Treatment in Germany knee joint by autogenous cartilage transplantation — a new method in orthopedics!
Own (autogenous) cartilage cells, which are then used for «grafting», are cultured in the laboratory.
Cartilage (cartilage cells or chondrocytes) transplantation is an operation that helps repair cartilage damage by replacing dead cells with new ones. Only trained specialists can perform this procedure successfully.
The benefits of cartilage cell transplantation include:
— reduction and sometimes complete elimination of pain;
— increased tolerance to exertion;
— improving joint mobility;
— rebuilding the cartilage layer;
— the rejection of the artificial joint.
Thanks to the fact that real cartilage tissue can now be added to the defect, it is now possible for the first time to eliminate the problem completely. Previously, it was assumed that cartilage could not be repaired, but only slowed down the process of its destruction.
Cartilage transplantation — the essence of the process
Autologous cells (i.e. human cells) are used for transplantation. These cartilage cells are grown directly in our laboratory. For this purpose, endoscopic visualization is performed to assess the condition of the joint, the amount of damage, and to take a sample of cells from the undamaged cartilage. They are then sent to the laboratory and multiplied outside the body in a test tube.
The transplantation procedure itself is a minimal surgical intervention by arthroscopy. Two small incisions (1-2 cm) are made, through which cells are injected with a special device.
There are many causes of joint damage: trauma, fractures, inflammation… I can’t list them all. However, the final process is often the same — partial or complete destruction of cartilage tissue, which leads to osteoarthritis. Cartilage is virtually incapable of regeneration, and with age, the situation progressively worsens. This leads to pain, difficulty in movement, and sometimes complete immobilization in the damaged joints.
Only cartilage transplantation can create the effect of regeneration, i.e. complete restoration of structurally and functionally identical cartilage tissue.
In certain circumstances, further development of such a method of treating cartilage damage using 3D chondrospheres, along with autogenous cartilage transplantation (also autogenous chondrocyte transplantation, abbreviated ATX), offers the possibility of preventing the need for early joint replacement .
Transplantation of own cartilage cells provides for certain differences between the classic ATX method and the advanced version of ATX in 3D.
In the case of classic ATX, the autogenous periosteum is sutured into the area of the treated defect under waterproof conditions, followed by injection of the grown own cartilage cells into this cavity.
Three-dimensional cartilage cell transplantation (autologous matrix-induced chondrocyte transplantation, abbreviated as ATX 3D) involves the introduction of three-dimensional cartilage cell spheroids (spheroids) into the area of the treated defect without the need to remove the coating.
This surgical intervention is performed using the microarthrotomy technique under arthroscopic control. This method provides the gentlest possible treatment (minimally invasive), thus significantly reducing the risks associated with surgery.
The viability of the cartilage tissue surrounding the defect is more significant when compared to the actual age of the patient.
Surgical technique
Stage: collection of a cartilage sample (biopsy) of the knee joint(taking a sample of knee cartilage).
During arthroscopic intervention (joint endoscopy), first a fragment of your own cartilage tissue is taken. Cartilage cells are isolated from the harvested tissue in a highly specialized cell culture laboratory and then cultured under sterile conditions.
Cartilage tissue is taken from a healthy, minimally stressed area of the joint. The surgical intervention is performed on an outpatient basis within approximately 30 minutes. At the same time, about 120 — 150 ml of blood is taken from the patient. This blood is intended for serum production in the laboratory.
Stage: culturing cells in the laboratory.
Cartilage cells multiply in the patient’s own blood serum. This method eliminates contact with foreign proteins and helps to maintain stable cell growth conditions. In this way, we eliminate the risk of cartilage rejection in the future as much as possible, because only cells from the person being prepared for treatment are used.
The collected sample, the size of a grain of rice, is sent, at the same time as the blood obtained from the patient, to the co.don® AG.
The process of new cell maturation lasts approximately 3 to 4 weeks, when small three-dimensional aggregates of cartilage cells are formed.
