Unique procedure gets Coast Guard medic back on track
U.S. Coast Guard medic Erin Murray had set her sights on search and rescue operations off Kodiak Island for the kind of work that involves being lowered from a helicopter to save drowning crewmen after a boat capsizes.
After years of being fit — soccer, tennis, workouts to maintain the regime of military fitness — at the age of 29 Murray found herself limping.
“In March of 2016, I had a knee injury and I couldn’t pinpoint the cause,” she said. “Working out made it worse. I couldn’t climb the stairs without holding on to the railing.”
Three doctor referrals later, Murray flew from the Coast Guard base on Kodiak to Anchorage and met Dr. Doug Vermillion at the Orthopedic Research Clinic of Alaska. An MRI showed a huge piece of cartilage floating behind Murray’s kneecap.
“I had a huge hole where the cartilage should be,” she said.
Vermillion recommended an innovative treatment called MACI, a procedure that repairs cartilage using the patient’s own cells.
Vermillion took a biopsy of tissue samples the size of a couple of Tic Tacs from Murray’s knees. Using her own cartilage cells, the procedure grows new cartilage in 6 to 8 weeks at a lab in Cambridge, Mass. The new cells were later implanted back into Murray’s knee to allow for re-growing her own natural cartilage.
Glue holds the MACI implant in place as opposed to sutures, making this a faster and less invasive procedure. MACI is the first product approved by the Food and Drug Administration that applies the process of tissue engineering to grow cells on scaffolds using healthy cartilage tissue from the patient.
MACI stands for matrix-induced autologous chondroycte implantationm, but its common name in the US is Autologous Cultured Chondrocytes on Porcine Collagen Membrane. The procedure became available in 2013 after FDA approval. MACI engineering is done at the Vericel Corp. Lab in Cambridge.
MACI focuses on the articular cartilage defect of the knee. The articular cartilage is a tissue that covers the surface of joints and is responsible for pain-free movement. If damaged, the ends of the bones rub against each other and cause pain, swelling and catching in the knee.
MACI is a two-step process.
“First you harvest the healthy cartilage cells from the non-weight bearing area of the bone,” Vermillion said. “These chondrocytes are then sent to the laboratory where the cells are cultivated for four to six weeks.”
Or, the cells can be harvested while a person is healthy and injury-free. A cryogenic lab in Cambridge can store the cells for five years and then make them available as needed, returning the person’s own healthy cells back for the implantation.
The second stage is an open procedure or arthrotomy. A small incision is made to the exposed the area of cartilage damage. The chondrocyte cells that have been seeded onto the collagen membrane are implanted into the defective area of the knee, Vermillion said.
And, instead of micro-suturing, MACI — prepared in 3 centimeter by 5 centimeter sheets — can be cut precisely to match the defect and positioned using surgical glue.
First in Alaska
Vermillion, an orthopedic surgeon who retired from the U.S. Army in 2002, saw a lot of knee injuries while treating soldiers, but not much was available other than surgery. At his residency at the Fort Sam Houston Brooke Army Medical Center in San Antonio, Texas, he saw active duty soldiers injured from jumping out of Humvees or hit by explosions.
“One had a big rock hit his knee. Another was injured jumping off a track vehicle at night,” Vermillion said. “They wake at 5 a.m. and run 10 miles without regard to how they feel doing it. At 25, they get these knee injuries. We didn’t have much to offer the active duty solders.”
It was gratifying to find an alternative to knee replacement surgery or signing off on a soldier’s disability. To watch active duty enlistees forced to give up their military roles to disability means loss on a number of levels, he said.
Because knee replacements last only 20 years or so, a young person has to look forward to least a second replacement in his or her lifetime.
Vermillion was able to learn an early version of the MACI procedure, this one developed in 1986 by Swedish medical doctor Lars Peterson of the International Cartilage Repair Society. He developed procedure that involved growing patients’ own cartilage cells in test tubes.
Out of 25 soldiers who received the procedure in the 1990s, 18 of them went back on duty, Vermillion said.
“The military doesn’t lose their expertise after getting them trained to do maintenance for an aircraft carrier or a nuclear submarine. These patients went back on duty. With MACI, after surgery, they can keep working. They’re only disabled while healing nine to 18 months,” Vermillion said.
Through the years, Vermillion figures he has used that procedure on about 100 patients suffering from bad knees. He even re-did his own knees at the age of 45.
The MACI procedure is more advanced. It holds the cells in place better, more equally distributes the cells across a joint and carries better results, he said.
Vermillion, now 60, graduated from West Point Academy with an engineering degree, then attended medical school at the University of Utah in Salt Lake City before joining the Army as a surgeon. Because he had a background in both engineering and medical school, he said he was drawn to how new technologies can solve medical problems.
Vermillion has now practiced the past 10 years in Alaska, from Orthopedic Research Clinic of Alaska or ORCA, located by the Alaska Regional Hospital. He has performed about five MACI surgeries in Anchorage and believes he is the only doctor so far using the technology.
Murray, now eight months after surgery, is glad she benefited at the cutting edge of this newly available procedure.
“I’m not allowed to run yet,” she said. “But I’m back on the treadmill.”
Thanks to the surgery, she plans on continuing to push herself in new directions. Only, instead of the search and rescues on the open sea, she wants to go deeper into a medical specialty.
“I’m healing beautifully. This was an amazing process and I’m glad I could see it firsthand,” she said.
Naomi Klouda can be reached at firstname.lastname@example.org.
Correction: MACI is no longer referenced by its acronym, matrix induced autologous chondrocyte implantation. In Europe, Vericel was not allowed to obtain a trademark on a product that referred to a method of treatment.