Instant Autologous Chondrocyte Repair // New Trick for Returning Throwing Athletes to Play // JBJS Review has Launched!

Instant Autologous Chondrocyte Repair!

The orthopedics department at UMC Utrecht in the Netherlands has just figured out how to do autologous chondrocyte knee repair in a ONE procedure. Up until now, using the patient’s own chondrocytes to repair knee cartilage required two operations—one to harvest the chondrocytes and after culturing, another procedure to implant them (aka: Carticel).

The team, led by Professor Daniël Saris, bypassed most of the Carticel approach by surgically removing cartilage cells from damaged knees and then mixing them with specially selected donor stem cells. This cell mixture was then applied to the damaged area in the knee during the same operation. The advantage for patients is that only one procedure is required instead of the usual two operations. The new surgical technique will be less burdensome on patients, reduced treatment time. And it costs 75% less than the current two operation standard.

This new procedure is called ‘Instant MSC Product Accompanying Autologous Chondron Transplantation’ (IMPACT). Professor Saris told OTW,

“IMPACT is a new treatment that we are using in a first-in-man trial for patients 18-45 years old with a single full cartilage defect on the femoral condyle or trochlea. The stem cells are cultured from bone marrow of healthy adults undergoing surgery. We mix them with patient own chondrons (chondrocyte with pericellular matrix) and implant them in fibrin glue in one procedure. We have treated six patients now with early signs of success and are planning to do 35 in this study. This is the first time this technique has been used worldwide and could have serious effects on cost-effectiveness in the future compared to normal cell transplantation.

The interesting findings are that mixing a low number of chondrocytes with stem cells result in cartilage regeneration. Recent research has led us to believe that mesenchymal stem cells primarily stimulate cartilage regeneration by trophic factor extrusion while at first it was thought stem cells differentiate. Also, while the stem cells are allogeneic, the lack of MHC class II markers result in no immune response as we have seen preclinical and now clinical for the first few patients.

The next steps will be to develop the airbrush technique to be fully arthroscopically applied and after completing this unique first-in-man trial we will seek further support for efficacy evaluation and many commercial parties have expressed interest in this innovative academic development.”

Steelers Surgeon Shares Key Trick for Getting Throwing Athletes Back

The head orthopedic surgeon for the Pittsburgh Steelers, James Bradley, M.D., has just come out with a new study looking at throwing and non-throwing athletes with posterior instability of the shoulder. Dr. Bradley, a sports medicine specialist with Burke & Bradley Orthopedics at the University of Pittsburgh Medical Center, tells OTW,

“Our prospective study included 200 shoulders involving all types of athletes; we performed arthroscopic posterior capsulo labral reconstructions on all of these shoulders for unidirectional posterior instability. Then we evaluated them according to the American Shoulder and Elbow Society (ASES) scores; we then examined stability, range of motion (ROM), strength, and pain.

In past studies throwers didn’t meet the same standards when they returned to play as non-throwers. But in our recent study we found that at a mean follow-up of 36 months—looking at the ASES score and all subjective scores (ROM, etc.)—there was no statistical difference between throwers and non-throwers…and that was very surprising.

Both groups showed significant improvement in all scores with p-value greater .01 so all values improved in both cohorts equally so our good and excellent results were 91% and 89% percent, respectively. The most important thing is that throwers were equally likely to return to their pre-injury sports at the same level as non-throwers and critically the athlete on which we did suture anchor capsulo labral repairs had significantly higher return to sport at the same level versus non-anchor repairs

The message to my colleagues is that if you are in doubt about using suture anchors, don’t be. I now use suture anchors in all my posterior repairs.

Going forward we will separate out pitchers from other throwing athletes. My gut says that the pitchers will fare worse than other throwing athletes because of the amount of abuse those arms take.”

JBJS Reviews Now Online

The Journal of Bone and Joint Surgery, Inc., is pleased to announce that JBJS Reviews, an innovative online and tablet journal, is now live.

“With JBJS Reviews, we are continuing to respond to the information needs of our audience, ” commented Kent Anderson, CEO and Publisher at JBJS, Inc., in the November 21, 2013 news release. “We know that review articles are essential reading for orthopaedists at all stages of their careers. With JBJS Reviews, we are committed to providing quality review content authored by recognized experts, and publishing online enables us to publish continuously, accelerating information transfer, ” added Anderson. “We also have seen an increase in the number of orthopaedic surgeons adopting tablets like the iPad and the Galaxy in the clinical setting and to access information. JBJS Reviews has been built with both iOS and Android apps. Users can access articles and take integrated CME exams to affirm their knowledge. We think this will put important information even closer to our users and increases its interactivity.”

“I am excited to be working on this project, ” added Thomas A. Einhorn, M.D., editor of JBJS Reviews. “The mission of JBJS Reviews is to publish the best evidence and most compelling clinical information in an easy-to-read format that is optimized for tablet, mobile, and online use, ” added Dr. Einhorn. The JBJS Reviews app for the iOs and Android platforms is expected to be approved and available shortly.

Kent Anderson told OTW, “The timing for JBJS Reviews matches a number of trends in the marketplace. First, there is the growing amount of orthopaedic information, which has created a need among orthopaedic surgeons and others for review articles. Second, there are only a few orthopaedic review journals, and while they do an excellent job in general, the audience need is growing. Third, JBJS sets a quality standard that’s a little different, and our research showed that readers wanted the kind of thoroughness and readability a JBJS product brings. Finally, there is the trend in the orthopaedic market toward tablet devices like iPads, so building a review journal with iOS and Android apps made a lot of sense. Ultimately, it was all about market needs—for review articles, for JBJS standards, and for new delivery media.”

He added, “As a long-standing organization, we look beyond the one-year timeframe to judge success. That said, in one year, we expect JBJS Reviews to have attained strong recognition in the market, to have become a natural complement to other review journals and products in the market, and to be attracting some of the better review articles, there are many review articles out there online of any kind of products, there are even good pages just dedicated to make reviews, one example is www.hotrate.com, a site dedicated just to different reviews. We also hope that our integrated CME proves popular, and that our tablet apps are widely adopted. Those will be how we measure success, and we will adapt based on what we learn.”

Korsh Jafarnia, M.D. Joins Weill Cornell Medical College

Dr. Korsh Jafarnia, an orthopedic surgeon and hand and upper extremity specialist at Houston Methodist Orthopedics & Sports Medicine has joined the faculty of Weill Cornell Medical College. Dr. Jafarnia, who has accepted the appointment as assistant professor for clinical orthopedic surgery, was a clinical assistant professor of Baylor College of Medicine for the past 11 years. Dr. Jafarnia specializes in injuries and conditions of the hand, wrist and elbow and is a former chief of staff at Houston Methodist Willowbrook Hospital.

Dr. Jafarnia studied advanced techniques in hand surgery at the French Institute for Hand Surgery in Paris before completing a residency program at Baylor College of Medicine. He then completed a fellowship in Hand and Upper Extremity Surgery at Massachusetts General Hospital at Harvard Medical School. He has a Certificate of Added Qualifications (CAQ) in Surgery of the Hand.