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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 .
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]
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]
Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly. Some small or acute fractures can be cured without bone grafting, but the risk is greater for large fractures like compound fractures.
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]
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.