It's been quite the strum and drang experience researching this
technique. Although the ACI procedure has only been performed in the
U.S. since 1995, it originated in Sweden some 15 years ago. This
article explains ACI (autologous chondrocyte implantation) with
Carticel® which is just one of the available biosurgical products for
cartilage transfer. http://www.iasm.com/ccc.html
If you have Real Player, there is an audiovisual presentation of the
surgery here: http://www.arthroscopy.com/genzyme.htm
The downside to this procedure is that the ideal candidate is between
the ages of 15-55. I suppose the rationale being that the
osteoporotic effect could compromise the integrity of the procedure in
anyone beyond that age. Another drawback to this procedure is that
it's a two-step procedure -- one pass for harvesting and another for
the actual implantation four weeks later, each with its own risk for
infection and attendant problems.
A person would also need to investigate not only the surgeon's
expertise with this procedure but the laboratory performing the cell
cloning as well.
One of the primary advantages to this surgery is the total lack of
instrumentation involved. Except for the periosteal patch containing
the cells themselves, no rods, screws, or prosthesis, so no foreign
bodies to reject. Consider it an autologous blood transfusion except
Additionally, from this article on general information on ACI:
"Existing and ongoing research in the use of autologous cells to treat
articular defects supports the clinical evidence that ACI results in a
superior repair tissue. When examined grossly, microscopically and
histochemically, the repair tissue more closely resembles hyaline
cartilage: the basis of normal articular tissue. Evidence indicates
that the resultant repair tissue is one which gradually matures over
time forming a durable long lasting repair, and which preserves the
integrity of the joint."
From the makers of Carticel® these statistics were taken from the
"As of March 31, 2000, 3,952 patients had been treated since Genzyme
began marketing the product in 1995. There are 136 million people
covered by insurance plans that pay for Carticel® (autologous cultured
chondrocytes) as a matter of policy in the United States.
Today Carticel® is considered a viable treatment option and most
healthcare plans now reimburse fully for appropriate patients - check
with your health care administrator where you work for more details or
contact us at Genzyme Biosurgery."
Since ACI for the knee has paved the way for additional joint surgery,
hopefully there won't be any lag time deeming ankle cartilage
Implantation Billing Codes:
27599 Open knee arthrotomy with microsuturing of a periosteal patch
and autologous cultured chondrocyte implantation
ADDITIONAL ARTICLES OF INTEREST
From Senior Health Week:
Patient Selection for ACI:
Hospitals using Carticel:
Cartogen in Australia:
New drug for rhematoid arthritis:
American Orthopaedic Foot and Ankle Society:
Recent article on rheumatoid arthritis including experimental
Texas Center for Joint Replacement:
Hospital for Special Surgery:
There have been definite advances in arthroplasty -- specifically with
the Agility ankle.
From a Medscape article discussing the Agility ankle prosthesis
http://www.medscape.com/viewarticle/413174 (registration required)
"This fixed-bearing, constrained implant, developed by Dr. Franklin G.
Alvine, is the only Food and Drug Administration (FDA)-approved
implant available in the United States for ankle arthroplasty. The
unique design offers complete resurfacing of the ankle joint with
syndesmotic* fusion. The device uses the distal fibula to support the
prosthesis, so a larger surface is available for force dissipation.
The smaller talar component creates a size difference between the
proximal and distal weight-bearing surfaces that allows rotation and
sliding for better range of motion. (...) In an unpublished yet formal
survey of 294 patients conducted at least 1 year following Agility®
ankle arthroplasty (performed by Dr. Alvine), 93.5% reported
improvement in specific quality-of-life areas, and 92.1% said they
would have the procedure done again if necessary."
*syndesmotic (that was a new one on me too!): Anatomy. A type of
joint in which the articulating bones are held together by a ligament
of connective tissue. [New Latin, from Greek sundein to bind
The article also discusses the STAR (Scandanavian Total Ankle
Replacement) and the Buechel-Pappas prostheses.
While the ACI technology has been available quite a while on the knee,
the success stats aren't in yet on the ankle ACI procedure. Maybe
within the next five years there will be some figures available to
take a look at. If your surgery is imminent, an ankle arthrodesis or
a resection arthroplasty (with possibly an Agility® ankle prosthesis)
might be your best treatment course. Please discuss any of these
options with your orthopedist.
Regarding a home health worker during your recuperation, here is the
website for Medicare's coverage and requirements. You might also
check this recent question answered by my colleague, websearcher
Thanks for the opportunity to learn more about this exciting new
procedure. Good luck with whichever course of treatment you choose.
If there's any additional information you require, please don't
hesitate to ask for a clarification. Should there be any further
research after your appointment on the 10th, do give us a shout.
Very best wishes,