Profilaksa DVT kod velikih ortopedskih operacija - Depol ...

20 - 22 September 2012, Opatija, Croatia
AUTOLOGOUS CHONDROCYTE TRANSPLANTATION TODAY
AND TOMORROW
Gian Salzmann, Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-
Ludwigs University Freiburg, Germany
Following the 1994 pioneer work by Brittberg and colleagues autologous chondrocyte implantation has evolved
significantly until today. The traditional periosteum-covered technique has retrospectively been termed first generation
ACI-P. In order to reduce operating time and as well to avoid graft hypertrophy the second generation
ACI-C has been introduced by replacing the periost by an artificial membrane such as collagen. While the cells are
applied beneath a cover when performing first or second generation ACI, third generation ACI is matrix-assisted
(m-ACI). The chondrocytes are cultured within the matrix for a certain time prior to transplantation. The idea was
to give better primary stability, handling and probably partial cellular redifferentiation. As further alternatives
there are ACI-Cs, where the cells are seeded within the matrix intraoperatively and consecutevily implanted to
have high vitality and mitotic activity. Also bioreactor-assembled implant-ready cartilage products are on the
threshold to clinical implementation, which are sought to present with an already assembled extracellular matrix
at time of implantation. Furthermore one-step cartilage repair techniques are on the rise in order to reduce the
traditional 2-step into a 1-step procedure.
Concerning outcome data, it is now becoming increasingly apparent that ACI gives better tissue quality when
compared to the concurring methods foremost in the long-term and is much better suited for larger cartilage defects.
Literary information on the younger techniques is sparse and one has to await longer-term follow-up among
large patient cohorts to give out treatment suggestions.
Oral
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