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Cartilage repair potentially delays, halts morbidity of early OA
Research indicates disease prevention may be a possible outcome of articular cartilage repair.
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MONTREAL — Articular cartilage repair may be a promising early osteoarthritis treatment, offering the potential to alter arthritic changes, thus delaying the need for joint replacement surgery. However, orthopaedic surgeons must be realistic about outcomes, as research in this area is in its infancy, according to a Dutch researcher.
“The role of cartilage repair in osteoarthritis (OA) would be great because it would open us to the opportunity of halting or delaying the considerable morbidity the disease causes so many people,” Daniël B.F. Saris, MD, PhD, told Orthopaedics Today Europe.
He said research in this area is important because the incidence of early OA is increasing, especially in younger, active patients, and the disease limits these patients’ quality of life.
“If we were to find a way in which we could transpose our success of cell therapy from defect treatment to OA treatment, that would be a stellar achievement,” Saris, an orthopaedic surgeon at the University Medical Center Utrecht in The Netherlands, said at the International Cartilage Repair Society (ICRS) World Congress 2012, here.
Saris discussed cartilage repair research in early OA during an International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine symposium held in conjunction with the ICRS during the meeting.
Daniël B.F. Saris
Early success
Research Saris did with a goat model demonstrated success in treating early OA, he said at the meeting. “We showed if you treat a cartilage defect early in a goat, you will be successful; if you treat it late in a goat, you will be less successful histologically.”
He said this result correlated with 5-year results of a trial he and colleagues conducted that compared microfracture and characterized chondrocyte cell treatment and revealed similar clinical outcomes for both.
In a 2002 study, Hogervorst and colleagues demonstrated that bone scans normalized 2 years after ACL reconstruction, which Saris noted indicates patients can see improvement in some biological systems with the tools orthopaedists now use.
According to Saris, now that it is clear that cells play a role in tissue homeostasis, these findings beg the question of whether or not it is possible to prevent OA.
“The jury is still out on that and will be for a long time.”
Joint homeostatis is depicted by (left) a fresh knee defect at the stage where it is still small and “quiet” and (right) by a defect present for a longer period of time, which has become larger and the knee is more inflamed.
Image: Saris DBF
Research challenges remain
Data are lacking about whether cell therapy prevents OA, Saris said.
“We don’t have the patients to wait for 20 years to see if the effect is there,” he said. “That’s the only goal — and proof — if you want to reverse OA.”
Furthermore, “Cartilage repair is a feasible treatment in a patient for early OA or for a degenerative knee,” he said. “I think some of the promising developments in the research field make prevention relatively realistic.”
Saris encouraged orthopaedists to be conservative, as well as realistic when they discuss cartilage repair outcomes with patients. “They think it’s a solved thing. You go to a stem cell clinic. They take a needle and inject embryonic stem cells or liposuction-derived stem cells and your OA goes away. It’s a challenge to explain that [it does not],” he said in his presentation at the meeting.
Despite cartilage repair advances made to date, much work remains. Saris told Orthopaedics Today Europe, “We need to use the current clinical therapies wisely and expand the indications while investing heavily in understanding the biology behind cellular reconstruction of the knee in OA.” – by Colleen Owens
References:
Hogervorst T, Pels Rijcken T, Ruckert D, et al. Changes In bone scans after anterior cruciate ligament reconstruction. A prospective study. Am J Sports Med. 2002;30:823-833.
Saris DBF, De Windt TS. Cartilage repair to prevent osteoarthritis — Fact or fiction? Paper #9.1.1. Presented at the International Cartilage Repair Society World Congress 2012. May 12-15. Montreal.
Saris DBF. Dhert WJ, Verbout AJ. Joint homeostasis. The discrepancy between old and fresh defects in cartilage repair. J Bone Joint Surg Br. 2003;85:1067-1076.
Vanlauwe J, Saris DBF, Victor J, et al. Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters. Am J Sports Med. 2011;39:2566-2574.
For more information:
Daniël B.F. Saris, MD, PhD, can be reached at HPN G05.228, PO Box 85500, 3508 GA Utrecht, Netherlands; email: d.saris@umcutrecht.nl.
Disclosure: Saris receives research support from Sanofi Genzyme and is a consultant to Smith & Nephew.