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Cartilage cells introduced into joints form new cartilage, attach to bones

By Robert Mitchum
Chicago Tribune
April 8, 2009

An Ironman triathlete, Gregg Szilagyi never could have expected the hazard that destroyed his knee and effectively ended his athletic pursuits: a runaway poodle.

The blind-side collision led to knee surgery for Szilagyi, 46. And with the accident, surgery and his years of triathlon training, Szilagyi’s left knee was left with virtually no cartilage, producing painful arthritis and limiting his ability to run and work out.

A doctor advised Szilagyi that his only option was a total knee replacement, which would permanently end his athletic pursuits and limit his ability to hike and ski with his teenage children. But another told the Deerfield resident that a procedure to implant cartilage tissue from a cadaver into Szilagyi’s knee might allow him to maintain an active life.

“I think it’s hard to say anything out there might be the magic bullet, and I’m just hoping I can be as active as I can be,” said Szilagyi, who expects to have the surgery soon. “If I can, I’d like to remain relatively bionic parts-free.”

If he’s found suitable, Szilagyi will undergo what is known as an allograft meniscal transplant, which would transfer cartilage–the spongy white material that fills and cushions the joints between bones–into his left knee. The surgery would be performed by Dr. Brian Cole, team physician for the Chicago Bulls and one of the country’s foremost experts on cartilage transplant surgery.

Cole, head of the Cartilage Restoration Center at Rush University Medical Center, has performed the procedure for 12 years. He now performs up to 200 such surgeries a year, replacing cartilage in knees, elbows, hips, shoulders and ankles.

Though the procedure has existed in some form for decades, advances in the preservation of the tissue and the method of implantation have made cartilage transplants a more common option for patients in chronic pain who are too young or unwilling to opt for total joint replacement.

“It’s not cancer, it’s not going to kill you, but for a person who’s used to being active, having that taken away from you can put you under heavy emotional duress,” Cole said. “It’s amazing how it transcends every single level of life.”

John Golden, 42, an insurance executive from St. Charles, was one such case. After suffering a catastrophic knee injury while playing college football in the late 1980s, Golden underwent a total of 23 knee surgeries in the subsequent 20 years–13 on the injured right knee and 10 on the left after he overcompensated for the original injury.

When such extensive work failed to alleviate Golden’s pain, his orthopedic surgeon told him he had no option but to implant an artificial knee.

“He basically told me to go buy a ranch-style home because I may not be able to do stairs,” Golden said.

But after Golden received a double cartilage transplant from Cole in May 2005 and recovered his mobility, he resolved to climb more than just flights of stairs. In late March, after two years of training, Golden left on a 70-day trek to climb Mt. Everest.

The meniscus and articular cartilage serve as the cushion between the femur and the tibia at the knee. When either type of cartilage is worn down–through injury, corrective surgery or general wear and tear–painful arthritis can result.

In a cartilage transplant, a plug of the tissue is removed from a person who recently has died—similar to the process of organ donation. That plug then can be surgically inserted into the joint of a person with reduced cartilage, where it can form new cartilage that attaches itself to surrounding bones.

Unlike with organ transplants, rejection of the new tissue by the recipient is not a concern, Cole said. But for reasons that are still being studied the implant takes hold only 75 percent to 80 percent of the time a decent success rate, but not good enough for Cole.

As such, alternative methods are being studied by Cole and at other centers. One procedure, already in limited use, takes cartilage from another part of the patient’s own body; the cartilage then is stimulated to grow new cartilage cells in a laboratory before being implanted in the injured joint in a second surgery.

Eventually, stem cells may be employed to help regrow damaged cartilage, but Cole said that technology is not yet ready for the clinic.

“We want to trick the body into doing a better job of healing itself,” Cole said.

For now, Cole continues to rely mostly upon donor tissue, such as the cartilage from a 28-year-old man implanted into the left knee of Don Anderson, 47, late last month.

Like Golden, Anderson suffered a football injury decades ago that now has made athletic activity nearly impossible–a serious concern given his job as a physical education instructor at Bloomington High School.

Before driving into Oak Park for his surgery, Anderson reflected on the operation facing him.

“It’s strange to sit down here waiting on this cartilage, knowing someone’s going to die for me to get it,” Anderson said. “But I just hope to be able to walk normal.”

Reprinted by permission Copyright © 2009, Chicago Tribune