Joliet orthopaedic surgeon works to reduce pain, restore movement

JOLIET – When former Joliet resident Rachel Stoddard was 11 year old, she had a skiing accident that led to knee pain and inflammation whenever she was active, such as in gym class.

“The problem went undiagnosed for several years until we saw Dr. [Mukund ] Komanduri,” the now 23-year-old Warrenville resident said. “We even saw another doctor, who said, ‘Oh, she’s just got some scar tissue.’ ”

Possibly, but Stoddard also had torn cartilage, which Komanduri repaired with a cartilage implant when Stoddard was 19. Stoddard later had a another implant for a second, unrelated accident, which also went well, she said.

Today, Stoddard engages in aerobics. She enjoys bicycling and horseback riding, activities she avoided before the cartilage implant work.

“I think it’s great for anyone wanting to continue leading an active life,” Stoddard said of the procedure.

Vericel Corp., which develops cellular therapies, according to its website at vcel.com, recently recognized Komanduri, chief of staff at MK Orthopaedics Surgery & Rehabilitation, for having performed the second-most Carticel cartilage implant procedures – 75 – in Illinois since the procedure became available in 1997.

Cartilage implants are not commonly done, Komanduri said, because patients must meet stringent qualifications. They must be under age 55, have a body mass index lower than 35 and have self-contained injuries less than a half-dollar in size.

In addition, issues such as joint instability, alignment issues or tears in the meniscus must be addressed before a cartilage implant can be considered, Komanduri said. Some insurance companies won’t pay for them.

Even when they do, many patients can’t afford to be off their feet for six weeks, much less out of work, during the recovery time, Komanduri said.

“The sad part is, if the procedure were a lot easier, a lot more people would go for it,” Komanduri said.

Komanduri suspects torn cartilage when a patient with a knee injury can’t bear weight for prolonged periods and an MRI is negative for possible causes. After conducting a comprehensive history, Komanduri will check for tenderness over the bone, he said. Then, he will order an MRI with specialized mapping software for cartilage.

“A lot of scans give blurry images and are not very helpful,” Komanduri said.

Next, Komanduri performs an arthroscopy to assess the damage. He also will take a biopsy, which is put into a solution and transported overnight to a facility, where it will be frozen, stabilized and grown, he said. Growth time is about four weeks, when it works.

“There is a percentage of biopsies that just don’t grow,” Komanduri said. “Either the patient’s cartilage was poor quality, the biopsy was inadequate in size or the chemicals didn’t work the way they were supposed to.”

When the cartilage is ready, surgery is scheduled. Any remaining cartilage is trimmed away and a layer of artificial collagen – think “tire patch,” Komanduri said – is sewn over the bone. The new cartilage cells then are injected.

Physical therapy begins six to 24 hours later with the use of a continuous-passive-motion machine, Komanduri said. Some patients may require additional therapy, but adhering to the “no weight-bearing” maxim for six weeks is imperative, Komanduri added.

“You need time for the cells to stick together,” Komanduri said.

After the implant some patients – Stoddard was one – return for “debridement.” Sometimes, cartilage grows too quickly and the large fronds become pinched in the joints, Komanduri said.

Komanduri said outcomes are good. Ninety-five percent of patients at five years, 75 percent at 10 years and 65 percent at 15 years are still doing well. However, cessation of pain and return to mobility may happen slowly – as Corvin Tate, 31, of Shorewood well knows.

About 2010, Tate was restoring a ’72 Cutlass in his garage when he fell, fracturing his knee cap and tearing his meniscus, patella and two ligaments, Tate said. After completing physical therapy, Tate still had pain and trouble moving his leg forward, so he consulted with Komanduri and had surgery to repair the meniscus, which restored partial movement, Tate said.

A month later, Komanduri disassembled the cartilage and regrew it. A month after that, Komanduri implanted the cells into Tate’s knee. Within two years, Tate once again was jogging and playing softball.

“Everything feels good now,” Tate said. “I was very happy with the surgery.”

Tate can’t say the same about the Cutlass. He sold it.

“I didn’t get back to it quickly enough and it was taking up space in the garage, with parts everywhere,” Tate said.

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KNOW MORE

Dr. Mukund Komanduri, chief of staff at MK Orthopaedics Surgery & Rehabilitation, has offices in Joliet, Mokena and Bolingbrook. Visit www.jolietortho.com or call 815-741-6900.