Name of the Procedure:

• Common Name: Autologous Chondrocyte Implantation (ACI)
• Technical Term: Autologous Cultured Chondrocytes Implant (HCPCS code: J7330)

Summary

Autologous Chondrocyte Implantation (ACI) is a procedure where a patient's own cartilage cells are extracted, cultured, and later implanted into a damaged area of the cartilage. This technique helps repair cartilage defects, particularly in the knee, by encouraging the growth of new, healthy cartilage.

Purpose

• Medical Conditions: Primarily treats cartilage defects or damage in the joints, especially the knee.
• Goals: The key goals are to reduce pain, enhance the joint's function, and delay or prevent the progression of joint degeneration.

Indications

• Symptoms: Persistent knee pain, swelling, and limited mobility.
• Conditions: Cartilage damage resulting from trauma, osteochondritis dissecans, or focal chondral defects.
• Patient Criteria: Typically recommended for younger patients with localized cartilage damage and no widespread osteoarthritis. Must have healthy surrounding cartilage and stable knee ligaments.

Preparation

• Pre-Procedure Instructions:
  • Fasting: Required if general anesthesia will be used.
  • Medication Adjustments: May need to stop taking certain medications like blood thinners.
• Diagnostic Tests: MRI or arthroscopy to assess the extent and specific location of cartilage damage.

Procedure Description

• Step-by-Step:
  1. Cartilage Biopsy: A small piece of healthy cartilage is harvested arthroscopically.
  2. Cell Culturing: The harvested cells are sent to a laboratory where they are cultured and multiplied over several weeks.
  3. Implantation:
     • The knee is opened via a small incision.
     • The damaged cartilage area is cleaned and prepared.
     • Cultured chondrocytes are implanted into the defect and secured with a periosteal patch or biomembrane.
• Tools & Equipment: Arthroscope, surgical instruments, cell culture mediums.
• Anesthesia: General or regional anesthesia is typically used.

Duration

The implantation procedure usually takes around 1 to 2 hours. The overall process, including cell culturing, takes several weeks.

Setting

• Setting: Performed in a hospital operating room or specialized surgical center.

Personnel

• Healthcare Professionals:
  • Orthopedic Surgeon
  • Surgical Nurses
  • Anesthesiologist
  • Laboratory Technicians (for cell culturing)

Risks and Complications

• Common Risks: Infection, blood clots, and post-operative pain.
• Rare Risks: Graft failure, overgrowth of the newly implanted cartilage, and allergic reactions.
• Management: Close monitoring after surgery, appropriate use of antibiotics, and physical therapy.

Benefits

• Expected Benefits: Pain relief, improved joint function, and the potential for long-term cartilage repair.
• Timeline: Benefits may be noticed within 6 to 18 months post-implantation.

Recovery

• Post-Procedure Care:
  • Initial immobilization of the joint.
  • Gradual introduction of physical therapy.
  • Regular follow-up visits for assessment.
• Recovery Time: Full recovery can take 6 to 12 months, with restrictions on weight-bearing and high-impact activities during the initial stages.

Alternatives

• Other Treatment Options: Microfracture surgery, osteochondral autograft transplantation, conservative management with physical therapy, and medications.
• Pros and Cons:
  • Microfracture: Less invasive but may not provide long-lasting results.
  • Osteochondral Grafts: Immediate restoration but limited by donor site availability.

Patient Experience

• During Procedure: Patient will be under anesthesia and should not feel pain during the surgery.
• Post-Procedure: Some pain and swelling are expected, which can be managed with pain relievers and ice packs. Physical therapy is crucial for recovery.
• Comfort Measures: Use of pain management techniques, supportive braces, and gradual, guided rehabilitation activities will enhance comfort and recovery.