Cartilage Regeneration: Treatment of Osteoarthritis

Cartilage Regeneration: Treatment of Osteoarthritis
Image Credit: FXRX

“Time and health are two precious assets that we don’t recognize and appreciate until they have been depleted.”  – Denis Waitley 

Article Authors: Gordon Slater| Tandose Sambo

As our bodies age, there are a few complications that can develop and affect mobility. Osteoarthritis is one of the conditions that are often associated with older patients. Within the knee, articular cartilage abnormalities can develop. While traditional treatments for arthritis do have their merit, with a new understanding of the mechanisms of the condition, it is now possible to utilize self healing techniques to facilitate cartilage regeneration, along with conventional treatments.

During Osteoarthritis, the joint cartilage that coats the joint surface and enables their smooth operation is injured, and does not regenerate. Cartilage regrowth therefore will be an important focus of new medical therapies dedicated to the treatment of osteoarthritis. A treatment that has facilitated cartilage regrowth in patients, couples with distraction procedures in order to yield optimal results.

With up to 10% of the world’s population who are aged 60 years and older being affected by osteoarthritis, the patient community will greatly benefit from advanced in medical treatment that is available to them in the therapeutic market. With adequate treatment of osteoarthritis, the healthcare burden of the condition can be alleviated, and treatment of other orthopaedic conditions can then be tackled. Ideally, prevention is better than cure, but if osteoarthritis develops, enabling natural healing or inducing joint restoration will be one of the best ways to heal as a patient.

Articular Cartilage

Articular Cartilage is soft tissue that lines the exterior surfaces of the bones that connect in a joint cavity. Previous medical theories proposed that articular cartilage has limited regeneration potential. The paradigm shifted when medical studies proved that symptomatic pain relief, and cartilage regeneration are actually possible in patients. The condition that warranted this possibility was the incorporation of prolonged joint distraction that enabled the joint to rest, yet be supported by an external scaffold to minimize stresses on the joint. As the joint is relieved of weight, healing mechanisms can be enabled, and the cartilage regeneration can be facilitated. Articular cartilage contains an extracellular matrix with scattered chondrocytes. These chondrocytes enable the healing and restoration of the cartilage. The concentration of chondrocytes differs through the joint and the functions change with distribution through the cartilage.

Image Credit: Arthritis National Research 

What is Morphangiogenesis: Utilization of Stem Cells for Articular Cartilage Restoration

The science of angiogenesis is the process of creating new blood vessels from pre-existing units. The vessels are formed during the process of vasculogenesis, and the angiogenesis process facilitates the growth of the vessels via a series of biological mechanisms. As with all scientific processes, there is always an evolution of the angiogenesis process. 

Developed by the American orthopaedic surgeon, Dr Allan Dunn, a new method of inducing angiogenesis was developed in the past decade. The process is known as morphoangiogenesis (M-A). The technology is based on the utilization of stem cells, with the process facilitating two streams of stem cells. When a site is injected with IAGH,  a growth hormone, two structures are developed. One resembles cartilage canals, the other is similar to renal glomeruli. The growth rates of these structures vary, but they produce units with capillaries that can develop into articular cartilage. 

What are the applications of Morphoangiogenesis? 

There are some parts of the body that take a long time to restore if they are damaged. These include the cartilage in the various joints in the body, particularly in the knees, ankles and elbows. During therapy of these areas, medical innovation has facilitated the utilization of growth hormones such as IAGH to help restore joints. From the above discussion, it was identified that IAGH facilitates rejuvenation because it helps to regrow the cartilage. 

With medical procedures in place that typically will remove existing cartilage, and allow the growth of a scar tissue called Fibrocartilage, IAGH facilitates the regeneration of the original tissue. Fibrocartilage is weaker than its original cartilage, so it is in the best interest of both the physician and the patient to restore the healthier tissue. For persons with arthritis, cartilage regeneration is an option that your orthopaedic surgeon will consider during your arthritis treatment. 

Based on significant measurable increase in motion, decrease of pain, and increase of joint space, the following percentages give some idea of the success rate:

  • Ankles 95%
  • Knees 86%
  • Hips 50%
  • Elbows 95%
  • Shoulders 75%
  • Thumbs 75%


Decrease or complete abatement of pain, swelling, heat and stiffness in the treated joint were noted improvements. Measurable increase in the space between the bone surfaces. The bone on bone condition often improves and space re-appears – up to a 4 millimeters between the bones. Several patients have been followed over five (5) years, and their symptoms have not recurred. In several cases of osteoarthritis of the knee, the bow-legged deformity was reversed and the alignment of their knees was restored to normal. Some patients require booster injections of IAGH once per year or every two years.

Joint Distraction

The procedure that enables the joints to heal in a natural fashion over a period of months is known as distraction arthroplasty. As a procedure that requires surgical intervention, ask your foot and ankle surgeon about this procedure if you feel that it will be appropriate for your condition. Your consultation will involve a series of tests, inclusive of X-rays, to identify the state of degradation of your joint. If you suffer from mild arthritis, distraction arthroplasty may not be ideal for you, but more advanced cases are ideal candidates for the procedure. Via a series of mechanical braces, the stresses experienced by the ankle joint are alleviated, and the cells in the region are given a chance to regenerate themselves and restore the joint to its former capabilities. 

Mechanism of Action 

The mechanism of action of distraction arthroplasty is to unload the joint. The knee and ankles are both hinge joints and are amazing biological engineering marvels.The distraction arthroplasty treatment is a series of mechanical braces that aims to restore the original alignment of the bones in the ankle, and facilitate a restoration of the cartilage. 

How long is the Distraction Arthroplasty Treatment? 

The distraction arthroplasty treatment lasts for ten to twelve weeks, or approximately three months. Via a second procedure, your orthopaedic surgeon will remove the external fixator, and apply a cast to hold the foot in place.  

Reference Articles: 

  1. Morphoangiogenesis: https://www.ncbi.nlm.nih.gov/m/pubmed/11969306/
  2. IAGH Mechanism: http://www.iagh.com/
  3. Angiogenesis: https://en.wikipedia.org/wiki/Angiogenesis
  4. Cartilage Regeneration: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426098/

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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