MACI knee

UK orthopaedic surgeon performs first knee surgery of its kind in Kentucky

Christian Lattermann, MD

Dr. Christian Lattermann, director of UK’s Center for Cartilage Repair and Restoration in UK Orthopaedic Surgery & Sports Medicine, recently became the first surgeon in Kentucky and in the Midwest to perform a Matrix Associated Chondrocyte Implantation (MACI). The procedure is a less invasive version of cartilage repair surgery that allows patients to recover more quickly. The technology for this new procedure is the first new cartilage technology to be approved by the U.S. Food and Drug Administration (FDA) since 1996.

A different approach to cartilage repair

The MACI technology uses a patient’s own cartilage cells to create the MACI scaffold which, unlike preceding technology, can be glued into the cartilage defect. That means this procedure can be done through smaller incisions, which Lattermann said offers a significant improvement in operating time as well as an easier path to recovery for patients. The MACI technology is new in the U.S. but has an almost 10-year track record in Europe, with excellent results.

On Feb. 15, Victoria Long was the first patient to receive this treatment at UK. An 18-year-old student who had suffered from a cartilage loss in the knee as a consequence of multiple falls onto her knee cap, Long had been experiencing pain for more than a year and had been receiving nonoperative treatment during that time. At her follow-up appointment on Feb. 21, she was recovering from the surgery and was excited to begin the recovery process.

While the procedure is new, Lattermann is familiar with it. Over the past 10 years, he has helped advance the MACI technology through regulatory agencies and receive FDA approval. During that time, he has performed more than 150 Autologous Chondrocyte Implantations, a less sophisticated version of the MACI procedure.

Becoming a major referral center

When Lattermann joined UK Orthopaedics and Sports Medicine a decade ago, he was tasked by Dr. Darren Johnson, chair of UK Orthopaedic Surgery and Sports Medicine, and UK Executive Vice President for Health Affairs Dr. Michael Karpf, with building the Center for Cartilage Repair and Restoration. The goal was to make UK a referral center for complex and difficult-to-treat injuries in patients at the crossroads between joint restoration and joint replacement.

“We have been on the forefront of treating these defects for several years,” Lattermann said. “Every year, a couple of thousand patients in the U.S. require a true cartilage restoration, and we have become a major referral center for these patients and, at this point, regularly serve patients from Kentucky, Tennessee, West Virginia, and parts of Ohio and Indiana.”


Next steps:

When Jennifer Thomas, a nurse at UK HealthCare, injured her knee, her work became nearly impossible. But an orthopaedic clinical trial offered hope.

Orthopaedic clinical trial helps UK nurse regain mobility

Working as a bedside nurse requires extensive physical effort – pushing wheelchairs, twisting and lifting, and standing for long periods. Jennifer Thomas, who’s been a nurse at UK HealthCare for six years, can attest to this. In fact, it was while assisting a patient from a wheelchair that she badly injured her knee.

“The pain was excruciating – a sharp, stabbing burn,” Thomas said. “It was constant regardless of sitting or walking. My sleep was interrupted due to the discomfort, stairs were next to impossible to navigate and playing with my newborn grandbabies – be it pushing a stroller or carrying them from room to room – was difficult at best.”

The injury also made it difficult to do her job as a pre-op nurse. Sometimes she’d be walking into a patient’s room when her knee would give out, causing her to fall. She had trouble standing for the long enough to assist with epidurals and nerve blocks, and her knee would swell after long days.

Thomas cycled through the standard treatment options: cortisone shots, physical therapy and two surgeries. These treatments required time off work and extended periods of rest, but they didn’t provide relief. The only way to reduce the pain was to stay off her knee and keep her feet elevated.

Participating in a clinical trial

In November 2015, a year after her original injury, Thomas was referred to Dr. Christian Lattermann, director of UK’s Center for Cartilage Repair and Restoration in UK Orthopaedic Surgery & Sports Medicine. In order to fix Thomas’ injury, Lattermann need to perform a cartilage transplant. Unfortunately, many patients who undergo this type of procedure experience muscle weakness afterward. To combat this problem, Lattermann, along with co-principal investigator Caitlin Whale, are leading a clinical trial to investigate how muscle stimulation using a device called the Phoenix Device could improve muscle strength following surgery.

“Weakness in the thigh musculature after this procedure is a big problem that we have not been able to improve,” Lattermann said. “[The Phoenix Study] is a way to find better techniques to treat this weakness.”

