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Article Bum Knee? Here's Help

By Abbott Kagan II, MD

San Francisco - Patients with damaged cartilage in their knees are being successfully treated longterm with transplants of their own cells, new studies reported here show, but some surgeons caution the operation may prove nothing more than a fad.

Nearly 100 patients have now been studied up to nine years after undergoing the controversial new procedure, and nearly all have been significantly helped, said the Swedish researchers who pioneered it, and U.S. doctors reported similar successes in their more limited experience.

"My patients love it; I'm convinced it works," Dr. Tom Minas, an orthopedic surgeon at Brigham and Women's Hospital in Boston, Mass., reported here at the annual meeting of the American Academy of Orthopaedic Surgeons.

Minas said his patients include elite athletes as well as middle-aged parents who "can't get down on the floor and play with their kids." and for whom all other treatments have failed.

Yet, many experts continue to criticize the research and the procedure, which was first reported two years ago. Perhaps no development in more than two decades has provoked such contention among orthopedic surgeons, and more than 3,000 of them packed into a scientific session here that did little to resolve the dispute.

There is "misleading hype" that this is "a great medical breakthrough,"said Dr. Bertram Zarins, chief of the Sports Medicine Unit at Massachusetts General Hospital in Boston, who has criticized the scientific integrity of the studies done on the operation.

Critics like Zarins say the studies have not been scientifically controlled and that there is no true measure of the procedure's success. The academy, meanwhile, officially states that while there is some evidence cell reimplantation works, the technique remains unproven and the long-term results are unknown.

Even so, dozens of doctors across the country are embracing the new technique, often even advertising it. More than 120 now perform cell reimplantation, at a cost of about $30,000, and many insurance companies now cover it.

Each year, perhaps as many as half a million people in the United States suffer damage to their knee cartilage, the cushioning material in the knee joint. Pain and swelling may result, their knees lock up and they have trouble walking. Eventually, the damage can lead to arthritis, perhaps necessitating a total knee replacement, which costs about $25,000.

Cell reimplantation promises the unique ability of regrowing cartilage, its proponents claim. In the treatment, surgeons take a sample of cartilage the size of a nail clipping from a healthy part of the damaged knee, send it to a commercial tissue laboratory where it is grown and weeks later implant it into the damaged area.

A piece of tissue from the upper shin bone is sewn over it to serve as a sort of manhole cover so the cells incubate. Within a year, the cartilage is largely grown back, they say. There is a small risk of infection, but otherwise no harm to the patient, even if the procedure does not work.