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  1. #1
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    Do meniscal allograft transplants really work?

    Does anyone here actually have one? My surgeon says that they do not work. He said that so far there has been no proof that they reduce the risk of arthritis. I am a heavy-set, 28 year old female skier with 1/2 my medial meniscus missing in my left knee (along with 3 ACL reconstructions on the same knee). I will say that I am a fan of the good old single-bundle reconstruction. Less holes and screws mean less errors. I blew my ACL's out due to be a little too heavy and skiing like a bat out of hell (moguls, jumping and racing). And yes I do use a brace.

    I am having my ACL done on my right knee on May 28 and I also have a large osteochondral defect in my knee. My doc says that microfracture is all he can do. However, I hear some people have osteochondral allografts. I trust him and I can have more surgeries later on if need be. My doc just is not a firm believer in allograft tissue other than using it ocassionally for ACL grafts (I had an allograft patellar tendon for my last ACL). Just wondering what other docs have said about meniscal and osteochondral allografts.

    Thanks,

  2. #2
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    Lose weight.

  3. #3
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    Mine Did

    I had one done in December 2008 because I'm young, very active, and had 70% or more of my meniscus removed from 3 prior tears. I was symptomatic daily, and had trouble simply walking a golf course. I had the surgery done in December and rode a metric century on my road bike 6 months later. At 9 months I started playing cutting sports (basketball, etc. wearing a functional brace), and at 1 year I snowboarded. At two years I started skiing again, and I'm just about to order my season pass for next year. I'm not pain free, and I have occasional issues, but nothing like I had before. However, I'm a former professional athlete, in pretty good shape (rode over 5,000 miles on my road bike the past two years), and I was prepared physically and mentally for a very tough rehab. So for me, yes, it was great. Will I avoid a knee replacement? I have no idea, but I've already had two awesome years of sports I would not have had but for my surgery. If you have it done by the wrong surgeon, or aren't ready and able to go through a brutal first 4 months of rehab (pretty much like an ACL rehab but with NWB and the associated complications), then I can't imagine you'll be satisfied. Be careful, it's no new knee, and you better find the best guy or gal you can to do it. I've heard of some poor results out there to go along with my outstanding result (so far...knock on wood). Good luck.

  4. #4
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    An ACLR with a large osteochondral lesion on the femur? You should have orthoradiograms to be sure you don't also need a relalignment procedure at the same sitting.

    Microfracture is never on my menu. I am suprized that you doc does it. Up till now, I admired him/her.

  5. #5
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    Thanks for your reply. What exactly is wrong with microfracture? I have never heard of ortho diagrams before. He said he will fix whatever is wrong that was not seen on the MRI when he gets in the knee. The thing is that I am not sure where the osteochondral defect is. He just said I had a big hole in my bone from smacking it so hard on the snow. He said that microfrcature was all he could do but that the effects would only last a few years at best. I guess it's better than nothing. However, he won't exactly know until he sees the inside of my knee. He is very a very competent doc so I do trust him (chief of orthopedics at one of the most highly regarded university hospital networks in Canada and a sports surgeon). I guess my question is do you think meniscal or osteochondral allografts are effective?

  6. #6
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    Orthoradiograms are weight bearing X-rays that include the hip, knee, and ankle on the same cassette. The angles are drawn out and if you need an osteotomy, that can be determined.

    Meniscal alllografts have not yet been shown to reduce arthritis. An owner of a meniscal allograft needs to give up sports, although there are probably several out here that have not and will soon post about what a jerk I am to say that. But time will prove that meniscal allografts deteriorate.

    You, yourself, said that MF results deteriorate with tiime. Thats putting it mildly. Considering that MF requires you to be nonweight bearing for at least six weeks, and that builds in a flexion contracture after ACL surgery, I just ignore the osteochondral lesion when I do ACL surgery.

    Dr. Don Shelbourne has published a huge series of ACL cases in which he ignored these lesions, and provided the knee was stable, and had full motion, the results were comparable to those cases with normal cartlage. That says alot.

  7. #7
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    Not a hater

    Dr. Mark, I'm an owner of a meniscal allograft, but not a hater. My doc's post-op protocol does not include giving up sports. However, I'm a realist. If I can get 5-10 more years of sports I'll be thrilled. At that point, the rest of my body will probably already tell me I'm going to have to slow down anyway.

