Autologous chondrocyte implantation, knee

CPT4 code

Name of the Procedure:

Autologous Chondrocyte Implantation (ACI), also known as Cartilage Regeneration Therapy.

Summary

Autologous Chondrocyte Implantation (ACI) is a surgical procedure used to repair damaged cartilage in the knee. It involves taking a sample of the patient's own cartilage cells, growing them in a lab, and then implanting the new cells into the damaged area of the knee.

Purpose

ACI is designed to treat cartilage damage in the knee, which can occur due to injury or conditions like osteoarthritis. The goal is to restore the function and integrity of the knee joint, reduce pain, and improve mobility.

Indications

Persistent knee pain that does not respond to conservative treatments.
Cartilage defects or damage confirmed by imaging tests.
Patients who are generally healthy and have stable knee structures.
Typically performed on younger patients or active adults with localized cartilage damage.

Preparation

Patients may need to fast for a certain period before the procedure.
Adjustments to current medications may be required.
Pre-procedure imaging tests like MRI or X-rays to assess cartilage damage.
Blood tests to ensure the patient is fit for surgery.

Procedure Description

Biopsy Stage:
- An initial arthroscopic procedure to remove a small sample of healthy cartilage cells from a non-weight-bearing area of the knee.
Cell Culturing:
- The cartilage cells are sent to a laboratory, where they are cultured and expanded over a period of 3 to 6 weeks to produce a sufficient number of cells.
Implantation Stage:
- A second surgery where the patient is put under anesthesia.
- The damaged cartilage area is prepared by debriding the defect.
- Cultured chondrocytes are implanted into the defect and held in place with a periosteal patch (taken from another part of the shinbone) or a synthetic membrane.

Duration

The biopsy stage usually takes about 30 minutes, while the implantation stage can take 1 to 2 hours.

Setting

Both stages of the procedure are typically performed in a hospital or a specialized surgical center.

Personnel

Orthopedic Surgeon
Surgical Nurses
Anesthesiologist
Medical Laboratory Technicians (for cell culturing)

Risks and Complications

Infection at the surgical site.
Graft failure or insufficient cartilage growth.
Bleeding or blood clots.
Joint stiffness or decreased range of motion.
Pain and swelling in the knee.
Allergic reaction to anesthesia.

Benefits

Restoration of knee function and reduction in pain.
Potential to return to normal or near-normal activities.
Long-term improvement in joint health.
Benefits are usually realized several months after the procedure as the cartilage heals and integrates.

Recovery

Initial recovery involves immobilization of the knee, followed by physical therapy.
Weight-bearing activities are limited for several weeks to months.
Full recovery may take 6 to 12 months.
Follow-up appointments to monitor the healing process.

Alternatives

Microfracture surgery: Less invasive but may not be suitable for larger defects.
Osteochondral autograft: Transfer of bone and cartilage from another area of the patient's body.
Osteochondral allograft: Use of donor tissue.
Conservative treatments: Physical therapy, medications, and lifestyle changes.
Each alternative has its own set of benefits and risks which should be discussed with the healthcare provider.