About 15 to 20 years ago, a severe knee injury often meant the end of a person’s active lifestyle. Once cartilage was removed from the ends of the bones in the knee, nonstop pain and limited motion frequently were the results.
Then along came arthroscopy and magnetic resonance imaging (MRI) and all kinds of new technologies and surgeries to alleviate the trauma and pain and shorten the rehabilitation process for people with knee problems.
Dr. Mike Malek, founding director of the Washington Orthopaedic and Knee Clinic in Oxon Hill and Vienna is playing a part in the next phase of knee-pain study. His center is one of 20 in the United States and Canada participating in a new study comparing different treatment options for cartilage repair, focusing in particular on a new technique called autologous chondrocyte im-plantation (ACI). The National Naval Medical Center in Bethesda also is participating in the study, but only military personnel are eligible to take part there.
“This new technique has been going on in Europe Sweden for 14 years or so,” Dr. Malek says. “It allows us to take a very small piece of normal human cartilage from somewhere on the [patient’s] knee and send it to a lab, and under laboratory conditions, this cartilage is grown to large amounts of cartilage cells, 12 million or so, to be exact.”
After that, a doctor would go back to the patient and patch the damaged area with the new laboratory-grown cartilage.
“There’s no rejection, since it’s the patient’s own cartilage,” Dr. Malek says. “Once the area has healed, then we have normal or very close to normal cartilage there, and it has all the good characteristics of regular cartilage. It contributes to weight distribution, produces joint fluid and is very durable it will last forever.”
All that stands in contrast to the old way of treating cartilage injury, which basically was to take out the damaged cartilage, drilling tiny holes into the base of the damaged area and letting scar tissue form. Dr. Malek says the scar tissue generally would be more fibrous than regular cartilage, and since it’s not real tissue, it wouldn’t have any of the good characteristics he mentioned.
Dr. Malek says he has performed ACI procedures on about 30 patients in the few years since the U.S. Food and Drug Administration approved it in 1997.
Now his clinic is participating in a study sponsored by Genzyme Tissue Repair of Cambridge, Mass., which has been monitoring ACI procedures in the United States for the past three years and growing the replacement cartilage. The study will compare ACI surgery with the traditional forms of cartilage injury treatment, such as drilling, to help surgeons de-termine the best course of action for their patients.
About 700 patients nationwide have undergone the new procedure, Dr. Malek says.
One of those patients, Christine Worrell of Centreville, says she was able to return to her job as a respiratory therapist at Inova Fairfax Hospital two weeks earlier than she expected. She says “something had always been wrong” with her right knee, but it was misdiagnosed continually until Dr. Malek discovered a small hole at the base of her femur, or thigh bone.
“It could have taken almost anything to wreck the knee,” Mrs. Worrell says. “Bumping it against a file cabinet just right, anything.”
“I still can’t run, and I can’t play tennis for a year,” she says, “but the alternative for me would have been knee replacement in five to 10 years.”
Dr. Malek has no reservations about the procedure, having performed it on people from “all categories of life” and found that every patient returned to a normal lifestyle. He says the study will be important, nonetheless, because orthopedic surgery breakthroughs need a good five or 10 years of follow-up to see the long-term effects, and doctors in the United States haven’t been able to do that because the procedure has been allowed for only three years.
“Those of us who have been involved in this from Day One know from our patient population that it works,” Dr. Malek says. “We’re trying to look at those other patients, those individuals who have had other procedures done and it did not work. And we’re going to bring them in and do this procedure and then follow them for the next four years so that we can say, ‘These patients had that procedure done and it didn’t work, and they followed this and it worked.’ It’s a reasonable way to compare different procedures so it won’t be like comparing apples and oranges.”