WEBVTT 1 00:00:00.440 --> 00:00:03.319 Oh, Hi, hey, Hi, it's the lady at the COVID 2 00:00:03.399 --> 00:00:05.879 swapping clinic who always has the best scrubs with like 3 00:00:06.080 --> 00:00:09.000 holiday lamas on them, Alley Ward. And actually I'm not her, 4 00:00:09.039 --> 00:00:11.400 because that lady actually does exist at the Bourbon COVID 5 00:00:11.400 --> 00:00:14.199 clinic drive through, and I love her every time I 6 00:00:14.199 --> 00:00:17.359 see her. Okay, let's talk about your shitty niece. Let's 7 00:00:17.359 --> 00:00:21.039 talk about Jarrett, your pod mom's shitty knies. So in 8 00:00:21.120 --> 00:00:23.640 late August, he was vaccinated. He was in a small 9 00:00:23.679 --> 00:00:26.760 pod of jiu jitsu folks starting to train again. He 10 00:00:26.800 --> 00:00:29.320 has a brown belt, two stripes so close to his 11 00:00:29.320 --> 00:00:31.079 black belt, was so excited to get back into the 12 00:00:31.079 --> 00:00:34.280 sport he loves. He was grappling, took a wonky fall, 13 00:00:34.560 --> 00:00:38.840 heard a pop, and here we are, folks. Terrible pain swelling. 14 00:00:39.000 --> 00:00:43.399 MRIs busted ACL surgery, physical therapy, and now he's two 15 00:00:43.399 --> 00:00:46.759 months out. He's still healing. Luckily, a friend of his 16 00:00:46.880 --> 00:00:50.479 family happens to be this world celebrated surgeon who has 17 00:00:50.520 --> 00:00:53.240 pioneered knee reconstructions and gotten a bunch of patents and 18 00:00:53.280 --> 00:00:57.840 fixes everyone from pro athletes to actors to actual ballerinas. 19 00:00:58.520 --> 00:01:02.200 This surgeon is also in Bay area and very out 20 00:01:02.200 --> 00:01:05.719 of network, but he understands how to get athletes back 21 00:01:05.760 --> 00:01:07.480 on their feet. So we packed our bags. We stayed 22 00:01:07.519 --> 00:01:10.799 with Jared's wonderful mob Christine, for a two week blur 23 00:01:11.040 --> 00:01:14.840 of general anesthesia and thailanol and ice and pain and 24 00:01:14.879 --> 00:01:18.840 crutches and rehab. But amid all that fun, why not 25 00:01:19.000 --> 00:01:22.280 record an episode? I feel like most people I know 26 00:01:22.680 --> 00:01:26.159 have kind of an on off relationship with their joints. 27 00:01:26.280 --> 00:01:29.159 And I found myself looking at these knee diagrams wondering 28 00:01:29.159 --> 00:01:32.079 what was going on in there. And luckily, Jared's surgeon, 29 00:01:32.359 --> 00:01:37.799 who is this athletic, soft spoken and deeply knowledgeable knee 30 00:01:37.840 --> 00:01:40.480 celebrity if you will, was down to sit on a 31 00:01:40.519 --> 00:01:44.439 porch this October afternoon in his neighborhood in the Redwoods, 32 00:01:44.519 --> 00:01:47.920 just north of San Francisco. So he studied internal medicine 33 00:01:47.959 --> 00:01:52.400 and orthopedic surgery at Harvard University and then went to 34 00:01:52.439 --> 00:01:56.280 this place called Stanford University to study general surgery. And 35 00:01:56.319 --> 00:01:59.719 he's written books and done ted talks and educated people 36 00:01:59.799 --> 00:02:02.280 all the world on this stuff. People who call him 37 00:02:02.319 --> 00:02:07.200 Doc include the Marin Ballet, the US ski team, dance companies, 38 00:02:07.719 --> 00:02:12.719 rugby teams, pentathletes, and of course my husband. So I 39 00:02:12.840 --> 00:02:16.039 was like, hey, Hi, can you explain knees? And I'm 40 00:02:16.080 --> 00:02:20.680 pretty sure he was like, okay, yeah, you make a podcast. Sure, okay, 41 00:02:20.719 --> 00:02:22.680 that's fun. But little did he know that I would 42 00:02:22.719 --> 00:02:26.280 lob one million all of our knee questions right at 43 00:02:26.280 --> 00:02:29.400 his face, but before I ask him your questions. Patrons, 44 00:02:29.439 --> 00:02:32.719 thank you for supporting the show like a beloved crutch 45 00:02:32.919 --> 00:02:35.960 since before the beginning. Anyone can join that club for 46 00:02:35.960 --> 00:02:38.319 a dollar a month. You can also send this episode 47 00:02:38.360 --> 00:02:40.400 to a friend, or rate, or subscribe, or even review, 48 00:02:40.400 --> 00:02:43.240 because yes I do read them and weep happily. And 49 00:02:43.520 --> 00:02:47.159 this week's