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Sunday September 15, 2013 MYT 6:00:00 AM
Sunday September 15, 2013 MYT 7:29:44 AM
by fiona ho
Knee cartilage structures can be damaged with regular wear and tear, but damage is more likely to occur from accidents or trauma from sports events.
A surgical treatment option based on stem-cell transplantation can help repair articular cartilage damage.
FOR many years, articular cartilage damage has been the stuff of nightmares for orthopaedic surgeons.
This is because once injury or disease from a damaged articular cartilage (which usually occurs in the knee joint) sets in, it does not usually regenerate or heal well. This often leads to a permanent loss of tissue and formation of a defect.
By definition, cartilage is a tough, flexible tissue that is found throughout the body. It serves two main functions: as a shock absorber, and as a mould.
This tissue covers the surface of joints, enabling bones to slide over one another while reducing friction and preventing damage. On top of that, it helps to support your weight when you move, bend, stretch and run.
Unlike muscles and other types of tissue, cartilage does not have its own blood supply. Blood vessels carry nutrients and other essential components to the site of tissue damage to assist the healing process. Due to this, damaged cartilage does not heal as quickly as damaged skin or muscles.
Unfortunately, cartilage structures and functions can be damaged with regular wear and tear, but is more likely to occur from causes such as a bad fall or trauma from sports events. Symptoms include persistent pain, swelling, stiffness and a decreased range of knee movement.
Such cases are more common in people under the age of 35. This is because people from this age group are more likely to engage in sporting activities, where there is a higher chance of injury.
However, cartilage damage also occurs with ageing. Cartilage damage associated with osteoarthritis is most common in adults aged 50 and above, and is seen more in women than in men.
Generally, those who have undergone surgical interventions are more vulnerable to articular cartilage damage, due to the altered mechanics of the joint.
Treating cartilage damage
There are a number of non-surgical and surgical treatment options that can help relieve the symptoms of damaged articular cartilage. Most of these treatments aim to reduce inflammation and pain.
Some common non-surgical treatments include physiotherapy exercises to strengthen the muscles surrounding the joint, making lifestyle changes to reduce activity that involves the affected joint, as well as using painkillers and/or supportive devices such as a cane or a leg brace to manage the pain.
However, non-surgical treatment options may only provide short-term relief. In more severe cases of articular cartilage damage, surgery may be required.
Articular cartilage repair, a surgical treatment option based on stem-cell transplantation, is a minimally-invasive surgery that can help regenerate articular cartilage.
The treatment uses mesenchymal stem cells (MSCs) – adult stem cells that are found in the bone marrow, blood and adipose (fat) tissue.
MSCs are multipotent stem cells, and are able to differentiate to form adipocytes, cartilage, bone, tendons, muscle, and skin.
As with other stem cell types, MSCs have a high capacity for self-renewal while maintaining its multipotency. Thus, these cells have enormous therapeutic abilities for cartilage repair.
In a recent talk in Kuala Lumpur, Dr Choi Yun-Jin, director of the stem cell and arthritis research centre in South Korea’s Yonsei Sarang Hospital, explains that MSCs have attracted attention for clinical use due to their multilineage potential, limited immunogenicity, relative ease of growth in culture, and generally acceptance by society.
“These qualities make MSCs a viable option in cell-based treatment of cartilage lesions,” says Dr Choi.
He adds that the choice of stem cell source depends on the ease of harvesting, population density, as well as differentiation potential of the cells.
Currently, the haematopoietic stem cells (stem cells extracted from the bone marrow) are the most commonly used here.
Unfortunately, bone marrow extraction is often painful and could lead to donor site morbidities, as well as risks of wound infection, Dr Choi says.
He observes that adipose tissue is a better source of MSCs as it involves less complications and has been reported to give a higher yield for stem cells.
In his study on MSCs injection and knee osteoarthritis, Dr Choi and his team found that intra-articular injection of infrapatellar fat pad–derived mesenchymal stem cells is effective for reducing pain and improving knee function in patients being treated for knee osteoarthritis.
The study, published earlier this year, sought to evaluate the clinical and imaging results of patients who received intra-articular injections of autologous MSC stem cells for the treatment of knee osteoarthritis. It comprised 18 patients (six men and 12 women), aged between 41 and 69 years old.
Consultant orthopaedic surgeon Dr Ng Swee Soon describes the MSCs treatment, now available in Malaysia, as a “one-step procedure”.
“These MSCs are harvested from adipose tissues found at the posterior region (buttocks) under local anaesthesia in the one-step procedure. The surgery will usually last around two hours,” Dr Ng told the media at the talk.
Dr Ng also points out that an increasing number of Malaysians are suffering from articular cartilage damage due to heightened interest in sporting events such as marathon-running in recent years. Long and strenuous exercise can lead to weakened joints.
The one-step procedure provides pain relief and restores functionality in the joint. The goal is to allow patients to regain full mobility, and over time, to go back to their previous lifestyle and activity level.
In doing so, it also slows down cartilage degeneration with the intent to avoid or delay partial or total joint replacement (eg knee replacement) surgery.
“Generally, most patients will have to rely on crutches for about two weeks to a month before they resume their usual daily activities after surgery,” says Dr Ng.
“In most cases, patients should be able to go back to playing sports or an active lifestyle in about three to six months.”
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Health, Lifestyle, Quill Orthopaedic Specialist Centre, articular cartilage damage
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