2015 ISAKOS Biennial Congress ePoster #205

The Prevention of Early OA of the Knee Following Meniscal or ACL Surgery is Possible by the Achievement (& Maintenance) of Joint Homeostasis

Scott F. Dye, MD, Mill Valley, CA UNITED STATES
Mailene Chew, MD, San Francisco, CA UNITED STATES
California Pacific Medical Center/ University of California San Francisco Department of Orthopedic Surgery, San Francisco, CA, USA

FDA Status Not Applicable

Summary: We show that early OA of the knee can actually be prevented following meniscal or ACLR surgery by emphasizing the achievement (and maintenance) of what, in essence, constitutes a new, emergent paradigm in orthopedics: Joint Homeostasis, rather that structural or biomechanical normality.

Abstract:

Introduction

The human knee is an excellent model for the development of post-traumatic OA (PTOA) in the medial compartment following meniscal or ACL surgery. The current world-wide rates of PTOA 10 years after ACLR, for example, exceed 50%. This is an alarming statistic and reflects the failure of the current paradigm of orthopedic sports medicine which emphasizes the achievement of structural and kinematic normality, as well as early return to high demand sport. We have discovered, however, that early PTOA of the knee can actually be prevented by the achievement and maintenance of normality in another biological realm: Joint Homeostasis.

Methods

The development of Early PTOA was assessed in 19 ACLR and 74 Partial medial menisectomy (PMM) patients ACLR (mean 12.3 years P/O) , and PMM (mean 7.4 years P/O). by the use of multiple criteria, including radiographs (Rosenberg X-rays) and scintigraphs (Tc99m-MDP Bone Scans) in addition to the standard subjective and objective criteria (e.g. P/O laxity).

Results

Early PTOA was Prevented if Joint Homeostasis was achieved and maintained (as in in 89% of cases) proven by the presence of 3 criteria: 1) Total Clinical Silence No stiffness, no aching, no sense of instability - totally asymptomatic - The Subjective correlate of Joint Homeostasis 2) A Normal Tc Bone Scan Proof of physiologic normality i.e. restoration of bone/tissue homeostasis -The Objective ,Metabolic correlate of Joint Homeostasis 3) A Normal Rosenberg X-Ray (Kellgren-Lawrence ‘0’) proof of non-progression to early OA - the Objective structural correlate of Joint Homeostasis (long-term) If these 3 Criteria were met It Did Not Matter What other factors may have been present including: timing of surgery, degree of P/O laxity, “non-anatomic” position of the ACL graft, presence of grade 3 CMP, level of activity, partial menisectomy, overall alignment, age, sex, height and weight, i.e., the structural and biomechanical characteristics that to the present have been deemed of supreme importance from the current orthopedic paradigm.

Discussion

By emphasizing the restoration of Joint Homeostasis of the knee as the primary clinical goal, rather than the achievement of structural normality, or the biologically hazardous and unsupported concept of “return to sport as soon as possible”, an important P/O complication – PTOA- was averted following meniscal and ACLR surgery.

Conclusions

The achievement (& maintenance) of Joint Homeostasis is More Important, clinically than the achievement of structural and kinematic normality in the prevention of early PTOA of the knee, and thus represents a new, emergent paradigm in orthopedic surgery and musculoskeletal medicine The implications for the possible prevention of early OA in joints other than the knee are vast.