Olympic Athlete Undergoes Career Saving Knee Arthroscopic Surgery

“First, we are pleased to report that the procedure was entirely successful in placing a new meniscus into the joint,” said orthopaedic knee surgeon Frank R. Noyes, M.D. in a press conference following Phelps’ surgery at Deaconess Hospital. “She will be undergoing a period of 6-8 weeks to restore muscle strength and no strenuous activities will be allowed for 6 – 9 months. The healing phenomenon of the meniscus occurs over a period of 1-2 years.”

Dr. Noyes, director of Cincinnati Sportsmedicine and Orthopaedic Center, is an internationally recognized orthopaedic surgeon and an authority on the diagnosis and treatment of complex knee disorders.

It’s not a typical procedure for someone young or old. But a meniscus allograft reconstruction was the only choice for Phelps, a choice that will hopefully allow her to return to gymnastics.

The meniscus is the crescent shaped, pad-like structure, between the femur (end of the thigh bone) and the tibia (end of the lower leg), which is crucial to the proper function of the human knee. As the knee’s “shock” absorber, it plays an essential role in protecting the femur and tibia from rubbing together. Without this cushion, it is very painful for people to walk, much less be active. Jaycie sustained a complete tear of the lateral meniscus of the left knee joint many years ago and now experiences knee pain and swelling with activities.

“The loss or severe damage of the meniscus can be devastating to a young and competitive athlete like Jaycie,” said Dr. Frank R. Noyes, Director of Cincinnati Sportsmedicine and Orthopaedic Center. “Without a meniscus the joint deteriorates and can lead to an early onset of osteoarthritis in just a few years. Up until five or six years ago,” he added, “there was no treatment for this injury. Patients gave up athletics and their active lifestyles. Knee centers in the U.S. and Europe are working to develop a transplant or synthetic replacement for the meniscus. At this time though, the only real option for those with a severely damaged meniscus is to take one from a donor’s healthy knee,” shared Dr. Noyes.

Injury to the meniscus cartilage of the knee is the most common diagnosis ultimately leading to arthroscopic surgical intervention. Each year there are approximately 750,000 operations performed to address these injuries. Unfortunately, only about 15% of meniscus tears can be repaired, with the remaining 85% requiring the removal of all or part of the meniscus cartilage.

The meniscus cartilage grafts provided by CryoLife, Inc. originate through a process similar to that for hearts, livers and other whole organs and tissues. Meniscus cartilage must be recovered from a donor and shipped to the preservation laboratory within 24 hours of death. The tissue is then treated with antibiotics, measured and catalogued before being frozen by a process very similar to that used for the preservation of sperm and embryos. This sophisticated process incorporates a combination of cryoprotective agents and controlled-rate freezing to preserve the structural proteins and cells of the tissue. The goal is to provide a cartilage graft at surgery that closely resembles fresh, unprocessed meniscus tissue. The cartilage graft is then transplanted into the knee arthroscopically with the hope that the body will accept it. This procedure is only performed on younger patients as a last option to delay the onset of osteoarthritis, or the breakdown of the joint’s articular cartilage.

Following surgery, patients can expect an extensive and rigorous rehabilitation program. For at least the first six months, patients are restricted from running, pivoting and deep squatting activities that may put the graft at risk. For at least an entire year, the graft is watched very closely to see if the body has accepted the tissue. To minimize and control unnecessary forces placed at the knee, patients are even retrained in how to walk.

For those with meniscus damage, such as seventeen-year old Jaycie Phelps, this new innovative treatment approach has shown encouraging results. At the 1996

American Society for Sports Medicine’s annual meeting, Dr. Frank Noyes reported on the longest series of patients to date with meniscus allografts, stressing the importance of performing the procedure in young individuals prior to the development of joint damage. He added that the procedure is still not uniformly successful and predictable, requiring further research and long term studies. At the 1997 American Society for Sports Medicine’s annual meeting, Thomas Carter, MD of Phoenix reported in a study of 33 patients that 80% had increased activity levels and symptomatic improvement in a 2-5 year follow up study after meniscus allograft reconstruction.

When asked about Phelps’ goal of competing in the 1998 John Hancock U.S. Gymnastics Championships and the 2000 Olympic Games, Noyes said, “Every athlete needs a goal and we do not want to discourage her from trying to achieve those goals. We are doing everything orthopaedically possible to obtain those goals. We’ll know much better a year from now, but overall we tell athletes it’s a 50-50 situation. Some athletes will be able to return to their activities and do reasonably well while other athletes – because of the arthritis they have in the joint – may have future trouble. We’re going to remain very optimistic, but we need some help from Mother Nature to heal the transplant.”

Besides the meniscus allograft reconstruction, Jaycie also underwent a transfer of her own articular cartilage lining from a non-critical area of the knee joint to an area of loss in an attempt to resurface a portion of the joint. This procedure is called an osteochondral plug.

Dr. Noyes has successfully performed 108 meniscus allograft reconstructions, the first in 1988. He was one of the first to perform the procedure arthroscopically, decreasing the risk of surgical complications and minimizing the surgical incision size. This innovative procedure draws patients from throughout the United States and around the world to Cincinnati Sportsmedicine and Orthopaedic Center. The development, testing and application of new, more effective treatment options for orthopaedic injuries and conditions is a Cincinnati Sportsmedicine and Orthopaedic Center priority. Toward that goal, Cincinnati Sportsmedicine is involved in ongoing research in surgical techniques and therapies that improve the quality of life and level of activity for persons of all ages and activity.

An interview with Frank Noyes, MD or the Phelps can be arranged and copies of surgical video or illustrations can be obtained by calling Amy Leroux at Cincinnati Sportsmedicine and Orthopaedic Center, (513) 559-2107.

Birthdate:	September 26, 1979
Hometown:	Greenfield, Indiana
Parents:	Jack and Cheryl Phelps
Club:	Cincinnati Gymnastics Academy
Coach:	Mary Lee Tracy
Began gymnastics:	1983