Week 6!

This week I saw a bunch of interesting cases in the clinic and the OR and happened to catch a talk by Dr. Chubinskaya from Rush University. Early in the week I shadowed Dr. Rodeo and saw patients in the office. Being here has convinced me never to ski despite living in Ithaca because ACL tears are way too common! One patient was not comfortable with MRIs because of the tight space. Instead of MRI, ultrasound will be used on them to check if there are any rotator cuff tears.  I'm curious since MRIs are such clean and useful images that can be used in surgery how not having one may affect diagnosis and treatment in orthopedics issues. Other than that a couple of interesting cases was a few months post-op TKR that had had a buildup of scar tissue indicated by reduced range of motion. I learned about a quick procedure where they apply an epidural in the PACU and just forcibly move the knee around the break up the tissue. I wonder how the floating tissue is tolerated by the joint.
Outside the clinic, I continued with research and finished segmenting all the menisci, huzzah! Hong Sheng and I spoke about the data with Dr. Maher and unfortunately there's not enough data to make a worthwile ORS abstract, so we'll just have to wait. I did learn that meniscus deformation measurements are not so standard as I thought, so I also did a literature search and learned about what we could apply to our segmentations. As I mentioned, Dr. Chubinskaya gave a talk and heard about some treatment agents I've never heard of including OP-1 and notably P188. P188 is a surfactant that is thought to seal holes in the cell membrane of cells during necrosis, and this was used as a chondroprotective agent in a model of cartilage injury. It's a very cool and clever idea and showed promsing results in that it stopped DNA fragmentation and reduced cell death and apoptosis. And finally in surgery this week, there were a couple of neat cases. One patient was under a clinical trial operation this week for rotator cuff repair. The study's purpose is to examine how different MSC sources in the body modulate healing. What was crazy about this patient and apparently the worst ever seen is the weakness of the patient's bone. When drilling a tunnel or turning a screw into the bone, it just fell apart. A special screw and suture system had to be used to secure the cuff. The final and long case of the day was a patient who was roughhousing and apparently only fell but managed to dislocate their patella, tear their MCL, and break a piece of cartilage off their femur! They received some allograft tissue to fill in the defect of the cartilage, and then it took most of the surgery time to re align the patella and fix the MCL. There were ligaments and allograft ligaments everywhere. It amazes me how well the surgeons can keep track of everything and how they choose to do what steps of the repair when. With so much wrong, there are many options for how to proceed and it is really cool to see that process.