Treatment with Carticel

A treat for your damaged knee cartilage.

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Carticel uses your own cartilage cells (chondrocytes) to treat and repair the articular cartilage damage in your knee.

When implanted into a knee cartilage injury, your own cells can form new cartilage; this new cartilage is very similar to your original cartilage.

The Carticel implantation procedure is called autologous chondrocyte implantation (ACI)


Biopsy: There’s a little bit of you in Carticel.

Step 1: Cartilage biopsy

Harvest site
Cartilage defect
Cartilage biopsy transport container

Knee Cartilage Arthroscopy and Biopsy

Once your orthopedist confirms the likelihood of a cartilage injury that is right for Carticel treatment, all you need to do is confirm your desire to move forward with the Carticel treatment process.

  1. Your orthopedic surgeon will complete the arthroscopic procedure by harvesting a small piece of cartilage to be used as your biopsy.
  2. Your Carticel Care Coordinator will then work with you, your insurance provider, and your orthopedist’s staff to get your Carticel treatment approved and scheduled.
  3. Meanwhile, our state-of-the-art, FDA-licensed and regulated cell processing facility will be hard at work, multiplying your biopsy into millions of chondrocytes in preparation for implantation.

Carticel Manufacturing and Delivery

  1. Cell Processing: Our cell processing manufacturing facility uses specific enzymes to free your cartilage cells (chondrocytes) from the cartilage matrix. Then your chondrocytes begin the initial culturing (multiplying) phase, lasting approximately 14 days. At this point, your cultured chondrocytes are placed into cryopreservation until implantation surgery can be scheduled at a time determined by you and your orthopedist.
  2. Final Phase: During this final phase, your chondrocytes are cultured (multiplied) until there are approximately 12 million cells per vial. Depending on the size and amount of cartilage defects, more than one vial may be produced (up to 4). We have you covered!
  3. Quality and Safety. Every step of the manufacturing process is vigorously monitored to ensure the highest quality and safety possible. Before your Carticel vial(s) are shipped, they undergo final quality assurance testing. Assays are utilized to ensure that the viability and identity of your cultured chondrocytes meet our very high standards.After passing these tests, a courier will deliver your Carticel vial(s) to your treatment facility, arriving hours before your procedure.

Implantation: Several million reasons why Carticel can restore your cartilage.

Cartilage Injury Cleaned

Cartilage defect trimmed/prepared

During the Carticel implantation procedure, your orthopedic surgeon makes an incision to expose your knee and removes any dead or damaged cartilage tissue from the injury, leaving only healthy tissue.

Carticel Implantation

Your surgeon injects Carticel under the patch. Your chondrocytes stay within the defect and adhere to the bone bed’s defect, then begin the formation of cartilage matrix. The cartilage matrix will grow and harden throughout your rehabilitation period.

Rehabilitation: The surgeon is done. Now it’s your turn.

After the surgery is finished, it’s time to get to work on rehabilitating your knee.

After the Surgical Procedure

Following Carticel implantation surgery, each patient requires personalized considerations for their rehabilitation regimen. That said, your surgeon and physical therapist will most likely follow our clinically researched and validated rehabilitation protocol.

This protocol has been studied and widely used for years, and provides a proven regimen to help you achieve a successful outcome.

This is what you might expect:

  • Immediately after your knee surgery, you will be brought to the recovery room.
  • As the anesthesia wears off, you may feel tired and slightly disoriented; the after effects can vary greatly from person to person.
  • Typically for 4 to 6 hours your knee will be in a brace that locks it straight out.
  • After 6 hours you may begin to use a continuous passive motion (CPM) machine. This passive motion helps to prevent stiffness in your knee joint while nourishing your articular cartilage and preventing adhesions from forming.
  • Before you leave the treatment facility, your physical therapist will teach you how to safely transfer from sitting to standing, putting minimal weight on your healing knee.

Discharge Criteria

A member of your medical team will see you to determine the timing of your discharge following knee surgery and recovery. Their decision may be based on:

  • Adequate pain management on oral medications
  • Normal temperature (no fever)
  • Ability to get in and out of bed without help
  • Ability to walk with crutches

After implantation, rehabilitation.

With Carticel, rehabilitation begins within hours after surgery. Every patient and injury is different, so everyone progresses through rehabilitation at a different pace. However, for all patients, rehabilitation is vital to a successful outcome with Carticel.

Remember, all surgical procedures have recovery time involved. Following your rehabilitation protocol is an investment in yourself and your future ability. No matter what kind of rehabilitation your doctor prescribes for you, it’s important to follow it exactly.

Post-surgery follow-up

Most surgeons will require routine follow-up visits, generally at 2, 4, and/or 6 weeks, 3 months, and 6 months.

Leg brace

Your doctor may recommend you wear a leg brace for the first 2 to 4 weeks—even while you sleep.

Bracing your leg protects it from movements that might injure your knee, including twisting and turning.

You should take it off only when you are using the CPM (continuous passive motion) machine or during other physical therapy.

Physical therapy

Your doctor will send you home with specific physical therapy exercises, a list of dos and don’ts, and crutches. You may also receive a CPM machine, which helps restore motion to your knee.

Pain management

As with any surgery, the first week after Carticel implantation is usually the most uncomfortable; your doctor will discuss your individual pain management with you in more detail.

After the first week, medication may be only necessary before physical therapy exercises and at bedtime.

Normal activity

While the length of your recovery depends on many factors, most patients can perform normal activities like walking or driving relatively quickly.

How soon you can return to work or other activities depends on how much stress those activities place on your healing knee.

Patients may return to various sport activities as progression in rehabilitation and cartilage healing allows. However, always follow the advice of your medical team.

Rehabilitation is a team sport.

An important principle of your rehabilitation involves taking a team approach with your orthopedic surgeon and physical therapist.

There are four distinct phases you will experience as you progress through rehabilitation. As you achieve your goals, your physical therapist will help you move on to the next phase.

Here are some general guidelines:

0 to 6 weeks: Protection. During the first phase of rehabilitation, Carticel begins to fill the injured area with soft repair tissue. It is critical that the area be protected.

  • Protect healing tissue from movement and weight
  • Decrease pain and swelling
  • Gradually improve knee’s ability to flex and extend
  • Regain quadriceps control

6 to 12 weeks: Transition. For the second phase, the repair tissue is spongy and remains fairly soft. So protection is still required. Toward the end of this phase, as the tissue continues to mature, you’re typically able to bear full weight on your knee and resume most daily activities.

  • Obtain full range of motion
  • Further improve strength and endurance of quadriceps and hamstrings
  • Increase endurance of functional activities

12 to 26 weeks: Maturation. As your repair tissue becomes firmer and has a hardness like that of soft plastic, you should be able to perform more functional and physical therapy activities, and notice improvements of symptoms and more normal motion of the knee.

  • Improve muscular strength and endurance
  • Improve balance and stability
  • Achieve full range of motion and functional activities by the end of this phase with minimal or no pain and swelling

6 to 18 months: Active. During the final phase of your rehabilitation, the repair tissue reaches full maturity and its firmness resembles that of the surrounding cartilage.

  • Gradual return to full, unrestricted functional activities

Patients may return to various sports activities as progression and rehabilitation of cartilage healing allows.

Individual results may vary. Many patients are able to participate in sports with some limitations.