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The Inaugural Meeting of the International Association for Joint Reconstruction took place at the ArabellaSheraton Grand Hotel.
In his inaugural speech, Professor Toft emphasized the importance of an organisation which focuses on biologic and joint-preserving treatment concepts as opposed to joint replacement. In this context he praised Professor Lanny L. Johnson´s outstanding contribution, describing him as a true pioneer in biologic and arthroscopic joint surgery (see the speech on Prof. Johnson on this site).
Prof. Johnson, Honorary President of the Association, congratulated the organisation on its endeavour to establish a forum for surgeons from all over the world who take a vivid interest in biologic surgical concepts. From his own clinical work and research he concluded that in light of his results joint repair is not only possible but also very successful. He presented clinical results with a follow-up of up to 20 years postoperatively and concluded that repair techniques such as abrasion arthroplasty and other bone-marrow-based techniques have stood the test of time.
On a similar note, Professor Kevin Stone of the Stone Clinic and Foundation in San Francisco presented his long-term results utilising a special technique called paste grafting. Dr. Stone felt that contrary to not violating the subchondral bone plate, his paste graft works best when he does break this barrier before introducing the paste graft, a mixture of bone marrow, cartilage fragments and blood. He demonstrated that the subchondral bone plate reconstitutes itself after a certain period of time. To reach a more complete result, Dr. Stone strongly recommends the implantation of meniscal allografts, even in osteoarthritic knees and in some cases he feels that by doing so he can avoid an otherwise indicated osteotomy. Dr. Stone reported excellent results in cases of combined open-wedge osteotomy and abrasion.
As an alternative to abrasion arthroplasty and paste grafting, Professor William Rodkey of the Steadman-Hawkins Institute was elaborating on microfracture, a concept that stems from this institute, feeling that microfracure has a place in the armamentarium of cartilage repair in Outerbridge grade-IV lesions and that it is most successful in cases where the damage is contained, with a rim of healthy cartilage around the lesion. He reported on his results with the Collagen Meniscal Implant (CMI) which he feels is a good substitute in cases where there is still some meniscal remnant in place. In his institute, the combination of microfracture and osteotomy has also found to be successful.
More basic science work was presented by Professor Myron Spector from the Harvard Medical School in Boston. He described various new developments involving the addition of growth factors and other elements to repair processes as being very promising. In the animal model, such additions result in a significantly higher percentage of hyaline cartilage in cases of cartilage cell transplantation. Although not tested in humans yet, there seem to be exciting new pathways to greatly enhance and improve existing techniques of cartilage repair. In another animal study, Dr. Spector also presented an alternative method for micro fractures where he found little slits made by a powered instrument to yield a more even repair growth on bare bone than observed for the traditional holes from micro picks.
Professor Sansone of the University of Milan presented his 10-year results of abrasion arthroplasty for contained grade IV cartilage lesions, finding that the newly-formed tissue stays in place for long periods of time and that clinical results 10 years postoperatively are still impressive.
Professor Pascale of the Galeazzi Orthopedic Institute in Milan was lecturing on latest developments in ACL reconstruction, emphasizing the need for ever more atraumatic and cosmetically satisfactory techniques.
Dr. Alcy Vilas Boas of the Alpha Klinik in Munich reported on long-term results following double-loop and quadrupled semitendinosus ACL replacements operated on by Dr. Toft between 1988 and 1998, with a minimum follow-up of 10 years.
Using the Lysholm score, it was found that the doubled-loop group (94) had slightly higher scores than the quadrupled group (91) but no factor was found to explain this phenomenon.
Dr. Tim Rose, an orthopedic and trauma surgeon at the Alpha Klinik, presented his results for double-bundle PCL replacement, finding that the double-bundle technique, in his hands, yielded better results than single-bundle cases, with less residual laxity.
Professor Toft, president of the IAJR and director of the Alpha Klinik, presented his long-term results of up to 15 years follow-up from a group of about 300 patients, demostrating amazing results from abrasion and simultaneous osteotomy for severe unicompartmental osteoarthritis. The procedure termed "bioprosthesis" in analogy to artificial joint replacement was found to be a viable alternative to prosthetic joints as only 2.5 per cent in this group of patients went on to have joint replacement at a later date. This study comprises the largest number of patients to have been published to date, with all patients operated on by the same surgeon and with the same technique.
At the end Professor Johnson outlined the future mission of the Association and offered his generous support in the development of this new organisation. It was announced to hold the second IAJR meeting in Milan, Italy, with Vice President Professor Walter Pascale as the organiser. A precise date for the meeting in 2007 had not been fixed but will be communicated on this site shortly. It was also decided to publish the papers presented at the Inaugural Meeting and make them available to orthopedic and trauma surgeons.
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