Autologous Chondrocyte Implantation for Knee Cartilage Defects: Five-Year Follow-Up
DOI:
https://doi.org/10.5281/zenodo.22327994Keywords:
Autologous chondrocyte implantation, Matrix-induced autologous chondrocyte implantation, Microfracture, Knee cartilage defect, Osteochondral autograft transplantationAbstract
Background: Autologous chondrocyte implantation (ACI) has evolved through three technical generations for treating
symptomatic articular cartilage defects of the knee, yet its comparative durability against microfracture and osteochondral
grafting remains debated. Objective: To synthesise evidence on ACI's generational evolution and five-year and longer functional outcomes, durability, andreturn to sport relative to alternative cartilage repair techniques.Methods: Narrative review of randomised trials, long-term cohort studies, and meta-analyses.Findings: Randomised trials show ACI and matrix-induced ACI (MACI) achieve functional outcomes equal to or better thanmicrofracture at two to five years, with superior durability beyond five years, particularly for larger defects; MACI reoperationrates at 10-17 years (9.0%) are markedly lower than pooled first/second-generation ACI failure rates at 11.4 years (18%).Conclusions: ACI/MACI provides durable, generation-dependent improvement in knee function, favouring larger defects and younger patients, though comparative superiority over osteochondral grafting remains procedure- and lesion-specific.
References
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. New England Journal of Medicine, 331(14): 889-895.
Davies, R.L., Kuiper, N.J. (2019) Regenerative medicine: a review of the evolution of autologous chondrocyte implantation (ACI) therapy. Bioengineering, 6(1): 22.
Goyal, D., Goyal, A., Keyhani, S., Lee, E.H., Hui, J.H.P. (2013) Evidence-based status of second- and third-generation autologous chondrocyte implantation over first generation: a systematic review of level I and II studies. Arthroscopy, 29(11): 1872-1878.
Bartlett, W., Skinner, J.A., Gooding, C.R., Carrington, R.W.J., Flanagan, A.M., Briggs, T.W.R., Bentley, G. (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. Journal of Bone and Joint Surgery (British), 87-B(5): 640-645.
Benthien, J.P., Behrens, P. (2010) Autologous matrix-induced chondrogenesis (AMIC): combining microfracturing and a collagen I/III matrix for articular cartilage resurfacing. Cartilage, 1(1): 65-68.
Knutsen, G., Engebretsen, L., Ludvigsen, T.C., Drogset, J.O., Grøntvedt, T., Solheim, E., Strand, T., Roberts, S., Isaksen, V., Johansen, O. (2004) Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. Journal of Bone and Joint Surgery (American), 86(3): 455-464.
Saris, D.B.F., Vanlauwe, J., Victor, J., Haspl, M., Bohnsack, M., Fortems, Y., Vandekerckhove, B., Almqvist, K.F., Claes, T., Handelberg, F., Lagae, K., van der Bauwhede, J., Vandenneucker, H., Yang, K.G.A., Jelic, M., Verdonk, R., Veulemans, N., Bellemans, J., Luyten, F.P. (2008) Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. American Journal of Sports Medicine, 36(2): 235-246.
Vanlauwe, J., Saris, D.B.F., Victor, J., Almqvist, K.F., Bellemans, J., Luyten, F.P. (2011) Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters. American Journal of Sports Medicine, 39(12): 2566-2574.
Saris, D., Price, A., Widuchowski, W., Bertrand-Marchand, M., Caron, J., Drogset, J.O., Emans, P., Podskubka, A., Tsuchida, A., Kili, S., Levine, D., Brittberg, M. (2014) Matrix-applied characterized autologous cultured chondrocytes versus microfracture: two-year follow-up of a prospective randomized trial. American Journal of Sports Medicine, 42(6): 1384-1394.
Brittberg, M., Recker, D., Ilgenfritz, J., Saris, D.B.F. (2018) Matrix-applied characterized autologous cultured chondrocytes versus microfracture: five-year follow-up of a prospective randomized trial. American Journal of Sports Medicine, 46(6): 1343-1351.
Yoon, K.H., Yoo, J.D., Choi, C.H., Lee, J., Lee, J.Y., Kim, S.G., Park, J.Y. (2020) Costal chondrocyte-derived pellet-type autologous chondrocyte implantation versus microfracture for repair of articular cartilage defects: a prospective randomized trial. Cartilage, 13(1 suppl): 1092S-1104S.
Yoon, K.H., Lee, J., Park, J.Y. (2024) Costal chondrocyte-derived pellet-type autologous chondrocyte implantation versus microfracture for the treatment of articular cartilage defects: a 5-year follow-up of a prospective randomized trial. American Journal of Sports Medicine, 52(2): 362-367.
