Purpose
The purpose of this study was to examine the Level I and II evidence for newer generations
of autologous chondrocyte implantation (ACI) versus first-generation ACI and to establish
whether the newer generations have overcome the limitations associated with first-generation
ACI.
Methods
A literature search was carried out for Level I and II evidence studies on cartilage
repair using the PubMed database. All the studies that dealt with ACI were identified.
Only Level I and II studies that compared newer generations against earlier generations
were selected, whereas studies that compared ACI against other methods of cartilage
repair were excluded.
Results
A total of 7 studies matched the selection criteria. Two studies compared periosteum-based
autologous chondrocyte implantation (P-ACI) against collagen membrane–based autologous
chondrocyte implantation (C-ACI), whereas one study each compared membrane-associated
autologous chondrocyte implantation (MACI) against P-ACI and C-ACI. One study on C-ACI
compared results related to age, whereas 2 studies evaluated postoperative rehabilitation
after MACI. There was weak evidence showing that C-ACI is better than P-ACI and that
MACI is comparable with both P-ACI and C-ACI. The weak evidence is because of studies
with short durations of follow-up, small numbers of patients, medium-sized defects,
and younger age groups. There is good evidence favoring an accelerated weight-bearing
regimen after MACI. There is currently no evidence that supports scaffold-based ACI
or arthroscopic implantation over first-generation ACI.
Conclusions
The hypothesis is thus partly proved in favor of C-ACI/MACI against P-ACI with weak
evidence, in favor of accelerated weight bearing after MACI with strong evidence,
and not in favor of arthroscopic and scaffold-based implantations because of unavailable
evidence.
Level of Evidence
Level II, systematic review of Level I and II studies.
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Article Info
Publication History
Published online: September 30, 2013
Accepted:
July 17,
2013
Received:
July 11,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.