    I've definitely adjusted my sporting activities since my MT, but I remain hopeful I can continue to be a recreational skier (not a charger), hike, ride my roadie, enjoy an occasional pick up basketball game, walk the golf course, and enjoy my kids. So far so good.

    Docs can disagree, and your opinion, while not that of my OS, is there for your patients. My doc has done over 150 meniscal allografts, and has studied them for years. I trust his opinion and study results.

    Lastly, I try to convince people how hard the recovery and rehab will be, and that their results may not be like any other patient including me. Since I had no existing arthritis at the time of my allograft (just little/no meniscus left after the last injury), I may be in a different boat. A nice side effect for me was increased stability I experienced having a new meniscus in place.

    Now if you decide to insult me and my doctor for my medical decisions...well .

  8. #8
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    Check out Dr. Kevin Stone in SF. He seems to be the west coast go-to guy for meniscal allografts for the core skiers in the Sierra with amazing results, based on what those who have been under his knife say. I'm looking at having it done, having had a meniscus repair re-tear and gotten 60% removed.

    Dr. Mark - the osteotomy just transfers weight bearing to the lateral meniscus, thus inducing increased weight bearing to one side and increasing the the chances of tearing that meniscus, doesn't it?

  9. #9
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    The valgus osteotomy doesn't increase the incidence of injury on that side, unless you move the bone beyond the reccommended amount.

    For 50 years, osteotomy was the treatment of choice for these problems. THen came meniscal allograft. Low and behold, the meniscal allografters nowadays are reccommending osteotomy to be combined with allogafts.

    The results of meniscal allograft combined with osteotomy seem to be almost as good as osteotomy alone. Tells ya something, eh?

  10. #10
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    Well, there it is.

    My doctor, Kevin Stone (the guru of the West Coast Meniscus Transplants), does not automatically perform osteotomies with the MT. His results after years and over 150 MT's are pretty impressive, even in arthritic knees. I didn't have an osteotomy.

    I don't know much other than my experience, and other patients of Dr. Stone, but my results speak for themselves. I played 2 hours of pick up hoops this morning blocking shots, running the floor, and cutting and my knee is perfect right now. I would have been limping for days before my MT.

    Good thing Dr. Mark's not my doctor...I'd be done.

  11. #11
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    Young athletic people will contiue to dowhat they want to do, and in the short run, they will feel that they are doing what is best for them.

    The consensus of Sports Medicine Orthopaedic Surgeons in the United States is that meniscal allograft patients should avoid high impact sports.

    My osteotomy patients continue to involve themselves in high impact activities, and since they have no dead tissue to protect, then can knock their lights out.

  12. #12
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    Well, it's nice to see a discussion coming along. I'll admit that my surgeon has pretty much the same views as Dr. Mark.

    People need to understand that Dr. Mark is not telling you what to do. What he says is his opinion based on his experiences as an orthopedic surgeon. Many people do not like what he says but then again he's not your surgeon so don't get so caught up over it. Consider another view of the same shape. Surgeons have different views and ideas about what is good and what is not. Just because your doctor does something differently does not make him/her a bad or better doctor than someone else. It is all relative to what your doctor believes.

    I just get the feeling that people are becoming too reliant on allograft tissue. It seems that every time something goes mechanically wrong we call upon the dead to lend us a part. In theory it makes sense to replace a broken part with another but really is it that effective? Unfortunately, people are not as simple as automobiles. If God wanted us to replace all of our broken parts with a new one he would have given us a spare set.

    I really do not know what to think. I just have this fear that in a few years I'll need knee replacements and it scares the shit out of me. I am not against allograft tissue by any means since I have an allograft patellar tendon in my left knee. I just wonder where to draw the line.

  13. #13
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    I tried to be respectful

    Frankly, Dr. Mark doesn't know a damn thing about MTs other than what he has read in journals. How many has he done? What studies has he participated in on MTs? Has he rehabbed an MT patient? My Doc has done far more than 150 of them, developed the procedures, and rehabs every one of his patients.

    I'm not saying they are for everyone, far from it, but my doc, Kevin Stone (Google him if you want to know what others think and check out his website with the studies etc), is on the leading edge of cartilage treatment. I was directed to resume whatever activities I wanted other than distance running at 11 months post-op. I'm still in touch with a number of former MT patients, and we are all better than before, and many are kicking ass.

    I just bought my Pass for Squaw next year and I can't wait to have a great 2010-11. So, as I said before, it's a damn good thing Dr. Mark is not my doc, I'd be missing out on some damn fun stuff.

