Cartilage Regeneration

Do Vestibular Disorders Go Away With Manual Lymphatic Drainage?

The vestibular sensory organs in our inner ear, the cochlea, and the semicircular canals are responsible for our balance and proprioception/position. When these organs are damaged with disease or injury, it can lead to dizziness, vertigo, balance problems, and other symptoms. These can be transient as people are able to recover after a few weeks of normal activity due to vestibular compensation. Conversely, the symptoms can be lasting, affecting a person’s ability to maintain posture and balance.

 

A person with a vestibular disorder may have difficulty in maintaining balance and may adopt an exaggerated hip sway, swivel the entire body while keeping the head still when turning to look at something, or always look down to avoid a confusing swirl of activity. Ironically, these mannerisms can worsen the vestibular symptoms and often cause headaches, muscle tension, and fatigue.
Meniere’s disease is the most common vestibular disorder this procedure is considered for

Endolymphatic sac decompression is a procedure that involves draining of the excessive endolymph from its sac in order to decompress it. It is sometimes indicated for Ménière’s disease or secondary endolymphatic hydrops to relieve endolymphatic pressure in the cochlea and vestibular system. Meniere’s disease is the most common vestibular disorder this procedure is considered for. It is characterized by vertigo, tinnitus, hearing loss, imbalance and a feeling of pressure deep inside the ear. While there are several treatment options for it, including betahistine, cyclizine, steroid injections, and gentamicin injections, but endolymphatic sac decompression is considered for refractory cases.

 

There are multiple ways to perform this procedure. One method involves removing the mastoid bone surrounding the endolymphatic sac and allowing the sac to decompress. Alternatively, a shunt may be placed into the endolymphatic sac so that the excess fluid can drain out into the mastoid cavity.

Endolymphatic sac decompression is performed as an outpatient procedure. During the procedure, an incision is made behind the ear and the mastoid bone is exposed. The bone is fragmented to reveal the endolymphatic sac and a hole is cut into the outer layer of the sac using a laser. A shunt is then inserted into the sac and the incision is closed. The procedure takes approximately 90 minutes and is performed under general anesthesia. If there are no adverse events, the patient is discharged an hour later. Most patients return to work the day after surgery. The patient’s hearing gradually improves in the ensuing few weeks and then returns to normal.

Endolymphatic sac decompression has proven to be an effective treatment for patients with Meniere’s disease with vertigo and light-to-moderate hearing loss. In a recent study published in JAMA, endolymphatic sac surgery provided an improvement in major spells of vertigo in 77% of patients at 24 months after surgery. Furthermore, revision surgery provided an improvement in 65% of cases, especially those with recurrent symptoms more than 24 months after their original procedure.

What Does the Research Show on Articular Chondrocyte Implantation?

With new research studies and the development of new technology, scientists and surgeons have been able to develop a variety of different approaches for restoring cartilaginous surfaces. These new technologies are necessary in order to relieve pain, as well as improve the mobility in people that have suffered degenerative or traumatic damage to synovial joints.

A promising new method is utilizing transplanted autologous cells, which is called articular chondrocyte implantation (ACI). However, some randomized studies that compared cell transplantation to microfractures have not been able to show better results with cell transplantation. There are several possible acireasons for these studies not producing better results, such as a limited amount of chondrocytes being available with cell therapy and chondrocytes tend to experience phenotype changes with ex vivo expansion during monolayer culture. There is strong scientific and clinical evidence that chondrogenic stem cells and chondrocytes lose their potential with age.

Study of Cadavers Offers New Information regarding ACI

From cadaver donors, articular cartilage was obtained and only areas that had healthy cartilage were used, while those that showed any types of grade I or grade II osteoarthritis were not used. Through these donors, 65 different whole knees were aseptically processed in order to obtain the articular cartilage from the distal tibia, and proximal femur. The minced cartilage was then disaggregated with sequential enzymatic dissociation in a pronase solution, which was then digested overnight in a mixture of collagenase and hyaluronidase.

Of the tissues that were collected, 19 came from adult donors between the ages of 13 and 72 years old, and the remaining 46 tissues came from donors ranging from birth to 13 years old, and the majority of the tissues came from males. Through a seeding process, neocartilage was produced and chemically defined by displayed growth characteristics. The cultures were then supplemented with a solution of ascorbate after the third day of culture, with a medium exchange that occurred every three to four days. The neocartilage was then obtained for characterization or for the use in animal studies when cultured between 44 and 63 days.

By overnight digestion of the chopped cartilage, human articular chondrocytes were able to be isolated from 9 adult donors and 5 juvenile donors. The cells were then counted and plated inside cultural flasks, and then grown from five to ten days. The cells that were isolated from cartilage samples were then serially passaged in a monolayer culture for a maximum of 104 days.

