IN THE LAB
When knees can't take any more
Biotechnology is tackling worn-out cartilage with cell culture, artificial plugs and growth factors to coax the knee to heal.
DANGER ZONE: Knee injuries are all too common -- and they often damage the cartilage, which can't heal itself. New methods may make it possible to rebuild that tissue, bringing relief to worn joints. (Ken Hively / Los Angeles Times)
Our knees. We put them through their paces, so to speak, every day. No wonder that, every now and then, they fall down on the job.
Treatments for needy knees generally fit into three categories, says Dr. David Caborn, professor of orthopedic surgery at the University of Louisville: relief (treating the symptoms); repair (getting things back in working order, if not back to normal); and, most recently, restoration (trying to return a damaged knee to its original condition).
In particular, researchers these days are looking for ways to make damaged cartilage as good as new again -- and they're getting closer and closer to pulling it off.
Articular -- or hyaline -- cartilage is the firm, shiny, slick tissue that protects the ends of the thigh bone and the shin bone. Its nearly frictionless surface allows the bones to glide past each other smoothly even when the knee is carrying around a lot of weight.
But strong as it is, articular cartilage -- unlike the bones it safeguards -- has no blood supply of its own, leaving it helpless when it gets hurt. A cut in the skin will heal itself, but a tear in articular cartilage will not.
That's where scientists are stepping in to help.
"We're going through a very exciting time in the whole world of cartilage regeneration," says Dr. Bert Mandelbaum, vice president of the International Cartilage Repair Society and team physician for the U.S. soccer team and for Pepperdine University.
Advances are being made in three main areas: manipulating cartilage cells, or chondrocytes; developing scaffolds for new tissue to grow on; and using growth factors to hurry things along.
"The holy grail will be to have all three come together," Mandelbaum says. "We need to integrate all three into a lunar excursion module. That's how we'll get to the moon."
In 2005, Miguel Rueff of Rialto would feel fine after his weekly softball and basketball games. But his left knee would swell up, and he felt some unidentified floating objects that didn't use to be there.
Those objects were broken-off pieces of cartilage that had left behind two lesions, or holes, says Rueff's doctor, Raffy Mirzayan, co-director of sports medicine and director of cartilage restoration and repair at Kaiser Permanente in Baldwin Park.
Mirzayan treated Rueff, now 28, with an autologous chondrocyte implantation, or ACI, using a method called Carticel, developed by Genzyme Corp. in Framingham, Mass.
In this procedure, a surgeon takes a raisin-size sample of healthy articular cartilage from a patient's knee and sends it to Genzyme's laboratory. There, the 200,000 to 300,000 chondrocytes originally contained in the sample are grown (using a proprietary process) until there are about 12 million.
The surgeon then injects these 12 million cells into the patient's lesion under a patch of tissue he makes from the periosteum, the lining of the patient's shin bone. The company says these cells "mature and eventually fill the defect with a durable cartilage with properties similar to original cartilage."
It's hard to check and see, of course. As Mirzayan says, patients aren't eager to have another surgery just for the sake of science.
But Rueff is happy with his results. "Last week was my first basketball game since the surgery," he says. "I actually felt great."