Skip to main content

Good healing potential of patellar chondral defects after all-arthroscopic autologous chondrocyte implantation with spheroids: a second-look arthroscopic assessment



To report second-look arthroscopic assessment after all-arthroscopic autologous chondrocyte implantation (ACI) for articular cartilage defects at the patella.


A second-look arthroscopy after all-arthroscopic ACI using chondrospheres® (ACT3D) was performed in 30 patients with 30 full-thickness retropatellar cartilage defects. The mean time from ACI to second-look arthroscopy was 14.9 ± 16.3 (6–71) months. The quality of cartilage regeneration was evaluated by the International Cartilage-Repair Score (ICRS)—Cartilage Repair Assessment (CRA).


Eleven lesions (36.7%) were classified as CRA grade I (normal) and 19 lesions (63.3%) as grade II (nearly normal). Concerning the degree of defect repair, 25 lesions (83.3%) were repaired up to the height of the surrounding articular retropatellar cartilage. Five lesions (16.7%) showed 75% repair of defect depth. The border zone was completely integrated into the surrounding articular cartilage shoulder in 28 lesions (93.3%) and demarcated within 1 mm in 2 lesions (6.7%). Macroscopically and by probing, 12 lesions (40%) had intact smooth surface, 17 lesions (56.7%) had fibrillated surface and 1 lesion (3.3%) had small, scattered fissures. A negative correlation was found between the overall repair assessment score and the defect size (r2 = − 0.430, p = 0.046) and between integration into border zone and defect size (r2 = − 0.340, p = 0.045). A positive correlation was found between macroscopic appearance and age (r2 =  + 0.384, p = 0.036).


All-arthroscopic ACI using chondrospheres® (ACT3D) for full-thickness retropatellar articular cartilage defects proved to be reproducible and reliable. The advantage of the procedure is that it is minimal invasive. Arthroscopic second-look demonstrated a high grade of normal or nearly normal cartilage regeneration. Although statistically significant differences were not observed, larger defect size and younger age may compromise the result of overall repair.

Level of evidence


This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Adachi N, Ochi M, Deie M, Nakamae A, Kamei G, Uchio Y et al (2014) Implantation of tissue-engineered cartilage-like tissue for the treatment for full-thickness cartilage defects of the knee. Knee Surg Sports Traumatol Arthrosc 22(6):1241–1248

    Article  Google Scholar 

  2. 2.

    Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone JtSurg Am 85-A(Suppl 2):58–69

    Article  Google Scholar 

  3. 3.

    Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13(4):456–460

    CAS  Article  Google Scholar 

  4. 4.

    Donoso R, Figueroa D, Espinoza J, Yañez C, Saavedra J (2019) Osteochondral autologous transplantation for treating patellar high-grade chondral defects: a systematic review. Orthop J Sports Med 7(10):2325967119876618

    Article  Google Scholar 

  5. 5.

    Ebert JR, Fallon M, Smith A, Janes GC, Wood DJ (2015) Prospective clinical and radiologic evaluation of patellofemoral matrix-induced autologous chondrocyte implantation. Am J Sports Med 43(6):1362–1372

    Article  Google Scholar 

  6. 6.

    Ebert JR, Schneider A, Fallon M, Wood DJ, Janes GC (2017) A comparison of 2-year outcomes in patients undergoing tibiofemoral or patellofemoral matrix-induced autologous chondrocyte implantation. Am J Sports Med 45(14):3243–3253

    Article  Google Scholar 

  7. 7.

    EMA (2017) Spheroids of human autologous matrix-associated chondrocytes. Accessed 23 Oct 2020

  8. 8.

    Enea D, Cecconi S, Busilacchi A, Manzotti S, Gesuita R, Gigante A (2012) Matrix-induced autologous chondrocyte implantation (MACI) in the knee. Knee Surg Sports Traumatol Arthrosc 20(5):862–869

    Article  Google Scholar 

  9. 9.

    Federico DJ, Reider B (1997) Results of isolated patellar debridement for patellofemoral pain in patients with normal patellar alignment. Am J Sports Med 25(5):663–669

    CAS  Article  Google Scholar 

  10. 10.

