Alternative treatment to autologous chondrocyte implantation
Bone Marrow Prolotherapy: A great alternative treatment to Autologous Chondrocyte Implantation (ACI)
By Ross Hauser, MD
For those patients with full-thickness or large focal cartilage defects one of the mainstay surgical procedures is autologous chondrocyte implantation (ACI). Some of the limitations of ACI include the need for general anesthesia for two knee procedures, difficulty in obtaining adequate number of chondrocytes, a slow rate of chondrocyte proliferation, and donor-site morbidity.1
Another downside of ACI is the due to the fact that results just aren’t that good (in my opinion) compared to Prolotherapy. Some of the major advantages of using bone marrow as a cell source for cartilage repair are the easy ability to harvest a sufficient number of cells, acceptable cellular proliferation capacity, trophic effect on neighbor cartilage tissues, acceptable capacity for chondrogenic differentiation, and less donor-site morbidity.1
So let’s look at the actual procedures and you decide which one you would rather have:
PROCEDURE HOSPITALIZATION DONOR-SITE MORBIDITY COST
ACI Yes – twice Yes $130,000
BMP Outpatient No <$10,000
Other comparisons:
PROCEDURE OUTPATIENT REHAB TIME: TIME OFF WORK
ACI Months and months Lots of MD appts & missed days of work
BMP None Very little
Difference in procedures: Autologous chondrocyte implantation involves taking healthy cartilage cells from the patient’s knee and growing them in a lab. What folks may forget is that the cartilage extraction site doesn’t repair that well, so there is donor-site morbidity. Yes, that site itself can become degenerated. Another serious point that needs to be made is that ACI requires the patient to undergo general anesthesia. I don’t know about you, but I avoid that at all possible cost.
Bone marrow Prolotherapy (BMP), on the other hand, is done in a doctor’s office and the whole visit and procedure takes an hour or less. BMP requires limited time off work and no outpatient rehabilitation for most patients. Chondrocyte implantation requires a long period of immobilization of the knee, followed by a major course of outpatient physical therapy to repair the disuse atrophy and stiffness that developed from the immobilization. The whole process costs well over $100,000, whereas direct Bone Marrow Prolotherapy is less than $10,000 start to finish.
As with most surgical procedures, surgery should be a last resort after more conservative treatments have failed. Bone Marrow Prolotherapy is a great alternative treatment to autologous chondrocyte implantation or microfracture. In this technique Bone Marrow is directly injected into joints to stimulate repair of injured musculoskeletal tissues such as ligaments, tendons, menisci and cartilage. Typically patients are seen for four to six visits, every six to eight weeks. This is a much simpler process than getting two surgeries under general anesthesia and then receiving outpatient physical therapy at the hospital three times per week for several months.
I don’t know about you, but I choose Bone Marrow Prolotherapy!
1Nejadnik H, Hui JH, Choong EP. Autologous bone marrow-derived mesenchymal stem cells versus autologous chondrocyte implantation: an observational study. The American Journal of Sports Medicine. 2010;38:1110-1116.
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