Whether arising from being felled on the soccer pitch or a seemingly harmless collision with a coffee table, a minor injury to the cartilage in your knee can have major consequences. In the worst case, the weak spot gives rise to severe arthritis and an artificial knee is the only hope. However, if the problem is caught early, further deterioration could be prevented by a patch repair. Doctoral candidate Meike Kleuskens developed a âtraining deviceâ to test how such cartilage implants behave under considerable strain.
Your knees have to put up with a lot. Even gentle walking subjects the knee to a constant barrage of forces: compression, stretching, shearing. So the flexible cartilage in the knee joint has an ingenious structure, explains Meike Kleuskens. âThanks to the unique curvature of the elastic collagen fibers in the cartilage, the forces are spread evenly throughout the tissue. That's not something we can simulate with the current generation of implants.â
Even a relatively minor injury to the cartilage impairs this distribution of forces, causing tissue damage to occur elsewhere in the knee joint. Cartilage then starts to wear away and eventually even the surrounding bone can become damaged. âAt some point the entire joint must be replaced by an artificial knee,â tells Kleuskens. âBut that is major surgery, something you don't want to perform more than once.â Yet, unfortunately, artificial knees last only fifteen to twenty years. And so it becomes advisable to postpone the operation for as long as possible, especially in view of people's increasing longevity.
Growing tissue
This explains why ways to repair tissue damage immediately are eagerly being sought worldwide, to prevent it later having such devastating effects. Since no synthetic implants with the right properties exist as yet, hope is pinned on tissue engineering. This involves growing pieces of new tissue from the body's own cells - in this case cartilage cells - supported by a synthetic yet biodegradable framework (or âmatrixâ). This cultivation can take place in the lab or within the body; once the implant is in place, tissue develops naturally within it as the matrix gradually decays.
The situation is further complicated by the fact that the knee has to be capable of withstanding such great forces. Experience shows that when the implant fails to integrate sufficiently with the surrounding tissue, the surgery outcome is often poor. Moreover, it takes months before the implant is, as it were, âfully grownâ and can actually withstand these forces, Kleuskens explains. In her doctoral project in the Orthopaedic Biomechanics group at the Department of Biomedical Engineering she therefore studied the circumstances most conducive to growing implants and integrating them in existing cartilage. Her research was based on cylindrical âplugsâ of cartilage on a disc of bone measuring a centimeter in diameter.