    P.S. Dr. Stone reconstructed Jen Hudak's knee (Articular Cartilage Paste Grafting)...yeah, the X-Games Gold Medalist Jen Hudak. Oh yeah, and his walls are filled with former great skiers, football players, ice skaters, ballerinas, etc., and one old-broke down minor league catcher. So who do you believe? The Dr. who is in every chat room ripping the treatment plans by some of the most well-respected surgeons in the Country or the Dr. who is putting world class athletes back on the field? It's up to you.

    Pray for another sick snow year in 2011!!!

  14. #14
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    Hi there,

    I'm 35- years old athlete and I broke my meniscus in skiing accident in january 2010. 2 weeks after accident I went to meniscectomy and orthopaedic took about 80% away from my medial meniscus. After meniscectomy I have had lot's of pain and my knee is swollen even from light exercise. I'm now 9 months post meniscectomy and pain is present constantly.

    Here is lots of discussion and testimonials around meniscus transplant operation's. I think I need meniscus transplant operation before it's too late and I have arthritis in my knee. I miss skiing and my active life before meniscectomy.

    I am also trying to find clinical studies about Actifit treatment. Have you heard about this new meniscal implant?

  15. #15
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    I had 60% of my meniscus removed and developed an arthritic condition after I tore the original meniscus repair that was done and had the removal. I had the weight bearing xray done and an osteotomy was recommended. However, I feel completely reluctant to do this will not take the word of the doctors recommending this. I'll take my time and investigate what other options I have. The athletes I have met that went to Dr. Stone cadaver for meniscus transplants have returned full tilt to their sports and endlessly sing the praises of Doc Stone. I would take/try the cadaver meniscus before ever considering the osteotomy. At the rate stem cell tissue (meniscus) growth is developing, I'd hate to have had a wedge taken out of my tibia plateau and the bone sawn to an off angle, only to find out a few years from now that I could grow a new meniscus but wasn't a candidate because my knee joint would be out of line from the osteotomy.

  16. #16
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    Splat, I have all most the same situation in my knee as you have. Are you able to ski with your knee? I have so much pain in my knee after meniscectomy that I will sell all my telemark gear. I want to prolong arthritis and knee replacement operation. Are you considering also meniscus transplant operation?

    What are you talking about stem cell tissues. Are they able to grow all ready meniscus with stem cells? Dude, that is really good news

  17. #17
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    Splat, company called Regenexx says that they can fix meniscus tears with stem cell treatment. Here is introduction what they do. I'm a bit sceptical that they can really isolate and grow enough stem cells to grow new meniscus. [nomedia="http://www.youtube.com/watch?v=PPDbXP1bNvE"]YouTube - What is a knee meniscus tear? www.regenexx.com[/nomedia] youtube clip how it is done.

    From what I have read it will take many many year's before stem cell treatment is everyday procedure. Try Google with words like 'stem cell meniscus' and you will find many articles like this.

    Are you considering to take meniscus transplant operation? I think transplant is only option for me.

    Take it easy and try not to brake you're knee more.
    Last edited by Juha_74; 02-04-2011 at 01:39 AM.

  18. #18
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    Hi!

    I have now new x-ray and MRI-pictures from my knee. X-ray shows that I have joint space narrowing in my knee's medial side. That is probably the reason which is causing constant pain. One orthopaedic recommend to me HTO (high tibial osteotomy) to move pressure from medial side to the lateral side. Orthopaedic said that I HTO would slow down arthrosis essentially
    and it will reduce pain in my knee's medial side.

    What do you think about this?

    Click picture for bigger format.

    joint space narrowing



    joint alignment


    joint side-view



  19. #19
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    It will only requre a small correction or about 5 degrees. Doing this procedure is reasonable, and I would reccommend the same for my patient.

  20. #20
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    Quote Originally Posted by drmark View Post
    It will only requre a small correction or about 5 degrees. Doing this procedure is reasonable, and I would recommend the same for my patient.
    Thanks! 3 orthopaedic from 4 has recommended HTO to me. I have understood that HTO would give me couple of more years to prevent total knee replacement.

    By the way, what is you're professional opinion about [ame=https://www.tetongravity.com/forums/showthread.php?t=198571]Actifit[/ame] treatment? One orthopaedic said to me that he would like to insert Actifit scaffold in to my knee within the same operation with HTO.

