Increased Failure Rate of Autologous Chondrocyte Implantation after Previous Treatment with Marrow Stimulation Techniques Effect of Accelerated Weightbearing after Matrix-Associated Autologous Chondrocyte Implantation on the Femoral Condyle on Radiographic and Clinical Outcome after 2 Years A Prospective Study of Autologous Chondrocyte Implantation in Patients with Failed Prior Treatment for Articular Cartilage Defect of the Knee Autologous Chondrocyte Implantation and Osteochondral Cylinder Transplantation in Cartilage Repair of the Knee Joint: A Prospective, Comparative Trial Arthroscopic second generation autologous chondrocyte implantation A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered. Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. Autologous osteochondral grafting--technique and long-term results. Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes A Prospective, Randomized Clinical Study of Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of Osteochondritis Dissecans in the Knee Joint in Children Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study Ten-Year Follow-up of a Prospective, Randomized Clinical Study of Mosaic Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of Osteochondral Defects in the Knee Joint of Athletes Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Five-Year Outcome of Characterized Chondrocyte Implantation Versus Microfracture for Symptomatic Cartilage Defects of the Knee Treatment of Symptomatic Cartilage Defects of the Knee A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. A Randomized Trial Comparing Accelerated and Traditional Approaches to Postoperative Weightbearing Rehabilitation After Matrix-Induced Autologous Chondrocyte Implantation Comparison of osteochondral autologous transplantation, microfracture, or debridement techniques in articular cartilage lesions associated with anterior cruciate ligament injury: a prospective study with a 3-year follow-up. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. Comparative Evaluation of Autologous Chondrocyte Implantation and Mosaicplasty: A Multicentered Randomized Clinical Trial Autologous Chondrocyte Implantation Using the Original Periosteum-Cover Technique versus Matrix-Associated Autologous Chondrocyte Implantation Autologous Chondrocyte Implantation for Treatment of Focal Cartilage Defects in Patients Age 40 Years and Older Current Treatments of Isolated Articular Cartilage Lesions of the Knee Achieve Similar Outcomes Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. Characterized Chondrocyte Implantation Results in Better Structural Repair When Treating Symptomatic Cartilage Defects of the Knee in a Randomized Controlled Trial versus Microfracture Clinical Experiences With Autologous Osteochondral Mosaicplasty in an Athletic Population
Background Marrow stimulation techniques such as drilling or microfracture are first-line treatment options for symptomatic cartilage defects . Common knowledge holds that these treatments do not compromise subsequent cartilage repair procedures with autologous chondrocyte implantation . Hypothesis Cartilage defects pretreated with marrow stimulation techniques will have an increased failure rate . Study Design Cohort study ; Level of evidence , 2 . Methods The first 321 consecutive patients treated at one institution with autologous chondrocyte implantation for full-thickness cartilage defects that reached more than 2 years of follow-up were evaluated by prospect ively collected data . Patients were grouped based on whether they had undergone prior treatment with a marrow stimulation technique . Outcomes were classified as complete failure if more than 25 % of a grafted defect area had to be removed in later procedures because of persistent symptoms . Results There were 522 defects in 321 patients ( 325 joints ) treated with autologous chondrocyte implantation .  On average , there were 1.7 lesions per patient . Of these joints , 111 had previously undergone surgery that penetrated the subchondral bone ; 214 joints had no prior treatment that affected the subchondral bone and served as controls . Within the marrow stimulation group , there were 29 ( 26 % ) failures , compared with 17 ( 8 % ) failures in the control group . Conclusion Defects that had prior treatment affecting the subchondral bone failed at a rate 3 times that of nontreated defects . The failure rates for drilling ( 28 % ) , abrasion arthroplasty ( 27 % ) , and microfracture ( 20 % ) were not significantly different , possibly because of the lower number of microfracture patients in this cohort ( 25 of 110 marrow-stimulation procedures ) . The data demonstrate that marrow stimulation techniques have a strong negative effect on subsequent cartilage repair with autologous chondrocyte implantation and therefore should be used judiciously in larger cartilage defects that could require future treatment with autologous chondrocyte implantation 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 is a prospect i ve clinical study to assess the effectiveness of autologous chondrocyte implantation in patients who failed prior treatments for articular cartilage defects of the knee . Hypothesis Autologous chondrocyte implantation provides clinical benefit in patients with failed articular cartilage treatments . Study Design Cohort study ; Level of evidence , 2 . Methods One hundred fifty-four patients with failed treatment for articular cartilage defects of the knee received autologous chondrocyte implantation in a multicenter , prospect i ve study . Follow-up was 48 months . Outcomes included change from baseline in knee function , knee pain , quality of life , and overall health . Duration of benefit