Gou, G.H., Tseng, F.J., Wang, S.H., Chen, P.J., Shyu, J.F., Weng, C.F., Pan, R.Y. (2020) Autologous chondrocyte implantation versus microfracture in the knee: a meta-analysis and systematic review. Arthroscopy, 36(1): 289-303.
Vavken, P., Samartzis, D. (2010) Effectiveness of autologous chondrocyte implantation in cartilage repair of the knee: a systematic review of controlled trials. Osteoarthritis and Cartilage, 18(6): 857-863.
Li, Z., Zhu, T., Fan, W. (2016) Osteochondral autograft transplantation or autologous chondrocyte implantation for large cartilage defects of the knee: a meta-analysis. Cell and Tissue Banking, 17(1): 59-67.
Nassar, J.E., Guerin, G., Keel, T., Russo, R., Familiari, F., Tollefson, L.V., LaPrade, R.F. (2024) Autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 33(8): 2745-2762.
Triana, J., Hughes, A.J., Rao, N., Li, Z.I., Moore, M.R., Garra, S., Strauss, E.J., Jazrawi, L.M., Campbell, K.A., Gonzalez-Lomas, G. (2025) Comparable clinical and functional outcomes between osteochondral allograft transplantation and autologous chondrocyte implantation for articular cartilage lesions in the patellofemoral joint at a mean follow-up of 5 years. Arthroscopy, 41(3): 745-758.
Valisena, S., Azogui, B., Nizard, R.S., Tscholl, P.M., Cavaignac, E., Bouché, P.A., Hannouche, D. (2024) Microfractures, autologous matrix-induced chondrogenesis, osteochondral autograft transplantation and autologous chondrocyte implantation for knee chondral defects: a systematic review and network meta-analysis of randomized controlled trials. EFORT Open Reviews, 9(8): 785-795.
Sochacki, K.R., Varshneya, K., Calcei, J.G., Safran, M.R., Abrams, G.D., Donahue, J., Chu, C., Sherman, S.L. (2020) Comparison of autologous chondrocyte implantation and osteochondral allograft transplantation of the knee in a large insurance database: reoperation rate, complications, and cost analysis. Cartilage, 13(1 suppl): 1187S-1194S.
Pareek, A., Carey, J.L., Reardon, P.J., Peterson, L., Stuart, M.J., Krych, A.J. (2016) Long-term outcomes after autologous chondrocyte implantation: a systematic review at mean follow-up of 11.4 years. Cartilage, 7(4): 298-308.
Nawaz, S.Z., Bentley, G., Briggs, T.W.R., Carrington, R.W.J., Skinner, J.A., Gallagher, K.R., Dhinsa, B.S. (2014) Autologous chondrocyte implantation in the knee: mid-term to long-term results. Journal of Bone and Joint Surgery (American), 96(10): 824-830.
Niemeyer, P., Porichis, S., Steinwachs, M., Erggelet, C., Kreuz, P.C., Schmal, H., Uhl, M., Ghanem, N., Südkamp, N.P., Salzmann, G. (2014) Long-term outcomes after first-generation autologous chondrocyte implantation for cartilage defects of the knee. American Journal of Sports Medicine, 42(1): 150-157.
Peterson, L., Vasiliadis, H.S., Brittberg, M., Lindahl, A. (2010) Autologous chondrocyte implantation: a long-term follow-up. American Journal of Sports Medicine, 38(6): 1117-1124.
Knutsen, G., Drogset, J.O., Engebretsen, L., Grøntvedt, T., Ludvigsen, T.C., Løken, S., Solheim, E., Strand, T., Johansen, O. (2016) A randomized multicenter trial comparing autologous chondrocyte implantation with microfracture: long-term follow-up at 14 to 15 years. Journal of Bone and Joint Surgery (American), 98(16): 1332-1339.
Wang, A.S., Nagelli, C.V., Lamba, A., Saris, D.B.F., Krych, A.J., Hevesi, M. (2024) Minimum 10-year outcomes of matrix-induced autologous chondrocyte implantation in the knee: a systematic review. American Journal of Sports Medicine, 52(9): 2407-2414.
Campbell, A.B., Pineda, M., Harris, J.D., Flanigan, D.C. (2016) Return to sport after articular cartilage repair in athletes' knees: a systematic review. Arthroscopy, 32(4): 651-668.
Kunze, K.N., Mazzucco, M., Thomas, Z., Uzzo, R., Rodeo, S.A., Warren, R.F., Wickiewicz, T.L., Williams, R.J. (2025) High rate of return to sport for athletes undergoing articular cartilage restoration procedures for the knee: a systematic review of contemporary studies. American Journal of Sports Medicine, 53(10): 2471-2482.
