Autologous chondrocyte implantation

Autologous chondrocyte implantation (ACI, ATC code M09AX02 (WHO)) 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. The goal of ACI is to allow people suffering from articular cartilage damage to return to their old lifestyle; regaining mobility, going back to work and even practicing sports again.

Autologous chondrocyte implantation
Specialtyorthopedia

ACI procedures aim to provide complete hyaline repair tissues for articular cartilage repair. Over the last 20 years, the procedure has become more widespread and it is currently probably the most developed articular cartilage repair technique.

The procedure fails in about 15% of people.[1]

Procedure

This cell based articular cartilage repair procedure takes place in three stages. In a first stage, between 200 and 300 milligrams cartilage is sampled arthroscopically from a less weight bearing area from either the intercondylar notch or the superior ridge of the medial or lateral femoral condyle of the patient. The matrix is removed enzymatically and the chondrocytes isolated. These cells are grown in vitro in a specialised laboratory for approximately four to six weeks, until there are enough cells to reimplant on the damaged area of the articular cartilage. The patient then undergoes a second treatment, in which the chondrocytes are applied on the damaged area during an open-knee surgery (also called arthrotomy). These autologous cells should adapt themselves to their new environment by forming new cartilage. During the implantation, chondrocytes are applied on the damaged area in combination with a membrane (tibial periosteum or biomembrane) or pre-seeded in a scaffold matrix.

Complications

The occurrence of subsequent surgical procedures (SSPs), primarily arthroscopy, following ACI is common. For example, in the Study of the Treatment of Articular Repair (STAR), 49% of Carticel ACI patients underwent an SSP on the treated knee, during the 4-year follow up. The most common serious adverse events (up to 5% of patients), include arthrofibrosis and joint adhesions, graft overgrowth, chondromalacia or chondrosis, cartilage injury, graft complication, meniscal lesion, graft delamination, and osteoarthritis. Source: Carticel.

A recent study from Germany, published in the November 2008 issue of the American Journal of Sports Medicine, analyzed 349 ACI procedures of the knee joint. Three different ACI techniques were used. A major proportion of complications after ACI can be summarized by 4 major diagnoses: symptomatic hypertrophy, disturbed fusion, delamination, and graft failure. Among those, the overall complication rate and incidence of hypertrophy of the transplant were higher for periosteum-covered ACI. Furthermore, an increased rate of symptomatic hypertrophy was found for patellar defects. Source: Philipp Niemeyer, MD, et al.: Characteristic Complications After Autologous Chondrocyte Implantation for Cartilage Defects of the Knee Joint. The American Journal of Sports Medicine 36:2091-2099 (2008).

Improvement of ACI

Techniques such as the EELS-TALC[2] to enhance ACI and its next generation advancement called Matrix Assisted Chondrocyte Implantation (MACI)[3] with enabling chondrocytes to be tissue engineered with long term native knee cartilage phenotype maintenance in vitro and in vivo,[4][5] with the engineered tissue construct containing stem cell progenitors[6] along with those expressing pluripotency markers[7] and with added advantage of enriched hyaluronic acid (HA) expression[8] by the cells have been reported which will contribute to improved regenerative therapies for cartilage damage.

References
  1. Andriolo, L; Merli, G; Filardo, G; Marcacci, M; Kon, E (March 2017). "Failure of Autologous Chondrocyte Implantation". Sports Medicine and Arthroscopy Review. 25 (1): 10–18. doi:10.1097/JSA.0000000000000137. PMID 28045868. S2CID 19085219.
  2. "EELS-TALC". EELS-TALC. Retrieved 20 March 2021.
  3. Jacobi, M (2011). "MACI - a new era?". Sports Med Arthrosc Rehabil Ther Technol. 3 (1): 10. doi:10.1186/1758-2555-3-10. PMC 3117745. PMID 21599919.
  4. Yasuda, Ayuko (2006). "In vitro culture of chondrocytes in a novel thermoreversible gelation polymer scaffold containing growth factors". Tissue Engineering. 12 (5): 1237–1245. doi:10.1089/ten.2006.12.1237. PMID 16771637.
  5. Arumugam, S (2007). "Transplantation of autologous chondrocytes ex-vivo expanded using Thermoreversible Gelation Polymer in a rabbit model of articular cartilage defect". Journal of Orthopedics. 14 (2): 223–225. doi:10.1016/j.jor.2017.01.003. PMC 5293721. PMID 28203047.
  6. Katoh, Shojiro (2021). "A three-dimensional in vitro culture environment of a novel polymer scaffold, yielding chondroprogenitors and mesenchymal stem cells in human chondrocytes derived from osteoarthritis-affected cartilage tissue". Journal of Orthopedics. 23: 138–141. doi:10.1016/j.jor.2021.01.005. ISSN 0972-978X. PMC 7815488. PMID 33510554.
  7. Katoh, Shojiro (2020). "Articular chondrocytes from osteoarthritic knee joints of elderly, in vitro expanded in thermo-reversible gelation polymer (TGP), exhibiting higher UEA-1 expression in lectin microarray". Regenerative Therapy. 14: 234–237. doi:10.1016/j.reth.2020.03.006. PMC 7229400. PMID 32435676.
  8. Katoh, Shojiro (2021). "Enhanced expression of hyaluronic acid in osteoarthritis-affected knee-cartilage chondrocytes during three-dimensional in vitro culture in a hyaluronic-acid-retaining polymer scaffold". The Knee. 29: 365–373. doi:10.1016/j.knee.2021.02.019. PMID 33690017.
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