Swedish Procedure Offers Hope For Damaged Cartilage

It happened last spring on the softball field: Richard Adams made it safely to third base but when he tried to stop he heard “a loud crack” - the sound, he learned later, of ligaments tearing and, even worse, of cartilage being ripped apart.

Today, doctors at Massachusetts General Hospital will perform the first operation in America to regrow damaged cartilage, transplanting back into Adams’ knee cartilage cells that were removed three weeks ago and made to multiply in a Cambridge laboratory. The procedure, pioneered in Sweden, offers hope to thousands of people who suffer from similar cartilage damage, and if it works as well as doctors hope, it someday could help millions of Americans afflicted by arthritis.

“There is currently no good method for treating joint cartilage injuries,” said Dr. Bertram Zarins of MGH, Adams’ doctor and team physician for the Bruins and Patriots. “Early results with the transplantation technique have been good and if they can be reproduced and hold up over time, then we have an important advance.”

Dr. Thomas Minas, an orthopedic surgeon at Brigham and Women’s Hospital who has harvested cells from five patients and plans to perform his first transplantation next month, is even more bullish: “I really believe it works.”

The transplant procedure first attracted international attention last fall, when results on 23 patients in Sweden were published in the New England Journal of Medicine. The Swedish surgeons have subsequently completed more than 140 operations, and their success rate is getting better and better.

They first use an arthroscope to harvest a tiny slice of cartilage from a healthy part of the knee. Those cells are taken to a lab, fed nutrients and allowed to grow and multiply for three weeks. Then, in a procedure that requires cutting open the knee, a solution containing the new cells is injected into the damaged area and covered with a flap of tissue taken from lower in the leg.

The procedure worked best in the thighbone, producing cartilage that cushions the joint surface almost as effectively as the original.

Minas and Zarins both visited and assisted the Swedish doctors. Their trips were coordinated by Genzyme, a Cambridge, Mass., biotechnology company that has patented a process for culturing cartilage cells.

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