Goble Medical | Personal Biography
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Dr. E. Marlowe Goble has specialized as a knee surgeon for 30 years. During that time he has researched and published on virtually every orthopedic procedure involving the knee. To provide the best quality care possible, Dr. Goble has concentrated his practice narrowly. It is not just specialized around disorders of the knee but further focused on the following three knee disorders: Anterior Cruciate Reconstruction (ACL), Meniscal Allograft Transplantation (MAT), & Minimally Invasive Total Knee Arthroplasty.

Dr. Goble has had a significant impact on the field of Orthopedics and knee disorders. He performed the world’s first Minimally Invasive Total Knee Arthroplasty in 1992 and has had a generous amount of experience in each of the three areas. Expand the fields below to learn more about his impact and research in each area.

Education

Personal: European Tour (Knee Ligament Reconstruction), 2 months, 1983; Dr.Paul Maquet, Dr. Werner Muller, Dr. Paul Dejour

Board Certified: Orthopedic Surgery, July 26-27, 1984, American Board of Orthopedic Surgery

Fellowship: Slocum Clinic, 3 months, 1982, Eugene, Oregon

Residency: Orthopedic, University of Utah 1976 – 1981, Dr. Sherman S. Coleman ,Chairman

Internship: Barnes Hospital, Surgery 1976, St.Louis, Missouri

Medical Degree: Washington University, June 1976, St. Louis Missouri

Baccalaureate Degree: Chemistry/Medical Biology, June 1971, University of Utah

ACL Repair
HOW DR. GOBLE CAME TO SPECIALIZE IN ACL REPAIR

IN 1977 an injured Anterior Cruciate Ligament was rarely reconstructed. Indeed, as resident in  Utah Dr. Goble had no knowledge of the function or the treatment of the Anterior Cruciate Ligament, or its injury. His first substantive venture into the knee wasn’t until 1979 when he published an article with doctorial candidate Paul France,  called “Simultaneous Quantitation of Knee Ligament Forces” in 1979. This landmark publication in the Journal of Biomechanics was the first quantitative analysis of the then-misunderstood function of the cruciate ligament pair.

In the years immediately thereafter, he completed a sports medicine fellowship at the Slocum Clinic (Eugene, Oregon) and a European fellowship tour in 1982 and 1983.

While studying with Werner Mueller in Basel Switzerland, Dr. Goble imagined his first medical invention. Upon his return, he developed a new devise (and accompanying arthroscopic surgical technique) for reattaching torn ligaments back to their long origins. He applied for a patent in 1984 called a ‘suture anchor’. The “Suture Anchor” has since matured into the single most important arthroscopic implant in Sports Medicine. While primarily developed for use in the knee, variations of the original idea are now used in the repair of major joints throughout the body.

In 1986 Zimmer Inc. hired Dr. Goble to develop a surgical technique for a Prosthetic (nonbiological) Anterior Cruciate Ligament. During this development period (1986-1988) they learned that artificial Anterior Cruciate Ligaments would not consistently survive within the knee for more than one year. Instead, Dr. Goble, together with other researchers, developed a Straight Tunnel Anterior Cruciate Ligament reconstruction surgical technique. This introduced arthroscopic Anterior Cruciate Ligament reconstruction. Today, this same basic technique is still used, with only minor changes, in almost all Anterior Cruciate Ligament reconstruction surgeries.

The development of the Suture Anchor and the Arthroscopic Anterior Cruciate Ligament surgery led the establishment of Medicine Lodge Inc, a sports medicine research and development company, in 1990.

This extant research enterprise has been responsible for the creation of several orthopedic companies, all located (initially) in Logan, Utah.

  1. Innovasive Devices
  2. IMDS
  3. Facet Solutions
  4. Venture M.D.

Alan Chervitz and Wade Fallin, two Georgia Tech engineers co-founded these companies with Dr. Goble. Working through these companies the creation of many ACL implants and surgical techniques would come about over the next 15 years. These patented systems which are currently utilized include:

  1. Cannulated Interference Screw
  2. Cross Pin Femoral Fixation for Anterior Cruciate Ligament Grafts
  3. Set Screw Anterior Cruciate Ligament fixation
  4. Tibial Tunnel Drilling System
  5. Cross Pin Interference Screw
  6. Periosteal Femoral Anterior Cruciate Ligament Fixation

Of all the above, the Cannulated Interference Screw, co-developed by David McQuire and Dr. Goble, is the most universally utilized. This rigid femoral and tibial implant is used in 65% of Anterior Cruciate Ligament surgeries worldwide.

Dr. Goble has utilized all of the above Anterior Cruciate Ligament systems over the past 30 years.

The development moves forward, on the horizon is yet another new system, called non-rigid Anterior Cruciate Ligament fixation. It is currently still in the development process. This new system, to be released in 2012, will decrease the rate of late occurring degenerative arthritis in Anterior Cruciate Ligament Reconstructed knees.

