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{{Short description|Medical treatment for articular cargilage damage}} |
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{{Expert-subject|medicine|date=November 2008}} |
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{{Multiple issues|{{UDP|date=September 2017}} |
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{{more citations needed|date=July 2015}}}} |
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| ⚫ | Autologous |
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{{Infobox medical intervention |
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| name = Autologous chondrocyte implantation |
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| caption =Autologous Chondrocyte Implantation |
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| specialty = orthopedia |
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| ⚫ | '''Autologous chondrocyte implantation''' ('''ACI''', [[ATC code]] {{ATC|M09|AX02}}) is a biomedical treatment that repairs damages in articular cartilage. ACI provides pain relief while at the same time slowing down the progression or considerably delaying partial or total [[joint replacement]] ([[knee replacement]]) surgery. |
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ACI procedures aim to provide complete [[hyaline]] repair tissues for [[articular cartilage repair]]. Over the last 20 years, the procedure has become more widespread and it is currently probably the most developed articular cartilage repair technique. |
ACI procedures aim to provide complete [[hyaline]] repair tissues for [[articular cartilage repair]]. Over the last 20 years, the procedure has become more widespread and it is currently probably the most developed articular cartilage repair technique. |
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The procedure fails in about 15% of people.<ref>{{cite journal|last1=Andriolo|first1=L|last2=Merli|first2=G|last3=Filardo|first3=G|last4=Marcacci|first4=M|last5=Kon|first5=E|title=Failure of Autologous Chondrocyte Implantation.|journal=Sports Medicine and Arthroscopy Review|date=March 2017|volume=25|issue=1|pages=10–18|doi=10.1097/JSA.0000000000000137|pmid=28045868|s2cid=19085219}}</ref> |
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The surgical technique was first published on humans by Brittberg in 1994. He reported good and promising results with 23 patients for defects on the femoral condyles (Brittberg et al, 1984).The technique also seems promising with regard to long-term results. <ref> |
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Brittberg, M., et al. "Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation." N.Engl.J.Med. 331.14 (1994): 889-95.</ref> |
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__TOC__ |
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== Complications == |
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This cell based [[articular cartilage repair]] procedure takes place in three stages. In a first stage, between 200 and 300 miligrams [[chondrocyte|chondrocyte cells]] are sampled arthroscopically from a non [[weight bearing]] area from either the intercondylar notch or the superior ridge of the medial or lateral femoral chondyle of the patient. These harvested cells are grown in vitro in a specialised laboratory for approximately four to six weeks, until there are enough cells to reimplant on the damaged area of the articular cartilage. The patient then undergoes a second treatment, in which the chondrocyte cells are applied on the damaged area during an open-knee surgery (also called arthrotomy). These autologous cells should adapt themselves to their new environment by forming new [[cartilage]]. During the implantation, [[chondrocyte|chondrocyte cells]] are applied on the damaged area in combination with a membrane (tibial periosteum or biomembrane) or pre-seeden in a scaffold matrix. |
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The occurrence of subsequent surgical procedures (SSPs), primarily arthroscopy, following ACI is common. For example, in the Study of the Treatment of Articular Repair (STAR), 49% of Carticel ACI patients underwent an SSP on the treated knee, during the 4-year follow up. The most common serious adverse events (up to 5% of patients), include [[arthrofibrosis]] and joint adhesions, graft overgrowth, [[chondromalacia]] or [[Chondromalacia patellae|chondrosis]], cartilage injury, graft complication, meniscal lesion, graft delamination, and osteoarthritis.<ref>Source: Carticel.</ref> |
