Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 12, pp 1645–1655

Autologous chondrocyte implantation for the treatment of cartilage lesions of the knee: a systematic review of randomized studies

  • Haris S. Vasiliadis
  • Jason Wasiak
  • Georgia Salanti


Autologous chondrocyte implantation (ACI) techniques are becoming more popular for the treatment of full thickness cartilage lesions of the knee joint. However, there is no systematic information for the efficacy of the new generation ACI techniques compared to other treatment options. A systematic review of the existing evidence from randomized clinical trials of ACI treatment would contribute to understanding the advantages and limitations of this method and would inform the planning of future studies. Using pre-defined criteria, we searched a number of electronic databases to identify all the existing randomized control trials of any type of ACI treatment. Risk of bias was assessed and an analysis of the reported outcomes was performed. Information on the clinical efficacy and safety of ACI compared to other interventions was collected and presented. Nine trials were identified with 626 patients. Patients ranged from 15 to 52 years, and the size of treated lesions was between 1 and 22 cm2. ACI was associated with improvement in clinical outcomes compared to baseline. However, the body of evidence did not suggest any superiority of ACI over other treatments. Complication rates were comparable between interventions except from an increased rate of graft hypertrophies after ACI with periosteum. ACI is an effective treatment for full thickness chondral defects of the knee, providing an improvement of clinical outcomes. However, there is insufficient data to say whether ACI is superior to other treatment strategies. More high quality studies and harmonization in the reported outcomes are needed before specific suggestions for practice can be made.


Cartilage Chondrocyte implantation Knee Repair Chondral Systematic review 

Supplementary material

167_2010_1050_MOESM1_ESM.doc (262 kb)
(DOC 262 kb)


