David Bendick steps gingerly around the toy-strewn living room.
He’s got reason to be careful in his home in Orange, Calif. The last thing he wants is to fall and wrench his right knee.
Inside that knee is a palm-size piece of cartilage that came to Bendick from the body of a dead person–and ended four years of excruciating pain for the 46-year-old.
Bendick is one of a handful of people in Orange County who have had cryopreserved cartilage transplanted into their knees, an experimental option for one of the most common injuries of the knee: a damaged meniscus.
“It’s been like a miracle,” Bendick said of the surgery he had in late February.
It is, however, a miracle few can qualify for.
There are two meniscuses in each knee, “C” shaped pieces of cartilage that reduce friction between the thigh and shin bones, help distribute weight in the knee and act like shock absorbers.
Meniscuses can be injured by any sudden twist of the knee, causing pain, swelling and, sometimes, a locking sensation. Unlike skin, cartilage doesn’t repair itself or grow back.
Meniscal tears are the most common orthopedic injury requiring surgery, with more than 300,000 performed each year.
Part or all of the meniscus may need to be removed, a procedure surgeons formerly thought had little long-term effect. But studies show that removing the cartilage eventually leads to arthritis as the ends of the two bones grind together.
Eventually, a total knee replacement may be needed, at a cost of about $35,000.
But about 10 years ago, doctors began transplanting meniscus tissue into some patients. The tissue is harvested from donors and evaluated for contaminants, including viruses such as HIV and hepatitis.
Most of the meniscus allografts come from a company called CryoLife, in Georgia, which freezes the tissue and ships it to surgeons.
In the past year, the company has seen a 50 percent increase in tissue supplied for allografts, with about 400 transplants performed in 1997.
The procedure is gaining popularity because of new techniques that improve results and cut operating time from seven hours to about two hours, said Newport Beach, Calif., orthopedic surgeon Ralph J. Venuto, who has performed two transplants since January.
Additionally, new studies showing successful results as long as seven years after the surgery have piqued the interest of more surgeons.
But University of California orthopedic surgeon Patrick McMahon has a warning. He says that about one-third of meniscus recipients will tear the allograft or, in more rare cases, the cartilage will degenerate in the knee.
The surgery itself is relatively simple. The surgeon uses an arthroscope to clean out the old meniscus, them makes a 2-inch incision in the knee and carves a keyhole-shaped groove from the front to the back of the tibia, or shinbone.
The graft arrives attached to a chunk of bone, which the surgeon carves into the “key” to fit the tibia.
The graft is then slid into the slot in the tibia, and the surgeon sutures the edges of the meniscus to the base of the bone and closes the incision.
The surgery, which costs about $40,000, including hospital expenses, is usually performed on an outpatient basis, Venuto said. He said most insurance plans cover it.
Patients usually spend about six weeks on crutches, then another several weeks in physical therapy to strengthen the knee.
But it’s not for everyone.
“A patient should have pain, should be young and should have had at least most of the meniscus removed and pain despite other treatments–arthroscopic clean-out, exercise and physical therapy,” Venuto said.
That’s a tough combination, said Dr. Daniel Veltri, an orthopedic surgeon in Connecticut who performs the surgery. Usually, by the time someone with a torn meniscus begins having the kind of pain that would warrant a transplant, the rest of the knee has also deteriorated.
“There are not a lot of true candidates.”
Bendick was one. He had been in terrible pain for nearly four years since his first surgery, in which 90 percent of a meniscus was removed.
Doctor after doctor told him there was nothing he could do–except wait until he was older and have a knee replacement. Replacing the joint too early would just necessitate another replacement later.
Now, nearly four months after his surgery with Venuto, Bendick is playing with his two young sons, walking, riding a stationary bike and using nothing stronger than ibuprofen for pain.