  21. #21
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    I dont use scafolds. In a non smoker, I can do a biplanar osteotomy, repaired wiht a TOMOFIX plate without a scafold, a cadaver bone graft, or a bone graft from your hip. Find a Finnish surgeon with AO training. Perhaps you should google AO International.

  22. #22
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    Mark, I would like to understand more about Tomofix plate and operation. What is the reason for bone graft operation? How does that helps in this situation?

    Thanks in advance. I don't smoke

  23. #23
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    Send me a ping and I will send you a power point about this
    sandersclinic@comcast.net

  24. #24
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    Dr. Kevin R. Stone

    From Wikipedia, the free encyclopedia

    Kevin R. Stone
    Known for biologic joint repair and research, articular cartilage paste grafting (regeneration), meniscus allograft tranplantation

    Kevin Robert Stone, M.D. (born June 4, 1955), is an American orthopedic surgeon, who specializes in sports medicine and injuries of the knee, shoulder, and ankle joints. He has lectured and is recognized internationally as an authority on cartilage and meniscal growth, replacement, and repair. Stone is known for his 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.[1] He has, since, taught these techniques to surgeons in the US and worldwide.

    He is the founder and chairman of the Stone Research Foundation for Sports Medicine and Arthritis, a center that conducts research in advanced surgical techniques and tissue regeneration in San Francisco, California. This research has led to advancements in cartilage replacement and regeneration, cruciate ligament repair and reconstruction, and techniques to prevent osteoarthritic degeneration. He holds more than 50 U.S. patents on healthcare inventions.

    Education

    Stone was born in Providence, Rhode Island in 1955. He was educated at the Moses Brown School and Harvard College, class of ’77, where he led the Eliot House Crew to row at The Henley Regatta and played polo. As a cum laude biology graduate, he enrolled in the University of North Carolina School of Medicine graduating in 1981. He was trained at Harvard’s Beth Israel Hospital in internal medicine from 1981-82, then in general surgery at Stanford University Medical Center from 1982-83, and lastly in orthopaedic surgery at The Harvard Combined Orthopaedic Residency 1983-1986. He undertook a fellowship in research at the Hospital for Special Surgery in New York under Steven Arnoczky, D.V.M. and in knee surgery in Lake Tahoe under Richard Steadman, M.D., from 1986 -1987.

    Clinical practice

    Stone founded The Stone Clinic, combining himself, an orthopaedic surgeon, 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 clinical practice goal of rehabilitating all patients to a level higher than they were before they were injured set the tone. Surgical procedures were subjected to rigorous outcomes analysis with the results reported in peer reviewed journals. The surgical techniques have been taught to surgeons around the world, through lectures and videos. [2]

    Stone is a physician for the Lawrence Pech Dance Company, The Marin Ballet, and TheSmuin Ballet. He has served as a physician for the U.S. Ski Team[4], the U.S. Pro Ski Tour, the Honda Ski Tour, the 48 Straight Ski Tour, the Old Blues Rugby Club, the modern pentathlon at the U.S. Olympic Festival, and for the United States Olympic Training Center.

    Research

    Stone initiated his research career in high-altitude physiology under the direction of Ross McFarland, at the Harvard School of Public Health. Working with his associate Dr. Spengler, Stone searched for a high-altitude environment in a city and published the first paper on carbon monoxide in hockey rinks noting the effect of carbon monoxide on the hockey players' visual acuity was similar to that of hypoxia at altitude.

    Meniscus research

    In 1984, Stone, at the encouragement of his mentor Dr. Steadman, turned his focus to replacing the meniscus cartilage in the knee joint. After two years of research to understand the biomechanics and biology of the meniscus, Dr. Stone concluded that if he couldn’t replace the meniscus, possibly he could re-grow it. With this approach he entered his Fellowship in research under the direction of Dr. Arnoczky and proceeded to design the first collagen meniscus regeneration template.

    While a clinical fellow in Lake Tahoe, Stone initiated research at the Letterman Army Institute of Research in collaboration with Bill Rodkey, D.V.M., to test the collagen template in various animal models for meniscus, ligament, articular cartilage and intervertebral disc repair. These trials were subsequently published and led to several research awards including the Albert Trillat Young Investigator’s Award from the International Knee Society and the Cabaud Award in 1990 from the American Orthopaedic Society for Sports Medicine. The FDA approved the first human clinical trial of the collagen meniscus scaffold which was carried out at The Stone Clinic from 1991-1994. Recent 15-year follow-ups on these patients revealed continuing successful outcomes. The U.S. Food and Drug Administration gave U.S. approval for a collagen meniscus implant (CMI) device designed by Stone in 2008.

