A Victory for Injured Athletes
Science of tissue engineering transforms how athletes and others heal
Mike McDonald, a former Lake Forest College ice hockey goalie, would simply put his arms behind his head to rest and his shoulder would dislocate. Brooke Evans, a college basketball player from Mundelein, had multiple knee surgeries before reaching her eighteenth birthday. Up until a few years ago, their conditions would have meant an uncertain future for their athletic careers and possibly a lifetime of pain.
Today, the advanced science of orthobiologics, or tissue engineering, is transforming orthopaedic care for athletes and others suffering from knee and shoulder problems. Transplants of real human bone and cartilage, cloning of the patient’s own cartilage cells and platelet-rich plasma injections are helping promising young athletes like Mike McDonald and Brooke Evans return to highly physical, competitive activities with confidence and strength.
At Northwestern Lake Forest Hospital, Roger N. Chams, MD was only the second orthopaedic surgeon in the Chicago area to perform cadaveric ankle cartilage-to-shoulder reconstruction when he operated on Mike McDonald. Dr. Chams is the team physician for the U.S. Soccer Federation, an NCAA team and multiple high school teams, as well as professional and amateur adult athletes.
He has extensive experience treating sports injuries, performing more than 1,200 arthroscopic knee and shoulder procedures each year, including anterior cruciate ligament (ACL) repair, multiple ligament reconstruction, shoulder rotator cuff reconstruction repair and cartilage preservation. This experience has made him hopeful about how orthobiologics may help athletes today and in the future.
Shoulder Reconstruction with Cadaver Tissue Transplants
Patients like McDonald who have frequently dislocating shoulders and severe bone loss can now benefit from a new procedure that transplants fresh bone and cartilage from a donated cadaver ankle directly into the shoulder socket (osteochondral allograft reconstruction). The materials fuse with the shoulder over a period of six months, during which time the patient receives physical therapy. Within six months, most patients return to a level of functionality nearly identical to their pre-injury condition.
“In the past, for patients with frequently dislocating shoulders—which is common among athletes—we would surgically reconstruct the shoulder or use a bone block and about 35 percent of them would fail,” says Dr. Chams. “But with biologic materials, we take traditional orthopaedic procedures and dramatically improve the outcomes and overall patient functionality.”
The shoulder transplant procedure requires only 90 minutes and is performed on an outpatient basis. The procedure reduces the risk of recurrent instability and may prevent the arthritis that would otherwise develop as the patient ages. The procedure also avoids the complications that can occur with traditional reconstructive procedures.
“We get the cadaver tissue from the most reputable bank, and everything is thoroughly tested,” explains Dr. Chams. “This is very fresh, high-quality material that is reimplanted within 15 days to preserve the viability of the transplanted cartilage cells.”
Within six months of his surgery, McDonald was back on the ice and looking forward to a new season with a new college team—an opportunity he thought was gone forever. Read Mike's complete story.
Cartilage Cloning Transplants for Knees
Cartilage cloning transplants (autologous chondrocyte implantation) are a highly effective solution for patients like Brooke Evans, who experienced acute and repetitive trauma to the knee and responded poorly to more conservative treatments.
The procedure is performed in two stages: the knee is arthroscopically biopsied (the patient’s own cartilage is removed) and the tissue is sent to a laboratory where it is “cloned,” or grown into millions of new cells. A product called Carticel® is used with the patient’s own cells to form new cartilage. Roughly five weeks later, this material is transplanted back into the knee and gradually adheres to the natural bone and shape of the knee.
“This technique has only been available for a few years, but it provides much better outcomes than what was available in the past,” explains Dr. Chams, one of the few surgeons in the area who performs the procedure. “Cartilage cloning, stem cells and transplantation offer earlier biologic interventions. Previously, younger patients had to wait for knees to become arthritic and endure more extensive partial or total knee replacement surgery.”
Dr. Chams performed the cartilage cloning and transplant on Evans in the summer of 2010. By the following year, she was back on the basketball court and playing with even more strength and stability. Read Brooke's complete story.
Other Advances Using Orthobiologics
“At Northwestern Lake Forest Hospital, we are advancing the field of orthopaedics with other techniques using orthobiologics,” explains Dr. Chams. “Platelet-rich plasma (PRP) injections contain and release growth factors that stimulate stem cells and accelerate healing in conjunction with ACL repair, meniscal repair, rotator cuff, torn tendons or allograft orthopaedic surgeries. Patients who may not be candidates for surgery but who have severe joint, tendon or ligament damage can also benefit from PRP.”
Bone morphogenetic protein (BMP) stem cells are now used for fractures. This material is essentially a hormone that signals the development of tissue throughout the body and has been beneficial in the treatment of bone-related conditions. BMP may serve as a more effective alternative to orthopaedic procedures where bone grafting traditionally has been used.
“With orthobiologics, we’re reconstructing cartilage and bone the way it should be; we’re preserving it and building it, not just trying to make do without it,” says Dr. Chams. “Fifteen years ago, traditional arthroscopic procedures were new, and they were good. Then we discovered that we could make these procedures even better with biologic material. We can provide better outcomes for our patients, increased function and longer-lasting freedom from pain. These advanced procedures will markedly improve long-term results.”