BINGHAM FARMS, Mich. – Potholes are a constant problem on our roads, and they're no good in your knees, either.
"The cartilage is like a road," said Beaumont Hospital orthopedic surgeon Dr. Joseph Guettler. "If there is a pothole in their cartilage road, we can fill the pothole and perhaps prevent the road from going bad. If you don't do something with the pothole, the pothole turns to bad road and arthritis."
Guettler and his colleague Dr. James Bicos say the wear and tear on some patients' knee cartilage looks as bad as our much-maligned roads. The cartilage is the tissue that covers the ends of the bones where they come together to form joints.
The damage isn't just from overuse. Some patients have suffered an injury that left them with damaged cartilage, which happened to 44-year-old Matt Draving.
"I was a skier in high school and I needed surgery on both knees at the time," Draving said. "Both were meniscal tears. Since then, I have been having more meniscal tears in my right knee."
The pain and symptoms have gotten worse over time.
"Catching, clicking, popping, a little bit of grinding, just a lot of pain," Draving said. "It made me feel old."
Draving works as a surgical assistant in the orthopedics department at Beaumont and heard about their research study to restore a patient's knee cartilage using their own cells.
"The problem with articular cartilage is it really does not have the capacity to heal itself," said Guettler. "The pothole is not going to fill in on its own, so we have to be innovative and thinking about ways to fill the pothole in."
One of those innovations is an experimental treatment called NeoCart. Surgeons obtain a small sample of healthy cartilage from the patient's knee through a minimally invasive knee scope. That sample is then treated and grown to form a tissue implant that looks like a small disc. The disc is then implanted in the injured knee.
"Instead of putting metal and plastic within the knee, we're actually putting patients' own live cells within the knee," said Bicos.
The alternative is an older procedure called microfracture, during which doctors poke holes in the bone to stimulate new cartilage-building cells.
Patients who are accepted into the study won't know which procedure they're getting, and neither will the surgeons, until they're inside the operating room.
"When you go into the operating room, if you are a candidate for that, basically an envelope is opened up," Bicos said. "It is randomized and you go into either the area where we take the cells and implant them or we do the microfracturing technique."
Draving was accepted into the study, but ended up receiving the standard microfracture procedure. As it turns out, his knee already had signs of arthritis.
"Everybody wants the newest, the greatest thing," Draving said. "Sometimes it doesn't work out. I'm doing great. It's getting better every day."
A total of 245 patients will be chosen to participate in the study at 40 sites across the country, including about 20 at Beaumont. They'll be followed for three years after surgery to compare knee function and pain.
To qualify for the study, participants have to be 18-50 years old and have symptoms related to cartilage damage and knee pain in one knee. Patients who have failed other treatments or smoke may not be eligible.
Doctors and patients are excited to see where this new procedure goes.
"The sky's the limit when we talk about the potential," Guettler said.
"There are going to be a lot of people that are going to benefit from this," Draving said. "I think it is going to have a great application in the future."
To learn more about the NeoCart study at Beaumont, click here.
To visit Guettler's and Bicos' website, click here.