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Surgeon Employs Novel Technique Using Cadaver Meniscus to Reconstruct Finger Joints

Cedars-Sinai Hand Surgeon Pioneers Use of the Knee's Spongy Cushion to Improve Outcomes for Patients Who Suffer From Damaged Finger Joints or Severe Arthritis  

Los Angeles - Sept. 24, 2014 - Artist Joost van Oss was chopping wood a few years ago when he injured the middle knuckle on his right hand. The intense pain and swelling that followed forced him to give up his love of cooking and sailing, and nearly ended his career as a painter and a sculptor.

Then van Oss, 58, turned to plastic surgeon David A. Kulber, MD, and underwent a novel surgery. Kulber used knee meniscus from a cadaver to reconstruct van Oss' finger joint, departing from the customary technique of inserting a hard silicone implant.

The meniscus – a resilient, spongy cushion that prevents joints from rubbing against one another – blended into van Oss' finger. The result was life-changing: Nine months after surgery, he is cooking, sailing, painting and sculpting again – all without pain.

"It's given me a new lease on life," van Oss said. "I have a hard time remembering what it used to be like."

Kulber, director of the Cedars-Sinai Center for Plastic and Reconstructive Surgery, pioneered joint reconstruction with cadaver meniscus in the hope of achieving better outcomes for patients like van Oss who suffer from damaged finger joints or arthritis, the most common cause of disability among U.S. adults, according to the Centers for Disease Control and Prevention.

Silicone implants, Kulber said, are imperfect because they can become infected or break over time, leaving patients with lasting pain or in need of follow-up surgeries. Because the meniscus is malleable, it fits neatly into the joint, merging into the finger as new blood flows through it.

"This is a very exciting approach to a problem that has defied reliable solutions," said Kulber, who also serves as director of the Plastic Surgery Center of Cedars-Sinai Medical Group. "It's a promising option because the meniscus becomes part of the finger."

Kulber's approach has won praise from other leaders in the field of orthopedic surgery.

"Dr. Kulber's technique utilizing cadaver knee meniscus to repair arthritic finger joints has great potential to avoid problems associated with prosthetic reconstructions that limit motion, loosen or break," said Michael Hausman, MD, chief of Hand and Elbow Surgery at Mount Sinai School of Medicine in New York and a member of the American Society for Surgery of the Hand. "Early results look extremely promising."

Van Oss is pleased that he has regained mobility in his finger. Before surgery, severe pain had prevented him from even picking up a pen or reading a newspaper. Now, he's thinking again about one of his grandest dreams – sailing around the world.

"You don't realize what you're missing when you have pain," he said. "Once it's gone, all of the possibilities that were once there show up again."