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Treatment of large full-thickness chondral defects of the knee with autologous chondrocyte implantation

      As treatment options for repair of articular cartilage defects have continued to evolve over the past decade with promising new techniques of tissue transfer using osteochondral autografts and allografts as well as cellular repair with autologous chondrocyte implantation, there has been intense focus on optimizing the use of these methods. While no treatment option is ideal for all full-thickness cartilage defects, nonetheless, the goal remains a repair that can restore the normal surface congruity of the joint, control the patients’ symptoms, maintain the durability to withstand the intra-articular forces of the knee over time, and prevent the progression of focal chondral injuries to osteoarthritis. These newer treatment methods continue to be evaluated as to their indications, consistency and reproducibility of outcomes, durability of repair, and cost-effectiveness.
      • Minas T.
      Chondrocyte implantation in the repair of chondral lesions of the knee Economics and quality of life.
      The technique of autologous chondrocyte implantation (ACI), first reported by Brittberg et al.
      • Brittberg M.
      • Lindahl A.
      • Nilsson A.
      • Ohlsson C.
      • Isaksson O.
      • Peterson L.
      Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.
      in 1994, has gained considerable interest and acceptance, particularly for treatment of large full-thickness chondral injuries. In this technique, a small biopsy specimen of healthy chondral tissue is obtained arthroscopically when the lesion is identified and then undergoes in vitro chondrocyte cell culture returning a 12-fold increase in autologous chondrocyte cells available for implantation into the defect at the second stage of the procedure. The principle behind using autologous chondrocytes is to produce a repair tissue that more closely resembles the morphologic characteristics of hyaline cartilage, and is thus better able to restore the durability and natural function of the knee joint.
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