Comparative analysis of autologous chondrocyte implantation and other treatment modalities: a systematic review
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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.
KeywordsAutologous chondrocyte implantation Articular cartilage Cartilage repair Review Systemic
- 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
- 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
- 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.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
- 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
- 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
- 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.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.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
- 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
- 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