By Katy Gladysheva, Knee1/Body1 Staff
After spending two years in a profitable and fast-paced financial business, Dr. Kenneth Alleyne decided to pursue his life-long interest in medicine on a professional level. He is currently a Sports Medicine Fellow at the Yale University School of Medicine. He trained at the Wake Forest University School of Medicine, completed a research fellowship at Harvard-MIT Division of Health Sciences and Technology. His residency training was undertaken at the Howard University Hospital. Dr. Alleyne is also a founder of Morphogen Pharmaceuticals and an author of multiple published research papers, including a presentation on the longest follow-up on arthroscopic partial menisectomy in recreational athletes.
Knee1: You have quite an unusual background for a surgeon, having spent several years in finance before starting your medical training. Did you always know you wanted to go into medicine?
Dr. Alleyne: Yes, I was always pre-med. My work in business gave me a chance to gain a different experience in life before focusing professionally on medicine. Orthopedic surgery appealed to me because of the opportunity to see the immediate results of your interaction, surgical or non-surgical, with patients. Since our specialty deals greatly with function, our patients frequently are very motivated and are compliant with our recommendations. The thing that I think I got the most out of in terms of business was gaining the confidence and experience to put together financing for my company. I have founded Morphogen Pharmaceuticals in 1995 with another partner.
Knee1: Please tell me more about your company. How do you balance the time between the hospital and Morphogen Pharmaceuticals?
Dr. Alleyne: The vast majority of my time during the day is devoted to the activities related to my fellowship, which mainly comprises research, clinical time in the office seeing patients, and OR time. The company, I handle mostly on my free time in the morning and late at night reviewing e-mails, faxes, and the like. We have recently hired a CEO and a CFO to deal with the day-to-day matters. Morphogen Pharmaceuticals, a biotech company based in New York, was founded in 1995, and now four years later it has between 8 and 12 employees. We have one lab director and two main investigators, in addition to numerous consultants. The primary thrust of our research focuses on developing novel ways to heal mesenchymally derived tissues through isolating specific cells that then can be directed to grow either bone, cartilage, tendon, or muscle.
Knee1: Has research in that field been an interest of yours for a while?
Dr. Alleyne: The company came out of my long-standing research interests. I have spent a year on a research fellowship at the Harvard-MIT Division of Health Sciences and Technology in Cambridge, and the company was formed out of some of the work that I participated in during that year.
Knee1: I know that your research interests extend beyond just your company's. Please tell me about the presentation at the American Academy of Orthopaedic Surgeons on arthroscopic partial menisectomy.
Dr. Alleyne: That was a research project that I carried out with Dr. Dinesh Patel of Massachusetts General Hospital on looking at the recreational athlete population, which is essentially high functioning athletes who spend a significant amount of time at their sport, but are not professional or even semi-professional athletes. We were examining a concept regarding managing injuries to their meniscus, which acts as a shock absorber inside the knee. There is a debate as to whether or not a damaged meniscus should be repaired or if it could be safely, partially excised. We found that by partially excising it ten years out, patients still had excellent function and were able to participate in their respective athletic activities. There were about 45 subjects enrolled in this retrospective study.
Knee1: While there are quite a few current controversies in orthopedic surgery, it seems that the process of diagnosing and treating an injury in orthopedics lends itself well to an algorithmic approach. Can you think of any cases that struck you as unusual in some ways?
Dr. Alleyne: One of the basic tenets of orthopedic surgery is that the physical examination is the sine qua non of diagnosis; and the other tests that we order - MRIs, X-rays, etc. are just adjuncts; and really, you should have in your mind what your differential diagnosis is and those tests serve as confirmatory examinations. As a physician you don't want to blindly order tests searching for a diagnosis. One should be adequately trained in the appropriate physical diagnosis and history taking that allows 80% surety of your diagnosis, with the tests as supplements. Recently we had a patient who had a diagnosis of a mass in her knee that was causing her a great deal of pain. We ordered an MRI to help delineate that mass and it appeared to be a soft tissue mass. We were going into the knee to remove the mass and to figure out what it was and to make sure it wasn't something cancerous - a tumor. When we entered the knee, we saw an enormous articular cartilage lesion that the MRI completely missed. It was a very significant lesion; to a point that she is going to be scheduled to have Carticel done to her knee.
This was something that we had no idea we would find when evaluating her preoperatively, which enforces one of the tenets of medicine and surgery - that you really have to be completely prepared when dealing with patients to handle any eventuality that you might come across in the course of a procedure. The test we performed on this patient was quite definitive, but this case illustrates some of the limitations of the technology and really shows the importance of putting an entire picture together on any given patient by taking an appropriate history and physical from the patient. The technology has caused us to focus on one area, but when we got inside the knee, we found that her discomfort quite possibly was coming from something completely different