April 06, 1999

Nancy Lawrence
Media Relations, LHSC
519-685-8500, ext. 77642

London Health Sciences Centre only Canadian Centre participating in cartilage transplantation study

(LONDON, Ontario) - Two London Health Sciences Centre (LHSC) orthopaedic surgeons are participating in a North American clinical trial to study the effectiveness of a new treatment for patients with damaged knee cartilage (lesions). LHSC is currently the only Canadian hospital participating in the study. Drs. Sandy Kirkley and Peter Fowler, who work out of LHSC's Fowler-Kennedy Sport Medicine Clinic, have performed cartilage transplants in three patients since January.

Normal knee function requires a smooth gliding cartilage surface on the ends of the bones. This surface is composed of a thin layer of slippery, tough tissue called hyaline cartilage. The cartilage also acts to distribute force during repetitive pounding-like movements such as running or jumping.

A lesion typically appears as a hole or divot in the cartilage surface. Since cartilage has a limited ability to repair itself, even small lesions (approximately the size of a dime), if untreated, can hinder a person's ability to move free from pain and can progress to deterioration of the joint surface. Current treatment options may moderately improve symptoms, but are not capable of correcting the damage, so satisfactory outcomes of current treatments are usually short-lived and symptoms often return requiring further treatment, says Dr. Kirkley.

The transplantation treatment involves taking a tiny biopsy of healthy cartilage tissue via arthroscopic surgery then sending the tissue cells away to Boston, Mass. to be cultured. Cell culturing - the growth of cells outside of the body - takes about four to five weeks, during which time the cells multiply significantly. The surgeons will be supplied with about 12 million cells at the time of the patient's next surgery. A procedure is then performed whereby the damaged cartilage is removed and the healthy cells implanted into the damaged area, or lesion. Here, the cells continue to multiply and integrate with the surrounding healthy cartilage, eventually filling in the lesion that existed.

Rehabilitation therapy is necessary following the surgery. Patients use crutches for approximately six weeks following the procedure and most patients can resume low-level activities such as swimming, walking and biking within six months. Strenuous activities that involve pivoting or jumping, such as tennis, should be postponed for approximately one year following surgery to allow the cells time to regenerate.

"We are now ready to enrol patients in the clinical trial to determine how effective this new treatment option is for patients with damaged cartilage," says Dr. Kirkley. "For the technique to work, however, there must be normal, healthy cartilage surrounding the lesion. For this reason, it is not suitable for most patients with generalized osteoarthritis of the knee."

Patients wishing more information, or those who feel they might be suitable candidates for the procedure, are asked to contact The LHSC Fowler-Kennedy Sport Medicine Clinic at 519-661-2111, ext. 7505.