I am post-op day 1 from right knee arthroscopy, debridement, with amniotic stem cell injection to treat full thickness articular cartilage defect of my right lateral femoral condyle. That is a mouthful, right? Thus here is my experience with regenerative medicine.
Three months ago while downhill skiing I began to have significant knee pain and swelling. Being a Physical Therapist, I treated myself conservatively. I addressed my biomechanics to reduce force through my knee joint in conjunction with strengthening core, hip, and knee stabilizers, optimistically wishing my symptoms away.
My symptoms persisted. A visit to the orthopedic surgeon, radiographs, and MRI findings indicated that I was a candidate for knee surgery. The gold standard to treat my knee was a procedure called micro-fracture, where the surgeon stimulates bleeding through the defective site, creating a scab of mesenchymal cells. These stem cells have the ability to differentiate into a mix of cartilage cells, which have a similar function to the original cartilage. The drawback: the cartilage cells are not the same and do not withstand compressive forces as well. I began researching alternative cartilage regenerative medicine therapies. Following are some of the techniques that are currently being practiced.
- Autologous Chondrocyte Implantation (ACI): a 2 step surgical procedure where healthy cartilage cells are harvested from a non-weight bearing surface of the joint, grown in a lab, and then implanted into defective area in the joint.
- Osteochondral Autograft Transplantation (OATS): Surgical transfer of healthy cartilage from one part of the joint to another. Grafting of cartilage leaves a smooth surface in the joint.
- Osteochondral Allograft Transplantation: Cadaver graft of cartilage is surgically transplanted into defect area. Tissue is harvested, tested for pathology, sterilized, and implanted. Typically reserved for larger cartilage defects.
- Stem cell injection therapy: mesenchymal cells harvested from the following tissue and injected into defect area.
- Adipose (fat)
- Bone marrow: harvested from iliac crest
- Amniotic fluid: donated from healthy newborns, FDA regulated
As you can imagine there are advantages and disadvantages of each of the above techniques. With each option, the size of the cartilage defect, the location of the defect (weight-bearing surface versus non-weight bearing), patient age, activity level, and BMI are considered.
In my opinion (and now experience), if you are considering having any type of “regenerative” procedure you must also address the movement patterns and weakness that ultimately contributed to malalignment and degeneration of healthy articular cartilage. Using a Physical Therapist as a guide towards successful recovery, and return to the activities that you enjoy, has many benefits. Physical Therapists evaluate your movement patterns and identify any compensatory patterns that you might have developed due to pain or adaptive tightness of soft tissues (muscles, tendons, ligaments, nerves). A Physical Therapist will test your strength and recommend specific exercises to address weakness or inhibition (when muscles stop contracting typically due to pain). Manual therapy, including soft tissue mobilization, joint mobilization, use of specialized tools, and dry needling, can help lengthen tight tissues to improve joint alignment, muscular activation, and to decrease pain and swelling.
Following my own advice, I am working on adapting new movement patterns, strength, and mobility to provide for the best chances of success for the regenerative procedure that I had.
Amy Slabaugh, PT, DPT, LMT
Amy is a physical therapist with APRS Physical Therapy at our East Clinic location. Amy is very passionate about biking and skiing and in seeing her patients return to their favorite recreational activities!
- American Academy of Orthopedic Surgeons. Articular Cartilage Restoration. https://orthoinfo.aaos.org/en/treatment/articular-cartilage-restoration/. Accessed March 14, 2018.
- K Uth – 2014. Stem cell application for osteoarthritis in the knee joint: A minireview. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178263/
- Kon, A. Gobbi, G. Filardo, M. Delcogliano, S. Zaffagnini, M. Marcacci (2008). Arthroscopic Second-Generation Autologous Chondrocyte Implantation Compared With Microfracture for Chondral Lesions of the Knee: Prospective Nonrandomized Study at 5 Years The American Journal of Sports Medicine, 37 (1), 33-41 DOI: 10.1177/0363546508323256
- K. Zaslav, B. Cole, R. Brewster, T. DeBerardino, J. Farr, P. Fowler, C. Nissen (2008). A Prospective Study of Autologous Chondrocyte Implantation in Patients With Failed Prior Treatment for Articular Cartilage Defect of the Knee: Results of the Study of the Treatment of Articular Repair (STAR) Clinical Trial The American Journal of Sports Medicine, 37(1), 42-55 DOI: 10.1177/0363546508322897