Posts Tagged ‘cartilage transplant’

Cartilage Replacement Surgery – A Patient’s Success Story


cartilage repair
Marcus Hutchinson knows all too well about surgery and physical therapy – he has had 6 surgeries on his left knee. He has also been a physical therapist for 22 years. As a teenager, Marcus was diagnosed with osteochondritis dissecans, also known as OCD, a joint condition in which a piece of cartilage, along with a layer of the bone beneath it, comes loose from the end of a bone due to trauma or lack of blood flow to this area. Osteochondritis dissecans is most commonly found in the knee and often occurs in young men.

By the time Marcus arrived at Emory Orthopaedics & Spine in Dr. Sam Labib’s clinic in 2006, his left knee had been operated on 4 different times. Dr. Labib examined Marcus and determined he had a massive osteochondral defect in his left knee that involved his entire lateral femoral condyle, a portion of the top bone of the knee joint.

Previous doctors had told Marcus that the only option he had left was total knee replacement. Dr. Labib did not recommend knee replacement because Marcus was too young to have this procedure. Typically, a joint replacement will only last about 15-20 years so if Marcus were to have the knee replaced in his 30’s, he would probably need to have another knee replacement by his 50s.-

Dr. Labib was able to offer Marcus a unique procedure called cartilage replacement surgery. Marcus had a massive fresh allograft implantation taken from a cadaver in February 2010 to treat his osteochondral defect.

There are several surgical techniques available to treat patients with OCD.

Below are three that Dr. Labib regularly performs.

• Microfracture Surgery – In microfracture surgery, small holes are drilled into the underlying bone, creating blood clots. As the blood clots heal, new repair cartilage or fibrocartilage forms.

• Autologus Osteochondral Plug Transfer – In this procedure, the patient’s own cartilage and bone are harvested from a low-stress area of the knee and implanted into the patient’s knee in the damaged area to fill the holes and defects with healthy cartilage and bone.

• Fresh Allograft Implantation – In this surgery, the cartilage and bone are taken from a fresh cadaver that has been donated for medical use. The donated tissue, also called an allograft, is thoroughly screened and matched to the patient defect to give it the best possible chance of successful healing. The surgeon prepares the patient’s knee by removing the damaged area. The allograft is then implanted and anchored to the surrounding bone.

Marcus’ surgery was performed at Emory University Orthopaedics & Spine Hospital. When asked about his experience he states, “I had such a positive experience at the hospital. Great care! Very attentive staff. Clean, professional and efficient.”

Marcus had one major goal following surgery and that was to walk and stand without pain. “I stand all day at work when seeing my patients for physical therapy. Before surgery with Dr. Labib, I had so much pain in my knee that it was affecting my job and day to day life. I feel so much more stable and pain-free now after having cartilage replacement surgery.” Marcus says he has a new perspective on what patients are experiencing after surgery and during physical therapy which has made him better at his job as a physical therapist. He is back to enjoying life with no pain and participating in low-impact activities such as swimming, cycling, and yoga.

About Dr. Sameh (Sam) A. Labib

Sam Labib, MD, is a sports medicine fellowship-trained surgeon and director of the foot and ankle service at Emory. Dr. Labib started practicing at Emory in 1999. He is an Associate Professor of Orthopedic Surgery.

Dr. Labib has a particular interest in problems and procedures of the knee, ankle, and foot. He is the head team physician for the athletic programs at Oglethorpe University, Spelman College, and Georgia Perimeter College. He is also an orthopaedic consultant to the Atlanta Falcons, Georgia Tech and Emory University.

He has lectured both nationally and internationally at many orthopedic meetings. His research has been published in several journals, including the JBJS, Arthroscopy, Foot and Ankle International and the American Journal of Orthopedics as well as numerous video presentations and book chapters. Dr. Labib is Board Certified in orthopedic surgery with additional subspecialty certification in Sports Medicine Surgery. For the past 5 years, Dr. Labib has been nominated by his peers as one of “America’s Top Doctors” as tracked by CastleConnelly.com.

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Repairing Cartilage Injuries with Cartilage Transplants

cartilage repairDr. Sameh LabibWith another exciting football season well underway, athletes all over the country are putting enormous strains and stresses on their cartilage, the connective tissue between bones that absorbs shock and helps joints move smoothly. Cartilage is a remarkable tissue, but with such punishing forces applied to it, cartilage is sometimes damaged. A new procedure we’re studying at Emory Sports Medicine – cartilage transplantation – may offer an alternative approach to cartilage repair.

Cartilage damage is common in active people, particularly among those who play sports that involve lots of pivoting and twisting. Basketball, soccer, football… basically any sport involving a ball and running increases the risk of a cartilage injury, most commonly in the knees, ankles, and hips. In many cases, these injuries cause no serious, long-term problems. But sometimes a chip, divot, or hole in cartilage can cause significant pain and mechanical symptoms such as clicking, catching, and locking up of the affected joint.

Standard approaches to cartilage repair include scraping or smoothing the damaged cartilage, or poking a hole in the underlying bone to provoke a blood clot and a healing response. Emory Sports Medicine is one of only 25 centers around the country studying cartilage transplantation.

Cartilage transplantation repairs damaged cartilage with replacement cartilage. We mix the donated cartilage with fibren glue (a common medium for biological repairs), form it into a patch of the appropriate size and shape, and insert it into the damaged area. Low and behold, it knits with the surrounding cartilage, stays in place, and forms new, healthy cartilage.

Unlike with many organ transplants, a cartilage transplant does not provoke a harmful immune response that could lead to rejection of the transplant. Cartilage is “avascular”: it doesn’t have any blood elements in it for the body to reject. This is why cartilage heals so slowly on its own, but it is also why we are able to transplant it without risk of rejection. It is what we call “immune-privileged tissue,” tissue that does not provoke an immune response.

Cartilage transplantation is still a new procedure. The study in which Emory Sports Medicine is participating will help us better determine the pros and cons of it in comparison to other approaches to cartilage repair. Will a repair made with actual replacement cartilage offer an expedited or improved recovery? We don’t yet know, but I can’t wait to find out.