{"page":"\u003clink rel=\"stylesheet\" href=\"https://lessonplanet.com/assets/packs/css/resources-c03aa079.css\" /\u003e\n\u003clink rel=\"stylesheet\" href=\"https://lessonplanet.com/assets/packs/css/lp_boclips_stylesheets-517835be.css\" media=\"all\" /\u003e\n\u003cdiv data-title='Exclusive look at experimental knee surgery  ' data-url='/boclips/videos/5c54d2e6d8eafeecae1e5635' data-video-url='/boclips/videos/5c54d2e6d8eafeecae1e5635' id='bo_player_modal'\u003e\n\u003cdiv class='boclips-resource-page modal-dialog panel-container'\u003e\n\u003cdiv class='react-notifications-root'\u003e\u003c/div\u003e\n\u003cdiv class='rp-header'\u003e\n\u003cdiv class='rp-type'\u003e\n\u003ci aria-hidden='true' class='fai fa-regular fa-circle-play'\u003e\u003c/i\u003e\nVideo\n\u003c/div\u003e\n\u003ch1 class='rp-title' id='video-title'\u003e\nExclusive look at experimental knee surgery  \n\u003c/h1\u003e\n\u003cdiv class='rp-actions'\u003e\n\u003cdiv class='mr-1'\u003e\n\u003ca class=\"btn btn-success\" data-posthog-event=\"Signup: LP Signup Activity\" data-posthog-location=\"body_link_boclips\" data-remote=\"true\" href=\"/subscription/new\"\u003e\u003cspan\u003e\u003cspan\u003eGet Free Access\u003c/span\u003e\u003cspan class=\"\"\u003e for 10 Days\u003c/span\u003e\u003cspan\u003e!\u003c/span\u003e\u003c/span\u003e\u003c/a\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='rp-body'\u003e\n\u003cdiv class='rp-info'\u003e\n\u003cdiv aria-label='Hide resource details' class='rp-hide-info' role='button' tabindex='0'\u003e\u0026times;\u003c/div\u003e\n\u003ci aria-label='Expand resource details' class='rp-expand-info fai fa-solid fa-up-right-and-down-left-from-center' role='button' tabindex='0'\u003e\u003c/i\u003e\n\u003ci aria-label='Compress resource details' class='rp-compress-info fai fa-solid fa-down-left-and-up-right-to-center' role='button' tabindex='0'\u003e\u003c/i\u003e\n\u003cdiv class='rp-rating'\u003e\n\u003cspan class='resource-pool'\u003e\n\u003cspan class='pool-label'\u003ePublisher:\u003c/span\u003e\n\u003cspan class='pool-name'\u003e\n\u003cspan class='text'\u003e\u003ca data-publisher-id=\"30356011\" href=\"/search?publisher_ids%5B%5D=30356011\"\u003eCurated Video\u003c/a\u003e\u003c/span\u003e\n\u003c/span\u003e\n\u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv class='rp-description'\u003e\n\u003cspan class='short-description'\u003eSWITZERLAND KNEE OPERATIONSOURCE: AP TECHNOLOGY RESTRICTIONS: TECHNOLOGY CLIENTS ONLYLENGTH: 7:02SHOTLIST:Basel, Switzerland - 9 January 20171. Various of former Javelin champion Nicola Mueller doing exercises on the bank of the River...\u003c/span\u003e\n\u003cspan class='full-description hide'\u003eSWITZERLAND KNEE OPERATIONSOURCE: AP TECHNOLOGY RESTRICTIONS: TECHNOLOGY CLIENTS ONLYLENGTH: 7:02SHOTLIST:Basel, Switzerland - 9 January 20171. Various of former Javelin champion Nicola Mueller doing exercises on the bank of the River Rhine 2. Various of Mueller sitting on a bench and rolling up the leg of his track suit3. Various of Mueller tracing the scar from his stemcell knee operation in 20124. Various of Mueller pulling down his trouser leg5. Close of Mueller's feet 6. SOUNDBITE (German) Nicola Mueller, former Swiss javelin champion: \"The pain after the accident, when the cartilage was damaged, was a sort of an acute pain that occurred with every single step I have made while climbing stairs, as if someone stabs with a needle into the knee. And then the pain got stronger and stronger. Let's say, at the beginning it was rather soft while climbing stairs, but the afterwards it also occurred in everyday life while walking.\"Basel, Switzerland - 10 January 20177. Various of Basel University Hospital in the snow 8. Mid of patient Nick Schmid in bed on the morning before his knee operation 9. Pull focus from Schmid through to hand grip 10. SOUNDBITE (German) Nick Schmid, trial patient:\"It was approximately 8 month ago when I was jogging I suddenly felt a very strong, intense pain inside my right knee, so that I wasn't able to continue jogging, I could hardly walk from that moment on. So, I walked back home and then of course made contact with my doctor. And he said that it is likely that one must take radiographs (x-rays) and so on. And well, it is a fact that they have discovered a 'cartilage damage' and it actually was a very painful action, the whole thing.\"11. Schmid drawing back the curtains and winding up the window shutters12. Various of Schmid looking out at the snow 13. SOUNDBITE: (English) Dr. Marcus Mumme, lead researcher, Basel University Hospital:\"We see lots of problems with artificial joint replacements. It's a point of no return for the patient, you cannot bring it (the knee) back and then if you have problems with joint replacement, then you have difficulties coming back to normal daily life. We think with our therapy in the future we can also end these conditions and improve patient function. I also think for the patient it feels right to have a biological repair of his joint and not to have something artificial in his joint.\"14. Mid of operating team preparing Schmid who has been anaesthetised15. Mid of Schmid lying on hospital trolley before his operation 16. Close of Schmid's hand17. Mid of team wheeling Schmid into operating theatre18. Close of window onto operating theatre 19. Various of Professor Ivan Martin working on a potential prototype machine to automate production of tissue 20. SOUNDBITE: (English) Professor Ivan Martin, department of bioengineering, University Hospital Basel\"The process consists of the harvest of a small biopsy, it's a six millimetre punch biopsy from the nasal septum (nose) of the patient. This biopsy is chopped into small pieces. The cells are isolated from the small pieces and expanded in number over a culture time of about two weeks.