Comparative analysis of autologous chondrocyte implantation and other treatment modalities: a systematic review

  • Sangeetha Naveen
  • Noorzurani Robson
  • Tunku Kamarul
General Review



The purpose of this systematic review was to analyze and determine the effectiveness of autologous chondrocyte implantation (ACI) when compared with other treatment modalities, which includes microfracture, mosaicplasty, abrasionplasty, bone marrow–derived mesenchymal stem cell (BMSC), and matrix-assisted autologous chondrocyte implantation (MACI).


Literature search using online databases PubMed, Scopus, National Institute for Clinical Excellence and Cochrane controlled trial register regarding all cell-based therapies and other interventions for chondral lesions was explored. Data on clinical outcome and repair quality were analyzed. Duplicates and irrelevant articles were omitted.


Seventeen (n = 17) studies were included in this review. Among the four trials on ACI versus mosaicplasty, two studies showed no differences in clinical scores, one suggested similar performance while the other suggested better results in tissue quality for ACI. A systematically performed assessment comparing ACI with microfracture shows better clinical outcomes and higher tissue quality after ACI. Studies comparing ACI with MACI or BMSC demonstrated similar results. Although many of these studies had substantial flaws, on the overall, the evidence comparing ACI with other treatment modalities shows better clinical outcomes and higher tissue quality.


Despite significant differences between the methodologies employed by different researchers, we can conclude that all except two studies demonstrated ACI being the better treatment for cartilage defects. However, final conclusions regarding long-term effects are still difficult, and therefore, future studies are needed to answer the long-term effects of ACI.


Autologous chondrocyte implantation Articular cartilage Cartilage repair Review Systemic 


  1. 1.
    Behrens P, Bitter T, Kurz B et al (2006) Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI): 5-year follow-up. Knee 13:194–202PubMedCrossRefGoogle Scholar
  2. 2.
    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 85:223–230PubMedCrossRefGoogle Scholar
  3. 3.
    Erggelet C, Steinwachs MR, Reichelt A (2000) The operative treatment of full-thickness cartilage defects in the knee joint with autologouschondrocyte transplantation. Saudi Med J 21(8):715–721Google Scholar
  4. 4.
    Erggelet C, Sittinger M, Lahm A (2003) The arthroscopic implantation of autologouschondrocytes for the treatment of full-thickness cartilage defects of the knee joint. Arthroscopy 19:108–110PubMedGoogle Scholar
  5. 5.
    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 85:185–192PubMedGoogle Scholar
  6. 6.
    Horas U, Schnettler R, Pelinkovic D, Herr G, Aigner T (2000) Osteochondral transplantation versus autogenous chondrocyte transplantation. A prospective comparative clinical study. Chirurg 71:1090–1097Google Scholar
  7. 7.
    Dozin B, Malpeli M, Cancedda R, Bruzzi P, Calcagno S, Molfetta L et al (2005) Comparative evaluation of autologous chondrocyte implantation and mosaicplasty: a multicentered randomized clinical trial. Clin J Sport Med 15:220–226PubMedCrossRefGoogle Scholar
  8. 8.
    Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E et al (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86:455–464PubMedGoogle Scholar
  9. 9.
    Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC et al (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at 5 years. J Bone Joint Surg Am 89:2105–2112PubMedCrossRefGoogle Scholar
  10. 10.
    Van Assche D, Staes F, Van Caspel D, Vanlauwe J, Bellemans J, Saris DB 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 18:486–495PubMedCrossRefGoogle Scholar
  11. 11.
    Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y 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 36:235–246PubMedCrossRefGoogle Scholar
  12. 12.
    Saris DB, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans 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–19SGoogle Scholar
  13. 13.
    Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T (2009) Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med 37:902–908PubMedCrossRefGoogle Scholar
  14. 14.
    Kon E, Verdonk P, Condello V, Delcogliano M, Dhollander A, Filardo G, Pignotti E, Marcacci M (2009) Matrix-assisted autologouschondrocyte transplantation for the repair of cartilage defects of the knee: systematic clinical data review and study quality analysis. Am J Sports Med 37(Suppl 1):156S–166SGoogle Scholar
  15. 15.
    Niemeyer P, Pestka JM et al (2008) Characteristic complications after autologous chondrocyte implantation for cartilage defects of the knee joint. Am J Sports Med 36(11):2091–2099PubMedCrossRefGoogle Scholar
  16. 16.
    Zeifang F, Oberle D, Nierhoff C, Richter W, Moradi B, Schmitt H (2010) Autologous chondrocyte implantation using the original Periosteum-Cover Technique Versus matrix-associated autologous chondrocyte implantation. Am J Sports Med 38:5Google Scholar
  17. 17.
    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 e a randomized controlled study. Acta Chir Belg 104:709–714PubMedGoogle Scholar
  18. 18.
    Nejadnik H, Hui JH, FengChoong EP, Tai BC, Lee EH (2010) Autologous bone marrow-derived mesenchymal stem cells versus autologous chondrocyte implantation: an observational cohort study. Am J Sports Med 38:1110PubMedCrossRefGoogle Scholar
  19. 19.
    Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A (2000) Two- to 9-year outcome after autologouschondrocyte transplantation of the knee. ClinOrthopRelat Res 374:212–234Google Scholar
  20. 20.
    Basad E, Stürz H, Steinmeyer J (2004) Die Behandlung chondraler Defekte mit MACI oder Microfracture e erste Ergebnisse einer vergleichenden klinischen Studie. Orthop Prax 40:6–10Google Scholar
  21. 21.
    Wakitani S, Imoto K, Yamamoto T, Saito M, Murata N, Yoneda M (2002) Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees. Osteoarthr Cartil 10:199–206Google Scholar
  22. 22.
    Kon E, Gobbi A, Filardo G, Delcogliano A, Zaffagnini S, Marcacci M (2009) Arthroscopic second-generation autologouschondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 37:33–41PubMedCrossRefGoogle Scholar
  23. 23.
    Bekkers J, Inklaar M, Saris DB (2009) Treatment selection in articular cartilage lesions of the knee: a systematic review. Am J Sports Med 37(Suppl 1):148S–155SGoogle Scholar
  24. 24.
    Brittberg M (2010) Cell carriers as the next generation of cell therapy for cartilage repair: a review of the matrix-induced autologouschondrocyte implantation procedure. Am J Sports Med 38:1259–1271PubMedCrossRefGoogle Scholar
  25. 25.
    Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J (2010) Matrix-induced autologouschondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomized study. Knee Surg Sports Traumatol Arthrosc 18:519–527PubMedCrossRefGoogle Scholar
  26. 26.
    Henderson I, Tuy B, Oakes B (2004) Reoperation after autologouschondrocyte implantation: indications and findings. J Bone Joint Surg Br 86:205–211PubMedCrossRefGoogle Scholar
  27. 27.
    Erggelet C, Endres M, Neumann K, Morawietz L, Ringe J, Haberstroh K, Sittinger M, Kaps C (2009) Formation of cartilage repair tissue in articular cartilage defects pretreated with microfracture and covered with cell-free polymer based implants. J Orthop Res 27(10):1353–1360PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Sangeetha Naveen
    • 1
  • Noorzurani Robson
    • 1
  • Tunku Kamarul
    • 1
  1. 1.Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia

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