OSCELL ARTICULAR CARTILAGE CELL IMPLANTATION (FEMORAL CONDYLE SITES) PATIENT ADVICE.

Transcription

1 OSCELL ARTICULAR CARTILAGE CELL IMPLANTATION ( SITES) PATIENT ADVICE. Anatomy of the Right Knee example of a femoral articular defect site Knee Straight Knee Bent KEY: Patella Kneecap Trochlea Groove on the thigh bone lying under the kneecap. Femur Thigh bone Articular Cartilage Protective coating at the end of a bone Articular Defect Area of loss of articular cartilage ACL Anterior Cruciate Ligament Meniscus Crescent shaped washer, commonly referred to as cartilage. Collateral Ligaments Tough bands of tissue, either side of knee that prevent extremes of movement. Fibula Bone at the outside of shin. Tibia Shinbone Articular cartilage is the coating covering the end of a bone. It allows the joint friction-free movement and protects the underlying bone. When articular cartilage is damaged as a 1

2 result of trauma or abnormal wear you may experience pain, swelling and loss of normal function. Mechanical symptoms such as locking, clicking and giving way may also be experienced. This area of damage is often referred to as a defect or lesion. If a defect is present it can often act as sandpaper and go on to wear adjacent joint cartilage. In an attempt to alleviate the problems caused by articular cartilage defects, a relatively new surgical technique has been developed, autologous chondrocyte implantation (ACI). The procedure currently involves two operations, an arthroscopy (keyhole surgery using two or three small incisions) and an arthrotomy (opening and viewing the knee with a larger incision): The first operation is performed arthroscopically and the defect is trimmed back to provide a stable boarder. A biopsy (a sample) will be taken from a healthy, non-weight bearing part of the knee. This biopsy contains the chondrocyte cells that create the articular cartilage. The cells are extracted and grown in the laboratory at the Arthritis Research Centre, Oswestry. This culturing process usually takes three to four weeks. The second operation (usually about three to four weeks following the first), is performed via an arthrotomy. Depending on the criteria of your procedure a patch, which is either a piece of your bone lining/ membrane (periosteum) taken from the adjacent upper shinbone, or alternatively a manufactured porcine patch may be used. The patch is sewn over the defect and the cultured cells are injected under it. The patch may then be sealed with a bovine derived fibrin glue. As the site of your treated defect is over the end of your thigh bone you will have to limit your weight bearing by using elbow crutches for up to eight weeks and follow the rehabilitation guide outlined in this booklet. Your physiotherapist will go through this with you and adapt the guide if necessary. 1. Healthy cells are taken from a non-weight bearing area of the thigh bone (femur). Femoral defect 3. When the cells have multiplied they are returned for implantation. 2. The cells area cultured and grown in the laboratory. 4. Either a periosteal patch is taken from the shinbone (tibia) or a manufactured patch is sewn over the defect. 5. The cells are injected under the patch. Cartilage repair using this procedure is a slow process and maturation usually occurs between twelve to eighteen months following the implantation and can vary between individuals. 2

3 Included in this booklet is a series of exercises specifically for your affected leg. Under the supervision of your physiotherapist you may be able to perform these exercises independently following your discharge home. Your physiotherapist will add other exercises to these to ensure you are conditioning your whole body and he/ she may delete exercises as you progress. Depending on your physiotherapists clinical judgement you may also be offered other physiotherapeutic modalities in order to promote your recovery. You will be under the care of a physiotherapist throughout your rehabilitation. If you cannot attend physiotherapy at RJAH an appointment will be arranged for you elsewhere. If you have any queries involving your rehabilitation then do not hesitate to contact the Physiotherapy Department at RJAH; *andrea.bailey@rjah.nhs.uk (Tel: Fax: EXERCISES FOLLOWING YOUR ARTICULAR CARTILAGE CELL IMPLANT OPERATION. THE OSCELL PROGRAMME Exercise within your own limits if you are uncertain of any of the following exercises STOP and consult your physiotherapist. FROM DAY 1 (as comfort allows): 1. Sitting as below with the thigh muscles of your affected leg relaxed. Move your kneecap side to side and up and down. each direction. 2. Sitting as below, pull foot toward you from the ankle. Tighten the thigh muscles, bracing your knee back straight. 3. As above and lift your straight leg, approximately 6, lower slowly. HOLD sec 3

4 4. Sitting as below, ensuring the non-affected leg is bent, lean forwards from your hips, reaching toward your toes. Feel the stretch at the back of your thigh/knee. 5. As weight bearing allows, (using crutches or parallel bars) lift and lower heels. 6. Standing (limiting your weight bearing as necessary), place your affected leg behind you, keeping your heel in contact with the floor lean forwards. Feel the stretch at the back of your calf/ knee.. 7. Sitting on a chair, hook your non-affected leg under your affected leg, allowing it to take all the weight. Bend and straighten within your limits. 4

5 8. Lying on your front bend and straighten your affected leg within your limit of range and comfort. 9. As above, pausing at various points within your available range. 10. Lying as above, hook your non-affected leg under your affected leg and over press the bend to your limit. 11. If available use a Unicam bike on passive movement setting for treated knee. Range adjusted as necessary. FROM WEEK 3 (as comfort allows): 1. Within the limits of your range of movement and comfort bend and straighten the affected leg. 2. As above pausing at various points in available range. FROM WEEK 4 (as comfort allows): 1. If straight leg raising exercise can be achieved with no bend at the knee, add an ankle weight. Lift straight leg approximately 6, lower slowly. 5

6 2. Cycling on a static exercise bike or Unicam, low resistance. 3. Step touch onto a low step, progress by increasing the height of the step. 4. Use your other leg as a resistance to any of the aforementioned exercises, for example see picture below. FROM WEEK 6 (as comfort allows): 1. As range of movement allows, bend the knee and ease the heel further toward the buttock using the hand on the same side, as shown below. Feel the stretch at the front of the thigh. 2. Sitting on chair bend and straighten the affected leg with an ankle weight. 6

7 3. Lying on front, bend and straighten the affected leg with an ankle weight. 4. Standing allowing recommended ½ body weight through the affected leg, bend and straighten aiming to get the centre of your kneecap travelling over your second toe. FROM WEEK 6-8 (as comfort allows): 1. Standing as below transfer your weight forwards onto your affected leg. Note heel toe movement. Progress from ½ to full body weight at week Standing as above push your weight forwards off your back affected leg. Note toe off movement. Progress from ½ to full body weight at week 8. 7

8 3. Standing as below transfer your body weight side to side. Progress from ½ to full body weight at week As able, balance on affected leg, progress to eyes closed, uneven surfaces etc. (your physiotherapist will guide you) 5. Vary the speed (but maintain control) of any of the aforementioned exercises. FROM WEEK 9 (as comfort allows): 1. Unrestricted weight training. FROM WEEK 11 (as comfort allows): 1. Unlimited gym work, including cycling, stepper, rower, etc (except treadmill jog/ run), tailored to your specific needs. FROM MONTH 6 (as comfort allows): 1. Commence light jogging (on sprung surface). 3. Breaststroke legs/ unlimited swimming. FROM MONTH 8 (as comfort allows): 1. Running as guided. FROM MONTH 9 (as comfort allows): 1. Commence sport specific training, as able. 8

9 FROM 1 YEAR (as comfort allows): 1. Earliest return to contact sport, as able. 9