The topic today is biologic knee reconstruction and replacement. Most people have heard of artificial knee replacement, which is when the knee is arthritic, which means the articular cartilage surfaces have worn down to bone and bone spurs are present, the joint space is narrow, and a person complains of pain, limited ability to walk, usually loss of range of motion. These afflictions of the knee, when they become bad enough, limit people’s enjoyment in life and ability to do activities.

Artificial knee replacement has been a pretty successful method of treating older people who have lost their joint cartilage. Artificial knee replacement with the new designs that permit plateau rotation, excellent motion, and return to sports have a number of great features to them; however, they are also limited in their life span in that the survival of the artificial joint is usually at about 90% in 15 – 20 years. Many of our patients are young and in their 40s, 50s, and 60s, and have 40 or 50 more years of playing sports and being active to go. If they underwent an artificial joint replacement they might have to undergo more than one in their later life and we know that the first joint replacement tends to be the best and therefore we like to do everything possible to rebuild the knee joint with biologic tissues rather than artificial tissues to help delay the time in which artificial joint replacement is necessary.

Rebuilding the joint with biologic tissues means replacing the knee joints meniscus cartilage, the fibrous tissue in the joint that provides shock absorption and stability, re-growing the joint articular cartilage, the white shiny surface that covers the ends of the bone, sometimes re-building the ligaments of the joint and sometimes realigning the joint to depending on the findings. By restoring the meniscus shock absorber, and smoothing and re-growing the arthritic articular cartilage, many people can gain significant pain relief and improved function and delay the time in which joint replacement is necessary for decades. Additionally, when we replace the joint with biologic tissues we permit our patients to go back to full sports since there is no artificial material to wear out. This ability to return to running or impact sports without concern for damaging the artificial material has permitted many of our patients to return to a very active lifestyle. Additionally, biologic knee joint reconstruction and replacement can be done as an outpatient arthroscopic procedure, therefore limiting the risk to the patient, time in the hospital, the cost, and the time for recovery.

Many patients ask us if they are too old or too arthritic, if their joint space is too narrow, or if their legs are too bowed to undergo biologic joint reconstruction. Often they have been told they couldn’t have those procedures because of the degree of arthritis. We have found, however, that people with fairly significant or severe arthritis can benefit from cleaning up the joint and replacing the meniscus shock absorber and smoothing down the arthritic surfaces despite what the x-ray looks like, thus we have been encouraged by people whose joints looked fairly arthritic and their response to biologic joint replacement has been quite gratifying, delaying the time in which joint arthroplasty has been required.

We have published our data on the results on the components of biologic knee joint reconstruction in the Journal of Arthroscopy under the terms “Meniscus Transplantation for the Arthritic Knee and Articular Cartilage Paste Grafting for the Arthritic Knee,” with long-term follow-ups over 12 years. We now have experience with patients going out more than 15 years with meniscus or articular cartilage replacement. These patients have found return to sports and return to activities to be a very gratifying component of biologic knee joint reconstruction.

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The Stone Clinic in San Francisco concentrates on returning injured people to their active lives, fitter, faster, and stronger than they were before. The Stone Clinic includes Dr. Kevin Stone, physician and surgeon, a staff of physical therapists, and an x-ray and MRI facility. Our specialties include the treatment of joint injuries and arthritis with leading edge surgical and rehabilitation techniques. Elite athletes and everyday people alike come to The Stone Clinic from around the world for the best in orthopaedic care. The Stone Clinic is located at 3727 Buchanan St., San Francisco, CA 94123. For more information, please call us at (415) 563-3110 or visit us at www.stoneclinic.com