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Autologus Chondrocyle Implantation


WHAT IS ACI?


ACI (Autologus Chondrocyte Implantation) is a process whereby articular cartilage cells {chondrocytes} are collected, multiplied in a laboratory to increase cell number and then reimplanted with a special surgical technique into the damaged area. This allows cell growth and cartilage repair to occur and means that your own cartilage cells can grow new, durable cartilage. Your cartilage cells are grown in a dedicated laboratory in a special mixture of nutrients, mixed with your own serum (part of your blood). This is a safe and well understood laboratory method.

The television camera attached to the arthroscopy displays the image of the joint on a television screen, allowing the surgeon to look, for example, throughout the knee at cartilage and ligaments, and under the kneecap. The surgeon can determine the amount or type of injury, and then repair or correct the problem, if it is necessary.

WHAT IS ARTICULAR CARTILAGE?

Articular cartilage is the firm, smooth covering on the ends of bones where they contact each other inside joints. Together with the thick synovial fluid, cartilage forms a slippery surface that allows easy, low friction movement of the joint and also acts as a shock absorbing tissue when running or walking. Cartilage is made up of cells {chondrocytes} in a supporting tissue that has a high water content.


HOW IS CARTILAGE DAMAGED?

Cartilage can be damaged by direct injury {eg. sports injuries, car accidents}, inflammation {eg. rheumatoid arthritis} or slow degeneration {eg. osteoarthritis}. At present, treatment with ACI is only suitable for cartilage damage caused by direct injury, where damaged areas are surrounded by normal cartilage.


WHAT OTHER TREATMENT OPTIONS ARE AVAILABLE?

Before the technique of articular cartilage cell culture and ACI was developed, traditional treatment were attempted to smoothen the surface of the damaged cartilage. If the cartilage damage was severe exposing the underlying bone, this bone was surgically penetrated to allow fresh blood to enter the damaged area, carrying cells capable of producing scar tissue. This was done in the expectation that new cartilage would grow into the damaged regions. Unfortunately, this procedure produced a less resilient type of fibro-cartilage scar that usually wore out within a short time. Traditional treatment therefore usually failed to prevent the return of pain and reduced movement in the joint. Many patients with this condition often had multiple hospital admissions and operations similar to the above to try and relieve these symptoms, usually with only temporary success.

WHAT ARE THE RESULTS OF ACI?

International studies show that with the use of cartilage culture and implantation, 80%-90% of patients have significantly improved, many returning to full, normal pain-free activity. The results of cartilage cell implantation are better than those of previous treatments.

WHAT TYPES OF CARTILAGE DAMAGE ARE SUITABLE FOR REPAIR WITH ACI?

Your specialist surgeon will advise you whether ACI is suitable for your condition. Generally, this will be based on the assessment of the specific damage, as shown by direct examination with an arthroscope, MRI scanning or other means. The knee is the most common site for articular cartilage injury, however other joint can be affected including the ankle, hip, shoulder, elbow and joints of the hand.

WHAT TYPES OF CARTILAGE DAMAGE ARE NOT SUITABLE FOR ACI?

Wide spread cartilage damage, as is often seen with osteoarthritis, and inflammatory disease such as rheumatoid arthritis when involving the whole joint, is not suitable for this treatment.
If the bones of the leg are meeting in the area of the knee at an abnormal angle, it may be necessary for the surgeon to perform a realignment procedure before or at the same time as ACI.

WHAT IS INVOLVED IN ACI?

The ACI requires 2 short operations.
The first operation involves harvesting a small sample of your cartilage for your cells for reimplantation. This operation is carried out arthroscopically (key hole surgery) as a day case.
Approximately 4-6 weeks later, the second short open operation will be performed to implant your new cartilage cells. To ensure your new cells are protected after implantation, it is necessary to stay in hospital for two to three days to allow progressive joint mobilization.

 

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