Could your knee heal itself?

With an ageing population that doesn’t – or isn’t allowed to – slow down as they get older, there’s never been more time, expertise and effort being exerted into the problem of knee osteoarthritis. Barely a month goes by these days without a new development in this area, but the latest research has raked up a whole new approach – a device which sweeps up stem cells from the joint lining and then ‘brushes’ them into blood clots. Why? Because stem cells have the ability to form new tissue and have the potential to let the knee heal itself.

The study, from the University of Leeds, has not only demonstrated that the treatment increases the number of repair cells in the area by a hundredfold, but it also casts doubt upon arthroscopy – the keyhole procedure which examines and clears out knee damage – as it may actually inadvertently sluice out the resident stem cells that are capable of repairing knees.

Break up to make up

The key discovery made by the Leeds research team involved the technique of microfracture, which involves using a drill or pick to make small holes in the bone surfaces inside the joint to release stem cells which are trapped in blood clots, and contribute to the repair of the cartilage. The downside to this is that it had been assumed that the number of repair stem cells in the knee is low.

However, the research team discovered that the synovial fluid – which lubricates the joints – contains stem cells too, but the self-same lubrication was stopping the cells from bonding to injured cartilage, and the standard knee procedures were washing them away. So, they’re currently trialling a procedure which creates a microfracture, which results in a clot – followed by a specially designed device which ‘rakes’ the stem cells into the clot, which is inserted through a small hole which has been made in the joint.

A new trial forthcoming

And according to the study, which was published in The American Journal of Sports Medicine, the researchers found that the brush resulted in a 105-fold increase in the number of stem cells. The results have been so encouraging that a new trial is already being prepared, which will involve twenty patients undergoing the microfracture procedure, with ten of them having the stem cell ‘raking’ procedure as well.

Unsurprisingly, the knee OA medical community are sitting up and taking notice, while also striking a note of caution that self-healing knees are still a way away.“Stem cells still represent an exciting area of research for providing a biological solution to knee injury and arthritis,” explains Mr Jonathan Webb. “Several lines of treatment are being studied but it remains an enormous challenge to reliably replicate the complex structure of articular cartilage. For younger athletes with an injury to an otherwise healthy joint, there is more promise, whereas in the older population the damage goes deeper than just the layer of joint surface and so stem cells have not yet proven to be as reliable.” But it’s fair to say that this development is an interesting step forward for knee OA treatment, and one that will be followed with great interest.