Advances in knee cartilage transplants help locals get back in action
Late February snowstorms can make for epic skiing conditions in Steamboat Springs, so longtime local and expert skier Kevin Olsen was enjoying fresh powder in the Sundown area after a huge storm in 2011.
“One minute I was having the run of my life, and the next minute changed my life,” Olsen said. While snowboarding, he smacked into a downed tree, sustaining extensive damage to his left knee from the blunt force trauma.
A surgeon repaired some damage initially, but cartilage damage remained a painful issue.
“I was in extreme discomfort for many years, struggling walking upstairs, struggling with basic skiing,” Olsen said. “One doctor said the only way around it was a knee replacement at age 37, but I was too young for a knee replacement. I felt stuck.”
Then in summer 2018, Olsen worked with local orthopedic surgeon Dr. Alex Meininger to undergo a then-relatively new procedure, which Olsen’s health insurance initially did not want to pay for, considering it experimental. Olsen received a knee cartilage transplant or graft, where the patient’s own cartilage cells are harvested from the knee during arthroscopic surgery. Those cells are enlarged or cloned in a Vericel lab on a 3D matrix of protein fibers synthesized partially from pig collagen. Vericel Corp., based in Massachusetts, creates advanced cell therapies for sports medicine and severe burn care.
The lab process to duplicate the cartilage cells takes about three weeks. The surgeon cuts the cartilage implant to fit the defect in the patient’s knee cartilage, and the protein matrix with the cloned cells is attached with fibrin glue into the cartilage hole during open surgery. The new cartilage cells with fresh potential then strengthen during recovery, leading to joint repairs where patients regain 90% to 95% of original function, strength and activity levels, Meininger said.
Olsen, 41, now skis about five days per week, limited only now that he has children. He said the surgery provided “drastic improvement and an impressive increase in function to where I was.”
“I’m very thankful that a procedure like this exists to help very specific injuries that previously were a struggle to treat,” said Olson, who owns a business consulting company in Steamboat. “I felt really thankful that a talented doctor in my hometown would offer this procedure.”
The procedure, which was approved by the Food and Drug Administration in December 2016, is called MACI, or matrix-induced autologous chondrocyte implantation. Meininger had performed many traditional cartilage implantation procedures since 2005, but the M, or matrix, in MACI is the game changer and represents an evolution of decades of technology, he said.
“It’s a huge breakthrough to heal with your own cells and DNA,” said Meininger, a managing partner at Steamboat Orthopaedic & Spine Institute. “MACI grows your own cartilage just like you are born with.”
The surgeon performed MACI locally in spring 2017 and performs about 10 of the advanced implants per year.
The procedure of replicating human cartilage cells on a protein sponge is significant, because adult cartilage does not grow, does not have blood circulation and cannot repair itself. Cartilage restoration using the protein matrix is more successful and durable, Meininger said. Before the matrix, cartilage repairs might have lasted two years and created cartilage scaring, whereas the MACI procedure should last up to 20 years based on European use. The longevity of MACI helps to postpone or prevent the major surgery of artificial knee joint replacements, the surgeon said.
The MACI procedure is also more user friendly and easier for surgeons to perform, since the cartilage graft on the matrix does not have to be sewn in with micro-surgery sutures.
The surgeon said he is passionate about the field of regrowing cartilage and cartilage restoration, and he serves as a master instructor on the topic for the Arthroscopic Association of North America. MACI is appropriate for patients who have a stable knee joint, and cartilage cells can be harvested during other arthroscopic procedures and preserved for up to five years, Meininger said. MACI can be used to repair cartilage damage greater than 2 centimeters to resurface a large section of cartilage on the end of bone in the knee joint. He said MACI treatment is best preformed sooner rather than later, before cartilage damage becomes too progressive or arthritic.
Justin Keys, owner of The Barley Tap and Tavern in downtown Steamboat, had the MACI surgery on his right knee earlier this year after a multiday backpacking trip last fall in southern Wyoming started his knee damage. Keys had difficulty going up and down stairs and said, “I wasn’t able to ski or hike or do much of anything.”
He tried physical therapy and platelet-rich plasma therapy injections without relief.
Now three months after the two-part implant surgery, Keys is able to walk to work and ride his bike around town. He is hoping to ski again this upcoming season.
“I’ve been really happy with it,” Keys said. “For me, it’s going to get me back to sports that I don’t know how would have been possible otherwise.”
To reach Suzie Romig, call 970-871-4205 or email sromig@SteamboatPilot.com.
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