Jan 29, 2015
Bulletin Board: Plugging Healthy Cartilage Growth

Plugging Healthy Cartilage Growth

The first successful surgery that took cartilage from a healthy part of the knee and transplanted it to a damaged area to promote new growth was groundbreaking. Now, another breakthrough has been found to prompt the re-growth of damaged bone and cartilage in the knee without harvesting healthy tissue from elsewhere.

At least two companies have developed small plugs or cylinders that mimic the composition of bone and cartilage, supporting new tissue as it grows. Called osteochondral scaffolds, the cylinders are placed into a hole drilled in the bone during an arthroscopic procedure. Stem cells that form bone or cartilage then impregnate the pores of the object.

“The scaffold guides the tissue formation of bone on one side and cartilage on the other,” Lorna Gibson, PhD, Professor of Materials Science and Engineering at the Massachusetts Institute of Technology and one of the inventors of the device, told The New York Times. “Over time, the cells that attach to the scaffold produce enzymes that dissolve it.”

The cylinder dissolves completely in about six months. One company has developed a cylinder approved for use in Europe, while another company has a version approved for use in Europe, Canada, Australia, and limited application in the U.S. Because the cylinders can be inserted during arthroscopic surgery, the procedure is much less invasive–not to mention faster and less expensive–than taking cartilage from another area of the knee and relocating it to the damaged area.

The plugs are currently used only for treating small lesions with no more than half a square inch of surface area, and they have not yet been tested in clinical trials. But the sports medicine community anxiously awaits further experimentation with the cylinders, especially because of their potential to expedite return to play when compared to traditional cartilage repair surgeries.

The Beet Helps You Go On

It may not taste great, and it’s certainly not the first thing people think of when fueling for exercise, but nitrate-rich beetroot juice may soon gain in popularity among endurance athletes. A recent study from the University of Exeter in England found that athletes’ stamina significantly improved after drinking the juice, allowing them to exercise up to 16 percent longer.

Eight healthy men ages 19 to 38 drank 500 milliliters of organic beetroot juice for six days in a row before completing a cycling endurance test. The same men were later given a placebo for six days before redoing the same test. When the group ingested the beetroot juice, they were able to cycle an average of over 11 minutes longer than after the placebo.

The study, published in the August issue of the Journal of Applied Physiology, also found that when the subjects drank beetroot juice, their resting blood pressure rates were lower. This echoes the results of a study published last year that found subjects’ blood pressure dropped within an hour of drinking beetroot juice. Researchers said they aren’t sure what causes the nitrate in beetroot juice to boost endurance, but they suspect it turns into nitric oxide in the body, which reduces the oxygen cost of exercise. When the body doesn’t have to work as hard for oxygen, it can work longer to exhaustion.

To view an abstract of the study, “Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans,” go to: jap.physiology.org and enter “beetroot juice” into the quick search window.

Coach Acquitted In Player’s Death

Kentucky high school football coach Jason Stinson made national headlines in September when he was found not guilty of reckless homicide and wanton endangerment in the death of one of his players. There was mixed reaction to the verdict in the medical community, but everyone agrees there will be lasting effects from the heightened attention brought to heat illness safety.

In August 2008, 15-year-old Max Gilpin died from heat stroke, sepsis, and multiple organ failure three days after collapsing at football practice. During the trial, Stinson was accused of forcing players to run without water breaks until they vomited or passed out. Doug Casa, PhD, ATC, FACSM, FNATA, Director of Athletic Training Education and Professor in the Department of Kinesiology at the University of Connecticut, testified that had Gilpin been immersed in an ice bath after he collapsed, he might have lived.

But defense witnesses said the players only ran a few more sprints than usual the day Gilpin collapsed. Medical experts, including the state medical examiner, also said Gilpin’s use of creatine and Adderall (a prescription drug for Attention Deficit Hyperactivity Disorder), along with signs of illness the day of his death, predisposed him to heat illness risk by contributing to dehydration.

Even before the trial began, the Kentucky General Assembly passed a bill requiring the state’s high school coaches to complete a sports safety course that includes protocols for heat illness emergencies. But athletic trainers are hoping the trial has shed new light on the need for certified athletic trainers at high schools. Earlier this year, the NATA released updated guidelines for avoiding heat illness, which recommend eliminating two-a-day practices during the first week in August.

“This trial has put a major focus on the healthcare of young athletes,” NATA President Marjorie Albohm, MS, ATC, said in a statement. “What is more important than ensuring the right medical professional is taking care of your kids? Athletic trainers are the first responders when a student-athlete goes down on the playing field. Without the presence of the athletic trainer, students risk the onset of prolonged or misdiagnosed illness or injury and even fatal consequences if they are not responded to immediately.”

Safe and Smart Mouthguard Use

A study in the September/October issue of Sports Health: A Multidisciplinary Approach underscores the importance of athletes regularly cleaning and disinfecting their mouthguards–and discarding old and misshapen ones. As mouthguards are a required piece of equipment in many contact sports, the findings are relevant to athletes at all levels of play.

Researchers from the Oklahoma State University Center for Health Sciences examined the mouths of 62 college football players before the start of their season and again at the end. The first set of examinations found lesions on the gums, inner cheeks, and roofs of the mouths of 75 percent of the players. By season’s end, 96 percent of the players had sores–mostly in the same areas of the mouth.

“We saw not only an overall increase in the number of lesions, but also a wider distribution,” study author Richard Glass, DDS, PhD, a Center for Health Sciences Professor at Oklahoma State, said in a press release. “By no means should the value of a mouthguard be discounted. The protection they offer teeth during contact sports is important. However, the length of time that a mouthguard is used and how often it is cleaned needs to be revised.”

Mouthguards not disinfected on a regular basis can collect bacteria, so the study’s authors suggest athletes sanitize their mouthguards daily with an antimicrobial denture-cleaning solution. The authors also say that as soon as a mouthguard develops jagged edges or become misshapen, it should be replaced. Even small abrasions not visible to the naked eye can become infected if exposed to the bacteria a mouthguard can collect.

To view an abstract of the study, “Protective Athletic Mouthguards: Do They Cause Harm?” go to: sph.sagepub.com, click on “Archive,” and select “September 2009.”

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