    Fickert S, Gerwien P, Helmert B, Schattenberg T, Weckbach S, Kaszkin-Bettag M et al (2012) One-year clinical and radiological results of a prospective, investigator-initiated trial examining a novel, purely autologous 3-dimensional autologous chondrocyte transplantation product in the knee. Cartilage 3(1):27–42

    Article  Google Scholar 

  11. 11.

    Fossum V, Hansen AK, Wilsgaard T, Knutsen G (2019) Collagen-covered autologous chondrocyte implantation versus autologous matrix-induced chondrogenesis: a randomized trial comparing 2 methods for repair of cartilage defects of the knee. Orthop J Sports Med 7(9):2325967119868212

    Article  Google Scholar 

  12. 12.

    Gillogly SD, Arnold RM (2014) Autologous chondrocyte implantation and anteromedialization for isolated patellar articular cartilage lesions: 5- to 11-year follow-up. Am J Sports Med 42(4):912–920

    Article  Google Scholar 

  13. 13.

    Gobbi A, Kon E, Berruto M, Filardo G, Delcogliano M, Boldrini L et al (2009) Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years’ follow-up. Am J Sports Med 37(6):1083–1092

    Article  Google Scholar 

  14. 14.

    Gomoll AH, Gillogly SD, Cole BJ, Farr J, Arnold R, Hussey K et al (2014) Autologous chondrocyte implantation in the patella: a multicenter experience. Am J Sports Med 42(5):1074–1081

    Article  Google Scholar 

  15. 15.

    Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38(6):1125–1133

    Article  Google Scholar 

  16. 16.

    Henderson IJ, Lavigne P (2006) Periosteal autologous chondrocyte implantation for patellar chondral defect in patients with normal and abnormal patellar tracking. Knee 13(4):274–279

    CAS  Article  Google Scholar 

  17. 17.

    Insall J, Falvo KA, Wise DW (1976) Chondromalacia patellae. A prospective study. J Bone JtSurg Am 58(1):1–8

    CAS  Article  Google Scholar 

  18. 18.

    Kon E, Filardo G, Gobbi A, Berruto M, Andriolo L, Ferrua P et al (2016) Long-term results after hyaluronan-based MACT for the treatment of cartilage lesions of the patellofemoral joint. Am J Sports Med 44(3):602–608

    Article  Google Scholar 

  19. 19.

    Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M et al (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. OsteoarthrCartil 14(11):1119–1125

    CAS  Google Scholar 

  20. 20.

    Macmull S, Jaiswal PK, Bentley G, Skinner JA, Carrington RW, Briggs TW (2012) The role of autologous chondrocyte implantation in the treatment of symptomatic chondromalacia patellae. Int Orthop 36(7):1371–1377

    Article  Google Scholar 

  21. 21.

    Meyerkort D, Ebert JR, Ackland TR, Robertson WB, Fallon M, Zheng MH et al (2014) Matrix-induced autologous chondrocyte implantation (MACI) for chondral defects in the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 22(10):2522–2530

    Article  Google Scholar 

  22. 22.

    Migliorini F, Eschweiler J, Maffulli N, Driessen A, Rath B, Tingart M et al (2021) Management of patellar chondral defects with autologous matrix induced chondrogenesis (AMIC) compared to microfractures: a four years follow-up clinical trial. Life (Basel) 11(2):141

    Google Scholar 

  23. 23.

    Nawaz SZ, Bentley G, Briggs TW, Carrington RW, Skinner JA, Gallagher KR et al (2014) Autologous chondrocyte implantation in the knee: mid-term to long-term results. J Bone JtSurg Am 96(10):824–830

    Article  Google Scholar 

  24. 24.

    Niemeyer P, Laute V, John T, Becher C, Diehl P, Kolombe T et al (2016) The effect of cell dose on the early magnetic resonance morphological outcomes of autologous cell implantation for articular cartilage defects in the knee: a randomized clinical trial. Am J Sports Med 44(8):2005–2014

    Article  Google Scholar 

  25. 25.