At the end of the cultivation time, the biological therapeutic material is sent to the treating physician. The material is transported for several hours under specific conditions, in special refrigerated vessels, in order to preserve the quality of the cells.
Stage: implantation of knee cartilage cells with chondrospheres.
Cartilage balls (chondrospheres) fill the treated cartilage defect in the joint. The cells are immediately fixed to the bone tissue, filling the defect and repairing it.
Once the cartilage spheroids come in contact with the defect itself, their «binding molecules», adhesive proteins, remain relatively mechanically unstable near the bone tissue for about 10 minutes. Cartilage cells then ingrowth into the defect until the defect is completely filled.
This intervention is performed minimally invasively under arthroscopic control and lasts approximately 30-60 minutes. First, the damaged cartilage tissue is removed and then cultured native cartilage cell aggregates are inserted.
The benefits of cartilage cell transplantation have been medically proven in the 25 years of scientific research since the method was developed.
Minimally invasive arthroscopic techniques are now available to repair cartilage defects of the knee, ankle and hip joints.
The implanted material is not perceived by the body as a foreign body, because it has identical properties to natural cartilage.
Thus, living chondrocytes are capable of building a new functioning cartilage layer. Due to the fact that spherically cultured cartilage cells (so-called spheroids) are placed in a second step directly into the area of the damaged joint where there is a lack of cartilage mass, the cells continue to proliferate in the body in the area where cartilage is needed.
This leads to the development of healthy autogenous cartilage tissue that has all the protective properties that the damaged joint lacked.
What happens after surgery?
After 6 weeks, the defect is completely covered with living cartilage cells, which do not yet have the same density and resistance to stress as the surrounding cartilage. Therefore, it is necessary to use a cane to relieve the joint for some time. At the same time, attention should be paid to sufficient mobility of the joint, which will help to improve blood circulation.
Cartilage nutrition is realized by diffusion. When the tissues are compressed, toxins are released and when they are unloaded, nutrients are delivered. Healing is facilitated by special movement splints and physiotherapy.
When is a return to previous workloads possible?
After approximately 6 weeks, you should start partial load bearing, and you should stop using the cane after a maximum of three months.
When are sports allowed?
Cycling, swimming and other sports that are gentle on the joint are allowed after about three months. After complete regeneration of the cartilage defect, approximately one year after surgery, when the new cartilage has completely healed, the joint can be loaded with any kind of sport.
Who can be helped by this method?
Cartilage transplantation is not always a treatment option. If the joint is too large or the joint surface is very badly damaged, it is too late to perform this procedure.
The basic prerequisite for successful cartilage transplantation is a stable joint, a normal articular axis, and the absence of debris in the joint cavity that could damage the graft.
The main indications localized defects of articular cartilage, especially of the knee or ankle joint, are the ideal conditions for transplantation of cartilage cells (chondrocytes). The ideal conditions for transplantation in patients aged 15 — 55 years are a defect size of up to 10 cm2, with healthy residual cartilage tissue.
The knee joint should be stable, i.e. the ligaments should be intact. Unusual stresses on the joint, such as excessive body weight, should be avoided as far as possible.
Thus, although this method is recommended for patients under 55 years of age, the deciding factor is the patient’s biological rather than calendar age.
Clinic stay — 3 days
Rehabilitation period — 8 weeks (including outpatient 2 weeks)
- Prices may vary depending on the patient’s condition.
Treatment of knee joints in Germany by autogenous cartilage transplantation in more than 90% of cases increases the probability of successful treatment and gives positive postoperative results.
- NAME OF SERVICE ADDITIONALLYPRICE, €
- Diagnosis based on submitted documentation Orthopedics 250
- Cartilage cell harvesting surgery Arthroscopy is a minimally invasive intervention 10 000
- Cartilage cell growth Laboratory Medicine 5 000
- Cartilage cell implantation surgery Arthroscopy is a minimally invasive intervention 10 000
- Rehabilitation period Rehabilitation medicine from 300 a day
- Total cost excluding rehabilitation 25 250