Cartilage Cell Transplantation

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The Robert Jones and Agnes Hunt Orthopaedic Hospital is currently the only hospital in the UK to offer a type of cartilage cell transplantation procedure called Autologous Chondrocyte Implantation (ACI).

What is it?

Cartilage cell transplantation involves the removing of healthy cartilage cells from the patient's knee and growing them in culture, where they multiply at least 20 fold. The patient then has an operation to remove the damaged part of the cartilage and the cells are implanted in its place.

The cells anchor themselves to the bone within 24 hours - "growing" new cartilage at the damaged site. A patient can expect to resume everyday use in three months and full activities including sports, in twelve months. This development is important as previously the only alternative was knee replacement which for young patients is unsatisfactory.

RJAH ran trials for ACI over a 20-year period, the procedure finally winning approval for funding on the NHS from has won official approval from the National Institute for Clinical Excellence (NICE) to be funded by the NHS in October 2017.

It has been working in partnership with Keele University and the Oswestry-based Orthopaedic Institute; the trio setting up the Oscell Cell Manufacturing Facility to produce the chondrocytes.

We are grateful to the support we have had over that time from a number of sources, including the charity Arthritis Research UK as well as Medical Research UK and the Orthopaedic Institute.

The use of ACI at RJAH were first pioneered by the legendary Professor James Richardson, who spent 20 years leading trials before the procedure won NICE approval. He was still leading research into developing the technique right up to his untimely passing in February 2018.

Procedures are still performed at RJAH by experienced Consultant Orthopaedic Surgeons  Mr Pete Gallacher, Mr Paul Jermin and Mr Andrew Barnett.

Who is eligible?

ACI can only be offered to patients who meet a number of defined criteria as set out by NICE in their guidance note TA477, which can be read here.

These criteria include that the patient must not have had previous surgery to repair articular cartilage defects, as evidence from previous trials has shown ACI to be much less effective in these cases.

There should also be minimal osteoarthritic damage to the knee and the defect should be over two square centimetres.

RJAH accepts patients from across the UK. It is important they have the support of their orthopaedic surgeon and an MRI which confirms the diagnosis and satisfies the criteria. Referrals can be made direct to Mr Pete Gallacher. 

What our patients say

What do our consultants say?

“ACI can help patients who have a particular defect or early arthritis, one which starts with what appears as a small pothole on the surface of the knee. When the normal, smooth surface is broken in this fashion it may not heal naturally.

“We take a small sample of cartilage out and grow cells up in the lab. These cells are then put back into the patient’s knee in what is a second, bigger operation.

“The patients are usually only in hospital for two days post-operatively, though there is a lot of rehabilitation and physiotherapy to follow after that. The results we have seen have been positive, particularly if the patient has not had prior microfracture.

“The typical patient would be under the age of 40 and would be someone who might have picked up an injury playing football which has led to a chondral defect in their knee that causes pain and is tender on examination.

“This patient would otherwise be healthy, with intact ligaments and a straight leg.”