Knee Cartilage Repairs with Dr. Michael Kuhn
Toree: Hey, I’m Toree McGee, and this is The Rapid Recovery Report, sponsored by ROMTech, the modern technology of rehabilitation. So, we’re doing the series on Thursdays at 4:00pm Pacific, 7:00pm Eastern, where we talk to different guests, whether it’d be surgeons, patients, insiders at ROMTech, all of the above, to talk about wellness and health, and touch on ROMTech’s PortableConnect.
So, if you’re new here, we’ve got this awesome little device called the PortableConnect. It’s a high-tech recovery device that’s geared to get patients moving, and on the road to recovery faster from injuries and surgeries. So, to learn a little more about, you can visit Romtech.com, and follow us on social media at the handles listed there in that little ticker, or below in our description.
Athletic Physician Michael Kuhn
So, today, we’ve got a great guest, Dr. Michael Kuhn. He’s got a passion for the treatment of athletes of all ages and arthroscopic surgeries, including shoulder, elbow, hip, knee, ankle. He routinely performs advanced cartilage restoration procedures, returning athletes to the highest level of functioning, and preserving joints to avoid joint replacement surgeries.
He was recognized as the Federal Healthcare Physician of the Year in 2013 for his cutting-edge techniques and skills in cartilage restoration, resulting in combat athletes returning to their occupations and duties at high levels not previously achieved. So, Dr. Kuhn, actually is at the Orthopedic Associates of Middletown after a 27-year career as a distinguished military service in the US Navy.
So, it’s great to have you on with us, Dr. Kuhn. We really appreciate you being here.
Dr. Kuhn: Toree, thanks for having me. I really appreciate the opportunity.
Toree: Yeah, absolutely. Well, let’s kind of dig right in. So, you have a really impressive background in orthopedics while you served in the Navy for 27 years. Did you always know that you would wind up pursuing orthopedics?
Dr. Kuhn: I always thought I would pursue something in medicine. Actually, we all sort of change as we go along. I first thought I was going to be a pediatrician. And then as I got more into medical school and our rotations, and doing the clinicals, orthopedics really gravitated to me. I enjoy athletics, and certainly found that the rehab and recovery and treatment of athletic individuals was really sort of my passion, and orthopedics fit right into that. Not only could I treat them in the clinic, but I could also help them on their way to recovery and the operating room, so was just really was the perfect fit for me.
And certainly, as an orthopedic surgeon in the Navy, for which I spent a lot of time, it was a great fit. I mean, these young men and women dedicate their lives or bodies to service to their country, and as a result of training or in combat, they sustained some injuries, and so, it’s always our job, our goal to get them back to functioning, so they can get back to their active lifestyle like they enjoy.
So, yeah, orthopedics was a perfect blend in the Navy, and I enjoyed my time with my colleagues and our patients immensely.
Toree: Being there for 27 years, you must have liked it to have stuck around that long.
Dr. Kuhn: Some of that was training, and then others were additional experiences. I spent some time overseas as a physician, and then I spent some time in the combat arena, but most of it was spent back in the United States, taking care of a lot of marines and their family members in the southern states. So, it wasn’t all difficult assignments, so yeah, time flew by quickly, and it made it very rewarding and enjoyable.
Toree: That’s great. So, how is the experience, I guess, being in orthopedics in the Navy different than your experience now at the practice where you are?
Dr. Kuhn: Absolutely. When I was in the Navy, I always joke that my athletes were aged 18 to 35, and sustaining a lot of different types of joint injuries, whether it’s the shoulder, the hip, and the ankle, or any joint, honestly, and a lot of cartilage injuries, and it was reconstructing joints, and trying to preserve their joints to get them back, and to give them the longevity in their life and their athletic careers that they want.
Then I transitioned out, and joined our practice in Connecticut, and my athletes just changed their age a little bit. Now, I’m saying my athletes range from about age 12 to age 92, and so we treat athletes of all different sizes, shapes, walks of life, and activity levels at this point.
Toree: Okay. Well, I mean, I’m sure that postop is very different for those 18-year-old athletes, versus the 92s.
Dr. Kuhn: It certainly is, and we’re all young at hear no matter what, and so again, it’s always my job, my task, my requirement to give them the best functional outcome they can, and use whatever is at our armamentarium to really help them with that.
