autologous chondrocyte implantation

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Post on 11-May-2015



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  • 1.Autologous Chondrocyte Transplantation Dr. Babloo

2. Chondral Injuries Commonly these injuries heal by scar tissue formation : 3. - Arthroscopic Debridement : - Arthroscopic lavage - Subchondral drilling - Microfracture Marrow stimulation techniques - Abrasion arthroplasty to induce the growth of fibrocartilage into the chondral defect. Treatment options 4. Stages of ACI healing Healing process has several stages. They include the proliferative stage (0 to 6 weeks), the transition stage (7 to 12 weeks), and a remodeling and maturation stage which occurs over a prolonged period (13 weeks to 3 years) 5. Proliferative stage During this stage, a primitive cell response occurs with tissue fill of the defect and poor integration to underlying bone or adjacent cartilage. Mostly type I and some type II collagen is produced. The tissue is soft and jelly-like and easily damaged 6. Transition phase This marks the production of type II collagen framework and the early production of proteoglycans. The proteoglycans, which form the matrix, help imbibe water to give cartilage its viscoelastic properties. The tissue is not yet firm or well integrated and has the consistency of a firm gelatin. It is milkable when probed with an arthroscopic nerve hook, indicating incomplete integration to underlying bone 7. Stage of remodeling and maturation The matrix proteins cross-link and stabilize in large aggregates. The collagen framework reorganizes so as to integrate into the subchondral bone and form arcades of Benninghoff. Usually by 4 to 6 months, the tissue has firmed up to a putty-like consistency and is integrated to the underlying bone 8. At this stage, patients experience good symptom relief During this stage excessive activity may cause repair tissue degeneration or continued improvement in remodeling Hence, the concept of a time course of healing is critical during the rehabilitation phase of ACT 9. Indications for ACT Symptomatic full-thickness chondral injury of the femoral articular surface (femoral weight- bearing condyles and sulcus or trochlea) in a physiologically young (


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