Osteochondral transplantation using autografts from the upper tibio-fibular joint for the treatment of knee cartilage lesions Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up Long-term Results of Autologous Chondrocyte Implantation in the Knee for Chronic Chondral and Osteochondral Defects Osseous Integration after Fresh Osteochondral Allograft Transplantation to the Distal Femur Outcomes After a Single-Stage Procedure for Cell-Based Cartilage Repair Effect of Accelerated Weightbearing after Matrix-Associated Autologous Chondrocyte Implantation on the Femoral Condyle on Radiographic and Clinical Outcome after 2 Years Arthroscopic mosaicplasty: long-term outcome and joint degeneration progression. NeoCart, an autologous cartilage tissue implant, compared with microfracture for treatment of distal femoral cartilage lesions: an FDA phase-II prospective, randomized clinical trial after two years. Autologous Chondrocyte Implantation and Osteochondral Cylinder Transplantation in Cartilage Repair of the Knee Joint: A Prospective, Comparative Trial Large osteochondral defects of the femoral condyle: press-fit transplantation of the posterior femoral condyle (MEGA-OATS) Treatment of Full-Thickness Chondral Defects With Hyalograft C in the Knee Arthroscopic second generation autologous chondrocyte implantation Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles. A prospective outcomes study. The treatment of chondral lesions of the knee with the microfracture technique and platelet-rich plasma. Treatment of patellofemoral cartilage defects in the knee by autologous matrix-induced chondrogenesis (AMIC. Comparison of two different matrix-based autologous chondrocyte transplantation systems: 1 year follow-up results Autologous Chondrocyte Implantation in the Adolescent Knee Arthroscopic Second-Generation Autologous Chondrocyte Implantation Compared with Microfracture for Chondral Lesions of the Knee Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at two years’ follow-up Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)--5-year follow-up. Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study Prospective Evaluation of Prolonged Fresh Osteochondral Allograft Transplantation of the Femoral Condyle Return to Athletic Activity After Osteochondral Allograft Transplantation in the Knee Clinical Outcomes After Cell-Seeded Autologous Chondrocyte Implantation of the Knee Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes Matrix-induced autologous chondrocyte implantation (MACI) in the knee: clinical outcomes and challenges Is platelet-rich plasma able to enhance the results of arthroscopic microfracture in early osteoarthritis and cartilage lesion over 40 years of age? Chondrocyte-seeded type I/III collagen membrane for autologous chondrocyte transplantation: prospective 2-year results in patients with cartilage defects of the knee joint. Clinical and Radiological Outcomes 5 Years After Matrix-Induced Autologous Chondrocyte Implantation in Patients With Symptomatic, Traumatic Chondral Defects Activity levels are higher after osteochondral autograft transfer mosaicplasty than after microfracture for articular cartilage defects of the knee: a retrospective comparative study. Matrix-induced autologous mesenchymal stem cell implantation versus matrix-induced autologous chondrocyte implantation in the treatment of chondral defects of the knee: a 2-year randomized study Articular Cartilage Repair in Soccer Players with Autologous Chondrocyte Transplantation CaReS® (MACT) versus microfracture in treating symptomatic patellofemoral cartilage defects: a retrospective matched-pair analysis The Manangement of Knee Cartilage Defects with Modified Amic Technique: Preliminary Results Third-generation autologous chondrocyte implantation versus mosaicplasty for knee cartilage injury: 2-year randomized trial. An Autologous Cartilage Tissue Implant NeoCart for Treatment of Grade III Chondral Injury to the Distal Femur Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture Treatment of Symptomatic Cartilage Defects of the Knee Influence of Sex on the Outcome of Autologous Chondrocyte Implantation in Chondral Defects of the Knee A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. Arthroscopic Autologous Osteochondral Grafting for Cartilage Defects of the Knee Autologous Chondrocyte Implantation Using the Original Periosteum-Cover Technique versus Matrix-Associated Autologous Chondrocyte Implantation Arthroscopic matrix-induced autologous chondrocyte implantation: 2-year outcomes. Autologous chondrocyte implantation for traumatic full-thickness cartilage defects of the knee in 14 patients: 6-year functional outcomes. Microfracture treatment of single or multiple articular cartilage defects of the knee: a 5-year median follow-up of 110 patients Current Treatments of Isolated Articular Cartilage Lesions of the Knee Achieve Similar Outcomes One-Stage Cartilage Repair Using a Hyaluronic Acid–Based Scaffold With Activated Bone Marrow–Derived Mesenchymal Stem Cells Compared With Microfracture Cartilage extra-cellular matrix biomembrane for the enhancement of microfractured defects Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Second-Generation Autologous Chondrocyte Implantation
Purpose Treatment of large cartilage lesions of the knee in weight-bearing areas is still a controversy and challenging topic . Autologous osteochondral mosaicplasty has proven to be a valid option for treatment but donor site morbidity with most frequently used autografts remains a source of concern . This study aims to assess clinical results and safety profile of autologous osteochondral graft from the upper tibio-fibular joint applied to reconstruct symptomatic osteochondral lesions of the knee . Methods Thirty-one patients ( 22 men and 9 women ) with grade 4 cartilage lesions in the knee were operated by mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint  , between 1998 and 2006 . Clinical assessment included visual analog scale ( VAS ) for pain and Lysholm score . All patients were evaluated by MRI pre- and post-operatively regarding joint congruency as good , fair ( inferior to 1 mm incongruence ) , and poor ( incongruence higher than 1 mm registered in any frame ) . Donor zone status was evaluated according to specific protocol considering upper tibio-fibular joint instability , pain , neurological complications , lateral collateral ligament insufficiency , or ankle complaints . Results Mean age at surgery was 30.1 years ( SD 12.2 ) . In respect to lesion sites , 22 were located in weight-bearing area of medial femoral condyle , 7 in lateral femoral condyle , 1 in trochlea , and 1 in patella . Mean follow-up was 110.1 months ( SD 23.2 ) . Mean area of lesion was 3.3 cm2 ( SD 1.7 ) , and a variable number of cylinders were used , mean 2.5 ( SD 1.3 ) . Mean VAS score improved from 47.1 ( SD 10.1 ) to 20.0 ( SD 11.5 ) ; p = 0.00 . Similarly , mean Lysholm score increased from 45.7 ( SD 4.5 ) to 85.3 ( SD 7.0 ) ; p = 0.00 . The level of patient satisfaction was evaluated , and 28 patients declared to be satisfied/very satisfied and would do surgery again , while 3 declared as unsatisfied with the procedure and would not su bmi t to surgery again . These three patients had lower clinical scores and kept complaints related to the original problem but unrelated to donor zone . MRI score significantly improved at 18–24 months comparing with pre-operative ( p = 0.004 ) . No radiographic or clinical complications related to donor zone with implication in activity were registered . Conclusions This work corroborates that mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint is effective to treat osteochondral defects in the knee joint . No relevant complications related to donor zone were registered . Level of evidence Case series , Level IV Abstract Purpose To compare long-term functional and radiological outcome following microfracture technique ( MF ) versus osteochondral autologous transplantation ( OAT ) mosaicplasty for treating focal chondral lesions of the knee . Methods Twenty-five patients ( mean age 32.3 years , SD 7.7 ) with a full-thickness ( International Cartilage Repair Society grade 3 or 4 ) chondral lesion of the articulating surface of the femur were r and omized to either MF  ( n = 11 ) or OAT mosaicplasty  ( n = 14 ) . At a median follow-up of 9.8 years ( range 4.9–11.4 ) , the patients were evaluated using Lysholm score ( n = 25 ) , Knee Injury and Osteoarthritis Outcome Score ( KOOS , n = 25 ) , isokinetic quadriceps measurement and hamstring strength measurement ( n = 22 ) and st and ing radiographs ( n = 23 ) . Results There were no significant differences in Lysholm score , KOOS , isokinetic muscle strength or radiographic osteoarthritis between MF-treated patients and OAT mosaicplasty-treated patients at follow-up . Mean Lysholm score at follow-up was 69.7 [ 95 % confidence interval ( CI ) , 55.1–84.4 ] for the MF group and 62.6 ( 95 % CI , 52.6–72.6 ) for the OAT mosaicplasty group . Conclusion At long-term follow-up , there were no significant differences between patients treated with MF  and patients treated with OAT mosaicplasty in patient-reported outcomes , muscle strength or radiological outcome .Level of evidence Therapeutic study , Level II Background : Autologous chondrocyte implantation ( ACI ) has been shown to be effective in the midterm for the treatment of symptomatic articular cartilage lesions of the knee , but few long-term series have been published . The multioperated chronic articular cartilage defect remains a difficult condition to treat . Purpose : To examine the long-term clinical results of ACI for large chronic articular cartilage defects , many treated as salvage . Study Design : Case series ; Level of evidence , 4 . Methods : This is a prospect i ve case series of 104 patients with a mean age of 30.2 years and a symptomatic lesion of the articular cartilage in the knee , who underwent ACI between 1998 and 2001 . The mean duration of symptoms before surgery was 7.8 years . The mean number of previous surgical procedures on the cartilage defect , excluding arthroscopic debridement , was 1.3 . The defects were large , with a mean size of 477.1 mm2 ( range , 120 - 2500 mm2 ) . The modified Cincinnati , Stanmore/Bentley , and visual analog scale for pain scoring systems were used to assess pain and functional outcomes at a minimum 10 years ( mean , 10.4 years ; range , 10 - 12 years ) . Results : Twenty-seven patients ( 26 % ) experienced graft failure at a mean of 5.7 years after ACI . Of the 73 patients who did not fail , 46 patients ( 63 % of patients with a surviving graft ) had an excellent result , 18 ( 25 % ) were good , 6 ( 8 % ) were fair , and 3 ( 4 % ) had a poor result . Of a total of 100 patients successfully followed up , 98 were satisfied with the ACI technique for their chronic knee pain and would undergo the procedure again . Conclusion : Autologous chondrocyte implantation can provide a long-term solution in more than 70 % of young patients of a difficult-to-treat group with large chronic articular cartilage lesions , even in the salvage situation Objective : Fresh osteochondral allograft transplantation ( OCA ) is an increasingly available option for patients with damage to the bone-cartilage complex of the distal femur . This study prospect ively assesses osseous integration and early clinical results following fresh OCA with single or multiple cylindrical grafts to the femoral condyle . Design : Patients with grade 4 International Cartilage Repair Society ( ICRS ) defects of the distal femur were treated with OCA .  Outcome measures were collected preoperatively and postoperatively at 6 , 12 , and 24 months . Computed tomography ( CT ) scans obtained at 6 months were used to assess degree of osseous incorporation regionally . Results : Thirty-four patients , with a mean age of 34.5 years ( range , 15 - 61 ) , with a mean femoral osteochondral lesion of 5.7 cm2 ( range , 1.5 - 15.0 ) due to focal osteoarthritis , osteochondritis dissecans , and avascular necrosis , are reported . Statistically significant ( P < 0.05 ) mean improvement in outcome scores at 2 years included Knee Injury and Osteoarthritis Outcomes Score ( KOOS ) pain , sports and recreation , quality of life , and International Knee Documentation Committee ( IKDC ) . CT imaging indicated grafts implanted to direct weightbearing regions had > 75 % incorporation ( 20/26 grafts ) compared to < 50 % incorporation in the indirect weightbearing regions ( 8/14 grafts ) . A greater degree of incorporation and earlier outcome improvement were found after single ( n = 23 ) compared to multiple ( n = 11 ) grafts . Conclusion : CT scans were used to assess osseous incorporation of fresh osteochondral allografts in a cohort that showed significant improvements after 2 years . Single-graft implantation is associated with stable incorporation of a greater percentage of the graft . Lesser incorporation appears more frequently with grafts in posterior indirect weightbearing regions of the condyle and multiple contiguous grafts Background : There are currently several approaches being pursued to treat focal defects of articular cartilage , each having specific advantages or challenges . A single-stage procedure that uses autologous cartilage fragments , Cartilage Autograft Implantation System ( CAIS ) , is being evaluated in patients and may offer a clinical ly effective option . Purpose : To establish the safety of CAIS and to test whether CAIS improves quality of life by using st and ardized outcomes assessment tools . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Patients ( n = 29 ) were r and omized ( 1:2 ) with the intent to treat with either a  control ( microfracture [ MFX ] ) or an experimental ( CAIS ) procedure . Patients were followed at predetermined time points for 2 years using several st and ardized outcomes assessment tools ( SF-36 , International Knee Documentation Committee [ IKDC ] , Knee injury and Osteoarthritis Outcome Score [ KOOS ] ) . Magnetic resonance imaging was performed at baseline , 3 weeks , and 6 , 12 , and 24 months . Results : Lesion size and International Cartilage Repair Society ( ICRS ) grade were similar in both groups . General outcome measures ( eg , physical component score of the SF-36 ) indicated an overall improvement in both groups , and no differences in the number of adverse effects were noted in comparisons between the CAIS and MFX groups . The IKDC score of the CAIS group was significantly higher ( 73.9 ± 14.72 at 12 months and 82.95 ± 14.88 at 24 months ) compared with the MFX group ( 57.78 ± 18.31 at 12 months and 59.5 ± 13.44 at 24 months ) . Select subdomains ( 4/5 ) in the KOOS instrument were significantly different at 12 and 18 months , and all subdomains ( Symptoms and Stiffness , Pain , Activities of Daily Living , Sports and Recreation , Knee-related Quality of Life ) were significantly increased at 24 months in CAIS with scores of 88.47 ± 11.68 , 90.64 ± 7.87 , 97.29 ± 3.8 , 78.16 ± 22.06 , and 69 ± 23.15 compared with 75 ± 9.31 , 78.94 ± 13.73 , 89.46 ± 8.13 , 51.67 ± 26.01 , and 37.15 ± 21.67 in the MFX group . These significant improvements were maintained at 24 months in both IKDC and KOOS . Qualitative analysis of the imaging data did not note differences between the 2 groups in fill of the graft bed , tissue integration , or presence of subchondral cysts . Patients treated with MFX had a significantly higher incidence of intralesional osteophyte formation ( 54 % and 70 % of total number of lesions treated ) at 6 and 12 months when compared with CAIS ( 8 % and 25 % of total number of lesions treated ) . Conclusion : The first clinical experience in using CAIS for treating patients with focal chondral defects indicates that it is a safe , feasible , and effective method that may improve long-term clinical outcomes Background There is no consensus about the optimal time for weightbearing activities after matrix-associated autologous chon-drocyte implantation ( MACI ) of the femoral condyle . Hypothesis A comprehensive protocol after MACI on the femoral condyle with accelerated weightbearing leads to a better functional and radiographic outcome compared with the same comprehensive protocol with delayed weightbearing . Study Design R and omized controlled trial ; Level of evidence , 1 . Methods Thirty-one patients ( 22 male , 9 female ) after MACI on the femoral condyle were r and omly assigned to the  accelerated weightbearing group ( group A ) or the  delayed weightbearing group ( group B ) . Aside from increase and time of full weightbearing , both groups adhered to the same rehabilitation protocol and exercises . Patients were assessed preoperatively and at 4 , 12 , 24 , 52 , and 104 weeks after surgery . Clinical evaluation was performed by determining the subjective form of the International Knee Documentation Committee ( IKDC ) , the Tegner activity scale , and the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) . Radiological outcome was evaluated by the MOCART score and the size and amount of bone marrow edema and effusion . Results In both groups , there were no differences with regard to the clinical outcome . For the radiological outcome , group A showed a higher prevalence of bone marrow edema after 6 months without correlation to the clinical outcome ( P 5 .06-.1 ) . However , after 104 weeks , there were no differences in the radiological outcome between group A and group B. Conclusion A rehabilitation protocol with accelerated weightbearing leads to good clinical and functional outcome after 2 years without jeopardizing the healing graft BACKGROUND This study aims to document the long-term results in a group of patients treated with arthroscopic mosaicplasty for knee cartilage lesions , both in terms of clinical outcome and joint degeneration progression , evaluated by radiographs . METHODS 26 patients ( 19 men and 7 women , mean age 29 years , mean BMI 23 ) treated arthroscopically with mosaicplasty for cartilage defects of the femoral condyles ( mean/median/mode size 1.9 st and ard deviation , SD 0.6 cm(2 ) ) were prospect ively evaluated at 12 years follow-up . The clinical outcome was analyzed with IKDC and Tegner scores . Range of motion , transpatellar and suprapatellar circumferences were also measured . Radiographs with weight-bearing antero-posterior and Rosenberg projections were used for radiological evaluation in 18 patients , applying both Kellgren-Lawrence score and a direct joint line measurement to assess osteoarthritis . RESULTS A significant improvement in all clinical scores was obtained from the basal evaluation to the 12-year follow-up ( IKDC subjective score from 36.8 st and ard deviation , SD 13.0 to 77.3 st and ard deviation , SD 20.6 , P<0.0005 ; Tegner score from 2.9 st and ard deviation , SD 1.3 to 5.2 st and ard deviation , SD 2.5 , P<0.0005 ) , and better results in patients with a higher pre-injury activity level and those requiring fewer plugs . The radiographic evaluation showed significantly poorer Kellgren-Lawrence scores and a reduction of the joint line in the treated compartments . Knees with 3 - 4 plugs presented a significantly higher joint degeneration level with respect to those implanted with 1 - 2 plugs . CONCLUSIONS Mosaicplasty is an effective surgical option for small lesions of the femoral condyles . Although joint degeneration progression was present at 12 years , this did not affect significantly the clinical outcome which was satisfactory at long-term follow-up BACKGROUND Despite introduction of autologous chondrocyte therapy for repair of hyaline articular cartilage injury in 1994 , microfracture remains a primary st and ard of care . NeoCart , an autologous cartilage tissue implant , was compared with microfracture in a multisite prospect i ve , r and omized trial of a tissue-engineered bioimplant for treating articular cartilage injuries in the knee . METHODS Thirty patients were r and omized at a ratio of two to one ( two were treated with an autologous cartilage tissue implant [ NeoCart ] for each patient treated with microfracture )  at the time of arthroscopic confirmation of an International Cartilage Repair Society ( ICRS ) grade -III lesion(s ) . Microfracture or cartilage biopsy was performed . NeoCart , produced by seeding a type-I collagen matrix scaffold with autogenous chondrocytes and bioreactor treatment , was implanted six weeks following arthroscopic cartilage biopsy . St and ard evaluations were performed with vali date d clinical outcomes measures . RESULTS Three , six , twelve , and twenty-four-month data are reported . The mean duration of follow-up ( and st and ard deviation ) was 26 ± 2 months . There were twenty-one patients in the NeoCart group and nine in the microfracture group . The mean age ( 40 ± 9 years ) , body mass index ( BMI ) ( 28 ± 4 kg/m2 ) , duration between the first symptoms and treatment ( 3 ± 5 years ) , and lesion size ( 287 ± 138 mm2 in the NeoCart group and 252 ± 135 mm2 in the microfracture group ) were similar between the groups . Adverse event rates per procedure did not differ between the treatment arms . The scores on the Short Form-36 ( SF-36 ) , Knee Injury and Osteoarthritis Outcome Score ( KOOS ) activities of daily living ( ADL ) scale , and International Knee Documentation Committee ( IKDC ) form improved from baseline ( p < 0.05 ) to two years postoperatively in both treatment groups . In the NeoCart group , improvement , compared with baseline , was significant ( p < 0.05 ) for all measures at six , twelve , and twenty-four months . Improvement in the NeoCart group was significantly greater ( p < 0.05 ) than that in the microfracture group for the KOOS pain score at six , twelve , and twenty-four months ; the KOOS symptom score at six months ; the IKDC , KOOS sports , and visual analog scale ( VAS ) pain scores at twelve and twenty-four months ; and the KOOS quality of life ( QOL ) score at twenty-four months . Analysis of covariance ( ANCOVA ) at one year indicated that the change in the KOOS pain ( p = 0.016 ) and IKDC ( p = 0.028 ) scores from pretreatment levels favored the NeoCart group . Significantly more NeoCart-treated patients ( p = 0.0125 ) had responded to therapy ( were therapeutic responders ) at six months ( 43 % versus 25 % in the microfracture group ) and twelve months ( 76 % versus 22 % in the microfracture group ) . This trend continued , as the proportion of NeoCart-treated patients ( fifteen of nineteen ) who were therapeutic responders at twenty-four months was greater than the proportion of microfracture-treated participants ( four of nine ) who were therapeutic responders at that time . CONCLUSIONS This r and omized study suggests that the safety of autologous cartilage tissue implantation , with use of the NeoCart technique , is similar to that of microfracture surgery and is associated with greater clinical efficacy at two years after treatment Background : Current methods used to restore the joint surface in patients with localized articular cartilage defects include transplantation of an autologous osteochondral cylinder and implantation of autologous chondrocytes . The purpose of this study was to evaluate the clinical and histological outcomes of these two techniques . Methods : We performed a prospect i ve clinical study to investigate the two-year outcomes in forty patients with an articular cartilage lesion of the femoral condyle who had been r and omly treated with either transplantation of an autologous osteochondral cylinder or implantation of autologous chondrocytes . Biopsy specimens from representative patients of both groups were evaluated with histological staining , immunohistochemistry , and scanning electron microscopy . Results : According to the postoperative Lysholm score , the recovery after autologous chondrocyte implantation was slower than that after osteochondral transplantation at six months ( p ⩽ 0.015 ) , twelve months ( p ⩽ 0.001 ) , and twenty-four months ( p ⩽ 0.012 ) . On the basis of the Meyers score and the Tegner activity score , the results were equally good with the two methods two years after treatment . Histomorphological evaluation of biopsy specimens within two years after autologous chondrocyte implantation demonstrated a complete , mechanically stable resurfacing of the defect in all patients . The tissue consisted mainly of fibrocartilage , while localized areas of hyaline-like regenerative cartilage could be detected close to the subchondral bone . Although a gap remained at the site of the transplantation in all five biopsy specimens examined as long as two years after osteochondral cylinder transplantation , histomorphological analysis and scanning electron microscopy revealed no differences between the osteochondral transplants and the surrounding original cartilage . Conclusions : Both treatments result ed in a decrease in symptoms . However , the improvement provided by the autologous chondrocyte implantation lagged behind that provided by the osteochondral cylinder transplantation . Histologically , the defects treated with autologous chondrocyte implantation were primarily filled with fibrocartilage , whereas the osteochondral cylinder transplants retained their hyaline character , although there was a persistent interface between the transplant and the surrounding original cartilage . Limitations of our study included the small number of patients , the relatively short ( two-year ) follow-up , and the absence of a control group . Level of Evidence : Therapeutic study , Level II-2 ( poor- quality r and omized controlled trial [ e.g. , < 80 % follow-up ] ) . See Instructions to Authors for a complete description of levels of evidence Abstract . Background and aims : Large osteochondral defects in the weight-bearing zone of the knee remain a challenging therapeutic problem . Surgical options include drilling , microfracturing , and transplantation of osteochondral plugs but are often insufficient for the treatment of large defects of the femoral condyle . Patients and methods : Large osteochondral defects of the femoral condyle ( mean defect size 7.2 cm2 range 3–20 ) were treated by transplantation of the autologous posterior femoral condyle .  Between 1984 and 2000 , 29 patients were operated on : in 22 the medial , in 6 the lateral femoral condyle , and in one the trochlear groove was grafted . Thirteen patients underwent simultaneous high tibial valgus osteotomy .  In the first series ( 1984–1999 ) the graft was temporarily fixed with a screw ( n=12 ) , but from 1999 we used a newly developed press-fit technique ( n=17 ) avoiding screw fixation of the graft . The operative technique comprising graft harvest , defect preparation , transplantation , and fixation is described . Patients were clinical ly evaluated using the Lysholm score , and magnetic resonance imaging with intravenous contrast was performed 6 and 12 weeks after surgery ( mean follow-up 17.7 months ( range 3–46 ) . Results : Pain and swelling were reduced in 26 patients . Three patients of the first series reported persistent problems and were subjectively not satisfied . The mean Lysholm score rose from preoperatively 52 to 77 points after 3 months , 74 after 6 , 88 after 12 , and 95 after 18 . Magnetic resonance imaging showed good graft viability in all cases . We saw one arthrofibrosis after 6 months but noted no problems related to the loss of the missing posterior condyle . Conclusion : Large osteochondral defects of the femoral condyle can be treated by transplantation of the autologous posterior femoral condyle . The use of only one osteochondral piece renders better approximation of the femoral cartilage curvature and thus joint congruence than in mosaic plasty . However , whether loss of the posterior condyle has a long-term negative impact on the knee joint remains to be eluci date Background : Matrix-associated autologous chondrocyte transplantation ( MACT ) has become an established articular cartilage repair technique . It provides good short-term and midterm results ; however , long-term results are lacking . Purpose : To prospect ively assess the clinical outcome after MACT in the knee to report long-term results . Study Design : Case series ; Level of evidence , 4 . Methods : Fifty-three subjects ( females/males , 22/31 ; mean age , 32 ± 12 years ) were treated between 2000 and 2006 with a hyaluronan-based MACT product  and were followed prospect ively .  The mean body mass index ( BMI ) was 24.5 ± 3.8 kg/m2 and the mean defect size was 4.4 ± 1.9 cm2 . Fifty patients had single defects and 3 had multiple defects ( 41 medial femoral condyle , 6 lateral femoral condyle , 2 patella , 1 tibia ) . Two patients had 2 defects ( medial femoral condyle [MFC]/lateral femoral condyle and tibial/MFC ) , and in 1 case , multiple defects on the MFC were treated . The patients were stratified into 23 “ simple , ” 22 “ complex , ” and 8 “ salvage ” cases . Instability or malalignment was treated before or at the time of graft implantation . For 6 patients with small defects ( < 2 cm2 ) , microfracturing was used as first-line treatment before MACT . Clinical assessment was performed once a year with the subjective and objective International Knee Documentation Committee ( IKDC ) scores , Lysholm score , and a modified Cincinnati Knee Rating System . Results : The mean follow-up time was 9.07 ± 2.9 years ( range , 5 - 12 years ) . Treatment failure occurred in 12 of 53 cases ( 22.6 % ) an average of 2.99 ± 1.40 years after surgery . There was 1 failure ( 4.3 % ) among the simple cases , 4 failures ( 18.2 % ) in complex cases , and 7 failures ( 87.5 % ) in salvage cases . Statistically significant increases were observed in all scores at all time points compared with presurgery levels ( P < .05 ) . The subjective IKDC score improved from median 40.4 preoperatively to 74.7 at 10-year follow-up ( n = 13 patients ; P < .05 ) . Conclusion : MACT is an excellent surgical therapy for full-thickness cartilage defects of the knee , with good long-term results for simple defects . However , it should not be used in salvage cases A biodegradable , hyaluronian-based biocompatible scaffold was used for autologous chondrocyte transplantation . This prospect i ve study analyzes a clinical outcome of 70 consecutive patients treated by arthroscopic autologous chondrocyte transplantation at minimum 24 months follow up ( 47 of these patients achieved minimum 36 months follow-up and 21 patients minimum 48 months follow-up ) in order to establish clear indication criteria for this type of treatment . 31 of these patients presented isolated chondral lesions , while 39 patients with associated lesions ( 23 ACL lesions , 28 meniscal lesions , 1 varus knee ) were treated during the same surgical procedure with cartilage harvesting . A statistically significant clinical improvement was shown just at 24 months and the second-look arthroscopy demonstrated a complete coverage of the grafted area with a hyaline cartilage-like tissue in 12 of 15 analyzed patients . A better clinical outcome was observed in young , well-trained patients and in traumatic lesions . Other factors , such as defect size , localization , previous and associated surgery did not influence significantly the results . This matrix autologous chondrocyte transplantation procedure simplifies the surgical procedure and can be performed arthroscopically , thus reducing surgical morbidity and recovery time BACKGROUND Because of concerns about infections with the use of fresh osteoarticular allografts , osteoarticular allografts are currently stored hypothermically for a minimum of fourteen days to allow for serologic and microbiologic testing prior to implantation . Refrigerated osteoarticular allograft transplants are often used to treat symptomatic chondral and osteochondral defects in young , active patients . Chondrocyte viability has been shown to decrease substantially when allografts are stored for longer than twenty-eight days . The purpose of this study was to examine the clinical and functional outcomes of patients receiving refrigerated osteoarticular allografts between fifteen and twenty-eight days after procurement . METHODS Twenty-three consecutive patients ( twenty-three knees ) who underwent treatment of focal articular cartilage defects of the femoral condyles with refrigerated osteoarticular grafts were prospect ively followed for an average of three years . The average age of the implanted refrigerated allografts was 20.3 days . The patients were assessed preoperatively and postoperatively with vali date d outcome surveys . RESULTS The mean modified Cincinnati knee ratings significantly improved from baseline to the time of the final follow-up , with an increase from 27.3 to 36.5 on the subscale rating for function ( p<0.01 ) , from 21.9 to 32.5 on the subscale rating for symptoms ( p<0.03 ) , and from 49.2 to 69.0 for the overall score ( p<0.02 ) . The mean International Knee Documentation Committee subjective score improved from 52 points at baseline to 68.5 points at the time of the final follow-up ( p<0.03 ) . A significant improvement was also found for effusions and functional testing ( the single-leg hop ) ( p<0.001 for both ) . Radiographic evaluation at the time of the final follow-up revealed that twenty-two of the twenty-three grafts were in stable position with good osseous incorporation into host bone . No graft failure was encountered . CONCLUSIONS Transplantation of refrigerated osteoarticular allografts stored between fifteen and twenty-eight days provides significant functional and clinical improvement after an average follow-up of three years in patients treated for a full-thickness osteochondral defect of the femoral condyle , with similar outcomes to historical reports of patients with fresh allograft implants PURPOSE to assess the efficacy of associating the microfracture technique with platelet-rich plasma ( PRP ) injections in the treatment of chondral lesions to promote acceleration and optimization of the healing process compared with the traditional microfracture approach . METHODS from September 2011 to August 2012 , 20 patients ( 9 males and 11 females , aged 30 - 55 years ) were treated . All presented with chondral lesions of the medial femoral condyle of the knee and a pain duration ranging from 8 to 12 months . The patients were r and omized into two groups ( A and B ) . Group A was treated with the microfracture technique and a total of three intra-articular injections of PRP . Group B was treated with microfractures alone . Clinical follow-up was performed at 3 , 6 and 12 months after treatment . Clinical function was assessed on the basis of the International Knee Documentation Committee ( IKDC ) score . Pain was evaluated using a visual analogue scale ( VAS ) . RESULTS the patients in group A had a mean baseline IKDC score of 31.2 , which rose to 84.2 at 12 months . The IKDC scores in group B were at 30.1 at baseline and 81 at 12 months . CONCLUSIONS the results of our study suggest that functional recovery and resolution of pain are obtained more quickly in PRP-treated patients . We also observed a better functional outcome in the patients treated with the combination of PRP and microfractures , even at 12 months , although the difference was not statistically significant . LEVEL OF EVIDENCE level II , r and omized clinical study This study presents the prospect i ve two-year clinical and MRI outcome of autologous matrix-induced chondrogenesis ( AMIC ) for the treatment of patellofemoral cartilage defects in the knee . Ten patients were clinical ly prospect ively evaluated during 2 years .  MRI data were analysed based on the original and modified MOCART ( Magnetic Resonance Observation of Cartilage Repair Tissue ) scoring system . A satisfying clinical improvement became apparent during the 24 months of follow-up . The MOCART scoring system revealed a slight tendency to deterioration on MRI between one and 2 years of follow-up . However , the difference was not statistical significant . All cases showed subchondral lamina changes . The formation of intralesional osteophytes was observed in 3 of the 10 patients ( 30 % ) . In conclusion , AMIC is safe and feasible for the treatment of symptomatic patellofemoral cartilage defects and result ed in a clinical improvement . However , the favourable clinical outcome of the AMIC technique was not confirmed by the MRI findings Purpose The treatment of full-thickness cartilage defects of the knee is a common problem in orthopaedic surgery . Autologous chondrocyte transplantation ( ACT ) is one of the few reliable treatment options of cartilage defects with good long-term outcomes . The improvement of ACT led to the matrix-based ACT ( MACT ) . The purpose of the study was to compare two different commercially available MACT systems . Methods Eleven patients with a cartilage defect of the knee were treated with the MACI ® system and another nine patients with the CaRes ® implant .  The patients were prospect ively followed and re-examined after one year . Results One year after surgery all but one patient have significantly improved in their clinical outcome . Both types of MACT revealed similar results in terms of increase in level of activity , pain relief and knee function . Conclusion The study showed that MACT is a good therapeutic option for full-size defects of the femoral condyle . The MACI ® implant seems to be easier to h and le which is reflected by smaller incisions and a shorter operation time Background Autologous chondrocyte implantation ( ACI ) has been shown to have favorable results in the treatment of symptomatic chondral and osteochondral lesions . However , there are few reports on the outcomes of this technique in adolescents . Purpose The aim of this study was to assess pain relief and functional outcome in adolescents undergoing ACI .  Study Design Case series ; Level of evidence , 4 . Methods Thirty-five adolescent patients undergoing ACI or matrix-assisted chondrocyte implantation ( MACI ) were identified from a larger cohort . Four patients were lost to follow-up , leaving 31 patients ( 24 ACI , 7 MACI ) . The mean age was 16.3 years ( range , 14 - 18 years ) with a mean follow-up of 66.3 months ( range , 12 - 126 months ) . There were 22 male and 9 female patients . All patients were symptomatic ; 30 had isolated lesions and 1 had multiple lesions . Patients were assessed preoperatively and post-operatively using the visual analog scale ( VAS ) score for pain , the Bentley Functional Rating Score , and the Modified Cincinnati Rating System . At 1 year postoperatively , patients were recalled for a diagnostic biopsy , which was successfully attained in 21 patients . Results The mean pain scores improved from 5 preoperatively to 1 postoperatively . The Bentley Functional Rating Score improved from 3 to 0 , while the Modified Cincinnati Rating System improved from 48 preoperatively to 92 postoperatively with 84 % of patients achieving excellent or good results . All postoperative scores exhibited significant improvement from preoperative scores . One patient underwent graft hypertrophy and 1 patient 's graft failed and was revised . Biopsy results revealed hyaline cartilage in 24 % of cases , mixed fibro/hyaline cartilage in 19 % , and fibrocartilage in 57 % . Conclusion Results show that , in this particular group who received ACI , patients experienced a reduction in pain and significant improvement in postoperative function after ACI or MACI . The authors believe that ACI is appropriate in the management of carefully selected adolescents with symptomatic chondral and osteochondral defects Background Various approaches have been proposed to treat articular cartilage lesions , which are plagued by inherent limited healing potential . Purpose To compare the clinical outcome of patients treated with second-generation autologous chondrocyte implantation implants with those treated with the microfracture repair technique at 5-year follow-up . Study Design Cohort study ; Level of evidence , 2 . Methods Eighty active patients ( mean age , 29.8 years ) and grade III to IV cartilage lesions of the femoral condyles or trochlea were treated with  arthroscopic second-generation autologous chondrocyte implantation Hyalograft C or microfracture ( 40 patients per group ) . Patients achieved a minimum 5-year follow-up and were prospect ively evaluated . Results Both groups showed statistically significant improvement of all clinical scores from preoperative interval to 5-year follow-up . There was a significant improvement for the International Knee Documentation Committee subjective score from preoperative to 5-year follow-up ( Wilcoxon test , P < .001 ) . In the microfracture group , the International Knee Documentation Committee objective score increased from 2.5 % normal and nearly normal knees before the operation to 75 % normal and nearly normal knees at 5-year follow-up , and the subjective score increased from 41.1 ± 12.3 preoperatively to 70.2 ± 14.7 at 5-year follow-up . In the group treated with Hyalograft C , the International Knee Documentation Committee objective score increased from 15 % normal and nearly normal knees before the operation to 90 % normal and nearly normal knees at 5-year follow-up , and its subjective score increased from 40.5 ± 15.2 preoperatively to 80.2 ± 19.1 at 5-year follow-up ( Wilcoxon test , P < .001 ) . When comparing the groups , better improvement of the International Knee Documentation Committee objective ( P < .001 ) and subjective ( P = .003 ) scores was observed in the Hyalograft C group at 5-year follow-up . The return to sports at 2 years was similar in both groups and remained stable after 5 years in the Hyalograft C group ; it worsened in the microfracture group . Conclusion Both methods have shown satisfactory clinical outcome at medium-term follow-up . Better clinical results and sport activity resumption were noted in the group treated with second-generation autologous chondrocyte transplantation Purpose Focal chondral and osteochondral knee lesions are a common condition , particularly hard to treat , and often involve young active patients with high expectations in terms of symptomatic relief and return to sports .  Autologous osteochondral transplantation allows the defect area to be restored with hyaline cartilage . The aim of this study is to analyse whether it represents a safe and effective treatment option for small – medium-sized knee chondral and osteochondral lesions in a young and active population . Methods Thirty-one patients ( 18 men , 13 women ; mean age 32 ± ten ; mean BMI 24 ± 3 ) affected by focal knee chondral and osteochondral lesions were enrolled and treated with autologous osteochondral transplantation . They were prospect ively followed-up for 24 months with the IKDC-subjective , IKDC- objective , and Tegner scores . Adverse events and failures were also reported , as well as the B and i score to detect symptoms from the donor area . Results A significant increase was reported in all the clinical scores adopted . In particular , the IKDC-subjective score increased from a basal value of 40.3 ± 16.2 to 62.6 ± 18.0 at the 12 months ’ evaluation , with a further significant increase up to 71.6 ± 20.5 at the final 24 months ’ follow-up ( p < 0.0005 ) . A positive trend was also found by analysing the IKDC- objective score . The Tegner score revealed a significant improvement from a basal value of 2.2 ± 1.8 to 3.7 ± 1.5 at the final evaluation ( p = 0.003 ) , although it was not possible to regain the same pre-injury sports activity level of 5.0 ± 2.2 . Two failures were reported . The B and i score revealed patients complaining of mild and moderate symptoms , not correlated to the lesion size . The presence of symptoms ascribable to the donor area was significantly correlated with a lower clinical outcome . Conclusions Autologous osteochondral transplantation proved to be , at short-term evaluation , a suitable option to treat small – medium sized chondral and osteochondral lesions . However , clinical improvement is slow and a significant percentage of patients develop symptoms attributable to the donor area , thus reducing the overall benefit of this procedure Matrix-associated autologous chondrocyte transplantation/implantation ( MACT/MACI ) is a new operation procedure using a cell seeded collagen matrix for the treatment of localized full-thickness cartilage defects . A prospect i ve clinical investigation was carried out in order to clarify whether this proves suitable and confirms objective and subjective clinical improvement over a period of up to 5 years after operation . Thirty-eight patients with localised cartilage defects were treated with MACT .  Within the context of clinical follow-up , these patients were evaluated for up to 5 years after the intervention . Four different scores ( Meyers score , Tegner-Lysholm activity score , Lysholm-Gillquist score , ICRS score ) as well as the results of six  arthroscopies  and  biopsies  obtained from four patients formed the basis of this study . For 15 patients , 5 or more years had elapsed since the operation at the time this study was completed . It was possible to obtain results 5 years postoperatively from 11 ( 73.3 % ) of these 15 patients . Overall , we included 25 patients into the evaluation with a 2-year or longer postoperative period . Five years after transplantation 8 out of 11 patients rated the function of their knee as much better or better than before . Three of the four scores showed significant improvement compared to the preoperative value . One score , the Tegner-Lysholm score showed improvement , which , however , did not prove to be significant . The significantly improved results on three scores after 5 years suggest that MACT represents a suitable but cost-intensive alternative in the treatment of local cartilage defects in the knee Cartilage defects occur in approximately 12 % of the population and can result in significant function impairment and reduction in quality of life . Evidence for the variety of surgical treatments available is inconclusive . This study aim ed to compare the clinical outcomes of patients with symptomatic cartilage defects treated with matrix-induced autologous chondrocyte implantation ( MACI ™ or microfracture ( MF ) . Included patients were ≥18 and ≤50 years of age with symptomatic , post-traumatic , single , isolated chondral defects ( 4–10 cm2 ) and were r and omised to receive MACI ™ or MF .  Patients were followed up 8–12 , 22–26 and 50–54 weeks post-operatively for efficacy and safety evaluation . Outcome measures were the Tegner , Lysholm and ICRS scores . Sixty patients were included in a r and omised study ( 40 MACI ™ , 20 MF ) . The difference between baseline and 24 months post-operatively for both treatment groups was significant for the Lysholm , Tegner , patient ICRS and surgeon ICRS scores ( all P < 0.0001 ) . However , MACI ™ was significantly more effective over time ( 24 months versus baseline ) than MF according to the Lysholm ( P = 0.005 ) , Tegner ( P = 0.04 ) , ICRS patient ( P = 0.03 ) and ICRS surgeon ( P = 0.02 ) scores . There were no safety issues related to MACI ™ or MF during the study . MACI ™ is superior to MF in the treatment of articular defects over 2 years . MACI ™ and MF are complementary procedures , depending on the size of the defect and symptom recurrence . The MACI ™ technique represents a significant advance over both first and second generation chondrocyte-based cartilage repair techniques for surgeons , patients , health care institutions and payers in terms of reproducibility , safety , intraoperative time , surgical simplicity and reduced invasiveness Background Focal articular cartilage lesions of the knee in young patients present a therapeutic challenge . Little information is available pertaining to the results after implantation of prolonged fresh grafts . Hypothesis Prolonged fresh osteochondral allografts present a viable option for treating large full-thickness articular cartilage lesions . Study Design Case series ; Level of evidence , 4 . Methods This study presents the results of 25 consecutive patients who underwent prolonged fresh osteochondral allograft transplantation for defects in the femoral condyle . The average patient age was 35 years ( range , 17 - 49 years ) . The average length of follow-up was 35 months ( range , 24 - 67 months ) . Prospect i ve data were collected using several subjective scoring systems , as well as objective and radiographic assessment s. Results Statistically significant improvements ( P < .05 ) were seen for the Lysholm ( 39 to 67 ) , International Knee Documentation Committee scores ( 29 to 58 ) , all 5 components of the Knee injury and Osteoarthritis Outcome Score ( Pain , 43 to 73 ; Other Disease-Specific Symptoms , 46 to 64 ; Activities of Daily Living Function , 56 to 83 ; Sport and Recreation Function , 18 to 46 ; Knee-Related Quality of Life , 22 to 50 ) , and the Short Form-12 physical component score ( 36 to 40 ) . Overall , patients reported 84 % ( range , 25 % to 100 % ) satisfaction with their results and believed that the knee functioned at 79 % ( range , 35 % to 100 % ) of their unaffected knee . Radiographically , 22 of the grafts ( 88 % ) were incorporated into host bone . Conclusion Fresh osteochondral allograft transplantation is an acceptable intermediate procedure for treatment of localized osteochondral defects of the femur . At 2-year follow-up , it is well incorporated and offered consistent improvements in pain and function . Clinical Relevance Prolonged fresh allograft transplantation is a safe and effective technique for addressing symptomatic osteoarticular lesions in the knees of young patients Background : Fresh-stored osteochondral allografts have been used successfully to resurface large chondral and osteochondral defects of the knee . However , there are limited data available for the return to athletic activity . Purpose : To review the rate of return to athletic activity after osteochondral allograft transplantation in the knee and to identify any potential risk factors for not returning to sport . Study Design : Case series ; Level of evidence , 4 . Methods : Forty-three athletes were treated with fresh-stored osteochondral allograft transplantation for symptomatic large chondral or osteochondral defects of the knee from 2000 to 2010 . The average age of the athletes ( 30 men , 13 women ) was 32.9 years ( range , 18 - 49 years ) . Patients were prospect ively evaluated by International Knee Documentation Committee ( IKDC ) , activities of daily living scale of the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , Marx Activity Rating Scale , and Cincinnati Sports Activity Scale scores . A multivariable regression analysis was performed to identify potential risk factors for failure to return to sport at the preinjury level . Results : At an average 2.5-year follow-up , limited return to sport was possible in 38 of 43 athletes ( 88 % ) , with full return to the preinjury level achieved in 34 of 43 athletes ( 79 % ) . In these 34 athletes , time to return to sport was 9.6 ± 3.0 months . Age ≥25 years ( P = .04 ) and preoperative duration of symptoms greater than 12 months ( odds ratio , 37 ; P = .003 ) negatively affected the ability to return to sport . In the athletes who returned to their previous level of competition , IKDC ( P < .001 ) , KOOS ( P = .02 ) , and Marx Activity Rating Scale ( P < .001 ) scores were all significantly greater than in those athletes who did not return to sport . Conclusion : Osteochondral allograft transplantation in an athletic population for chondral and osteochondral defects in the knee allows for a high rate of return to sport . Risk factors for not returning to sport included age ≥25 years and preoperative duration of symptoms ≥12 months Background : Autologous chondrocyte implantation ( ACI ) has been associated with satisfying results . Still , it remains unclear when success or failure after ACI can be estimated . Purpose : To evaluate the clinical outcomes of cell-seeded collagen matrix – supported ACI ( ACI-Cs ) for the treatment of cartilage defects of the knee at 36 months and to determine a time point after ACI-Cs at which success or failure can be estimated . Study Design : Cohort study ; Level of evidence , 3 . Methods : A total of 80 patients with isolated full-thickness cartilage defects of the knee joint treated with ACI-Cs  were prospect ively assessed before surgery as well as postoperatively by use of the International Knee Documentation Committee ( IKDC ) score and Lysholm knee score . Results : Preoperative IKDC and Lysholm scores increased from 49.6 and 59.5 , respectively , to 79.1 and 83.5 , respectively , at 36 months . Only half the patients ( 46.6 % ) with poor IKDC scores ( ie , < 70 ) at 6 months postoperatively showed continued poor or fair scores at 36 months ’ follow-up . The probability of poor scores at 36 months after surgery further increased to 0.61 and 0.81 , respectively , when scores were persistent at 12 and 24 months . All 3 patients ( 100 % ) with good IKDC scores ( ie , 81 - 90 ) at 6 months after surgery showed constant or even improved scores at 36 months ’ follow-up . Ninety-one percent of patients with good and excellent scores at 12 months and 83 % of patients with good and excellent scores at 24 months ( a total of 23 and 37 patients , respectively ) were able to maintain these scores at 36 months ’ follow-up . Similar results were obtained for the Lysholm score . Conclusion : With regard to the improvements in functional outcomes after ACI-Cs at 36 months after surgery , the technique described here appears to lead to satisfying and stable clinical results . This study helps the treating physician to predict the likeliness of further clinical improvements or constant unsatisfactory results after ACI . In patients with good/excellent scores shortly after surgery , deterioration of the knee ’s condition is rarely found . For patients with poor and fair postoperative scores , clinical outcomes are more difficult to predict , especially during the first year after the procedure Abstract Purpose Microfracture is a well-established treatment procedure for chondral defects in high-dem and population with good short-term results . The purpose of our study was to evaluate long-term clinical outcome of microfracture treatment in athletes with full-thickness chondral defects . Methods Between 1991 and 2001 , 170 patients were treated with microfracture for full-thickness knee chondral lesions at our institute and 67 of them were included in this study and prospect ively followed up . Sixty-one athletes ( 91 % ) were available at final follow-up ( average 15.1 years ) . Average lesion size was 401 ± 27 mm2 . Lysholm , Tegner and International Knee Documentation Committee ( IKDC ) ( subjective– objective ) scores were utilized pre-operatively and at 2-year , 5-year and final follow-up ; Knee injury and Osteoarthritis Outcome Score ( KOOS ) , visual analog scale ( VAS ) and Marx scores were also collected at final follow-up . Results IKDC , Lysholm and Tegner scores increased significantly at 2 years , but gradually deteriorated at long term ; however , average scores were significantly above baseline at final follow-up . Seven patients ( 11 % ) were considered as failures as they underwent another operation because of reinjury or persistent pain during the first 5 years . Pain and swelling during strenuous activities was reported only in nine patients by the end of 2 years and in 35 patients at final follow-up . Patients with smaller lesions ( ≤400 mm² ) and younger patients ( ≤30 years ) showed significantly better results in KOOS , VAS and Marx scores . Radiographs performed at final follow-up showed evidence of progression of osteoarthritis changes in 40 % of the knees , with higher rate in older patients with large or multiple lesions ( p < 0.05 ) . Conclusions Microfracture when applied in young patients with smaller lesions can offer good clinical results at short- and long-term follow-up ; lesion size is more important prognostic factor of outcome than age . Deterioration of the clinical outcome should be expected after 2 and 5 years post-treatment , and degenerative changes are present at long-term follow-up , with higher rate in older athletes with large , multiple lesions . Level of evidence IV Abstract Purpose Matrix-induced autologous chondrocyte implantation ( MACI ) has demonstrated effectiveness in treating isolated cartilage defects of the knee but medium- and long-term evidence and information on the management of postoperative complications or partially successful cases are sparse . This study hypothesised that MACI is effective for up to 5 years and that patients with posttreatment problems may go on to obtain clinical benefit from other interventions . Methods A follow-on , prospect i ve case series of patients recruited into a previous controlled , r and omised , prospect i ve study or newly enroled . Patients were followed up 6 , 12 , 24 and 60 months after surgery . Outcome measures were Tegner ( activity levels ) and Lysholm ( pain , stability , gait , clinical symptoms ) scores . Zone-specific subgroups were analysed 6 , 12 and 24 months postoperatively . Results Sixty-five patients were treated with MACI .  