Thomas was eligible to participate in the clinical trial. First, Thomas’ strength and functional performance were measured. She then underwent an osteochondral allograft, a surgical procedure where a living piece of cartilage and bone from a cadaver is implanted in the knee. After surgery, Thomas had nine weeks of rest. Within days of surgery, she began a home treatment program, and a couple of weeks after surgery, she began participating in physical therapy. After completing the 12-week home treatment, Thomas’ strength and function were measured, and then again at six months and one year.

Lattermann’s team is still collecting data for this study, which will help them evaluate post-surgical treatment programs and how muscle stimulation can improve recovery.

“The basis for any clinical treatment has to be evidence-based research, and that’s what we’re doing here,” Lattermann said. “Our goal is for every patient being seen clinically to be enrolled into a research study or register as a research participant.”

Meeting her goals

After 12 months of treatment, Thomas feels she’s achieved the goals set out at her first appointment, even if she’s not exactly where she was before the injury.

“I am not 100 percent, but I understand Dr. Lattermann never promised or expected 100 percent,” she said. “I believe we met the goals he had hoped we would achieve. There are still some things I can’t do and some things I will never be able to do again. Aside from those few downfalls, I can walk, play with my grandchildren, stroll in a park or mall, get around my house, wear normal shoes and boots. I can live my live without falling to the ground, limping and enduring horrid pain.”

This was Thomas’ first time participating in research, an experience she describes as extremely positive. She felt comforted by the fact that she would leave each appointment with a plan of care and established treatment goals.

“I’ve had a lot of experiences with a lot of surgeons, and there’s no one like Dr. Lattermann,” Thomas said. “I can’t begin to express the gratitude I have for him and his team.”

Thomas now works as a nurse case manager, which is less strenuous for her knee. She says her own experience as both a patient and research participant have made her better at her job.

“I’m thrilled to be in the position I am and honored to be able to continue nursing,” she said. “I have yet another experience I can share with my patients. Understanding and personal knowledge are among the best gifts a nurse can share with her patients.”


Next steps:

It’s been six years since the UK football team played in a college bowl game, and this year's team doctors also are excited about the trip.

UK’s team doctors ready to bring their expertise to bowl game sideline

It’s been six years since the UK football team played in a college bowl game, and this year’s team doctors from UK Orthopaedics & Sports Medicine also are excited about the trip.

After a 7-5 season, including four wins against SEC teams and a win over in-state rival University of Louisville, the Cats are making a trip down south. UK will play Georgia Tech in the Tax Slayer Bowl in Jacksonville, Fla., at 11 a.m. on Saturday, Dec. 31. The team doctors responsible for keeping the team in tip-top shape and ready for another win include:

Dr. Darren Johnson, chair of UK Orthopaedic Surgery & Sports Medicine​, who for 20 years has worked as the head team orthopaedic surgeon with UK Football. The upcoming bowl game will be the eighth one he has had the chance to attend. Johnson has appreciated the way fans have rallied around the team; he thinks it helps the team feel encouraged and motivated. He’s especially looking forward to the game because he thinks it will be a chance for everyone to really see how much work goes into a winning season. “No one knows how many hours these people put in to make this all happen,” Johnson said. (Learn more about Dr. Johnson here.)

Dr. Robert Hosey, professor of UK Family & Community Medicine, has been with UK since 1998. He has worked as a team doctor since joining the department and began working with UK Football in 2002. While transporting what Hosey described as “essentially a traveling sports medical clinic” can be difficult, he says the athletic training staff does a great job making sure they have everything they need to ensure the team is in great shape. Hosey is looking forward to traveling to Florida. This is the first time he’s had the chance to attend a bowl game since he began working with the football team.

Dr. M. Kyle Smoot, UK Orthopaedic Surgery & Sports Medicine and Family Medicine, is in just his second year at UK.  However, this isn’t the first team he’s worked with or the first time he’s attended the Tax Slayer Bowl as a team doctor. The last bowl trip he made was with the University of Iowa when they played in the same bowl in 2014.


Next steps:

UK chaplain returns to work with renewed spirit following cycling accident

Exactly five months ago today, Laura Babbage had a devastating accident while biking through the French Alps with her 22-year-old son Brian.

Babbage, a chaplain at UK HealthCare, suffered a traumatic brain injury during the accident, which required months of treatment and rehabilitation. With the help of her care team at UK HealthCare and the prayers of friends and family, Babbage has returned to her work more than six months ahead of doctors’ estimates.

