Mimicking Human Cartilage Latest in Repairing Knee
I was just sent a very interesting article from John Cattermole, Clinic Owner of Egoscue Phoenix. This is somewhat of a follow-up to my post about knee cartilage being able to regenerate. There seems to be a lot of new research coming out proving what Pete Egoscue has been saying for a while now; knee cartilage isn’t any different than any other part of your body. Why would bone, skin, hair, etc. all grow back, but cartilage wouldn’t? Articles like this one (and the research behind them) are further proving that the body is a stimulus-response mechanism. If you change the stimulus, you’ll get a different response meaning if you change WHY the knee cartilage is degenerating, you’ll change the degeneration response. The body has an amazing ability to health itself if given the opportunity!
MIMICKING HUMAN KNEE CARTILAGE TO REPAIR A KNEE
By ANNE EISENBERG
ONE way for surgeons to repair injured knees is to take cartilage and bone from another part of the knee and transplant it in the damaged area.
Now companies are developing potentially simpler knee patches: small, off-the-shelf plugs engineered to mimic the composition of human bone and cartilage.
These ready-made cylinders can be inserted in an arthroscopic procedure; they are often used after a sports injury. They are known as osteochondral scaffolds, because they support new bone and cartilage as it grows.
Orthomimetics, a company in Cambridge, England, has developed a scaffold approved for use in Europe that resulted from a collaboration between faculty members at theMassachusetts Institute of Technology and the University of Cambridge.
The scaffold provides a temporary, engineered matrix when inserted into a drilled hole, said Lorna Gibson, a professor of materials science and engineering at M.I.T. and one of the inventors of the device. Stem cells from the bone marrow that can form bone or cartilage impregnate the pores of the cylinder.
“The scaffold guides the tissue formation of bone on one side and cartilage on the other,” Dr. Gibson said.
The scaffold disappears in about six months. “Over time the cells that attach to the scaffold produce enzymes that dissolve it,” Dr. Gibson said. At the same time, the cells are putting down their own matrix.
Dr. Constance R. Chu, director of the Cartilage Restoration Center at the University of Pittsburgh and the Albert Ferguson associate professor of orthopedic surgery and bioengineering, said that there were potential benefits to using the cylinders to help repair cartilage that protects bones in the knee joint from rubbing against one another.
“Surgeons can do effective repairs by borrowing bone and cartilage from another part of the knee” that is less weight-bearing, Dr. Chu said. “But people don’t have a lot of extra cartilage — if any — to go around.”
Dr. Chu has herself worked on creating such devices. “The thinking has always been that the scaffold will support and guide the repair,” she said. “That’s why people will spend years to make something like this.”
The plugs are for the treatment of small lesions of no more than half a square inch of surface area, said Andrew Lynn, the chief executive of Orthomimetics. Myron Spector, a professor of orthopedic surgery at Harvard Medical School who collaborated with the M.I.T.-Cambridge group in a preliminary study, said the scaffold had promise. An off-the-shelf equivalent of transplanted cartilage and bone is clearly better than such a transplant, Dr. Spector said, but he pointed out that the device was as yet unproven in clinical trials.
Dr. Spector said he was also concerned that doctors might use the device in patients who had only cartilage damage, drilling into bone to insert it. “You wonder, why create a defect in bone where it didn’t exist before, to put in the device?” he said.
Another plug, TruFit CB, is approved for use with bone and cartilage injuries in Europe, Canada and Australia, said Joe Metzger, a spokesman for its maker, Smith & Nephew of Andover, Mass. It is sold in the United States under the name TruFit BGS, and is cleared for use to fill some voids or gaps in bone but not for cartilage repair, he said. The TruFit plugs are being tried out by Dr. Riley J. Williams III, director of the Institute for Cartilage Repair at the Hospital for Special Surgery in New York, where he treats many professional basketball and soccer players. Dr. Williams first used the devices to fill holes from which tissue had been taken for transplants, and, after seeing good results inMRI scans, experimented with using them for cartilage repair in about 250 patients. Doctors are permitted to use approved drugs and devices in unapproved, or “off label,” ways as they deem appropriate.
“I’m very pleased with the clinical results,” said Dr. Williams, who said he had no connection to Smith & Nephew. “It’s a less traumatic surgery and you are not damaging the other areas of the knee” by removing cartilage.
Dr. Bert R. Mandelbaum, an orthopedic surgeon at the Santa Monica Orthopaedic and Sports Medicine Group in Santa Monica, Calif., said the new plugs were appealing. “They are off-the-shelf, and the intervention is relatively easy,” he said. “They don’t bring in those other variables of big expense and time.”
But the scaffolds aren’t appropriate for everyone, Dr. Mandelbaum said: “The problem is that sometimes they don’t integrate with the surrounding bone.”
One solution is to consider surgical intervention earlier in life and in the development of the problem being treated. “A 16-year-old will respond well to our interventions, but a person who has had a problem for 16 years might respond differently,” Dr. Mandelbaum said. “Every cartilage repair technique works better in the young.”