Orthopedic surgeon in Oneida offers new kind of surgery on knee cartilage. ‘We’re regrowing the patient’s own cartilage cells to repair a cartilage defect that’s causing knee pain,’ he explains
By Chris Motola
Q: I understand you’re doing a new kind of surgery on knee cartilage?
A: Yeah, it’s called the MACI (matrix-induced autologous chondrocyte implantation). Basically what it is, it’s a way to culture cartilage from someone’s knee. Essentially what happens is that culture is grown into new cartilage cells in a lab and then we come back later and implant those cells into the knee, wherever the cartilage is damaged. So it’s used to treat cartilage defects in active patients. It’s a newer type of procedure. We’re regrowing the patient’s own cartilage cells to repair a cartilage defect that’s causing knee pain in the patient.
Q: What is this procedure replacing? How would it have been addressed before?
A: It’s more of an adjunct technique. Other options would be either taking cartilage from other places in the patient’s knee and moving them to the damaged area, which is kind of robbing Peter to pay Paul. The other option would be using cadaver cartilage. The benefit here is that we’re using the patient’s own cells and we don’t have to take any cartilage from healthy places in the knee. We can use it to repair larger defects and more complex cartilage issues.
Q: Is there normally a risk of rejection using cadaver tissue?
A: It’s more of a theoretical problem. The actual incidences of rejecting cadaver tissue are really low, but you don’t have even that theoretical risk with MACI.
Q: Is the cartilage healthier when you grow it this way?
A: The studies show that it fills in defects pretty well, but it’s still being studied.
Q: Have you found it easier to work with?
A: I think compared to previous generations of this type of procedure, it’s much easier. The surgeries are generally shorter, which means less blood loss, less anesthesia time. I think the technology, at least with this procedure, have taken a jump.
Q: Does it reduce the likelihood that a patient will need a joint replacement down the road?
A: That would be the idea, but it really depends on arthritis, on how much cartilage they have. It’s not used to treat generalized arthritis so much as cartilage defects. So, it’s not so much a treatment for arthritis as a way to prevent arthritis. Ideally you’d prevent the patient from needing a knee replacement later on in life.
Q: So it’s more of a sports medicine intervention?
A: Yes, correct.
Q: How are outcomes so far?
A: It’s generally a very good outcome. In my experience, so long as the patients are selected appropriately and they follow up, I’ve seen very good outcomes. It also depends on other factors going on in the knee. The idea is for patients to be able to get to the level of activity that they want to do, whether that’s running or exercise or even just walking and hiking.
Q: I take it these are fairly common sports injuries?
A: Yes, cartilage defects can happen on their own. They can be the result of ligament tears, ACL tears, meniscus tears. It’s becoming more and more common as our imaging gets better and better. We start to recognize this more. I’d say we find cartilage damage in around 60% of the patients who undergo knee scopes. So it’s pretty prevalent.
Q: At what point do you consider replacements compared to more conservative treatments?
A: Generally for most patients we try conservative treatments like therapy, activity modifications, bracing, medications, even injections sometimes. Usually when those fail and we’re pretty confident that the source of the pain is the cartilage damage, that’s when we’ll start to take this step.
Q: What put MACI on your radar? Is it common for smaller hospitals like Oneida Health to do procedures like this?
A: It can be. For me, during my sports medicine training, I trained with one of the pioneers of the MACI procedure, so it was part of my training, so I got extensive experience with that in my sports medicine fellowship. It’s usually performed at bigger academic centers just because of the resources and patient base. This is the first time it’s been done at Oneida.
Q: Do you specialize in knees?
A: I’d say knees and shoulders are what I treat most commonly, but I also treat hips, ankles, hands, wrist, elbows. But it’s mostly knees and shoulders.
Q: Do you see a similar use for this technology in shoulders?
A: Yes. In fact, it’s been done, it’s just not well-studied. It’s not completely approved for shoulder use yet. It was designed for knees, so other joints are pending data for approval.
Q: What got you interested in sports medicine?
A: My father was a team physician and I was an athlete growing up. I played a lot of basketball. I played a lot in college too. For me, this was a way to stay involved in sports, which was my passion while going down the medicine route. I treat athletes of all ages, from youth to recreational weekend warriors. I treat all levels of athletes. So it’s a way to stay involved in athletics.
Q: Having been an athlete and having played basketball in particular with all the pressure cutting puts on your knees, have you found that your medical education changes how you approach the game, assuming you still play?
A: I do and it does. I completely changed the way I play. Being a taller guy, I was usually in the post. Sometime in residency, I hurt my back doing that and ended up getting back surgery. After that, I changed the way I play. I don’t really play the post much anymore.
Q: With that in mind, what advice would you give a younger basketball player?
A: Keeping up with your strength and cardio makes a big difference. Stretching after a game to stay flexible. And then also knowing your limitations. You may not want to be dunking at 40 or 50.
Lifelines
Name: M. Asad Khalid, M.D.
Position: Director of orthopedic and sports medicine at Oneida Health
Focus: Sports medicine and general orthopedic surgeon. Specializes in treating injuries of the knee, shoulder, hip, elbow, foot and ankle. Serves as the team physician for the Utica Comets, SUNY Morrisville, Syracuse FC, and multiple local high schools including Oneida and Camden high schools.
Hometown: Houston, Texas
Education: Medical school: University of Texas Health Science Center at Houston; residency: University of Texas Medical Branch at Galveston; fellowship: Ochsner Clinic, New Orleans
Affiliations: Oneida Health
Organizations: American Arthroscopy Association of North America, American Orthopedic Association, American Orthopaedic Society for Sports Medicine
Family: Wife
Hobbies: Basketball, travel