A cotton floor mop hangs above the door to James Cook’s office in the Missouri Orthopaedic Institute.
The mop’s handle holds signatures in black and gold marker and is signed by 11 members of Cook’s research and surgical teams. They gave him the mop after the first transplant surgery using his breakthrough procedure.
The procedure doubles the time tissues can be preserved for transplant in knees, hips, shoulders and other joints. It is called MOPS – the Missouri Osteochondral Preservation System.
Cook, a William & Kathryn Allen Distinguished Chair in orthopedic surgery, developed MOPS to extend the time tissue can be viable before a transplant. He is also the director of Thompson Laboratory for Regenerative Orthopaedics and Mizzou BioJoint Center.
Cook began the project in 2011, when doctors had only 28 days after donated joint tissues were obtained before cartilage, bone and menisci were considered unviable and had to be tossed.
At least 14 of those days, Cook said, were used to determine whether the joint tissue was acceptable, based on donor and tissue screening. That drove the time doctors could use the tissue down to 13 or 14 days in a best-case scenario.
“That’s what stimulated us to go down that path,” he said.
MOPS stretches the time joint tissues can be preserved to 56 days, which gives doctors more donated tissue for joint restoration surgeries — athletic knee injuries, meniscal tears, trauma, hip malformation problems, shoulder disorders and ankle fractures, among them.
Looking closer at the cotton mop above his door, it’s hard not to smile.
It was the perfect gift for Cook — a mop to celebrate MOPS.
Six years ago, the procedure for preserving joint tissues was “suboptimal,” Cook said. When a donor died, joint tissues were sent to tissue banks to preserve for patients, but they didn’t immediately go to those in need.
They were kept by tissue banks for about two weeks for testing. Then, with just 10 days or so for doctors to use the tissues, just a fraction of the donations could be used.
The narrow window wasn’t just wasteful. It was expensive. With banks throwing away 80 percent of their tissues as a result of the high turnover, Cook said, the cost was high.
So, having found a problem, Cook’s team went to work to solve it.
They started with temperature. Current systems kept tissues at 4 degrees Celsius (about 25 degrees Fahrenheit). That was too chilly for Cook’s taste.
If cells could be kept at body temperature, he thought they might be kept alive longer.
“We wondered, is there a better way?” he asked. “After all, your cells are at body temperature. They don’t like to be too warm or too cold.”
The team set off to see if there was a way to keep joint tissues viable at room temperature.
When one of his graduate students forgot to put preserved tissue into the body-temperature incubator after testing, it became a lucky mistake.
“He came to me and told me about it. I said, ‘Let’s see what happens,’” Cook said.
Those turned out to be the best grafts: They remained high quality for a longer period of time.
There was a lesson to be learned from the discovery, Cook said.
“Always tell the truth, and don’t automatically discard something you think is a mistake,” he said, laughing.
In 2012, Cook and his team emerged with a new method of preserving donor joint tissues for use in restoration surgical procedures. It keeps tissues at room temperature in a special “sauce” that keeps them viable for 56 days — double the time of the colder, older preservation method and more than triple the time to take them to patients in need.
Now they had to find a tissue bank willing to bring their idea from theory into practice. Of the five tissue banks in the U.S., only one — New Jersey’s Musculoskeletal Transplant Foundation — decided to pursue the new method.
“That wasn’t what we expected,” Cook said. He thought the banks would squabble for the ability to use his team’s discovery.
“We didn’t realize how ultra-conservative the banks were.”
In 2013, the tissue bank in New Jersey funded a study to determine the usefulness of the system, which Cook said went “even better” than the initial tests performed in the lab. As a result, the New Jersey bank has exclusive rights to the MU-trademarked and patented system.
Now, Cook said, the other tissue banks have changed their tune.
“They all want it now, and while I felt like saying ‘I told you so,’ I am happy that the Musculoskeletal Transplant Foundation took the chance and believed in us and is seeing the benefits of their investment,” Cook said.
Although the tissue banks changed their attitudes about the procedure, there are still critics.
Edward Adelstein, chief of the laboratory at the Veterans Hospital in Columbia and a medical examiner, believes the procedure goes against medical knowledge of the body.
Adelstein said that when a person dies, their body is immediately flooded with bacteria from their intestinal tract. That bacteria, he said, would infect the joints and render them — and the media in which they are placed — useless.
“What they’re doing is quite unique and, as far as I can tell, quite risky,” Adelstein said.
Jonathan Williams had no idea that his first month playing football for School of the Osage in 2013 would likely be his last.
“I was a defensive lineman, and it was my junior year of high school,” he said. “I tackled the quarterback, and when I took him down with me, my teammate’s helmet was under my leg, and he landed on top of me. It was a bad deal.”
Williams remembers being taken to the Missouri Orthopaedic Institute and learning that his leg and his femur were broken. A year and a half later, his leg had healed, but a new problem presented itself: His knee was deteriorating.
“They told me about (the procedure that uses MOPS grafts) and how it was real blood and tissue and not metal and plastic,” Williams said. “It sounded like the best choice.”
After surgery, he spent four months in physical therapy, where he worked on exercises like stretching, leg lifts and stationary biking. He said it wasn’t an easy process, but it was worth it.
“I ran my first three miles the other day,” Williams said. “I almost threw up, but I didn’t stop.”
Now he works at the Missouri Orthopaedic Institute as a clerical assistant alongside Cook, the man who made his recovery possible.
“He’s doing some really cool stuff with preserving tissue, but he won’t brag about it,” Williams said. “So I’ll brag about it for him.”
Cook’s breakthroughs haven’t been limited to MOPS.
He spent years working on a technique to help decrease complications in ACL surgeries. An ACL tear in the knee can be a devastating blow, especially to young athletes.
Cook also has made advances in “biomarkers,” which he calls the “fortune-teller” for detecting future joint-related medical troubles, like arthritis, before they occur.
“When arthritis is diagnosed by conventional methods, it’s end-stage,” he explained. “By the time people come in, it’s too late and they need to have joint replacement.”
The development is a useful technique, he said, because it gets patients inspired to change the factors in their control before arthritis sets in.
“Then you’re going to be motivated,” he said. ”You can start swimming or biking. You can start taking nutritional supplements, with proven benefits. And joint-preserving surgeries are great options then, too.”
On the horizon for Cook is working with disc transplants, which he said can help patients with spinal problems. Though the procedure hasn’t yet been performed in human patients, he said it has been successfully completed in dogs.
Despite the work he’s done, he distributes the credit to his team.
“It’s not me,” he said. “I’ve had so many people support me, and everything we do is as a team. There’s nothing I’ve done by myself.”