Pain and discomfort in the knee are prevalent among athletes and older individuals
due to high level of stress and impact from physical activities and repetitive motions.
Doctors attempt to extinguish pain and discomfort by performing surgical techniques
such as a knee replacement surgery (arthroplasty) or microfracture surgery. Prochondrix Cartilage Restoration
Matrix is a new alternative solution for restoring the cartilage surface.
The knee contains the largest joint in the body linking three bones
(femur, tibia, and patella) together which is responsible for carrying one’s
own body weight. Within the joint cavity lies structures such as cartilage, ligaments,
and tendons to allow for smooth sliding, protection, and stability (Sophia-Fox,
Bedi, & Rodeo, 2009). The cartilage covering the surface of the bones
specifically the condyles (distal end) of the femur is composed of hyaline
cartilage. The hyaline cartilage is a smooth articular layer about 2-4 mm thick
without blood vessels, nerves, and lymphatics, and the smooth layer allows for
low friction articulation (Sophia-Fox, Bedi, & Rodeo, 2009).
The issue at hand is the inability of injured cartilage to repair
itself since cartilage is avascular (lack of blood vessels); thus, surgical
procedures are performed to repair, regenerate, and replace the cartilage.
Prochondrix is a thin disc-shaped fresh allograft (a donor tissue graft) that
aids in delivering biological components to restore the damaged cartilage
tissue (Nelson, Barrett, and Sakthivel, 2016). The disc is implanted by a slightly
invasive surgical technique known as arthroscopy potentially eliminating a
partial or full knee replacement. A fibrin glue is used for the disc to secure
it in place (Nelson, Barrett, and Sakthivel, 2016). The healthy cartilage of Prochondrix
contains living cells (chondrocyte) and growth factors which are involved in
the cartilage restoration process, and the extracellular matrix is present to
offer structural support for cellular adhesion (Bugbee et al., 2016).
As mentioned earlier, Prochondrix is an allograft, and post-mortem tissue
donation can give rise to many ethical challenges particularly autonomy. Tissue
donation is proceeded by obtaining informed consent, but who is the person to
provide the final consent, the deceased patient or the patient’s family? What
if the deceased patient provided consent to donate before his or her death, but
the family disagrees and overrule the decision, should the family have the
final say after a patient’s death? Prochondrix can enhance the quality of life,
but it is also imperative to value respect and appreciation of donation.
https://www.allosource.org/products/prochondrix/
References:
Sophia-Fox, A.J., Bedi, A. & Rodeo, S. A. (2009). The Basic Science of Articular Cartilage.
Sports Health. 1(6), 461-468. doi: 10.1177/1941738109350438
Nelson, A.L., Barrett, C., and Sakthivel, R. (2016). Prochondrix
Osteochondral Allograft Maintains Viable Chondrocytes, Osteoblasts, and a
mineralized Matrix Necessary to Support Bone and Cartilage Formation. Basic
Science. Vol. 4.
Obtained from: https://www.prochondrix.org/wp-content/uploads/2015/10/071317-M8S0128.001_Basic-Sci-Vol-4-ProCh-Osteoblast-singlepgs-rgb.pdf
Bugbee, W.D., Pallante-Kichuram, A.L., Görtz, S., Amiel, D., Sah, R.(2016).
Osteochondral Allograft Transplantation
in Cartilage Repair: Graft Storage Paradigm, Translational Models, and Clinical
Applications. Journal of Orthopaedic Research: official publication of the
Orthopaedic Research Society. 34(1):31-38. doi:10.1002/jor.22998.
This is new alternative approach for cartilage restoration is very interesting. I’ve worked in a rehabilitation facility and have encountered many patients who underwent partial or full knee replacements. These patients would stay at the facility for several weeks along with weeks of physical therapy. I’m assuming that since Prochondrix Cartilage restoration is a slightly invasive procedure, the recovery time and physical therapy sessions would not be as long. Like you mentioned this is great for athletic individuals who want to return to their daily routines. In addition, a procedure such as this would minimize the cost for knee replacements and recovery. Perhaps more insurance companies would find this more attractive, along with it being more beneficial to the patient. Unfortunately, patient families may override the consent of the deceased. I found a journal article by Truog (2008) who mentioned that patient families tend to overturn the deceased’s consent when it comes to new procedures which is even more unfortunate. It’s a challenge when patient families overturn consent and I feel that people (patient and their family) who desire to donate should be transparent and fair. In addition, they medical teams and guidance counselors should be incorporated in the decision making to provide support and information as to where their donation will may be going.
ReplyDeleteTruog, R. (2008). Consent for organ donation -- balancing conflicting ethical obligations. New England Journal Of Medicine, 358(12), 1209-1211.
Although the hyaline cartilage found in the knee is different from the fibrocartilage of the intervertebral discs, this made me wonder what the possibilities might be for herniated disc replacement. A herniated disk can occur when the fibers of the annulus fibrosis tear, allowing the inner portion of the disc, the nucleus pulposes, to escape. The outer portion of the IV disc is the annulus fibrosis, which is composed of fibrocartilage. Inflammatory responses are common in this situation because the nucleus pulposes comes in contact with the blood and is targeted as a foreign invader (Rogers, 2017). The inflammation around the herniated disc most likely will press on the near by spinal nerves, which is what sends afferent signals to the brain that there is pain. Since this type of injury is due to the tearing of the outer fibrocartilage, I wonder if a simple fix would be to replace or repair that with something similar to prochondrix cartilage. Currently, artificial discs are made up of plastic or metal, which in my opinion would be less comfortable and could potentially lead to heightened issues in the future. I was unable to find any current procedures that include a donor allograft for herniated discs, however, I do think this could be beneficial if this type of cartilage was able to be replaced or mimicked by a material more similar to the fibrocartilage.
ReplyDeleteRogers , R. (n.d.). The Physiology of a Herniated Disc. Retrieved October 12, 2017, from
http://livehealthy.chron.com/physiology-herniated-disc-1041.html