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  • Cardiosolutions names Dr. Lars Svensson Chief Surgical Officer
  • Five Questions With: Dr. A. Robert Buonnano
  • Knees In Need
  • CE Mark approval for UniCAP knee
  • Spirus Medical Announces 510(k) Clearance from FDA for Expanded Use of Endo-Ease(R) Discovery SB(TM)
  • Cardiosolutions Raises $7 Million for Spacer Technology to Mitigate Mitral Regurgitation
  • STDMed Inc. Brings Forward Fourth Startup, Closes Series A Financing for Cardiosolutions
  • Spirus gets $8.5M Series B for med devices
  • Frost & Sullivan Names Spirus Medical 2007 U.S. Endoscopy Entrepreneurial Company of the Year
  • Spinoff cycle: STD Med builds devices, startups
  • Arthrosurface Raises $10.5 million in 4th Round of Preferred Equity Financing
  • STD Manufacturing Announces Sale Of AngioLink Corporation
  • Medtronic Acquires Angiolink Corporation, Maker Of Wound Closure Device For Vascular Procedures

Knees In Need

Joint repair returns baby boomer jocks to active lifestyles

The knee is the body's most commonly injured joint. All it takes is an awkward twist, a bad landing or a blow to the joint to end up with an injured knee. Knee injuries can also result from overuse and multipleimpact activities, such as running.

Bruce Berry, 55, and Chris von Kleist, 50, know this well. Thes ard-working and hard-playing Californians arrived in the Napa office of Stephen Franzino, MD, with a ypical problem for men their age: knee pain caused by years of wear and tear on the joint. They had worn-out cartilage, the soft and essential tissue that cushions the bones.

Dr. Franzino, an orthopaedic surgeon at St. Helena Hospital who is specially trained in knee cartilage restoration, often sees patients in their 30s, 40s and 50s who have grinding in the knee, stiffness and chronic pain and can no longer do the activities they love.

"Once the cartilage starts to deteriorate, you're usually on your way to a knee replacement," Dr. Franzino says. "By age 50 most patients have limited options: live with it, cortisone injections, modify your activities or, if the pain becomes too much, replace your knee joint."

lifetime athletes

Bruce has worked in the family business, Berry's Sawmill, since age 6. The mill is located in Cazadero, Calif., in the rugged Sonoma County mountains near the Russian River and Pacific Ocean. He spends his days walking Cazadero's steep canyon paths among the redwoods with his dog, Zoe, for work and exercise.

"I'm a real active guy and have been involved in a lot of sports," says Bruce. "I was a running back on my high school football team...you get tackled in a lot of funny ways. Th en there was wrestling, track, soft ball, martial arts, motocross racing and 20 years of competitive volleyball."

Chris is a married father of three boys and a girl, ages 17 to 28. He lives in Chico, Calif., where he spends his days walkingthe halls and campuses of the seven schools he oversees as superintendent of the Orland Unified School District.

"My problem dates back to 1978 when I was skiing competitively," recalls Chris. "I competed in Far West Ski Association events as a freestyle skier in aerial and mogul events. In 1978 I had an accident that essentially turned my left leg around at the knee, cracking the femur and tibia, and tearing up ligaments. It took a long time to recover from surgery, but a year or so later, I began teaching skiing. While teaching, someone up hill from me careened down hill out of control and hit me. It tore up my knee again.

"After my last skiing accident I took up wind surfing for 10 years, and in 1992 I got into off -road motorcycle racing, competing in 80- to 120 -mile endurance events. Both of these activities put a lot of stress on my knees."

time to pay the piper

The feeling that someone was "sticking a screw driver" into his knee drove Bruce to Dr. Franzino, while Chris says he was motivated by a knee becoming arthritic, and "grinding bone-on-bone. I was in constant pain". Dr. Franzino specializes in minimally invasive procedures at St. Helena Hospital, where arthroscopy safely guides instruments through small incisions in the knee area. With the smaller incisions come the potential benefi ts of a shorter hospital stay, shorter recovery and less damage to healthy cartilage and bone.

He says an area of major study is preserving joint cartilage because the loss of cartilage leads to osteoarthritis, a degenerative disease. "The bones in the knee have a surface that is smooth like the shell of a hard boiled egg, which allows the bone to glide as the joint moves. You start taking away that gliding surface by wear and tear and eventually you get to bone," Dr. Franzino says. "Once you lose this specialized surface, you're on the way to a knee replacement surgery. We want to try to stop or at least delay that progression."

repairing the right damage

For Bruce, Dr. Franzino performed a procedure known as an osteoarticular transfer system, known as OATS. A plug of cartilage from a cadaver replaced the same size defect in Bruce's damaged knee. Th is will prevent the breakdown of surrounding normal cartilage.

Bruce is happy with the results, saying, "I've been able to do more over time, there's less pain and I feel like I'm progressing.... I'm getting my range of motion back in my knee and my strength is increasing."

Chris had a different kind of procedure, called a patella( knee cap ) resurfacing, and is making a steady recovery. The cartilage-damaged area of his patella was replaced with a synthetic implant that was custom fit to his knee. "I was actually walking a couple of days aft er my surgery, with no pain," Chris says. "My recovery took about fi ve months. I've pretty much fully recovered."

Dr. Franzino says there are several treatment options depending on the extent of the cartilage damage. The latest, approved by the FDA in April, is a resurfacing procedure for people who have cartilage damage on only one side of their knees or under their knee caps.

The procedure replaces the damaged and ineffective cartilage in the joint with a metal or plastic implant. "The theory is that this can preserve the remaining healthy tissues and bone," he says. "It's a stop gap between full knee replacement surgery and is intended for patients who need more than a graft and less than a full joint replacement."

If you're experiencing knee pain, you may call Dr. Franzino at St. Helena Sports Medicine & Orthopaedics. For more information about osteoarthritis and knee replacement, visit our online health source library at www.sthelenahospital.org.

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For more information on Arthrosurface http://www.arthrosurface.com