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injections are used in both preoperative and postoperative settings to help with treatment and recovery. "Orthobiologics injections have become a major topic of conversation in the ortho- pedic community," Dr. Macalena says. "One of the nice things about being in a university setting is that we can closely follow their development and be involved in breakthroughs. This doesn't just benefit our patients — we publish research that helps inform the larger community about treatments that show promising results." THE ROLE OF RESEARCH University of Minnesota Health patients have a ccess to a va r iet y of cl i n ica l tria ls a nd resea rch studies through the Ca r ti la ge Restoration a nd Joint P reser vat ion P rog ra m . T hese bot h examine new treatments — such as the use of mesenchymal stem cells — and test new technologies. Patients' recovery is followed long after treatment ends so that researchers can gather data about their progress. That includes asking patients to complete outcome forms that assess treatment results. "We are all waiting for the full prom- ise of stem cells to be realized, and for a number of reasons, that hasn't happened as rapidly as we'd like," Dr. Jewison says. "Right now, our focus is on improving patients' ability to grow their own car- tilage and improving the success rate of donor implants." University of Minnesota Health phy- sicians recently completed a phase III clinical trial that examined the outcome of growing patients' own cells in an envi- ronment outside of the body in order to create more robust repair tissue. Older techniques such as microfracture — the process of creating small holes in bone near damaged cartilage in order to pro- mote the growth of new cartilage — result in the creation of repair tissue that is not very durable. One solution to this is autologous chondrocyte implantation (ACI), an approach in which the patient's own cells are grown and implanted into a collagen membrane. This membrane is then replaced at a future surgery. It is hoped that new and evolving techniques like this will improve the quality of the repair cartilage. TECHNOLOGY AND TECHNIQUES During an ACI biopsy, an arthroscopy is performed to harvest a small sample of the patient's cartilage from a lesser weight- bearing area of the knee. The removed ca r tilage cells a re grown a nd seeded onto a membrane. The membrane and cartilage cells are then re-implanted into the defect to treat injuries or conditions like osteochondritis dissecans. ACI is one of many newly developed therapies University of Minnesota Health providers offer to patients with joint paint. The Ca r tilage Restoration a nd Joint Preservation Program also partners with leading industry groups to test budding solutions to joint pain. Other treatment options for trauma and osteochondritis dissecans include the use of osteochondra l autog ra f ts, sma ll segments of bone and cartilage from healthy areas of the patient's knee, to repair defects in damaged areas. For larger areas of damage and for patients who may lack viable harvest locations, donor bone and cartilage transplants can be used to replace damaged areas of the joint. According to a study published in The American Journal of Sports Medicine, more than 70 percent of patients with ost eochond r it i s d i sseca n s who a re " Dr. Macalena and I have had an interest in complicated joint conditions for quite some time. We decided to put together a multidisciplinary program that can improve outcomes and the care of people with joint pain throughout the region and beyond." — BRADLEY J. NELSON, ORTHOPEDIC SURGEON WITH UNIVERSITY OF MINNESOTA HEALTH The University of Minnesota Health Cartilage Restoration and Joint Preservation Program caters to patients with a variety of medical concerns, including: • Joint pain • Cartilage defects and degeneration • Complex ligament and multiligament injuries • Meniscus tears and deficiencies • Osteochondritis dissecans 0 8❱❱❱❱❱ C O V E R S T O R Y 0 8

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