We believe that continuous medical education is an obligation for every scientist today. For our team this includes staying update with current knowledge, being certified in new methods and procedures, following the ortopaedic literature, and participating in congresses around the world. All these are performed along with everyday medical practice. Moreover, all the doctors of the TheMIS team participate in research protocols, and publish in established domestic and international journals.
The main aim of the research protocols we participate is to publish the results of our work and experience in certain procedures, and to compare our results with the ones of other scientists around the world. This will establish our work in the international orthopaedic community, and help us improve our practice for the benefit of our patients.
Some of the protocols our team is currently running are:
Articular cartilage lesions in the knee lead to osteoarthritis; this will lead to total destruction of the joint, often requiring the replacement of the joint with metal implants. The main issue in dealing with cartilage lesions is that cartilage cannot heal itself, especially when the lesion is larger than 2-3 cm2. The state of the art intervention for this problem is the autologous chondrocyte implantation. Autologous means that the chondrocytes come from the same patient where they will be implanted. Up until recently this procedure was performed in two stages: 1. Arthroscopy of the knee, identification of the lesion, harvest of healthy chondrocytes from a non-weight bearing area, and transfer of the chondrocytes in specialized laboratories where they are cultivated, and 2. Arthrotomy of the knee, and implantation of the cultivated chondrocytes in the lesion area some weeks after the first procedure.
Today, a novice procedure allows us to perform the implantation in one stage. During the same procedure the chondrocytes are harvested and cultivated inside the operating room, and are subsequently implanted in the lesion. TheMIS team is the first worldwide to have performed this procedure arthroscopically only, without the need for an open knee arthrotomy, which reduces the length of hospital stay, and speeds up rehabilitation of the patient post-operatively.
The current trend in orthopaedics is to “save the meniscus” whenever this is feasible. The meniscus is a crescent-shaped fibrocartilage structure that lies between the femur and the tibia; it protects the cartilage and provides structural integrity to the knee when it undergoes tension and torsion. The tear of the meniscus can lead to destruction of the cartilage. Total or even partial meniscectomy increases the load on the articular surfaces causing problems in the joint. Meniscal repair – although not always feasible – is the treatment of choice, especially in young patients, with lesions in the red-red zone in the periphery of the meniscus.
Small cartilage lesions that are less than 2 cm2 can be successfully treated with microfractures. During arthroscopy, debridement is performed on the lesion, which is cleaned to healthy tissue. With the use of a special instrument small holes are performed on the lesion in order to create a communication between the joint and the subchondral bone. This will allow multipotential mesenchymal cells to come to the joint surface. These cells will create a new tissue layer that will cover the defect, which looks like normal cartilage, although it is more fibrous than the normal hyaline cartilage. This new layer is sufficient for good joint function without future problems.
Joint replacement has changed the way osteoarthritis of large joints is being treated during the last 50 years. It is a procedure that has given back to the patients the quality of life they lose due to osteoarthritis. These procedures however, require extended approaches, followed by long rehabilitation time. Following the latest orthopaedic trends, minimally invasive surgery is our choice for these procedures. AMIS (Anterior Minimally Invasive Surgery) is a minimal invasive technique for performing total hip arthroplasty. The skin incision is only 8-10 cm (instead of 20-25 using other approaches), while no muscle or tendon is violated. Blood loss is minimal, the patient is mobilized within the first 24 hours, and the rehabilitation and the return to activities is very fast. The.M.I.S. team, following education in a specialized center in France, has been performing this technique in St. Luke’s Hospital since 2010.
The aim of all surgical procedures and interventions is early return of the patient to daily activities. For athletes this is particular important. The short lifespan of their career and the intense degree of their activities, make return to sports a challenging issue. Early return to sports is TheMIS team’s focus. Choosing the appropriate therapeutic intervention, and following the correct rehabilitation protocol, will allow the athlete to safely return to competitive sports as early as possible.
Anterior cruciate ligament (ACL) tear can have disastrous consequences for the knee. TheMIS team has been involved in reconstructing ACLs and evolving the surgical techniques for many years. Lately, there is an increased need for revision of previously reconstructed ACLs. Newer surgical techniques, aggressive rehabilitation protocols, and an organized network of collaborators all help the patient to safely return to their desired level of activities.