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Cartilage Implants

Cartilage implantation also known as known as autologous chondrocyte implantation (ACI) is an advanced procedure, employing artificially grown cartilage cells, for the repair and replacement of damaged articular cartilage. ACI involves the collection of cartilage cells from non-weight bearing regions of the bone, which are then artificially cultured in laboratories, and later implanted in the region of the damaged cartilage.

Cartilage is a smooth, white tissue covering the articular surface of the bone which ensures a smooth joint movement by decreasing the friction between the bones. Any damage to the cartilage hampers smooth movement of the joint and increases friction between the articulating surface resulting in erosion of the articular surface which can lead to pain and arthritis.

Causes

Cartilage damage may be caused by daily wear and tear, a direct injury to the joint or other conditions such as oesteonecrosis and osteochondritis. As cartilage has a poor healing process due to limited blood supply, any damage to the cartilage is usually progressive leading to pain, immobility and arthritis. Sometimes ligament injuries may also cause cartilage damage.

Symptoms

The most common symptoms of cartilage damage are pain, swelling, inflammation and limitation of mobility of the affected joint.

Surgical procedure

Cartilage implantation or autologous chondrocyte implantation comprises of two steps.

The first surgery is performed using an arthroscopic approach. The healthy cartilage cells are harvested and sent to the laboratory for culture. After the cells have significantly multiplied, they are collected for the second step of the implantation procedure.

The second surgery is an arthrotomy or open surgical procedure. A larger incision is made over the site of cartilage damage. Another incision is done over the adjacent tissue known as periosteum and a periosteal patch is made, at the site of the damaged cartilage. The periosteal patch is placed over the damaged cartilage and sealed properly to the surrounding cartilage. The newly cultured cells are injected into the defect under the periosteal cover.

Eligible patient

ACI is an extensive surgical procedure. The recovery is lengthy and the patient must participate in a physical therapy program, after the surgery. This procedure is suitable for patients with a smaller area of cartilage damage or young adults with a single cartilage injury. Cartilage implant may be considered in patients with a small area of cartilage damage, mild arthritis, a stable joint without associated ligament injury and patients with an appropriate body weight experiencing limitation of movement due to pain and swelling.

Complications

The most common complication of cartilage implant is the formation of scar tissue around the edge of the periosteal patch, also known as periosteal hypertrophy, which may require another arthroscopic surgery for removal of the excess scar tissue. Other complications include failure of integration of the implanted cells, infection of the joint and joint stiffness.

Rehabilitation

The success of the cartilage implant depends on the post operative rehabilitation program. It takes approximately a year to completely rehabilitate the patient.  The rehabilitation program depends on the size and location of the damaged cartilage and includes passive movement therapy as well as muscle strengthening, weight bearing and range of motion exercises.

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Dr.James Macielak
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