Abstract
Autologous chondrocyte implantation (ACI) has evolved over many generations. The third-generation ACI evolved with cultured chondrocytes directly seeded on a membrane in the laboratory itself and then transported to the operating room for an implantation. This eliminated the need for suturing of a periosteum/membrane during the surgery [1–4]. The third-generation ACI technique further evolved from a monolayer distribution of the cells to the 3-dimensional distributions of the cells by using 3-dimensional scaffolds. Hyalograft-C and BioSeed C are some of the third-generation 3-dimensional scaffold-based ACI [5, 6]. These techniques helped to overcome many disadvantages associated with the first- and second-generation ACI, like graft hypertrophy, poor access to the lesion, membrane suturing and monolayer distribution [5–8]. Chondrocytes grown on a monolayer have a tendency for a slow growth, dedifferentiation and a switch of collagen synthesis from type II to type I [7, 8]. As any chondral defect is a 3-dimensional defect, it is quite logical to fill the defect with a 3-dimensional repair method. Gel-based ACI is a third-generation 3-dimensional scaffold-based technique that allows a 3-dimensional distribution of the autologous cultured chondrocytes in a scaffold that is made of fibrin glue [9–11]. As it is gel based, the scaffold can take any shape and does not require lesion preparation in the form of an oval/round shape. The purpose of this chapter is to illustrate the step-by-step technique and the postoperative rehabilitation of a gel-based third-generation ACI in an ideally indicated case.
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Brittberg M. The illustrative 1st and 2nd generation autologous chondrocyte implantation (ACI) for the cartilage repair. In: Goyal D, editor. The illustrative book of cartilage repair. Springer; 2021; In Press.
Ramos N, Mandelbaum B, Banffy M. The illustrative membrane based autologous chondrocyte implantation for the cartilage repair. In: Goyal D, editor. The illustrative book of cartilage repair. Springer; 2021, In Press.
Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TW, et al. Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br. 2005;87(5):640–5.
Behrens P, Bitter T, Kurz B, Russlies M. Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)—5-year follow-up. Knee. 2006;13(3):194–202.
Pavesio A, Abatangelo G, Borrione A, Brocchetta D, Hollander AP, Kon E, et al. Hyaluronan-based scaffolds (Hyalograft C) in the treatment of knee cartilage defects: preliminary clinical findings. Novartis Found Symp. 2003;249:203–17; discussion 229–233, 234–238, 239–241.
Ossendorf C, Kaps C, Kreuz PC, Burmester GR, Sittinger M, Erggelet C. Treatment of posttraumatic and focal osteoarthritic cartilage defects of the knee with autologous polymer-based three-dimensional chondrocyte grafts: 2-year clinical results. Arthritis Res Ther. 2007;9(2):R41.
Grigolo B, Lisignoli G, Piacentini A, Fiorini M, Gobbi P, Mazzotti G, et al. Evidence for redifferentiation of human chondrocytes grown on a hyaluronan-based biomaterial (HYAff 11): molecular, immunohistochemical and ultrastructural analysis. Biomaterials. 2002;23:1187–95.
Goyal D, Goyal A, Keyhani S, Lee EH, Hui JHP. Evidence-based status of second- and third-generation autologous chondrocyte implantation over first generation: a systematic review of level I and II studies. Arthroscopy. 2013;29(11):1872–8.
Choi NY, Kim BW, Yeo WJ, Kim HB, Suh DS, Kim JS, et al. Gel-type autologous chondrocyte (Chondron) implantation for treatment of articular cartilage defects of the knee. BMC Musculoskelet Disord. 2010;11:103.
Goyal D, Vishvas M. Gel based autologous chondrocyte implantation: the surgical technique. Asian J Arthroscopy. 2019;4(1):27–33.
Goyal D. The illustrative overlay autologous chondrocytes implantation (overlay ACI) technique for repair of the extra-large osteochondral defects. In: Goyal D, editor. The illustrative book of cartilage repair. Berlin: Springer; 2021, In Press.
Kim MK, Choi SW, Kim SR, Oh IS, Won MH. Autologous chondrocyte implantation in the knee using fibrin. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):528–34.
Peterson L, Minas T, Brittberg M, Nilsson A, Sjögren-Jansson E, Lindahl A. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000;374:212–34.
Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A. Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med. 2002;30(1):2–12.
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Goyal, D.R. (2021). The Illustrative Third Generation Autologous Chondrocyte Implantation for Cartilage Repair: The Gel Based ACI Technique. In: Goyal, D.R. (eds) The Illustrative Book of Cartilage Repair. Springer, Cham. https://doi.org/10.1007/978-3-030-47154-5_15
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DOI: https://doi.org/10.1007/978-3-030-47154-5_15
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