fresh reviews from Mary Mama Sunshine, who wrote, 50 00:02:47.159 --> 00:02:49.800 I started listening when pregnant with my fourth little guy, 51 00:02:50.199 --> 00:02:52.520 especially on my trips to and from doctor's appointments, and 52 00:02:52.560 --> 00:02:55.439 your podcast helped mellow me out to get me through 53 00:02:55.479 --> 00:02:58.759 a post miscarriage pregnancy. Now fast forward and come to 54 00:02:58.759 --> 00:03:01.240 find out that apparently ology is the magic that mellows 55 00:03:01.240 --> 00:03:03.840 out my pandemic baby who hates car rights. So Mary 56 00:03:03.879 --> 00:03:07.680 or Mama, I'm super sorry your first child sentence is 57 00:03:07.759 --> 00:03:10.080 going to be about butts or have the aff word. 58 00:03:10.439 --> 00:03:14.080 But you're welcome. Also Smology's episodes. They're released every two weeks, 59 00:03:14.240 --> 00:03:15.879 their classroom and kid Safe. 60 00:03:15.960 --> 00:03:16.319 Okay. 61 00:03:17.479 --> 00:03:22.800 Genicular traumatology, so genicular means of the knee, and the 62 00:03:22.919 --> 00:03:26.639 root in Latin means having knots or bent, and traumatology 63 00:03:26.680 --> 00:03:29.120 comes from the Greek for to twist or to rub, 64 00:03:29.280 --> 00:03:31.919 and Surett was like, I mean pretty spot on the 65 00:03:31.960 --> 00:03:34.840 study of twisting and rubbing knee injuries. Boom. 66 00:03:35.039 --> 00:03:36.680 So we talk about. 67 00:03:36.479 --> 00:03:42.479 Joints, tendons versus ligaments, robot doctors, cartilage donuts, physical therapy, 68 00:03:42.919 --> 00:03:48.319 self surgery, joint juices, sporty injections, donor tissues, pig legs, 69 00:03:48.800 --> 00:03:52.759 if weight has any effect on knee health, types of arthritis, 70 00:03:53.000 --> 00:03:56.080 how to make exercise like play, and then how to 71 00:03:56.120 --> 00:03:58.759 play Forever, which is the title of his new book, 72 00:03:59.000 --> 00:04:03.000 Bionic Body Part Biologic Ones. The Best Exercises for healthy 73 00:04:03.080 --> 00:04:08.520 knees creaking, popping, locking, bending, biking, walking, and if knees 74 00:04:08.599 --> 00:04:12.240 are the worst. Also, some of these asides go off 75 00:04:12.319 --> 00:04:15.599 on some stories that maybe you'll remember forever, but I 76 00:04:15.599 --> 00:04:18.279 couldn't help it include them. This episode is It's a 77 00:04:18.319 --> 00:04:21.319 wild ride. You never knew your knees, but you will 78 00:04:21.600 --> 00:04:23.319 right now. So pull up a seat or go for 79 00:04:23.360 --> 00:04:25.360 a walk and get ready for an episode that we 80 00:04:25.399 --> 00:04:30.079 all need so much with orthopedic surgeon and researcher doctor 81 00:04:30.160 --> 00:04:53.120 Kevin Stone. Doctor Stone, can I get you a water 82 00:04:53.279 --> 00:04:57.240 or a tea or anything? Yeah, okay, we got that. 83 00:04:58.040 --> 00:05:05.759 We got that in spades. It's fine if. 84 00:05:05.639 --> 00:05:07.319 You hear us and you want to chime in on anything. 85 00:05:07.439 --> 00:05:09.560 As a patient, the people who. 86 00:05:09.480 --> 00:05:11.720 Are excited to figure out their knees work. 87 00:05:11.680 --> 00:05:14.160 And how mostly their knees don't work. 88 00:05:14.800 --> 00:05:18.920 So it's Kevin Stone, it's he and him cool. 89 00:05:19.360 --> 00:05:22.959 And doctor Kevin Stone. Do people call you doc a lot? 90 00:05:23.240 --> 00:05:23.560 They do? 91 00:05:23.680 --> 00:05:26.680 Yeah? Hey, Doc? Do you think that that's like an 92 00:05:26.720 --> 00:05:29.319 informal thing because they see you a lot? They know 93 00:05:29.439 --> 00:05:31.839 you're not just like a surgeon who works on them 94 00:05:31.839 --> 00:05:35.160 while they're in twilight sleep, but you're you see them, 95 00:05:35.639 --> 00:05:36.720 you know, follow up and stuff. 96 00:05:37.519 --> 00:05:41.000 Yes. And the structure of our clinic is that our 97 00:05:41.079 --> 00:05:45.000 rehab team is rate next all on one floor, So 98 00:05:45.160 --> 00:05:48.240 I'm floating around seeing them when they're rehabbing, when they're 99 00:05:48.240 --> 00:05:50.160 on the bike, when they're working with the therapists, and 100 00:05:50.240 --> 00:05:53.399 so it's a very familiar environment. Yeah. 101 00:05:53.480 --> 00:05:57.480 I know when Jared had surgery, you called him to 102 00:05:57.560 --> 00:06:00.639 check on him, like every day for after surgery. He 103 00:06:00.680 --> 00:06:03.759 was like, oh, thanks for I'm doing well. You called 104 00:06:03.759 --> 00:06:05.680 me just to let me know how he was doing. 