T. Minas (West Palm Beach, US)

Paley Orthopedic & Spine Institute Cartilage Repair & Joint Preservation
Tom Minas is the President of the ICRS; 2019-2021. He is an Attending Orthopaedic Surgeon at the Paley Orthopedic and Spine Institute; West Palm Beach; Florida. He remains a Professor Emeritus of Orthopaedic Surgery at Harvard Medical School; where he was from 1989-2019; and set up the first Cartilage Repair Center in the USA at the Brigham and Women’s Hospital; Boston MA. Tom received his medical degree from the University of Toronto and his Masters in Epidemiology from the Harvard School of Public Health. He completed his fellowship in Pelvic Trauma and Joint Reconstruction at the Sunnybrook Medical Centre in Toronto; Canada and a Total Joint Arthroplasty fellowship at Brigham and Women’s Hospital. He is an internationally recognized leader in joint preservation approaches to treating knee OA. He performs surgery of the knee; arthroscopy; joint preserving osteotomies; partial; total and revision joint replacements. He is also an expert in cartilage repair and autologous chondrocyte implantation (ACI); having brought the technique to the US from Sweden. He is a member of the ICRS since its founding in 1997; having served on the Education Committee and the Executive Board; and also as the Chairman of the Cartilage Research Foundation,US. He is a member of the Knee Society; and in 2013; his team was honoured with the Insall Award for his work on The Long Term Outcomes assessment of ACI in the knee. He is involved in the development of tissue preserving implants and instrumentation for knees targeted at joint resurfacing. His work in patient-specific knee replacement has led to the introduction of a family of tissue preserving; customized implants based on patient-specific imaging data to restore native articulating geometry. (Member of the American Academy of Orthopedic Surgeons; Canadian Orthopedic Association; International Society of Arthroscopy; Knee Surgery and Orthopaedic Sports Medicine; 2007); Honorary Fellow of ICRS (International Cartilage Repair Society; 2007); Honorary Member of Swiss Society of Accident Surgery and Insurance Medicine (2008) and Honorary Member of Swiss Orthopaedic Society (2009).

Presenter Of 4 Presentations

Extended Abstract (for invited Faculty only) Please select your topic

Opening Session

Presentation Topic
Please select your topic
Date
12.04.2022
Lecture Time
16:15 - 16:15
Room
Potsdam 1
Session Type
Plenary Session
Abstract Others

All Slides

Presentation Topic
Others
Date
14.04.2022
Lecture Time
17:30 - 18:30
Room
Bellevue
Session Type
Plenary Session
Extended Abstract (for invited Faculty only) Cartilage /Cell Transplantation

2.0.2 - Restore Joints - A Complex Task?

Presentation Topic
Cartilage /Cell Transplantation
Date
12.04.2022
Lecture Time
13:30 - 13:45
Room
Potsdam 1
Session Type
Plenary Session

Abstract

Introduction

The success of cartilage repair techniques in the knee joint is multifaceted. A fundamental element to successful clinical outcomes is addressing the causation of the articular cartilage breakdown. Abnormal anatomy and altered biomechanical loading are common factors causing or contributing to cartilage loss in the knee. Such co-pathologies or “background factors” include tibiofemoral malalignment or meniscal deficiency, which exposes a joint compartment to excessive overloading. Altered patellofemoral alignment and kinematics are additional pathological features attributed to cartilage loss. When all causative factors are addressed, even the most advanced cases are amenable to biological repair with good to excellent clinical outcomes.

Content

The success of cartilage repair techniques in the knee joint is multifaceted. A fundamental element to successful clinical outcomes is addressing the causation of the articular cartilage breakdown. Abnormal anatomy and altered biomechanical loading are common factors causing or contributing to cartilage loss in the knee. Such co-pathologies or “background factors” include tibiofemoral malalignment or meniscal deficiency, which exposes a joint compartment to excessive overloading. Altered patellofemoral alignment and kinematics are additional pathological features attributed to cartilage loss. When all causative factors are addressed, even the most advanced cases are amenable to biological repair with good to excellent clinical outcomes.

For example, bipolar or “kissing” lesions in the patellofemoral compartment, a notoriously difficult problem for orthopedic surgeons, can be successfully treated with autologous chondrocyte implantation (ACI) and a concomitant osteotomy, when warranted. A case series of 58 patients (60 knees) who underwent ACI for repair of bipolar patellofemoral lesions demonstrated significant improvement in pain and function, with good survival rates at 5 and 10 years postoperatively (83% and 79%, respectively). Of this cohort, 42 (72%) patients had a corrective osteotomy for either patellofemoral lateral maltracking, patellar instability, or tibiofemoral malalignment. The best survivorship rates were observed among the patients who underwent ACI with a concurrent tibial tubercle osteotomy (TTO). Additional unpublished subcohort analysis demonstrated a 10-year survival rate of 91% when a TTO was performed at the time of ACI using a type I/III bilayer collagen membrane.

