The ideal treatment for any knee injury or disease is a biologic treatment that can restore the knee to a near normal state. Anterior Cruciate Ligament reconstruction, meniscal repair, and anatomic repair of fractures of the knee are three examples of successful biological surgical repairs for the injured knee.
Symptomatic full thickness chondral lesions of the knee pose a difficult management issue for both orthopedists and patients. If injury leads to articular cartilage cell death the best treatment is restoration of the joint surface cells (articular cartilage-the shiny white surface that forms all joints in the body). One procedure to restore the knee surface to near normal is termed ACI or autologous chondrocyte implantation ( the other treatment option not discussed in this post is OATS - OsteoArticular Transfer System for smaller lesions - http://aboutjoints.com/patientinfo/topics/oats/oatspg3.htm or Osteochondral Allograft Procedure for larger lesions- http://www.proceduresconsult.com/medical-procedures/osteochondral-allograft-OR-procedure.aspx#preprocedure) . Cartilage restoration is a procedure has strict use criteria, or indications. The surgical indication for ACI is a symptomatic, full thickness, weightbearing chondral injury of the femoral articular surface in a physiologically young patient who can be compliant with the 18 month long rehabilitation process. The results of ACI surgery for lesions on the tibia and patella are not as consistently successful and use for this part of the knee is not usually paid for by insurance companies. Also, ACI is not a treatment for Osteoarthritis (two reciprocal joint surfaces are damaged with xray changes of joint space narrowing, and bone spur formation). 3T MRI can be helpful with assessing knees for ACI but in almost all circumstance a knee arthroscopy is performed to be sure the knee is suitable for ACI. At the time of Diagnostic Knee Arthroscopy the articular cartilage cells are harvested for reimplantation at a later date (after cell expansion in the lab at Genzyme Biosurgery).
For those readers who want to know more regarding surgery technique and rehabilitation protocols see this link: http://www.carticel.com/patients/treatment.aspx
Carticel is a industry trade name. The following is an excerpt from the Genzyme Biosurgical web site.
" CARTICEL is a biologic product used to repair articular cartilage injuries in adults who have not responded to an arthroscopic or other surgical repair procedure. It uses your body’s own cultured cells to regenerate the articular cartilage in your knee during a surgical procedure called autologous chondrocyte implantation (ACI). CARTICEL is the name of the cells that are grown from the samples (or biopsy) taken from your knee. When implanted into a cartilage injury, these cells can form new hyaline-like cartilage. CARTICEL poses little risk of disease transmission since it comes from your own tissue, and is not transplanted from an unrelated donor. CARTICEL is not indicated for the treatment of cartilage damage associated with generalized osteoarthritis."
Sunday, March 29, 2009
Cartilage Restoration Surgery of the Knee - Carticel procdure by Genzyme
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4 comments:
Out of curiosity, do you know Dr. Wayne Gersoff?
Adelita, Dr. Gersoff is one of the leading Cartilage Restoration Surgeons in the U.S. He practices in Denver. I have visited him to observe/learn his surgical techniques. SDT
Hello Dr. Tarlow,
I am reading up on the Carticel procedure. I was hit by a car a year and a half ago-medial femoral condyle lesion. I am 23 and ended up resigning from my first of teaching. I had my first surgery in dec of 07-just clean up. I had OATS Sept of 08. My quad is still very atrophied and I am in so much pain-I can only walk--couldn't think about jogging or playing any sports. I am live in Corvallis (you went to school in Portland I read!!) My current doctor is considering doing an allograft?? Wondering if Carticel might be a better option...
Becca, First of all, traumatic chondral lesions are difficult to get a good surgical or non surgical outcome because the mechanism of knee pain is poorly understood when the knee sustains a direct blow from a hard object such as a car dash or concrete floor. Cartilage Restoration has the best outcome in diseases like Osteochondritis Dissecans in which the diseased bone and cartilage can be replaced or a chondral lesions secondary to compartment overload such as in the patellofemoral joint or medial or lateral compartments of the knee when an osteotomy can be performed to unload the cartilage surface and then restoring the cartilage once the new, less harmful environment is created. Sorry to say I am not sure any "better options" exist for your particular injury.
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