105 00:06:05.720 --> 00:06:08.199 So do you feel like that's important to have that 106 00:06:08.319 --> 00:06:10.959 kind of relationship, like to just check on people, make 107 00:06:10.959 --> 00:06:12.800 sure that you're not just kind of them open and 108 00:06:13.079 --> 00:06:15.120 sam ba by, Yeah. 109 00:06:15.160 --> 00:06:17.319 The fun of what we do is to try to 110 00:06:17.360 --> 00:06:21.800 convince people to become athletes for life. And so if 111 00:06:21.800 --> 00:06:25.240 I can convince them to use their injury as an 112 00:06:25.319 --> 00:06:28.600 excuse to become fitter, faster, stronger, which is the phrase 113 00:06:28.639 --> 00:06:32.279 we like to use, than they've ever been, then it's 114 00:06:32.319 --> 00:06:36.360 a fun relationship for a lifetime because number one, yes, 115 00:06:36.439 --> 00:06:38.759 I get to know them immediately after surgery and check 116 00:06:38.800 --> 00:06:40.600 in on them and make sure that they're doing okay. 117 00:06:41.160 --> 00:06:43.439 But then number two, I get to see them as 118 00:06:43.519 --> 00:06:46.920 they come back for their what we call stone fit tests, 119 00:06:47.519 --> 00:06:50.480 which occur at one month, three months, six months, one year, 120 00:06:50.519 --> 00:06:53.759 and then every year or thereafter, because we want to 121 00:06:53.800 --> 00:06:57.560 figure out how do we help somebody become better than 122 00:06:57.560 --> 00:06:58.680 they've been before. 123 00:06:58.680 --> 00:07:00.360 So better than when they first. 124 00:07:00.480 --> 00:07:03.600 Yeah, and so using that injury as an excuse to 125 00:07:03.639 --> 00:07:05.959 become better we've got a whole rehab team. We're going 126 00:07:06.040 --> 00:07:08.160 to take a moment of your life where you're going 127 00:07:08.240 --> 00:07:10.800 to be really focused on your knee or shoulder or ankle, 128 00:07:10.879 --> 00:07:14.120 whatever we fixed. And so we can use that moment 129 00:07:14.759 --> 00:07:19.000 to engage you fully in your fitness program and your 130 00:07:19.079 --> 00:07:21.519 diet and your mental attitude. And so in order to 131 00:07:21.600 --> 00:07:25.279 do that, you need to have trust that I'm on 132 00:07:25.399 --> 00:07:29.399 board with you, not just during surgery, but immediately afterward 133 00:07:29.560 --> 00:07:32.240 and then forever. And the fun of what we get 134 00:07:32.240 --> 00:07:34.319 to do is that when we fix things and then 135 00:07:34.399 --> 00:07:37.639 watch people go back and do, whether it's an Olympic 136 00:07:37.680 --> 00:07:39.839 sport and win a gold medal or whether it's just 137 00:07:39.879 --> 00:07:41.959 be able to go to the grocery store. Yeah, but 138 00:07:42.000 --> 00:07:44.000 we get the feedback when they come back for their 139 00:07:44.079 --> 00:07:48.360 sport fit tests and show how they're doing and see 140 00:07:48.360 --> 00:07:51.240 where they are in life. And so, yes, to answer 141 00:07:51.279 --> 00:07:54.439 your question with a long winded answer, that immediate phone call, 142 00:07:54.480 --> 00:07:56.959 post up the next few days and bonding with them 143 00:07:57.040 --> 00:07:59.240 during that little window of time when it's kind of 144 00:07:59.279 --> 00:08:01.680 scary is a really important time. 145 00:08:01.920 --> 00:08:05.560 Yeah, it definitely works. Now, obviously, you were not born 146 00:08:05.839 --> 00:08:09.720 an orthopedic surgeon. You became one. How did you decide 147 00:08:09.839 --> 00:08:14.759 that cutting open and fixing knees being a knee and 148 00:08:14.800 --> 00:08:18.040 a joint mechanic, How did that even come about? 