Likewise, we showed that ACI for the treatment of symptomatic bipolar cartilage lesions in the tibiofemoral compartments provides successful clinical outcomes in patients at mid- to long-term follow-up. Predisposing risk factors were addressed through concurrent osteotomies in 44 (76%) of the 58 knees. In this series, the survival rate was 80% at 5 years and 76% at 10 years, with significantly higher survival rates in the cohort of patients treated with collagen membrane versus periosteum (97% vs 61% at 5 years, respectively; p = .0014). The patient satisfaction was also high. Of the 46 knees with retained grafts, 91% were satisfied with their outcome, 85% rated their knee as better with the surgery, and 83% rated their outcome as good or excellent at a mean 8.3 years follow-up. At the final follow-up, 24 of the 46 successful knees were radiographically assessed and showed no significant osteoarthritis progression in K-L grading.

Another challenging problem for orthopedic surgeons that can be managed with consideration of the predisposing factors are cartilage lesions in the presence of meniscal deficiency. Our study evaluating 17 symptomatic patients (18 knees) with concomitant cartilage lesions and meniscal deficiency demonstrated 5- and 10-year survival rates of 75% with patient-reported functional improvements at a mean 7.9 years postoperative when meniscal allograft transplantation (MAT) was performed at the time of ACI. Of the cohort, there was no significant osteoarthritic progression using K-L grading from preoperative to mean 5.9 years postoperative. Thirteen patients (76%) maintained their native knee at the final follow-up.

All in all, challenging cases, ranging from bipolar cartilage lesions of the patellofemoral and tibiofemoral joints to cartilage lesions with concurrent meniscal deficiency, can be successfully treated through a means of joint preservation. Careful consideration and management of the causative factors, however, is imperative for good clinical outcomes.

References

Ogura T, Bryant T, Minas T. Biological Knee Reconstruction With Concomitant Autologous Chondrocyte Implantation and Meniscal Allograft Transplantation: Mid- to Long-term Outcomes. Orthop J Sports Med. 2016;4(10):2325967116668490. Published 2016 Oct 19. doi:10.1177/2325967116668490.

Ogura T, Bryant T, Merkely G, Minas T. Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Patellofemoral Compartment: Clinical Outcomes at a Mean 9 Years' Follow-up. Am J Sports Med. 2019;47(4):837-846. doi:10.1177/0363546518824600.

Ogura T, Bryant T, Mosier BA, Minas T. Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Tibiofemoral Compartment. Am J Sports Med. 2018;46(6):1371-1381. doi:10.1177/0363546518756977.

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Extended Abstract (for invited Faculty only) Clinical Research

21.2.2 - Case Presentation 2

Presentation Topic
Clinical Research
Date
15.04.2022
Lecture Time
07:45 - 08:00
Room
Potsdam 1
Session Type
Morning Workshop

Moderator Of 5 Sessions

Glienicke Board Room (18) ICRS Committee Meeting

Executive Board Meeting

Session Type
ICRS Committee Meeting
Date
12.04.2022
Time
08:00 - 09:45
Room
Glienicke Board Room (18)
Session Description
Only for invited Committee Members
Potsdam 1 Special Session
Session Type
Special Session
Date
12.04.2022
Time
12:00 - 13:00
Room
Potsdam 1
Session Description
In this session, the interaction and overlapping topics of Germany and ICRS will be discussed. Special focus on the presentation of international activities for future developments.
Session Learning Objective
  1. Participants should understand the contribution of German institutions to the international IRS community and experience worldwide networking.
CME Evaluation
Bellevue Plenary Session
Session Type
Plenary Session
Date
14.04.2022
Time
17:30 - 18:30
Room
Bellevue
Session Description
All ICRS members, present in Berlin are expected to attend the ICRS General Member’s Assembly. Retired Members and Corporate Members have no right to vote but are most welcome to attend. It is of utmost importance that as many members as possible attend this important meeting and take part in decision-making and approval processes of our association.
Potsdam 1 Morning Workshop
Session Type
Morning Workshop
Date
15.04.2022
Time
07:30 - 08:15
Room
Potsdam 1
Session Description
Experts of cartilage repair discuss various algorithms of treatment in principal and in case presentations. Different approaches of surgical treatment with pros and cons are presented.
Session Learning Objective
  1. Participants are involved in the discussion of various cases, create solutions and discuss the options with the experts in different joints and locations. Although aspects of rehabilitation and back to sports are involved.
CME Evaluation

Meeting Participant Of

Glienicke Board Room (18) ICRS Committee Meeting

Cartilage Executive Office - General Assembly

Session Type
ICRS Committee Meeting
Date
13.04.2022
Time
18:00 - 18:20
Room
Glienicke Board Room (18)
Glienicke Board Room (18) ICRS Committee Meeting

Executive Board Meeting

Session Type
ICRS Committee Meeting
Date
12.04.2022
Time
08:00 - 09:45
Room
Glienicke Board Room (18)
Session Description
Only for invited Committee Members
Bellevue Plenary Session
Session Type
Plenary Session
Date
14.04.2022
Time
17:30 - 18:30
Room
Bellevue
Session Description
All ICRS members, present in Berlin are expected to attend the ICRS General Member’s Assembly. Retired Members and Corporate Members have no right to vote but are most welcome to attend. It is of utmost importance that as many members as possible attend this important meeting and take part in decision-making and approval processes of our association.