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synonyms: ACI, autologous chondrocyte implantation
ACI Indications
- articular cartilage defect with intact cartilage space document on xrays. Lesions should be well contained with normal cartilage margins.
- typically limited to defects of 2 cm or larger (up to 10 cm2), and where more than one lesion is present and are nonarticulating.
ACI Contraindications
- Greater than 6mm of bone loss.
- Limb malalignment
- Arthritic changes
ACI Alternatives
ACI Pre-op Planning / Special Considerations
- Underlying etiology of defect and any pathomechanics must be identified and corrected.
- Associated malalignmnet must be corrected before any cartilage restoration procedure. Most isolated lesions involve the MFC and can be associated with varus alignment. Concomitant HTO is indicated.
- Consider MACI.com
ACI Technique
- Sign operative site
- Pre-operative antibiotics, +/- regional block
- General endotracheal anesthesia
- position. All bony prominences well padded.
- Examination under anesthesia.
- Prep and drape in standard sterile fashion.
- Irrigate.
- Close in layers.
ACI Complications
- Overall 3.8% complication rate. (Wood JJ, JBJS 2006;88:503)
- Graft failure
- Delamination
- Tissue hypertrophy / hypertrophic periosteal healing (10-15%)
- Infection
- Arthrofibrosis
- Adhesions
ACI Follow-up care
- Post-op: 6hrs/day CPM, NWB x6wks unless lesion treated was patellofemoral.
- 7-10 Days: Wound check, continue CPM, NWB
- 6 Weeks: Discontinue CPM, advance to full weight bearing
- 3 Months: Resume all normal ADLs.
- 6 Months: Gradually begin running / sport specific rehab.
- 1Yr: Return to sport / full duty. Return to high-impact activites after treatment of large defects is not recommened.
ACI Outcomes
- 94% graft survival at 36months (Micheli LJ, Clin J Sport Med 2001;11:223).
- 82% good/excellent outcomes (Petersen L, AJSM 2002;30:2).
ACI Review References
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