Knee cartilage surgery

Cartilage  is a dense connective tissue found in the knee  where it provides a protective surface.  It is composed of cells called chondrocytes.  Unlike other tissues,  articular cartilage does not contain blood vessels and therefore has poor regenerative qualities.  Injury to the articular cartilage of the knee can be the result of trauma, meniscal knee surgery where a portion or all the mensicus was removed and other sources. Osteoarthrits is a common condition  of cartilage failure that results in limited range of motion, possible bone damage and pain.

Until recetnly the only treatment options included non-surgical treatments and knee cartilage surgery.  Short of total knee replacement sugery,the most common knee cartilage surgery was microfracture.

 Microfracture is an arthroscopic knee surgerywhere the calcified cartilage is removed and small fractures are created in the bone with an surgical pic.  There are a series of limiations to this procedure and it has been found to be less effective in patients who are older, overweight and have cartilage damage larger the 2.5cm.  Apart from the knee surgery pain, the most significant drawback is the need to be on crutches for 4-6 weeks in addition to daily physical therapy.

The newest and less invasive option for the treatment of damaged knee cartilage is the use of autologous mesenchymal stem cell.  A published case report demonstrated successful cartilage growth in human knees using this stem cell therapy.  Unlike knee cartilage sugery,this procedure is performed using a small needle that is directed under x-ray into the affected area.  Recovery time is significantly different in that after 5-7 days the patient is able to bear weight on the affected limb without crutches.  Specifcs regarding this technique and the use of  autologous stem cell is available at regenexx.com

Knee ligament surgery

Knee sugery has improved over time.  At one point when someone injured their knee it was not uncommon fo the surgeon to remove the “diseased” or damged structure.  The cushions in the knee are called meniscus.  They pad and absorb the forces exerted by the leg during walking, running and skiing.

The knee is divided into two principal sections:  the inside and the outside.  In each of these compartments there is a meniscus.  Like a disc in the lumbar spine they supply support and structure.  When arthroscopic knee surgery is performed often it removes and trims the meniscus. In removing or trimming this vital structure the stability of the knee if often affected as well a pain after knee surgery.

There are four principal ligaments:  Anterior Cruciate, Posterior Cruciate, medial collateral and lateral collateral ligament.  The collateral ligaments provide stability.  After meniscal knee surgery or arthroscopic knee surgery the medial or lateral collateral ligaments are often weaken and lax which can give rise to pain after knee surgery. 

The medial and lateral colleral ligament can be repaired without knee ligament surgery.  The most common approach is prolotherapy in which a sclerosing agent is injected to strenghten as well as tighten the ligament.  Alternatively the use of autologous mesenchymal stem cells can be used via regenexx.com

Autologous Mesenchymal Stem Cell Therapy

Human Applications of MSCs

The process begins by isolating a person’s own (Autologous) Mesenchymal stem cells (MSCs) from a sample of bone marrow drawn from their hip.   The MSCs then divide in a natural growth medium that comes from the same person’s blood platelets.  The result is to take the relatively small number of MSCs found in a sample bone marrow, say 2 million, and expand them to a population of 20 – 50+ million.  With these numbers, substantial tissue growth is made possible.  The MSCs are then injected with a small needle, under live x-ray, into areas of bone, cartilage, and ligament/ tendon damage.

 

     Cartilage can be regrown in generalized arthritis and/or solitary cartilage defects in knees, shoulders, ankles, hips, and fingers.  It can also grow to repair partial meniscus tears. Ligaments and tendon injuries, such as sprains or partial tears of the ACL, PCL and MCL of the knee, the rotator cuff and supporting ligaments of the shoulder, ankle and hand/wrist, as well as plantar fasciitis, golfer’s and tennis elbow, can also be repaired.  Bone can be re-grown in chronic non-healing stress fractures or fractures of larger bones that have not healed in spite of casting or even surgery.  Chrinic conditions such as avascular necrosis have also been successfully treated.  Finally, some painful disc bulges in lumbar spine (low back) can be corrected to relieve back and leg pain.

 People undergoing these treatments are back on their feet the same day.  Those undergoing hip, knee, and ankle injections can begin walking longer distances after the first week.  Their activity levels are gradually increased over the following month, with the expectation that they will be back to their pre injury activity level after three months

Autologous Mesenchymal Stem Cells and Knee Surgery

Countless numbers of people suffer from knee pain on a daily basis.  When this pain is due to cartilage loss causing bone to rub against bone, the condition is called osteoarthritis.  Until recently, treatments for knee pain secondary to osteoarthritis has been limited. 

Medications alone, such as NSAIDS and narcotics provide temporary, often incomplete relief and can have unwanted side effects such as oversedation and stomach ulcers. 

Injections of steroid and artificial joint fluid, such as Synvisc and Hyalgan, may prove beneficial, but relief is usually temporary.

Prolotherapy, or injection of a dextrose based irritant solution, induces the body’s own healing process, and can offer longer term sympotom relief.

There are several surgical options ranging from microfracture to total knee replacement are intended to offer more definitive, longer term relief from artiritic knee pain.  Thse procedures, however often fall short of their promised pain relief.  Pain after knee surgery can be significant and result in a prolonged recovery period.  While microfracture’s recovery is less than that of knee surgery pain, it’s cartilage growth is often minimal and short lived.

Autologous mesenchymal stem cell therapy is an exciting alternative to knee replacement surgery.  Unlike any of the procedures mentioned above, this procedure actually regrows cartilage and results in reduced knee pain.  There are several successful case studies in the literature which attest to this.