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Stone K.R.,The Stone Clinic | Stone K.R.,The Foundation Stone | Pelsis J.R.,The Foundation Stone | Crues J.V.,RadNet | And 3 more authors.
Knee | Year: 2014

Background: Revision of failed surgical treatments of osteochondritis dissecans (OCD) lesions remains a challenge without an obvious solution. The aim of this study was to evaluate seven consecutive patients undergoing osteochondral grafting of a failed OCD repair. Methods: The mean time from surgery to the latest evaluation was 7.0. years. IKDC, WOMAC, Tegner, and MRI studies were collected both preoperatively and during follow-up. Evaluation of the graft was assessed using the magnetic resonance observation of cartilage repair tissue (MOCART) grading system. Results: Over the course of the study period, five patients required additional surgery with a study median of one additional surgery (range, zero to 3). At most recent follow-up, there was significant improvement from preoperative values in median IKDC (p = 0.004), WOMAC (p = 0.030), and Tegner (p = 0.012). Complete cartilage fill and adjacent tissue integration of the paste graft were observed by MRI evaluation in five of the seven (71.4%) patients. Definitive correlation between clinical outcomes and MRI scores was not observed. Conclusions: This study shows promising results of osteochondral grafting as a viable option for the revision of failed OCD lesion repairs; however, more patients are needed to fully support its efficacy in these challenging failed revision cases. © 2014 Elsevier B.V.


Stone K.R.,The Foundation Stone | Pelsis J.R.,The Foundation Stone | Surrette S.T.,The Foundation Stone | Walgenbach A.W.,The Foundation Stone | Turek T.J.,The Foundation Stone
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2014

Methods: Forty-nine patients with moderate to severe cartilage damage who underwent meniscus allograft transplantation were included in this study; those with symptoms related to articular cartilage damage also underwent articular cartilage repair. Kaplan–Meier (KM) survival estimate, potential hazards to survival, and subjective clinical outcomes were analyzed. For KM survival, failure was defined as progression to knee arthroplasty, surgical removal of the meniscus transplant without revision, a self-reported follow-up pain level that was more than preoperative level, or constant moderate pain with no relief from non-operative treatment.Results: The mean follow-up time was 8.6 ± 4.2 years. The mean age at surgery was 45.3 ± 12.9 years. Meniscus transplantation was performed in 37 medial cases and 12 lateral cases. There were 41 patients with Outerbridge Grade IV and 8 with Grade III. Thirty-six (73.5 %) patients were able to participate in sporting activities postoperatively. Eleven (22.4 %) meniscus transplants failed at an average of 5.2 ± 4.4 years. The KM mean estimated survival time was 12.6 ± 0.7 years. No tested risks were found to affect sports participation or procedure success.Conclusions: Meniscus transplantation is a viable surgical option for patients with severe cartilage damage and missing or irreparable menisci to provide significant improvements in pain and function levels in the medium to long term with the majority of patients achieving their goal of participation in sporting activities. These results indicate that symptomatic patients may be able to participate in sports activities for an average of 12.6 years following meniscus transplantation.Level of evidence: Case series, Level IV.Purpose: The purpose of this study was to evaluate the efficacy of meniscus allograft transplantation in an active patient population with moderate to severe cartilage damage and the procedure’s ability to allow sports participation postoperatively. © 2014, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).


Feuerstein J.D.,Beth Israel Deaconess Medical Center | Pelsis J.R.,The Foundation Stone | Lloyd S.,Beth Israel Deaconess Medical Center | Cheifetz A.S.,Beth Israel Deaconess Medical Center | Stone K.R.,The Foundation Stone
Seminars in Arthritis and Rheumatism | Year: 2016

Objective: To determine the validity of the hip and knee osteoarthritis guidelines. Methods: A systematic search of PubMed using a combination of Mesh and text terms with limitations to guidelines was performed to identify hip and knee osteoarthritis guidelines. The study was performed from April 17, 2014 to October 1, 2014. Guidelines were reviewed for graded levels of evidence, methods used to grade the evidence, and disclosures of conflicts of interest. Additionally, guidelines were also assessed for key quality measures using the AGREE II system for assessing the quality of guidelines. Results: A total of 13 guidelines relevant to the diagnosis and/or treatment of hip/knee osteoarthritis was identified. The 180 recommendations reviewed were supported by 231 pieces of evidence. In total, 35% (n = 80; range: 0-26) were supported by level A evidence, 15% (n = 35; range: 0-10) were by level B, and 50% (n = 116; range: 0-62) were by level C. Median age of the guidelines was 4 years (±4.8; range: 0-16) with no comments on planned updates. In total, 31% of the guidelines included patients in the development process. Only one guideline incorporated cost consideration, and only 15% of the guidelines addressed the surgical management of osteoarthritis. Additionally, 46% of guidelines did not comment on conflicts of interest (COI). When present, there was an average 29.8 COI. Notably, 82% of the COI were monetary support/consulting. Conclusions: In total, 50% of the hip/knee osteoarthritis guideline recommendations are based on lower quality evidence. Nearly half the guidelines fail to disclose relevant COI and when disclosed, multiple potential COI are present. Future hip/knee osteoarthritis guideline development committees should strive to improve the transparency and quality of evidence used to formulate practice guidelines. © 2015 Elsevier Inc.