149 00:08:19.399 --> 00:08:22.399 So probably two big events. One as I went to 150 00:08:22.439 --> 00:08:26.120 college as a government major oh okay, and was playing 151 00:08:26.160 --> 00:08:29.680 soccer and tore my knee while playing soccer as a 152 00:08:29.720 --> 00:08:33.879 freshman at Harvard, Oh God. And in the training room 153 00:08:33.960 --> 00:08:37.240 after the brutal surgery at that time, I watched the 154 00:08:37.399 --> 00:08:41.120 orthopedic surgeon rome amongst the different athletes and check on 155 00:08:41.159 --> 00:08:43.279 them the way I get to do now, And I 156 00:08:43.320 --> 00:08:46.559 so admired that environment and that ability to be around 157 00:08:46.600 --> 00:08:49.960 athletes who are trying to come back, the ability to 158 00:08:49.960 --> 00:08:52.960 help somebody who's broken something where you can fix it 159 00:08:53.000 --> 00:08:55.960 and they can get better was just clearly I knew 160 00:08:56.080 --> 00:08:59.519 that that looked mighty attractive. So that was a first 161 00:08:59.559 --> 00:09:03.440 major thing. The second major thing was, unfortunately, that surgeon 162 00:09:03.519 --> 00:09:06.559 took out a key structure in my knee called the 163 00:09:06.639 --> 00:09:08.840 meniscus cartilage. And I'm sure we'll get a chance to 164 00:09:08.879 --> 00:09:12.120 talk about that some more later, but that structure is 165 00:09:12.159 --> 00:09:15.600 critical to how the knee functions. And so years later 166 00:09:15.679 --> 00:09:17.720 I was out for run with my mentor at the 167 00:09:17.799 --> 00:09:20.240 time and he looked at my bow legs and said, 168 00:09:20.279 --> 00:09:22.799 you know, Kevin, if you could ever figure out how 169 00:09:22.799 --> 00:09:27.279 to replace the meniscus, you'd make a big contribution to orthopedics. 170 00:09:27.679 --> 00:09:30.159 And in my typical Harvard arrogant way at the time, 171 00:09:30.200 --> 00:09:31.840 I said, great, I'll do it. You pay for it. 172 00:09:31.960 --> 00:09:36.320 And that started off my entire research career around replacing 173 00:09:36.320 --> 00:09:37.559 tissues in people's bodies. 174 00:09:37.960 --> 00:09:42.440 Oh cut Banks, Texture Crush, ask someone for millions of 175 00:09:42.480 --> 00:09:45.200 dollars to learn how to replace parts of bodies. That's 176 00:09:45.240 --> 00:09:48.120 apparently how the world works. But how do knees work. 177 00:09:48.480 --> 00:09:50.840 Let's get into it. Let's talk about what a meniscus is. 178 00:09:51.080 --> 00:09:52.960 I tried to study this before you got here so 179 00:09:52.960 --> 00:09:54.840 that I would not be a total adult, but I 180 00:09:54.919 --> 00:09:58.879 understand that there are three bones involved in the knee. 181 00:09:59.120 --> 00:10:00.879 I'm going to let you. I'm going to let you start. 182 00:10:00.919 --> 00:10:02.399 What are we even looking at it? 183 00:10:03.159 --> 00:10:06.600 Okay, Well, first of all, you've had some other folks 184 00:10:06.679 --> 00:10:08.480 on your show who talked about the heart or the 185 00:10:08.639 --> 00:10:11.639 kidneys or other things, and let me just prioritize the 186 00:10:11.639 --> 00:10:14.080 only purpose of the heart is to provide blood flow 187 00:10:14.159 --> 00:10:16.840 to the knee. So you need to understand our sense 188 00:10:16.879 --> 00:10:19.120 of priorities. Let's just get that straight up. 189 00:10:19.000 --> 00:10:21.279 Front, spoken like a true knee search exactly. 190 00:10:22.240 --> 00:10:26.519 That's number one. Number two. In normal walking, you take 191 00:10:26.639 --> 00:10:29.759 one to three million steps per year, add up to 192 00:10:29.879 --> 00:10:32.120 five times your body weight depending on the height of 193 00:10:32.159 --> 00:10:33.879 the step, because you're coming down on one leg, and 194 00:10:33.919 --> 00:10:35.879 if you're coming down from a height, it can be 195 00:10:35.919 --> 00:10:39.480 five times your body weight. And so for your knee 196 00:10:39.559 --> 00:10:42.399 joint to be able to take that many cycles and 197 00:10:42.399 --> 00:10:45.679 that many repetitions and not wear out, it needs to 198 00:10:45.720 --> 00:10:49.360 have some pretty unique structures inside it. And so the 199 00:10:49.480 --> 00:10:51.759 key structures that will probably get a chance to talk about, 200 00:10:51.799 --> 00:10:54.399 and I'm sure your listeners like to know about, are 201 00:10:54.480 --> 00:10:57.919 number one. The two types of cartilage. First, there's the 202 00:10:58.200 --> 00:11:02.120 articular cartilage, the shiny white surface on the end of bones. 