Stone initiated his research career in high-altitude physiology under the direction of Ross McFarland, at the Harvard School of Public Health. Working with his associate Dr. Spengler, Stone searched for a high-altitude environment in a city and published the first paper on carbon monoxide in hockey rinks noting the effect of carbon monoxide on the hockey players' visual acuity was similar to that of hypoxia at altitude.
While in internship, Stone published one of the first case reports on the formation of a liver cancer in patients who had hepatitis C. His subsequent residency research returned to the area of tissue oxygenation, focusing on ligament oxygen tension using a self-designed oximeter.
Meniscus research
In 1984, Stone, at the encouragement of his mentor Dr. Steadman, turned his focus to replacing the meniscus cartilage in the knee joint. After two years of research to understand the biomechanics and biology of the meniscus, Dr. Stone concluded that if he couldn’t replace the meniscus, possibly he could re-grow it. With this approach he entered his Fellowship in research under the direction of Dr. Arnoczky and proceeded to design the first collagen meniscus regeneration template.While a clinical fellow in Lake Tahoe, Stone initiated research at the Letterman Army Institute of Research in collaboration with Bill Rodkey, D.V.M., to test the collagen template in various animal models for meniscus, ligament, articular cartilage and intervertebral disc repair. These trials were subsequently published and led to several research awards including the Albert Trillat Young Investigator’s Award from the International Knee Society and the Cabaud Award in 1990 from the American Orthopaedic Society for Sports Medicine. The FDA approved the first human clinical trial of the collagen meniscus scaffold which was carried out at The Stone Clinic from 1991-1994. Recent 15-year follow-ups on these patients revealed continuing successful outcomes. The U.S. Food and Drug Administration gave U.S. approval for a collagen meniscus implant (CMI) device designed by Stone in 2008.
Stone turned his attention to complete meniscus replacement with a biological implant(rather than re-growing the meniscus) in 1994. He published one of the first techniques for arthroscopic meniscus replacement in 1991 and conducted the first long-term study of meniscus replacement in knee joint arthritis which was published in 2006. The replacement of the meniscus permits the arthritic patient to have improved pain relief and knee joint function as well as delay or avoid the time for artificial joint replacement. In a 2 to 7 year follow-up study, 89.4% of meniscus tranplantation patients were successful, having showed significant signs of improvement in pain, activity, and functioning.
Articular cartilage research
In addition to meniscus replacement, Stone focused on articular cartilage regeneration for the arthritic knee. His design of a “paste graft” technique with custom instrumentation was promoted by the DePuy orthopaedic company. The paste graft technique 2-12 year results were published in 2006 revealing 85% of the patients obtained improvement in pain and function scores.Biologic joint replacement
The combination of meniscus replacement and articular cartilage grafting led to Stone’s pursuit of biologic knee replacement, a technique to fully replace the damaged cartilage in the knee with natural tissues. This program is underway at The Stone Clinic and includes a stem cell with shell graft approach to replacing the articular cartilage surface of the knee.Stone's experience with collagen scaffolds sourced from bovine Achilles tendons led him to focus on other animal tissues that might be useful for orthopaedic reconstruction. In 1996 he initiated a research program to determine if the carbohydrates that cause rejection of animal tissues could safely be removed without damaging the tissues. His research led him to the New York Blood Center where a technique for removing similar carbohydrates was developed for blood. Dr. Stone identified and collaborated with the leading immunologist in the field Dr. Uri Galili in order to transfer the blood technique to orthopaedic tissues. Their work led to multiple patents, animal trials and subsequently, a human clinical trial of a porcine bone-patellar tendon-bone graft for reconstructing the anterior cruciate ligament (ACL) of the knee joint. In the surgical procedure, the proteins on the transplant ligament that would trigger rejection from the recipient's body are stripped off prior to transplantation. One recipient of this pig ligament ACL transplant went on to win the Canadian Master's Downhill Ski Championship, three times. This work has received FDA approval for a wide clinical trial to be conducted in the U.S.
Allison Gannet, a World Cup freeskier Champion, had had 7 previous knee surgeries before having a biological joint replacement, with Stone as her surgeon. This procedure included the articular cartilage paste grafting procedure, and following, Gannet reported being pain free for the first time in 8 years.
Adapted from the Wikipedia article Kevin R. Stone, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki
