Autologous chondrocyte implantation

Abstract

Currently, autologous chondrocyte implantation (ACI) is ideally indicated for symptomatic ICRS grade III-IV lesions greater than 2 cm2 along the femoral condyle or trochlear regions. High-demand patients between the ages of 15 to 55 years of age with excellent motivation and compliance potential should be chosen. Lars Peterson assessed his first 101 patients at intermediate to long-term follow-up. Good to excellent clinical results were seen in 92% of the isolated femoral condylar lesions, while these results decreased to 67% in patients with multiple lesions. Osteochondritis dissecans lesions demostrated 89% good-to-excellent results, and in contrast to the initial series patellar lesions did relatively well with 65% good-to-excellent results. Histologic analysis of the matrix in 37 biopsy specimens assessing for type II collagen showed a correlation between hyaline-like repair tissue and good-to-excellent clinical results. Scott Gillogly evaluated 112 patients with 139 defects treated with the ACI procedure over a 5-year period of time. Average size of the defect was 5.7 cm2 with over 60% of patients having failed at least one prior procedure. According to the clinician evaluation portion of the Modified Cincinnati Scale 93% demonstrated good-to-excellent outcomes, while the patient evaluation portion demonstrated 89% good-to-excellent outcomes. This chapter will describe the technique of ACI first reported by the senior author (LP) in 1994, as well as additional methods to deal with the various complex problems that can arise during these demanding procedures. A further review of the current literature supporting this techique as well as those studies that compare ACI to other accepted treatment options will be undertaken as well. In addition, we will review and discuss developing literature supporting current use of various matrices in combination with autologous chondrocytes to treat this difficult patient population. © 2007 Humana Press Inc.