Babbage’s accident happened in France, she was airlifted back to Lexington and was treated at UK HealthCare. She completed her inpatient and outpatient rehabilitation at Cardinal Hill Hospital.

Babbage knows that many of her UK HealthCare family know her story, because she has heard of the many staff who prayed outside the door of her ICU bed and has delighted at the numerous people who’ve stopped her in the halls with a “welcome back!” smile or a hug.

“I’m overwhelmed by how much people rooted for me,” Babbage said. “There was an ocean of prayer entire churches I’d never heard of were praying for me. And I believe prayer, in all its forms, does matter.”

Read Babbage’s open letter of thanks to the UK doctors, nurses and staff who cared for her.

Using her experience for others

Since her return to chaplaincy about two weeks ago, Babbage has gone about her work with the grace and empathy that all who know her recognize: She is a patient and willing listener, she is trained to develop a relationship of trust without judgment and to add dimension to the skilled care provided by physicians and staff.

While Babbage acknowledges that, at least in the beginning, this ordeal was easiest on her – “I don’t remember a thing, but my family was sorely tested,” she said – she knows that this experience will help her do her job better.

“I am always aware of and sensitive to the desire for a visit from a chaplain as well as for prayer,” she said. “Chaplains are a listening presence for patients and families to help them begin to make sense of their situation. We are available for prayer if requested. Often we simply meet someone in the midst of their pain and suffering, aware of this special privilege.

“But now I have a deeper appreciation for families and their experience with their ill or injured family member since I’ve returned to work,” she explained. “Chaplains listen far more than we talk, allowing time and space for families to grasp the gravity of the moment. I have a heightened tenderness for family members now that I recognize what my own family experienced during my hospital stay. Like other chaplains, I will continue to learn.”

Returning to the patient’s bedside

Babbage and Joe Alverson, UK HealthCare’s director of pastoral care, were very careful to make sure she was prepared to meet and address patient and family needs.

“We wondered what would happen if I was needed to minister to a patient or family who’d experienced a trauma similar to mine,” Babbage said. “But we’ve been trained to eject ourselves from any situation if necessary – sometimes you’re not the right person for that patient, and sometimes they don’t want you there at all.  I felt I’d still be able to do that.”

Alverson remembers the shock and disbelief he felt when he learned that “one of our own” was in serious trouble.

“My first thought was for her – and my second thought immediately after that was for her family,” he said.  “As chaplains we see the sickest of the sick, and her condition was a huge worry for us.”

The pace of Babbage’s recovery was “beyond belief,” Alverson said.

“The first time I saw her was after she’d completed inpatient rehab at Cardinal Hill in September, and the first words out of her mouth were ‘When can I come back?'” he said. “I was excited for her, for me and for the hospital as well.”

Alverson knows that Babbage will make good use of her experience as she continues to care for others.

“We work in the midst of trauma and chaos every day, but to actually live that makes it more real,” he said. “I really look forward to seeing how her experience changes the trajectory of her work, but regardless of the exact path, I know it will be a good one.”

“We’re just thrilled to have her back.”

Media inquiries: Laura Dawahare, University of Kentucky Public Relations and Marketing, laura.dawahare.uky.edu


Next steps:

  • Learn more about Pastoral Care at UK HealthCare, where our chaplains are available to help patients, families and staff deal with spiritual and emotional challenges associated with medical events and crises.
  • The world-renowned doctors at UK Neurosurgery provides diagnosis and management of a wide range of conditions involving the brain, spine and nervous system. Learn more about the care we provide.
Making the Rounds with Dr. Stephen Duncan

Meet Dr. Stephen Duncan, renowned orthopaedic surgeon and avid cyclist

Making the RoundsIn our latest edition of Making the Round, we spoke with Dr. Stephen Duncan, a nationally recognized surgeon at UK Orthopaedic Surgery & Sports Medicine.

Dr. Duncan specializes in hip surgery and hip preservation and sees patients of all ages. He’s also an avid cyclist who appreciates the importance of an active lifestyle.

What is your care philosophy when you meet a new patient?

I’m not an operate-first, meet-you-second doctor. I want to get to know you and figure out what’s the best treatment for you. And whether that’s doing medication or physical therapy or surgery, the biggest thing is getting to know you and what’s going to work for you.

What’s your favorite hobby outside of work?

Running and biking. I’ve been biking for 13 years. I used to bike competitively but now with the demands of being employed and having kids, I can’t really do it as much anymore. If I wasn’t a doctor, though, I’d be a bike mechanic.

