RESUMO
Autologous chondrocyte implantation (ACI) is a widely accepted procedure for the treatment of large, fullthickness chondral defects involving various joints, but its use in developing countries is limited because of high cost and failure rates due to limited resources and support systems. Five patients (age <45 years) with focal cartilage defects received ACI at University of Malaya from 2006 to 2007 and followed up for 36 months. The average presubjective Knee Evaluation Forms (IKDC) improved from 38.44±6.29 to 25.6±8.04 postoperatively, the Oxford Knee Score (OKS) went from 25.6±8.04 to 13.96±1.63 and the American Knee Society Score (AKSS) improved from 80±14.33 to 92.96±5.82 post-operatively. Thus improvements were seen in the IKDC and AKSS score but not in the OKS. Magnetic resonance images showed the presence of cartilage tissue filling in the lateral and medial patellar facet and medial femoral condyle in three patients. Failures were seen in two patients, both with patellar defects and over the age of 36 years. Treatment with autologous chondrocyte implantation for focal cartilage defect in lateral and medial patellar facet and medial femoral condyle showed early improvement which was maintained at 3 yrs follow-up. ACI provided satisfactory outcome in focal cartilage defects involving the femoral condyle.
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CondrócitosRESUMO
Context: Rehabilitation Medicine is dedicated to optimise patients function and health in the most comprehensive manner. ICF, the latest International Classification by World Health Organization (WHO) is a conceptual framework for the assessment of functioning, disability and health. The purpose of this paper is to describe the applications of ICF in Rehabilitation Medicine practice in the Medical Rehabilitation Unit, University of Malaya Medical Centre (UMMC), Kuala Lumpur. Issues: ICF consists of body function, structure, activity, participation and environmental factor. ICF categories are exhaustive, but are not practical to be used entirely and not applicable in clinical practice on their own. How is ICF used from the clinical perspective? It has to be adapted to make it usable. In Rehabilitation Medicine settings, the following are ways ICF is applied in clinical practice: research in terms of validating the use of available ICF Core Sets and development of new ICF Core Set; clinical practice based on the ICF-based sheet; and educational tools. Conclusion: The practice of Rehabilitation Medicine is in line and compatible with the concept of ICF and can serve as a new important language that can improve the practice of Rehabilitation Medicine. It can be a universal language in functioning, disability and health and can improve understanding in addressing issues on disability within the medical community, improve multi professionals’ communication among patients, healthcare providers and stakeholders.
