A new procedure using stem cells can regenerate joints

What is subjected to more weight and is injured more than any other joint in our body? Our ankles are. When an injury, sprain, or break does not heal right, the problem creeps up years later in the form of arthritis.

A new procedure using stem cells from the patient's own body is regenerating joints and giving people more mobility.

His resume includes conquering mount McKinley 40 times, Mount Kilimanjaro 20 times and Mount Everest nine times, and a broken ankle from 30 years ago created his biggest barrier yet.

He said, "It's getting to the point where I'm limping."

The cartilage in between his subtalar joint right below the ankle was gone.

Dr. S. Robert Rozbruch, Chief at Limb Lengthening and Complex Reconstruction Service
Hospital for Special Surgery, said, "The conventional treatment for that is to fuse the subtalar joint which means make it stiff."

That is not an option for Vern, so doctors tried a new approach. Implant a fixator for three months that pulls apart the joint. Then, inject stem cells in the new four-millimeter space where cartilage will regenerate.

Dr. Rozbruch said, "We used stem cells derived from his pelvis."

Dr. Rozbruch has done 100 of these procedures on ankle joints. So far, 90 percent of patients are relieved of pain and do not need fusions.

He said, "Basically you see a reversal of arthritis."

You can see the difference between the ankle joint before the procedure, which has no space between the bones, and after...

"Look at the difference You can see a space, there's about three millimeters of cartilage compared to nothing," said Dr. Rozbruch.

"With this new technique I'll have a foot than can go 20, 30 years," said Vern.

Vern is a climbing king who was not going to let pain prevent him from his next adventure. This is the first time ever the procedure was done in the joint below the ankle.

Vern's next trip is an expedition across the South Pole in November.

Doctors say the cartilage continues to regenerate years after the procedure. If it does not work, patients can still have a fusion.
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MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC: STEM CELLS REACH NEW HEIGHTS
REPORT: MB #3217

STEM CELL RESEARCH: According to the National Institute of Health, the key application of stem cells is in "cell-based therapies." Here, cells such as bone marrow-derived mesenchymal cells are able to stimulate growth in muscles, bones, tendons, ligaments and adipose tissue. When applied during cell-based therapies, such stem cells can be applied to a tissue, muscle or organ to generate new cells in the respective area. Successful cell-based therapies rely on a stem cell's ability to significantly generate large amounts of tissue, specialize into the specific cell type, survive in the body following the transplant, and function correctly for the rest of the receiving patient's life.

VERN TEJAS: Since 1992, Vern Tejas has been serving as a guide for Alpine Ascents International and building an unparalleled climbing resume. His accomplishment of being the first person to ever climb the Denali Mountain alone stands as one of the most inspiring climbing feats in history. His other achievements include the first solo climb of Mt. Vinson in Antarctica, the thirteenth scaling of Mt. Everest, and a successful climb of Mt. Vaughn in Antarctica. He has bicycled the Americas' highest peak of Aconcagua and paraglided from Europe's highest point of Mt. Elbrus. (SOURCE: Mountainzone.com).

TREATMENT: In the summer of 2010, HealthDay News reported that a research experiment conducted on test rabbits by Jeremy Mao of Columbia University yielded potentially game-changing results. Mao found that whole joints could be grown by injecting a "bioscaffold," which contains stem cell-recruiting "homing" molecules. In Tejas' case, stem cells were injected directly into the fixated joint below his ankle to stimulate the growth of much-needed cartilage. His doctor S. Robert Rozbruch was unable to apply the typical treatment of simply stiffening the joint and minimize movement because it would prevent him from ever retaining enough foot motion to climb. The stem cell procedure is called "Ankle Distraction," wherein Rozbruch reported to have "[prepared] that joint by drilling some small holes into the bone, which helped allow blood to come to the surface. We injected a biosynthetic material into the joint, which basically was a composite of his stem cells - we used stem cells from his pelvis and injected them into the subtalar joint - and then we applied this little fixator that helped pull apart the joint. And what that did was helped unload the joint and allow cartilage to regenerate. It's got all of the right stuff; it's unloading it, it has stem cells, it has the channels of blood coming up, as well as a carrying agent that holds the stem cells in place. So that was the plan."

FOR MORE INFORMATION, PLEASE CONTACT:

Robert Rozbruch, MD
Chief, Limb Lengthening and Complex Reconstruction Service
Hospital For Special Surgery
(212) 606-1415
RozbruchSR@hss.edu


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