Scott F Dye
University of California San Francisco, USA
Scott F Dye is an Associate Clinical Professor of Orthopedic Surgery, University of California San Francisco. He has completed his BA in Physical Anthropology from University of Pennsylvania 1971 and his MD from University of Virginia 1975. Research devoted to the Knee. He has developed the concept of knee as biologic transmission with an envelope of function. He discovered the internal neurosensory characteristics of the knee by having arthroscopy performed on himself without intra-articular anesthesia.
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. 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 89% of cases) proven by the presence of 3 criteria:
• Total clinical silences: No stiffness, no aching, no sense of instability - totally asymptomatic - the subjective correlate of Joint Homeostasis.
• A normal Tc bone scan: Proof of physiologic normality i.e. restoration of bone/tissue homeostasis - the objective, metabolic correlate of joint homeostasis.
• 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.
Discussion: By emphasizing the restoration of joint homeostasis of the knee as the primary clinical goal, rather than the achievement of structural or kinematic normality, an important P/O complication - PTOA- was averted following meniscal and ACLR surgery.
Conclusion: 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 orthopedics and musculoskeletal medicine The implications for the possible prevention of early OA in joints other than the knee are vast.
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