Former College Athlete Gives Unique Perspective on Knee Cartilage Injury

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It was a typical winter afternoon in southern California playing with his son at the park.

He stepped in a small hole, not unlike a hundred times before in the past without incident, so he brushed it off as just a temporary tweak or mild sprain. He then did a quick jog to the car and noticed a pinch of pain on the outside of his knee with every step forcing him to stop and walk.

Joshua grew up in Southern California playing about every sport imaginable sometimes playing hockey and football games in the same day. He was a varsity four sport athlete in high school, at one point even training with future professional Olympic and elite spartan runners running up ski slopes at the local resorts. In college, he ran under a coach who was an American record holder in the mile. No matter what sport or how many thousands of miles in training, he never suffered any major injuries.

The day after rolling his ankle he noticed he could not quite bend his knee as much and then when playing with his one-year old daughter his knee suddenly locked for a few minutes unable to straighten or bend at all. In the next couple days, Joshua was able to get a stat MRI.

He did know that since college he had put on about five pounds a year and this raised the risk of him having a knee injury or potentially damaging his cartilage.  With his ten years of experience as a Physicians Assistant (PA) in Orthopedic Surgery specializing in sports medicine, he started speculating on his diagnosis – quite possibly a bucket handle meniscus tear.

What he saw on the MRI scan immediately shocked him. He could see clearly that he had sheared off a chunk of his articular cartilage the size of a dime, which looked like a snow plow went through it. “I knew I was in big trouble,” Joshua explains, “…it’s such a bad injury because cartilage does not heal itself and doesn’t regenerate.”

Being dealt this curveball, Joshua started immediately reviewing and researching more about current cartilage surgeries to make the best decision on how to get it treated. Coincidentally, ten years earlier, while going through his graduate PA program, he chose as his master’s project “new treatment strategies in knee injuries for the prevention of knee arthritis.” As a PA in Orthopedic Surgery, he had scrubbed about a dozen cases throughout his ten-year career and knew the complexity of cartilage surgeries. After weighing the pros and cons, he eliminated a possible autograft or microfracture. He reached out to a renowned sports Orthopedic surgeon, Dr. Raffy Mirzayan, about performing a cartilage allograft transplantation.

A few months after the injury and finding a right match, Joshua went through with the two-hour outpatient surgery with no complications. Within six weeks he was walking with a cane and had full range of motion. Now, at five months after the surgery, he can walk normally and go up and down stairs; perhaps most importantly, he is able to play with is two kids again. His hope is to get back to running once his knee has healed (after about eight months) and to get back to running with his competitive college teammates.

He is eternally grateful to the donor and the family and he wants to do something special before he reaches out to them to thank them for the gift of donation. “I really enjoy helping others… I want to be able to pay it forward.

“I haven’t written a letter yet because I want to do something to thank them… I want to write a letter with me doing something (finishing a race) to show them how much of an impact it made for me.”

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Bipolar Osteochondral Allograft Transplantation of the Patella and Trochlea

Purpose: To evaluate the outcomes of bipolar osteochondral allograft (OCA) transplantation in the patellofemoral joint.

Summary:

  • Limited studies are available pertaining to OCA transplantation in the patellofemoral joint, especially on bipolar OCAs to both the patella and trochlea
  • Follow-up was obtained on 15 knees that underwent a combined OCA transplant to address either trochlear dysplasia with patellofemoral instability or high grade chondral lesions
  • OCA plugs were harvested from patella and trochlear grafts from the same donor to provide a congruent anatomic surface
  • At an average follow-up of 33.2 months, significant functional improvements were observed in KOOS, IKDC, Tegner, Oxford, Cincinnati, VAS and SANE scores
  • While two patients did require further surgery to address postoperative stiffness and lysis of adhesions, no patient needed revision or conversion to arthroplasty and there were no patellar re-dislocations

JRF Ortho Take Away: While previous studies have shown that OCA transplantation to the patellofemoral joint can have an increased risk of failure compared to other areas of the knee, bipolar OCA transplantation to the patella and trochlea using tissue from the same donor can be a good option. At short to mid-term follow-up, this technique demonstrated significant improvement for recurrent dislocation and high grade chondral lesions.

Click here for the abstract or full article.

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Knee Cartilage Transplant Video Performed by Orthopedic Surgeon Dr. Brian Cole

After a string of serious knee injuries, Mark, a 19-year-old college football player, faces an uncertain future playing the game he loves. In addition to the emotional toll the injuries have taken, Mark also endures unbearable knee pain.

To repair his knee, Mark undergoes a breakthrough knee cartilage transplant, performed by orthopedic surgeon Dr. Brian Cole, the Chicago Bulls’ team physician.

Do you want to learn more about knee cartilage transplantation? Click here to watch Dr. Cole on “The Doctors” treat a young college football player using this breakthrough surgery.


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Osteochondral allograft transplantation effective for certain knee cartilage repairs

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By JRF Ortho

Isolated femoral condyle lesions account for 75% of the cartilage repair procedures performed in the knee joint, and physicians have a variety of techniques to consider as part of surgical treatment. Osteochondral allograft transplantation (OCA) is a valuable and successful approach for this condition, as described by research presented today at the American Orthopaedic Society for Sports Medicine‘s Specialty Day in New Orleans.

“Our study demonstrated that the modern OCA transplantation technique, which utilizes thin, dowel type grafts, was very effective in treating patients with femoral condyle cartilage lesions,” noted Luís E. Tírico, MD, who is currently with the University of Sao Paulo in Sao Paulo, Brazil and served as the research fellow and lead author on the presentation under Dr. William Bugbee, Director of Clinical Research and Head of the Scripps Cartilage Restoration and Transplant Program at Scripps Clinic in La Jolla, CA. “In 200 cases, we noted an 89% satisfaction rate with those treated by this method, along with significant improvements in clinical scores and a low graft failure rate.”

The study, which represents the largest reported cohort of isolated femoral condyle lesions treated with the modern, dowel technique for OCA transplantation included 187 patients (200 knees) who underwent OCA transplantation between June 1999 and August 2014. At a minimum follow-up of two and average of 6.7 years, International Knee Documentation Committee (IKDC) total scores improved from 43.7 to 76.2 on average, and Knee injury and Osteoarthritis Outcome Score (KOOS) for pain improved from 66.5 to 85.3, and 74.5 to 91.1 for activities of daily living. Further surgery was required in 52 knees (26%), of which 16 (8%) were considered failures, as defined by removal or revision of the allograft.

“The modern technique of OCA transplantation for treating isolated femoral condyle lesions offers patient better results over other cartilage repair procedures,” commented Tírico. “These results appear to be equal or superior to any other cartilage repair procedure for the treatment of femoral condyle lesions and leads us to consider whether fresh OCA should be viewed as the current gold standard in cartilage repair for focal femoral condyle lesions.

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