2019 04 09

A unique joint cartilage restoration operation prevents many years in pain

Bone, Joint, Ligament and Muscle Diseases

Unikali sanario kremzles atkurimo operacija isgelbejo nuo ilgameciu skausmu

Increasingly, people remain active longer. Unfortunately, according to the most recent statistics, as many as one-third of them are overweight or obese, increasing the load on their joints. Our joint cartilage increasingly experiences constant strain and trauma; it is easy to damage, but complex to restore.  

“Joint cartilage lesions are caused by both acute and repeated traumas or various illnesses. Research shows that 5% to 10% of all people older than 40 have deep cartilage lesions, whereas 80% of those over the age of 75 are diagnosed with osteoarthrosis. When performing arthroscopic operations on the knee joints, I diagnose cartilage lesions for approximately 60% to 70% of patients,” says Darijus Rimas, an orthopaedist and traumatologist at the Medical Diagnostic and Treatment Centre on Grybo Street in Vilnius, who recently performed a unique knee joint cartilage restoration operation. “It could boldly be called natural because during the operation a resource of the human body – blood – was used.”

Doctor Darijus Rimas

Just a single day was required to establish the diagnosis for the patient and just a single hour to give him back the joy of movement. This short narrative aptly describes what happened when a 40-year-old man applied to an orthopaedist and traumatologist Darijus Rimas. Due to his pain, the patient had to forgo a lot of things, including his beloved tennis.

Too young for such indisposition? Do you believe this was an isolated case? Nowhere near. Just listen to men and women of a similar age talking at sports clubs – there’s no shortage of complaints about joint pains or the necessity of having to forgo their favorite activities or change them to other ones. Even substantially younger people initially just laugh when they hear their joints cracking, but eventually, a feeling of heaviness in the knees, swelling, and aches become constant companions.

Orthopaedist and traumatologist Darijus Rimas replied to some questions on the exceptional joint cartilage restoration operation.

What is the exact description of the operation that you performed?

This was the treatment of the knee joint cartilage using a clot of a mixture of autologous plasma enriched with thrombocytes and growth factors, and healthy cartilage.

Joint cartilage is a unique tissue capable of resisting repeated compression forces throughout a person’s life. A cartilage lesion is quite a frequent trauma of the joint; however, the possibilities for its renewal are very limited. Most often, the cartilage is damaged as a result of direct mechanical impact, upon sustaining trauma, or due to the gradual wear of the cartilage due to osteoarthrosis and other system diseases. In all cases, biochemical and physiological processes occurring in the cartilage are disturbed.

How do such patients feel before administering treatment or an operation?

As the population ages and physical activity increases, osteoarthrosis is becoming the main joint disease damaging the cartilage surfaces of the joint and the surrounding soft tissues and bones. The articular function deteriorates together with the quality of life.

Patients suffer from joint gnawing, pain, cracking, a feeling of seizure, and swelling. X-ray examinations generally show no lesions, but magnetic resonance imaging shows the lesions of the cartilage, quite often including damage to the ligaments of the menisci and potentially free fragments of the cartilage.

Due to the weak healing and regeneration potential of the cartilage, special surgical treatment is required.

What was the uniqueness of the operation you performed?

The key task in cartilage restoration surgery is to enable the cartilage to regenerate itself. The most recent achievements in tissue engineering allow for the quality restoration of the cartilage.

Cartilage lesions may be treated by different surgical methods: marrow stimulation by microfractures, chondroplasty, mosaicplasty using cartilage and bone grafts, autologous chondrocyte implantation using collagen membranes, or autologous cartilage implantation.

We applied technology refined by the Spanish orthopaedist and traumatologist Ramon Cugat. The new method refers to the treatment of an articular cartilage defect by a clot mixture of autologous plasma, enriched with thrombocytes and growth factors and healthy cartilage. I heard of this technology at a conference. I met with Dr Ramon Cugat and started asking him, and he told me: “Come and I will show you”. So we brought the new technology back to the Medical Diagnostic and Treatment Centre.

Orthopedics surgery

In the picture: orthopaedist and traumatologist Darijus Rimas during an operation

The method is thrombocyte biology. Thrombocytes perform a significant function in healing, reduce inflammation, and promote cell proliferation and the regeneration of damaged tissues. They also have an angiogenetic effect on cell migration to the damaged tissues. Growth factors released by the thrombocytes perform a key function in the complex tissue regeneration processes.

What is the procedure of the operation?

A standard arthroscopic operation is performed, and the cartilage lesion and its surrounding area are evaluated. Then the patient’s blood is prepared and processed, and plasma is separated. After enriching it with thrombocytes and growth factors, it is mixed with fragments of the healthy cartilage and clotted, applying a special methodology. A graft of plasma and cartilage is obtained and affixed to the cartilage defect area.

Orthopedics surgery

In the case of small cartilage lesions of up to a few square centimeters, the operation is minimally invasive and performed through small incisions. If the cartilage lesion is bigger, a 5cm to 7cm incision needs to be made so that the defect can be covered properly. For this, no additional membranes or synthetic gels are used.

The operation takes an hour.

What should the patient do after the operation?

During the healing period, it is crucial to protect the formed cartilage from traumatization. So, for some time (up to 6 weeks), the patient should walk on crutches gradually increasing the load on the operated limb. The patient has also prescribed rehabilitation treatment. After the operation, it is necessary to build up muscle strength and promote cartilage regeneration and formation.

By increasing the physical load gradually, after six to 12 months the patients can go back to their favorite physical activities.

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