\"21. Close of Schmid in operating theatre 22. Various of operating team preparing Schmid for knee and leg surgery  23. Wide top view of operating theatre 24. Wide of monitor25. Close of scans showing where an implant will support the corrected tibia bone to keep the knee straight26. Close of laboratory grown articular cartilage from nose stem cells in bowl27. Wide top view of surgeon putting cartilage on tray next to pieces of the patient's damaged cartilage 28. Close of laboratory grown and patient's own damaged cartilage (right) being picked up with tweezers29. Close of the damaged cartilage 30. Close of lab cartilage being cut into shape with moulded tool31. Close of surgical team watching 32. Close of lab cartilage being trimmed 33. Various of surgeon showing the shaped cartilage 34. Various of surgeon replacing the articular cartilage in the knee35. SOUNDBITE: (English) Professor Ivan Martin, department of bioengineering, University Hospital Basel:\"We do not have evidence about the long term durability of our grafts (cartilage), that is clear. Also we do not have evidence that our graft will be able to perform sufficiently and functionally upon exposure to harsher environments with stronger levels of inflammation that are present for instance during osteoarthrosis (osteoarthritis). So in our indications for treatment we exclude patients with degenerative diseases.\"  36. Low angle of surgery 37. Close of Dr. Mumme in mask and gown38. Close of Schmid's knee being covered with layer to keep his knee cooler under bandages 39. Wide of surgeon applying compression bandage to leg at the end of the operation Basel, Switzerland - 9 January 201740. Wide tilt down from Basel cathedral from across the River Rhine 41. Various of Mueller sprinting 42. SOUNDBITE (German) Nicola Mueller, former Swiss javelin champion: \"Yes, the first days, weeks I fell into a deep hole, but after this I have received the positive response from the doctors for this study and I felt a bit better. And then after the study, after the transplantation, I have seen that I was able to practice sport without any pain again.\"43. Nicola Mueller sprinting away from camera LEADIN: Swiss doctors have launched a large scale trial to discover if knee injuries can be repaired with stem cells taken from the patient's nose.Phase two of the trial has now begun following the success of an earlier study. STORYLINE: Nicola Mueller was a three times Swiss javelin champion when he badly damaged the cartilage in his knee.An initial operation to try mend it failed and his career in top level sport ended.Despite retiring from elite athletics Mueller continued to suffer pain.Articular cartilage is the smooth white tissue which cushions the ends of our joints, preventing the bones from rubbing against eachother.It's not possible to move painlessly without it.It's not just sportsmen and women who suffer from knee damage.Our knees experience tremendous wear and tear over the decades. The cartilage is a difficult area to repair because it doesn't have it's own blood supply.For this reason, doctors at Basel's University Hospital wanted to find another part of the body from which they could take stem cells to multiply and grow into cartilage.  They decided to take stem cells from the patients nose because they multiplied more quickly than cells taken from articular cartilage.The cell also needed to be able to withstand a degree of inflammation that would result from the operation.In 2012 Mueller took part in their first trial of twenty patients with knee injuries.Mueller describes falling into a deep hole in the first days and weeks after sustaining the injury which ended his athletic hopes.He believes the operation has been a success.Although no longer competing at a national level, he plays sports and helps in training. Mueller says: \"The pain after the accident, when the cartilage was damaged, was a sort of an acute pain that occurred with every single step I have made while climbing stairs, as if someone stabs with a needle into the knee. And then the pain got stronger and stronger. Let's say, at the beginning it was rather soft while climbing stairs, but the afterwards it also occurred in everyday life while walking.\"At the University Hospital Nick Schmid is waiting to become the first of over a hundred patients who'll take part in phase two of the Nose Knee trial (NK2).Schmid is a 47 year old social worker and keen amateur sportsman.He explains: \"It was approximately 8 month ago when I was jogging I suddenly felt a very strong, intense pain inside my right knee, so that I wasn't able to continue jogging, I could hardly walk from that moment on. So, I walked back home and then of course made contact with my doctor. And he said that it is likely that one must take radiographs (x-rays) and so on. And well, it is a fact that they have discovered a 'cartilage damage' and it actually was a very painful action, the whole thing.