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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.
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.
Marrow-nucleated cells are used every day in regenerative orthopedics. The knee microfracture surgery technique relies on the release of these cells into a cartilage lesion to initiate fibrocartilage repair in osteochondral defects. [13] In addition, this cell population has also been shown to assist in the repair of non-union fractures. [14]
Rehabilitation following any articular cartilage repair procedure is paramount for the success of any articular cartilage resurfacing technique. The rehabilitation is often long and demanding. The main reason is that it takes a long time for the cartilage cells to adapt and mature into repair tissue. Cartilage is a slow adapting substance.
The AMIC procedure was first proposed by Behrens in 2003. it aims to extend the use of microfracture surgery to larger cartilage lesions > 2.5 cm2. [5] Its clinical efficiency in autologous chondrocyte implantation (ACI), another cartilage repair technique for larger cartilage lesions, has been studied. [6] [7] [8]
There are several different repair options available for cartilage damage or failure. "Maci" or autologous cultured chondrocytes on porcine collagen membrane, is a treatment to correct cartilage defects in the knee. This treatment has been approved by the Food and Drug Administration in 2016 for adult treatment only. [1]
This is an autologous matrix-induced chondrogenesis procedure which prevents tissue rejection complications since the transplanted cartilage comes from the same person. [ 3 ] Autologous cultured chondrocytes on porcine collagen membrane was approved for use in the United States in May 2019.
The procedure is less effective in treating older patients, overweight patients, or a cartilage lesion larger than 2.5 cm. [11] Further on, chances are high that after only 1 or 2 years of the surgery symptoms start to return as the fibrocartilage wears away, forcing the patient to reengage in articular cartilage repair.