Evolution of Autologous Chondrocyte Repair and Comparison to Other Cartilage Repair Techniques

Abstract

Articular cartilage defects have been addressed using microfracture, abrasion chondroplasty, or osteochondral grafting, but these strategies do not generate tissue that adequately recapitulates native cartilage. During the past 25 years, promising new strategies using assorted scaffolds and cell sources to induce chondrocyte expansion have emerged. We reviewed the evolution of autologous chondrocyte implantation and compared it to other cartilage repair techniques. Methods. We searched PubMed from 1949 to 2014 for the keywords “autologous chondrocyte implantation” (ACI) and “cartilage repair” in clinical trials, meta-analyses, and review articles. We analyzed these articles, their bibliographies, our experience, and cartilage regeneration textbooks. Results. Microfracture, abrasion chondroplasty, osteochondral grafting, ACI, and autologous matrix-induced chondrogenesis are distinguishable by cell source (including chondrocytes and stem cells) and associated scaffolds (natural or synthetic, hydrogels or membranes). ACI seems to be as good as, if not better than, microfracture for repairing large chondral defects in a young patient's knee as evaluated by multiple clinical indices and the quality of regenerated tissue. Conclusion. Although there is not enough evidence to determine the best repair technique, ACI is the most established cell-based treatment for full-thickness chondral defects in young patients.

Third‐generation autologous chondrocyte implantation versus mosaicplasty for knee cartilage injury: 2‐year randomized trial

“…In contrast to our trial, a randomized controlled trial showed that first-generation ACI (n ¼ 58) was significantly better than mosaicplasty (n ¼ 42) after a mean follow-up of 19 months. 14 The proportion of patients with excellent or good results was 82% with ACI and 69% with mosaicplasty. We may hypothesized that the difference with our study is due to both differences in patients and assessments methods.…”

“…Few studies have compared cartilage repair techniques. [12][13][14] Furthermore, wide variations in the assessment methods and patient populations hinder comparisons across studies. In contrast to our trial, a randomized controlled trial showed that first-generation ACI (n ¼ 58) was significantly better than mosaicplasty (n ¼ 42) after a mean follow-up of 19 months.…”

“…The mean O'Driscoll score was 15.1 AE 3.7 (range, [10][11][12][13][14][15][16][17][18][19] in the Cartipatch 1 group and 18.5 AE 2.5 (range, [14][15][16][17][18][19][20][21] in the mosaicplasty group, yielding a significant 3.3-point difference in favor of mosaicplasty (p ¼ 0.02). The O'Driscoll score was not significantly different between the groups with defects <3.5 cm 2 or !3.5 cm 2 (p ¼ 0.43 and p ¼ 0.28).…”

Strategies for Improving the Repair of Focal Cartilage Defects

“…The ACI initial technique, where a periosteal flap is used to maintain the transplanted chondrocytes, is the only technique that is US FDA-approved [33]. While it has shown favorable results with 73.5% success at mean 12.8 years post surgery [34], remain the issue of 30% periosteum hypertrophy and a limitation to lesions small in size (average defect size 5.2 cm 2 ).…”

“…They consist of crosslinked hydrophilic polymer networks having the attractive feature of being minimal-invasively injected as a solution and capable to polymerize in situ. Crosslinking methods include light irradiation, temperature modulation and pH alteration [33]. Hydrogels used for chondrogenesis can be naturally-derived such as agarose [44,45], collagen [46,47], fibrin [48,49], alginate [50][51][52] and hyaluronan [53]; or derive from synthetic polymers such as polyethylene glycols hydrogels [54,55].…”