Bad knees get new life from cadavers

December 07, 1993|By Nancy McVicar | Nancy McVicar,Fort Lauderdale Sun-Sentinel

That bum knee -- the one you use as an excuse for not exercising -- might be a candidate for a new type of surgical repair.

Dr. Paul Meli, an orthopedist who practices at Holy Cross Hospital in Fort Lauderdale, Fla., is one of a handful of doctors in Florida doing the procedure that uses cartilage from cadavers to cushion the knee joint.

"The typical patient would be a person who at 20 years old tore knee cartilage playing volleyball or some other sport, and had arthroscopic surgery to remove the bad cartilage," Dr. Meli says.

Over time, the loss of cartilage causes osteoarthritis and an accelerated rate of degeneration in the knee because there is no shock absorber between the thigh bone and the shin bone, he says.

Dr. Keith Hechtman, assistant professor at the University of Miami School of Medicine's department of orthopedics, also does the procedure, which is called a meniscal allograft.

He says doctors began doing it about 1986, but early results were not always good. The technique has evolved and improved over time. Some studies currently under way are trying to measure the success rate.

Dr. Hechtman says the patient's age is not as important as the health of the knee going in. He doesn't do the surgery if the knee is already badly deteriorated.

"The most important thing to consider is whether you are really a good candidate, whether you fit all the criteria necessary to get a good result," he says. That is something you and your doctor will have to decide.

Surgery to insert the cartilage and stitch it into place takes about two hours. The patient may be required to stay overnight in the hospital, but sometimes it is done on an outpatient basis. The knee may not be ready for a return to active sports for up to six months.

"This is not like a routine arthroscopy where the damage is repaired and the person is back on the playing field in a couple of weeks," Dr. Meli says. "It's really a major knee operation."

Patients will be on crutches for about six weeks and will need therapy to keep strength and range of motion in the leg during that time.

Cartilage is obtained through laboratories whose standards are set by the American Association of Tissue Banks. Testing is done to make sure the tissue is free of viruses.

The doctor bill for the procedure is in the $2,500 range, Dr. Meli says. That doesn't include the hospital's charges.

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