Autologous 3D Chondrocyte Graft
Information about the treatment method
Autologous
3D Chondrocyte Graft
from the body’s own cartilage cells
- Information about the treatment method -
Dear Patient,
Your doctor has found that you have damage to your joint cartilage.
Depending on the extent of the damage, various operative approaches are
used to treat it. Among these, autologous (patient’s own) cartilage cell
transplantation is a very promising approach. This booklet is intended to give
you an overall view of this treatment with a three-dimensional, pre-formed
cartilage cell graft which is produced from your own cartilage cells.
Cartilage - an important building
material in our joints
Cartilage fulfills important functions within the complex structure of our joints.
It ensures that the bones move smoothly within the joint and, at the same
time, it can cushion and absorb stresses and impact up to seven times our
bodyweight. It is because of these properties that cartilage is able to prevent
damage to the bones.
In order to fulfill its functions properly, joint cartilage is able to absorb fluid
from its surroundings in the joint and release it again when under stress. In
addition, this absorption and release of tissue fluid ensures the cartilage tissue
is supplied with nutrients. This is important because cartilage does not contain
any blood vessels, which are the normally means of supplying the body with
nutrients. The lack of blood supply to the joint cartilage does, however, mean
that damaged cartilage can only partly regenerate. The resulting graft tissue is
not of the same quality as the original cartilage and cannot fully cope with the
demands placed on it.
There are different types of cartilage. The white, glass-like transparent hyaline
articular cartilage covers the end surfaces of the bones of moving joints,
makes up the rib cartilage and also the cartilage of the windpipe (trachea).
As well as hyaline cartilage, there is also elastic cartilage (e. g. the outer part
of the ear) as well as fibrous cartilage (e. g. intervertebral disks).
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Autologous 3D Chondrocyte Graft
Information about the treatment method
Cartilage is largely made up of a network of tissue consisting of a few
cartilage cells (chondrocytes) which are embedded in a characteristic matrix
(surrounding substance) formed by you yourself. The constituents of this
matrix - type II collagen and proteoglycans - are taken as specific proof of the
presence of hyaline cartilage and are crucial to how well it performs its
functions.
Damage to joint cartilage
Millions of people all over the world suffer from defective joint cartilage. In
Germany alone, there are thousands of patients each year with cartilage
problems in their knee joints. This damage can result from age-related wear
and tear or be caused by sports injuries, for instance. If left untreated, deepseated cartilage defects will considerably reduce the quality of life and, at
worst, can cause persistent pain and loss of function. Ultimately the picture of
osteoarthritis will develop (chronic, painful joint disease with permanent
articular damage).
Joint cartilage [with the underlying bone] can be divided into six zones:
1)
2)
3)
4)
5)
6)
surface cartilage zone
middle cartilage zone
deep cartilage zone
calcified cartilage zone
subchondral bone plate
(calcified) bone
A defect in the upper layers of cartilage does not necessarily warrant surgery.
A number of methods can be used for minor damage in order to stimulate
regeneration of the articular cartilage. These include methods such as flushing
out the joint (lavage), drilling the bone underlying the cartilage (microfracturing) and removal of the diseased cartilage (abrasion). These do relieve
the symptoms but they cannot restore any hyaline cartilage. Defects
measuring up to about 3 cm2 can be treated by grafting cylinders of the
patient’s own bone/cartilage from minimally stressed, healthy areas of joint
cartilage into the affected areas (mosaic-plasty or OATS).
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Autologous 3D Chondrocyte Graft
Information about the treatment method
Outerbridge-classification
Grade 0
Grade I
Grade III
Grade IV
Grade II
Transplantation of the patient’s own cartilage cells can be used, particularly
for larger cartilage damage over 3 cm2 in area, with an Outerbridge
classification (severity of a cartilage injury) of grade III or IV.
Autologous (patient’s own) Chondrocyte Transplantation (ACT) has proved to
be a promising method for deep-seated damage to articular cartilage, which
leads to the defects being refilled with hyaline cartilage.
