Episode 2 - The Background

The Background and History of the knee Problem.

I experienced knee buckling on my right knee some 18 months ago. It was a strange feeling as there was no pain and I was unable to simulate such loss of muscular control. Later, I felt pain whenever I jogged or played a round of golf. Usually, rubbing medicated oil and putting on a knee guard would keep the pain in check. I also started taking glucosamine and chondroitin sulphate supplements and also applied transdermal glucosamine cream to the knee. They helped to relief the pain somewhat, but these products are really costly. I decided to seek medical treatments when the knee started to lock up briefly in the bent position occasionally. Trying to straighten the leg to stand up would cause intense pain at the knee. Massaging the knee and relaxing the muscles would eventually ease up the locked knee. Again, I was unable to simulate the knee locking, no matter how hard I tried - it was as if nothing had happened and there was no pain afterward.

I was referred to a specialist consultant in NUH, an Assoc Professor, who specialised in orthopaedic, tissue engineering and stem cells. He examined my leg and told me that, based on the symptoms, it is likely to be knee osteoarthritis - the wearing out of or damage to the knee cartilage. Subsequent MRI and X-ray confirmed localised damage of the cartilage known as chondral ulcer. Cartilages are normally meant to last one's lifetime. However, diseases, trauma to the joints, high intensity & high impact activities and even obesity can aggravate the cartilage wear.

The Prof said that at my age, I was neither here nor there - too young for knee replacement and too old for tissue engineering, such as using stem cells or cultured cells. Normal age range for cells replacement is from 13 - 55 years old and knee replacement is usually for those above 65, as artificial knee can only last 10 - 15 years, shorter if the person is active in sports. Obviously, I'm outside these age ranges. Later, however, he asked if I'm prepared to try stem cells for the repair. There are special stem cells called mesenchymal stem cells (MSCs) which can be extracted from one's bone marrow, usually taken from the hipbone. The very small number of stem cells are cultured in the lab, multiplied into millions in number and then implanted back to the knee. The stem cells will eventually transform into new cartilage cells in the knee. I agreed without hesitation. He suggested monitoring my conditions for a short period. In the meantime, however, the episodes of knee locking happened more and more often and the locking up sometimes lasted 30 minutes or more. The Prof said that it was caused by broken fragments of cartilage in the knee and these would have to be removed under a key-hole surgery called Arthroscopy. In April 2007, I underwent arthroscopy and the Prof removed 3 pieces of somewhat rounded fragments, which he called 'meteorites' floating in the knee cavity. The fragments were probably damaged a long time ago, ground until somewhat rounded over many years. He told me later that he took the opportunity to harvest some chondrocyte (cartilage) cells to grow in the lab. He asked me to be prepared for ACI, Autologous Chondrocyte Implantation in 4 weeks' time. (Please see my post on 'What is ACI'). The surgery date was eventually fixed 5 weeks later, on 30 May 2007, provided of course, my harvested cells survived and had thrived in the bioreactor.

Click the links below from Arlington Orthopedic Associates to watch 3-D video animations of Knee Arthroscopy and Knee ACI.

Acknowledgements:

National University Hospital, Singapore. (http://www.nuh.com.sg/index/index.htm)
Stem cells. (http://www.nuh.com.sg/nuh_ortho/ortho/sports/stemcell.html)
Arthroscopy. (http://www.nuh.com.sg/nuh_ortho/ortho/sports/arthroscopy.html)

Arlington Orthopedic Associates. 3-D Video animations

Knee Arthroscopy. http://arlingtonortho.com/ka/

Knee ACI. http://arlingtonortho.com/aci/