I was doing my usual browse through the latest articles and came across this one from a sports Doctor, Dr. Rick Cunningham, who recommends ACI for osteoarthritis. He rightly says that microfracture has been shown to be “limited and somewhat discouraging” (actually I would say downright dreadful!) but then goes on to say he us using autologous chondrocyte implantation or ACI instead.
But is this OK for osteoarthritis sufferers?
What is ACI?
Dr. Rick gives a good simple description of the procedure:
The ACI procedure takes a small sample of cartilage cells from a patient’s affected knee in a simple arthroscopic procedure. These cells are then sent to a lab that isolates the cartilage cells and multiplies them in a culture over a 4-6 week period of time. The cells are then reimplanted back into the knee where the defect exists. The result is a cartilage surface that more closely resembles normal articular cartilage.
Is ACI Suitable for Osteoarthritis?
There have been a number of studies done recently but the biggest problem I have is that they seem to be done on relatively young candidates. ACI is being used for younger subjects usually with sports injuries.
They are generally published in Sports Journals and these are a couple of them with a summary of the results:
Two- to 9-Year Outcome After Autologous Chondrocyte Transplantation of the Knee : multiple lesions 67% success rate
The John Insall Award: A Minimum 10-year Outcome Study of Autologous Chondrocyte Implantation : 71% success overall in all clinical reasons for doing the ACI (i.e. not just for OA but other conditions as well) but with a history of large lesions as you get in moderate or severe OA had a high failure rate.
The Most Important Paper I Found on ACI for Osteoarthritis
This was the most important paper I found on the ACI for osteoarthritis. It actually says:
Contraindications include: obesity (body mass index (BMI) >35), inflammatory joint disease, and established osteoarthritis
So maybe that is why I can find NO studies on ACI for osteoarthritis because it shouldn’t be used! It appears it is really only suitable for young people with focal (small) areas of cartilage injury rather than a general wear and tear. All I can say, Dr Rick, is if you are getting the good results you suggest you are then get some research published to back it up!
For me it is back to the exercises!