Grow your own cure for damaged knees

The stem cells – early stage “master” cells that can develop into any tissue type – will be harvested from the patient before being grown in a laboratory prior to implantation into damaged joints.

Researchers hope the new technique will be available within three years as it will improve current surgical treatments for painful knee injuries by creating a “one-stop” procedure.

Although cartilage can already be developed from mature cartilage cells, it involves a biopsy, to remove the tissue before it is grown and then replaced in a second procedure. However, stem cells can be drawn more easily from bone marrow or fat tissue before being chemically “tricked” into developing as cartilage and then implanted into an ailing joint.

Experts predict stem-cell treatment will be cheaper for the NHS, which spends around £1 billion a year on knee replacement surgery alone.

Leela Biant, consultant orthopaedic surgeon at Edinburgh Royal Infirmary, said the research carried out with colleagues at Edinburgh University had been very promising, suggesting a move to stem-cell treatment may not be far away.

Stem-cell techniques could potentially create an inexhaustible supply of cells to treat injuries, as well as reducing the number of procedures the patient would have to undergo on the damaged area.

“It would be a one-stop technique because you wouldn’t have to go in and take the biopsy in the first place,” she said. “You would also have an unending source of cells, whereas you have only got a few cells that come out of the cartilage biopsy and then you have to expand and grow them in the lab.

“All that wouldn’t be necessary if you got as many stem cells as you need, put them in the right environment and then put them back in whichever joint you wanted to regenerate.”

Arthritis Research UK, which is funding scientific work involving stem cells, said such approaches would vastly improve the lives of patients.

Medical director Professor Alan Silman said: “Osteoarthritis of the hip and knee will be an increasing problem in our society as people age and want to remain active. Although joint replacement can be spectacularly successful, finding an injectable cell-based answer that could be used earlier would be a major breakthrough, reducing pain and disability and minimising health service costs.”

As they prepare to use the procedure in the first patients, surgeons are launching a new service this week to repair knee injuries using a similar technique growing tissue using samples of mature cartilage.

Biant, who works at both the Royal Infirmary and the private Spire Murrayfield Hospital in Edinburgh, has spent more than ten years refining a technique known as matrix-induced chondrocyte implantation (MACI) in patients with cartilage damage in their knee. By perfecting MACI, Biant said the team hoped to be ready to treat patients using the stem cell tissue within three years.

Joint injuries are common among sports participants, causing serious pain and swelling and, eventually, conditions such as arthritis.

The MACI procedure starts with keyhole surgery to look for damage to the cartilage that lines the joint.

“It is a very common type of injury and usually very difficult to treat,” Biant said. “Firstly you assess the damage and take a small biopsy of cartilage from the knee.

“That is sent to the lab where they grow the patient’s own cells from that bit of cartilage. They then send it back and you re-implant the cells back into the knee in a second operation.”

The technique has been used in some trials in Scotland, and offered in a handful of centres in the past. But changes to the licensing arrangements needed to carry out the procedure meant it became too expensive to continue.

However, this week the procedure will start to be available to NHS patients at the ERI and private patients at Spire Murrayfield, costing around £15,000.

“We are very keen to get this technique up and running in Edinburgh for both NHS and private patients to offer them the best available standard of care,” Biant said.