Autologous chondrocyte implantation aci is the most wellestablished and widely used biologic cell transplantation technique. Mri and indirect mrartro knee in patients treated with. Autologous chondrocyte implantation may be used for fullthickness chondral or. Aci autologous chondrocyte implantation verywell health. Autologous chondrocyte implantation synonyms, autologous chondrocyte implantation pronunciation, autologous chondrocyte implantation translation, english dictionary definition of autologous chondrocyte implantation. Over the last decade, regenerative treatment options have become the. There are longterm data demonstrating its excellent clinical success in defects of the femoral condyles as well as those involving the patellofemoral joint 35. Autologous chondrocyte implantation for joint preservation. Autologous chondrocyte implantation aci information. Autologous chondrocyte implantation aci, atc code m09ax02 is a biomedical treatment that repairs damages in articular cartilage. Therapeutic strategy of third generation autologous. Maci is a cellular sheet that consists of autologous chondrocytes seeded on a 3 x 5 cm, resorbable porcine type iiii collagen membrane. March 2015 note that this document is not nices final guidance on these technologies.
Matrixinduced autologous chondrocyte implantation and. Autologous chondrocyte implantation aci autologous chondrocyte implantation aci is a relatively new, stateoftheart procedure used to treat isolated fullthickness down to bone articular cartilage defects of the knee. This treatment uses your bodys own cells to repair the articular cartilage in your knee. In vitro chondrogenic potency of surplus chondrocytes from. However, aci has also been used rarely in other joints, such as the ankle. Chondrocytes, autologous cultured is to be given only by or under the direct supervision of a trained doctor. Matrixassociated autologous chondrocyte implantation ncbi. Autologous chondrocyte implantation payment policy policy number m.
Autologous chondrocyte implantation for traumatic fullthickness. Autologous chondrocyte implantation aci is one type of resurfacing procedure, developed in the late 1980s to treat areas of cartilage damage in the knee. Aci is an expensive procedure to perform, and the institutions that regulate access to treatment have not so far understood the benefit to patients of this technique or the potential national economic gains over the long term. Matrixinduced autologous chondrocyte implantation maci. Carticel autologous cultured chondrocytes are cartilage cells used for the repair of symptomatic cartilage defects of the femoral condyle medial, lateral or trochlear, caused by acute or repetitive trauma, in patients who have had an inadequate response to a prior arthroscopic or other surgical repair procedure e. The goal of aci is to allow people suffering from articular cartilage damage to return to their old. Results and conclusions safety a total of 53 studies were identified for inclusion in the assessment of the safety of maci and aci.
Autografts and allografts in the treatment of focal articular cartilage lesions. Autologous chondrocyte implantation may be more costeffective than other procedures over the longterm based on the assumption that it can generate new hyaline cartilage and prevent osteoarthritis. To describe the autologous chondrocyte implantation aci sandwich technique with autologous bone grafting abg and compare it with abg alone for restoration of the osteochondral unit. This procedure is typically used for larger areas of damage or where other cartilage repair procedures have failed. The purpose of the present study was to determine 1 whether the current literature supports the choice of using autologous chondrocyte implantation over other cartilage procedures with regard to clinical outcome, magnetic resonance imaging, arthroscopic assessment, and durability of treatment, 2 whether the current literature supports the use of a specific generation of. Autologous chondrocyte implantation aci is considered medically necessary for the repair of. A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee. Since the clinical introduction of autologous chondrocyte implantation aci by brittberg et al. Revision surgery after third generation autologous chondrocyte implantation in the knee thomas r. The first surgical procedure is an arthroscopic procedure during which a. The aim of this procedure is to replace damaged cartilage. Autologous chondrocyte implantation aci surgery tricare covers aci surgery for the repair of clinically significant, symptomatic, cartilaginous defects of the femoral condyle click to close a pair of round, bony protrusions on each side of the femur bone in the thigh. Pdf the mediumterm results of autologous chondrocyte implantation aci have shown good to excellent outcomes for the majority of patients. The animal results stimulated a pilot study with autologous chondrocyte implantation in humans with the first operation performed in 1987 when a knee with an articular cartilage defect on the femoral condyle was treated by implanting the patients own chondrocytes that had been expanded in vitro and then implanted into the defect in.
The midterm to longterm outcomes in patients after the treatment for ocd and avn will be reported and compared. The first generation aci provided significant and longterm benefits for. Autologous chondrocyte implantation sandwich technique. Autologous chondrocyte implantation aci patient education. It has been approved by the food and drug administration for cartilage defects located at the end of the femur bone thigh. Autologous chondrocyte implantation aci for the treatment of articular cartilage lesions of the knee joint provides successful and durable long. Autologous chondrocyte implantation aci is a surgical procedure for the treatment of full thickness cartilage defects in the knee. Autologous chondrocyte implantation aci has been used over the last two decades to treat focal cartilage lesions aiming to delay or prevent the onset of osteoarthritis. Patients undergoing knee cartilage repair fare slightly better with autologous chondrocyte implantation, a new study has shown, but that might not be enough to justify the cost. To assess the safety, effectiveness and costeffectiveness of matrixinduced autologous chondrocyte implantation maci and autologous chondrocyte implantation aci for the treatment of articular cartilage defects.
Aci provides pain relief while at the same time slowing down the progression or considerably delaying partial or total joint replacement knee replacement surgery. Autologous chondrocyte implantation for focal articular. Cartilage restoration techniques for the patellofemoral. Autologous chondrocyte implantation aci journal of clinical.
