Cell Based Therapies May Prevent Joint Replacements

The Rewards of Cartilage Restoration

 

By Joseph M Berman, M.D.

Autologous Chondrocyte Implantation (ACI) is a revolutionary procedure combining new techniques in bio-tissue-engineering, specialized cell cultures and clinical application. We now have the ability to repair defects in the knee (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 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 Food and Drug Administration and have successfully completed thousands of procedures to repair articular cartilage with bioengineered cartilage.

 

The result is the possibility of returning the joint surface to its original form, creating a potential life long 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 USA) where the cells are grown and cultured into 10-12 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 pre-operative occupation.

 

The development of cell-based therapies is continuing with the exciting goal of biologically resurfacing joints rather than replacing them with metal and plastic.