Annex B - The Next Few Months

After implanting the cultured cells into the knee, the knee would be protected by a post-operative knee brace. This special brace is reinforced on both sides with hinged steel bars. The range of motion can be set on the hinge from 0 to 90° and free range. In my case it was set to 0 to 30° for now. The angle could be gradually increased over time, until free range is achieved. The brace may need to be used for up to 3 months to prevent the knee from buckling.

Since the implanted cultured cells may not be fully modeled into semi-solid form till the 6th week, crutches would have to be used. The operated leg must not bear any weight at all for the first few weeks and light pressure can be partially exerted until 12 weeks. The crutches can then be gradually weaned off by increasingly putting pressure on the foot until walking slowly indoor is possible. Up to the 6th week, the cells continued to proliferate and would still be in semi-liquid form. From then on they will form into matrixes with the surrounding tissues and start to remodel and consolidate into semi-solid, toothpaste-like consistencies and gradually hardening during the next 6 to 18 months. Rehabilitation exercise programme will have to start slowly, provided the range of motion has reached 90 or more degrees. Initially, hydro-therapy and wading in water may help, if the facilities are available. Other exercise equipment that is suitable include using machine that have adjustable loading, such as a stationary magnetic exercise bike, starting from almost zero force to 9 levels of resistance. Later, a more rigorous physiotherapy programme will help to rebuild the atrophied muscles. Full strength recovery may take up to 2 years for the knee to regain almost the original flexibility and strength needed for most sports activities. I know of people who could resume soccer and participated in vertical run and even full marathon 2 to 3 years after the ACI operation.

Acknowledgements – References & Further Readings

National University of Singapore - Mesenchymal Stem Cells in Musculoskeletal Tissue Engineering: A Review of Recent Advances

http://annals.edu.sg/pdf/34Vol200501/V34N2p206.pdf

National University of Singapore - Stem Cells and Cloning, The 8 Essential Steps to Achieving A Kick Like Beckham By - Prof Lee Eng Hin & Dr James Hui

http://www.sma.org.sg/sma_news/3506/stemcells_leh&jh.pdf

Singapore Biopolis: CSI Award - Repairing Cartilage Defects through New Therapies – A Prof James Hui

http://www.biomed-singapore.com/bms/sg/en_uk/index/research_resources/research_highlights/year_2006/csi_award_-_repairing.html

Orthopaedic Sports Medicine, Mt Elizabeth Hospital – Knee injuries and cartilage problem

http://www.sportsmedicine.com.sg/patedu.html

The Center for Orthopaedics & Sports Medicine  - ACI Rehabilitation Protocols

http://www.arthroscopy.com/sp08027.htm

Oscell - Tissue Engineering in Orthopaedics

http://www.oscell.enta.net/technique.htm

Allen Comer - (ACI): A Patient's Perspective

http://users.erols.com/equinox/aci_rehab.html

Chester Knee Clinic - Patient and General Practitioner Information

http://www.kneeclinic.info/download/CKC_ACI_Information.pdf

Rehabilitation - http://www.kneeclinic.info/knee_rehabilitation.php

About.com ACI - Autologous Chondrocyte Implantation

http://orthopedics.about.com/od/hipknee/a/aci.htm

Orthopaedic Technology Review - Updating Autologous Chondrocyte Implantation Knee Rehabilitation

http://www.orthopedictechreview.com/issues/julaug03/pg30.htm

The Knee Guru - Osteoarthritis of the knee

http://www.kneeguru.co.uk/

John Hopkins University - Repairing Knee Joints by Growing New Cartilage

http://www.birchbob.com/MarketingPieces/jhu/indexJE.htm

Uconn Health Center, Sports Medicine - Autologous Chondrocyte Implantation (ACI), Femoral Condyle Rehabilitation Protocol

http://uconnsportsmed.uchc.edu/patientinfo/postop/knee/re_kneacifemchond.html

Sports Medicine Institute, University of Minnesota Orthopaedics - Autogenous cartilage implantation

