2200 Ft. Jesse Rd.
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309-454-1616 (p)
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2500 W. Reynolds Ave.
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Pontiac, IL 61764
815-842-2779(p)
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Autologous Chondrocyte Implantation (ACI)

About Articular Cartilage:

Normal knee function requires a smooth gliding articular cartilage surface on the ends of the bones. This surface is composed of a thin layer of slippery, tough tissue called hyaline cartilage. This cartilage also acts to distribute force during repetitive pounding-like movements such as jumping or running. Articular cartilage is different from meniscal cartilage (meniscus). The menisci act as a cushion between the femur and the tibia and are not part of the joint surface. Meniscal injuries can be treated with excision or repair of the torn meniscus. ACI is not appropriate for meniscal injuries.

Injured Articular Cartilage:

A severe knee articular surface cartilage injury can radically change an active adult's lifestyle. Symptoms such as locking, catching localized pain and swelling often affect your ability to work, play, even perform normal activities. A cartilage lesion appears as a hole or divot in the cartilage surface. Since cartilage has minimal ability to repair itself, even what may seem like a small lesion (ranging from the size of a dime to a quarter), if left untreated, can hinder your ability to walk or run pain free, and cause deterioration to the joint surface.

Treatment with Autologous Chondrocyte Implantation (ACI):

Although articular cartilage in unable to repair itself on its own, advanced FDA-approved technology allows cartilage cells, know as chondrocytes to be harvested from your knee, then cultured and multiplied. The fresh chondrocytes are then reimplanted in your knee and regenerate hyaline(articular) cartilage. This biological repair is known as ACI. When you successfully complete ACI and rehabilitation, you should be able to resume all normal activities, including sports.

ACI, also known as Carticel treatment, restores the articular surface and regenerates hyaline cartilage without compromising the integrity of healthy tissue or the subchondral bone. Carticel is the brand name that Genzyme Tissue Repair has given for cultured chondrocytes

ACI has demonstrated important benefits in patients with a type of lesion called a femoral focal chondral defect. If your orthopedic surgeon has determined that you have this type of lesion, then Carticel may be an appropriate treatment option. ACI is not appropriate in patients who are over age 55, or patients with generalized osteoarthritis, rheumatoid arthritis, knee instability, or patellofemoral arthritis.

The procedure consists of two steps. The first is the arthroscopic harvesting of some healthy cartilage from your knee. This sample of cartilage is then used to grow new cartilage cells (chondrocytes). After 4-5 weeks, about 12 million chondrocytes have been grown for reimplantation.

The second step is the reimplantation of the cultured chondrocytes, or Carticel. This procedure is done through an arthrotomy (incision in the knee joint), and is depicted on the back of this sheet.

Implantation of Carticel:

Step 1

An Arthroscopic Biopsy : First, the surgeon examines your knee through an arthroscope - a small device that allows the doctor to see into your knee joint. If a lesion is detected, a tiny biopsy of healthy cartilage tissue will be removed.

Step 2

Cell culture processing - The cartilage sample is then sent to Genyzme Tissue Repair (Cambridge, MA), where it is cultured and grown. Cell culturing takes about 4-5 weeks, during which time your cells multiply significantly. About 12 million cells will be supplied to your surgeon at the time of your operation.

Step 3

The chondral defect is prepared to receive the cartilage cells. Smooth vertical margins are created so than the periosteal flap can be sewn in to seal it.

Step 4

Periosteum, a tissue that covers bone, is harvested from the proximal tibia and sutured over the prepared defect to act as a manhole cover to keep the cartilage cells sealed in while healing occurs. Periosteum has chondrogenic (cartilage generating) properties.

Step 5

Surgical implantation - The cultured cells are then implanted into the lesion. Here, the cells will continue to multiply and integrate with surrounding cartilage. With time, the cells will mature and fill the lesion with hyaline (articular) cartilage.

Vial of Carticel

This vial of Carticel has a volume is 0.4 ml and contains 12 million cartilage cells. This suspension is what is actually reimplanted in the chondral defect and then sealed in by the periosteal patch.

Post-Operative Rehabilitation:

The post-operative rehabilitation will include a period of non- weight bearing, followed by a period of protected weight bearing. Early range of motion is started with a continuous passive motion (CPM) machine the next day, and strengthening exercises are started early to minimize quadriceps muscle atrophy. It is possible to return to low impact activities after 6 months and high impact activities after one year. Strict adherence to the post-operative rehabilitation program is necessary for successful return to sports.