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Tissue transplant, repair can reduce need for extensive joint replacement in younger, more active patients University of Missouri Health Care orthopaedic surgeons who specialize in sports-related injuries may be able to offer younger, more active patients a different approach to restoring joint health. Traditional knee replacement surgery has been performed for decades by using metal, ceramic and plastic components to provide an alternative bearing surface and restore mobility to diseased joints. For patients who are experiencing degenerative conditions such as arthritis of the knee joint, this approach is an excellent option. But for the young individual who has experienced trauma to a joint through a sports-related activity, automobile accident or some other non-degenerative injury, joint replacement may not be the best option. Injuries to the meniscus or articular cartilage are quite common and are a focus of research interest by the orthopaedic surgeons at MU. “At our clinic, we see quite a few younger patients who range in age from their late teens to their early 40s who have some form of trauma to their joints,” said Kevin Marberry, M.D., an orthopaedic surgeon at University of Missouri Sports Medicine. “If I have a patient who has experienced a tear to their meniscus or injury to their articular cartilage, my first reaction is going to be to focus on an option that involves repairing the joint and not replacing it.” Articular cartilage is the layer of tissue the covers the ends of opposing bones and permits nearly friction-free movement of the joint. The meniscus consists of two oval-shaped wedges of fibrous tissue in the knee joint that are positioned between the tibia and the femur. This cartilage acts as a shock absorber and prevents damage to both bones. Tendons and ligaments, such as the anterior cruciate ligament, or ACL, hold the joint in place and are also subject to damage or injury. Significant articular cartilage lesions are much less common and are present in approximately 5 percent of all knee arthroscopy procedures. Meniscal tears are the most common knee injury and account for approximately 850,000 surgical repair procedures each year in the United States. “In a recent case where a patient presented with a large fracture of the patellar articular cartilage and bone due to a dislocated knee cap, we were able to repair the damage using a fibrin glue and a fine suture in addition to bioabsorbable compression screws,” said Marberry. “This was a young elite-level athlete who may have otherwise needed a total knee replacement. A replacement would have restored mobility to the joint, but it would have also reduced the kinds of activity this young individual could have participated in, which ultimately is a quality-of-life issue that we avoided altogether.” When repair of meniscus tears is not an option, Richard White, M.D., an orthopaedic surgeon with University of Missouri Sports Medicine, is able to avoid replacement of the joint by implanting an allograft of bone and meniscal tissue from a donor to a recipient. “By combining research, technology and technique, we now have options that were not previously available,” said White. “There are some cases where repair is not an option, but we want to avoid replacement as well. An allograft is a remarkable solution because we are able to transplant bone or soft tissue into the joint and avoid removing the vital components, such as the meniscus. Once the graft is accepted by the body, it is slowly converted into new, living tissue and incorporated into a functioning part of the joint.” The MU sports medicine team includes Marberry; White; William Allen, M.D., orthopaedic surgery; and Steven Kane, M.D., orthopaedic surgery and director of University of Missouri Sports Medicine. University of Missouri Health Care’s system of hospitals, clinics and telehealth sites employs approximately 6,000 clinicians, scientists, educators and other health professionals. The system includes University Hospital and Clinics, Children’s Hospital, Columbia Regional Hospital, Ellis Fischel Cancer Center and University Physicians, all based in Columbia, Mo. The health system also includes a long-term acute care facility, Missouri Rehabilitation Center, in Mount Vernon, Mo. Academic affiliates of the health system include the University of Missouri-Columbia School of Medicine, Sinclair School of Nursing and School of Health Professions. Other affiliates of the health system include Rusk Rehabilitation Center in Columbia, Mo.; Capital Region Medical Center in Jefferson City, Mo.; and Cooper County Memorial Hospital in Boonville, Mo. |
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