Before the trypsinization and replating procedure, the cells were allowed to grow, and the growth rate for each culture was able to be calculated with a regression analysis of the data that was collected throughout the linear phase of growth. After being grown in monolayer cultures with multiple passages, there were up to 35 population doublings from 4 adult donors and 3 juvenile donors.

Fundamental Difference with Biological Activity in Adult and Juvenile Articular Chondrocytes

In the early development of neocartilage, researchers observed culture methods such as supplementation of fetal bovine serum, had remarkably reduced the cultured articular chondrocytes ability to deposit the insoluble hyaline extracellular matrix while in vitro. This resulted in a variety of serum-free media formulations to be developed and tested so matrix production could be optimized when there is an absence with exogenous growth factors that are derived from the articular cartilage.

Studies were then conducted in vitro so the de novo synthesis of the cartilage matrix could be measured. These were isolated from over 68 of the cartilage donors. While maintained under specific conditions, the chondrocytes that were obtained from juvenile cartilage was found to be more efficient with the production of neocartilage compared to the adult articular chondrocytes. These studies would indicate that there is possibly a fundamental difference with the biological activity in adult and juvenile articular chondrocytes that are reflected in the molecular level.

In regard to extra cellular matrix production, studies have found that the chondrocytes that are obtained from juveniles significantly outperforms those from adult donors. This provides evidence on the potential of the strongly developed juvenile chondrocytes compared to adult chondrocytes. Other data suggests the juvenile chondrocytes are possibly not immunogenic with adult hosts, which supports the possibility that these cells may be utilized as allografts with cartilage regeneration in vivo.

The treatment of articular cartilage damage in the knee still remains a clinical challenge. Unlike the vascularized tissues, articular cartilage in adults shows a limited capacity with repairing, and once it is damaged it does not heal. Results would indicate that unlike antigen presenting cells, the chondrocytes will not stimulate proliferation with xenogenic or allogenic lymphocytes. This is consistent with other studies that have demonstrated how chondrocytes do not elicit lymphocyte alloproliferation following the introduction of class II antigens in a cytokine treatment.

Conclusions

Allogenic chondrocytes obtained from juvenile cartilage possibly represents an advanced source of cells for the repair of cartilage. Furthermore, in vivo immunogenicity studies suggest when the allogenic juvenile chondrocytes are transplanted with the neocartilage, it does not promote graft rejection in the immune responses of unrelated recipients.

For top knee cartilage procedures, OSPI in the East Valley offers Board Certified sports medicine physicians treating patients from Chandler, Gilbert, Mesa, Tempe and surrounding areas. Most insurance is accepted, and the outcomes for cartilage restoration have been exceptional. Call today!

Resources

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3774103/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3521894/

Overview of Cartilage Repair from an Arizona Orthopedic Surgeon

Whether you’re a beloved grandparent or an elite athlete, joint damage affects a large portion of the population. Approximately twelve million individuals visit their doctors, annually, due to some sort of joint pain and or knee discomfort. While each case varies, most knee pains can be attributed to the degradation of the bones articular cartilage.

Articular cartilage consists of a smooth white tissue that envelops the ends of bones where theyKnee pain meet to form a joint. By acting as an impact-cushion, when healthy, this firm rubbery substance supports normal movement within a joint by lubricating the bone segments and assisting in its natural gliding movement.

Whenever articular cartilage begins to deteriorate and or becomes damaged, patients begin to experience limited movement within their knee joint coupled with extraordinary pain. If a patient experiences these symptoms they should schedule a visit with their orthopedic specialist as these symptoms can worsen. Due to the cartilages inability to heal itself, if left untreated many simple cases of cartilage degradation can result in more serious conditions, such as osteoarthritis, that consequently results in more serious procedures such as knee replacements.

Cartilage repair procedures exhibit the most success with osteoarthritis-free knees. Typically candidates are individuals who have:

  • Experienced some sort of injury to the area (sports injuries included)
  • Degraded the cartilage due to sustained periods of strain and wear
  • Inherited hereditary deformations that affect the function of the knee joint

The procedure process usually begins with a magnetic resonance imaging (MRI) screening that allows the doctor to assess the region, severity, and magnitude of the injury. Once observed, your orthopedic specialist can diagnose the severity of the injury and formulate a regimen of treatment options that will successfully alleviate your condition. The most common forms of cartilage restoration procedures are:

 

  • Microfractures: This minimally invasive procedure has cemented itself as the standard treatment option for cartilage injuries within the United States. Using an arthroscope, several small incisions are made above the knee joint- giving the surgeon discrete access to the injured area. Once the degraded area is reached, the surgeon uses an awl to drill small, multiple holes in the joint surface and subchondral bone. By using the body’s natural regenerative processes these small holes trigger a minimal amount of bleeding, stimulating cartilage regeneration and the formation of new cartilage tissue.

