Washington, Nov 30 : A revolutionary clinical trial may provide a minimally invasive option for cartilage repair in the knee that uses the patient's own cells to repair the joint damage.
The clinical trial is being held at Hospital for Special Surgery (HSS).
Arthritis is characterized by a loss or erosion of articular cartilage, which is the soft lining at the ends of bones.
Generally, the arthritic process begins with damage to the cartilage surface, and can appear as a small hole or defect. With the expansion of damage, the chances of proper healing go down, as cartilage, the material that cushions the joints, cannot re-grow naturally.
"A small hole is going turn into a big hole eventually, given enough time," said Riley Williams, M.D., orthopedic surgeon, Sports Medicine and Shoulder Service, Hospital for Special Surgery in New York, and director of the Institute for Cartilage Repair at HSS.
Following an initial injury that has caused damage to a specific area of the cartilage, there are few options that can repair the damage, which is likely to lead to severe osteoarthritis.
The most popular current treatment for such lesions is called the microfracture procedure, in which a tiny 'pick' spikes holes into the base of the damaged cartilage area to promote bleeding. This allows the patient's bone marrow cells to come to the surface of the damaged tissue, thus making the cells change into fibrocartilage cells and heal the defect.
Although, microfracture is minimally invasive and very quick, research has found that the defect may not always be fully repaired.
Now, a new multi-center clinical trial led by Dr. Williams at Hospital for Special Surgery makes use of a patient's own cells to heal damaged cartilage, but in a much different way.
First, a small piece of the patient's healthy cartilage is taken and then the cells are grown in a laboratory. These cells are put into a piece of protein matrix, called NeoCart, which has an internal structure shaped like a honeycomb.
The cells use the NeoCart as a scaffold and begin to grow over and around the structure. This creates a piece of new cartilage which is then, through a tiny incision, implanted into the patient's joint over the damaged area, much like a living patch.
Scientists are hoping that the new cartilage will repair the damage and integrate seamlessly with the surrounding cartilage.
"This operation is much shorter than previous similar procedures and is made through a very limited incision with much less pain. You're able to go in and, if not stop the arthritis, certainly delay its progress," said Williams.
The trial is being held at six investigational sites around the United States and will test up to 30 patients between the ages of 18 and 55 to compare, on a randomized basis, the NeoCart technology with the microfracture treatment.
The data will be used to evaluate safety, the efficacy of the NeoCart implant, identify appropriate patient populations and help inform future clinical trial design.
The NeoCart procedure was developed by the Histogenics Corporation, located in Waltham, Mass.
HSS will host a symposium Dec.5 and 6 to examine recent advances in cartilage repair.