Pioneering knee surgery may help prevent arthritis

Surgeons have pioneered a knee operation that could prevent the development of arthritis and extend sporting careers.

The procedure, being trialled at Southampton General Hospital, involves coating damaged cartilage with stem cells, taken from a patient’s own hip, and surgical glue.

Known as Abicus (Autologous Bone Marrow Implantation of Cells University Hospital Southampton), the technique, if successful, will regenerate the remaining tissue and create a permanent “like-for-like” replacement for the first time.

Cartilage is a tough, flexible tissue that covers the surface of joints and enables bones to slide over one another while reducing friction and acting as a shock absorber.

Damage to the tissue in the knee is common and occurs mainly following sudden twists or direct blows, but can also develop over time through wear and tear.

Thousands of people a year suffer cartilage damage serious enough to require treatment due to pain, “locking”, and reduced flexibility. If left untreated, it can progress to arthritis and severely impair leg movement.

The most commonly used procedure to repair the injury — microfracture — involves trimming any remaining damaged tissue and drilling holes in the bone beneath the defect via keyhole surgery to promote bleeding and scar tissue to work as a substitute.

However, the technique has variable results, with studies in the US suggesting the procedure offers only a short-term benefit (the first 24 months after surgery), and does not lead to the formation of new cartilage.

Patients who undergo the Abicus operation have the cartilage cut and tidied and undergo microfracture, but their cartilage tissue is then coated with a substance made of bone marrow cells, platelet gel, and hyaluronic acid.

During the 30-minute procedure, the bone marrow sample is spun in a centrifuge in the operating theatre to give a concentrated amount of the patient’s own stem cells. These are mixed with the gel and acid to create a “glue” substance that is placed over the cartilage defect and allowed to set.