Innovative way to restore knee cartilage

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Feeling brand new: Robbi Ward, of Joliet, had cartilage in both knees restored by a two-stage procedure that harvested cells from her own cartilage. | Supplied photo

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Cartilage injury is the most common cause of knee pain in the United States today. In fact, more than two million Americans suffer cartilage problems each year, resulting in pain and swelling that make it difficult or nearly impossible to maintain an active lifestyle.

Robbi Ward of Joliet was one of them.

Diagnosed with arthritis at age 12, Ward, now 38, struggled with achy knees for more than two-thirds of her life. It didn’t hold her back much when she was younger. As an energetic teen, she played softball and basketball.

But everyday wear and tear continued to take its toll.

“Other than at work, I didn’t walk or exercise much,” she recalls. “I have a high tolerance for pain, so for the most part, I did pretty well.”

Or at least she did until 2012, when an injury to her left knee nearly stopped her in her tracks.

That’s when she went to see Mukund Komanduri, M.D., board-certified orthopedic surgeon on staff at Presence Saint Joseph Medical Center in Joliet. Dr. Komanduri ordered an MRI and detected a tear in the meniscus, a rubbery C-shaped disc that cushions the knee.

Dr. Komanduri recommended a minimally invasive knee arthroscopy to repair the meniscal tear in June of 2012. During that procedure, however, he discovered that Ward had almost no cartilage in her knee.

“Damaged articular cartilage (the tough elastic tissue that covers the ends of bones to form the smooth surface of joints) does not heal as rapidly or effectively as other tissues in the body,” Dr. Komanduri said. “Instead, the damage tends to progress, allowing the bones to rub directly against each other, resulting in pain and reduced mobility.”

Left untreated, the condition may cause severe osteoarthritis and eventually necessitate a partial or total knee replacement.

Implant own cartilage

Since Ward is considered too young for joint-replacement surgery, Dr. Komanduri suggested a highly advanced cartilage-restoration technique that offers patients as close to a complete recovery as possible.

Called “autologous chondrocyte implantation,” or ACI, the revolutionary two-part technique allows doctors to harvest cells from a patient’s own cartilage, grow them in a lab and then later implant them in the patient’s injured knee.

Ward agreed and during a series of arthroscopic procedures over the next several months, Dr. Komanduri harvested cartilage cells from both of Ward’s weakened knees.

About ACI

Articular cartilage is produced by chondrocytes, which are cells that divide or multiply very slowly. This is one of the reasons that articular cartilage injuries do not repair well and can lead to continued degeneration and deterioration.

“One of the most advanced techniques available for cartilage restoration is ACI,” Dr. Komanduri explained. “The first stage is performed when the orthopedic surgeon harvests a small amount of healthy knee cartilage during an arthroscopy. The cells are harvested from a part of the knee that is subject to minimal loading or weight-bearing stresses.”

The harvested cells are then biologically engineered in a specially equipped laboratory. Through cell growth and culturing techniques, the chondrocyte number is increased from a few hundred thousand to more than 10 million cells.

In a second surgical procedure, the cultured cartilage is sewn to the neighboring cartilage using a patch.

“Within a few months, the cells synthesize to re-establish a normal articular cartilage surface within the knee, restoring the knee to near normal function,” he added.

Complete recovery can take up to a year, with several weeks spent on crutches immediately after surgery, followed by weeks of physical therapy.

“ACI is most useful for younger patients who have single (cartilage) defects larger than 2 centimeters in diameter,” Dr. Komanduri said.

The average age range for a patient who may be a candidate for an ACI is 15 to 55 years. Patients older than 55 typically have thinner remaining cartilage and are generally felt not to benefit from this procedure.

Ward underwent an ACI procedure of her left knee in January. To ensure appropriate healing time, she waited several months before having the right knee done in May. Both were outpatient surgeries.

“I’m feeling much better,” she adds. “I was too young for knee replacements, so this was the best option for me. I would definitely recommend ACI and Dr. Komanduri.”

Following several more weeks of physical therapy, Ward, a new grandmother, looks forward to when she can take her grandbaby to the zoo and walk around for hours — something she couldn’t have dreamed of doing before the ACI procedures.

“It’ll be like having two brand-new knees,” she concluded.

For more information about ACI and other orthopedic procedures available at Presence Saint Joseph Medical Center, call (877) 737-INFO (4636). To watch a video of the patient and physician discussing this procedure, visit www.provena.org/stjoes/ortho.

Provided by Presence Saint Joseph Medical Center