    Ogura T, Bryant T, Merkely G, Minas T (2019) Autologous chondrocyte implantation for bipolar chondral lesions in the patellofemoral compartment: clinical outcomes at a mean 9 years’ follow-up. Am J Sports Med 47(4):837–846

    Article  Google Scholar 

  26. 26.

    Olivos Meza A, Cortés González S, Ferniza Garza JJ, Pérez Jiménez FJ, Enrique VC, Ibarra C (2019) Arthroscopic treatment of patellar and trochlear cartilage lesions with matrix encapsulated chondrocyte implantation versus microfracture: quantitative assessment with MRI T2-mapping and MOCART at 4-year follow-up. Cartilage.

    Article  PubMed  Google Scholar 

  27. 27.

    Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38(6):1117–1124

    Article  Google Scholar 

  28. 28.

    Schiavone Panni A, Del Regno C, Mazzitelli G, D’Apolito R, Corona K, Vasso M (2018) Good clinical results with autologous matrix-induced chondrogenesis (Amic) technique in large knee chondral defects. Knee Surg Sports Traumatol Arthrosc 26(4):1130–1136

    PubMed  Google Scholar 

  29. 29.

    Siebold R, Karidakis G, Feil S, Fernandez F (2016) Second-look assessment after all-arthroscopic autologous chondrocyte implantation with spheroides at the knee joint. Knee Surg Sports Traumatol Arthrosc 24(5):1678–1685

    Article  Google Scholar 

  30. 30.

    Siebold R, Karidakis G, Fernandez F (2014) Clinical outcome after medial patellofemoral ligament reconstruction and autologous chondrocyte implantation following recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 22(10):2477–2483

    Article  Google Scholar 

  31. 31.

    Siebold R, Suezer F, Schmitt B, Trattnig S, Essig M (2018) Good clinical and MRI outcome after arthroscopic autologous chondrocyte implantation for cartilage repair in the knee. Knee Surg Sports Traumatol Arthrosc 26(3):831–839

    Article  Google Scholar 

  32. 32.

    Solheim E, Krokeide AM, Melteig P, Larsen A, Strand T, Brittberg M (2016) Symptoms and function in patients with articular cartilage lesions in 1,000 knee arthroscopies. Knee Surg Sports Traumatol Arthrosc 24(5):1610–1616

    Article  Google Scholar 

  33. 33.

    Stefanik JJ, Niu J, Gross KD, Roemer FW, Guermazi A, Felson DT (2013) Using magnetic resonance imaging to determine the compartmental prevalence of knee joint structural damage. OsteoarthrCartil 21(5):695–699

    CAS  Google Scholar 

  34. 34.

    Vanlauwe JJ, Claes T, Van Assche D, Bellemans J, Luyten FP (2012) Characterized chondrocyte implantation in the patellofemoral joint: an up to 4-year follow-up of a prospective cohort of 38 patients. Am J Sports Med 40(8):1799–1807

    Article  Google Scholar 

  35. 35.

    von Keudell A, Han R, Bryant T, Minas T (2017) Autologous chondrocyte implantation to isolated patella cartilage defects. Cartilage 8(2):146–154

    Article  Google Scholar 

  36. 36.

    Zarkadis NJ, Belmont PJ Jr, Zachilli MA, Holland CA, Kinsler AR, Todd MS et al (2018) Autologous chondrocyte implantation and tibial tubercle osteotomy for patellofemoral chondral defects: improved pain relief and occupational outcomes among US army service members. Am J Sports Med 46(13):3198–3208

    Article  Google Scholar 

Download references


No funding.

Author information



Corresponding author

Correspondence to Rainer Siebold.

Ethics declarations

Conflict of interest

All the authors have no potential conflict of interest.

Ethical approval

The study was approved by the local ethics committee of the ATOS hospital.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sumida, Y., Nakamura, K., Feil, S. et al. Good healing potential of patellar chondral defects after all-arthroscopic autologous chondrocyte implantation with spheroids: a second-look arthroscopic assessment. Knee Surg Sports Traumatol Arthrosc (2021).

Download citation


  • Second-look arthroscopy
  • ACI
  • Autologous chondrocyte implantation
  • Spheroid
  • Retropatellar
  • Cartilage defect
  • Patella