ACI

Regenerative medicine (Latin: regeneratio = regenerate) is a relatively new area of medicine. This medical discipline is directed at the recreation or recovery of tissues and organs. For this purpose, foreign cells or the body’s own cells are activated in specialized laboratories under controlled conditions to reproduce themselves. These cultivated cells are then implanted at the location of the injury.

An ACI treatment comprises two phases, namely the arthroscopy and implantation. The cell culture takes place between these two phases.

The exploratory operation (arthroscopy) – phase 1
During an exploratory operation two small incisions are made in the knee. The surgeon will use a small fiber optic camera to look inside the knee and assess the degree and location of the injury . Any loose bits of cartilage are also removed at this time. At the same time, a bit of healthy cartilage of a non-supportive or lesser supportive region will be removed and used for the cultivation of the cartilage cells. This is a minor intervention, and in most cases the patient should be able to leave the hospital the same day.


Cell cultivation
The chondrocytes (the cartilage cells that are isolated from the cartilage tissue) are cultivated in vitro in a specialized laboratory. When these cells have reproduced sufficiently to fill up the defect, which usually is the case after four to six weeks, the cells will be implanted in the knee.



The implantation – phase 2
During a second clinical procedure, an open knee operation, the surgeon will first clean the damaged cartilage area. The surgeon will then attach a thin membrane over this gap. The cultured cartilage cells are then injected under this membrane.

The cartilage cells will first attach to the bone and then slowly start forming new cartilage tissue. Initially, a three-dimensional structure is created, across which the implanted cartilage cells are distributed. As the regeneration process continues, these cartilage cells will form tissues that are characteristic of hyaline cartilage tissue. The regenerated cartilage tissue has biomechanical properties that are similar to native cartilage tissue. After the open-knee surgery, the patient usually remains in the hospital for a few days.


Rehabilitation
Rehabilitation is very important and will already start during the stay in the hospital, usually the day following the operation. It will take some time before the new cartilage cells form healthy, stable cartilage tissue. During the first two weeks following the open knee surgery, no strain should be placed on the knee. After this period, the stress on the knee can be gradually increased. To aid the rehabilitation progress, the patient is given a personalized scheme, depending on location and size of the original injury, that is used by the physiotherapist during the rehabilitation period.