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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.N Engl J Med. 1994; 331: 889-895
- Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: A 2-year randomised study.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 519-527
- Cell carriers as the next generation of cell therapy for cartilage repair: A review of the matrix-induced autologous chondrocyte implantation procedure.Am J Sports Med. 2010; 38: 1259-1271
- Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: A prospective, randomised study.J Bone Joint Surg Br. 2005; 87: 640-645
- The arthroscopic implantation of autologous chondrocytes for the treatment of full-thickness cartilage defects of the knee joint.Arthroscopy. 2003; 19: 108-110
- Autologous chondrocyte implantation in the knee joint: Open compared with arthroscopic technique. Comparison at a minimum follow-up of five years.J Bone Joint Surg Am. 2008; 90: 90-101
- Second generation issues in cartilage repair.Sports Med Arthrosc. 2008; 16: 221-229
- Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: Prospective nonrandomized study at 5 years.Am J Sports Med. 2009; 37: 33-41
- Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques.Am J Sports Med. 2009; 37: 902-908
- Two- to 9-year outcome after autologous chondrocyte transplantation of the knee.Clin Orthop Relat Res. 2000; : 212-234
- Effect of gravity on localization of chondrocytes implanted in cartilage defects.Clin Orthop Relat Res. 2002; : 254-262
- The use of chondrogide membrane in autologous chondrocyte implantation.Knee. 2004; 11: 51-55
- A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee.J Bone Joint Surg Br. 2003; 85: 223-230
- Treatment of focal degenerative cartilage defects with polymer-based autologous chondrocyte grafts: Four-year clinical results.Arthritis Res Ther. 2009; 11: R33
- Arthroscopic autologous chondrocyte transplantation: Technical note.Knee Surg Sports Traumatol Arthrosc. 2002; 10: 154-159
- A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered.Knee. 2006; 13: 203-210
- Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)—5-Year follow-up.Knee. 2006; 13: 194-202
- Autologous chondrocyte implantation using a bilayer collagen membrane: A preliminary report.J Orthop Surg (Hong Kong). 2003; 11: 10-15
- Articular cartilage treatment in high-level male soccer players: A prospective comparative study of arthroscopic second-generation autologous chondrocyte implantation versus microfracture.Am J Sports Med. 2011; 39: 2549-2557
- Autologous chondrocyte implantation using the original periosteum-cover technique versus matrix-associated autologous chondrocyte implantation: A randomized clinical trial.Am J Sports Med. 2010; 38: 924-933
- Evidence-based status of microfracture technique: A systematic review of level I and II studies.Arthroscopy. 2013; 29: 1579-1588
- Comparative evaluation of autologous chondrocyte implantation and mosaicplasty: A multicentered randomized clinical trial.Clin J Sport Med. 2005; 15: 220-226
- A randomized trial comparing accelerated and traditional approaches to postoperative weight bearing rehabilitation after matrix-induced autologous chondrocyte implantation: Findings at 5 years.Am J Sports Med. 2012; 40: 1527-1537
- Osteochondral lesions of the talus: Randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation.Arthroscopy. 2006; 22: 1085-1092
- Comparison of osteochondral autologous transplantation, microfracture, or debridement techniques in articular cartilage lesions associated with anterior cruciate ligament injury: A prospective study with a 3-year follow-up.Arthroscopy. 2013; 29: 89-97
- Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes.Am J Sports Med. 2012; 40: 2499-2508
- A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes.Arthroscopy. 2005; 21: 1066-1075
- A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children.J Pediatr Orthop. 2009; 29: 741-748
- Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 834-842
- Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial.J Bone Joint Surg Am. 2003; 85: 185-192
- A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years.J Bone Joint Surg Am. 2007; 89: 2105-2112
- Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial.J Bone Joint Surg Am. 2004; 86: 455-464
- Importance of sports in cartilage regeneration after autologous chondrocyte implantation: A prospective study with a 3-year follow-up.Am J Sports Med. 2007; 35: 1261-1268
- Current treatments of isolated articular cartilage lesions of the knee achieve similar outcomes.Clin Orthop Relat Res. 2012; 470: 2261-2267
- Treatment of focal articular cartilage defects in the knee: A systematic review.Clin Orthop Relat Res. 2008; 466: 952-962
- Autologous chondrocyte implantation for treatment of focal cartilage defects in patients age 40 years and older: A matched-pair analysis with 2-year follow-up.Am J Sports Med. 2010; 38: 2410-2416
- Cost-effectiveness analysis of autologous chondrocyte implantation: A comparison of periosteal patch versus type I/III collagen membrane.Am J Sports Med. 2012; 40: 1252-1258
- Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture.Am J Sports Med. 2008; 36: 235-246
- Treatment of symptomatic cartilage defects of the knee: Characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture.Am J Sports Med. 2009; 37: 10S-19S
- Autologous chondrocyte implantation versus microfracture for knee cartilage injury: A prospective randomized trial, with 2-year follow-up.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 486-495
- Physical activity levels after characterized chondrocyte implantation versus microfracture in the knee and the relationship to objective functional outcome with 2-year follow-up.Am J Sports Med. 2009; 37: 42S-49S
- Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: Early treatment matters.Am J Sports Med. 2011; 39: 2566-2574
- Autologous chondrocyte implantation for the treatment of cartilage lesions of the knee: A systematic review of randomized studies.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1645-1655
- Treatment of deep cartilage defects of the knee using autologous chondrograft transplantation and by abrasive techniques—A randomized controlled study.Acta Chir Belg. 2004; 104: 709-714
- Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees.Osteoarthritis Cartilage. 2002; 10: 199-206
- Effect of accelerated weight bearing after matrix-associated autologous chondrocyte implantation on the femoral condyle on radiographic and clinical outcome after 2 years: A prospective, randomized controlled pilot study.Am J Sports Med. 2009; 37: 88S-96S
- A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: Results of the Study of the Treatment of Articular Repair (STAR) clinical trial.Am J Sports Med. 2009; 37: 42-55
- Articular cartilage engineering with autologous chondrocyte transplantation. A review of recent developments.J Bone Joint Surg Am. 2003; 85: 109-115
- Autologous chondrocyte implantation: A long-term follow-up.Am J Sports Med. 2010; 38: 1117-1124
- Autologous cultured chondrocytes: Adverse events reported to the United States Food and Drug Administration.J Bone Joint Surg Am. 2006; 88: 503-507
- Evidence for redifferentiation of human chondrocytes grown on a hyaluronan-based biomaterial (HYAff 11): Molecular, immunohistochemical and ultrastructural analysis.Biomaterials. 2002; 23: 1187-1195
- Return to sports participation after articular cartilage repair in the knee: Scientific evidence.Am J Sports Med. 2009; 37: 167S-176S
- Who is the ideal candidate for autologous chondrocyte implantation?.J Bone Joint Surg Br. 2006; 88: 61-64
- Early postoperative adherence of matrix-induced autologous chondrocyte implantation for the treatment of full-thickness cartilage defects of the femoral condyle.Knee Surg Sports Traumatol Arthrosc. 2005; 13: 451-457
- Influence of fibrin sealant (Tisseel) on osteochondral defect repair in the rabbit knee.Biomaterials. 1997; 18: 235-242
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.
