(Fig 5-C.09) MRI Findings of Autologous Chondrocyte Implantation

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MSK MRI Jee Eun Lee

Visualizing MSK Radiology: A Practical Guide to Radiology Mastery

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📌 Overview of Autologous Chondrocyte Implantation (ACI)

• Autologous chondrocyte implantation (ACI) is a cell-based cartilage restoration strategy aimed at repairing relatively larger (>2 cm²) defects with mature hyaline cartilage.

• ACI is generally used for large, full-thickness traumatic defects in patients aged between 15 and 60 years.

 

✅ Procedure

 

• Stage One: Harvesting Chondrocytes

In the first stage, an arthroscopic biopsy of chondrocytes is harvested from a lesser weight-bearing region of the distal femur (e.g., intercondylar notch and trochlear margin). 

Once harvested, chondrocytes undergo in vitro culturing.

 

• Stage Two: Reimplantation

The second stage occurs 2 to 6 weeks later, where an increased quantity of chondrocytes are reimplanted into the focal chondral defect, most commonly through a miniarthrotomy. 

While earlier generations relied on a periosteal patch or collagen membrane to deliver chondrocytes, more recent techniques enable chondrocytes to grow within a matrix, eliminating the need for suturing a cover over the defect.

 

✅ MRI Characteristics

 

• Within the first 3 months following surgery, MRI typically shows a hyperintense signal of repair cartilage.
• Beyond 12 months, MRI visualization shows repair cartilage becoming isointense with neighboring hyaline cartilage, indicating graft maturation.

 

✅ Initial Post-Operative Appearance

• The initial post-operative appearance varies depending on the type of chondrocyte implantation procedure performed. 
• For ACI, there is usually complete filling or slight overfilling. 
• Underfilling may occur early after matrix-assisted chondrocyte transplantation, with complete filling over 1–2 years.

 

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📌 Cartilife®: Fourth-Generation ACI

✅ Costal Cartilage as a Source

• The study by Siclari et al. (2012) investigates using costal cartilage for cartilage repair. 
• It details the method of harvesting costal cartilage, expanding the chondrocytes, and using them in a scaffold-free approach. 
• The research highlights the advantages of costal cartilage, including its abundant supply and robust chondrogenic potential.

 

• Cartilife® is a fourth-generation ACI in which pellet-type chondrocyte tissue is implanted without a scaffold, reducing the rehabilitation period and minimizing side effects such as foreign body reactions. 
• Donor tissue is collected from the patient's rib cartilage, cultured for 6–7 weeks to generate pellets containing cartilage cells and extracellular substrates, and then transplanted to the defective area.

 

References

• J Knee Surg. 2021 Jan;34(1):2-10
• Radiology 2015; 277:23–43
• Clin Imaging. 2019 Nov-Dec;58:129-139
• Journal of Orthopaedic Research, 30(6), 876-882
• Regen Ther. 2022 May 3;20:126-137

 

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