Swiss doctors have demonstrated a way to use cartilage from a nose to repair damaged cartilage in a knee. Ten patients underwent the procedure two years ago, and MRIs taken recently showed new growth very similar to the knee’s own cartilage, and patients reported improvements in knee function, reductions in pain, and improvements in quality of life, it was reported on October 22 in The Lancet.
“We have developed a new, promising approach to the treatment of articular cartilage injuries,” said lead researcher Ivan Martin, a professor of tissue engineering at the University of Basel. The articular cartilage is the tissue that covers and protects the ends of the knee bones, and injuries to it can lead to degenerative joint conditions like osteoarthritis.
Although the results of this preliminary trial are encouraging, more research is needed before this technique could become widely available, Martin stressed.
“Before this can be offered to patients as a standard treatment, obviously it needs to be tested in a larger number of patients and in randomized trials with long-term assessment of clinical outcomes,” Martin said.
One joint repair expert welcomed the new approach.
“Treatment of cartilage injuries remains a significant clinical problem, and there is no gold standard treatment and no optimal treatment available,” said Dr. Nicole Rotter, vice chair of the department of otorhinolaryngology at Ulm University in Germany.
Using cells from the nose for joint repair is completely new, added Rotter, who co-wrote an editorial accompanying the study. “Nasal cartilage might be a great source for cartilage repair; however, further clinical studies are required,” she said.
For the study, Martin and colleagues took a small sample of cartilage cells from the patient’s nose bone, then grew more cells by exposing them to growth hormone for two weeks. All the cells were then placed in a membrane of collagen and cultured for two more weeks.
The engineered graft was cut into the right shape and used to replace damaged cartilage after it was surgically removed from the patient’s knee.
With the procedure, only a small sample of cells is taken from the nose, using a local anesthetic. After the knee is repaired, the patient is on crutches for six to eight weeks. It typically takes several months for a full recovery, the researchers said.
No bad reactions were reported, but two serious adverse events unrelated to the procedure occurred — an independent injury in the untreated knee and new cartilage damage in other areas of the treated knee, the researchers said.
Dr. Matthew Hepinstall, an orthopaedic surgeon at Lenox Hill Hospital Center for Joint Preservation and Reconstruction in New York City, welcomed the new findings.
Even small articular cartilage injuries can cause pain, limit walking and running, and restrict joint motion, Hepinstall told HealthDay. “Over time, surrounding healthy cartilage can deteriorate — resulting in arthritis,” he added.
A variety of surgical procedures have been developed to fill “potholes” in articular cartilage, with varying success, he said.
For the last two decades, surgeons have been able to take cartilage cells from the knee, grow them in a lab, and put them back into a patient’s knee, Hepinstall said.
But that procedure requires two operations, Hepinstall noted.
This new study demonstrates the plausibility of taking cartilage cells from the nose in a less invasive procedure that only requires a local anesthetic, he said.