Advanced Cartilage Repair
Toree: Yeah, absolutely. So, we’ve talked to a lot of orthopedic surgeons on the show, mostly about total knee replacements and procedures and recovery. So, now as a sports medicine subspecialist, you deal with a lot of advanced cartilage repair for prevention of joint replacements, so can you talk a little bit about that for our audience? So, what is it, and how exactly does it prevent those joint replacements?
Dr. Kuhn: Absolutely. For those athletic injuries, more so in the military, and now so in a lot of my patients, when there’s a traumatic event, and the knee becomes big and swollen, and you get an MRI, and all of a sudden, you see what we call a focal cartilage defect, or as I would describe, a pothole in the road. Now, that’s an area that if we can treat it early, we can repair that defect, and hopefully, prevent them from needing a knee replacement in their lifetime, or at least delay that for sure. Restore their function and their recovery.
So, involves just that, involves trying to take a structure, which is very difficult to heal. Cartilage doesn’t like to heal in the knee. And trying to find ways and techniques to help it to heal, help it to restore, and help it to maintain that longevity.
So, I tell the patients, it’s like taking that pothole in the road in front of your house. You see it. It starts with this little tiny thing. And if you watch it over time with weather and more traffic over it, it gets bigger and bigger, until all of a sudden, it’s one of those things that pops up on your navigation, and said, “You better avoid this, or you’re going to have a flat tire.” So, that’s how I explain it to patients. We’re trying to restore those cartilage injuries. That’s what we’re trying to do. We’re trying to keep that, prevent that pothole from getting bigger. Fill in that pothole, so your car can drive smoothly across your road, and so when you’re biking or you’re swimming, playing golf, tennis, or in this area, pickleball, you can do it without pain and swelling in your knee, and enjoy your life.
Toree: That’s a really great correlation to make, probably is able to get things to sink in a little bit better for patients.
Dr. Kuhn: Yeah, keep the terminology simple so everybody can understand, right? Don’t use the medical terminology that we all use in our profession, and everybody looks at you like, okay, speak English please, translate that for me. It certainly helps a lot to correlate what’s going on in your body, when somebody can show you on a picture or a diagram, or explain it in something that you can relate to.
Toree: Yeah, definitely. And I mean, it’s probably a lot less scary for patients when you speak to them in plain terms. It sounds more complicated, I would assume, when you’re talking the medical lingo.
Dr. Kuhn: Yeah, I tell all the patients, I try to treat you like I were with family. And I would want somebody to explain it my family that way. Each day when we go to work, they put their trust in us, in the medical profession. And we rely on a lot of people. We rely on our skillset. We rely on our rehab folks. We rely on our equipment representatives. We rely on technology to really help us to get that done for them. You can’t do it alone, can’t do it all by ourselves. We need everything we can. And always looking for new and better ways to do that that keep people better more completely, faster, and have an easier road to recovery.
Toree: Absolutely. So, you were actually in the news back in 2017 for being the very first ortho-surgeon in Connecticut to perform – is it a MACI?
Dr. Kuhn: It’s MACI. So again, what we do is we find that defect in the knee and that cartilage, that pothole. Now, we got to resurface it, and so we can actually do – as I tell my patients in a more simple term, we can take a sample of cartilage from the knee, send it to the lab where we clone it. It’s not really cloning, but it’s a simple process to describe what happens in several thousands to multimillion cells. And then originally, through an open incision, like a total knee incision, and now I’ve developed a technic to do it arthroscopically, so through a couple small incisions in the knee, we can actually go in there, and reimplant it. Allow your knee to heal that cartilage, which as I said before, it doesn’t like to do, but this is one of the techniques and technologies that allows it to do it, and fill in that cartilage defect with a more durable product. And the results have been great.
When you see a 16 or 18-year-old athlete in your office, and they have pain, and they can’t play their sports, or you see that 45-year-old, can’t run and play soccer with their kids, or coach baseball because their knee hurts, and you see this on their X-rays and MRI, and when you can get them back to doing those things after their recovery, it’s definitely rewarding for everyone.
Toree: Yeah. So, do you perform those a lot?
Dr. Kuhn: I do a lot of that, yes. It certainly depends. As I mentioned earlier, my patient ages have dramatically changed, so in that 18 to 35-year-old group, it’s more common for them. Certainly, patients of all ages under the age of 55 will do that. And it’s just obviously one of the things we can do to try to help restore cartilage.
