We should be making greater efforts to repair damaged cartilage and carry out more restorative surgery for meniscal tears, and patients should be made aware of the latest technology, says Simon Moyes
Consultant orthopaedic surgeon Simon Moyes sees many patients with damaged knee cartilage. “I think this is for a number of reasons,” says Moyes. “We’re all living longer, there are more of us. People are often bigger now, which adds increased loading on joints, causing strain.
“While more people are exercising to keep fit, if it’s not as regular or consistent as it could be, or people exercise without preparation, this can result in a lot more cartilage damage in joints. I see many patients with knee damage who have been pursuing an active lifestyle for longer than previous generations, and are naturally keen to continue doing so. For many of my patients, a sedentary life with no exercise is not an option.”
Moyes says: “The issue is that most meniscal tear surgery involves removing the damaged cartilage rather than repairing it. We should be doing far more in the way of restorative surgery.
“The problem with meniscal resection is that this can increase the chance of arthritis down the line. The latest cartilage repair and restorative technology is becoming more accessible, and patients should know that it exists – whether this be in the public or private sector.”
Treatments
“Repairs to torn menisci can be carried out with a combination of stitching and adjuvant cell technology,” explains Moyes. “Damage to hyaline cartilage can be repaired with microfracture surgery – this uses tiny drill holes to expose bone marrow stem cells, which, in turn, generates neo-cartilage to cover the bone.
“For hyaline cartilage, surgeons can also use a range of stem cell treatments or cartilage grafting. A small amount of cartilage stem cells can be taken from the knee, multiplied in a laboratory and turned into a sheet of new cartilage, which, six weeks later, can be re-implanted into the knee. Other technologies available involve taking healthy knee cartilage from where it isn’t needed and moving it to an area where it is. Transplanted cartilage from a donor can also be effective. Companies are currently developing artificial cartilage substitutes.
“Viscosupplementation can reduce pain for people with arthritic and damaged knees, improve function and may help cartilage heal. Also, PRP (platelet-rich plasma) derived from your own blood can be injected into knees therapeutically, and is very popular in America.”
Stem cells
“Stem cell technology is moving at a fast and exciting pace,” says Moyes. “There are already systems where stem cells can be taken from your bone marrow, and used to augment cartilage repair techniques.”
According to Moyes, stem cells are the future; however, he admits that at the moment stem cell treatments are incredibly expensive, running to thousands of pounds. With time though, as with all new technologies, he’s confident that the cost will come down.
“Restorative and regenerative techniques are more involved than routine keyhole surgery, and the patient may be out of action for longer,” he admits. “However, ultimately, these techniques are more beneficial to the sufferer in the long term, as the damaged joint surfaces are restored and reconstructed rather than simply repaired. To improve patient care, it’s important that more is done in the way of restorative orthopaedics.”
Case study – Lucy Schwerdtfeger
Lucy Schwerdtfeger suffered a knee injury in March 2013 and a complication from the original injury manifested itself in June 2015. The first resulted in a full leg cast and she was unable to walk. The complication made it difficult for her to undertake everyday tasks or any sport.
In March 2013, Lucy was skiing in France when she fell and her boot bindings didn’t release. She sustained an unusual proximal tibial fracture with a displaced anterior tibial spine, which was essentially an avulsion injury of the anterior cruciate ligament with some cartilage issues.
Lucy was taken to a local hospital in France where she was X-rayed and put in a full leg cast to enable her to fly back to the UK, where she visited Simon Moyes to establish what her next stage of treatment would be.
During her visit to Moyes, he informed her that she had to wait 24 hours before undertaking any surgery due to the heparin injections she had been prescribed in France in order to safely fly home with the full leg cast. He confirmed that surgery was necessary in order to reset the section of bone that had come loose following her acc