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Outside the Lines

The Athlete of the 21st Century

Science to give the human body a makeover

Genetics: Finding the right stuff

Rehab: Knees made easy

Bionics: Calling Steve Austin

Next 100 years: The future is in your hands


Audio chat wrap: Princeton geneticist Lee Silver and Oakland A's strength coach Bob Alejo

Chat wrap: Gymnastics coach Bela Karolyi


Haywoode Workman was skeptical about the 'groundbreaking' surgery on his knee.
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Russell Herndon, president of Genzyme Tissue Repair, envisions the future of cartilage repair.
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This five-day online series is a companion to the ESPN Outside the Lines television special that originally aired Jan. 14.

Tuesday, June 3
Let's grow a body part
By Greg Garber
Special to

SAN FRANCISCO -- Dr. Kevin Stone, who has the lithe hands of a concert pianist, is, well, he's whacking away on a piece of cartilage with a hammer. This is not your typical operating room protocol, but then again, Stone is not your typical surgeon.

"In the past," Stone says, "the alternative was to tell the patients, 'We're sorry that you have an arthritic knee. Try to live with it and then wait until you need a replacement.' I see patients day in and day out who come in having been told that advice. Our goal is to change that course of treatment."

Remember when a snapped knee ligament was the end of a career? That was only 20 years ago. What might stars like Bobby Orr and Joe Namath have accomplished if their knees had allowed them to pursue full, healthy careers?

Joe Namath
Today's knee treatments might have extended Joe Namath's brief NFL career.
Today, a blown-out anterior cruciate ligament is merely an inconvenience for a top-flight running back like Terrell Davis or Jamal Anderson. The next frontier, with respect to athletes, is cartilage.

More than 25 percent of sports injuries involve the knee, and many of those traumas involve damaged cartilage, the smooth, slippery connective tissue that forms the surfaces of the knee joints.

Unlike ligaments, skin or bones, cartilage is not surrounded by blood vessels and, therefore, it is almost impossible to regenerate. Enter Stone, who has taken research and methodology pioneered by Dr. Lars Peterson of Sweden and reduced it to a single, stunning step.

Stone, who works with the United States Ski Team, removes healthy articular cartilage from a non-weight-bearing area of the knee, pounds it to a pulp, adds a few vitamins and other factors that promote growth to the paste and reinserts it where the cartilage is missing. Most of the time, the cartilage regenerates. In other words, the body heals itself with a little help from Stone. He has done more than 150 such operations and claims the success rate approaches 94 percent.

"We have patients who are running marathons on these, who are riding horses, who are playing tennis," Stone says. "We tell our patients when we try to paste-graft a defect it's like grouting a hole in a plaster wall. We're trying to fill in that defect with the body to grow into it. We know the plaster isn't perfect, but it's pretty good repair tissue."

While Stone's procedure is in utero, there are other outside alternatives. The method created by Peterson and advanced at Genzyme Tissue Repair in Cambridge, Mass., is a two-step method that removes healthy cartilage and grows it outside the knee in petri dishes. Norwegian goalkeeper Thomas Myrhe is among those who has successfully undergone this surgery.

Closer to home, NBA guard Haywoode Workman, a former Indiana Pacer now with Milwaukee, had similarly unprecedented knee surgery last year. Pacers team doctor Sanford Kunkel extracted healthy cartilage from a non-weight-bearing part of Workman's knee and grew it outside the knee for six weeks before reinserting the cartilage plugs in several different affected spots within the knee. By last March, Workman was back on the court, averaging 28 minutes in 29 games last season, all as a starter.

How will the future treat injured cartilage? Very, very kindly.

At Advanced Tissue Sciences in La Jolla, Calif., Dr. Gail Naughton presides over a forward-looking company that already is growing new skin for burn victims. They'll begin testing their breakthrough cartilage product later this year.

"Our vision is to be able to go and create a piece of living cartilage that is identical to the patient's own," Naughton says. "We'll be able to tissue-engineer the product, have it available off the shelf and then in one minimally invasive procedure, go into the damaged knee surface and replace the damaged area with a piece of cartilage that will grow into their own joint and be a permanent fix."

Advanced Tissue Sciences, not far from the elegant edge of the Pacific Ocean, looks like something out of the Andromeda Strain. Workers in space suits bustle around in hyper-clean laboratories. Some day, Naughton predicts, they'll be able to grow full organs here.

"We have been able to grow tissue in livers or to fix enzyme deficiencies so common in young babies," Naughton says. "The goal since the beginning was to redefine transplantation, to be able to make sure that there wasn't a person who needed a tissue or organ who dies waiting for it. We're getting closer and closer to that goal every day."

Stone sees a more modest short-term future.

"This is only the beginning," Stone says. "What we're missing today is that we can only grow parts of the cells. We can grow parts of the tissue in small areas.

"Twenty, 30 years down the line, when you damage your knee from skiing and knock off your articular cartilage, or from playing years of football, we'll come back to your knee with a complete cover of cartilage or a completely new ligament, just like we would if we were resurfacing a tire."

Greg Garber is a regular contributor to and Outside the Lines.

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