http://www.sportsdoc.umn.edu/Patients_Folder/Knee/aciimplantpat/aciimplant2.htm

Southern California Orthopedic Institute - Cartilage Repair

http://www.scoi.com/carticel.htm

The Harvard Orthopaedic Journal - Autologous Chondrocyte Implantation for Chondral Defects of the Knee

http://www.orthojournalhms.org/volume2/html/articles6.htm

Royal National Orthopaedic Hospital Trust, Stanmore - Autologous Cartilage Implantation (ACI and MACI)

http://www.timspalding.com/PDF%20files/ACI%20Cartilage%20repair%20info.pdf

The University of Western Australia - Perioperative rehabilitation for autologous chondrocyte implantation: A review of two case studies

http://www.ausport.gov.au/fulltext/2001/acsms/papers/ROBE1.pdf

Knee1 - Dr. Kenneth Zaslav: Applying New Techniques to Repair Cartilage

http://www.knee1.com/hero/hero.cfm/20

Forums: http://www.knee1.com/forum/index.cfm?forumid=2

Genzyme Corporation – Carticel  (Autologous cultured chondrocytes)

http://www.carticel.com/home.asp

Wikipedia - Knee cartilage replacement therapy

http://en.wikipedia.org/wiki/Knee_Cartilage_Replacement_Therapy

National Institute for Health and Clinical Excellence (NICE) - Autologous chondrocyte implantation (ACI) - Review

http://guidance.nice.org.uk/TA89

University of Liverpool - A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee

http://findarticles.com/p/articles/mi_qa3767/is_200303/ai_n9167232

Tri-Valley Orthopedic Specialists, Inc. - Constructive Surgery of the Knee

http://www.trivalleyorthopedics.com/article_kneesurgery.html

HIP Health Plan of New York - Autologous cultured chondrocyte implantation (ACI) with Carticel®

https://www.hipusa.com/providers/ny/guidelines/pdf/surgical/MG_Autologou_Chondrocyte_Implantation_C.pdf

Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois - Chondral Injuries Of the Knee

http://www.cartilagedoc.org/downloads/sek/g4368.pdf

UniCare Medical Policy - Treatment of Osteochondral Defects of the Knee and Ankle

http://medpolicy.unicare.com/policies/SURG/chondral_defects.html

The TRIP Database - Listings of articles on knee cartilage defects

http://www.tripdatabase.com/SearchResults.html?s=1&gk=knee+aci&itemId=250053

Verigen UK - autologous Biotherapy® in orthopaedic surgery

http://www.sovereign-publications.com/verigen.htm

Answers.com  - Knee cartilage replacement therapy

http://www.answers.com/topic/knee-cartilage-replacement-therapy

Medscape Today - Articular Cartilage: The Search for the Holy Grail

http://www.google.com.sg/search?hl=en&q=%22Articular+Cartilage%3A+The+Search+for+the+Holy+Grail%22&btnG=Search&meta=

Institute for Arthroscopy & Sports Medicine, San Francisco - Cartilage Transplantation (Autologous Chondrocyte Implantation, ACI)

http://iasm.com/ccc.html

Biomedical Engineering Department, University of Wisconsin at Madison - Comparison of Four Treatments for Patients with Severe Knee Cartilage Damage

http://tc.engr.wisc.edu/UER/uer01/author1/content.html

Colorado Orthopedic Consultants - Cartilage Transplantation: Applying New Techniques to Repair Cartilage

http://www.cocortho.com/index.php~practiceId=10041&dir=article&lib=Article&articleId=2260.html

Orthopaedic Surgery and Sports Medicine at the University of Washington - Surgical options for early arthritis

http://www.orthop.washington.edu/uw/microfracture/tabID__3351/ItemID__288/PageID__3/Articles/Default.aspx

Joint Preservation Center, Texas – About ACI

http://www.jointpreservationcenter.com/about_aci.html

BBC News – Growing a new knee

http://news.bbc.co.uk/1/hi/health/1556883.stm

Action Medical Research – Growing your own knee cartilage!

http://www.action.org.uk/touching_lives/2003/09/knee_cartilage_repair/

eOrthopod - A Patient's Guide to Articular Cartilage Problems of the Knee

http://www.eorthopod.com/public/patient_education/6509/articular_cartilage_problems_of_the_knee.html