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A recent study from Germany, published in the November 2008 issue of the American Journal of Sports Medicine, analyzed 349 ACI procedures of the knee joint. Three different ACI techniques were used. A major proportion of complications after ACI can be summarized by 4 major diagnoses: symptomatic hypertrophy, disturbed fusion, delamination, and graft failure. Among those, the overall complication rate and incidence of hypertrophy of the transplant were higher for periosteum-covered ACI. Furthermore, an increased rate of symptomatic hypertrophy was found for patellar defects.<ref>Source: Philipp Niemeyer, MD, et al.: "Characteristic Complications After Autologous Chondrocyte Implantation for Cartilage Defects of the Knee Joint". ''The American Journal of Sports Medicine'' 36:2091–2099 (2008).</ref> |
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==The Next Steps in ACI - Using Characterized Chondrocyte Implantations (CCI)== |
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== Improvement of ACI == |
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The latest development in cell-based cartilage repair consists in of screening cartilage cultures on their cartilage forming abilities before implanting them on the damaged cartilage. This extra quality-release criterion aims to solve the risk of de-differentation of the cells during their culturing process. De-differentiation of cells means that the cultured cells lose their primary characteristics (the cartilage forming ability in case of [[chondrocytes]]). This process is referred to as Characterized Chondrocyte Implantation (CCI). |
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Techniques such as the EELS-TALC<ref>{{cite web |title=EELS-TALC |url=https://www.ncrm.org/myth/eelstalc/ |website=EELS-TALC |access-date=20 March 2021}}</ref> to enhance ACI and its next generation advancement called Matrix Assisted Chondrocyte Implantation (MACI)<ref>{{cite journal |last1=Jacobi |first1=M |title=MACI - a new era? |journal=Sports Med Arthrosc Rehabil Ther Technol |date=2011 |volume=3 |issue=1 |page=10 |doi=10.1186/1758-2555-3-10 |pmid=21599919 |pmc=3117745 |doi-access=free }}</ref> with enabling chondrocytes to be tissue engineered with long term native knee cartilage phenotype maintenance in vitro and in vivo,<ref>{{cite journal |last1=Yasuda |first1=Ayuko |title=In vitro culture of chondrocytes in a novel thermoreversible gelation polymer scaffold containing growth factors |journal=Tissue Engineering |date=2006 |volume=12 |issue=5 |pages=1237–1245 |doi=10.1089/ten.2006.12.1237 |pmid=16771637 |url=https://doi.org/10.1089/ten.2006.12.1237}}</ref><ref>{{cite journal |last1=Arumugam |first1=S |title=Transplantation of autologous chondrocytes ex-vivo expanded using Thermoreversible Gelation Polymer in a rabbit model of articular cartilage defect |journal=Journal of Orthopedics |date=2007 |volume=14 |issue=2 |pages=223–225 |doi=10.1016/j.jor.2017.01.003 |pmid=28203047 |pmc=5293721 }}</ref> with the engineered tissue construct containing stem cell progenitors<ref>{{cite journal |last1=Katoh |first1=Shojiro |title=A three-dimensional in vitro culture environment of a novel polymer scaffold, yielding chondroprogenitors and mesenchymal stem cells in human chondrocytes derived from osteoarthritis-affected cartilage tissue |journal=Journal of Orthopedics |date=2021 |volume=23 |pages=138–141 |doi=10.1016/j.jor.2021.01.005|issn=0972-978X |pmid=33510554 |pmc=7815488 |doi-access=free }}</ref> along with those expressing pluripotency markers<ref>{{cite journal |last1=Katoh |first1=Shojiro |title=Articular chondrocytes from osteoarthritic knee joints of elderly, in vitro expanded in thermo-reversible gelation polymer (TGP), exhibiting higher UEA-1 expression in lectin microarray |journal=Regenerative Therapy |date=2020 |volume=14 |pages=234–237 |doi=10.1016/j.reth.2020.03.006 |pmid=32435676 |pmc=7229400 |doi-access=free }}</ref> and with added advantage of enriched [[hyaluronic acid]] (HA) expression<ref>{{cite journal |last1=Katoh |first1=Shojiro |title=Enhanced expression of hyaluronic acid in osteoarthritis-affected knee-cartilage chondrocytes during three-dimensional in vitro culture in a hyaluronic-acid-retaining polymer scaffold |journal=The Knee |date=2021 |volume=29 |pages=365–373 |doi=10.1016/j.knee.2021.02.019 |pmid=33690017 |doi-access=free }}</ref> by the cells have been reported which will contribute to improved regenerative therapies for cartilage damage. |
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In February 2008, a scientific publication in the ''American Journal of Sports Medicine'' showed that CCI results in better structural repair than standard [[microfracture surgery]] when treating symptomatic cartilage defects of the knee.<ref> The American Journal of Sports Medicine, volume 36 number 2, pp 235-246, February 2008</ref> |