    Stone turned his attention to complete meniscus replacement with a biological implant(rather than re-growing the meniscus) in 1994. He published one of the first techniques for arthroscopic meniscus replacement in 1991 and conducted the first long-term study of meniscus replacement in knee joint arthritis which was published in 2006. The replacement of the meniscus permits the arthritic patient to have improved pain relief and knee joint function as well as delay or avoid the time for artificial joint replacement. In a 2 to 7 year follow-up study, 89.4% of meniscus tranplantation patients were successful, having showed significant signs of improvement in pain, activity, and functioning.

    Articular cartilage research

    In addition to meniscus replacement, Stone focused on articular cartilage regeneration for the arthritic knee. His design of a “paste graft” technique with custom instrumentation was promoted by the DePuy orthopaedic company. The paste graft technique 2-12 year results were published in 2006 revealing 85% of the patients obtained improvement in pain and function scores.

    Biologic joint replacement

    The combination of meniscus replacement and articular cartilage grafting led to Stone’s pursuit of biologic knee replacement, a technique to fully replace the damaged cartilage in the knee with natural tissues. This program is underway at The Stone Clinic and includes a stem cell with shell graft approach to replacing the articular cartilage surface of the knee.

    Stone's experience with collagen scaffolds sourced from bovine Achilles tendons led him to focus on other animal tissues that might be useful for orthopaedic reconstruction. In 1996 he initiated a research program to determine if the carbohydrates that cause rejection of animal tissues could safely be removed without damaging the tissues. His research led him to the New York Blood Center where a technique for removing similar carbohydrates was developed for blood. Dr. Stone identified and collaborated with the leading immunologist in the field Dr. Uri Galili in order to transfer the blood technique to orthopaedic tissues. Their work led to multiple patents, animal trials and subsequently, a human clinical trial of a porcine bone-patellar tendon-bone graft for reconstructing the anterior cruciate ligament (ACL) of the knee joint. In the surgical procedure, the proteins on the transplant ligament that would trigger rejection from the recipient's body are stripped off prior to transplantation. One recipient of this pig ligament ACL transplant went on to win the Canadian Master's Downhill Ski Championship, three times. [8] This work has received FDA approval for a wide clinical trial to be conducted in the U.S.

    Allison Gannet, a World Cup freeskier Champion, had had 7 previous knee surgeries before having a biological joint replacement, with Stone as her surgeon. This procedure included the articular cartilage paste grafting procedure, and following, Gannet reported being pain free for the first time in 8 years.

    Teaching


    Stone mentors nursing students, medical students, residents, fellows, and other physicians who rotate through The Stone Clinic from various institutions around the world.

    He lectures widely at orthopaedic courses and hosts the annual Meniscus Transplantation Study Group Meeting as well as the annual Professional Women Athlete's Career Conference.
    [edit] Additional projects

    Stone is the founder or co-founder of multiple companies in addition to his orthopedic medical practice and research.

    ReGen Biologics, a publicly traded medical device company focused on meniscus regeneration. At ReGen from 1984 – 1994, Stone invented the first collagen meniscus implant, a device designed to function as a regeneration template to grow a new meniscus cartilage in human knees. He tested that device in a series of experiments that led to the first successful human clinical trial of a tissue-engineered device in orthopaedics. The implant received FDA approval for sale in the United States and overseas after successful clinical trials.[10]

    CrossCart Inc., a venture capital funded medical device xenotransplantation company. At CrossCart Stone led a team with Uri Galili and Tom Turek to develop a technique for removing the antigens from pig tissues so that they may be used in humans. The first xenograft device for reconstruction of ruptured anterior cruciate ligaments (ACLs) received FDA approval for human clinical trials. If successful, this technology may permit animal tissues to be used in humans without the need for immunosuppression.[11]

    Joint Juice, Inc., a San Francisco-based nutraceutical beverage company. Stone’s invention of Joint Juice was a response to his patient's statements that glucosamine helped them and their animals but that the pills were too large to take regularly. Joint Juice is the first beverage with a full day’s dose of glucosamine, proven to reduce pain, act as an anti-inflammatory, and aid in cartilage repair without side effects.

  25. #25
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    bumping this.....

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