Week 3: Manav

    This was a very interesting week, as I was able to see my most anticipated knee surgery right off the bat, on Monday! This was a computer assisted uni-compartmental knee arthroplasty. The patient first had CT images taken on their knee, so as to see defects, and to classify their specific knee geometry. Stryker developed their MAKO system to help conduct computer assisted knee surgery. The patient CT images are uploaded to the MAKO software, and we are able to visualize the CT geometry. Dr. Gomoll then began the surgery by making the incision to open up the patient's joint capsule. The next step was calibration; Dr. Gomoll had to use the MAKO probe tool (which also took around 30 minutes to set up), to calibrate to regions on the patient CT, shown on the MAKO computer. This involved the computer showing Dr. Gomoll around 100-150 points on the patient CT that Dr. Gomoll then had to tap with the physical probe on the patient. This helped to create a transformed coordinate system between the physical patient geometry and the MAKO uploaded CT. After the long calibration was finished, the MAKO computer informed Dr. Gomoll (visually) where to start shaving down the cartilage and bone. The software was very precise, and was even built with an auto-off feature if Dr. Gomoll was not holding the probe in the exact area that the MAKO was visualizing to cut. After all the physical patient regions were shaved down to the desired height, Stryker implant samples were tested to see how big of a titanium implant the patient needed. Once sizing was completed, a freshly sealed titanium condyle implant, and rubber meniscus implant, were unwrapped. Since Stryker developed both the computer, the physical tools, and the implants, all dimensions lined up perfectly and Dr. Gomoll was simply able to press fit, and hammer in the implant to the shaved bone. The implant was secured with what I think was bone cement. This was so informative to see, and it was honestly insane that for most of the physical shaving, Dr. Gomoll wasn't even looking into the physical joint capsule. All the information and calibration that had to be done made it so that Dr. Gomoll just had to look at the MAKO screen the entire time, and shave down accordingly. 

    Tuesday included clinic in which I found out the next days that I will get osteochondral allografts (OCAs) for my research project. The OCA supply and surgery days are quite sparse, which mean every attempt at my project will need to really count. The next OCA comes in on 6/24 so next week will be quite busy as I attempt a full experimental run through, for the first time. In clinic, I saw a lot of meniscal root tears, and there were lots of moral dilemmas between parents and their children on which surgical option to go with, as the children wanted to return to sports but by doing so, could endanger themselves for osteoarthritis later in life. 

    Wednesday and Thursday consisted of starting literature review for my project, to learn the state of the field both from a clinical and basic science standpoint. It felt really good to get back into reading articles and compiling ideas; The past few weeks have been so informative for relating benchtop to bedside, but I have been itching to get back into reading consistently, and to start some hands-on work. Thus far, I have written a hefty intro, more for myself to understand the field of OCA cell viability testing, and am now currently working on compiling cell viability results from all the research groups who have done so in the past decade. I have, so far, been unable to find any articles that do direct bioenergetics testing (real-time mitochondrial function). Most groups only test cell viability via a fluorescent live/dead assay. Mitochondrial function is traditionally tested using metabolic, colorimetric assays, which are done after the fact and may involve cell lysis. The mitochondrial stains I plan to use are real-time and fluorescently seen, meaning that we can test cellular functionality at a very short timepoint after OCA extraction. One of the biggest things I've learned this year as I've progressed through my project, is that cell viability does not equate to cell functionality, and that though the chondrocytes can be labeled as 'alive' on a live/dead assay, that their mitochondria could still be depolarized. I also learned to use the Arthrex OATS kit (fig 1) on my donor tissue, to extract OCA plugs. 

Fig 1. Arthrex OATS (Osteochondral Autologous Transfer System), traditionally used to transfer articular cartilage from a non-load bearing area to a load bearing, and defective area. I will be using this setup to extract 6mm OCA plugs. This setup will allow me to tell whether surgical extraction of OCAs results in mitochondrial depolarization, even if it keeps chondrocytes alive. 

I look forward to next week when I can go through my entire experimental run! 

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