Articular Cartilage Repair and Regeneration
Articular cartilage is the soft tissues that surround the bones in the knee joint enabling smooth movement of the knee. Anyone who has suffered or is suffering from damaged cartilage will know just how painful it can be. This can also seriously impact their quality of life and daily function. Regeneration of damaged cartilage has long been thought impossible due to the nature of its tissues. The conventional way of treating cartilage damage often involves complex surgery and is limited to small areas. Even so, the success rates were variable and inconsistent. Often the treatments result in the formation of scar tissues, which cause the cartilage to breakdown faster than normal healthy cartilage; and eventually lead to revision of surgery, higher medical care cost, and little to no improvement in quality of life.
In 2007, Dr Saw Khay Yong from the Kuala Lumpur Sports Medicine Centre (KLSMC) pioneered a technology that can regenerate damaged articular cartilage back to its near-natural state, known as hyaline cartilage. This patented (US 8,377,432 B2) technology combines keyhole ’micro-drilling’ surgery and injections of patients’ own stem cells coupled with hyaluronic acid into the knee joint. He began his research in animal model with Universiti Putra Malaysia (UPM) in 2005, which concluded that it was possible to improve the quality of repaired cartilage with the application of autologous stem cells (own stem cells). This breakthrough led to a human pilot study in Year 2007 and randomized controlled trial (RCT) in Year 2009. The RCT was partially funded by the Ministry of Science, Technology and Innovation (MOSTI). The clinical results have been published in peer-reviewed journals and received many local and international awards. To date, there have been over 700 success cases of regenerated cartilage under this technology.
In clinical practice, the technology is used to treat cartilage problems that are untreatable anywhere else in the world. The next step to promote the technology is by getting recognition from the United States Food and Drug Administration (US-FDA). Currently, KLSMC Stem Cells (KLSMC-SC), a subsidiary of KLSMC, has received approval from US-FDA to conduct a Phase IIb multi-center clinical trial using this Malaysian innovated technology. The US-FDA trial involves KLSMC, Andrews Research Education Foundation, Florida, and The Department of Orthopaedic Surgery, Stanford University, California. With US-FDA approval, the technology will gain worldwide recognition and put Malaysia on the map for medical excellence.
Figure 1. Findings of second-look arthroscopy and histologic assessment of medial femoral condyle (MFC) and medial tibial plateau (MTP) at 2 years in a 49-year-old male patient. Histologic results of regenerated cartilage illustrate resemblance of characteristics to normal articular cartilage, with abundance of proteoglycan and collagen Type II. In addition, when the histologic results were graded using an established histological scoring system, the mean score of regenerated cartilage approaches 95% of the normal articular cartilage biopsy score. The findings show that stem cell therapy with ‘micro-drilling’ surgery may have the ability to regenerate high-quality cartilage that approaches the normal cartilage in medial-compartment ICRS grade 4 bone-on-bone lesions. (Adapted from Saw et al., 2015)
Dr Saw Khay Yong is a Consultant Orthopaedic Surgeon at the Kuala Lumpur Sports Medicine Centre in Kuala Lumpur, Malaysia. He completed his Masters in Orthopaedic Surgery (MCh Orth) at Liverpool University Medical School, UK in 1993. His specialisation in orthopaedic sports medicine includes knee joint arthroscopic surgery with application of stem cells for chondrogenesis together with bone and soft tissue regeneration. He has few patents and multiple publications in the field of peripheral blood stem cells for musculoskeletal regeneration.