Median Tegner score improved from II to IV at 12 months ; an improvement maintained to 60 months . Mean Lysholm score improved from 28.5 to 76.6 points ( ±19.8 ) at 24 months , settling back to 75.5 points after 5 years ( p > 0.0001 ) . No significant differences were identified in the zone-specific analysis . Posttreatment issues ( N = 12/18.5 % ) were resolved with microfracture , debridement , OATS or bone grafting . Conclusions MACI is safe and effective in the majority of patients . Patients in whom treatment is only partially successful can go on to obtain clinical benefit from other cartilage repair options . This study adds to the clinical evidence on the MACI procedure , offers insight into likely treatment outcomes , and highlights MACI ’s usefulness as part of an armamentarium of surgical approaches to the treatment of isolated knee defects . Level of evidence Prospect i ve case control study with no control group , Level III Most studies suggested that arthroscopic microfracture is effective method at only less than 40 years of age . Thus , the authors thought that “ how can this indication regarding age be extended ? , ” and tried to find a way to use this technique effectively over 40 years of age . The aim of this study was the first to report the results regarding the PRP as an adjunct for arthroscopic microfracture in the early osteoarthritic ( OA ) knee with cartilage lesion over 40 years of age . 49 patients who underwent arthroscopic microfracture for cartilage lesion sized less than 4 cm2 with early OA , aged 40–50 years , were enrolled and r and omly divided into 2 groups : a control group with only arthroscopic microfracture ( 25 patients ) and a study group with arthroscopic microfracture and PRP ( 24 patients ) . The patients were prospect ively evaluated with VAS , IKDC score at preoperative and postoperative 1 , 6 , 12 , and 24 months . And we perform second arthroscopies in 10 patients of each group to identify the extent of cartilage restoration at 4–6 months postoperatively . There were significant improvements in clinical results between preoperative evaluation and postoperative 2 years in both groups ( p = 0.017 ) . In the postoperative 2 years , clinical results showed significantly better in the study group than in the control group ( p = 0.012 ) . In post-arthroscopic finding , hardness and elasticity degree was better in the study group . The PRP injection with arthroscopic microfracture would be improved the results in early osteoarthritic knee with cartilage lesion in 40–50 years old , and the indication of this technique could be extended to 50 years PURPOSE We report the 2-year clinical results and identify prognostic factors in patients treated with autologous chondrocyte transplantation by use of a collagen membrane to seed the chondrocytes ( ACT-CS ) .  METHODS This is a prospect i ve study of 59 patients who were treated with ACT-CS and followed up for 24 months . Clinical function was assessed by International Knee Documentation Committee ( IKDC-2000 ) , objective International Cartilage Repair Society , and Lysholm scores before surgery and at 6 , 12 , and 24 months after surgery . RESULTS On the basis of objective International Cartilage Repair Society ( ICRS ) rating , the percentage of patients rated A ( normal ) and B ( nearly normal ) increased from 33.9 % preoperatively to 92.5 % at 24 months after ACT-CS .  IKDC and Lysholm scores increased from 50.1 points ( SD , 13.4 ) and 60.5 points ( SD , 9.4 ) , respectively , to 76.1 points ( SD , 15.2 ) ( P < .001 ) and 82.5 points ( SD , 13.7 ) ( P < .001 ) , respectively , at 24 months . The failure rate was highest , at 26.7 % at 2 years ' follow-up , in the subgroup of patients who underwent ACT-CS as a salvage procedure . The rate of failures in patients with isolated cartilage defects was 5.9 % . CONCLUSIONS ACT-CS represents a technical modification of membrane-associated autologous chondrocyte transplantation that combines easy h and ling and attractive application properties with reliable clinical results 24 months after surgery , especially in patients with isolated cartilage defects . Even though the failure rate was higher in patients with kissing lesions or mild osteoarthritis , ACT-CS also seems to improve function in a large proportion of such patients . LEVEL OF EVIDENCE Level IV , prospect i ve case series Background : To date , few studies have been published reporting the 5-year follow-up of clinical and radiological outcomes for chondral defects treated with matrix-induced autologous chondrocyte implantation ( MACI ) . Hypothesis : A significant improvement in clinical and radiological outcomes after treatment of symptomatic , traumatic chondral defects of the knee with the MACI implant will be maintained up to 5 years after surgery . Study Design : Case series ; Level of evidence , 4 . Methods : A prospect i ve evaluation of the MACI procedure was performed in 21 patients with chondral defects of the knee . After the MACI procedure , patients were clinical ly assessed with the Knee injury and Osteoarthritis Outcome Score ( KOOS ) , the Tegner-Lysholm score , the International Knee Documentation Committee ( IKDC ) Subjective Knee Form , and the modified Cincinnati score at years 1 , 2 , and 5 . The quality of repair tissue was assessed by magnetic resonance imaging using the magnetic resonance observation of cartilage repair tissue ( MOCART ) score at months 3 and 6 and years 1 , 2 , and 5 . Results : Significant improvements ( P < .05 ) were observed for all 5 KOOS subcategories at year 1 and were maintained through year 5 in 90.5 % of patients ( 19/21 ) . Treatment failure occurred in only 9.5 % of patients ( 2/21 ) . Significant improvements ( P < .05 ) from baseline to year 5 were also observed for the IKDC score ( 30.1 to 74.3 ) , the modified Cincinnati score ( 38.1 to 79.6 ) , and the Tegner-Lysholm activity score ( 1.8 to 4.3 ) . Similarly , the MOCART score significantly improved ( P < .001 ) from baseline to year 5 ( 52.9 to 75.8 ) . After 5 years , complete filling ( 83 % ) and integration ( 82 % ) of the graft were seen in the majority of patients . Signs of subchondral bone edema were still present in 47 % of patients at 5 years . No product-specific adverse events were reported over the 5-year follow-up period . Conclusion : Patients treated with a MACI implant demonstrated significant clinical improvement and good quality repair tissue 5 years after surgery . The MACI procedure was shown to be a safe and effective treatment for symptomatic , traumatic chondral knee defects in this study BACKGROUND There is limited information regarding direct comparisons of the outcome of osteochondral autograft transfer ( OAT ) mosaicplasty and microfracture for the treatment of isolated articular cartilage defects of the knee . The purpose of this retrospective comparative study was to compare the general health outcomes , knee function , and Marx Activity Rating Scale scores for patients treated with OAT or microfracture for symptomatic chondral defects of the femoral condyles or trochlea . We hypothesized that the patients in the two treatment groups would have similar clinical outcomes at intermediate-term follow-up . METHODS Ninety-six patients with full-thickness cartilage defects of the femoral condyles or trochlea were treated with either OAT mosaicplasty ( n = 48 ) or microfracture ( n = 48 ) . The average age of the patients ( thirty-two male and sixteen female in each group ) at the time of surgery was 29.7 years in the OAT group and 32.5 years in the microfracture group . Patients were prospect ively evaluated at baseline and at one , two , three , and five years postoperatively with use of vali date d clinical outcome measures including the Short Form-36 ( SF-36 ) physical component , International Knee Documentation Committee ( IKDC ) , Knee Outcome Survey activities of daily living , and Marx Activity Rating Scale instruments . Comparisons between outcomes before and after treatment or between outcomes after microfracture and mosaicplasty were made with use of two-tailed tests . RESULTS At the time of the latest follow-up , both groups demonstrated significant increases in SF-36 physical component , Knee Outcome Survey activities of daily living , and IKDC scores compared with baseline . These scores did not differ significantly between the two groups at any of the follow-up time points . However , the OAT group demonstrated a significantly greater improvement in the Marx Activity Rating Scale scores from baseline to the two-year ( p = 0.001 ) , three-year ( p = 0.03 ) , and five-year ( p = 0.02 ) time points compared with the microfracture group . CONCLUSIONS In the present retrospective comparative study , the hypothesis that patients treated with microfracture or OAT mosaicplasty for symptomatic articular cartilage defects of the femoral condyles or trochlea would have similar clinical outcomes at intermediate-term follow-up was affirmed for general health outcome and for knee function . However , patients treated with OAT mosaicplasty maintained a superior level of athletic activity compared with those treated with microfracture Abstract Background Cell-based strategies that combine in vitro- exp and ed autologous chondrocytes with matrix scaffolds are currently preferred for full-thickness cartilage lesions of the knee ≥2 cm2 . Although this approach is reasonable , continuing advances in the field of cartilage repair will further exp and the options available to improve outcomes .Hypothesis/ purpose In the present clinical study , we compared the outcomes of matrix-induced autologous mesenchymal stem cell implantation ( m-AMI ) with matrix-induced autologous chondrocyte implantation ( m-ACI ) for the treatment of isolated chondral defects of the knee . Study design Prospect i ve , single-site , r and omized , single-blind pilot study . Methods Fourteen patients with isolated full-thickness chondral lesions of the knee > 2 cm2 were r and omized into two treatment groups : m-AMI and m-ACI . Outcomes were assessed pre-operatively and 3 , 6 , 12 and 24 months post-operatively . Results Clinical evaluations revealed that improvement from pre-operation to 24 months post-operation occurred in both groups ( p < 0.05 ) . At all follow-up intervals , m-AMI demonstrated significantly better functional outcomes ( motion deficit and straight leg raise strength ) than did m-ACI ( p < 0.05 ) . At all follow-up intervals , m-AMI demonstrated significantly better subjective sub-scale scores for pain , symptoms , activities of daily living and sport and recreation of the knee injury and osteoarthritis outcome score ( KOOS ) than did m-ACI ( p < 0.05 ) . Additionally , m-AMI demonstrated significantly better ( p < 0.05 ) scores than m-ACI for the quality of life sub-scale of the KOOS and visual analog scale ( VAS ) severity at the 6-month follow-up . The Tegner activity score and VAS frequency were not significantly different between the two groups . Graft failure was not observed on magnetic resonance imaging at the 24-month follow-up . m-AMI and m-ACI demonstrated very good-to-excellent and good-to-very good infill , respectively , with no adverse effects from the implant , regardless of the treatment . Conclusion For the treatment of isolated full-thickness chondral lesion of the knee , m-AMI can be used effectively and may potentially accelerate recovery . A larger patient cohort and follow-up supported by histological analyses are necessary to determine long-term outcomes Background The ability of autologous chondrocyte transplantation to produce and maintain an effective articular cartilage repair under high mechanical dem and s has not been investigated . Hypothesis Autologous chondrocyte transplantation provides a reliable and durable repair of full-thickness knee articular cartilage lesions in high-dem and athletes . Study Design Case series ; Level of evidence , 4 . Methods A total of 45 soccer players were evaluated 41 ± 4 months after autologous chondrocyte transplantation  for their ability to return to soccer , the timing of their return , skill level , and functional outcome rating by the Tegner activity rating scale score and Brittberg score . The factors influencing the return to sport were analyzed . Results Of these players , 72 % reported good to excellent results , with significant overall improvement of Tegner activity rating scale scores ; 33 % returned to