CARTILAGE REGENERATION

Image Credit: Arthritis National Research 

The beauty about science is that it is always evolving and always changing. We are currently in an era of self healing, where the natural forces within the body are currently being utilized in order to heal the body. Within the human body, there are various elements such as the cartilage in our joints that can actually repair itself. There are known species in the animal kingdom that have been known to repair themselves if they lose a limb. Understanding these healing processes, led us to study our own healing mechanisms and allows us to identify new frontiers for the treatment of osteoarthritis. 

What is Morphangiogenesis?

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 originally 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. 

From the website of Dr Dunn, the following are some frequently asked questions that patients may have about cartilage regeneration via IAGH induced Morphoangiogenesis: 

What is the success rate of IAGH 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%

DISTRACTION ARTHROPLASTY AS AN ALTERNATE ARTHRITIS TREATMENT 

Ankle arthritis is a condition that is prevalent in young, active individuals predominantly. Via excessive usage of the joint, wear and tear can be induced, causing the joint to weaken. Because the healing ability of the body is slower than that of many animals, intervention has to be induced in order to facilitate the appropriate conditions that will enable change. The procedure that enables the ankle 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 the ankle 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 ankle. The ankle as a hinge joint, is an amazing biological engineering marvel. As a weight-bearing joint, the ankle is designed to withstand up to 5.5 times the body weight of an individual. Along with the stout ligaments, the steady control of the region is maintained. With time and activity, slight changes in alignment of the ankle (talus displacement) can generate up to a 42% decrease in available joint contact area. With such changes, the cartilage that is exposed will experience higher compressive forces at pressures that it was not originally designed for, and it will ultimately degenerate. 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. 

Unloading the ankle, relieves it of the external pressures and allows natural healing. With reduced pressure and more blood circulation to the area, healing will be facilitated. Alternate therapies for arthritis include fusions and complete ankle replacements. Consultations with your orthopaedic surgeon will determine the path that is best for you. With the external fixator adjoined to the bones via series of pins and hinges, the ankle is allowed the following in a combination with adjunct surgeries: 

  • Stability
  • Range of Motion – patients will be mobile during their treatment and can bear their full weight
  • Cartilage Repair
  • Exercise of the area will be permitted in order to facilitate motion, and joint repair

In order to facilitate the attachment of the fixator, your orthopaedic surgeon will perform two procedures. The first is a surgery, that facilitates the installation of the frame to the tibia (leg bone) and finally to the foot. You can envision the frame as an external scaffold around the critical areas that need healing. Via a series of fused wires and pins, the frame is built. With an attached hinge, the required motion is facilitated. If necessary, your orthopaedic surgeon will conduct further ankle joint modifications that will facilitate healing. If ligaments need to be loosened, this procedure will also be facilitated. 

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 for Distraction Arthroplasty: 

  1. http://legacy.aofas.org/footcaremd/treatments/Pages/Distraction-Arthroplasty.aspx
  2. https://www.hss.edu/files/Ankle-Distraction-Arthroplasty-Indications-Techniques-Outcomes.pdf

Reference Articles for Morphoangiogenesis: 

  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

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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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