Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

New procedure bests standard of care for fixing damaged cartilage

08.02.2012
A new study has demonstrated that a procedure wherein healthy cartilage is transplanted to fix an area of damaged cartilage (osteoarticular cartilage transplantation or OATS procedure) is superior to the standard of care for repairing cartilage defects.

It is thought that fixing such lesions may ultimately help to prevent the onset of osteoarthritis, and get athletic individuals back to sporting activities reliably. The study by Hospital for Special Surgery researchers was reported at the annual meeting of the American Academy of Orthopaedic Surgeons, Feb. 7-11.

"Studies have shown that there is only about a 40% return to sport after the microfracture procedure which is the standard of care treatment in the U.S. Over 90% of patients return to sport with the OATS procedure, said Riley J. Williams, III, M.D., a sports medicine orthopedic surgeon at Hospital for Special Surgery (HSS) in New York City and senior investigator of the study. "For those who have isolated cartilage lesions of the femur and are interested in a return to sport in a timely and predictable fashion, the OATS procedure, relative to microfracture, represents a better option."

For years, researchers have known that erosion of articular cartilage, the soft lining or cushion at the end of bones, can lead to symptomatic osteoarthritis. The cartilage can be damaged from normal wear and tear or from a traumatic injury. Once the cartilage is damaged, it continues to deteriorate. Athletes with progressive osteoarthritis are often forced to stop playing their sport of choice.

Over the years, researchers have developed a number of procedures for repairing cartilage in patients who range from roughly 16 to 50 years of age. The current standard of care is microfracture, an arthroscopic procedure that involves using a tiny pick to punch holes into the base of the damaged cartilage area. This promotes bleeding and allows bone marrow cells to come to the surface of the damaged tissue. As a result, the cells then change into fibrocartilage cells and heal the defect. A study from the HSS Cartilage Registry showed that only about 40% of athletes return to sport after this procedure. "40% is such an abysmal rate of return to sport, which is why we keep looking for other repair methods to help our patients," said Dr. Williams, who is also director of the HSS Institute for Cartilage Repair.

Another more recently developed procedure is OATS, which involves transferring healthy cartilage tissue from one part of a person's knee to the damaged area. The transplanted graft includes cartilage and underlying bone and can be performed arthroscopically. A single plug of cartilage may be transferred or multiple plugs may be transferred in a procedure called mosaicplasty. Each plug is a few millimeters in diameter, and when multiple plugs are moved to the damaged area, it creates a mosaic appearance.

Several European studies have shown that the OATS procedure provides a higher return to sport and a longer lasting result, but HSS researchers wanted to verify the results in the U.S. population. "There is an essential difference between American sports and European sports. When you talk about European sports, you are really talking about soccer," said Dr. Williams, whereas most U.S. patients mostly participate in American football, basketball, running, as well as soccer.

To test the two procedures in the U.S. population, HSS investigators recruited 48 patients who had "potholes" in their cartilage in the area known as the femoral condyle, an area located at the end of the thighbone in the upper half of the knee. For the control group, the researchers identified 48 patients in the HSS Cartilage Registry who were matched for gender and underwent microfracture for a similar cartilage repair, same lesion size and location.

Clinicians evaluated patients prior to surgery and at one, two, three and five years of follow-up. They used a variety of tools commonly used to measure outcomes in patients undergoing these types of procedures. They used the short-form (SF)-36 health survey, a 36-question scale that includes a gamut of questions about general health and is widely used across all fields of medicine. They used two knee specific questionnaires: the international knee documentation committee (IKDC) scores and the Knee Outcome Survey (KOS). And they used the Marx Activity Level that is scored on a scale from 0 to 16 and gauges a person's ability to do four activities: running, cutting, decelerating, and pivoting.

They found no difference in the knee outcome surveys or SF-36 form, but they did identify significant differences in the Marx Activity Level. Patients who underwent the OATS procedure had higher scores than patients who underwent microfracture at one year from baseline (score 5.21 vs. 4.11), two years (7.29 vs. 3.71), three years (7.75 vs. 2.91) and five years (8.55 vs. 2.89).

"The Marx activity rating scale correlates directly to the amount of physical activity that you can do at the time of the assessment," said Dr. Williams. "Patients who underwent the OATS were able to do more sports and more athletic activities compared to the microfracture group at the same time point. We now have another procedure which is likely to result in a return to sport more predictably."

He said the results are not surprising given that the OATS repair results in a natural cartilage repair whereas microfracture results in a repair comprised mainly of fibrocartilage that has been shown to be biomechanically inferior to articular cartilage.

Dr. Williams is the head team physician for the Nets NBA basketball team and the Major League Soccer's New York Red Bulls.

