I was prepared to take a chance. I had nothing to lose and everything to gain

PC Steve Taylor

When the dog-handler tripped and broke his ankle on a pub raid he thought his active career with the West Midlands force was coming to a close.

Misdiagnosed as a simple strain at first, the 41-year-old man was shocked to learn nine months later that the bone in his ankle had died leaving him unable walk without constant pain.

However, orthopaedic surgeons at a specialist UK clinic were prepared to attempt a controversial technique to 'grow' the father-of-two a new ankle.

Hope for millions

The procedure, which holds out hope to millions of arthritis sufferers, has enabled PC Taylor to go back on the beat this weekend.

PC Taylor was concerned for his future

When he was told of the Oswestry clinic, in Shropshire, where surgeons might be able to use his own cartilage cells to help create him another ankle, the policeman felt he had little to lose.

He said: "They told me that the clinic was already working on creating new knees, but that I would be the first ankle joint they had ever worked on.

"But I was prepared to take a chance. I had nothing to lose and everything to gain."

The procedure, which is known as autologous chondrocyte implantation (ACI) or as articular cartilage transplantation (ACT), was pioneered in Sweden 15 years ago and is aimed at helping younger people with damaged or defective cartilage.

But there are hopes that the technique, which is available in a handful of specialist UK orthopaedic centres, could eventually be adapted to help arthritis patients.

Healthy cells

Surgeons take healthy cells from the patient, in PC Taylor's case from his knee, and then grow them in a lab and replace the damaged cartilage with these new cells.

They also take a small piece of the lining of a patient's shin bone which is sewn onto the healthy cartilage and then sealed with glue.

A tiny hole is left for the cells to be injected back into the joint.

The cells then attach themselves to the bone and grow new cartilage.

Arthritis

There are 8 million people in the UK with some form of arthritis or rheumatic disease 60% of people over the age of 64 have moderate to severe arthritis in at least one joint Arthritis is the single biggest cause of disability in the UK

PC Taylor explained that although it took him months of intensive physio to get back to full strength, that the pain disappeared instantly.

He said: "As soon as I had the operation there was no pain. It had been awful and was as if I had a constant toothache in my ankle.

"The pain had been so bad that I would be woken up in the night with it and my ankle sometimes used to swell to twice its size."

Time for reflection

Although he is now fit enough to go back to dog handling he said the accident had given him time to reflect on a change of direction and he is now looking forward to taking up his new post as a community bobby.

He said: "I can now enjoy life. If I hadn't had this operation I don't know whether I would still be able to be in the police force."

Although ACI is currently only suitable for patients with cartilage defects or damage and not suitable as a treatment for osteoarthritis, arthritis of the bone, there are hopes it can be adapted, although some arthritis surgeons remain sceptical about its use and regard it as a developmental technique.

And their scepticism appeared to be backed up by the National Institute for Clinical Excellence (NICE) - which evaluated the technique in 2000 and did not recommend it as a routine treatment for articular cartilage defects and called for more extensive trials, which the Oswestry clinic are hoping to carry out if they can get funding.

New study

Sometimes you just have to go with something without really understanding how it works

Dr Sally Roberts

Dr Sally Roberts, a clinical scientist with an Arthritis Research Campaign grant at Oswestry, is undertaking a two-year study into the potential of the technique.

She admits that like many surgeons she was sceptical about ACI, but says her own research is showing promising results.

She said: "ACI is so alien to everything orthopaedic surgeons are used to and there are lots of reasons why it should not work.

"It is hard to grasp that these implanted cells don't float around in the joint but that they grow new cartilage at the damaged site; and in animal models it's true that repair of cartilage doesn't integrate very well.

"But I have been doing biopsies on patients 12 months after surgery and by then the cartilage seems beautifully integrated.

"The new cartilage that forms appears to be of similar quality to the rest of the joint."

Adapted

And Dr Roberts said hopes are high that the technique can soon be adapted to help some of the UK's osteoarthritis sufferers.

"Sometimes you just have to go with something without really understanding how it works.

"ACI is a starting point - using patients' own biology rather than metal and plastic.

ACI, she said, could be a stepping stone to the next generation of treatment for osteoarthritis.

PC Taylor said he would recommend the technique to anyone in a similar situation.

"It is not an overnight thing there is a lot of work and a lot of physio involved, but it has got me mobile again and has got me back to work."