaplan-Meier Survival Analysis In Patients OB III/IV Time-to-failure analysis with continuous enrollment over 12-yrs Takes into account remaining patients (still intact / lost to follow-up (N=13) ) Intact/Lost To Follow-Up 94% 92% 84% 79% 67%
22. Cox Proportional Hazards Model What is it? A Cox model provides an estimate of a variable’s effect on survival after adjustment for other explanatory variables. In addition, it allows us to estimate the hazard (or risk) of procedure failure, given their prognostic variables.
23. What factors affect survival? Cox Proportional Hazards Model was used to explore the relationship between procedure failure and several covariates. Age (p = 0.026) Number of Previous Surgeries (p = 0.006) Number of Additional Surgeries Osteotomy performed concomitantly Number of concomitant procedures Outerbridge Grade (III or IV) Medial v. Lateral Allograft Joint Space Narrowing Malalignment Severity Alignment Type Sex NOT RELATED RELATED
24. Cox Model - Related Hazards Independent of actual time-to-failure, increased number of previous surgeries (p = 0.026) and increased age at time of surgery (p = 0.006) increases the risk of meniscus allograft transplantation failure.
25. Effect of Age 53 patients over 50 (Mean = 56 yrs) KM mean survival = 8.84 years [95% CI: 7.51,10.17] 71.7% (38/53) Success Rate 1 allograft removed 2 mo. post-op 14 progressed to Joint Arthroplasty @ mean 5.1 years 66 patients under 50 (Mean = 39 yrs) KM mean survival = 10.67 years [95% CI: 9.76,11.58] 84.8% (56/66) Success Rate 6 allografts removed @ mean 4.0 years 4 Progressed to Joint Arthroplasty @ mean 5.2 years
26. Medial v. Lateral Transplants Non Significant Hazard (p = 0.848) Medial (N = 85) KM mean survival: 9.91 ± 0.46 years Lateral (N = 34) KM mean survival: 10.17 ± 0.78 years
28. Patient Example: BK 27 year old male Torn lateral meniscus in high school wrestling 1996 Partial lateral meniscectomy 2/96, 8/04 Pre-Operative X-Rays
29. BK: Pre-Op MRI MRI documents degenerative changes to LTP and loss of lateral meniscus
37. Patient Example: JA 37 Year old female Meniscectomy at age 20 R-Lateral Meniscus missing OB III chondral defect Microfracture, Chondroplasty LFC Long-Leg AP
65. Excellent joint space, intact meniscus allograft and ACL, but right knee clicking and catching RT: 18 Months Post
66. Intact meniscus allograft and ACL with diffuse thinning of patellofemoral cartilage RT: 18 Months Post
67. Surgery for catching due to chondral flap at patellofemoral joint Intact meniscus allograft and ACL RT: 18 Months Post
68. Conclusions Height and weight can be used to size meniscal allograft tissue. Three-tunnel Technique is necessary to fix meniscus allograft to tibial plateau, not the surrounding tissue, to avoid meniscus subluxation Improvements are maintained over the course of follow-up (2 – 12 yrs).
Editor's Notes
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD
Kevin R. Stone, MD Rath = severe arthritis excluded
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 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