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Meniscus Replacement
The meniscus is the fibrous shock absorber of the knee. When torn, this tissue is often partially removed. The loss of meniscus tissue leads to force concentration, rather than force dispersion, on the tibial plateau. Consequently, early wearing away of the articular cartilage surface down to the bone occurs. Replacing the meniscus with a cadaveric meniscus tissue can restore some of the meniscus protection, diminish pain and increase function for arthritic patients.2
When combined with cartilage replacement procedures, the new meniscus absorbs the force and protects the repaired cartilage surface. Combining meniscus replacement with articular cartilage repair is a biologic version of a joint replacement. Joint surfaces are replaced by natural tissue rather than metal and plastic. Fortunately, the biologic procedure can be performed as an outpatient arthroscopic procedure. The patient has to use crutches for a month and follow a defined rehabilitation program. Long-term outcomes for each of these procedures have been reported in peer-reviewed journals.2Outcomes for the combined procedures in
comparison to artificial joint replacement are part of a prospective trial now planned at the Stone Clinic.
We believe these results will expand the indications for cartilage repair surgery and delay artificial joint replacement surgery for many people suffering from arthritis. However, delaying artificial joint replacement is not always an option, and for some, total joint replacement may be the preferred treatment.
The Future
Biologic joint replacement is in its early stages. The current efforts at tissue regeneration with or without meniscus replacement will be rapidly replaced by preformed, preloaded matrices of collagen or collagen-like materials, with cells primed to make an extracellular matrix. These off-the-shelf implants will be arthroscopically inserted and applicable to a wider variety of arthritic joints than the current techniques. Each of these advances-cell optimization, matrix selection and growth factors-are in active development around the world.
For example, we are working on a new cartilage replacement technique that will resurface the joint with young, healthy tissue harvested from animals. This shell of articular cartilage is treated to remove the antigens (immune system stimulators) and then repopulated with new cells.
The Stone Research Foundation is now raising funds for these studies, and cell graft optimization studies are under way. These studies are in the preclinical phase and will not see clinical application for several years. However, if joints with only moderate arthritis can be treated biologically without artificial joint replacement, then we hope the developments of tomorrow will be available to patients.
For a list of references, click on the references toolbar.
Kevin R. Stone, MD, is a physician and surgeon at the Stone Clinic in San Francisco. The Stone Clinic is internationally recognized for the treatment of athletic injuries and arthritis. The Stone Clinic shares its developments with the medical community at seminars around the world. The results of these efforts are published in peer-reviewed journals and can be found online at http://www.stoneclinic.com/.
Disclosure: Dr. Stone, indicates that he is the orthopedic surgeon at the Stone Clinic, the Stone Research Foundation, and founder of Joint Juice Inc. and CrossCart Inc.
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