\"Since injuring his knee Schmid says he has put on twelve kilograms in weight and he's had no hesitation in accepting a place on the trial.The NK2 trial involves cutting open the knee all the way to the bone, but Schmid says he's not concerned about that.Like Mueller he has already undergone minimally invasive arthroscopic surgery which didn't alleviate his pain.Doctors at University Hospital believe it will not take long to recruit the cohort of patients needed for the new trial.According to The Lancet medical journal which published the results of the first trial, there are more than two million people across Europe and the USA who are diagnosed with damage because of injuries or accidents. Schmid's procedure is complicated further by having bow legs, so before the new cartilage can be inserted, surgeons need to correct his tibia, or shin bone.Surgeons say they don't want to replace the damaged articular cartilage without correcting the bone because it will put too much pressure on the new tissue.Usually when all other procedures fail, surgeons fit a prosthetic to replace part, or all of the patient's original knee. But one of the study's lead surgeons Dr. Marcus Mumme says this is not always a solution.Mumme says: \"We see lots of problems with artificial joint replacements. It's a point of no return for the patient, you cannot bring it (the knee) back and then if you have problems with joint replacement, then you have problems coming back to normal daily life. We think with our therapy in the future we can also end these conditions and improve patient function. I also think for the patient it feels right to have a biological repair of his joint and not to have something artificial in his joint.\"Out of twenty patients on the first trial, nine reported substantial improvement in movement and pain.Researchers say none suffered adverse effects from the graft, but two patients haven't made successful recoveries.The Basel team says their problems were unrelated to the trial procedure.They say one patient suffered an independent injury on their opposite leg.The other patient developed new lesions on the area of cartilage on the knee which had not been replaced.The latest trial is the result of twenty years of research at Basel by Professor Ivan Martin, a specialist in tissue engineering.He explains the process required in the weeks before the operation:\"The process consists of the harvest of a small biopsy, it's a six millimetre punch biopsy from the nasal septum (nose) of the patient. This biopsy is chopped into small pieces. The cells are isolated from the small pieces and expanded in number over a culture time of about two weeks.\"In the theatre surgeons begin the operation on Schmid's leg.Once the tibia is held at the correct angle, the damaged cartilage is cut out and the new one is prepared.This is what it looks like.When doctors took the biopsy from Schmid's nose under local anaesthetic there were a few thousand stem cells.Now seeded and cultivated on this strip of collagen, there are tens of millions of them ready to go into Schmid's knee.The stem cells are on the bumpier side of the collagen membrane.Here the surgeon places the new cartilage next to the section of old cartilage cut out of Schmid's knee and picks up an inflamed section which has for so long been a pain in Schmid's knee.The replacement cartilage is marked out and trimmed, before it's inserted into the joint.So far the team at Basel has calculated it's success by the patient's own assessments.The patients are asked to give scores on their level of pain and mobility and their capacity to return to sport.There are also objective measurements taken with MRI scanning.This shows the size and maintenance of the graft and how well it is integrating with the surrounding tissue.The team also use a special contrast agent enhanced MRI to examine the actual composition of the replacement tissue.This shows whether it closely resembles the patients own existing healthy cartilage, the aim is to create tissue that is as good as the original. What the team at Basel doesn't have is a long term assessment of the patient's grafts to prove the success of the procedure. Only then can the doctors carry out controlled trials comparing the best of existing treatments with the new stem cell implant.Martin says: \"We do not have evidence about the long term durability of our grafts (cartilage) that is clear. Also we do not have evidence that our graft will be able to perform sufficiently and functionally upon exposure to harsher environments with stronger levels of inflammation that are present for instance during osteoarthrosis (osteoarthritis). So in our indications for treatment we exclude patients with degenerative diseases.\"  Martin makes a vital point. It will be a long time before this procedure is shown to be suitable for patients with degenerative disease like osteoarthritis.Some people who've endured cartilage injury do go on to develop osteoarthritis which becomes especially problematic during old age -  and most populations around the world are aging.Doctors here will not be able to carry out the procedure on patients with diseases like arthritis until it has been declared successful after a controlled trial.   Also to be able to tackle a common chronic problem like arthritis, the team needs to be able to upscale the production of the stem cell grafts cheaply.Martin says this has happened in other areas of medicine using bio-reactors, but he says this area of industrial development can't be addressed until the success of the Nose Knee 2 trial.There is a long way to go.For Mueller though, the operation has, so far, brought relief.He says: \"Yes, the first days, weeks I fell into a deep hole, but after this I have received the positive response from the doctors for this study and I felt a bit better. And then after the study, after the transplantation, I have seen that I was able to practice sport without any pain again.\"====Clients are reminded: (i) to check the terms of their licence agreements for use of content outside news programming and that further advice and assistance can be obtained from the AP Archive on: Tel +44 (0) 20 7482 7482 Email: info@aparchive.com. 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