  1. 1.
    Bartlett W, Gooding CR, Carrington RW, Skinner JA, Briggs TW, Bentley G (2005) Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft. A preliminary report. J Bone Joint Surg Br 87:330–332CrossRefPubMedGoogle Scholar
  2. 2.
    Bartlett W, Skinner JA, Gooding CR et al (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87:640–645CrossRefPubMedGoogle Scholar
  3. 3.
    Basad E, Sturz H, Steinmeyer J (2004) Die Behandlung chondraler Defekte mit MACI oder Microfracture—Erste Ergebnisse einer vergleichenden klinischen Studie. Orthopadische Praxis 40:6–10Google Scholar
  4. 4.
    Bentley G, Biant LC, Carrington RW et al (2003) A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 85:223–230CrossRefPubMedGoogle Scholar
  5. 5.
    Brittberg M (2008) Autologous chondrocyte implantation—technique and long-term follow-up. Injury 39(Suppl 1):S40–S49CrossRefPubMedGoogle Scholar
  6. 6.
    Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889–895CrossRefPubMedGoogle Scholar
  7. 7.
    Browne JE, Branch TP (2000) Surgical alternatives for treatment of articular cartilage lesions. J Am Acad Orthop Surg 8:180–189PubMedGoogle Scholar
  8. 8.
    Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460CrossRefPubMedGoogle Scholar
  9. 9.
    Dozin B, Malpeli M, Cancedda R et al (2005) Comparative evaluation of autologous chondrocyte implantation and mosaicplasty: a multicentered randomized clinical trial. Clin J Sport Med 15:220–226CrossRefPubMedGoogle Scholar
  10. 10.
    Ficat RP, Ficat C, Gedeon P, Toussaint JB (1979) Spongialization: a new treatment for diseased patellae. Clin Orthop Relat Res 144:74–83PubMedGoogle Scholar
  11. 11.
    Ghazavi MT, Pritzker KP, Davis AM, Gross AE (1997) Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br 79:1008–1013CrossRefPubMedGoogle Scholar
  12. 12.
    Gooding CR, Bartlett W, Bentley G, Skinner JA, Carrington R, Flanagan A (2006) 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 13:203–210CrossRefPubMedGoogle Scholar
  13. 13.
    Hangody L, Kish G, Karpati Z, Udvarhelyi I, Szigeti I, Bely M (1998) Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. Orthopedics 21:751–756PubMedGoogle Scholar
  14. 14.
    Higgins JPT, Green S (2008) Cochrane handbook for systematic reviews of interventions. Wiley, LondonCrossRefGoogle Scholar
  15. 15.
    Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18:730–734CrossRefPubMedGoogle Scholar
  16. 16.
    Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R (2003) Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am 85-A:185–192PubMedGoogle Scholar
  17. 17.
    Hunziker EB (2002) Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects. Osteoarthr Cartil 10:432–463CrossRefPubMedGoogle Scholar
  18. 18.
    Ito Y, Fitzsimmons JS, Sanyal A, Mello MA, Mukherjee N, O’Driscoll SW (2001) Localization of chondrocyte precursors in periosteum. Osteoarthr Cartil 9:215–223CrossRefPubMedGoogle Scholar
  19. 19.
    Johnson LL (2001) Arthroscopic abrasion arthroplasty: a review. Clin Orthop Relat Res (391 Suppl):S306–S317Google Scholar
  20. 20.
    Jones DG, Peterson L (2007) Autologous chondrocyte implantation. Instr Course Lect 56:429–445PubMedGoogle Scholar
  21. 21.
    Knutsen G, Drogset JO, Engebretsen L et al (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89:2105–2112CrossRefPubMedGoogle Scholar
  22. 22.
    Knutsen G, Engebretsen L, Ludvigsen TC et al (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86-A:455–464PubMedGoogle Scholar
  23. 23.
    Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M (2009) 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 37:33–41CrossRefPubMedGoogle Scholar
  24. 24.
    Marcacci M, Berruto M, Brocchetta D et al. (2005) Articular cartilage engineering with Hyalograft C: 3-year clinical results. Clin Orthop Relat Res 435:96–105Google Scholar
  25. 25.
    Minas T (1998) Chondrocyte implantation in the repair of chondral lesions of the knee: economics and quality of life. Am J Orthop 27:739–744PubMedGoogle Scholar
  26. 26.
    Peterson L (2005) Autologous cartilage implantation: cartilage biopsy, cartilage implantation. In: Cushner FD, Norman Scott W, Scuderi GR (eds) Surgical techniques for the knee. Thieme, New York, pp 41–46Google Scholar
  27. 27.
    Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation. A long term follow up. Am J Sports Med [epud ahead of print]Google Scholar
  28. 28.
    Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30:2–12PubMedGoogle Scholar
  29. 29.
    Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 374:212–234CrossRefPubMedGoogle Scholar
  30. 30.
    Roberts S, McCall IW, Darby AJ et al (2003) Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology. Arthritis Res Ther 5:R60–R73CrossRefPubMedGoogle Scholar
  31. 31.
    Saris DB, Vanlauwe J, Victor J et al (2009) 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 37(Suppl 1):10S–19SCrossRefPubMedGoogle Scholar
  32. 32.
    Saris DB, Vanlauwe J, Victor J et al (2008) 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 36:235–246CrossRefPubMedGoogle Scholar
  33. 33.
    Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am 75:532–553PubMedGoogle Scholar
  34. 34.
    Shelbourne KD, Jari S, Gray T (2003) Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J Bone Joint Surg Am 85-A(Suppl 2):8–16PubMedGoogle Scholar
  35. 35.
    Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484CrossRefPubMedGoogle Scholar
  36. 36.
    Steinwachs M, Kreuz PC (2007) Autologous chondrocyte implantation in chondral defects of the knee with a type I/III collagen membrane: a prospective study with a 3-year follow-up. Arthroscopy 23:381–387CrossRefPubMedGoogle Scholar
  37. 37.
    Van AD, Staes F, Van CD et al. (2009) Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc [epud ahead of print]Google Scholar
  38. 38.
    Vasiliadis HS, Danielson B, McKeon B, Lindahl A, Peterson L (2010) Autologous chondrocyte implantation in cartilage lesions of the knee. Long term evaluation with MRI and delayed gadolinium enhanced MRI technique. Am J Sports Med [epud ahead of print]Google Scholar
  39. 39.
    Visna P, Pasa L, Cizmar I, Hart R, Hoch J (2004) Treatment of deep cartilage defects of the knee using autologous chondrograft transplantation and by abrasive techniques—a randomized controlled study. Acta Chir Belg 104:709–714PubMedGoogle Scholar
  40. 40.
    Wasiak J, Vasiliadis HS, Villanueva E (2010) Autologous chondrocyte implantation for full thickness articular cartilage defects of the knee. Cochrane Database Syst Rev. CD003323 [epud ahead of print]Google Scholar
  41. 41.
    Wood JJ, Malek MA, Frassica FJ et al (2006) Autologous cultured chondrocytes: adverse events reported to the United States Food and Drug Administration. J Bone Joint Surg Am 88:503–507CrossRefPubMedGoogle Scholar
  42. 42.
    Zaslav K, Cole B, Brewster R et al (2009) 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 37:42–55CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Haris S. Vasiliadis
    • 1
    • 2
  • Jason Wasiak
    • 3
  • Georgia Salanti
    • 4
  1. 1.Orthopaedic Sports Medicine Center, Department of Orthopaedics, School of MedicineUniversity of IoanninaIoanninaGreece
  2. 2.Molecular Cell Biology and Regenerative Medicine, Sahlgrenska University HospitalGothenburg UniversityGothenburgSweden
  3. 3.Victorian Adult Burns Service and School of Public Health and Preventative Medicine, Alfred HospitalMonash UniversityMelbourneAustralia
  4. 4.Clinical and Molecular Epidemiology Unit, Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece

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