Healthy autologous cartilage cells are collected during the course of
arthroscopy (procedure to visualize inside the knee joint) and these are used
to grow more cells in the laboratory. After a few weeks a suspension (fluid)
containing cartilage cells is available to the patient and this is injected into the
defect during transplantation. The site is then covered over with a flap of
periosteum (connective tissue covering bone) previously taken from the tibia
(shinbone).
Autologous 3D Chondrocyte Graft
An Autologous 3D Chondrocyte Graft is made up of the patient’s own cartilage
cells which, together with a “bio-adhesive”, are embedded in an biodegradable
fleece (i. e. it can be degraded by the body). In developing this pre-formed cell
graft, the company has drawn on years of experience with the autologous,
liquid ACT method and turned that experience into key product and handling
advantages.
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Autologous 3D Chondrocyte Graft
Information about the treatment method
Unlike the ACT method, the use of a pre-formed 3D Cartilage Graft does not
require a periosteal flap to be removed to cover the defect. This avoids the
pain at the donor site and greatly simplifies the procedure for the surgeon,
whilst considerably shortening the operating time.
The use of pre-formed Autologous 3D Cartilage Graft makes it possible to
produce cartilage tissue very similar to hyaline cartilage, which can almost
entirely fulfill the functions of articular cartilage. This means the affected joint
is fully operational again.
Treatment procedure with
Autologous 3D Cartilage Graft
1) The diagnosis and suitability for 3D Cartilage
Graft are established on the basis of the defect
found during arthroscopy (visualization of the knee
joint).
2) In order to produce the Autologous 3D Cartilage
Graft, about 250 mg of cartilage tissue will be
taken from an area of your knee joint cartilage that
is subject to little stress and the tissue is increased
by the technique of cell culturing in a laboratory.
(View of damage to articular cartilage through an
arthroscope)
3) The patient’s own blood serum is one of the
means used to supply the newly cultured cartilage
cells with nutrients. This is why a blood donation
from the patient is required. This blood donation
takes place when the biopsy is removed.
So that the cells grow as well as possible, you
should only eat light, extremely low-fat food during
the 12 hours before the blood sample is collected,
e. g. bread, jam, honey, yogurt, fruit juice, no
butter.
4) The cartilage cells and the blood are delivered
to the cell culture laboratory by a reliable
transportation service.
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Autologous 3D Chondrocyte Graft
Information about the treatment method
5) In these specially equipped laboratories, which
operate to the strictest cleanliness standards, the
cartilage cells are dissolved out of the cartilage
tissue, grown using the patient’s own blood serum
and shaped into the final three-dimensional
structure after approx. 21 days.
6) In time for transplantation, the 3D Cartilage
Graft is delivered by courier service to the doctor
carrying out the treatment.
7) During a single operation, the existing cartilage
defect is first cleared of damaged cartilage tissue
and the edges of the defect are smoothed.
8) The method of producing the 3D Cartilage Graft
ensures that it contains a defined number of
cartilage cells (approx. 24 million cells per cm3) in
an even distribution. It also guarantees that the
newly cultured cartilage cells are evenly distributed
in the defect.
9) The pre-formed graft can simply be cut to the
required size. Four anchoring stitches, tied to each
corner, ensure that the Cartilage Graft is
accurately fitted into the defect. The four stitches
are securely anchored in the bone. This enables
the cartilage cells to become incorporated into the
defect. The carrier fleece is biodegraded within a
period of six months.
10) Rehabilitation measures that are suited to your
individual cartilage damage will ensure that the
newly formed joint cartilage is incorporated,
matures and hardens within a period of between
six months and a year.
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Autologous 3D Chondrocyte Graft
Information about the treatment method
BioTissue Technologies GmbH
Engesserstraße 4a / 4b
D-79108 Freiburg
Tel. +49 (0) 7 61 76 76-555
Fax +49 (0) 7 61 76 76-475
customerservice@biotissue-tec.com
www.biotissue-tec.com
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