203 00:11:02.600 --> 00:11:05.480 When you crack open your chicken wing, that white, chiny 204 00:11:05.559 --> 00:11:10.279 surface that's articular cartilage. And when you get arthritis, it's 205 00:11:10.440 --> 00:11:13.639 wearing away of that white, shiny surface down to the bone. 206 00:11:13.759 --> 00:11:19.200 Okay, quick visual, So there's cartilage coating the foremoral condolites 207 00:11:19.519 --> 00:11:22.799 aka the nards of your femur, as well as the 208 00:11:22.799 --> 00:11:26.440 top of the tibia and fibula shin bones, and between 209 00:11:26.480 --> 00:11:31.200 them lie two c shaped cartilage wafers, kind of like 210 00:11:31.279 --> 00:11:32.559 airplane neck pillows. 211 00:11:32.919 --> 00:11:35.840 The second type of cartilage in the knee is a 212 00:11:35.840 --> 00:11:39.320 fibrous tissue called the meniscus cartilage, and there's a medial 213 00:11:39.360 --> 00:11:43.080 one and a lateral one, and those things distribute the 214 00:11:43.200 --> 00:11:46.879 force inside the knee. So when you walk that one 215 00:11:46.960 --> 00:11:49.000 to three million steps per year at up to five 216 00:11:49.080 --> 00:11:53.039 times body weight, that force gets distributed by the menesky. 217 00:11:53.159 --> 00:11:56.600 So there's not one area that wears out. So unfortunately, 218 00:11:56.639 --> 00:11:59.080 when you tear one or somebody takes one out, it 219 00:11:59.120 --> 00:12:03.200 becomes dysfunct, and you concentrate the force and start the 220 00:12:03.279 --> 00:12:06.559 wear process. And then the other last key structures that 221 00:12:06.559 --> 00:12:09.440 everybody wants to know about, of course, are the ligaments 222 00:12:09.480 --> 00:12:12.360 inside the knee. And you often hear about the ACL 223 00:12:12.559 --> 00:12:15.440 or the PCL, and you hear about the medial clouteral 224 00:12:15.519 --> 00:12:18.919 ligament in the lateral clauteralligment. So these ligaments you can 225 00:12:18.919 --> 00:12:21.279 think of as guide wires. So you think about the 226 00:12:21.279 --> 00:12:25.039 marionette and the guidewires that make the marionette work well. 227 00:12:25.080 --> 00:12:27.559 If one of those strings is broken, they are and 228 00:12:27.720 --> 00:12:30.840 the marionette doesn't floppy right and doesn't work so well. 229 00:12:31.120 --> 00:12:33.000 And that's true inside your knee. And so if you 230 00:12:33.120 --> 00:12:36.679 tear that ligament, any of those ligaments, the knee doesn't 231 00:12:36.799 --> 00:12:40.360 flex and rotate in the normal pattern. And just like 232 00:12:40.399 --> 00:12:43.600 a car tire that's out of line, the tire wears 233 00:12:43.639 --> 00:12:47.559 down quickly down to the steel rim. So your knee 234 00:12:47.720 --> 00:12:51.200 wears down quickly to the steel rim when either the 235 00:12:51.279 --> 00:12:55.159 ligaments are torn or dysfunctional, or the meniscus has been 236 00:12:55.240 --> 00:12:58.679 removed or is torn. And that wear and tear is 237 00:12:59.320 --> 00:13:03.039 what we call post traumatic arthritis. It's the most common 238 00:13:03.120 --> 00:13:06.240 kind of arthritis that people get, and it's what really 239 00:13:06.279 --> 00:13:09.039 wears out the knees and so much of my career 240 00:13:09.039 --> 00:13:10.919 and many things we'll talk about today, or how do 241 00:13:10.960 --> 00:13:12.320 you prevent that from happening. 242 00:13:13.000 --> 00:13:16.039 So the two most common kinds of knee arthritis. You 243 00:13:16.120 --> 00:13:20.279 got your osteoarthritis, which is a breakdown of that slippery 244 00:13:20.360 --> 00:13:24.600 cartilage from wear and tear or injury or infection. And 245 00:13:24.639 --> 00:13:28.679 then there's rheumatoid arthritis, where the lining of the capsule 246 00:13:29.000 --> 00:13:31.679 that holds all your knee parts gets broken down by 247 00:13:31.679 --> 00:13:35.600 your own sneaky, jerky immune system. So thanks, Dick, I 248 00:13:35.720 --> 00:13:38.200 was using that. You want to scream at your immune 249 00:13:38.200 --> 00:13:40.919 system and I understand. So, yes, you have your femur, 250 00:13:41.080 --> 00:13:45.159 your tibia, and your fibulous shin bones. There's that patella kneecap. 