Autologous chondrocyte implantation
- Micro-fracture
- Fibrous cartilage: poor resistance to shear force
Chondrocyte
- unable to migrate due to surrounded matrix
- could not fill the defect
injury deep into subchondral bone
- Release of potential mesenchymal cell
- Generation of fibrous cartilage
debridement, drilling and fixation, abrasion chondroplasty, microfracture and the use of carbon fibre pads,
1994 Britberg
- Chondrocyte harvested during arthroscopy
- Culture in suitable medua
- 5M cells
- injection into defect area and cover with periosteal flap: hyaline cartilage
< 2 cm2 condral defect: microfracture & mosaicplasty
1 ~ 12 cm2: ACI ( autologous chondrocyte implantation)
Pre OP evaluation
- correction of malalignment : mechanical axis
- r/o cruciate ligament and meniscus injury
- evaluation of chondrocyte lesion: Arthroscopy or MRI
Technique of ACI
- Harvest: chondrocyte from no-load-bearing area, trochlear groove
- Culture: 4-6 weeks
- Preparation of recipient area: arthrotomy, debrident, exposure of normal cartilage, avoidance of bleeding into defect area (hematoma formation), avoidance in bone defect area ( > 6mm lesion)
- Implantation
- Periosteal flap (proximal tibia) or biomembrane
- Secured with fibrin glue
- Suture: impairment of surrounding tissue and blood supply
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