Again, our goal is always to keep your native joint, whether it’s your hip, your knee, or your ankle, to avoid joint replacements, because when we do joint replacements, patient asks, “Am I going to be back to normal?” I say, “It’s a new normal, but it’s not the normal you were when you were 18.” So, the longer we can keep our own parts, the better we tend to do.
Toree: Yeah, well, makes sense to me. So, now, it seems that you’re really really busy all the time, lots of surgeries and family, and so much going on. So, how do you keep up with all of the advancements in surgery and technology?
Dr. Kuhn: I think that’s one of the most rewarding parts of our job. Again, the trust that our patients put into us. They come in and say, “I read your bio, and it sounds so great, and you’ve done all this wonderful stuff.” Well, what I did doesn’t help what I need to do. So, I say medicine is a lifelong learning experience. If you stop learning, then you stop growing, and you stop gaining new insights and new ways to do stuff. So, we continue research, right? We continue to research with our partners in other institutions. We continue to research with our technology affiliates. And ROMTech’s a great representative of that as well. And we just try to look for new and more effective, more efficient, more cost-effective ways, all those things to try to help with patients. We go to meetings, and just exchange that with each other.
I always say I hate the cell phone for a lot of reasons, but it’s very convenient when I can reach out to four or five colleagues at once, and say, “I’m seeing this patient with this condition, what do you think?” And send a couple of pictures, and immediately, we can have four consults at the same time.
And we learn from each other as well. So, there’s not just one avenue that we do. That’s how I keep the vigor. That’s how I keep going. Yeah, we’re all busy, but you have to make time for that as well.
Dr. Kuhn’s Patients on the PortableConnect
Toree: Yeah, definitely. Well, since we’re talking about it, technology and ROMTech, you’ve had a lot of patients recover from their surgeries using the PortableConnect technology. So, what’s it been like being able to prescribe the device for your patient’s recovery needs, and what’s different now that they’re using this device?
Dr. Kuhn: Yeah, the word I use is revolutionary, and I don’t use that lightly. When I first used the device in 2019 when we were doing some early clinical stuff, and it was presented to me, I’m like, this device, I’ll say, is so simple. I know it’s not simple, but it’s so genius in what it’s doing.
And we know that a joint in motion is happy. We know that a joint in motion lubricates itself, the tissues react, everything wants to heal and recover. And let’s face it, when we do surgery, we create scar, and so everything helps the scar to heal in position.
So, I’ll say back in the day, we would use a CPM or a device you’d strap your leg in on a bed, this big thing, and it would move your knee back and forth slowly, and it worked okay. But the problem for patients, after joint surgery, is sometimes, they physically can’t get their knee bent a lot, or sometimes, especially with the cartilage transplant, I can’t let them bend their knee fully. So, I always, before the device, I would say, “Low impact rehab is exactly what we need, biking, swimming.” But the problem is, until a patient can get beyond 90 degrees, they can’t ride a bike. And so, the ROMTech PortableConnect device really just knocked them out of the park. These patients can go home, whether it’s a joint replacement for the knee, whether they’ve had a cartilage repair. I use it in my hips and my hip replacements, but also my hip surgeries. That it just allows them to start their rehabilitation on the day of surgery or the day after. It’s seamless for myself and my staff.
The device comes to the house. The technicians in the field are wonderful. Patients react to them very well. They’re very helpful. They explain it to these patients. And some patients are very technology-savvy and some are not so technology-savvy, but they all find out that it works well.
So, when I first started using it in 2019, I thought, oh my goodness, is this going to be a big task? How is it going to be? How are we going to follow this? And it’s so simple. I almost forget that I use it sometimes. Until the patient comes in, and says, “You know, when I had my surgery before, I didn’t do as well, but after I got that PortableConnect device, this rehab and recovery was dramatically different than before.” You realize what’s going on in the background.
And that’s why I said it takes a whole team to help the patient recovery. It’s not just the surgeon. It’s not just the patient. And the whole ROMTech team is working on the background, making them happy. And so, that’s really, prescribing has been seamless, but it’s not just that, because if it works so well, you make the extra effort, but it just works so well for the patients. And patients like that I can see what they’re doing on my computer or on my phone.