Tell us about your family.

My wife is a pediatrician here at UK. We have two boys; they’re 5 and 7. The biggest challenge is trying to keep them out of the orthopaedic clinic. The best part of being a parent is that I get to be a kid with them.

What’s your favorite type of music?

Country. I lived in Nashville for eight years and it kind of grows on you there and then it finally just sinks in. You can actually hear the stories behind the music if you listen to it. It helps keep my blood pressure low.

What do you enjoy most about your work at UK HealthCare?

The biggest thing that gives me satisfaction is when I’ve seen that I was able to immediately help a patient in their life. When a patient comes in who has a lot of pain, and depending upon if we needed to operate on them or just do a simple injection, if they come back and give me a hug, I enjoy that.


Check out our video interview with Dr. Duncan below. He tells us more about the types of hip injuries he treats and why he chose orthopaedics as a specialty.


Next steps:

  • Duncan is hosting a public lecture about hip and knee arthritis on Dec. 8 at the Eastside Branch Public Library in Lexington. The event is free. Please call 800-333-8874 to reserve your seat.
  • Learn more about the comprehensive care for patients of all ages offered at UK Orthopaedic Surgery & Sports Medicine.
Making the Rounds with Dr. Darren Johnson.

Dr. Darren Johnson, top-ranked knee surgeon, talks about his most important role

Making the RoundsDr. Darren Johnson, chairman of UK Orthopaedic Surgery & Sports Medicine, joined us for our third installment of Making the Rounds, a blog series where you’ll get to know what our providers are like away from the hospital.

Dr. Johnson has been seeing patients, including UK student-athletes, at UK HealthCare since 1993, and thanks to his exceptional care, recently he was named one of the 16 best knee surgeons in North America.

In his free time, Dr. Johnson enjoys spending time with his wife, Nancy, a registered nurse, and their three children, Lauren, Kelsey and BrandonAll three Johnson children are pursing careers in medicine.

Dr. Darren Johnson

Dr. Darren Johnson

What person, real or fictional, do you most admire?

That’s a tough one because for me, you’d have to think of mentors that I’ve had. And that goes back to medical school at UCLA, residency at USC and then my fellowship at the University of Pittsburgh. It’s probably just physician-mentors that I’ve had that I try to model myself after.

I’m a huge John Wayne fan, and I’m a Clint Eastwood fan, too. That’s probably it.

Do you have a favorite movie?

A favorite movie for me, personally? Probably “Braveheart.” Great movie, right? But yeah [my kids and I] go to movies a lot. I like to go to movies. Unfortunately, I don’t get to go enough.

Do you have a favorite meal or type of food you like to eat with your family?

Fortunately for my wife I’ll eat anything, but if I had to pick, growing up in Southern California, probably Mexican food.

From left to right: Dr. Johnson, Mrs. Nancy Johnson, daughters Lauren and Kelsey, and son Brandon.

From left to right: Dr. Johnson, wife Nancy, daughters Lauren and Kelsey, and son Brandon.

When you do get time off, where do you like to go?

Destin, Florida, because we’ve always gone there since our kids were little, and that’s the kids’ favorite spot. So if it’s your kids’ favorite spot, that’s your favorite spot. Pretty simple.

How would your kids describe you?

Hard worker. Expects a lot out of them. Sometimes too honest for a father – kids don’t like honesty. You know, hopefully as a great dad. That’s my most important role – being a dad.

We have a very close family.


We asked Dr. Johnson about his work with patients with sports injuries. Watch the video:


Next Steps

Drs. Darren Johnson and Christian Lattermann have been ranked as two of the best knee surgeons in North America by Orthopedics This Week.

Two UK knee surgeons ranked among 16 best in North America

Dr. Darren Johnson

Dr. Darren Johnson

Dr. Christian Latterman

Dr. Christian Latterman

Drs. Darren Johnson, chairman of UK Orthopaedic Surgery & Sports Medicine, and Christian Lattermann, director of cartilage repair and restoration, have been ranked as two of the “16 Standout North American Sports Knee Surgeons” by the publication Orthopedics This Week, the most widely read publication in the Orthopedics industry.

“I am truly honored and humbled to be recognized at this level. I have always strived to provide the best care to the patients I serve,” said Johnson, who has been working at UK since 1993 and serves as chair of the department. “This could not be accomplished without those that I work with in my department including colleagues and partners, residents and fellows, athletic training staff as well as our overall staff support in the clinic and operating room.”

