| Lauren Dulay, all mended, is back on the team. |
As softball pitchers go, the Dulay girls were luminaries. Kristin, the oldest, starred for Seton Keough High School in Catonsville, Md., and it earned her a college scholarship. Lauren, her younger sister, looked every bit as good by the time she was 14 and hoped for the same payoff. Then, during a game in September 2001, Lauren's left knee locked in place and she was hit with pain so severe she was certain she'd broken her leg. An MRI showed a much more complicated problem. Lauren had damaged the thin layer of cartilage that decreases friction and weight-stress on the knee joint and acts as a sort of shock absorber. But because cartilage has no direct blood supply, this kind of injury can't heal itself. What's more, although conventional surgery can temporarily relieve the pain, about 60 percent of these patients need additional surgery within five years. Lauren's physician held out one hope. He'd heard that a Hopkins orthopedic surgeon named James Wenz was using a new approach for Lauren's problem. It went by the rather unwieldy name of "autologous chondrocyte transplantation." Wenz would harvest cartilage cells (chondrocytes) from a patient's knee and use them to grow new cells that he would then implant into the damaged knee. The procedure had given relief to about 80 percent of people with this problem. "We were nervous and scared," admits Lauren's mother, Kathleen, "until Dr. Wenz told us about the procedure." Lauren would first undergo a standard arthroscopy, in which Wenz would insert a tube with a tiny camera into her knee to examine the defect. If she was a candidate for the transplantation, he'd use the same tube to extract healthy cartilage cells and send them for cultivation to an outside laboratory for two or three weeks until they'd produce up to 15 million chondrocytes. At that point, in surgery, he'd trim Lauren's existing knee cartilage, patch it with a section of the fibrous periosteum tissue that covers bone, and suture a pouch onto the patch. He'd then inject the harvested cells into the pouch, and over the next few months they would grow new cartilage. Lauren turned out to be the perfect candidate for autologous chondrocyte transplantation. She underwent the procedure in March 2002, and then spent six months rehabilitating. Today, she's in her uniform at Seton Keough training for the spring softball season. "There's no pain at all," the teenager says nonchalantly. Her mother is less blasé. "Remarkable!" exudes Kathleen Dulay. "Looking at X-rays, you can't even tell there was a defect. It's absolutely unbelievable." - Gary Logan
Hopkins Medical News, Spring 2003 |