MAT
HOW DR. E. MARLOWE GOBLE CAME TO SPECIALIZE IN MAT SURGERY

Dr. Goble was first introduced to MAT in 1990 when a colleague, Dr. John Garrett of Atlanta Georgia,  consulted with Dr. Goble in the possible development of a standard surgical approach to replacement of a native meniscus by a donor meniscus. Conceptually, there were would be many  advantages of meniscal transplantation over knee replacement – if a practical and reliable procedure could be developed. A new transplanted meniscus would rejuvenate and protect an otherwise healthy knee joint.  It would provide an alternative to a total knee procedure and avoid the limitations it imposes.

To that point, Dr. Garrett had pioneered early MAT transplantation by use of fresh cadaver harvest and transplantation, within 48 hours. However, Dr. Garrett was confronted with the practical difficulty of using fresh meniscal tissue because of issues concerning supply, sizing, disease transmission, and cost.

Dr. Garret presented his early research and development to a group of knee surgeons: Doctors Wjoyts, Stone and Wolf. They accepted the challenge and began their own efforts to develop a practical MAT procedure.

Over the next 10 years, Dr. Goble implanted well over 100 Meniscal Allograft Transplantations. The surgical indications, allograft preparation, sizing, surgical technique and patient results are reported by Dr. Goble in these publications. The research and innovation performed by Doctors Goble, Wjoyts, Stone and Wolf resulted in an effective and practical MAT surgical procedure.

However, the MAT procedure is not widely offered by orthopedists who perform total knees for several reasons. First, the current Meniscal Allograft Transplantation procedure takes over 4 hours, and is very difficult for a surgeon to learn and perform. Second, it is relatively time consuming and expensive compared to alternatives. Last, insurance companies do not reimburse doctors who perform the surgery at a rate which makes the surgery cost effective for regular practice.

The MAT surgery works. For the proper patient it is a superior alternative to a total knee.  Although only a few surgeons are trained to perform this procedure, it is available to the educated candidate.

Dr. Goble accepts candidates for Meniscal Allograft Transplantation after referral from a local doctor. He will also accept a candidate who is otherwise sufficiently informed about their options regarding the procedure.

Minimally Invasive Total Knee Arthroplasty
WHAT IS MINIMALLY INVASIVE TOTAL KNEE

Total Knee Arthroplasty is a surgical procedure which replaces the weight-bearing surfaces of the knee joint with artificial, implanted surfaces.  The surgery reduces pain and disability caused by osteoarthritis.

Minimially invasive, or less invasive arthroplasty is a less physically traumatizing surgery. It utilizes smaller incisions into the knee to place the artificial implants and therefore avoids cutting major muscular and nervous tissues.

HISTORY

In 1992, Dr. E. Marlowe Goble performed the world’s first Minimally Invasive Total Knee Arthroplasty on 79 year-old Ms. West. His novel approach used a small 3-inch lateral incision, instead of the conventional approach which relied upon a 12-15 inch incision on anterior portion of the knee. For the next decade, Dr. Goble worked together with Dr. Richard Caspari to develop a technique and accompanying devices which would allow other doctors to more easily learn the minimally invasive procedure.

The lateral approach, begun by Dr. Goble in 1993 offered the advantage of completelysparing the quadriceps, in particular, the vastus medialis obliquus, as well as branches of the saphenous nerve and the genicular artery. The Minimally Invasive Total Knee Arthroplasty combined established knowledge gained from the long-term success of conventional total knee arthroplasty with the benefits of a less invasive surgical approach.

In 2002, Zimmer, a large orthopedic device company, partnered with Dr. Goble & Doctors Thomas Coon and Alfred Tria to finish development  and production  of new devices and techniques that would allow other orthopedist to operate using Minimally Invasive Total Knee Arthroplasty known as The Quad Sparing Total Knee. The technique revolutionized the approach to the total knee procedure.  Today, minimally invasive, or less invasive knee arthroplasty is common practice among orthopedists.

WHY MINIMALLY INVASIVE TOTAL KNEE

Today, all orthopedic surgeons use either a less invasive or the minimally invasive knee replacement procedures. With the proper technique, the minimally invasive knee surgery has several advantages.

The Quad Sparing Total Knee:

  • The incision is only 3 inches instead of 12 inches long. The tendons and muscle tissue is pushed aside and separated instead of being cut.
  • Post operation recovery is drastically shorter since tendon and muscle tissue is preserved, relatively uninjured; allowing post operation therapy to focus only on the knee.
  • Hospital stays are shortened from 4-5 days.
  • Physical Therapy and rehabilitation are much shorter.

Today, many other surgeons and orthopedic device companies have developed similar techniques since Zimmer released the MIK TKA. However, the surgery and technology developed by Goble, Coon and Alfred has remained relatively unchanged.

Soon, modified implants, robotics and improved visualization systems will advance Minimally Invasive Surgery Total Knee Arthroplasty to increase accuracy of implant placement and further reduce trauma to the surrounding tissues.