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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.
📌 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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#CartilageRepair, #OrthopedicSurgery, #ChondrocyteImplantation, #ACIProcedure, #KneeSurgery, #MRI, #CartilageRestoration, #OrthopaedicResearch, #Cartilife, #SportsMedicine
