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Adventures in cartilage

Veronica Whitney

Cauchois, who sells human-resources software in San Francisco, soon became a candidate for a knee replacement. But instead of choosing to rebuild his cartilage, Cauchois, 35, chose microfracture surgery, a procedure cartilage regeneration procedure pioneered by Vail’s Dr. Richard Steadman.

A year and a half later, which extensive rehabilitation, Cauchois and three teammates won the Race Across California Enviro, a four-day running race between Lake Tahoe and the Golden Gate Bridge.

“The irony is I got more fit and competitive after the injury,” Cauchois says.



Earlier this year, a cartilage defect could have changed the life of professional tennis player Lindsey Davenport.

“If we hadn’t come up with a solution, it would’ve ended up her career,” says Steadman, founder of the Steadman-Hawkins Clinic.



Davenport was facing a knee replacement, which would have made it impossible for her to go back to competitive tennis. In January, however, Steadman performed microfracture surgery, a less invasive procedure that allowed her to go back to full activity.

“She’s had a very strong recovery,” Steadman says. “She’s been in the finals in two tournaments and now is seeded fifth in the U.S. Open.”

Since he developed microfracture surgery 15 years ago, Steadman has used it on more than 2,000 patients – including more than 50 professional football players. The procedure recruits stem cells from bone marrow to form new cartilage over areas in the joint where bare bone is exposed, says John McMurtry, vice president for program development with the Steadman-Hawkins Sports Medicine Foundation.



“We now have solid data that shows this procedure has had a success rate of 80 percent,” McMurtry says. “The new cartilage seems to be more durable than the regular cartilage.”

Since he started practicing medicine 32 years ago, Steadman says he has seen an increase in ostheoarthritis, the most common form of arthritis and the most common joint disease. It happens when cartilage covering the ends of bones breaks down or wears away. Ostheoarthritis may be caused by excessive wear, injuries, age, obesity or accidents.

The U.S. Centers for Disease Control and Prevention reports that arthritis and other rheumatic conditions affect an estimated 43 million Americans. Nearly 50 percent of people 65 or older have arthritis. By the year 2020, an estimated 60 million people will have arthritis according to the CDC’s National Arthritis Action Plan.

“Thirty years ago, people weren’t so active, and if they had a problem, they just sat down,” Steadman says. “Today, people try to correct the problem and keep doing activities. Also, there’s a larger older population now, and ostheoarthritis cases are more common in older people.”

In fact, arthritis is a more frequent cause of activity limitation than heart disease, cancer or diabetes, McMurtry says.

“Arthritis is the result of losing cartilage, and cartilage doesn’t have the ability to repair itself like other tissues,” he says.

The microfracture procedure is useful for young or middle-aged athletes who’ve been injured, or for people trying to delay a knee replacement, Steadman says.

“There’s a lifetime for a knee replacement -10 to 15 years,” he says. “The more that’s done, the less effective it is. The longer we can delay a knee replacement, the better.”

One of the main advantages of microfracture surgery, Steadman says, is that no foreign substances are added to the body.

“It’s less likely that there will be a complication if it’s your own tissue that’s being regenearated,” he adds.

Lower cost makes microfracture procedures more desirable, too, McMurtry says. For example, a total knee replacement at Vail Valley Medical Center is $31,000, compared to $8,100 for microfracture surgery.

“This procedure is been accepted by orthopedist surgeons around the world as the procedure of choice for cartilage knee lesions,” McMurtry says.

In fact, about 77 percent of knee surgeons are now using microfracture as an alternative to knee replacement, says Steadman, who recently gave a lecture and demonstration on microfracture before 150 orthopaedic surgeons from around the world during the second International Vail Cartilage Symposium.

The two-day meeting, hosted by the Steadman-Hawkins Sports Medicine Foundation, featured an international faculty of orthopaedic surgeons, each a pioneer in treating articular cartilage injuries.

The foundation, a nonprofit organization in Vail, has raised $25 million in the past 12 years for research on ostheoarthritis.

“We’re approaching this condition from several disciplines, including clinical research and biomechanics,” McMurtry says.

Steadman says he also uses a similar procedure for ligament injuries, to avoid major surgery.

“For those who can’t have a microfracture, we’re looking at ways to decrease pain from orthoarthritis,” he says.

McMurtry says it’s still too soon to know how long microfracture procedures can last. Since he had his, however, Scott Cauchois has never had a follow up surgery.

“It feels good,” he says, “and I still do some competitive running.”

Biomechanics award

Researchers at Steadman-Hawkins Sport Medicine Foundation have won an award for their work on anterior-cruciate ligament injuries.

The American Society of Biomechanics selected the project, “Anterior-Cruciate Ligament Forces in the Intact Knee During Normal Gate,” as winner in the 2002 Journal of Biomechanics Award competition.

Kevin Shelburne, Ph.D., Marcus Pandy, Ph.D., Frank C. Anderson, Ph.D. and Michael Torry, Ph.D., all doctors in biomechanics at the foundation in Vail, jointly authored the research.

“The award is the Superbowl in biomechanical research,” Shelburne says. “Just being a finalist for this Award is a great honor.”

The award, one of the most prestigious in the biomechanics field, was announced and presented to the winner at the Fourth World Congress on Biomechanics in August in Calgary, Alberta.

“We (doctors in biomechanics) help the doctors understand the mechanics of knee joints,” says Michael Torry. “With this information, doctors can make better choices of treatment plans.”

The awarded research shows what happens to a healthy knee and one that has a torn the ACL while walking.

“We discovered that without the ACL, all ligaments have to make up for what the ACL isn’t doing,” Torry says.

The World Congress of Biomechanics, a conference held every four years, hosts biomechanists from around the world and includes much of the best biomedical research conducted during the previous four-year period. The goal of the congress is to facilitate the exchange of cutting-edge research in biomechanics.

Veronica Whitney can be reached at 949-0555, ext. 454, or at vwhitney@vaildaily.com.


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