soccer , including 83 % of competitive-level players and 16 % of recreational players . Of the returning players , 80 % returned to the same skill level and 87 % maintained their ability to play soccer at 52 ± 8 months postoperatively . Players who successfully returned to soccer were significantly younger and had a shorter preoperative duration of symptoms than did patients who did not return to the sport . Concomitant adjuvant procedures did not adversely affect the ability to return to soccer . Conclusion Repair of knee articular cartilage lesions by autologous chondrocyte transplantation in high-performance athletes is particularly successful in younger , competitive athletes with limited preoperative intervals Background Treating patellofemoral articular cartilage lesions remains a challenging task in orthopedic surgery . Whereas microfracture and autologous chondrocyte implantation yield good results on femoral condyles , the therapeutic state of the art for treating patellofemoral lesions is yet to be determined . In this study , we compared the CaReS ® technique , which is a matrix-associated autologous chondrocyte implantation technique , to microfracture for treating patellofemoral articular cartilage lesions . Methods Between May 2003 and December 2005 , 17 patients with an isolated patellofemoral cartilage defect ( International Cartilage Repair Society III/IV ) were treated with the CaReS ® technique at our department . After adjusting for inclusion and exclusion criteria , ten of these patients could be included in this study ; ten patients treated with microfracture  were chosen as a matched-pair group . Clinical outcome was evaluated 3 years after surgery by the 36-item Short Form Health Survey Question naire ( SF-36 ) , International Knee Documentation Committee ( IKDC ) subjective evaluation of the knee , Lysholm Score , and Cincinnati Modified Rating Scale scores . Results Patients treated with CaReS ® had statistically significantly improved IKDC , Lysholm , and Cincinnati scores 36 months after surgery compared with preoperatively . When comparing outcome between groups 36 months after surgery , there was no statistically difference in IKDC , Lysholm , and Cincinnati scores . Conclusions This is the first trial comparing the CaReS ® technique and microfracture for treating patellofemoral articular cartilage lesions , and results show that CaReS ® yields comparable results to microfracture . The small number of patients is a limiting factor of the study , leading to results without statistical significance . A multicentric prospect i ve r and omized study comparing the two procedures is desirable Cartilage defects represent a common problem in orthopaedic practice . The knee is frequently involved and the medial femoral condyle is the most common localization . Predisposing factors are : traumas , inflammatory conditions and biomechanics alterations . Several surgical options are available once correct diagnosis is given and accurate patient evaluation has been performed . The aim of our study was to prospect ively evaluate functional results of modified autologous matrix induced chondrogenesis ( AMIC ) technique in a population of patients affected by focal cartilage defects A population of 17 patients was enrolled in this study . 10 patients were male , mean age at the time of surgery was 39 years , right side was involved in 11 cases . All patients were evaluated with accurate physical exam and complete imaging study . At an average FU of 36 months , mean IKDC score and Lysholm score improved from 32 to 82 and from 38 to 74 . 13 patients out of 17 ( 76.5 % ) were satisfied or extremely satisfied with their functional result . MRI control showed reduction of the defect area and subchondral oedema in 10 cases ( 58.8 % ) . AMIC technique is a relatively new option in the treatment of full thickness cartilage lesions . It enhances the advantages of microfractures since the Chondrogide membrane protects and stabilizes the blood plug acting as a matrix for new cartilage formation . First reports on AMIC technique , show comparable results to  autologous chondrocyte implantation ( ACI ) with the advantage of a single stage technique and no donor site morbidity .  AMIC technique represents a new option in the treatment of full thickness cartilage defect . It is safe and reliable . Our data are in accordance with previously reported series in literature and confirm the good objective and subjective results of this procedure Numerous surgical techniques have been developed to treat osteochondral defects of the knee . A study reported encouraging outcomes of third-generation autologous chondrocyte implantation achieved using the solid agarose-alginate scaffold Cartipatch ® . Whether this scaffold is better than conventional techniques remains unclear . This multicenter r and omized controlled trial compared 2-year functional outcomes ( IKDC score ) after Cartipatch ® versus mosaicplasty in patients with isolated symptomatic femoral chondral defects ( ICRS III and IV ) measuring 2.5 - 7.5 cm(2 ) . In addition , a histological evaluation based on the O'Driscoll score was performed after 2 years . We needed 76 patients to demonstrate an at least 10-point subjective IKDC score difference with α = 5 % and 90 % power . During the enrolment period , we were able to include 55 patients , 30 of them were allocated at r and om to Cartipatch ® and 25 to mosaicplasty . After 2 years , eight patients had been lost to follow-up , six in the Cartipatch ® group , and two in the mosaicplasty group . The baseline characteristics of the two groups were not significantly different . The mean IKDC score and score improvement after 2 years were respectively 73.7 ± 20.1 and 31.8 ± 20.8 with Cartipatch ® and 81.5 ± 16.4 and 44.4 ± 15.2 with mosaicplasty . The 12.6-point absolute difference in favor of mosaicplasty is statistically significant . Twelve adverse events were recorded in the Cartipatch ® group against six in the mosaicplasty group . After 2 years , functional outcomes were significantly worse after Cartipatch ® treatment compared to mosaicplasty for isolated focal osteochondral defects of the femur Background The healing potential of damaged articular cartilage is limited . The NeoCart is a tissue-engineered collagen matrix seeded with autogenous chondrocytes design ed for the repair of hyaline articular cartilage . Hypothesis The NeoCart implant is well tolerated in the human knee . Study Design Case series ; Level of evidence , 4 . Methods Eight patients ( treatment group ) with full-thickness cartilage injury were treated with the NeoCart and evaluated prospect ively . Autogenous chondrocytes provided by arthroscopic biopsy were seeded into a 3-dimensional type I collagen scaffold . The seeded scaffold was subjected to a tissue-engineering protocol including treatment with a bioreactor . Implantation of the prepared cartilage tissue patch was performed via miniarthrotomy and secured with a collagen bioadhesive . Evaluations through 24 months postoperatively included the subjective International Knee Documentation Committee question naire , visual analog scale , range of motion , and cartilage-sensitive magnetic resonance imaging ( MRI ) , including quantitative T2 mapping . Results Pain scores after NeoCart implantation  were significantly lower than baseline at 12 and 24 months after the procedure ( P < .05 ) . Improved function and motion were also noted at 24 months . Six patients had 67 % to 100 % defect fill at 24 months with MRI evaluation . One patient had moderate ( 33%-66 % ) defect fill , and another patient had poor ( less than 33 % ) defect fill . Partial stratification of T2 values was observed for 2 patients at 12 months and 4 patients at 24 months . No patients experienced arthrofibrosis or implant hypertrophy . Conclusion Pain was significantly reduced 12 and 24 months after NeoCart treatment . Trends toward improved function and motion were observed 24 months after implantation . The MRI indicated implant stability and peripheral integration , defect fill without overgrowth , progressive maturation , and more organized cartilage formation Background : R and omized controlled trials study ing the efficacy and safety of matrix-applied characterized autologous cultured chondrocytes ( MACI ) versus microfracture ( MFX ) for treating cartilage defects are limited . Purpose : To compare the clinical efficacy and safety of MACI versus MFX in the treatment of patients with symptomatic cartilage defects of the knee . Study Design : R and omized controlled clinical trial ; Level of evidence , 1 . Methods : Patients enrolled in the SUMMIT ( Demonstrate the Superiority of MACI implant to Microfracture Treatment )  trial had ≥1 symptomatic focal cartilage defect ( Outerbridge grade III or IV ; ≥3 cm2 ) of the femoral condyles or trochlea , with a baseline Knee Injury and Osteoarthritis Outcome Score ( KOOS ) pain value < 55 . The co– primary efficacy endpoint was the change in the KOOS pain and function subscores from baseline to 2 years . Histological evaluation and magnetic resonance imaging ( MRI ) assessment s of structural repair tissue , treatment failure , the remaining 3 KOOS subscales , and safety were also assessed . Results : Of the 144 patients treated , 137 ( 95 % ) completed the 2-year assessment . Patients had a mean age of 33.8 years and a mean lesion size of 4.8 cm2 .  The mean KOOS pain and function subscores from baseline to 2 years were significantly more improved with MACI than with MFX ( pain : MACI , 37.0 to 82.5 vs MFX , 35.5 to 70.9 ; function : MACI , 14.9 to 60.9 vs MFX , 12.6 to 48.7 ; P = .001 ) . A significant improvement in scores was also observed on the KOOS subscales of activities of daily living ( MACI , 43.5 to 87.2 vs MFX , 42.6 to 75.8 ; P < .001 ) , knee-related quality of life ( MACI , 18.8 to 56.2 vs MFX , 17.2 to 47.3 ; P = .029 ) , and other symptoms ( MACI , 48.3 to 83.7 vs MFX , 44.4 to 72.2 ; P < .001 ) for patients treated with MACI compared with MFX . Repair tissue quality was good as assessed by histology/MRI , but no difference was shown between treatments . A low number of treatment failures ( nonresponders : MACI , 12.5 % vs MFX , 31.9 % ; P = .016 ) and no unexpected safety findings were reported . Conclusion : The treatment of symptomatic cartilage knee defects ≥3 cm2 in size using MACI was clinical ly and statistically significantly better than with MFX , with similar structural repair tissue and safety , in this heterogeneous patient population . Moreover , MACI offers a more efficacious alternative than MFX with a similar safety profile for the treatment of symptomatic articular cartilage defects of the knee Background Damaged articular cartilage has limited capacity for self-repair . Autologous chondrocyte implantation using a characterized cell therapy product results in significantly better early structural repair as compared with microfracture in patients with symptomatic joint surface defects of the femoral condyles of the knee . Purpose To evaluate clinical outcome at 36 months after characterized chondrocyte implantation ( CCI ) versus microfracture ( MF ) . Study Design R and omized controlled trial ; Level of evidence , 1 . Methods Patients aged 18 to 50 years with single International Cartilage Repair Society ( ICRS ) grade III/IV symptomatic cartilage defects of the femoral condyles were r and omized to CCI ( n = 57 ) or MF ( n = 61 ) . Clinical outcome was measured over 36 months by the Knee injury and Osteoarthritis Outcome Score ( KOOS ) . Serial magnetic resonance imaging ( MRI ) scans were scored using the Magnetic resonance Observation of Cartilage Repair Tissue ( MOCART ) system and 9 additional items . Gene expression profile scores associated with ectopic cartilage formation were determined by RT-PCR . Results Baseline mean overall KOOS ( ±SE ) was comparable between the CCI and MF groups ( 56.30 ± 1.91 vs 59.46 ± 1.98 , respectively ) . Mean improvement ( ±SE ) from baseline to 36 months in overall KOOS was greater in the CCI group than the MF group ( 21.25 ± 3.60 vs 15.83 ± 3.48 , respectively ) , while in a mixed linear model analysis with time as a categorical variable , significant differences favoring CCI were shown in overall KOOS ( P = .048 ) and the subdomains of Pain ( P = .044 ) and QoL ( P = .036 ) . More CCI- than MF-treated patients were treatment responders ( 83 % vs 62 % , respectively ) . In patients with symptom onset of < 2 years , the mean improvement ( ±SE ) from baseline to 36 months in overall KOOS was greater with CCI than MF ( 24.98 ± 4.34 vs 16.50 ± 3.99 , respectively ) and even greater in patients with symptom onset of <3 years ( 26.08 ± 4.10 vs 17.09 ± 3.77 , respectively ) . Characterized chondrocyte implantation patients with high ( > 2 ) versus low ( < 2 ) gene profile scores showed greater improvement from baseline in mean overall KOOS ( ±SE ) at 36 months ( 28.91 ± 5.69 vs 18.18 ± 5.08 , respectively ) . Subchondral bone reaction significantly worsened over time with MF compared with CCI ( P < .05 ) . Conclusion Characterized chondrocyte implantation for the treatment of articular cartilage defects of the femoral condyles of the knee results in significantly better clinical outcome at 36 months in a r and omized trial compared with MF . Time to treatment and chondrocyte quality were shown to affect outcome Background : Sex-specific outcomes have been reported in anterior cruciate ligament reconstruction as well as in osteoarthrosis progression , but there are currently no related published data on autologous chondrocyte implantation ( ACI ) . The present prospect i ve study was performed to investigate sex-dependent differences in the results after ACI . Hypothesis : The clinical and magnetic resonance imaging ( MRI ) results after ACI of the knee are influenced by the patient ’s sex . Study Design : Cohort study ; Level of evidence , 2 . Methods : The midterm clinical and MRI results