Research Challenges Standard Procedure for Treating Arthritic Knees

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Research Challenges Standard Procedure for Treating Arthritic Knees

Wednesday May 10, 10:29 am ET

End-stage Arthritis Patients Benefit from Meniscus Transplants for

Pain Relief and Mobility

SAN FRANCISCO, May 10 /PRNewswire/ -- The future of biologic knee

replacement rather than artificial joint replacement took one more

step forward with the publication of promising results indicating

that people with arthritis can benefit from meniscus cartilage

transplants, according to researchers at the Stone Research

Foundation in San Francisco.

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A study published by Arthroscopy: The Journal of Arthroscopic and

Related Surgery (www.arthroscopyjournal.org) this week indicates

strong results in the use of cadaveric meniscus transplants for pain

relief in arthritic knees. The study provides substantial evidence

that the transplant, known medically as meniscus allograft, can be a

reliable treatment in these degenerated knees for up to seven years.

Current convention supports meniscus cartilage transplants only in

young, pristine knees with acute damage, often created by sports or

accident. Doctors have often told 40 - 60 year old patients to live

with their pain until they were older and then undergo an artificial

knee replacement. Doctors treating patients with severely degenerated

arthritic knees frequently prescribe artificial knee joint replacements.

The research published in the Journal of Arthroscopy found that

higher- risk arthritic patients who had received the meniscus

allograft enjoyed prolonged pain relief and restored functioning. For

arthritic patients, these landmark findings support options now

referred to as " biologic knee replacement " that were that were

previously unobtainable due to the lack of natural implants.

" The findings of this study will open doors for many arthritis

patients suffering from pain and physical limitations, " said Dr.

R. Stone, orthopaedic surgeon at The Stone Clinic and lead

investigator in the study.

" By offering meniscus allograft to young and old patients, the

promise of greater mobility, comfort and quality of life includes

delaying the time when joint replacement is needed. The meniscus

replacement permits running and impact sports which are

contraindicated in joint replacement. "

Risks of meniscus allograft:

-- Any effort to make the knee better could make the knee worse,

as with

any surgical procedure

-- Transplantation of any kind carries risk of infection or joint

stiffness

Significant findings of the study:

-- Patients in the study gained up to seven years of reduced

pain and

increased function, with delayed knee replacement

-- There was no evidence of rejection or infection

-- Meniscal allograft can be used in higher-risk patients with

reasonable

expectations of a successful outcome

" By providing a new spacer in the form of an allograft meniscus, pain

can be alleviated or reduced significantly. This would delay the need

for partial or total knee replacement, at the same time allowing

impact activities, " said Dr. Lex Simpson, Orthopaedic Surgeon, CORE

Orthopaedics in Encinitas CA, who is familiar with the study.

Dr. Simpson continues, " Certainly a joint replacement might still be

needed, but quality of life has been improved, and the 'time clock'

of the joint replacement has been delayed until some time in the

future -- if at all. "

Study Design

The Arthroscopy prospective, longitudinal study details the results

of the seven-year treatment of 45 patients to determine if the

meniscus can survive in the arthritic joint of older adults. Among

the 45 patients (32 men, 13 women, mean age 48) allografts were

medial in 37 (79%) and lateral in 10 (21%). Of 47 knees, 9 were

Outerbridge (cartilage defect grading scale) Class III (19%), and 38

were Class IV (81%).

Surgical technique used was the " three tunnel technique " devised by

Dr. Stone in the mid-1990s. (Stone KR, Walgenbach AW. " Meniscal

Allografting: The Three-Tunnel Technique. " Arthroscopy -- The Journal

of Arthroscopic and Related Surgery. 2003, 19(4):426-30.)

Adverse Events

All surgery has associated risks. Disease transmission from the donor

is a concern, but is extremely rare. A major concern is the rate of

allograft re- tears. In this study, 10 tears occurred, with three

tears in the medial compartment and seven tears in the lateral

compartment. Of these 10 tears, eight underwent a partial

meniscectomy and the remaining two were repaired.

About Arthritis of the Knee

Arthritis is a disease characterized by deterioration and

inflammation in the joints. There are three major types of arthritis

(osteoarthritis, traumatic arthritis and inflammatory arthritis),

affecting about 70 million Americans. Osteoarthritis (OA) and

traumatic arthritis are the most common kinds, affecting most people.

Rheumatoid arthritis is a type of inflammatory arthritis that affects

two million people. Meniscus cartilage replacement is indicated for

people with osteoarthritis and traumatic arthritis.

For more information on arthritis, visit the Stone Clinic,

www.stoneclinic.com, the Stone Research Foundation,

www.stoneresearch.org, or the Arthritis Foundation at www.arthritis.org.

About the Stone Research Foundation

The Stone Research Foundation (www.stoneresearch.org) was founded in

1995 to evaluate research at The Stone Clinic (www.stoneclinic.com)

in San Francisco. The Foundation conducts research in advanced

surgical techniques for orthopaedic sports medicine. These efforts

have led to improvements in cartilage replacement and regeneration,

cruciate ligament repair and reconstruction, and techniques to

prevent osteoarthritic degeneration, taught and used by other

physicians worldwide.

Source: Stone Research Foundation

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