PUSHING THE ENVELOPE IN KNEE REPAIR - BIOLOGICAL ORTHOPEDICS HAS ARRIVE
For centuries, physicians have been frustrated by the apparent inability of damaged cartilage to repair itself. This problem has limited patients' complete recuperation from serious injuries involving knees, ankles, shoulders, and other major joints.
Recently researchers from the University of Göteborg in Sweden have pioneered a unique chondrocyte cell-transplant technique which aims to use a patient's own cells to repair damaged articular cartilage.
The procedure uses arthroscopy to remove cartilage cells from a part of the injured knee joint for regenerative purposes. The cells are sent to a laboratory where they are grown for at least several weeks. Once cultivated, they are to be injected during a more open and extensive knee procedure into areas of defective cartilage where it is hoped that they will facilitate the repair of damaged tissue.
It is anticipated that pain, swelling, and knee locking will soon be reduced. In time, the transplanted cells can become nearly indistinguishable from surrounding cartilage according to published reports by the Swedish team that originated this technique.
The Harvard Health Letter rated this new technique as one of the "Top Ten Medical Advances of 1994". According to published reports in The New England Journal of Medicine, this procedure will hopefully revolutionize the way deep cartilage defects are treated for the middle-aged patient.
Now, under a collaborative agreement with a physicians' group at the University of Göteborg and Sahlgrenska University Hospital in Göteborg, Sweden, American surgeons are now utilizing techniques that can be used to regenerate a patient's own cartilage cells.
The new procedure is designed for patients with limited cartilage damage primarily at the knee end of the thigh bone. It begins when an arthroscopic knee procedure is performed to provide the laboratory with a biopsy of cartilage from your knee. Millions of new cells are to be grown from that sample.
The regenerated cells can then be implanted into the defective portion of your knee in a second surgical procedure. A small flap of periosteal tissue from the the lower portion of your leg is sutured over the cartilage defect to hold the cells in place.
Because the new cells are derived from your own knee, there is believed to be no danger of rejection by the immune system. In addition, normal cartilage cells, when implanted, should help in the restoration of smoother movement of the knee.
Articular joint cartilage does not naturally regenerate in the body. As a result, damage tends to become more severe over time, as small tears can increase friction and cause larger defects. This damage can cause extreme pain and reduced mobility. It also may lead to debilitating osteoarthritis, a serious and crippling disease frequently corrected only by Total Knee Replacement.
Total knee replacement generally aims at facilitating about 10-15 pain-free years for the patient. Therefore, it is not a treatment normally recommended for patients under 45-50 years of age. For the younger patient, there have been few regenerative treatments available short of cutting out the affected bones and replacing them with bone-bank bones. Other more traditional methods include cutting a wedge cut out of the tibia to shift the weight onto the opposite non-affected side of the knee (High Tibial Osteotomy).
When a younger person experienced a major injury or trauma to the knee cartilage, he or she would suffer from mechanical symptoms that were largely noncorrectable. These often placed major limitations on the individual's normal occupational and lifestyle activities. In fact, many athletes have had their careers ended by such injuries.
Other established surgical procedures may provide temporary relief, but few provide a long-lasting remedy. While arthroscopic surgery smoothes the surface of the damaged area and other procedures allow bone marrow cells to infiltrate the defect, neither process results in a cure that affords the patient the strength and durability of natural joint cartilage.
I am the first physician in Florida trained to perform what I consider this major breakthrough in orthopedic surgery. I traveled to Sweden in April of 1995 to meet the founding doctors and observe their techniques. In Boston, I also witnessed the rigorous standards utilized in processing the cell samples.
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Updated 1/17/09