Autologous chondrocyte implantation burke and bradley. Methods and materials patients we enrolled 16 patients in our study, 2 of whom had no further control and 1 had surgery to repair knee ligament that impeded assessment of the magnetic resonance of knee, so we decided to exclude these 3 patients. Niethammer 0 siegfried valentin 0 andreas ficklscherer 0 mehmet f. Autologous chondrocyte transplantation of the knee. Autologous chondrocyte implantation for cartilage repair. Autologous chondrocyte implantation, or aci, is a procedure that was developed in the late 1980s to treat areas of cartilage damage in the knee. Autologous chondrocyte implantation policy guidelines for smaller lesions e. The autologous chondrocyte implantation aci procedure was performed as described previously 9, 24, 45, 54, 55. Autologous chondrocyte implantation can require extended recovery postoperatively, and return to sport.
There is no scientific literature to support the use of autologous chondrocyte implantation for all other. After implantation, the chondrocytes help form new, healthy cartilage. What are the disadvantages of autologous chondrocyte implantation aci. Osteochondral grafts for the treatment of articular cartilage defects are discussed in blue shield of california medical policy. Autologous chondrocyte transplantation for the treatment of cartilage defects of the knee is considered medically necessary when the abovenoted medical criteria are met. Translational application of microfluidics and bioprinting for stem cellbased cartilage repair.
Autologous chondrocyte implantation aci is another means of repairing damaged cartilage. Pdf chondral damage to the knee is common and, if left untreated, can proceed to degenerative osteoarthritis. Autologous chondrocyte implantation aci case type diagnosis. The recommendations in section 1 may change after consultation. The assessment concluded that it is not possible to draw definitive conclusions about the clinical effectiveness of this technology based on available literature. It provides a smooth gliding surface for joints and acts as a cushion between bones. Osteochondral grafts and autologous chondrocyte implantation aci attempt to regenerate hyalinelike cartilage and thereby restore durable function. The tissue is sent to a facility licensed by the u.
Autologous chondrocyte implantation for treatment of isolated cartilage defects of the knee has. Patients then returned for reimplantation, which table 1. In the first stage, 100 to 300 mg of healthy articular cartilage is harvested from the nonweightbearing portion of the femoral condyles or intercondylar notch, and the cartilage is. Autologous chondrocyte transplantation for the treatment of cartilage defects of the knee is considered medically necessary when the medical criteria below are met. Consequently, regulatory systems have put up barriers to the adoption of aci, which are. Aci is effective in filling fullthickness chondral defects of the knee.
This can lead to pain and swelling, and problems using your joint. The original technique used a periosteal graft 6, but this was found to have a. The active ingredients of maci are the autologous cultured chondrocytes and porcine type iiii collagen. Since its first description by brittberg in 1994, 1 chondrocyte implantation also known as chondrocyte transplantation has been performed in more than 15,000 patients worldwide and many studies have clinically validated this technique as a reliable method for biologic restoration of. Second and thirdgeneration techniques include combinations of autologous chondrocytes, scaffolds, and growth factors. Matrixassociated autologous chondrocyte implantation. Autologous chondrocyte implantation can provide a longterm solution in more than 70% of young patients of a difficulttotreat group with large chronic articular cartilage lesions. Autologous chondrocyte implantation aci involves harvesting chondrocytes from healthy tissue, expanding the cells in vitro, and implanting the expanded cells into the chondral defect under a periosteal or fibrin patch. Autologous chondrocyte implantation aci is a technique that involves the cultivation of chondrocytes in vitro, utilising a twostage operative approach that is usually spread over approximately five weeks.
The cells are then implanted placed in the damaged part of the knee. Autologous chondrocyte implantation clinical coverage criteria. Autologous chondrocyte implantation aci surgery tricare. Chondrocytes, autologous cultured implantation advanced. Lee, autologous bone marrowderived mesenchymal stem cells versus autologous chondrocyte implantation. Autologous chondrocyte implantation page 5 of 25 050120. The steps in open implantation include arthrotomy, radical lesion debridement, leaving subchondral bone intact periosteum procurement, periosteum fixation, periosteum watertight integrity testing, autologous or allogeneic fibrin glue sealant, chondrocyte implantation, wound closure, and. Dosage and administration for autologous implantation only contact vericel at 18004536948 or. Autologous chondrocyte implantation articular cartilage is a firm, rubbery tissue that covers the ends of bones. The full text of this article is available in pdf format. Pdf an overview of autologous chondrocyte implantation. Request pdf autologous chondrocyte implantation autologous chondrocyte implantation aci uses cultured chondrocytes implanted beneath a periosteal patch for the treatment of focal chondral. With autologous chondrocyte implantation, a region of healthy articular cartilage is identified and biopsied through arthroscopy. The process involves removal, expansion culture, and reimplantation of the.
Second and third generation approaches have evolved over the years, but aci is a twostage procedure. A number of biomarkers that can forecast the clinical potency of the cells have been proposed, but evidence for the relationship between in vitro. Autologous chondrocyte implantation aci is becoming increasingly common for the treatment of fullthickness, symptomatic chondral lesions in the knee 1, 2. Autologous chondrocyte implantation for chondral defects. Aci has also been used rarely in other joints, such as the ankle, but it is most commonly performed in the knee. Autologous chondrocyte implantation using a bilayer. Chondrocyte therapy effective in knee cartilage repair. Rehabilitation after autologous chondrocyte implantation for isolated. Autologous chondrocyte implantation for focal articular 7. Bluecross blueshield association bcbsa, technology evaluation center tec.