Other investigators involved in the research are Thomas Wickiewicz, M.D., Russell Warren, M.D., and Scott Rodeo, M.D., from Hospital for Special Surgery; Heather Harnly, M.D., a former HSS fellow who is now at Robert Wood Johnson University Hospital, East Brunswick, New Jersey; and Aaron Krych, M.D., a former HSS fellow who is now at the Mayo Clinic, Rochester, Minn.

Higher Activity Level after Mosaicplasty than Microfracture for Cartilage Defects of the Knee (Paper 282)

Wednesday, Feb. 8, 2:54 p.m.—3:00 p.m. Moscone West, 2024

About Hospital for Special Surgery

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 2 in rheumatology, No. 19 in neurology, and No. 16 in geriatrics by U.S.News & World Report (2011-12), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center three consecutive times. HSS has one of the lowest infection rates in the country. From 2007 to 2011, HSS has been a recipient of the HealthGrades Joint Replacement Excellence Award. HSS is a member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

For more information contact:
Phyllis Fisher
212-606-1197
FisherP@hss.edu
Tracy Hickenbottom
212-606-1197
HickenbottomT@hss.edu

Phyllis Fisher | EurekAlert!
Further information:
http://www.hss.edu

More articles from Health and Medicine:

nachricht Biofilm discovery suggests new way to prevent dangerous infections
23.05.2017 | University of Texas at Austin

nachricht Another reason to exercise: Burning bone fat -- a key to better bone health
19.05.2017 | University of North Carolina Health Care

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Strathclyde-led research develops world's highest gain high-power laser amplifier

The world's highest gain high power laser amplifier - by many orders of magnitude - has been developed in research led at the University of Strathclyde.

The researchers demonstrated the feasibility of using plasma to amplify short laser pulses of picojoule-level energy up to 100 millijoules, which is a 'gain'...

Im Focus: Can the immune system be boosted against Staphylococcus aureus by delivery of messenger RNA?

Staphylococcus aureus is a feared pathogen (MRSA, multi-resistant S. aureus) due to frequent resistances against many antibiotics, especially in hospital infections. Researchers at the Paul-Ehrlich-Institut have identified immunological processes that prevent a successful immune response directed against the pathogenic agent. The delivery of bacterial proteins with RNA adjuvant or messenger RNA (mRNA) into immune cells allows the re-direction of the immune response towards an active defense against S. aureus. This could be of significant importance for the development of an effective vaccine. PLOS Pathogens has published these research results online on 25 May 2017.

Staphylococcus aureus (S. aureus) is a bacterium that colonizes by far more than half of the skin and the mucosa of adults, usually without causing infections....

Im Focus: A quantum walk of photons

Physicists from the University of Würzburg are capable of generating identical looking single light particles at the push of a button. Two new studies now demonstrate the potential this method holds.

The quantum computer has fuelled the imagination of scientists for decades: It is based on fundamentally different phenomena than a conventional computer....

Im Focus: Turmoil in sluggish electrons’ existence

An international team of physicists has monitored the scattering behaviour of electrons in a non-conducting material in real-time. Their insights could be beneficial for radiotherapy.

We can refer to electrons in non-conducting materials as ‘sluggish’. Typically, they remain fixed in a location, deep inside an atomic composite. It is hence...

Im Focus: Wafer-thin Magnetic Materials Developed for Future Quantum Technologies

Two-dimensional magnetic structures are regarded as a promising material for new types of data storage, since the magnetic properties of individual molecular building blocks can be investigated and modified. For the first time, researchers have now produced a wafer-thin ferrimagnet, in which molecules with different magnetic centers arrange themselves on a gold surface to form a checkerboard pattern. Scientists at the Swiss Nanoscience Institute at the University of Basel and the Paul Scherrer Institute published their findings in the journal Nature Communications.

Ferrimagnets are composed of two centers which are magnetized at different strengths and point in opposing directions. Two-dimensional, quasi-flat ferrimagnets...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Marine Conservation: IASS Contributes to UN Ocean Conference in New York on 5-9 June

24.05.2017 | Event News

AWK Aachen Machine Tool Colloquium 2017: Internet of Production for Agile Enterprises

23.05.2017 | Event News

Dortmund MST Conference presents Individualized Healthcare Solutions with micro and nanotechnology

22.05.2017 | Event News

 
Latest News

New photocatalyst speeds up the conversion of carbon dioxide into chemical resources

29.05.2017 | Life Sciences

NASA's SDO sees partial eclipse in space

29.05.2017 | Physics and Astronomy

New drug reduces transplant and mortality rates significantly in patients with hepatitis C

29.05.2017 | Statistics

VideoLinks
B2B-VideoLinks
More VideoLinks >>>