Oschner surgeon champions new knee repair treatment

5th February 2018   ·   0 Comments

By Meghan Holmes
Contributing Writer

In early 2017, the FDA approved a new form of knee repair surgery in the United States – MACI (Matrix-Induced Autologous Chondrocyte Implantation). New Orleans-based doctor Deryk Jones took note and began performing the procedure almost immediately, using patients’ DNA to regrow cartilage onto a membrane that doctors later affix to damaged parts of the knee.

The process represents decades of research on how to best repair knee damage, and allows select patients to resume high-impact athletic activities that aren’t an option following other knee surgeries. To date, Jones, Section Head of Sports Medicine and Cartilage Restoration at Ochsner Sports Medicine Institute, has performed the procedure on more than a dozen patients.

Dr. Jones has spent his life repairing peoples’ knees.

“I’ve been researching articular cartilage since 1986, before most people cared,” he says.

Articular cartilage is the smooth tissue that protects the ends of bones where they come together and form joints.

“It’s the white glistening structure on the end of a chicken bone,” Jones says. “It allows two surfaces to glide past one another without irritation. Over time, particularly with repetitive trauma, or if there is some sort of defect, the bones can lose that protection and the area becomes painful.”

Jones began researching articular cartilage at Stanford in graduate school, and later transitioned into a residency at Harvard, where doctors first performed the precursor to MACI – the ACI.

“I was lucky enough to take benchmark research from Stanford and then see it performed live on a person at Harvard with the ACI, and you normally don’t see something go from the lab to a person that quickly. I was the first guy to perform that surgery in Louisiana, and for twenty years I did those. So, I’ve been holding my breath and waiting on the FDA to approve this new procedure for a long time.”

Approval for the MACI procedure in the United States came following a significant European study known as the Summit Trial, during which researchers monitored hundreds of subjects for five years following their knee repair procedure.

“There was a control group whose knee was repaired using another method – microfracture (creating tiny fractures in underlying bone), which is the FDA’s gold standard everything else compares to,” Jones says. “They had been doing MACI for ten years in Europe before this study proved to the FDA with enough certainty that it works.”

The MACI improves upon its predecessor (the ACI) by shortening both operating and recovery time. Doctors take a sample of the patient’s DNA and inject it directly onto the matrix – a collagen-based, lattice like structure where the patient’s cartilage sample begins to grow.

“The cells grow and we place that scaffolding structure in the affected area, where the cartilage adheres and continues to grow. With the previous ACI procedure, we inserted the matrix and later injected cells onto the membrane. We have shortened that process by taking the cells and growing them directly onto the scaffolding rather than injecting them later,” Jones says.

Ideal MACI patients are athletic, and want to maintain a high level of aerobic activity following their knee repair. One of Ochsner’s first MACI recipients was Michael Bergin, a longtime athlete with an enduring love for triathlons and cross-fit that led to significant knee damage. “Over the last couple of years I started experiencing a lot of pain while playing hockey, running, or jumping…after certain things my knee would really hurt.”

Bergin didn’t want to stop running, or taking long hikes in unpredictable terrain: activities that require a high level of knee function. “It wasn’t an option for me to give up on those activities; I’m a very physical person. I volunteer and teach swimming to kids, and I also work in manufacturing and I’m sometimes on the floor standing for hours at a time,” he said.

Four months ago, Bergin had the MACI procedure. The recovery was difficult — weeks without the ability to move, but he already feels like the surgery was worth it. “The other day I rode my bike at a really good clip, and my knee felt good, and I was shocked. It made me so happy.”

Bergin’s procedure was particularly invasive – with doctors attaching three separate matrices to different damage sites in the knee.

“Michael’s been the biggest procedure I’ve done so far, and he’s been a great patient,” Jones said. “His situation is ideal because his end goal is a high level of activity. This should be done on motivated patients, not people with fairly inactive goals like walking at a normal pace.”

Dr. Jones reiterates that MACI works best for younger patients with knee defects, or for highly athletic individuals.

“This is a big procedure, but for some people it makes complete sense to go through this. I am so excited that we are allowed to do this, and to see the positive results that we’ve seen so far,” Jones said.

This article originally published in the February 5, 2018 print edition of The Louisiana Weekly newspaper.