of a cell-based fibrin-polymer graft for the treatment of full-thickness cartilage defects were evaluated preoperatively and 6 , 12 , and 48 months after surgery in 52 patients ( male : female ratio , 25:27 ; average age , 35.6 years ) . Depending on the sex and the location of the defects ( femoral condyles , n = 32 ; patellofemoral compartment , n = 20 ) , patients were assigned to 4 different groups . Baseline clinical scores were compared with follow-up data by paired Wilcoxon tests for the Lysholm score and the International Knee Documentation Committee ( IKDC ) scoring system . Sex-specific differences were evaluated with the Mann-Whitney U test . The  MRI  evaluation was performed with the Henderson score at final follow-up . Results : Clinical scores improved in all groups over the whole study period ( P < .05 ) . Compared with female patients , male patients achieved significantly better results in the Lysholm score at all time intervals and in the IKDC score at 6 and 12 months after surgery ( P < .05 ) . In a subgroup analysis , female patients with patellar defects had the worst results in both clinical scores . With the available number of patients , MRI evaluation at 48 months after surgery revealed no significant difference in defect fill between male and female patients ( P > .05 ) . The Pearson correlation coefficient between both clinical scores and the MRI parameters of defect fill and cartilage signal was significant ( P < .05 ) . Conclusion : Autologous chondrocyte implantation is a promising treatment option for full-thickness cartilage defects of male and female knee joints . Female patients with patellar defects have worse prognostic factors BACKGROUND The optimal treatment for cartilage lesions has not yet been established . The objective of this r and omized trial was to compare autologous chondrocyte implantation with microfracture . This paper represents an up date , with presentation of the clinical results at five years . METHODS Eighty patients who had a single chronic symptomatic cartilage defect on the femoral condyle in a stable knee without general osteoarthritis were included in the study . Forty patients were treated with autologous chondrocyte implantation , and forty were treated with microfracture .  We used the International Cartilage Repair Society , Lysholm , Short Form-36 , and Tegner forms to collect clinical data , and radiographs were evaluated with use of the Kellgren and Lawrence grading system . RESULTS At two and five years , both groups had significant clinical improvement compared with the preoperative status . At the five-year follow-up interval , there were nine failures ( 23 % ) in both groups compared with two failures of the autologous chondrocyte implantation and one failure of the  microfracture  treatment at two years . Younger patients did better in both groups . We did not find a correlation between histological quality and clinical outcome . However , none of the patients with the best- quality cartilage ( predominantly hyaline ) at the two-year mark had a later failure . One-third of the patients in both groups had radiographic evidence of early osteoarthritis at five years . CONCLUSIONS Both methods provided satisfactory results in 77 % of the patients at five years . There was no significant difference in the clinical and radiographic results between the two treatment groups and no correlation between the histological findings and the clinical outcome . One-third of the patients had early radiographic signs of osteoarthritis five years after the surgery . Further long-term follow-up is needed to determine if one method is better than the other and to study the progression of osteoarthritis Background Articular cartilage lesions , with their inherent limited healing potential , remain a challenging problem for orthopaedic surgeons . Various approaches have been proposed to treat these lesions ; nevertheless , opinions on indications and clinical efficacy of these techniques are still controversial . Purpose To evaluate the outcome of osteochondral autografts for treatment of femoral condyle cartilage lesions at a medium-to long-term follow-up . Study Design Case series ; Level of evidence , 4 . Methods We prospect ively evaluated 30 patients ( mean age , 29.3 years ) with full-thickness knee chondral lesions ( < 2.5 cm2 ) treated with arthroscopic autologous osteochondral transplantation . Thirteen patients underwent previous surgery , while 17 patients were operated on for the first time . In 19 patients , associated procedures were performed . All patients were evaluated at 2- and 7-year follow-up . The International Cartilage Repair Society form , Tegner score , and magnetic resonance imaging were used for clinical evaluation . Results The International Cartilage Repair Society objective evaluation showed 76.7 % of patients had good or excellent results at 7-year follow-up , and International Knee Documentation Committee subjective score significantly improved from preoperative ( 34.8 ) to 7-year follow-up ( 71.8 ) . The Tegner evaluation showed a significant improvement after the surgery at 2- and 7-year follow-up ( from 2.9 to 6.2 and 5.6 , respectively ) ; however , we noticed reduced sports activity from 2- to 7-year follow-up . Magnetic resonance imaging evaluation showed good integration of the graft in the host bone and complete maintenance of the grafted cartilage in more than 60 % of cases . Conclusion The results of this technique at medium- to long-term follow-up are encouraging . This arthroscopic 1-step surgery appears to be a valid solution for treatment of small , grade III to IV cartilage defects Background Autologous chondrocyte implantation ( ACI ) is frequently used to treat symptomatic defects of the articular cartilage . Purpose To test whether matrix-associated autologous chondrocyte implantation or the original periosteal flap technique provides superior outcomes in terms of clinical efficacy and safety . Study Design R and omized controlled trial ; Level of evidence , 2 . Methods Twenty-one patients ( mean age , 29.3 ± 9.1 years ) with symptomatic isolated full-thickness cartilage defects ( mean 4.1 ± 09 cm2 ) at the femoral condyle were r and omized to matrix-associated autologous chondrocyte implantation or the original periosteal flap technique . The primary outcome parameter was the postoperative change in knee function as assessed by the International Knee Documentation Committee ( IKDC ) score at 12 months after ACI . In addition , the IKDC score was assessed at 3 , 6 , 12 , and 24 months after surgery . Secondary outcome parameters were postoperative changes in health related quality of life ( Short Form-36 Health Survey ) , knee functionality ( Lysholm and Gillquist score ) , and physical activity ( Tegner Activity Score ) at 3 , 6 , 12 , and 24 months after ACI . Magnetic resonance imaging was performed to evaluate the cartilage 6 , 12 , and 24 months after ACI and rated using the Magnetic Resonance Observation of Cartilage Repair Tissue score . Adverse events were recorded to assess safety . Results The primary outcome parameter showed improvement of patients 1 year after autologous chondrocyte implantation , but there was no difference between the periosteal flap technique and matrix-associated ACI ( P = .5573 ) ; 2 years after ACI , a similar result was found ( P = .4994 ) . The study groups did not show differences in the Short Form-36 categories and in knee functionality as assessed by Tegner Activity Score 12 months ( P = .4063 ) and 24 months ( P = .1043 ) after ACI . There was a significant difference in the Lysholm and Gillquist score at 12 months ( P = .0449 ) and 24 months ( P = .0487 ) favoring the periosteal flap technique group . At 6 months after surgery , a significantly lower Magnetic Resonance Observation of Cartilage Repair score was obtained in the matrix-associated ACI group ( P = .0123 ) , corresponding to more normal magnetic resonance imaging diagnostic findings . Twelve and 24 months after ACI , the differences between the 2 groups were not significant ( 12 months , P = .2065 ; 24 months , P = .6926 ) . Adverse events were related to knee problems such as transplant delamination , development of an osseous spur , osteochondral dissection , and transplant hypertrophy . Systemic ( allergic , toxic , or autoimmune ) reactions did not occur . Conclusion There was no difference in the efficacy between the original and the advanced ACI technique 12 and 24 months after surgery regarding International Knee Documentation Committee , Tegner Activity Score , and Short Form-36 ; however , with respect to the Lysholm and Gillquist score , better efficacy was observed in the periosteal flap technique group PURPOSE To determine the safety and efficacy of a new arthroscopic technique for matrix-induced autologous chondrocyte implantation ( MACI ) for articular cartilage defects in the knee . METHODS We undertook a prospect i ve evaluation of the first 20 patients treated with the MACI technique ( including 14 defects on the femoral condyle and 6 on the tibial plateau ) , followed up for 24 months after surgery . A 12-week structured rehabilitation program was undertaken by all patients . Patients underwent clinical assessment ( Knee Injury and Osteoarthritis Outcome Score , Short Form 36 Health Survey , visual analog pain scale , 6-minute walk test , knee range of motion ) before surgery and at 3 , 6 , 12 , and 24 months after surgery and underwent magnetic resonance imaging ( MRI ) assessment at 3 , 12 , and 24 months after surgery . MRI evaluation assessed 8 previously defined pertinent parameters of graft repair , as well as a combined MRI composite score . RESULTS A significant improvement ( P < .05 ) was shown throughout the postoperative time line for all Knee Injury and Osteoarthritis Outcome Score subscales , the physical component score of the Short Form 36 Health Survey , the frequency and severity of knee pain , and the 6-minute walk test . An improvement in pertinent morphologic parameters of graft repair was observed to 24 months , whereas a good to excellent graft infill score and MRI composite score were observed at 24 months after surgery in 90 % and 70 % of patients , respectively . CONCLUSIONS We report a comprehensive 24-month follow-up in the first 20 patients who underwent the arthroscopic MACI technique .  This technique is a safe and efficacious procedure with improved clinical and radiologic outcomes over the 2-year period BACKGROUND Autologous chondrocyte implantation ( ACI ) was introduced in 1987 in Sweden by Brittberg and Peterson for the treatment of severe chondral defects of the knee . Here , our objective was to evaluate mid-term outcomes of ACI in young athletic patients with deep chondral defects of the knee after trauma . HYPOTHESIS ACI is effective in filling full-thickness chondral defects of the knee . PATIENTS AND METHODS We prospect ively monitored 14 patients , with International Cartilage Repair Society grade III or IV lesions , who underwent ACI between 2001 and 2006 .  St and ard evaluation measurements were used . Mean age at surgery was 37.7 years ( range , 30 - 45 ) . A history of surgery on the same knee was noted in ten ( 67 % ) patients . The defect was on the medial femoral condyle in 11 patients , lateral femoral condyle in two patients , and both femoral condyles in one patient . Mean defect surface area after debridement was 2.1cm(2 ) ( 1 - 6.3 ) . RESULTS After a mean follow-up of six years , improvements were noted in 12 ( 86 % ) patients , with an International Knee Documentation Committee ( IKDC ) score increase from 40 ( 27.6 - 65.5 ) to 60.2 ( 35.6 - 89.6 ) ( P=0.003 ) and a Brittberg-Perterson score decrease from 54.4 ( 11.8 - 98.2 ) to 32.9 ( 0 - 83.9 ) ( P=0.02 ) , between the preoperative assessment and last follow-up . The visual analogic scale pain score decreased from 66.3 ( 44 - 89 ) to 23.2 ( 0 - 77 ) ( P=0.0006 ) . In two ( 14 % ) patients , no improvements were detectable at last follow-up . The remaining 12 patients were satisfied and able to resume sporting activities , albeit at a less strenuous level . Two ACI-specific complications occurred , namely , periosteal hypertrophy treated with debridement in one patient and transplant delamination in another . DISCUSSION Our findings are consistent with previous reports but cover a longer follow-up period . Although the outcomes are promising , longer follow-ups are needed to confirm the long-term effectiveness of ACI . LEVEL OF EVIDENCE IV , prospect i ve therapeutic study We compared the results of microfracture in single versus multiple symptomatic articular cartilage defects in the knee in 110 patients with a median age of 38 years ( range 15–60 ) . Cases of reoperation of the cartilage defect were classified as failures . Clinical outcome in non-failures was evaluated by the Lysholm score and grading of knee pain and function of the knee by the use of patient-administered visual analog scales ( VAS ; 0–100 ) . Data were prospect ively collected before the operation and at the 2- to 9-year follow-up . The single lesion or the largest of multiple lesions were located on the medial femoral condyle ( n = 62 ) , trochlea ( n = 18 ) , lateral tibia ( n = 11 ) , patella ( n = 10 ) or lateral femoral condyle ( n = 9 ) . We treated one ( n = 76 ) , two ( n = 27 ) or three ( n = 7 ) lesions with a median total area of 4 cm2 ( range 1–15 ) . A total of 24 failures ( 22 % ) were registered—18 % in the single-defect subgroup and 29 % in the multiple-defects subgroup . In the remaining group of patients ( n = 86 ) , the mean Lysholm score , mean pain-score ( 0 = no pain ; 100 = worst possible pain ) and mean function-score ( 0 = useless ; 100 = full function ) improved from 51 , 52 and 41 , respectively , to 71 ( P < 0.001 ) , 30 ( P < 0.001 ) and 69 ( P < 0.001 ) at the follow-up . The pain-score was significant lower ( P = 0.042 ) , and the function-score significantly higher ( P = 0.001 ) in the group of patients with a single lesion compared to the group with 2 or 3 lesions . The Lysholm score did not differ significantly between the two subgroups ( P = 0.06 ) Background Many surgical techniques , including microfracture , periosteal and perichondral grafts , chondrocyte transplantation , and osteochondral grafts , have been studied in an attempt to restore damaged articular cartilage . However , there is no consensus regarding the best method to repair isolated articular cartilage defects of the knee . Questions / purpose sWe compared postoperative functional outcomes , followup MRI appearance , and arthroscopic examination after microfracture ( MF ) , osteochondral autograft transplantation ( OAT ) , or autologous chondrocyte implantation ( ACI ) . Methods We prospect ively investigated 30 knees with MF , 22 with OAT , and 18 with ACI .  