Dr. Broyles' Cartilage Regeneration Research
for the Knee and Hip
Open Clinical Trials
Knee Cartilage Regeneration Study
This clinical trial is currently open to enrollment. Eligible study participants will be ages 18-64 with a BMI of 35 or less and have unipolar or bipolar cartilage damage. The study will involve an outpatient microdrilling surgery, 12 weeks of targeted physical therapy and 8 postoperative stem cell collections and knee injections.
Hip Cartilage Regeneration Study
Dr. Broyles has opened a new study for patients with hip cartilage damage. He is now enrolling patients ages 18-55 with a BMI of 30 or less with hip cartilage lesions for the study treatment. Consenting patients will undergo similar study procedures to those in the knee study.
Please refer to the information below to learn more about osteoarthritis and the study treatment. To determine if you are a candidate for the study procedures, please call (225)766-0050 to schedule an appointment with Dr. Broyles.
Osteoarthritis and Cartilage Damage
Osteoarthritis is the most common joint disease in humans. In the elderly population in developing countries, it is the leading cause of chronic disability. Many thousands of people in the US are unable to walk independently from bed to bathroom because of painful osteoarthritis of the knee. Conventional treatment is aimed at reducing pain, maintaining mobility and minimizing disability. The disease is usually addressed by non-pharmacologic measures and non-steroidal anti-inflammatory drugs. Knee replacement is usually reserved for more severely damaged knees in older patients because of the potential need for revision surgery when knee replacement is performed on younger, more active patients.
Localized cartilage damage or cartilage lesions of the knee can lead to early osteoarthritis. Treatment of cartilage lesions has been shown to improve function and decrease pain. Some orthopedists feel that these should be treated with biologic reconstruction as soon as possible. Numerous procedures are available. These procedures include microfracture or microdrilling surgery, autologous chondrocyte implantation, mosaicplasty, and matrix-guided autologous chondrocyte implantation, among other approaches. These techniques generally have better results for unipolar lesions where just one bone of the knee is involved. Bipolar or "bone-on-bone" lesions that involve more than one knee bone do not typically respond as well to treatment. Also, these available procedures generally produce abnormal, tough cartilage instead of the desired, normal, flexible and smooth hyaline cartilage. A procedure that is uniformly effective, less invasive and more cost-effective is needed.
Stem Cell Cartilage Regeneration
Dr. Khay Yong Saw and his research team in Kuala Lumpur, Malaysia have been studying stem cell cartilage regeneration for several years. First tested successfully in an animal model and later in human trials, Dr. Saw's protocol involves microdrilling surgery followed by weekly post-operative injections of autologous peripheral blood progenitor cells (PBPC's) and hyaluronic acid (HA).
- Microdrilling Surgery is an arthroscopic outpatient surgery where small holes are drilled in the bone at the location of cartilage damage. This procedure is a marrow stimulating technique performed to provide an environment for cartilage healing by mobilizing local bone marrow derived stem cells to the site of the cartilage lesion.
- PBPC's are a blood product containing mesenchymal stem cells, the stem cells capable of differentiating into normal cartilage. PBPC's are obtained by mobilizing stem cells from bone marrow into the peripheral blood.
- Hyaluronic acid is a building block for cartilage in the knee. It been shown to improve pain when injected into knees of patients with cartilage damage. HA injections have also been used in animal studies to generate better cartilage after microdrilling surgery.
In February 2011, Dr. Saw and his research team published the results of a patient case series testing this protocol. All of the study patients, including 2 with bone-on-bone cartilage damage, showed evidence of cartilage healing with normal hyaline cartilage regrowth. This finding was confirmed with second-look arthroscopy and biopsy. Dr. Saw and his team propose that the microdrilling surgery creates a blood clot scaffold on which injected PBPC's can be recruited and enhance normal cartilage regrowth. The significance of this cartilage regeneration protocol is that it is successful in patients with historically difficult-to-treat grade IV bipolar or bone-on-bone cartilage damage. To date, Dr. Saw has treated approximately 250 patients with this technique.
The intra-operative images and post-operative radiographs below show the re-establishment of joint space and regrowth of normal, smooth hyaline cartilage after the surgery and injections. Case 1, whose images are shown below, had advanced osteoarthritis affecting both bones of the knee.
Figure 1: Progressive serial weight bearing radiographs
of Case 1 with high tibial osteotomy. Notice re-appearance
of the medial articulation.
Figure 2: The intra-operative images show that the Case 1 had advanced, uncontained cartilage damage on both bones of the knee. Second look arthroscopy images show smooth cartilage regrowth. Safranin-O histological staining of the cartilage biopsy shows high content of proteoglycans. There is also a high content of type II collagen. These findings confirm that the new cartilage is the desired, normal hyaline cartilage.
Case 2 was a 34-year-old female with advanced osteoarthritis . Before entering Dr. Saw's study, she was told that she needed a knee replacement but was too young. Her follow-up radiographs show a progressive reappearance of patellofemoral joint space. Second-look arthroscopy images show regeneration of hyaline cartilage, confirmed by biopsy and staining.
Figure 3: 34 year-old female with recurrent dislocation of her patella as an adolescent. Immediate post-op radiographs showed evidence of subchondral drilling while radiographs at 6 months and 2 years showed a progressive reappearance of the lateral patello-femoral articulation.
Figure 4: Case 2's intra-operative images show spanning areas of cartilage damage. Second-look images 2 years later show histologically confirmed hyaline cartilage regrowth. This was an early case, and Dr. Saw now drills the holes much closer together, giving a more confluent area of regenerated cartilage.
All figures are copied with permission from Dr. Saw from Arthroscopy 2011 Apr;27(4):493-506.
Dr. Broyles goes to Malaysia
Since first learning about this cartilage research, Dr. Broyles has made several trips to Malaysia to study the techniques and protocol used by Dr. Saw's research team. Dr. Saw and Dr. Broyles were interviewed by a Malaysian newspaper during one of his trips. Click here to see the article
Dr Broyles operating with Dr Saw at the Kuala Lumpur Sports Medicine Center
Building off of Dr. Saw's methods and some of his own research, Dr. Broyles has collaborated with local Hematologist/Oncologist Dr. Patrick Stagg to design and execute a stem cell cartilage clinical trial at the Bone and Joint Clinic of Baton Rouge.
Interested in becoming a study participant?
Interested patients should call the Bone and Joint Clinic at (225) 766-0050 for an appointment with Dr. Broyles. Dr. Broyles will evaluate your knee or hip and determine if you are an appropriate candidate for the study procedures.