New to the Joint : Cartilage Growth Method Offers Knee Patients Relief
Revolutionary surgery--involving transplanting laboratory-cloned cartilage--was performed for the first time in Southern California on Friday in a procedure that doctors say may provide relief to as many as 120,000 people who have suffered knee injuries.
The breakthrough procedure, which involves harvesting a patient’s own cells to repair damaged tissue, was performed on two men at Hoag Memorial Hospital Presbyterian. The treatment was described by the Harvard Health letter as one of the top medical advances of 1994.
“The operations went exactly as planned. It’s been so long we’ve been waiting for something like this,” said Dr. Ralph Venuto of Newport Beach, who operated on the men with his partner, Dr. Michael Drucker.
The procedure, developed in Sweden, involves removing healthy cartilage--about the size of half a fingernail--from the knee and then sending it to a lab to undergo a patented three-week process called Carticel, in which millions of other healthy cells are grown.
When the new cartilage returns from the lab, a surgeon places the new cells into the patient’s damaged joint.
Since the replacement cartilage cells at the heart of the new technique come from the patient, there is no danger they will be rejected by the body’s immune system--a risk run in traditional transplants--doctors say.
Once in the knee, the fresh cells integrate into the surrounding tissue and mature into normal cartilage, restoring fluid movement to the knee. Patients who have the operation must use crutches to stay off the knee for six to eight weeks after surgery, doctors said. A year after the surgery, with the help of physical therapy, the joint should be totally recovered and resilient enough for the patient to play sports, doctors said.
None of the traditional procedures are able to re-create a knee strong enough for sports, Drucker said. The impact of the breakthrough on professional athletes who often sacrifice whole careers due to knee injuries is tremendous, he said.
While the procedure is relatively new in the United States, the Food and Drug Administration has ruled that it does not require regulation, Drucker said. And so far, he added, insurance companies have been paying for the treatment in other parts of the country.
Drucker and Venuto hope the new treatment, which costs about $20,000, will replace temporary procedures such as drilling holes in the cartilage to stimulate growth. That method, which costs $7,000 to $10,000, provides only partial relief.
The doctors also hope the new procedure will prevent the need for total knee replacements, which cost about $30,000 and last 10 to 15 years. About 200,000 such replacements, using plastic and steel parts, are performed each year in the nation.
Doctors say the procedure can be performed on athletes and other people 18 to 50 years old who injure their knees seriously enough to cause prolonged swelling or locking of the joint. However, some patients who injure their knees too severely may need other kinds of treatment.
The two men who underwent the procedure Friday were “perfect” patients, doctors said. One injured himself while climbing stairs at work and the other hurt himself playing volleyball.
“I guess this makes me the $6-million dollar man of knee surgery,” quipped Steven Schuster of Costa Mesa on the eve of his surgery. “I’m the first, the guinea pig.”
Schuster, 42, tore up his knee a few months ago while repairing air conditioners. Schuster said he felt a stabbing pain in his left leg when his knee gave out.
“It was like being kicked in the knee hard. I could hear something in there pop,” said Schuster, who has been unable to return to work because it requires climbing, stooping and bending.
“I’ve been sitting here all day going broke,” said Schuster, who was not able to run, play football or play with his two children, Samantha, 8 and Joey, 4.
Schuster said he had no doubts about undergoing the new procedure. The alternatives, such as a total knee replacement, were not acceptable, he said.
The other patient, Larry Wells, 48, of Yorba Linda, agreed.
“It’s pretty spooky. Real rocket science stuff,” he said. “But conventional treatments just don’t cut it.”
Wells said he was playing volleyball on a rocky surface thinly covered with sand in June. He lurched forward to get to the ball when his left knee slipped out from under him.
“Did I scream!” he said.
The pain was so severe that Wells had to give up a large part of his job as an engineer--spending whole days climbing around offshore drilling rigs inspecting machinery--to work at home.
“I’d hate to have to look at the rest of my life and know that I could never play sports again,” he said.
Neither man was available for comment after surgery.
(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)
A Growing Practice
New knee surgery technique grows patient’s own cells for cartilage replacement:
1) Healthy knee cartilage is sliced from non-weight-bearing segment
2) Cells are removed, placed in nourishment to stimulate growth
3) Increased both in size and number, cultured cells are returned to surgeon
4) Cultured cells are injected into defective section
5) Membrane is transplanted from lower leg bone and sutured on top of treated area
Source: Genzyme Tissue Repair
Researched by APRIL JACKSON / Los Angeles Times
