The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: LisaV on May 15, 2011, 08:00:35 PM

Title: ACI/CCI surgery. Questions on difference.
Post by: LisaV on May 15, 2011, 08:00:35 PM

On Friday I went in for the second part of the implant surgery on my knee to repair a defect 1.5cm in the cartlidge.
Now there has been a lot of arguements with my medical insurance because they thought I was having an ACI procedure.
Now my specialist has told me its CCI which is different in that the cells are not just grown but sampled and then the best cells are grown.
He said this is a much better option although more expensive as the implant is of a better quality.
I've searched the internet for any info on CCI but can not find anything.
Has anyone any ideas about what this is and a link to more information on it!
I thought I was all clear on this until Friday when I had the procedure and it was explained about CCI and my medical insurance problems.

Any info would be great.

Title: Re: ACI/CCI surgery. Questions on difference.
Post by: Chainsaw_gran on May 16, 2011, 09:03:28 PM
I am interested in your question but I'm not sure what ACI or CCI stand for. There are so many similar procedures with different abbreviations. I have recently had ACIC which stands for Autologous Collogen Induced Chondrogenesis. This is slightlly different from AMIC Autologous Matrix induced Chondrogenesis. Some knee surgeons at the forefront of research are performing procedures not generally recognised by medical insurance companies. I was given a procedure number for osteochondral graft which is the nearest recognisable procedure to the one I had done. This was accepted without question although I was told it may be questioned.
I hope it all works out for you.
Title: Re: ACI/CCI surgery. Questions on difference.
Post by: justin.m on May 17, 2011, 11:21:12 AM
Hi guys,

I am in my orthopaedics residency, so just starting to dive into this amazing world of orthopaedics.
However, i have been studying this biological cartilage replacement for a while now.
Simply put it -
ACI (autologous chondrovyte implantation) is a 1st generation of cartilalge regeneration (cells grown from patients' cartilage biopsy, then multiplied in the lab and replanted during second open operation under the periosteal patch).
MACI (or ACI w/ matrix) means instead of periosteal patch you use collagen membrane (usually type I/III).
CCI (characterised chondrocyte implantation) is what you would call 3rd gen, because you get your chondrocytes in to a 3d scaffold (structure made of collagen, hyaluronan), which you combine with characterised chondrocytes. Characterised meaning the ones that are more capable of producing hyaline-like cartilage (namely collagen II) instead of fibrous one. 3d composition helps mimicking actual biological environments.
Since the 3rd gen operation is the most challenging one it is the most expensive.
hope this helps, will answer any questions if you'd like  ;)
Title: Re: ACI/CCI surgery. Questions on difference.
Post by: Chainsaw_gran on May 17, 2011, 04:46:44 PM
Hello again
Well explained; thank you. My ACIC was in presumably 3rd generation as you decribed. I know it is at present specific to my surgeon. I also had Elmslie Trillat and I am now 10 weeks down the line, but in spite of much physio. I have only reached 110 flexion. For much of the time my knee feels as though it is on a vice like grip, which I think is muscle spasm. Is this par for the course? My surgeon has suggested that I go on a CPM machine following sedation, if the flexion has not greatly improved in a month from now. This sounds to me as though it could cause more damage and scarring hence more spasm but obviously he knows what he is doing.  :-\
Title: Re: ACI/CCI surgery. Questions on difference.
Post by: jbob on June 04, 2011, 06:03:30 PM
I am going through this process of the far not working for me at all. I started with alot of pain last September, and finally had an arthoscopy Dec 22 2010. My doc said to go with the ACI procedure in witch he took a biopsy in Dec. I had alot of insurance issues that ended up canceling the first sugery date of Feb 12. I finally got that taken care of and then had a new date scheduled for May 12 2011. I then got a call two days before the sugery saying my cells didn't grow and they would need to start the process of growing them all over again. My doc then scheduled a new date of June 9 2011. I got a call from Genzyme that my cells didn't grow again. Now my doc wants to go for a second biopsy to try to grow my cells again. He says this is still the best option for me. I really don't know what to do now. I am still in alot of pain and not able to staighten my knee to walk normally since last Dec from the arthoscopy. Do I go in for another biopsy...or is there another option for someone with a large defect in their cartilage??? I'm not sure that my cells will grow this time, since this has already failed me twice??? I would love any info that anyone has regaring this or anyone that has gone through this already??