Autologous Chondrocyte Implantation (Carticel)

Smooth gliding, frictionless surfaces are necessary for well functioning joints. Since bones are rough they can not provide such a surface. To meet this need, the ends of the bones that form joints are covered with a smooth, slippery substance called "joint cartilage" or "articular cartilage." Thus in the knee, the end of the thigh bone (femur) and the end of the shin bone (tibia) are covered with a smooth, white, shiny, slippery joint or articular cartilage.

The gradual wearing away of this articular cartilage with age and use is called "osteoarthritis" or "degenerative arthritis."

Sometimes, usually by injury, a small localized area of articular cartilage can become damaged or even completely dislodged from the underlying bone. This localized damaged area (usually with a size ranging between that of a dime and a quarter) is surrounded by normal articular cartilage.

Autologous chondrocyte implantation (Carticel) is perfect to treat this problem. This surgical procedure allows you to re-grow your own new joint cartilage in the damaged spot. Since you are essentially cloning your own joint cartilage cells, the quality of the new cartilage is better than any of the cartilage repair procedures discussed in the arthroscopy section of this website.

Autolgous chondrocyte implantation is a two stage surgical procedure:

First, an arthroscopic surgery is performed and several small pieces of joint cartilage (3 pieces, each the size of a tic-tac) are harvested from the very edge of the joint where they are not really needed. These harvested pieces of joint cartilage are then sent to a laboratory in Boston (Genzyme, Inc.) where the cartilage is then dissolved freeing the individual cells from the background matrix. The cells are then grown in tissue culture and the number of cells is expanded until there are enough to fill your knee’s defect. You then undergo a second surgery. The knee is opened, the defect is cleaned up and a water tight patch is sewn over the top of the defect. This sewing is precise requiring the use of magnification and very tiny suture. A natural glue (fibrin) is then applied over the sutures to be sure the seal is complete (like using seam sealer on a tent). Sterile water is injected behind the patch to be sure it is water tight. Then, your cartilage cells, which have now been returned to us in Madison, are injected behind the patch, filling the defect with your new cartilage. These cells are still in a liquid form and it will take time for them to solidify, grow, mature, and incorporate into the defect.

Usually, you are asked to be non-weight bearing for 2 weeks, partial weight bearing for 6 more weeks and then, at 8 weeks, you may begin full weight bearing. Low impact activities are resumed at 6 months and high impact activities at 1 year.

For more information go to: www.carticel.com