Stem cell augmented ACL reconstruction & single stage cartilage repair Gym injury

A young Seem Andhra lady underwent Anterior Cruciate ligament reconstruction and single stage cartilage repair of her knee for the first time in Chennai. This will preserve her knee joint from further deterioration.

Case report–

Mrs.  S Y, a 32 year old lady from Seem Andhra was troubled for over three years with an unstable knee.  She had damaged the anterior cruciate ligament in her left knee in a gym accident about three years ago. This resulted in episodes of giving away of her left knee.  She didn’t pay much heed to this for the last two years.

Only a recent second injury focused her attention to this knee.  An MRI scan revealed an old cruciate ligament injury and cartilage damage on the backside of the knee cap. This combination of two joint injuries disabled Mrs. S considerably. She couldn’t sit down on the floor, kneel or perform gym activities. She consulted Dr.A.K.Venkatachalam, orthopedic surgeon at Chennai Meenakshi multi-specialty hospital. Dr.Venkatachalam recommended an ACL reconstruction combined with cartilagerepair in one sitting. He explained that this combined surgery would shorten her recovery period and allow her to get back on her feet faster.

In the first part of the operation, he performed an anatomic arthroscopic ACL reconstruction.  This procedure reconstructed her missing ACL with her hamstring tendon in an anatomical method. During the second part of the same operation, Dr.Venkat repaired the damaged cartilage under the knee cap with stem cell concentrate and fibrin glue. He first aspirated stem cells from her bone marrow. These were processed to yield a concentrate.  An ml of this stem cell concentrate was mixed with an ml of fibrinogen and injected under arthroscopic visual guidance over the damaged cartilage as fibrin stem cell glue.  The stem cell fibrin glue set in five minutes.  Eventually it will mature into cartilage. The defective area of cartilage was thus repaired in a single stage with stem cells.
Dr. Venkat then delivered the remaining stem cell concentrate to the two sites of the new ligament’s attachment. This is known as stem cell augmentation of ACL reconstruction. Stem cells should hopefully reconstitute the natural tissues at the interface of the ligament.  This is also a novel procedure in Chennai.

Mrs. S was discharged two days later and has been undergoing physical therapy. She is progressing well. She says that the knee feels stable. The grinding sensation under the knee cap has disappeared suggesting that the stem cell glue is coating the damaged area. Over the next few months, the stem cell glue should regenerate hyaline like cartilage which is akin to the natural joint cartilage.

Discussion–

ACL injuries are the commonest ligament injury of the knee. They need surgical reconstruction in young and active patients to avoid further damage.  Untreated ACL injuries can result in further damage to the menisci and articular cartilage in active patients.  Accompanying meniscal and cartilage injuries will only hasten the deterioration.  A combination of ligament, meniscal and cartilage injuries can lead to early arthritis. Hence repair of all damaged structures is recommended in young patients.

Joint preservation entails surgical reconstruction of ligaments, menisci and regeneration of cartilage. Each of these procedures is ideally done as a separate operation and is followed by a necessary and specific type of physical therapy.  Most of these patients suffering from a combination of knee injuries have busy schedules and can’t afford to spend much time for physical therapy. However proper physical therapy is a necessary part of the treatment for each of the procedures. Combining two surgical procedures effectively shortens the rehab period as the common part of the physical therapy for two procedures can be squeezed into one.

The highlight of this operation is that two surgical procedures, namely ACL reconstruction and single stage cartilage repair with stem cells were combined in one sitting for the benefit of the patient. This would lead to Joint preservation in this young patient.  

Joint preservation and stem cells are the new frontier in orthopedic surgery. Medicinal signaling cells (MSC’s) popularly known as stem cells play a major role in joint preservation. These procedures are mainly useful in young and middle aged patients. They put a halt to further damage and prevent osteo-arthritis. This is the first time in Chennai that a joint preservation operation combined two separate surgical procedures to give the best possible result to the patient.

Key words: stem cell augmented ACL reconstruction, single stage cartilage repair, stem cells, Joint preservation