Annex B - The Next Few Months

What to expect for 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.

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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

University of Pittsburgh Medical Center - Articular Cartilage Regeneration
http://www.orthopedictechreview.com/issues/janfeb02/case.htm

Arlington Orthopedic Associates - Surgery & Rehabilitation
http://arlingtonortho.com/