New stem cell operation could revolutionise treatment of knee injuries- The Guardian, 23rd July 2014
I had just finished a perfect routine in the middle of an on-ice show when I dislocated my knee cap and knocked all of the cartilage out. I really do mean all of it. My doctor took great pleasure in waving the extracted bits of cartilage in front of me and telling me that it was the worst case he had seen, just what I needed whilst in an anaesthetic haze.
My options were not great; left untreated I would be in constant pain and unable to walk up a flight of stairs, let alone run or dance. Ice skating was out of the question. On the NHS I could have a knee replacement (at 18 years old that was not appealing) or have my knee cap removed entirely. However, my doctor had been trialling a new treatment called MACI: Matrix induced Autologous Cartilage Implantation which involved re-growing my cartilage in a lab in Sweden and then sticking it (literally) back into my knee. At the time this was an experimental procedure and only available with private healthcare, but since then treatment of knee injuries has come on leaps and bounds.
‘10.4 million’ injured knees in 2010
Nearly everyone knows someone who has suffered from a bad knee (there were so many of us at work we almost started a bad knee club!), but knee injuries are unlikely to be fatal so we rarely hear about advances in treatment. This doesn’t mean surgeons and scientists haven’t been working on it. Twenty years ago cartilage damage would have resulted in permanent discomfort, leading to osteoarthritis, and eventual knee replacement because cartilage cannot repair itself. Other treatments have been employed over the years such as bone marrow stimulation, which involves drilling into the bone to release stem cell rich bone marrow which forms clots and encourages the growth of new cells. However, with this type of procedure the cartilage produced is of a different type compared to the original ‘hyaline’ cartilage and cannot withstand as much force. When I had my treatment in 2004, cartilage implantation techniques (such as MACI) were relatively new and have since been fairly successful, especially in young people with sports related injuries. The procedure involves taking healthy cartilage cells from a patient and encouraging more growth in a lab, and then re-implanting them. The cells can be injected under a patch at the affected area or planted on a sponge like patch made of collagen that can be glued into the affected area. Since the cells are from the patient there is no rejection and during an extensive rehabilitation the cells can reintegrate into the remaining cartilage. There is a detailed article about the procedure and the history of cartilage repair surgery in the BMC Sports Science, Medicine and Rehabilitation Journal.
The future of knee surgery
I had my operation in 2004 and since then there have been a few advances in treating damaged cartilage. One such advance was the use of spider silk which could stimulate growth of new cartilage whilst performing the shock absorbing role of cartilage almost as well as the original, thus providing a short-term solution whilst the bodies’ own cells repaired themselves. This week surgeons at the University of Southampton have performed a new procedure that for the first time promises to completely repair the damage. During the procedure stem cells (the cells that can grow into any other kind of cell) are removed from the hip of the patient and mixed with platelet gel and hyaluronic acid to form a ‘glue’ that is applied to the injured cartilage. Platelet gel is a synthetic product containing a high concentration of platelets which are responsible for blood clotting and hyaluronic is naturally present in the body so neither presents an increased health risk. Early results are promising but we will have to wait to see if the regeneration is permanent.
Despite having the MACI operation I was never able to return to competitive skating, but at least I can walk up stairs painlessly. I am hoping that one of these new techniques will cure cartilage damage for good and I’ll be the first in line for treatment!