Google Answers Logo
View Question
Q: Restoring lost cartilage. ( Answered 5 out of 5 stars,   0 Comments )
Subject: Restoring lost cartilage.
Category: Health > Conditions and Diseases
Asked by: hobbledehoy-ga
List Price: $20.00
Posted: 29 Jan 2003 07:46 PST
Expires: 28 Feb 2003 07:46 PST
Question ID: 149946
Question for Voila.  Please do pursue the cartilage matter.  Thanks
for your comment added to my Ankle Surgery answer.  I thought this
should be put as a new question for you.  I saw an ad (in American Way
in-flight magazine, and did not keep the page) for a clinic in Florida
and someone told me they'd heard of a place in California.  But both
are far from me (in Texas).  Also, I wonder if the whole thing is
genuine proven treatment or a money-making rip-off!

Request for Question Clarification by voila-ga on 29 Jan 2003 11:31 PST
Hello HDH,

Thanks for requesting this research.  It is a legitimate procedure, 
primarily associated with the knee, but now extending to other joints in the body.

Since the U.S. lags our counterparts abroad due to the long FDA 
process, which has both its pros and cons, I doubt we'll find many 
docs with enough experience using this technique.  Also, most 
certainly Medicare or any other carrier will consider this 
"experimental" for at least the next decade (?).

I would, however, like to see which reputable institutions are 
currently performing this surgery.  Regrettably, my full-time job 
keeps me quite busy during the week (plus I'm a slowpoke researcher), 
so I hope this weekend will be soon enough for an answer.  I'm looking 
forward to seeing what's out there.

Kindest regards,

Clarification of Question by hobbledehoy-ga on 29 Jan 2003 16:42 PST
Certainly this weekend will be quite soon enough for anything you can
find out.  It will be fascinating to know about the new procedure,
though I doubt if I'll wait for a DECADE for insurers to catch up!  I
shall feel good about knowing (possibly) more on the subject than my
doctor, and I don't see him till Feb.10.  It will probably have to be
the fusion for me in the end, depending on how long I can put up with
the pain and immobility as is.  It will, as I think you understand,be
really difficult to manage the recovery period at home where I live
alone.  Perhaps Medicare would help out with some short-term nursing
care.  We shall see!  Thanks.
Subject: Re: Restoring lost cartilage.
Answered By: voila-ga on 02 Feb 2003 21:50 PST
Rated:5 out of 5 stars

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.

If you have Real Player, there is an audiovisual presentation of the
surgery here:

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
with cartilage.

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
Genzyme site:

"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 experimental.

Implantation Billing Codes:
27599  Open knee arthrotomy with microsuturing of a periosteal patch
and autologous cultured chondrocyte implantation


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 (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.

Agility® Ankle:

Physician Locator:


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,

Clarification of Answer by voila-ga on 03 Feb 2003 21:23 PST
Thanks so much for the five-star rating and your generous tip.  I
learned a lot with this question.  It certainly can't hurt to discuss
the ACI procedure with your surgeon.  It's definitely the wave of the
future and you might also have the bones of 45-year-old -- you never
know.  ;-)

Clarification of Answer by voila-ga on 12 Feb 2003 12:33 PST
Hello again,

Sorry I couldn't get this to you before your appointment but I just
ran across it today.  See page 8 of this document on "polymerized
cartilage replacement."

Hope you're doing well,
hobbledehoy-ga rated this answer:5 out of 5 stars and gave an additional tip of: $5.00
thanks so much.  It's all most interesting, but I wish I was at least
20 years younger to take advantage of it.  However, I'll at least
mention the procedure to the doctor when I see him; thanks to your
research, I may well know more than he does.

There are no comments at this time.

Important Disclaimer: Answers and comments provided on Google Answers are general information, and are not intended to substitute for informed professional medical, psychiatric, psychological, tax, legal, investment, accounting, or other professional advice. Google does not endorse, and expressly disclaims liability for any product, manufacturer, distributor, service or service provider mentioned or any opinion expressed in answers or comments. Please read carefully the Google Answers Terms of Service.

If you feel that you have found inappropriate content, please let us know by emailing us at with the question ID listed above. Thank you.
Search Google Answers for
Google Answers  

Google Home - Answers FAQ - Terms of Service - Privacy Policy