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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Ask the Doctor!

This regular segment of ‘Ask the Doctor’ addresses questions sent in by Sports Medicine Weekly followers. In this segment we are addressing questions about:

  • Koby Bryant’s technique involving Orthokine and how it compares to PRP.
  • How injuries establish scar tissue.

If you have a question to be addressed on an upcoming show, please click here to submit your question.

Sports Medicine Weekly on 670 The Score

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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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Division I Track Athlete Undergoes Cartilage Regrowth Treatment

jasmine smyles

Youngstown State University track team member Jasmine Smyles has been told many times that she has the perfect last name. Lately, this has proven true.

On a recent visit to see Dr. Brian Cole at Midwest Orthopaedics at Rush in Chicago, she was all smiles when Dr. Cole reported that her recovery from a brand-new treatment for knee pain was right on track.

A runner since age eight, Jasmine grew up training on less-than-ideal surfaces near her west side of Chicago home. Growing up, she also played basketball competitively, but decided to focus on running track in college.

One year into her track career at Youngstown State competing in the 200 and 400-meter events, she developed pain in her right knee. Like many determined athletes and just 19 years old, she assumed it was temporary and ran through the pain—for two years.

Finally, it became difficult to walk, much less run.

Jasmine’s persistent pain led her health care provider to order an MRI to further evaluate her knee. She was diagnosed with a localized area of complete cartilage loss, a devastating diagnosis for collegiate track runner. Determined to avoid a more invasive treatment, like a knee replacement, she began to do her research.

Finding a specialist

She searched ‘cartilage expert’ online and read about Dr. Brian Cole, a sports medicine surgeon and Director of the Cartilage Restoration Center at Rush University Medical Center. She was pleased to learn that a physician so knowledgeable about cartilage issues—and so familiar with high level athletes—was right in her back yard.

At their first meeting, Dr. Cole listened to her story and clearly understood her desire to run competitively again. He talked with Jasmine and her parents about options which included a clinical trial his team is leading using an innovative new procedure for knee cartilage regrowth. They were intrigued, so he further explained that in surgery, using a microfracture procedure, he would create tiny holes in the surface of the bones in her knee, so that her bone marrow cells would repopulate where her cartilage had deteriorated. A material called GelrinC would be injected over the microfracture and a UV light would be used to create a structure on which cartilage would grow.

Jasmine and her parents agreed to have her participate in the clinical trial and she underwent the microfracture/GelrinC surgery at Rush University Medical Center.

Now, three months post-surgery, Jasmine is walking pain-free and participating in regular physical therapy. She is looking forward to her six-month follow up at which time she will undergo another MRI to evaluate her progress.

She is all smiles when she talks about now being pain-free and perhaps one day running again.

Clinical Trial Information

If you have pain from cartilage loss in one or both knee and are interested in this clinical trial, call  (833) 519 9595. For more information, please visit http://www.gelrinc.com/.

To enroll in the study, patients must be:

  • Between the ages of 18 and 50;
  • Suffering from knee pain but are not yet candidates for knee replacement;
  • OR already diagnosed with a cartilage abnormality and not yet a candidate for knee replacement;
  • Willing to undergo initial evaluation and imaging to determine if pain is caused by cartilage abnormalities;
  • Motivated to participate in the GelrinC microfracture study.

To schedule an appointment with Dr. Brian Cole, call 877-MD-BONES or request an appointment here.

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