251 00:13:45.440 --> 00:13:48.240 You got your LCL on the outside of your knee 252 00:13:48.320 --> 00:13:51.399 that connects the shin bone to the femur bone, and 253 00:13:51.519 --> 00:13:54.240 it hurts like a goblin when you foam roller that, 254 00:13:54.399 --> 00:13:57.759 but it's also kind of so good. And you have 255 00:13:57.799 --> 00:14:01.840 a medial collateral ligament MC on the inside of your knee, 256 00:14:02.120 --> 00:14:04.720 and then your PCL ligament is on the backside, and 257 00:14:04.759 --> 00:14:10.600 then your ACL, the anterior cruciate ligament running inside diagonally, 258 00:14:10.840 --> 00:14:14.279 which is why we are up here recording this. It 259 00:14:14.320 --> 00:14:17.039 is a ligament that is not fun when it snaps. 260 00:14:17.519 --> 00:14:20.600 Is it a ligament? I guess yes, ACL, yes, And 261 00:14:20.639 --> 00:14:22.879 what about a ligament in attendon. What's the difference there. 262 00:14:23.120 --> 00:14:27.039 Yeah, So the ligaments connect the bones and the tendons 263 00:14:27.039 --> 00:14:30.159 connect the muscles to the bone. So you have a 264 00:14:30.159 --> 00:14:32.600 pateeller tenon in the front of your knee, and you 265 00:14:32.600 --> 00:14:34.440 have an ACL in the middle of the knee, which 266 00:14:34.440 --> 00:14:36.399 is the ligament connecting the bones. 267 00:14:36.120 --> 00:14:37.759 And you have to work on all of them. 268 00:14:38.080 --> 00:14:38.279 Right. 269 00:14:39.120 --> 00:14:41.679 When someone injures her knee and they hear a pop 270 00:14:41.879 --> 00:14:46.759 and they know that they're screwed. That happened to Jarrett. 271 00:14:47.279 --> 00:14:50.639 What are they hearing? Are they hearing popping? Tearing? Like 272 00:14:50.679 --> 00:14:53.120 when there's an injury like that when you tore yours 273 00:14:53.279 --> 00:14:55.639 in soccer? What was that experience? 274 00:14:55.759 --> 00:15:01.279 Like? Awful? Yeah, there's an intrinsic knuck useating feeling when 275 00:15:01.320 --> 00:15:05.080 it happens. And so when a patient sits down and says, hey, Doc, 276 00:15:05.519 --> 00:15:10.399 I twisted my knee. I heard a pop. My knee swelled, 277 00:15:10.960 --> 00:15:15.159 they have a ninety percent chance of having torn one 278 00:15:15.200 --> 00:15:17.480 of the key structures in the knee, either ligaments of 279 00:15:17.480 --> 00:15:22.559 the meniscus or damage the articular cartilage. And that tearing, 280 00:15:22.720 --> 00:15:26.120 it leads to swelling, leads to that gnos feeling, leads 281 00:15:26.159 --> 00:15:28.840 to that instability, leads this swelling leads to all the 282 00:15:28.840 --> 00:15:29.720 problems that occur. 283 00:15:30.399 --> 00:15:33.440 What about your meniscus? Did you ever get one back? 284 00:15:33.559 --> 00:15:36.759 Did you ever say, hey, I figured it out, let's 285 00:15:36.799 --> 00:15:38.519 put a little meniski back in there. 286 00:15:39.000 --> 00:15:41.639 So, yes, I figured it out, but no, I wasn't 287 00:15:41.679 --> 00:15:44.399 able to do it to myself. So at the end 288 00:15:44.440 --> 00:15:46.600 of the day, my knee wore out and I had 289 00:15:46.600 --> 00:15:49.320 to have a partial knee replacement, which is what we 290 00:15:49.399 --> 00:15:52.000 do for people when they're down to bone on bone. 291 00:15:52.039 --> 00:15:54.879 So it turns out that if you wear out your 292 00:15:54.960 --> 00:15:57.480 knee so that the bone on the femur and the 293 00:15:57.519 --> 00:15:59.919 bone on the tibia are now rubbing against each other, 294 00:16:00.639 --> 00:16:05.120 that's what we call severe arthritis. And about eighty percent 295 00:16:05.200 --> 00:16:08.919 of people who are told they have severe arthritis and 296 00:16:09.000 --> 00:16:13.159 need to have a total knee replacement actually don't. Oh no, 297 00:16:13.320 --> 00:16:16.720 they've worn down, usually one part of the knee, not 298 00:16:16.840 --> 00:16:20.200 the entire knee. And depending on how much they wear 299 00:16:20.240 --> 00:16:23.720 it determines whether we can do a biologic knee replacement 300 00:16:23.720 --> 00:16:25.720 that we can talk about some more, we replace all 301 00:16:25.720 --> 00:16:28.320 these tissues, or whether or not we can do a 302 00:16:28.399 --> 00:16:30.799 partial replacement or resurfacing. 