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Autologous chondrocyte implantation

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Traditional cartilage damage repair methods:

 Figure 1: Traditional cartilage damage repair method: A: cleaning method; B: scrape method; C: minimally invasive method
http://www.eorthopod.com/content/articular-cartilage-problems-knee

A: cleaning method: in the arthroscopy, repair the edge of the rough trauma cartilage, synovial fluid cleaning cartilage debris. This method can quickly relieve pain. For large area of cartilage injury, and the elderly crowd.
B: scraping scraping method: the use of special tools, grinding scrape off the damaged cartilage, and subchondral bone surface, resulting in blood oozing, line into blood clots, and gradually differentiate into fibrosis cartilage. This method is also short-term lifting pain.
C: minimally invasive method: with a special tool, in the subchondral bone surface poke a few holes, and scrape the scraping method is similar to the exudation of blood clots, and gradually differentiate into fibrosis cartilage.
Scratch method and minimally invasive method, only applies to patients with small lesions, no more than 2.0 cm2.

 

Autologous chondrocyte therapy (ACI):
V The traditional method of restoration can temporarily alleviate the pain, but clinical results suggest that some patients will soon return to clinical. At this time, autologous chondrocyte therapy can be used to return to clinical patients.
V Autologous chondrocyte therapy, is an innovative surgical modern technology, is now widely used in the West, the basic steps in two operations:
Ü The first surgery: in the arthroscopy, the doctor first check the cartilage trauma, the quality of cartilage around the wound, and then in patients with non-mechanical cartilage, take a small amount of autologous cartilage
Ü in vitro, from the cartilage tissue, extract the cells, and then amplify
The second operation: the doctor to open the joints, and then the cartilage cells into the cartilage trauma, and collagen film, suture seal.


Figure 2:Illustration of autologous chondrocyte therapy(www.carticel.com - Genzyme )

Figure 3: Illustration of autologous chondrocyte therapy

Clinical effect of autologous chondrocyte therapy (Batty, Dance et al. 2011)
ACI surgery, in 1994, the first in Sweden, Gothenburg, Goteborg, ACI has been in the West for nearly 20 years of clinical experience. ACI applies to a range of people. ACI clinical outcomes are superior to traditional therapies in meeting specific population-wide requirements and meeting specific rehabilitative conditions.

Rehabilitation after surgery:

The first stage: cell expansion (6 weeks), cells need 12-18 hours attached to the subchondral bone, this time is not recommended activities. 12-24 hours after surgery, can start using the knee joint movement machine. 6-8 hours per day, use 4-6 weeks time.
Phase 2: Cell growth Tissue matrix (6 weeks to 6 months), the new matrix is ​​softer. According to the size and location of trauma, can gradually load.
The third stage: the organization of matrix perfection (6 months to 12 months), hardness is increasing. At this time, the patient's premonitory signs of disease began to improve.

Cartilage wear is more terrible than broken bone
Joint is an important bone bearings, due to day-to-day operation, structure and function is relatively complex, so easy to bring a variety of injuries and chronic strain. The trouble is, compared with the bone, by the cartilage, connective tissue and lubricants and other components of the joint more difficult to recover after injury. Cartilage itself lack of blood vessels, nerves, in a high pressure and hypoxia, low nutritional environment, so slow cell metabolism, self-repair ability.
Fractures can be through the plaster, bone nails and other means to gradually heal, restore normal function, but once the articular cartilage wear and tear, it is difficult by traditional means and their ability to repair to restore normal use.
Researchers at the University of Copenhagen in the field of collagen in the articular cartilage of the regeneration of the situation in the field measurements, in the mature, the articular cartilage in the collagen skeleton is almost never renewed.
Almost no updated cartilage collagen
According to the study, the development of mature, the collagen in the cartilage is almost no update.
In the event of injury and disease, cartilage tissue is almost never self-repair and update. In the sample measurement of osteoarthritis patients, almost no new collagen components were found stimulated by cartilage damage. Broken skin can be scab healing, fracture fracture can grow their own recovery, but the cartilage once worn, want to rely on their own repair, is very difficult.

Protecting joints is important
Cartilage easily injured during exercise, but cartilage tissue without blood vessels, cell content is low, so poor self-repair. Clinical findings suggest that cartilage trauma, which is not promptly repaired, can lead to arthritis (Birk and DeLee 2001).
Modern emphasis on health, fitness and outdoor sports increased, increased physical activity. However, improper movement or inadvertent injury in exercise can lead to cartilage wear and tear, serious damage to quality of life, so that the purpose of our campaign counterproductive, so the growing demand for cartilage treatment.

What is cartilage damage

Figure 1: Comparison of Knee Joints with Traumatic Knee Joints. A: Health; B: Wounds
Cartilage trauma, according to the degree of injury can be divided into four:

Figure 2: Pictorial cartilage damage classification
http://www.eorthopod.com/content/articular-cartilage-problems-knee

A: cartilage is soft, and swelling phenomenon
2: cartilage damage only in the surface, subchondral bone is not damaged, the surface cracks, more than 1.5cm in diameter.
Grade 3: cartilage damage to subchondral bone fracture, more than 1.5cm in diameter
Grade 4: Complete loss of cartilage, exposing subchondral bone.

• All operations for chondrocyte processing are performed in the GMP lab at Okay
•  maintain the whole sterile
•  Each patient has a special set of operating boxes (including equipment / dishes, culture medium), and clean bench and incubator
•  Cell finished products must be strictly inspected before leaving the factory - Inspection includes:

All products, only qualified by the QA can be released