I get emails all the time. Patients doing this. I can check on their device. And I know if Mrs. Smith is really rehabbing her knee twice a day or not. Once she comes in and says, “My knee is stiff,” I say, “Well, how is your rehab going? Are you using the PortableConnect?” “I am.” I’m like, “Are you sure?” They know you’re checking up on them, and so it gives them goals, right? They have a goal that they say, “I want to do well.” I want to impress Dr. Kuhn. He works so hard to make my knee or my hip better. I want to make my hip and knee better too. So, it just helps the whole team effort for everybody.
Toree: Yeah. I mean, the accountability is huge. I always make the joke. If my dentist could tell if I was flossing, you believe that I would floss. But because he can’t, I don’t really. And it’s kind of the same thing with PT or anything really, if you’re doing exercises at home.
The telehealth is a huge part of the PortableConnect, and something that kind of sets it aside. I mean, what do you think about telehealth in technology now, and in the PortableConnect?
Dr. Kuhn: Absolutely. So, telehealth and myself were two dichotomous names until COVID hit, right? And this technology was being developed way before COVID, the forethought to think about this telehealth model or the ability to connect the patient with their doctor in an immediate feedback model was being developed before we had this pandemic, and had to shift to a telehealth model. For a long time, our patients we’re seeing like this. I would sit here in my office, and we would talk about what was going on. And so, it actually helped them a lot.
It’s definitely decreased their trips to physical therapy. It’s allowed them to rehab in the home, where they feel safe and comfortable. And it’s a cost savings for the patient and their insurance. So, the insurance companies love it if we’re saving money and performing a service that’s giving them as good or better than they had before. So, yeah, the telehealth component is huge, and I think it’s only going to become a bigger component of this, as we move forward other indications for this rehab as well.
Toree: Yeah, I think so too. I mean, people are getting used to being able to have everything at home. Just before we started the podcast, we were talking about Amazon, same-day deliveries, and grocery deliveries, and people are getting used to it. So, to be able to rehab at home is something that I think is not going away any time soon.
Dr. Kuhn: And patients want it. They are very happy for it. Everybody is a little more risk-averse now, I will say. They don’t want to get in big social environment, some people. So, they can sit in their pajamas, as we were talking about before, and they can sit in their PJs, an they can get in, and they can turn on their TV, and have their coffee on the side, and they can go through a rehab protocol. They can do it at 7:00 in the morning. They can do it at 4:00 in the morning. They can do it at 10:00 in the morning. They can do it before work or after work. They don’t have to drive somewhere, wait for somebody to see them. They could just plug in and go at any point. And if they are really overachievers, they can do it more often.
I tell my patients with any surgery that when you go to therapy, you see your therapist two or three times a week, you’re doing therapy at home many times a day. And so, this gives you the opportunity to do that as well.
Toree: Yeah, absolutely. I mean, it sounds pretty positive, but I’m just going to ask anyway. What are your overall impressions with the PortableConnect? And I mean, do you think that this sort of thing is going to be the new wave of rehab in the future?
Dr. Kuhn: I don’t think it’s going to be the new wave. It is the new wave. I think people are going to try to copy it. Patients come into me all the time. And they’ll say, “Hey, I’m waiting to get this surgery done, because I’m waiting for the new total knee, or I’m waiting until you can inject cells, something into my knee with a syringe, and all of a sudden, my knee is just back the way it was.” And they say, “I’m like really waiting a long time, because I keep up on the research and the new technology very well.” That isn’t coming in the next – I don’t think in my lifetime for sure.
But when they ask what’s new and great out there, this is what I tell them. I tell them this rehab technique is efficient, is effective, it’s functional, and it gets results. And so, I think, it’s the now and the future.
Toree: Yeah. Well, I love to hear that. Thank you again, Dr. Kuhn, for hanging out with us here today. I’ve had a blast chatting with you. I hope you had a good time as well.
Dr. Kuhn: I did too. Thank you for including me, of course.
Toree: Yeah, absolutely. So, to check Dr. Kuhn, to check out ROMTech, feel free to follow us on any of our social channels here, Instagram, LinkedIn. At @oamct is where you can find Dr. Kuhn, his practice. And you can find us always at Romtech.com. Be sure to subscribe if you enjoyed this podcast. Subscribe on YouTube, on Facebook. And we’ll see you guys next time.
Thank you so much again, Dr. Kuhn.
Dr. Kuhn: Thank you as well.
Toree: Of course, all right, bye-bye.
Dr. Kuhn: Bye.
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