After defeating seven players in a national school badminton championship four years ago, Pune resident Kunal Bhide, reached the finals. His opponent was an agile teenager from Haryana.
Bhide, who was representing Maharashtra, played a brilliant attacking shot early on in the game. In the process, Bhide, then 17, yanked his right side glenoid labrum, the ligament that connects the arm bone to the shoulder blade.
His shoulder began to hurt and it became impossible to rotate his arm, fully. He lost by a single point. Bhide’s pain worsened over time.
A few months later, he underwent an arthroscopic surgery in which screws were fitted into his shoulder joint to anchor the torn ligament in place. He was promised that within six months, arm rotation would be restored. But Bhide, who resumed playing, didn’t improve.
Ligament tear turned nasty
After playing for three months, he finally had to give up. The following year, Bhide missed each state tournament. Unable to raise his right hand more than 90 degrees, he began to develop premature osteoarthritis. “All roads led to a dark tunnel.” “I could not see my son’s dream coming to an end,” says father Ajit Bhide, a painting contractor.
“He was playing so well, he could have been a national champion. We took the help of counsellors to make him understand that playing more would only result in greater damage.” Ajit wasn’t far off the mark. The metal screws had not been fastened accurately during surgery, and protruded out of the ligament.
Each time Bhide would play, the metal scraped off a layer of his arm bone cartilage that faced the ligament. The cartilage is a flexible connective tissue found in joints such as the shoulders, elbows, knees and ankles. It provides a protective covering that absorbs shocks between joint surfaces, but it cannot regenerate inside the body. Bhide was inconsolable when he learned about the damage. Then, last year, on a friend’s recommendation, Bhide visited the Deenanath Mangeshkar Hospital in Pune.
Dr Ashish Babhulkar, shoulder specialist and joint replacement surgeon, suggested Bhide undergo a new procedure called Autologous Chondrocyte Implantation (ACI), which would take cartilage cells, (called chondrocytes) out of his body, multiply them in a laboratory, and implant the new cells in the damaged area to heal him.
Growing cartilage in a lab
Babhulkar surgically removed the metal screws from Bhide’s joint and assessed the scope of damage the young man had suffered. A sample of cartilage one centimetre in diameter was taken from Bhide’s knee and sent to a Lonavalabased cartilage regeneration laboratory for development.
“The knee has a generous area of cartilage that can be cultivated to cure other joints,” says Babhulkar. “The damage to his shoulder was large. We needed to cover a bald area of five centimetres in length and three-and-half centimetres in width.” In the laboratory, 400,000 chondrocytes were multiplied into 900 million cells to make a crescent that would cover the bald patch.
This took about six weeks. In the second stage of the procedure, these new cells were injected into Bhide’s shoulder with a biomembrane that acted as glue and held the implanted chondrocytes in place. Traditionally, the kind of cartilage damage that Bhide suffered is treated with microfracture surgery.
“That allows the person to walk, but not play a sport,” says Babhulkar. The ACI procedure that’s barely two years old in India, is becoming the more preferred line of treatment for cartilage defects, including for patients who need to undergo knee replacement surgeries. Bhide underwent the procedure on June 15 and was asked to rest for six weeks.
For the next four months, he will undergo physiotherapy to strengthen his shoulder muscles once again. “We hope that he will be able to return to playing badminton in 12 months,” says Babhulkar. said Dr Lakshmi.
Cured By Lab
Cells Kunal Bhide’s cartilage was damaged by screws inserted to treat a ligament tear in his shoulder blade. Cartilage, a flexible connective tissue cannot regenerate inside the body.
Using a procedure called Autologous Chondrocyte Implantation, medical experts grew new cells in a lab, using a sample from his knee cartilage. They injected those cells into the damaged area to plug the hole. The procedure cost Rs 1.5 lakh
► The damage to his shoulder was large. We needed to cover a bald area of five centimetres in length and three-and-half centimetres in width
- Dr Ashish Babhulkar