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Autologous chondrocyte implantation (ACI, ATC code M09AX02 ()) 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.
The cells targeted for the treatment of osteoarthritis are chondrocytes, synoviocytes, and their progenitors. Since the joint capsule is relatively well contained, intra-articular injections are highly successful at delivering the therapeutic gene therapy locally to the target cell types. Treatment of osteoarthritis may be successful via:
Articular cartilage, most notably that which is found in the knee joint, is generally characterized by very low friction, high wear resistance, and poor regenerative qualities. It is responsible for much of the compressive resistance and load bearing qualities of the knee joint and, without it, walking is painful to impossible.
This short-term solution is not considered as an articular cartilage repair procedure but rather a palliative treatment to reduce pain, mechanical restriction and inflammation. Lavage focuses on removing degenerative articular cartilage flaps and fibrous tissue. The main target groups are patients with very small defects of the articular cartilage.
Articular cartilage stem cell paste grafting was initially described by Kevin R. Stone M.D., a San Francisco-based orthopedic surgeon, in 1997 . The technique was devised in response to reports that many of the contemporary cartilage restoration procedures lead to the development of fibrocartilage , not true hyaline articular cartilage .
They reported a case study in which a full-thickness defect in the articular cartilage of a human knee was successfully repaired. [23] While the use of cultured mesenchymal stem cells has shown promising results, a more recent study using uncultured MSC's has resulted in full-thickness, histologically confirmed hyaline cartilage regrowth.
Autologous articular cartilage transfer from a non-weight-bearing area to the damaged area, called osteochondral autograft transfer system, is one possible procedure that is being studied. [140] When the missing cartilage is a focal defect, autologous chondrocyte implantation is also an option. [141]
An articular cartilage defect that initially may be small still has the potential to have a physical and chemical "domino effect" on the surrounding "normal" articular cartilage. [2] Pitkin et al. (2014) discovered a potential etiology for articular cartilage damage. When the interarticular transmission of pressures is interrupted so that ...