Years of playing sports take their toll on bodies, and for Ken Crovetti,
a lifetime of athletics had so damaged his left knee that he could barely
walk without pain. There is nothing newsworthy about sports-related knee
pain as it represents one of the biggest reasons for visiting an orthopedic
surgeon. What is newsworthy, however, is the development of new types
of treatments to help active patients like Crovetti return to sports again,
Crovetti, 49, is a computer software sales executive who lives in Phoenixville,
Pa., with his wife, Susan, and their children, ages 21, 18 and 15. In
his early 30s and already suffering from aches and pains in both his knees,
he shattered his left kneecap in a wakeboarding accident. His doctors
repaired the kneecap, but identified additional damage to his cartilage—the
soft tissue that provides a cushion where the bones meet in the knee joint—which
at that time was left untreated. Within two to three years, that benign
cartilage lesion had deteriorated to the point where his pain was present
with activities of daily living in addition to the limitations he experienced
That’s the point at which he went to see
Alan E. Cooper, M.D., an orthopedic surgeon at Saint Barnabas Medical Center. The two were already acquainted: “Our oldest kids went to nursery
school together, so I had known him a long time before I became his patient,”
Crovetti says. “You go to people you trust, right?”
Alan E. Cooper, M.D.
“We have a limited capacity to regenerate our own articular cartilage,”
Dr. Cooper says. This tissue lacks a blood supply, so it cannot repair
itself like other tissues can. “Until recently, we just told these
kind of patients to live with it until they were old enough to get a knee
replacement or drill holes to create fibrous tissue (false cartilage)”
he says. Over the past decade, though, several new options have been made
available to stimulate the growth of new cartilage.
For children and adolescents, damaged cartilage can be repaired with bio-absorbable
implants—which stabilize the piece of loose cartilage—as it
requires the healing capacities of youth; however, older patients like
Crovetti aren’t candidates. They are, however, eligible for either
an autograft (taken from own knee), allograft transplant from a cadaver
knee, infantile cartilage with regenerative capability or a two-stage
procedure which includes culturing one’s own harvested cartilage
cells in a lab and transplanting them back into the defect.
Crovetti met with Dr. Cooper to discuss these options, and included his
brother, an orthopedic surgeon, to be part of the consultation. “They
had a conversation, brother to doctor, and agreed a transplant from a
fresh cadaver made the most sense based on the size of my cartilage lesion,”
Crovetti says. It took a while to find fresh tissue that was an exact
match to his knee. When it was located, “He called me on a Friday
and asked if I could go in on Monday,” Crovetti recalls.
Dr. Cooper performed what is called an osteochondral allograft transplant.
He drilled a hole in the bone slightly larger than the defect and transplanted
a plug of cadaver bone and cartilage as a perfect match. Crovetti admits
the first week of recovery “was pretty painful.” After that,
however, he healed rapidly. Physical therapy helped him rehab the knee
to rebuild strength and range of motion. Six months after surgery, he
was back waterskiing and enjoying other activities.
Other patients may have an option of using implants generated from their
own tissues. Cartilage is removed from a non-weight-bearing part of their
knee, where it isn’t needed, and sent to a special laboratory, to
be encouraged to grow artificially. That tissue is then re-implanted back
into the knee defect where it is needed. Choosing between cadaver tissue
and the patient’s own cartilage depends mostly on the size and location
of the patients lesion(s). “With a larger lesion, cellbased treatment
might be the better option, and for smaller lesions the OATs procedure
(osteochondral autograft transfer system) performed arthroscopically might
be better,” Dr. Cooper says.
Yet another, even newer possibility is stem cell therapy. Stem cells are
taken from the patient’s own bone marrow in the pelvic bone or come
from amniotic fluid in stem cell banks. “We can inject stem cells
into the knee joint for an arthritic patient or use it as an adjunct into
the lesion itself,” Dr. Cooper says. “The early results for
this look promising, but it is not yet a universal application at this time.
Crovetti is still happy with his transplant. “I play golf, I spend
a lot of time walking my dogs,” he says. “Dr. Cooper bought
me years of activity.”
A Center for Knee Repair
Under the direction of Alan E. Cooper, M.D., Saint Barnabas Medical Center
will be opening a cartilage regeneration program as part of his practice
within the Barnabas Health Ambulatory Care Center.
“There is a definite need for this type of center in this region,”
Dr. Cooper says. “There is now an epidemic of athletic injuries,
due to increased activity levels and year-round single-sport participation
starting at very young ages. It makes treatment more seamless when you
have it all centered in one location.”
To find out more about Orthopedic services at Saint Barnabas Medical Center,
call the Joint Institute at 973.322.9908.