Minimum followup was 3 years ( mean , 5 years ; range , 3–10 years ) . We included only patients with isolated cartilage defects and without other knee injuries . The three procedures were compared in terms of function using the Lysholm knee evaluation scale , Tegner activity scale , and Hospital for Special Surgery ( HSS ) score ; modified Outerbridge cartilage grade s using MRI ; and International Cartilage Repair Society ( ICRS ) repair grade using arthroscopy . Results All three procedures showed improvement in functional scores . There were no differences in functional scores and postoperative MRI grade s among the groups . Arthroscopy at 1 year showed excellent or good results in 80 % after MF , 82 % after OAT , and 80 % after ACI . Our study did not show a clear benefit of either ACI or OAT over MF . Conclusions Owing to a lack of superiority of any one treatment , we believe MF is a reasonable option as a first-line therapy given its ease and affordability relative to ACI or OAT.Level of Evidence Level II , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Background : Articular cartilage injury is frequently encountered , yet treatment options capable of providing durable cartilage repair are limited . Purpose : To investigate the medium-term clinical outcomes of cartilage repair using a 1-stage technique of a hyaluronic acid – based scaffold with activated bone marrow aspirate concentrate ( HA-BMAC ) and compare results with those of microfracture . A secondary aim of this study was to identify specific patient demographic factors and cartilage lesion characteristics that are associated with superior outcomes . Study Design : Cohort study ; Level of evidence , 2 . Methods : Fifty physically active patients ( mean age , 45 years ) with grade IV cartilage injury of the knee ( lesion size , 1.5 - 24 cm2 ) were treated with  HA-BMAC or microfracture and were observed prospect ively for 5 years . Patients were placed into the HA-BMAC group if the health insurance policy of the treating institution supported this option ; otherwise , they were placed into the microfracture group . Objective and subjective clinical assessment tools were used preoperatively and at 2 and 5 years postoperatively to compare treatment outcomes . Results : Significant improvements in outcome scores were achieved in both treatment groups at 2 years ( P < .001 ) . In the microfracture group , 64 % were classified as normal or nearly normal according to the International Knee Documentation Committee ( IKDC ) objective score at 2 years , compared with 100 % of those treated with HA-BMAC ( P < .001 ) . Normal or nearly normal objective assessment s in the microfracture group declined significantly after 5 years to 28 % of patients ( P = .004 ) . All patients treated with HA-BMAC maintained improvement at 5 years according to Lysholm , Tegner , IKDC objective , and IKDC subjective scores . Tegner , IKDC objective , and Knee injury and Osteoarthritis Outcome Score ( KOOS ) assessment s demonstrated higher scores in the HA-BMAC treatment group compared with microfracture at 5 years . Lysholm and IKDC subjective scores were similar between treatment groups at 5 years . Poorer outcomes in the microfracture group were demonstrated in cases of lesions larger than 4 cm2 and nonsolitary lesions . Age greater than 45 years , large size of lesion , and treatment of multiple lesions were not associated with poorer outcome in patients treated with HA-BMAC . Conclusion : Repair of chondral injury using a hyaluronic acid – based scaffold with activated bone marrow aspirate concentrate provides better clinical outcomes and more durable cartilage repair at medium-term follow-up compared with microfracture . Positive short-term clinical outcomes can be achieved with either microfracture or HA-BMAC . Cartilage repair using HA-BMAC leads to successful medium-term outcomes independent of age or lesion size Abstract Purpose The purpose of the study was to evaluate whether the biomembrane made of cartilage extracellular matrix , design ed to provide cartilage-like favourable environments as well as to prevent against washout of blood clot after microfracture , would enhance cartilage repair compared with the conventional microfracture technique . Methods A prospect i ve trial was design ed to compare the biomembrane cover after microfracture with conventional microfracture among patients with grade III – IV symptomatic cartilage defect in the knee joint . Patients aged 18–60 years were assigned to either the microfracture/biomembrane ( n = 45 ) or microfracture groups ( n = 19 ) . Among them , 24 knees in the microfracture/biomembrane and 12 knees in the microfracture  were followed up for 2 years . Cartilage repair was assessed with magnetic resonance imagings taken 6 months , 1 year , and 2 years postoperatively , and the clinical outcomes were also recorded . Results Compared with conventional microfracture , microfracture/biomembrane result ed in greater degree of cartilage repair ( p = 0.043 ) . In the intra-group analysis , while microfracture showed moderate to good degree of cartilage repair in nearly 50 % of the patients ( 47 % at 6 months to 50 % at 2 years ; n.s . ) , microfracture/biomembrane maintained an equivalent degree of repair up to 2 years ( 88 % at 6 months to 75 % at 2 years ; n.s . ) . The clinical outcome at 2 years also showed improved knee score and satisfaction and decreased pain in each group , but the difference between the two groups was not statistically significant . Conclusions Compared with conventional microfracture , biomembrane cover after microfracture yielded superior outcome in terms of the degree of cartilage repair during 2 years of follow-up . This implies that initial protection of blood clot and immature repair tissue at the microfractured defect is important for the promotion of enhanced cartilage repair , which may be obtained by the application of a biomembrane . Level of evidence Prospect i ve comparative study , Level II BACKGROUND New methods have been used , with promising results , to treat full-thickness cartilage defects . The objective of the present study was to compare autologous chondrocyte implantation with microfracture in a r and omized trial . We are not aware of any previous r and omized studies comparing these methods . METHODS Eighty patients without general osteoarthritis who had a single symptomatic cartilage defect on the femoral condyle in a stable knee were treated with autologous chondrocyte implantation or microfracture  ( forty in each group ) . We used the International Cartilage Repair Society , Lysholm , Short Form-36 ( SF-36 ) , and Tegner forms to collect data . An independent observer performed a follow-up examination at twelve and twenty-four months . Two years postoperatively , arthroscopy with biopsy for  histological evaluation was carried out . The histological evaluation was done by a pathologist and a clinical scientist , both of whom were blinded to each patient 's treatment . RESULTS In general , there were small differences between the two treatment groups . At two years , both groups had significant clinical improvement . According to the SF-36 physical component score at two years postoperatively , the improvement in the microfracture group was significantly better than that in the autologous chondrocyte implantation group ( p = 0.004 ) . Younger and more active patients did better in both groups . There were two failures in the autologous chondrocyte implantation group and one in the microfracture group . No serious complications were reported . Biopsy specimens were obtained from 84 % of the patients , and histological evaluation of repair tissues showed no significant differences between the two groups . We did not find any association between the histological quality of the tissue and the clinical outcome according to the scores on the Lysholm or SF-36 form or the visual analog scale . CONCLUSIONS Both methods had acceptable short-term clinical results . There was no significant difference in macroscopic or histological results between the two treatment groups and no association between the histological findings and the clinical outcome at the two-year time-point . LEVEL OF EVIDENCE Therapeutic study , Level I-1a ( r and omized controlled trial [ significant difference ] ) . See Instructions to Authors for a complete description of levels of evidence PURPOSE Age-dependent studies about the clinical result after microfracture of cartilage lesions in the knee are still missing . This prospect i ve study was performed to discover age-dependent differences in the results after microfracture over a period of 36 months . METHODS Between 1999 and 2002 , 85 patients ( mean age , 39 years ) with full-thickness chondral lesions underwent the microfracture procedure  and were evaluated preoperatively and at 6 , 18 , and 36 months after surgery . Depending on the patients ' age ( < or = 40 years or > 40 years ) and the localization of the defects ( femoral condyles , tibia , and patellofemoral joint ) , the patients were assigned to 6 different groups . Exclusion criteria were meniscal pathologic conditions , tibiofemoral malalignment , and ligament instabilities . Baseline clinical scores were compared with follow-up data by use of paired Wilcoxon tests for the modified Cincinnati knee score and the International Cartilage Repair Society ( ICRS ) score . RESULTS The scores improved in all groups over the whole study period ( P < .05 ) . Patients aged 40 years or younger had significantly better results ( P < .01 ) for both scores compared with older patients . Between 18 and 36 months after microfracture , the ICRS score deteriorated significantly ( P < .05 ) in patients aged over 40 years whereas younger patients with defects on the femoral condyles and on the tibia showed neither a significant improvement nor a significant deterioration in the ICRS score ( P > .1 ) . Magnetic resonance imaging 36 months after surgery revealed better defect filling and a better overall score in younger patients ( P < .05 ) . The Spearman coefficient of correlation between clinical and magnetic resonance imaging scores was 0.84 . CONCLUSIONS The clinical results after microfracture of full-thickness cartilage lesions in the knee are age-dependent . Deterioration begins 18 months after surgery and is significantly pronounced in patients aged older than 40 years . The best prognostic factor was found to be a patient age of 40 or younger with defects on the femoral condyles . LEVEL OF EVIDENCE Level IV , prognostic case series Background Aging is responsible for degenerative changes in all cartilage elements , thus impairing its properties and healing potential . Most studies on surgical procedures for cartilage focus on young patients because these procedures are generally not considered suitable for older patients . Purpose To analyze the clinical outcome of cartilage lesion treatment using second-generation autologous chondrocyte implantation ( ACI ) techniques in patients more than 40 years old with no clear signs of osteoarthritis , to underst and their real potential in relation to aging , the failure rate , and complications in older patients . Study Design Case series ; Level of evidence , 4 . Methods Sixty-one patients with grade III to IV cartilaginous lesions of the condyles with no clear signs of osteoarthritis and a minimum age of 40 years were treated with second-generation ACI and prospect ively evaluated at 5 years ’ follow-up . Twenty-two patients were treated with arthroscopic Hyalograft C implantation , and 39 underwent the open Chondro-Gide MACI procedure . Results A significant improvement in both subjective and objective evaluations was observed . The International Knee Documentation Committee ( IKDC ) subjective score improved from 36.8 ± 8.4 to 68.1 ± 21.8 at the final evaluation . The failure rate was 20 % . A faster improvement was observed in the group treated with the arthroscopic Hyalograft C technique , whereas similar scores were found at the 24-month follow-up and final evaluation . Conclusion A clinical improvement was found in patients more than 40 years old , who in most cases benefited from second-generation ACI with good results lasting at medium-term follow-up . However , the results were inferior with respect to those previously found for younger population s , and the failure rate at medium-term follow-up was also higher . These findings were consistent in the 2 treatment groups . The only difference was the faster recovery when the arthroscopic approach was used
Background : Recent studies demonstrated a 5 % increase in cartilage repair procedures annually in the United States .
There is currently no consensus regarding a superior technique , nor has there been a comprehensive evaluation of postoperative clinical outcomes with respect to a minimal clinical ly important difference ( MCID ) .
Purpose : To determine the proportion of available cartilage repair studies that meet or exceed MCID values for clinical outcomes improvement over short- , mid- , and long-term follow-up .