MACI for car­ti­lage re­pair

New tech­nique for re­pair­ing knee car­ti­lage dam­age is only for cer­tain in­juries.

The Star Malaysia - Star2 - - Health -

I’M in­ter­ested in the new pro­ce­dure ap­proved by the US Food and Drug Ad­min­is­tra­tion that can re­pair car­ti­lage in the knee. How does it work? Who’s a good can­di­date for this pro­ce­dure?

The new tech­nique is called ma­trix-associated au­tol­o­gous chon­dro­cyte im­plan­ta­tion, or MACI.

It can be ef­fec­tive for re­pair­ing iso­lated car­ti­lage dam­age in the knee, but it’s not use­ful for peo­ple whose knee car­ti­lage is dif­fusely dam­aged due to arthri­tis.

Your knee has two kinds of car­ti­lage: the ar­tic­u­lar car­ti­lage and the menis­cus.

Ma­trix-associated au­tol­o­gous chon­dro­cyte im­plan­ta­tion is used to re­pair ar­tic­u­lar car­ti­lage dam­age, which can come from an iso­lated in­jury or de­fect, or as a re­sult of arthri­tis.

Of these two prob­lems, iso­lated in­juries and de­fects are much less com­mon than arthri­tis. They usu­ally hap­pen due to an ath­letic in­jury or another med­i­cal con­di­tion, such as os­teo­chon­dri­tis dis­se­cans.

Both iso­lated car­ti­lage de­fects and arthri­tis have sim­i­lar symp­toms, in­clud­ing knee pain, swelling and loss of mo­tion.

No mat­ter the cause, car­ti­lage dam­age is chal­leng­ing, be­cause car­ti­lage doesn’t have its own blood sup­ply. There­fore, it can’t heal it­self. Once car­ti­lage is dam­aged, with­out treat­ment the dam­age stays the same or gets larger over time.

And so, iden­ti­fy­ing car­ti­lage dam­age soon af­ter it hap­pens and start­ing treat­ment promptly is cru­cial to suc­cess­ful re­pair.

It’s also im­por­tant to have a thor­ough eval­u­a­tion to iden­tify what caused the car­ti­lage dam­age, be­cause treat­ment is based on the un­der­ly­ing cause and po­ten­tially cor­rect­ing those fac­tors.

The ma­trix-associated au­tol­o­gous chon­dro­cyte im­plan­ta­tion tech­nique is only use­ful for re­pair­ing iso­lated car­ti­lage dam­age.

To un­der­stand why it can be help­ful, con­sider a road re­pair anal­ogy.

If you have an iso­lated car­ti­lage de­fect or dam­age, it’s like hav­ing one or two pot­holes on a road.

Once those pot­holes are re­paired, the road is sound again.

With arthri­tis, it’s as if there are many pot­holes in the road. Fix­ing each in­di­vid­ual hole won’t re­store the road over­all, and more pot­holes will form over time. A more com­pre­hen­sive ap­proach is needed to make the sur­face sound.

For those who are good can­di­dates for ma­trix-associated au­tolIS ogous chon­dro­cyte im­plan­ta­tion, the tech­nique is a two-stage process.

The first step is knee arthroscopy. Dur­ing this min­i­mally in­va­sive pro­ce­dure, a physi­cian looks in­side your knee and as­sesses the car­ti­lage dam­age – mea­sur­ing its size and map­ping its lo­ca­tion.

A sam­ple of the car­ti­lage also is taken from the knee. After­ward, that sam­ple is sent to a lab, where the cells are used to grow more car­ti­lage cells.

With ma­trix-associated au­tol­o­gous chon­dro­cyte im­plan­ta­tion, the new cells are grown on a mem­brane scaf­fold in the lab. That’s dif­fer­ent than the car­ti­lage re­pair tech­niques pre­vi­ously used.

In the older ap­proaches, car­ti­lage cells were grown in a lab and im­planted into the knee un­der a patch cre­ated from a mem­brane taken off the outer sur­face of a bone, called the pe­rios­teum, or im­planted un­der a mem­brane made of col­la­gen.

By grow­ing the new cells on a mem­brane scaf­fold and then im­plant­ing them into the knee where the car­ti­lage is dam­aged, a 3-D struc­ture is cre­ated that more closely mim­ics nat­u­ral car­ti­lage, which al­lows for faster heal­ing and low­ers the risk of com­pli­ca­tions.

Full re­cov­ery from ma­trix-associated au­tol­o­gous chon­dro­cyte im­plan­ta­tion can take up to a year, so you need to be mo­ti­vated and will­ing to un­dergo re­ha­bil­i­ta­tion over the course of a year.

If you sus­pect knee car­ti­lage dam­age, see your health­care provider. He or she may re­fer you to an or­thopaedic sur­geon to re­view your op­tions and de­cide if you might be a good can­di­date for ma­trix-associated au­tol­o­gous chon­dro­cyte im­plan­ta­tion.

If you have iso­lated car­ti­lage dam­age that can be re­paired with ma­trix-associated au­tol­o­gous chon­dro­cyte im­plan­ta­tion, a sur­geon also can help iden­tify what led to the dam­age in the first place.

In some cases, prob­lems such as joint in­sta­bil­ity or mis­align­ment may re­quire another pro­ce­dure to cor­rect those is­sues, so the car­ti­lage isn’t dam­aged again. – Mayo Clinic News Net­work/Tri­bune News Ser­vice

The new tech­nique for re­pair­ing knee car­ti­lage dam­age is called ma­trix­as­so­ci­ated au­tol­o­gous chon­dro­cyte im­plan­ta­tion, or MACI. — TNS

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