Description
In this presentation, Pete Gallacher, a knee surgeon at the orthopedic hospital in Oswestry, discusses cartilage regeneration techniques including Autologous Chondrocyte Implantation (ACI), microfracture (MI), and Bone Marrow Aspirate Concentrate (BMAC). He begins by addressing the prevalence of chondral defects, noting that they are common in patients undergoing arthroscopy, with many presenting with significant injuries that may greatly affect their quality of life, even in younger, fitter individuals. Gallacher emphasizes the debilitating nature of these defects and the importance of understanding their classification using both the Outerbridge and International Cartilage Repair Society (ICRS) systems.
He explains that small, partial thickness defects should typically be managed conservatively with physiotherapy and supportive measures, while larger defects necessitate surgical intervention to halt progression and fill the defect. He highlights that many cartilage defects, particularly in adults, will not heal spontaneously due to their avascular nature. A thorough assessment of the knee's overall biological environment, including alignment and ligament stability, is essential prior to surgery.
Gallacher further describes ACI as a two-stage procedure, involving the harvesting of chondrocytes, which are then expanded and reimplanted into the defect. He discusses the technique's relatively high success rates, citing 85-90% tissue infill, positive mid-to-long-term outcomes, and regulatory approval from organizations like the FDA and NICE. However, he also outlines the downsides, including the costs, the need for two surgical procedures, and the biological variability of cell culture.
The presentation branches into comparative evaluation of various cartilage repair techniques, with Gallacher advocating for ACI for larger defects. He cautions against performing ACI on patients with prior cartilage repair procedures. Ultimately, he stresses the need for ongoing research to refine techniques and enhance clinical outcomes, concluding with the assertion that ACI remains a viable solution for cartilage repair despite its complexities.