Saturday, June 26, 2010

Week Two - Jenny Puetzer

My second week of immersion consisted primarily of seeing patients with Dr. Rodeo. I find seeing patients very interesting because it allows me to meet the patient to hear about the pain that is bothering them, observe the MRI and X-rays to see what is bothering them, and finally hear what can be done to help them. It allows me to see cases that demonstrate the need for research in the orthopedic field and cases where the research that is going on has completely changed the patient’s life.

One case I saw this week really touched me and demonstrated the need for the research I do, which is tissue engineering menisci. The patient was a 23 year old female who had already had an ACL repair and meniscus transplant starting back in 2003. She is now a graduate student in college and has difficulty sitting in class with her knee bent and pain in all her everyday activities. Arthritis has already taken over one side of her knee (most likely due to the meniscal transplant) and she is looking for some way to improve her pain. Dr. Rodeo suggested injections of hyaluronic acid, a molecule which provides a little bit of lubrication for 3 to 6 month at a time to reduce pain in arthritis patients. He adds this is all they can do to delay the inevitable total knee replacement which only last for about 10 years now. A tissue engineered meniscus may have delayed this breakdown of her knee or a tissue engineered repair for cartilage may relieve her pain if they were around as an option of treatment. This case, along with multiple juvenile sports injuries and arthritics cases, really demonstrated the need for further research in the orthopedic field. There is still so much we cannot do to help patient that experience pain every day of their life.

Another case I saw this week was very exciting because it demonstrated how research is touching patient’s lives. A female in her early twenties came in for a check-up 9 months after her ground breaking surgery. So far HSS has only preformed two of these surgeries and her surgery was the first one. She had a large lesion of missing cartilage on the back of her knee cap, most likely due to some sports injury early in her life. Since cartilage can’t grow back, she was pretty much stuck with constant pain for the rest of her life. However, she underwent a new procedure which consisted of taking juvenile cartilage from patients that are younger than 13 years of age. They cut this cartilage up into small pieces and then place them in the lesion on the back of her knee cap and secure them in the lesion with a fibrous capsule. Then since the cartilage is from young patients the cells are very active and have a good chance of growing new cartilage in the lesion. Just nine months after her surgery she has new cartilage growth as seen on her MRI scans and a remarkable change in the amount of pain she has day to day. Her knee is not completely repaired yet, but it’s definitely on its way.

Aside from seeing patients, I also went to a few meetings, including grand rounds, and saw two surgeries. Grand rounds was interesting because it was all about treating ankle injuries and debates on immobilization and taping. The two surgeries I saw were both arthroscopic with one on the knee and one on the shoulder. It’s very interesting to see the anatomy so clearly of the knee and shoulder during these procedures and to see all the tools they use to repair them.

Next week I look forward to starting my research project and exploring other areas of the hospital.

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