Monday Medical: Caring for your cartilage
More slippery than ice, with the ability to act like a spongy shock absorber, cartilage is found at every joint in our bodies.
Cartilage, a type of connective tissue, creates a friction-free gliding surface for joints. But, it’s also susceptible to injury, and since it doesn’t have arteries, veins or nerves, it can’t naturally heal itself when damaged.
“Cartilage is precious, because really, what we’re born with is all we get,” said Dr. Alex Meininger, orthopedic sports medicine surgeon at Yampa Valley Medical Center.
One way to keep cartilage healthy is to stay active.
“Joints are kind of a ‘move it or lose it’ phenomenon,” Meininger said. “Remaining active and keeping an active lifestyle keeps your joints healthy.”
But cartilage injuries happen. In fact, they’re fairly common: When a knee is scoped, more than half the time, a cartilage injury is found.
Cartilage can be injured during a fall, or, similar to the treads on your tire, cartilage may wear out over time. Sometimes, a cartilage issue is present at birth.
With worst-case scenario cartilage injuries, a joint might need to be replaced, though Meininger prefers to prevent the injury from spreading and preserve the natural joint for as long as possible.
That’s where cartilage repair comes in. Currently, there are three ways to repair cartilage:
Microfracture: In this method, tiny fractures are made in the bone beneath the cartilage to encourage cells to move out of the bone and into the injured cartilage. These cells form a scar in the gap in the cartilage, helping restore function. However, this technique is not always a long-term solution, as more treatment or surgery may be necessary down the road.
Osteochondral transplantation: In this method, a cartilage plug is transplanted into the injured defect. Transplant cells may be taken from a cadaver or donor, or from another region of the patient’s own knee joint.
Rebuild cartilage with the patient’s own cells: In this method, a patient’s own cartilage cells are sampled through a simple biopsy surgery and grown in a lab one million fold. The expanded cells are then reintroduced into the injured knee with a second operation.
“Genetically, it builds the same cartilage that you started with,” Meininger said. “It’s pretty neat that you can take a biopsy from your knee, grow it in a lab and receive it back by FedEx.”
Traditionally, the new cells have been placed in a pouch that’s sewn into the knee with a procedure called autologous chondrocyte implantation. However, sometimes, the pouch can leak, or the cells may not spread out or grow as intended.
The next generation of this treatment, known as NOVOCART 3D, uses nanotechnology, or tiny biochemical structures, to replicate the spongy environment in which cartilage cells naturally reside, making an ideal environment for the cartilage cells to grow.
Cartilage cells from the patient are grown in the matrix, which is then returned to the surgeon and sewn into the joint, giving the new cartilage cells the best chance to flourish.
This new treatment has been used in Europe since 2003, but an FDA trial aims to bring the treatment to the United States. Along with Harvard University, the University of Chicago and other institutions, Yampa Valley Medical Center has been selected to participate in the trial.
Meininger is overseeing the study in Steamboat Springs. To be part of the study, patients must be 18 to 65 years old with knee pain and a cartilage tear or defect. The trial is randomized, which means that, for every two people who receive the experimental surgery, one receives standard care. Participating patients agree to follow-up appointments and X-rays through a two year period.
So far, the treatment has been used on a few thousand people in Europe, with promising results.
“It’s kind of a big deal,” Meininger said. “To have a randomized trial at the FDA standard is pretty significant, and it speaks to the excellence of our facility and the orthopedic department.”
Susan Cunningham writes for Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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