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==External links== |
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* "Characterized Chondrocyte Implantation Results in Better Structural Repair When Treating Symptomatic Cartilage Defects in the Knee in a Randomized Controlled Trial Versus Microfracture" The American Journal of Sports Medicine, volume 36 number 2, pp 235-246, February 2008 |
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* Hangody, L. and P. Fules. "Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience." J.Bone Joint Surg.Am. 85-A Suppl 2 (2003): 25-32. |
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* Peterson, L., et al. "Two- to 9-year outcome after autologous chondrocyte transplantation of the knee." Clin.Orthop.374 (2000): 212-34. |
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* Steadman, J. R., et al. "Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up." Arthroscopy 19.5 (2003): 477-84. |
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* [http://ajs.sagepub.com/cgi/content/abstract/34/6/1020 Hambly K, Bobic V, Wondrasch B, Van Assche D, Marlovits S. Autologous chondrocyte implantation postoperative care and rehabilitation: Science and practice. Am J Sports Med. 2006;34(6):1020-1038.] |
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* “Autologous Chondrocyte implantation (ACI 2002 Update). Department of labor and Industries Office of the Medical director Technology Assessement. 2002. [http://www.lni.wa.gov/ClaimsIns/Files/OMD/AciUpdate.pdf]. April 14, 2006. |
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* “Cartilage Transplantation”. University of South Alabama Human Performance and Joint Restoration Center. USA Department of Orthopaedics. [http://www.southalabama.edu/usahealthsystem/jointrestoration/cartilage.html] |
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*Minas, Tom. Autologous chondrocyte implantation for full thickness cartilage defects of the knee. Brigham and Women’s Hospital, Cartilage Repair Center. [http://www.cartilagerepaircenter.org] |
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*“Minimally Invasive Total Knee Replacement.” American Academy of Orthopaedic Surgeons. [http://orthoinfo.aaos.org]. February 2005. |
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* [http://news.bbc.co.uk/1/hi/health/1556883.stm BBC Coverage of Autologous Chondrocyte graft in UK] |
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* [http://www.action.org.uk/touching_lives/pdfs/touching_lives.2003.autumn.pdf UK Health Charity covers Autologous Chondrocyte grafts] |
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== References == |
== References == |
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{{reflist}} |
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<references/> |
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{{Medicine}} |
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{{Bone, cartilage, and joint procedures}} |
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[[Category:Orthopedics| ]] |
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{{Other drugs for disorders of the musculo-skeletal system}} |
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[[Category:Surgical specialties]] |
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[[Category:Medical treatments]] |
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[[Category:Orthopedic surgical procedures]] |
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[[fr:Implantation de chondrocytes autologue]] |
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[[nl:Autologe Chondrocyten Implantatie]] |
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Latest revision as of 20:44, 1 December 2024
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| Autologous chondrocyte implantation | |
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_Therapy.png) Autologous Chondrocyte Implantation | |
| Specialty | Orthopedia |
Autologous chondrocyte implantation (ACI, ATC code M09AX02 (WHO)) is a biomedical treatment that repairs damages in articular cartilage. ACI provides pain relief while at the same time slowing down the progression or considerably delaying partial or total joint replacement (knee replacement) surgery.
ACI procedures aim to provide complete hyaline repair tissues for articular cartilage repair. Over the last 20 years, the procedure has become more widespread and it is currently probably the most developed articular cartilage repair technique.