 

  • Autologous Chondrocyte Transplantation (ACI): This procedure consists of two-steps in which, first, cartilage cells are removed from one part of the bone, harvested, and then subsequently transferred to the damaged cartilage area. During the first procedure cartilage acicells are removed from a non-weight bearing region of the bone and cultured in a laboratory setting for approximately three to five weeks. Once cultured these cells are then harvested for the second procedure. During the second procedure, the surgeon sews a protective tissue sheath (periosteum) over the affected area and then implants the harvested cells in the damaged region. This procedure proves extremely promising due to its lack of patient induced rejection- as the cells produced to repair the region are from the patient themselves.

 

  • Osteochondral Autograft Transplantation (OATS): This procedure is a bit more in-depth as it requires moving bone grafts from an independent region of the joint to the afflicted area. During this surgery several cone shaped samples of healthy cartilage are removed from non-weight bearing regions of the knee so that they can be transplanted into the damaged area. These “bone-cones” are used as plugs so that the surgeon can successfully resurface the area and provide a new cover for the once damaged area.

While most of these procedures are highly successful, the patients’ treatment options are dependent on your mesa orthopedic specialist and what they deem to be best fit. Once a patient undergoes one of these forms of cartilage repair the recovery period typically lasts several months.

The operated area must be looked after and patients must use crutches for the first several weeks so that weight-bearing strain does not interfere with the rehabilitation process. Many Gilbert orthopedic doctors may recommend physical therapy to aid in the healing process, but as mentioned before it is dependent upon the premise of each individual’s circumstances.

OSPI is the top orthopedic practice in the East Valley treating patients from Mesa, Gilbert, Chandler, Queen Creek, Casa Grande, Maricopa and surrounding areas. Most insurance is accepted, with the Board Certified orthopedic knee specialists offering all types of cartilage restoration procedures. This also includes stem cell procedures!

Call for the best Arizona knee doctors today at (480) 899-4333!

Cartilage Regeneration Options in Gilbert, Chandler, Mesa AZ

What Is Cartilage Regeneration?

 

Back in the year 2014, a study was carried out by researchers from the Hospital for Special Surgery. They discovered that patients who suffer from cartilage damage in their knee can have it treated with good results, due to the revolutionary technology of cartilage re-generation.knee cartilage defect

The research and a few case studies that followed after the discovery were presented to the American Orthopedic Society for Sports Medicine at its annual meeting held in Chicago that year.

Current Approaches to Cartilage Repair

The name of the tough and incredibly flexible tissue which acts as a cushion for bones and joints is Hyaline Cartilage and it’s this that prevents joints and bones from rubbing against each other during physical activity. Gradual wear and tear or trauma can result in the hyaline cartilage being damaged, which in turn, limits normal joint movement and cause patients to suffer through severe pain. This condition, if left untreated for a long time, can lead to disability.

You should know that damage done to the cartilage isn’t as readily repaired by the body naturally, as the cartilage tissue does not having its own blood supply that would have been otherwise used to bathe damaged tissue and promote cartilage regeneration.

Thus, the current approach of surgeons to effectively treat cartilage damage and help promote its growth is by employing a technique called micro-fracture, a surgery which is generally performed on young adults, who as a result of a sports injury, are suffering from a cartilage tear.

While the procedure promises and gives good results to damage on a smaller scale, micro-fracture is ineffective for those who have widespread cartilage de-generation, or osteoarthritis.

Lighting the Way towards Cartilage Regeneration

Attempts have been made over the years by researchers and orthopedic surgeons alike to build human cartilage outside of the body for years and most of the attempts have proved to be successful, largely due to today’s technological advancements.

The process that is widely used to mimic and grow human cartilage outside of the body involves planting a number of cartilage producing cells into a biological scaffold, then placing them into incubation conditions found in the human body.

There are a number of factors concerned with the effective and successful regeneration of cartilage, one of them being the scaffolds that are being used for the experiment according to Jennifer Elisseeff, director of the Cell and Tissue Engineering Program at John Hopkins University. In her own lab, she uses hydrogel which is a specific type of scaffold.

After spending several years working on creating the highest quality cartilage under lab settings, Elisseeff discovered that the quality of the regenerated cartilage can be influenced for the better if a hydrogel scaffold could be used on the patient following micro-fracture surgery. A series of clinical trials followed the discovery, the results of which were published in Science Translational Medicine.

Clinical Trial Results

The results showed that more of the cartilage defect was filled successfully by the repaired cartilage, i.e. in 86% of the patients, after receiving the special gel/adhesive as compared to 64% who didn’t. Moreover, the cartilage implanted closely resembled the native strains in those who underwent the gel/adhesive treatment following a micro-fracture surgery.

OSPI in Arizona offers comprehensive treatment options for cartilage regeneration, including microfracture, Carticel, OATS procedure and stem cell therapy. The Board Certified providers treats patients from the entire East Valley including Chandler, Gilbert, Mesa, Queen Creek, Casa Grande, Maricopa and surrounding areas.

Call today for the top knee, hip and shoulder specialists in Arizona’s East Valley today!

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