Lattermann was also included in the ranking and serves as director of cartilage repair and restoration. “This honor is the result of hard work towards the orthopaedic mission at the University of Kentucky,” he said. “As a physician scientist I am particularly happy to be included in this list of outstanding sports medicine physicians.”


Next Steps

Physical therapy

Physical therapy often better than opioids for long-term pain management

Written by Tony English, PT, PhD, director of the Division of Physical Therapy at the University of Kentucky‘s College of Health Sciences.  

Tony English

Tony English

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the U.S. since 1999, even though there has not been an overall change in the amount of pain reported.

People with chronic pain conditions unrelated to cancer often depend on prescription opioids to manage their pain. As opioid use has increased, so has the misuse, abuse and overdose of these drugs in Kentucky and across the country.

The statistics are sobering:

  • As many as one in four people who receive prescription opioids long term for non-cancer pain in primary care settings suffer with addiction.
  • Heroin-related overdose deaths more than quadrupled between 2002 and 2014, and people addicted to prescription opioids are 40 times more likely to be addicted to heroin.
  • More than 165,000 people in the United States have died from opioid pain-medication-related overdoses since 1999.
  • Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.

The CDC released guidelines in March urging prescribers to reduce the use of opioids in favor of safer alternatives in the treatment of chronic pain. Physical therapy is one of the recommended non-opioid alternatives.

If you or someone you know has pain not related to cancer, consider physical therapy as a safer alternative for managing your pain. Physical therapists diagnose and treat movement disorders that may be contributing to your pain and will develop an active treatment plan specific to your goals.

A 2008 study following 20,000 people over a period of 11 years found that people who exercised regularly reported less pain. Manual therapy can reduce pain and improve mobility so that people have more pain-free movement. That, in turn, promotes more activity, which reduces pain even further. Exercise and manual therapy are two components of an active treatment plan that may be used by a physical therapist to help manage pain.

The American Physical Therapy Association has launched a national campaign called #ChoosePT to raise awareness about the risks of opioids and the choice of physical therapy as a safe alternative for long-term pain management.


Next steps:

Preventive exercises have been shown to reduce the risk of ACL injury, and they are becoming increasingly important for young athletes.

Preventive exercises can reduce ACL injuries

Written by Dr. Cale Jacobs, Assistant Professor in UK’s Department of Orthopaedics and Sports Medicine.

Dr. Cale Jacobs, Assistant Professor in UK’s Department of Orthopaedics and Sports Medicine.

Dr. Cale Jacobs

Unfortunately, each year, about 7 million sports-related injuries occur in the U.S. Approximately half occur in people between the ages of 5 and 24 years old. Injuries, especially to the knee, remove young athletes from the playing field and can have long-term repercussions that limit mobility and lead to more severe issues.

Tearing the anterior cruciate ligament (ACL), the tough band of tissue joining the thigh bone and shin bone at the knee joint, is not uncommon in “cutting” sports like soccer, volleyball, football and basketball. An ACL tear is a particularly damaging injury as it often leads to knee arthritis, and studies have reported that 50 percent of people who tear their ACL develop arthritis within 15 years of their injury. When you consider that most ACL injuries happen to those under the age of 25, this means that many patients are developing knee arthritis in their 30s or early 40s.

The ACL can be surgically reconstructed, which improves the stability of the knee. However, for young female athletes playing in cutting sports after ACL reconstruction, roughly one in three of these athletes will suffer a second ACL injury. Also, recovery after ACL reconstruction differs from patient to patient, with some taking longer to safely return to sports.

Because of the high rate of early knee arthritis and the risk of a second injury, preventing the first ACL injury is crucial. Preventive exercise programs have been shown to reduce the risk of ACL injury, and the free Get Set-Train Smarter app available on Android and iOS is a great resource for parents and athletes. This app, created by the International Olympic Committee, enables athletes to select an exercise program that is specific to the sports they play.

In addition, UK researchers are studying a number of ways to prevent a second ACL injury as well as prevent or delay the onset of knee arthritis for younger athletes that suffer an ACL injury. These include injections to lessen cartilage damage, improved surgical techniques for younger athletes and innovative rehabilitation protocols like one’s being used with injured NFL athletes. Current research has also identified that athletes still have sizeable muscle imbalances when they return to sports, suggesting that both improved rehabilitation protocols and better testing methods be used to safely return young athletes back to their sport.


Next Steps