Stone K.R.,The Foundation Stone | Adelson W.S.,The Foundation Stone | Pelsis J.R.,The Foundation Stone | Walgenbach A.W.,The Foundation Stone | Turek T.J.,The Foundation Stone
Journal of Bone and Joint Surgery - Series B | Year: 2010

We describe 119 meniscal allograft transplantations performed concurrently with articular cartilage repair in 115 patients with severe articular cartilage damage. In all, 53 (46.1%) of the patients were over the age of 50 at the time of surgery. The mean follow-up was for 5.8 years (2 months to 12.3 years), with 25 procedures (20.1%) failing at a mean of 4.6 years (2 months to 10.4 years). Of these, 18 progressed to knee replacement at a mean of 5.1 years (1.3 to 10.4). The Kaplan-Meier estimated mean survival time for the whole series was 9.9 years (SD 0.4). Cox's proportional hazards model was used to assess the effect of covariates on survival, with age at the time of surgery (p = 0.026) and number of previous operations (p = 0.006) found to be significant. The survival of the transplant was not affected by gender, the severity of cartilage damage, axial alignment, the degree of narrowing of the joint space or medial versus lateral allograft transplantation. Patients experienced significant improvements at all periods of follow-up in subjective outcome measures of pain, activity and function (all p-values < 0.05), with the exception of the seven-year Tegner index score (p = 0.076). ©2010 British Editorial Society of Bone and Joint Surgery.


Verpoorte A.,Leiden University | De Loecker D.,Leiden University | Niekus M.J.L.T.,The Foundation Stone | Rensink E.,Cultural Heritage Agency
Quaternary International | Year: 2015

We present a concise overview of Middle Palaeolithic research in the Netherlands. The area, which is situated along the northwestern edge of the known Neanderthal world, is very divers in terms of geological development. As a result of glacial cycles, hominin occupation can be characterised as intermittent and probably sparse. Well-preserved sites are primarily known from the loess region in the southern part of the province of Limburg and to a certain extent from the Roer Valley Graben. Further to the north artefacts do occur 'geological in situ', i.e. in the ice-pushed ridges in the central Netherlands and on the Drenthe-Frisian till plateau in the northernmost part of the country, but primary archaeological in situ situations have yet to be discovered. The oldest traces of occupation date to MIS 9 or MIS 7 (Belvédère quarry and the 'Rhenen Industry'), the youngest (stray finds) can be attributed to the Blattspitzengruppen and the Lincombian-Ranisian-Jerzmanowician (MIS 3). The (Upper) Acheulian, several Mousterian variants and the Keilmessergruppen are also attested. This paper serves as a starting point for future research. © 2015 Elsevier Ltd and INQUA.


Thomas K.,The Foundation Stone | Thomas K.,Guys Hospital | Smith N.C.,The Foundation Stone | Hegarty N.,The Foundation Stone | Glass J.M.,The Foundation Stone
Urology | Year: 2011

Objectives: To report the development and validation of a scoring system, the Guy's stone score, to grade the complexity of percutaneous nephrolithotomy (PCNL). Currently, no standardized method is available to predict the stone-free rate after PCNL. Methods: The Guy's stone score was developed through a combination of expert opinion, published data review, and iterative testing. It comprises 4 grades: grade I, solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy; grade II, solitary stone in upper pole or multiple stones in a patient with simple anatomy or a solitary stone in a patient with abnormal anatomy; grade III, multiple stones in a patient with abnormal anatomy or stones in a caliceal diverticulum or partial staghorn calculus; grade IV, staghorn calculus or any stone in a patient with spina bifida or spinal injury. It was assessed for reproducibility using the kappa coefficient and validated on a prospective database of 100 PCNL procedures performed in a tertiary stone center. The complications were graded using the modified Clavien score. The clinical outcomes were recorded prospectively and assessed with multivariate analysis. Results: The Guy's stone score was the only factor that significantly and independently predicted the stone-free rate (P =.01). It was found to be reproducible, with good inter-rater agreement (P =.81). None of the other factors tested, including stone burden, operating surgeon, patient weight, age, and comorbidity, correlated with the stone-free rate. Conclusions: The Guy's stone score accurately predicted the stone-free rate after PCNL. It was easy to use and reproducible. © 2011 Elsevier Inc.


PubMed | The Foundation Stone and Beth Israel Deaconess Medical Center
Type: Journal Article | Journal: Seminars in arthritis and rheumatism | Year: 2016

To determine the validity of the hip and knee osteoarthritis guidelines.A systematic search of PubMed using a combination of Mesh and text terms with limitations to guidelines was performed to identify hip and knee osteoarthritis guidelines. The study was performed from April 17, 2014 to October 1, 2014. Guidelines were reviewed for graded levels of evidence, methods used to grade the evidence, and disclosures of conflicts of interest. Additionally, guidelines were also assessed for key quality measures using the AGREE II system for assessing the quality of guidelines.A total of 13 guidelines relevant to the diagnosis and/or treatment of hip/knee osteoarthritis was identified. The 180 recommendations reviewed were supported by 231 pieces of evidence. In total, 35% (n = 80; range: 0-26) were supported by level A evidence, 15% (n = 35; range: 0-10) were by level B, and 50% (n = 116; range: 0-62) were by level C. Median age of the guidelines was 4 years (4.8; range: 0-16) with no comments on planned updates. In total, 31% of the guidelines included patients in the development process. Only one guideline incorporated cost consideration, and only 15% of the guidelines addressed the surgical management of osteoarthritis. Additionally, 46% of guidelines did not comment on conflicts of interest (COI). When present, there was an average 29.8 COI. Notably, 82% of the COI were monetary support/consulting.In total, 50% of the hip/knee osteoarthritis guideline recommendations are based on lower quality evidence. Nearly half the guidelines fail to disclose relevant COI and when disclosed, multiple potential COI are present. Future hip/knee osteoarthritis guideline development committees should strive to improve the transparency and quality of evidence used to formulate practice guidelines.


PubMed | The Foundation Stone
Type: Journal Article | Journal: The Canadian journal of urology | Year: 2015

Calcification of the vas deferens and seminal vesicles is a rare condition of unknown incidence. It has been described in association with diabetes, hyperparathyroidism and genitourinary tuberculosis, amongst other conditions. Little is known about the clinical significance and management of this condition. We review the literature in an effort to find answers about an entity that is frequently appreciated as an incidental finding.An electronic database search was performed (Medline) using the key words: vas deferens; seminal vesicles; calcification, alone or in combination. Articles were selected according to relevance and quality of evidence.The search included published manuscripts between 1960 and 2012. A total of 17 relevant publications were identified. The majority were written in the English language and mostly consisted of case presentations and reports of radiologic findings.Calcification of the vas deferens and seminal vesicles is a rare condition. However, it may be implicated in male factor infertility and symptoms from the urogenital tract. Treatment should be directed towards the underlying cause on an individual basis. It is unknown whether control of the primary process has any effects on the histopathological appearance of the ducts and/or their improvement of function.


PubMed | The Foundation Stone
Type: Journal Article | Journal: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA | Year: 2015

The purpose of this study was to evaluate the efficacy of meniscus allograft transplantation in an active patient population with moderate to severe cartilage damage and the procedures ability to allow sports participation postoperatively.Forty-nine patients with moderate to severe cartilage damage who underwent meniscus allograft transplantation were included in this study; those with symptoms related to articular cartilage damage also underwent articular cartilage repair. Kaplan-Meier (KM) survival estimate, potential hazards to survival, and subjective clinical outcomes were analyzed. For KM survival, failure was defined as progression to knee arthroplasty, surgical removal of the meniscus transplant without revision, a self-reported follow-up pain level that was more than preoperative level, or constant moderate pain with no relief from non-operative treatment.The mean follow-up time was 8.6 4.2 years. The mean age at surgery was 45.3 12.9 years. Meniscus transplantation was performed in 37 medial cases and 12 lateral cases. There were 41 patients with Outerbridge Grade IV and 8 with Grade III. Thirty-six (73.5%) patients were able to participate in sporting activities postoperatively. Eleven (22.4%) meniscus transplants failed at an average of 5.2 4.4 years. The KM mean estimated survival time was 12.6 0.7 years. No tested risks were found to affect sports participation or procedure success.Meniscus transplantation is a viable surgical option for patients with severe cartilage damage and missing or irreparable menisci to provide significant improvements in pain and function levels in the medium to long term with the majority of patients achieving their goal of participation in sporting activities. These results indicate that symptomatic patients may be able to participate in sports activities for an average of 12.6 years following meniscus transplantation.Case series, Level IV.


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