Stone Research Foundation
The Stone Research Foundation is an independent, non-profit research institute based in San Francisco, conducting scientific research and education on new techniques for the treatment and prevention of arthritis and sports injuries.
WHAT WE DO
The Foundation leverages small amounts of capital into important clinical and translational research and education. In the clinical research we conduct outcome studies to measure the effectiveness of the biologic surgical techniques developed and utilized at The Stone Clinic. We conduct translational research to prove the scientific merit of new biologic approaches. And we disseminate of the results of this research through presentation, publication, and education in order that others may benefit.
Health care practitioners increasingly rely on outcome studies to evaluate the effectiveness of different treatment options. The Stone Research Foundation uses validated outcome tools to evaluate how our surgical patients do over time, from both physician and patient perspectives. The Foundation has conducted outcome studies on novel biologic surgical options since 1991. The results of these long-term outcome studies are fueling the paradigm shift away from bionics, towards biologics.
CLINICAL OUTCOME OF THE BIOKNEE PROCEDURE
This long-term follow up study involved 115 patients with severely damaged articular cartilage. Patients underwent combined meniscus transplantation and paste graft cartilage repair and were followed for an average of 5.8 years. The average estimated procedure survival time was 9.9 years. All study patients had severe articular cartilage damage and 46% of the population was older than 50 at time of surgery, criteria which commonly lead surgeons to avoid meniscus allograft transplantation
This study, which represents the longest and largest evaluation of its kind, demonstrated that meniscus allograft transplantation in combination with articular cartilage repair provides lasting pain relief and improved function in patients with severe articular cartilage damage. Meniscus replacement can improve patient symptoms, even patients with severe osteoarthritis, and should not be limited to patients without articular cartilage damage.
ADDITIONAL OUTCOME STUDIES
For a list of additional outcome studies currently underway and to learn more about each of them, please visit www.stoneresearch.org/cr.
During the past two decades, Dr. Stone has addressed many of the problems in making biologic knee repair viable. New technology, inspired by Dr. Stone, now exists to reconstruct the meniscus with an implanted bovine (cow) collagen scaffold into injured meniscus cartilage. Also in development is a Xenograft ligament procedure that uses a pig tendon to replace destroyed cruciate ligaments. Both of these procedures require sterilization of the animal tissue and removal of the antigens that might cause rejection.
The Foundation is extending the current state of science in order to solve remaining knee repair issues. The next challenge is to determine how to use human or animal cartilage to replace irreparably damaged articular cartilage.
THIN SHELL GRAFT STUDY: A NEW TREATMENT TO REPLACE THE ENTIRE CARTILAGE SURFACE
With Biologic Knee Replacement (see Outcome Studies), we now have the capacity to replace meniscus cartilage and repair arthritic lesions in many patients. However, some patients have such extensive cartilage damage that activity- restricting artificial joint replacement is the only treatment option available today.
In late 2010, the Stone Research Foundation initiated the Thin Shell Graft study to develop a biologically active, intact cartilage alternative to prosthetic knee replacement to treat advanced osteoarthritis. Articular cartilage thin shell grafting holds the promise of using donor cartilage tissue loaded with patient stem cells to replace extensively or totally destroyed articular cartilage surface.
The first phase evaluated the in vitro viability of a combination of thin shell grafts and various mixed cell populations. In 2011, this phase was completed. Optimized concentration, time and pressure conditions lead to viable cell loading of intact cartilage grafts. This re-loading of “dead” articular cartilage paves the way toward a complete biological resurfacing if, with animal implantation, the re-loaded grafts remain viable.
In December, 2011, the research team completed a pilot in-vivo phase of the thin shell graft study. The primary goal was to develop the porcine model to evaluate the feasibility of using thin shell grafts for the reconstruction of large, full-thickness, contoured surfaces of the femoral condyle. The objectives of this phase were met with the establishment of a challenging porcine model for condylar reconstruction.
The following summarizes key findings from the study to date:
- Thin shell grafts can be processed, shaped and surgically implanted in large contoured defects in articular cartilage.
- The biological activity of grafts can be maintained.
- Grafts maintaining cells can result in mid-term cartilage replacement.
- Deep defect graft integration can be accomplished and is not rate limiting.
- Graft margin integration is influenced by fit, fixation and biologic variables.
In the next phase of the Thin Shell Graft Study, launched in January 2013, the research team will evaluate a combination of thin shell grafts seeded with defined cell populations to determine the best sell mix for grafting and cartilage repair.
PRP TENDON DEFECT STUDY
Platelet-Rich Plasma (PRP) is blood plasma that has been enriched with platelets. As a concentrated source of platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue. The Foundation research team, in collaboration with Stryker Orthobiologics, initiated a PRP tendon healing study in December, 2011. The primary goal of this study is to evaluate the effects of PRP on tendon healing in a controlled preclinical model. We hypothesize that PRP will augment rate and quality of healing and will show superiority over allograft alone due to the associated containment and sustained released of platelet-derived growth factors. Augmentation of tissue repair with PRP would speed the return to work and sports. The study is slated for completion the third quarter of 2012.
Fellowships & Internships
The Stone Research Foundation and The Stone Clinic host US and international MDs, visiting scientists, medical and nursing students and physical therapy students to expose future health professionals to the techniques and methods developed and researched here The Joint Radiology Fellowship Program helps visiting radiologists create new ways of measuring surgical success. In the program, now in its seventh year in conjunction with Beverly Radiology / RadNet, Inc., fellows from Beverly Radiology gain clinical exposure with The Stone Clinic and contribute to studies at the Stone Research Foundation. Dr. Stone and renowned radiologist John V. Crues III, M.D. serve as faculty.
The Foundation disseminates of the results of their Outcome Studies and Basic Research through presentations, publication, and education in order that others may benefit.