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Alternatives to knee replacement for older athletes
Dr. Jeffrey Halbrecht
Published 3:30 pm, Tuesday, March 11, 2014
We live in a time where living to 100 is no longer a dream. Eighty-year-olds regularly participate in running races, and, as they say,
"Sixty is the new 40."
As an orthopedic surgeon and avid athlete, I am privileged to practice medicine in an era where medical innovation is keeping pace with
the requirements and dreams of aging athletes.
Twenty years ago, anyone over 40 with a torn meniscus (a cartilage disc in the knee) would be denied a repair because of being deemed
"too old," and there was only one solution for the arthritic knee - metal and plastic, the oft-dreaded total knee replacement.
Today, medical innovation offers new hope for injured knees. The modern-day mantra for treatment of knee injuries is joint preservation
rather than joint replacement.
Meniscus tears that were formerly irreparable can now be repaired with simplified techniques using absorbable tacks, with enhanced
healing encouraged by use of injectable growth factors or local stem cells. Patients who have lost their meniscus can receive a replacement
from a cadaver. Soon, even a bioengineered meniscus will be available.
Patients often fear being told they have arthritis, or damage to the cartilage coating the knee joint. Once the cartilage surface wears out,
joint replacement used to be the only option. Today there is a large menu of biological options available to restore the joint surface.
Most knee arthritis starts as an area of chipped cartilage. The chip needs to be filled or the cavity will enlarge and lead to arthritis.
Depending upon its size and severity, the hole in the cartilage can be filled with actual cartilage tissue, like replacing a lawn with sod; or
with cells, like replacing a lawn with seeds. When appropriate, the patient's own cartilage cells can be taken and grown in a lab, then
reinserted into the knee.
Newer technologies even exist that utilize "off-the-shelf" cells from young donors in an effort to provide better cartilage repair. For
patients with deeper cartilage holes, the defect can be filled with a plug of intact cartilage and bone taken from another area of the knee,
similar to a hair transplant.
For larger holes, a transplant can be taken from a cadaver knee. Some more advanced options for joint preservation are only available
overseas - among them cartilage "sponges" filled with cells that are "glued" into place using minimal incisions and arthroscopic techniques.
We now have patients in our clinic with preserved joints who have been able to avoid knee replacement for almost 20 years.
Some of the newest treatments for knee arthritis involve use of growth factors and stem cells. Early studies show that these materials can
be used to enhance healing of certain tissues and help treat the symptoms of arthritis.
Growth factors, or substances that stimulate cellular growth, are obtained by spinning the patient's blood and extracting the body's
natural growth factors, then reinserting them into the knee.
For cases of severe arthritis, there are options that make it possible for a patient to avoid a full knee replacement. However, when
replacement is necessary, modern techniques allow for partial and customized replacements, which can preserve much of the normal
knee, removing only the damaged portion and leaving healthy tissue alone.
Treatment of the aging knee is a rapidly changing field, with many exciting innovations for today's patients. With the help of modern
science, there is new hope for injured knees.
Dr. Jef rey Halbrecht is an orthopedic surgeon and medical director of the Institute for Arthroscopy & Sports Medicine, San Francisco.
He is af iliated with the California Pacific Medical Center.