Autologous Chondrocyte Implantation

[Introduction][1] Autologous chondrocyte implantation (ACI) for the treatment of articular cartilage lesions of the knee joint provides successful and durable long-term outcomes. [Indications & Contraindications][2] [Step 1: Preoperative Planning][3] ([Video 1][4]) Obtain standing radiographs and magnetic resonance imaging (MRI) scans to identify all associated abnormalities (background factors). [Step 2: Arthroscopic Assessment and Cartilage Biopsy][5] ([Video 2][6]) Evaluate the knee joint systematically and harvest cartilage tissue from the non-weight-bearing area. [Step 3: Make the Incision for the Arthrotomy][7] ([Video 3][8]) Use a medial or lateral parapatellar arthrotomy and expose the lesion adequately. [Step 4: Prepare the Defect][9] ([Video 4][10]) Debride all fissured and unstable articular cartilage surrounding the full-thickness chondral injury down to healthy contained cartilage. [Step 5: Address Associated Abnormalities][11] Address associated abnormalities (predisposing background factors) to optimize recovery and a successful outcome. [Step 6: Prepare and Fix the Collagen Membrane(s)][12] ([Video 5][13]) Orient the membrane patch with the rough surface to the subchondral bone and the smooth surface toward the articular surface; then sew it, tying the sutures knots on the membrane and not the cartilage, to tension it adequately throughout the entire defect. [Step 7: Chondrocyte Implantation][14] ([Video 6][15]) Gently deliver the cells and fill the defect. [Step 8: Postoperative Care][16] (1) Initiate range-of-motion exercises to enhance chondrocyte regeneration and decrease the likelihood of intra-articular adhesion, (2) protect the graft from loading for 6 to 12 weeks after surgery to prevent graft overload and central degeneration or delamination of the graft, and (3) initiate isometric muscle exercises to regain muscle tone and prevent atrophy. [Results][17] ACI provided durable outcomes in 210 patients followed prospectively for 10 to 17 years after treatment with the first-generation ACI-periosteum technique[6][18]. [Pitfalls & Challenges][19] [Introduction][1] Autologous chondrocyte implantation (ACI) for the treatment of articular cartilage lesions of the knee joint provides successful and durable long-term outcomes. [Indications & Contraindications][2] [Step 1: Preoperative Planning][3] ([Video 1][4]) Obtain standing radiographs and magnetic resonance imaging (MRI) scans to identify all associated abnormalities (background factors). [Step 2: Arthroscopic Assessment and Cartilage Biopsy][5] ([Video 2][6]) Evaluate the knee joint systematically and harvest cartilage tissue from the non-weight-bearing area. [Step 3: Make the Incision for the Arthrotomy][7] ([Video 3][8]) Use a medial or lateral parapatellar arthrotomy and expose the lesion adequately. [Step 4: Prepare the Defect][9] ([Video 4][10]) Debride all fissured and unstable articular cartilage surrounding the full-thickness chondral injury down to healthy contained cartilage. [Step 5: Address Associated Abnormalities][11] Address associated abnormalities (predisposing background factors) to optimize recovery and a successful outcome. [Step 6: Prepare and Fix the Collagen Membrane(s)][12] ([Video 5][13]) Orient the membrane patch with the rough surface to the subchondral bone and the smooth surface toward the articular surface; then sew it, tying the sutures knots on the membrane and not the cartilage, to tension it adequately throughout the entire defect. [Step 7: Chondrocyte Implantation][14] ([Video 6][15]) Gently deliver the cells and fill the defect. [Step 8: Postoperative Care][16] (1) Initiate range-of-motion exercises to enhance chondrocyte regeneration and decrease the likelihood of intra-articular adhesion, (2) protect the graft from loading for 6 to 12 weeks after surgery to prevent graft overload and central degeneration or delamination of the graft, and (3) initiate isometric muscle exercises to regain muscle tone and prevent atrophy. [Results][17] ACI provided durable outcomes in 210 patients followed prospectively for 10 to 17 years after treatment with the first-generation ACI-periosteum technique[6][18]. [Pitfalls & Challenges][19] [1]: #sec-14 [2]: #sec-15 [3]: #sec-18 [4]: #media-1 [5]: #sec-19 [6]: #media-2 [7]: #sec-20 [8]: #media-3 [9]: #sec-21 [10]: #media-4 [11]: #sec-22 [12]: #sec-23 [13]: #media-5 [14]: #sec-24 [15]: #media-6 [16]: #sec-25 [17]: #sec-26 [18]: #ref-6 [19]: #sec-27