Cartilage restoration center leads the state and is fourth in the country in procedure
FAYETTEVILLE--Mike Dunkel, 47, a lineman from Ozark, is back climbing electrical power poles and distance running after a successful Autologous Chondrocyte Implantation (ACI) procedure performed by orthopedic surgeons Chris Arnold, MD and Terry Sites, MD, at Physicians’ Specialty Hospital.
“Without this procedure, I was pretty much done as a runner,” said Dunkel, who had the surgery 18 months ago. “It would have been pretty hard climbing poles, as well. I was just so thankful that Dr. Arnold could do the procedure.”
Dunkel had torn his meniscus doing the long jump in high school, an injury that was aggravated later in life by the sport he is passionate about, running. That meniscal tear left his articular cartilage exposed and subjected it to continual wear, resulting in bone on bone contact in the exposed area.
Arnold was the first in the state to perform the procedure and is fourth in the country in the number of ACI surgeries.
“Dr. Terry Sites and I formed the Cartilage Restoration Center about three years ago to help provide younger people who have lost all or part of their cartilage a better option than knee replacement,” Arnold said. “We have had excellent results re-implanting a patient’s cartilage cells. What we basically do is two separate surgeries. We scope the knee first, take a few cartilage cells, and send them to a center in Boston where they multiply those cells. We put about 48 million of the patient’s own cartilage cells back into the area of the knee that has lost the cartilage. It works. You are using the patient’s cells – the patient’s own DNA – and it has good results. It may prevent them from ever having to have a knee replacement.”
Arnold said the majority of this procedure is done through the arthroscope. However, a small incision is made to introduce the cartilage into the knee joint. “The autologous cells have been tested to ensure that they are free of any transmittable disease,” Arnold said. “Unlike cadaver transplants this does not require that patients be on medications to prevent tissue rejection. You are essentially giving the patient back their own cartilage.”
Arnold has done about 100 of the procedures in the past 3 1/2 years. Patients who meet the right criteria have seen excellent outcomes.
“It has been very rewarding, because instead of replacing a knee in someone who is 30, 40 or 50, repairing their cartilage with their own cells allows them to avoid a knee replacement at that early of an age,” Arnold said. “It is a little more expensive than knee replacement. The higher cost isn’t for the surgeon, but for getting the cells multiplied. If you do a knee replacement on people in their 30s, they will need knee replacement several times in their life. While the initial cost of a cartilage transplant is more, the long term cost can be much lower.”
Sites said ACI is a biological solution to a previously unsolvable problem.
“Patients ages 15-55 now have the opportunity to restore the damaged surface of their knees instead of simply treating their symptoms or replacing the knee joint, which is not biological,” Sites said. “Unlike joint replacement surgery, which has permanent physical limitations, ACI has the potential to return patients to their activities unrestricted.”
After the surgery, it was about four months before Dunkel could go back to work, and during that interim he was aggressive with his physical therapy, swimming 50 minutes a day and doing other exercises. Dunkel started running again Jan. 1, and ran a half marathon in March.
“I’m back climbing poles, and doing pretty much everything I was doing before,” Dunkel said. “I’m not quite as fast running as before. It takes a while for the muscles to develop. Actually, eventually I should be better because I don’t have that old damage there now.”
Dunkel credits the procedure with saving his career, as well as his favorite hobby.
“Only a few doctors in the state do the procedure, so I was blessed to have Dr. Arnold as my doctor,” Dunkel said. “I remember the first time I had my knee scoped, another surgeon said it was one of the worst he had seen. The cartilage was gone. It was rubbing bone on bone. I had quite a bit of pain with it. It was swollen a lot, too.”
A torn meniscus is the most common knee injury requiring surgery in North America, and often results in the type of damage that led to Dunkel undergoing the ACI procedure. While often the meniscus tears result from sports or workplace injuries, they can also occur with activities of daily living without any specific trauma.
“Once a meniscus is torn, the body's natural response is to develop pain, as well as swelling,” said Sites. “Patients often complain that the knee may ‘lock’, give way, or go out. Once a meniscus is torn, it loses its normal cushioning affect. This causes the body's weight to distribute unevenly. As a result of this uneven stress over time, the articular cartilage can wear down which can lead to degenerative arthritis. At the Cartilage Restoration Center, we do everything possible to repair or even replace torn or worn down cartilage.”
In the past, many knee injury repairs would result in a large incision. Sites said this subsequently changed to performing most cartilage repairs and replacements through the arthroscope.
The Cartilage Restoration Center is the first of its kind in the state of Arkansas, and one of only a few designated cartilage restoration centers in the U.S. They provide a full range of treatment options for knee. The majority of these procedures are performed arthroscopically in an outpatient setting while others occasionally require an overnight stay.
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