Autologous Chondrocyte Implantation
CELL-BASED THERAPIES MAY PREVENT JOINT REPLACEMENTS
The Rewards of Cartilage Restoration By Joseph M. Berman, MD
Autologous chondrocyte implantation (ACI) is a revolutionary procedure combining new techniques in biotissue engineering, specialized cell cultures, and clinical application. We now have the ability to repair defects in the knee joint surface (the articular cartilage) of any size in any location with tissue that is comparable to the original articular surface that was damaged.
In the past, when a patient injured the articular cartilage, we had limited treatment
options. Most often, we simply did “Band-Aid” treatments and waited for the
almost inevitable progression, often resulting
in a knee replacement. Since 1997,
cultured chondrocytes (articular cartilage
cells) have received approval from the good
and Drug Administration and we have
successfully completed thousands of procedures
to repair articular cartilage with
the bioengineered cartilage.
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The result is the possibility of returning the joint surface to its original form, creating apotential lifelong repair, and possibly avoiding the need for future total knee replacement. Indications for the procedure include isolated articular cartilage injury from a single traumatic episode, damage from repetitive trauma or misalignment, and joint surface injury from repetitive microtraumas accumulating over a period of years. Patients range in age from adolescence to 50 years.
The procedure is performed
with a two-stage operative
technique. The first stage is
arthroscopy, which harvests
two tablet-size pieces of the
patient’s own articular cartilage,
a few hundred thousand
cells. These are sent to a specialized
laboratory in Boston
(the only one of its kind in the
United States), where the cells
are grown and cultured into
10 million to 12 million cells. Then, in the second operative procedure,
one that does require an incision, the
cells are implanted back into the knee
under a flap of tissue created from a piece
of the bone lining (periosteum).Results are gratifying. Some patients
have been relieved of pain they have
had to endure for as long as 20 years.
Many patients experience much improved
function and can return to some
sports. Almost all return to their preoperative
occupations.
The development of cell-based therapies is
continuing with the exciting goal of biologically
resurfacing joints rather than replacing
them with metal and plastic. ■
Joseph M. Berman, MD, is board certified and
a Fellow of the American Academy of Orthopaedic
Surgeons. He is the Founder and Medical
Director of the Joint Preservation Center, which
is affiliated with the Foundation for Joint
Preservation, a nonprofit organization that
encourages joint and cartilage research. He is a
member of the national speaking board for
Genzyme Corporation. He has been instrumental
in speaking and teaching at instructional
seminars, helping define the techniques of cartilage
restoration. He is a member of the
International Cartilage Restoration Society. Among his other affiliations, he is a Fellow of the
Arthroscopy Association of North America, for
which he has been an associate master’s instructor
at several seminars.