Autologous Chondrocyte Implantation 27412

Grade IV chondral injury image

chondromalacia patella

synonyms: ACI, autologous chondrocyte implantation

ACI Indications

  • articular cartilage defect with intact cartilage space document on xrays. Lesions should be well contained with normal cartilage margins.
  • typically limited to defects of 2 cm or larger (up to 10 cm2), and where more than one lesion is present and are nonarticulating.

ACI Contraindications

  • Greater than 6mm of bone loss.
  • Limb malalignment
  • Arthritic changes

ACI Alternatives

ACI Pre-op Planning / Special Considerations

  • Underlying etiology of defect and any pathomechanics must be identified and corrected.
  • Associated malalignmnet must be corrected before any cartilage restoration procedure. Most isolated lesions involve the MFC and can be associated with varus alignment. Concomitant HTO is indicated.
  • Consider

ACI Technique

  • Sign operative site
  • Pre-operative antibiotics, +/- regional block
  • General endotracheal anesthesia
  • position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Irrigate.
  • Close in layers.

ACI Complications

  • Overall 3.8% complication rate. (Wood JJ, JBJS 2006;88:503)
  • Graft failure
  • Delamination
  • Tissue hypertrophy / hypertrophic periosteal healing (10-15%)
  • Infection
  • Arthrofibrosis
  • Adhesions

ACI Follow-up care

  • Post-op: 6hrs/day CPM, NWB x6wks unless lesion treated was patellofemoral.
  • 7-10 Days: Wound check, continue CPM, NWB
  • 6 Weeks: Discontinue CPM, advance to full weight bearing
  • 3 Months: Resume all normal ADLs.
  • 6 Months: Gradually begin running / sport specific rehab.
  • 1Yr: Return to sport / full duty. Return to high-impact activites after treatment of large defects is not recommened.

ACI Outcomes

  • 94% graft survival at 36months (Micheli LJ, Clin J Sport Med 2001;11:223).
  • 82% good/excellent outcomes (Petersen L, AJSM 2002;30:2).

ACI Review References

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