303 00:16:31.279 --> 00:16:33.799 So in a partial they'll go in and say, okay, 304 00:16:33.840 --> 00:16:37.799 this part of the femoral condolit the femur nerds needs 305 00:16:37.840 --> 00:16:40.360 a new surface, So doctor Stone will do a bunch 306 00:16:40.360 --> 00:16:43.799 of imaging, make a computerized three D model, and then 307 00:16:43.879 --> 00:16:47.960 perform the surgery outpatient using a frickin' robot. And then 308 00:16:48.480 --> 00:16:51.480 on the new surface, they smack some metal or plastic 309 00:16:51.559 --> 00:16:54.320 over the worn down area, but they keep the healthy 310 00:16:54.360 --> 00:16:56.240 stuff as it is. It's kind of like having a 311 00:16:56.360 --> 00:17:00.600 tooth capped with crowns. But if things are not looking good, 312 00:17:01.000 --> 00:17:03.799 if things are more like ooh, then it might be 313 00:17:03.840 --> 00:17:05.799 a denture situation. Up in there. 314 00:17:06.200 --> 00:17:08.519 We just put a cap over the worn out part 315 00:17:08.759 --> 00:17:10.799 and a tray on the tibia, just on the worn 316 00:17:10.839 --> 00:17:13.440 out part, not touch any of the rest of the knee. 317 00:17:13.559 --> 00:17:17.359 It's an outpatient procedure under a robotic control, and it's 318 00:17:17.480 --> 00:17:21.640 much easier for patients than a totally replacement. If they 319 00:17:21.759 --> 00:17:24.160 have totally worn out their knee down to bone on 320 00:17:24.200 --> 00:17:26.880 bone or in multiple spots, then we do a total 321 00:17:27.000 --> 00:17:31.000 new replacement. But even that's completely changed from what your 322 00:17:31.039 --> 00:17:34.400 parent's totally replacement was. So now when we do that, 323 00:17:34.519 --> 00:17:38.279 it's an outpatient procedure. We use a robot in order 324 00:17:38.319 --> 00:17:42.079 to do it extremely precisely. We don't need to use 325 00:17:42.160 --> 00:17:46.359 cement anymore. So the body can grow into the implant, 326 00:17:46.359 --> 00:17:48.880 and the implant can become part of the patient, and 327 00:17:48.920 --> 00:17:51.160 therefore we let our patients go back to running and 328 00:17:51.200 --> 00:17:53.480 climbing and skiing and doing all the sports that they 329 00:17:53.480 --> 00:17:56.240 want to do that previously they were told not to do. 330 00:17:56.359 --> 00:17:59.200 After they have a partial or total new replacement. 331 00:17:58.920 --> 00:18:04.279 And is that like terminator metal? Is that titanium or 332 00:18:04.319 --> 00:18:07.920 what kind of materials are you seeing put into knees 333 00:18:07.960 --> 00:18:09.359 to get them back in shape? 334 00:18:09.440 --> 00:18:13.240 Sure? So two big groups, the biologic replacement or the 335 00:18:13.279 --> 00:18:16.880 bionic replacements. Okay. If they're in the bionic replacement, that 336 00:18:17.079 --> 00:18:20.079 is metal and plastic, it's usually cobalt chrome on the 337 00:18:20.079 --> 00:18:23.559 thermeral side and titanium on the tibial side, with a 338 00:18:23.640 --> 00:18:27.319 high molecular rate polyethylene tray in between, which acts as 339 00:18:27.319 --> 00:18:31.200 the new meniscus. If it's a biologic knee replacement, what's 340 00:18:31.240 --> 00:18:34.519 something we called a bio knee, then I'm putting back 341 00:18:34.559 --> 00:18:38.519 in a new meniscus, regrowing their articular kerdil It's using 342 00:18:38.559 --> 00:18:41.880 a combination of growth factors and stem cell recruitment and 343 00:18:41.920 --> 00:18:44.720 all the cool things we're doing these days, rebuilding their 344 00:18:44.720 --> 00:18:48.000 ligaments and creating a new biologic knee joint. The big 345 00:18:48.039 --> 00:18:50.960 discussion of animal tissue versus human tissue. So right now 346 00:18:50.960 --> 00:18:54.519 we're only using human tissue, okay, and so it will 347 00:18:54.559 --> 00:18:57.920 come back. The use of animal tissue to replace ligaments 348 00:18:57.920 --> 00:19:01.680 in meniscus was work that we spell fifteen years doing 349 00:19:02.400 --> 00:19:06.000 and develop the new, first, new successful pig ligament for people, 350 00:19:06.000 --> 00:19:08.400 and I have people still skiing on those ligaments today. 