The procedure fails in about 15% of people.[1]
Complications
[edit]The occurrence of subsequent surgical procedures (SSPs), primarily arthroscopy, following ACI is common. For example, in the Study of the Treatment of Articular Repair (STAR), 49% of Carticel ACI patients underwent an SSP on the treated knee, during the 4-year follow up. The most common serious adverse events (up to 5% of patients), include arthrofibrosis and joint adhesions, graft overgrowth, chondromalacia or chondrosis, cartilage injury, graft complication, meniscal lesion, graft delamination, and osteoarthritis.[2]
A recent study from Germany, published in the November 2008 issue of the American Journal of Sports Medicine, analyzed 349 ACI procedures of the knee joint. Three different ACI techniques were used. A major proportion of complications after ACI can be summarized by 4 major diagnoses: symptomatic hypertrophy, disturbed fusion, delamination, and graft failure. Among those, the overall complication rate and incidence of hypertrophy of the transplant were higher for periosteum-covered ACI. Furthermore, an increased rate of symptomatic hypertrophy was found for patellar defects.[3]
Improvement of ACI
[edit]Techniques such as the EELS-TALC[4] to enhance ACI and its next generation advancement called Matrix Assisted Chondrocyte Implantation (MACI)[5] with enabling chondrocytes to be tissue engineered with long term native knee cartilage phenotype maintenance in vitro and in vivo,[6][7] with the engineered tissue construct containing stem cell progenitors[8] along with those expressing pluripotency markers[9] and with added advantage of enriched hyaluronic acid (HA) expression[10] by the cells have been reported which will contribute to improved regenerative therapies for cartilage damage.
References
[edit]- ^ Andriolo, L; Merli, G; Filardo, G; Marcacci, M; Kon, E (March 2017). "Failure of Autologous Chondrocyte Implantation". Sports Medicine and Arthroscopy Review. 25 (1): 10–18. doi:10.1097/JSA.0000000000000137. PMID 28045868. S2CID 19085219.
- ^ Source: Carticel.
- ^ Source: Philipp Niemeyer, MD, et al.: "Characteristic Complications After Autologous Chondrocyte Implantation for Cartilage Defects of the Knee Joint". The American Journal of Sports Medicine 36:2091–2099 (2008).
- ^ "EELS-TALC". EELS-TALC. Retrieved 20 March 2021.
- ^ Jacobi, M (2011). "MACI - a new era?". Sports Med Arthrosc Rehabil Ther Technol. 3 (1): 10. doi:10.1186/1758-2555-3-10. PMC 3117745. PMID 21599919.
- ^ Yasuda, Ayuko (2006). "In vitro culture of chondrocytes in a novel thermoreversible gelation polymer scaffold containing growth factors". Tissue Engineering. 12 (5): 1237–1245. doi:10.1089/ten.2006.12.1237. PMID 16771637.
- ^ Arumugam, S (2007). "Transplantation of autologous chondrocytes ex-vivo expanded using Thermoreversible Gelation Polymer in a rabbit model of articular cartilage defect". Journal of Orthopedics. 14 (2): 223–225. doi:10.1016/j.jor.2017.01.003. PMC 5293721. PMID 28203047.
- ^ Katoh, Shojiro (2021). "A three-dimensional in vitro culture environment of a novel polymer scaffold, yielding chondroprogenitors and mesenchymal stem cells in human chondrocytes derived from osteoarthritis-affected cartilage tissue". Journal of Orthopedics. 23: 138–141. doi:10.1016/j.jor.2021.01.005. ISSN 0972-978X. PMC 7815488. PMID 33510554.
- ^ Katoh, Shojiro (2020). "Articular chondrocytes from osteoarthritic knee joints of elderly, in vitro expanded in thermo-reversible gelation polymer (TGP), exhibiting higher UEA-1 expression in lectin microarray". Regenerative Therapy. 14: 234–237. doi:10.1016/j.reth.2020.03.006. PMC 7229400. PMID 32435676.
- ^ Katoh, Shojiro (2021). "Enhanced expression of hyaluronic acid in osteoarthritis-affected knee-cartilage chondrocytes during three-dimensional in vitro culture in a hyaluronic-acid-retaining polymer scaffold". The Knee. 29: 365–373. doi:10.1016/j.knee.2021.02.019. PMID 33690017.