351 00:19:08.920 --> 00:19:10.599 Pig legs is they're called big legs. 352 00:19:10.640 --> 00:19:15.279 Yep. We ran a successful clinical trial in Europe, but 353 00:19:15.359 --> 00:19:17.440 for right now, it's all human tissue. 354 00:19:17.640 --> 00:19:21.240 Okay, So to recap there are knee replacements that resurface 355 00:19:21.599 --> 00:19:25.680 using metal or a high molecular weight polyethylene. And then 356 00:19:25.839 --> 00:19:30.079 there's biologic, which doctor Stone says can include stem cells 357 00:19:30.400 --> 00:19:35.000 injected into animal tissue or human cadamor tissue which is 358 00:19:35.160 --> 00:19:39.839 beautiful and spooky and relies on really generous donations from 359 00:19:40.160 --> 00:19:42.720 folks who are no longer with us. So why do 360 00:19:42.759 --> 00:19:45.160 they use only that if it's harder to come by. Well, 361 00:19:45.200 --> 00:19:46.839 it turns out that it's one thing to be a 362 00:19:46.839 --> 00:19:51.480 brilliant surgeon and compassionate doctor and author and innovative biotechnician, 363 00:19:51.839 --> 00:19:54.960 but when running animal trials there's a whole other bag 364 00:19:54.960 --> 00:19:58.400 of worms about needing to raise funding for research, whole 365 00:19:58.440 --> 00:20:02.200 business thing that's all a real pain in the meniscus. Now, 366 00:20:02.400 --> 00:20:05.400 you have some patents in this field, is that true? 367 00:20:05.599 --> 00:20:05.759 Yeah? 368 00:20:06.640 --> 00:20:07.960 What can you tell me? Can you give me a 369 00:20:08.000 --> 00:20:09.759 quick rundout of some of the patents you have, and 370 00:20:09.799 --> 00:20:12.680 what was that like applying for a patent and being like, dang, 371 00:20:12.720 --> 00:20:15.400 I really did do a lot of innovation in this field. 372 00:20:16.680 --> 00:20:19.920 Well, the first ones that I wrote were around a 373 00:20:20.160 --> 00:20:25.000 collagen scaffold for regrowing the meniscus. Remember at that time, 374 00:20:25.119 --> 00:20:27.640 back in the late eighties, when we tear them, they 375 00:20:27.680 --> 00:20:30.839 were taken out, and my feeling at the time the 376 00:20:30.960 --> 00:20:33.039 challenge from my mentor was to figure out how to 377 00:20:33.079 --> 00:20:35.640 replace it. And so at that time I thought, well, 378 00:20:35.680 --> 00:20:38.000 if I don't have the right materials to replace it with, 379 00:20:38.599 --> 00:20:41.920 maybe I can stimulate the body to regrow it. And 380 00:20:42.079 --> 00:20:46.160 so I designed a collagen scaffold which could be sewn 381 00:20:46.240 --> 00:20:49.519 into the meniscus and other tissues. Then you could tweak 382 00:20:49.559 --> 00:20:53.160 the tissues with growth factors and other things and stimulate 383 00:20:53.200 --> 00:20:56.640 the meniscus to regrow. Oh wow, And that that actually 384 00:20:56.920 --> 00:21:00.920 was a successful approach came on the market. Eventually, it's 385 00:21:00.920 --> 00:21:02.759 not currently on the market, as we're going to build 386 00:21:02.799 --> 00:21:05.480 a new, better one now of a stronger, better collagen. 387 00:21:05.599 --> 00:21:09.160 Now, when you have knee surgery, do you this is 388 00:21:09.200 --> 00:21:12.759 a question for my dad, Larry Ward, wants to know 389 00:21:12.960 --> 00:21:15.160 if you're like, can you just numb me up locally 390 00:21:15.440 --> 00:21:17.359 and I or put me in some kind of twilight 391 00:21:17.359 --> 00:21:19.319 where you have one eye open, because as one of 392 00:21:19.359 --> 00:21:22.799 the best orthopedic surgeons on the planet, do you want 393 00:21:22.839 --> 00:21:24.440 to be able to work on your own knee or 394 00:21:24.640 --> 00:21:26.039 you just like, put me out let me know how 395 00:21:26.039 --> 00:21:26.400 it goes. 396 00:21:27.160 --> 00:21:29.000 Yeah, So we did that for quite a while where 397 00:21:29.000 --> 00:21:31.559 patients would stay awake and comment on their surgery while 398 00:21:31.559 --> 00:21:34.000 we were doing their surgery, and it turned out to 399 00:21:34.000 --> 00:21:36.759 be more of a distraction and not a big benefit. 400 00:21:36.880 --> 00:21:39.599 What's happened in anesesia's The drugs have gotten so good 401 00:21:39.599 --> 00:21:42.960