after autologous chondrocyte implantation was compared with the failed prior non — autologous chondrocyte implantation procedure . Safety information was recorded . Additional analyses were performed on the 2 major cohorts of prior procedures entered into the study , marrow-stimulation technique or debridement alone , to assess if there were any significant differences in baseline characteristics , outcomes , or prognosis between the 2 groups . Results One hundred twenty-six patients ( 82 % ) completed the protocol . Seventy-six percent of patients were treatment successes at study end , while 24 % were deemed treatment failures . Preoperative mean knee pain score was 3.0 ( SD , 1.8 ; 0 = severe , 10 = normal ) . Mean improvements were observed from baseline to all time points ( P < .001 ) for all outcome measures . Preoperative to 48-month values , respectively , were as follows : On the Knee injury and Osteoarthritis Outcome Score subscales of pain : 48.7 to 72.2 ; other symptoms : 51.8 to 70.8 ; sports/recreation : 25.8 to 55.8 ; knee quality of life : 20.9 to 52.2 ; and activities of daily living : 58.6 to 81.0 ; on the Modified Cincinnati Overall Knee score : 3.3 to 6.3 ; on the visual analog scale : 28.8 to 69.9 ; and on the SF-36 Overall Physical Health 33.0 to 44.4 . Results did not differ between patients whose primary surgery had been a marrow-stimulating procedure and those whose primary procedure had been a debridement alone . The median difference in duration of benefit between autologous chondrocyte implantation and the failed non — autologous chondrocyte implantation prior procedure was at least 31 months ( P < .001 ) . Seventy-six patients ( 49 % ) had subsequent surgical procedure(s ) , predominantly arthroscopic . Need for a subsequent surgical procedure was not predictive of failure . Conclusion Patients with moderate to large chondral lesions with failed prior cartilage treatments can expect sustained and clinical ly meaningful improvement in pain and function after autologous chondrocyte implantation . The subsequent surgical procedure rate observed in this study ( 49 % overall ; 40 % related to autologous chondrocyte implantation ) appears higher than generally reported after autologous chondrocyte implantation 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 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 INTRODUCTION The results for autologous chondrocyte implantation ( ACI ) in the treatment of full thickness chondral defects in the knee are encouraging . At present two techniques have been described to retain the chondrocyte suspension within the defect . The first involves using a periosteal cover ( ACI-P ) and the second involves using a type I/III collagen membrane ( ACI-C ) . To the authors knowledge there are no comparative studies of these two techniques in the current literature . We have therefore undertaken such a study to establish if there is a difference between the 2 techniques based on a clinical and arthroscopic assessment . METHODS A total of 68 patients with a mean age of 30.52 years with symptomatic articular cartilage defects were r and omised to have either ACI-P ( 33 patients ) or ACI-C ( 35 patients ) . The mean defect size was 4.54 cm2 . All patients were followed up at 24 months . RESULTS A clinical and functional assessment showed that 74 % of patients had a good or excellent result following the ACI-C compared with 67 % after the ACI-P at 2 years . Arthroscopy at 1 year also demonstrated similar results for both techniques . However , 36.4 % of the ACI-P grafts required shaving for hypertrophy compared with none for the ACI-C grafts at 1 year . DISCUSSION This study has shown no statistical difference between the clinical outcome of ACI-C versus ACI-P at 2 years . A significant number of patients who had the ACI-P required shaving of a hypertrophied graft . We conclude that there is no advantage in using periosteum as a cover for retaining chondrocytes within an osteochondral defect ; as a result we advocate the use of an alternative cover such as a manufactured type I/III collagen membrane Autologous chondrocyte implantation ( ACI ) is used widely as a treatment for  symptomatic chondral and osteochondral defects of the knee . Variations of the original periosteum-cover technique include the use of porcine-derived type I/type III collagen as a cover ( ACI-C ) and matrix-induced autologous chondrocyte implantation ( MACI ) using a collagen bilayer seeded with chondrocytes . We have performed a prospect i ve , r and omised comparison of ACI-C and MACI for the treatment of symptomatic chondral defects of the knee in 91 patients , of whom 44 received ACI-C and 47 MACI grafts .  Both treatments result ed in improvement of the clinical score after one year . The mean modified Cincinnati knee score increased by 17.6 in the ACI-C group and 19.6 in the MACI group ( p = 0.32 ) . Arthroscopic assessment s performed after one year showed a good to excellent International Cartilage Repair Society score in 79.2 % of ACI-C and 66.6 % of MACI grafts . Hyaline-like cartilage or hyaline-like cartilage with fibrocartilage was found in the biopsies of 43.9 % of the ACI-C and 36.4 % of the MACI grafts after one year . The rate of hypertrophy of the graft was 9 % ( 4 of 44 ) in the ACI-C group and 6 % ( 3 of 47 ) in the MACI group . The frequency of re-operation was 9 % in each group . We conclude that the clinical , arthroscopic and histological outcomes are comparable for both ACI-C and MACI . While MACI is technically attractive , further long-term studies are required before the technique is widely adopted Autologous chondrocyte implantation ( ACI ) and mosaicplasty are both cl aim ed to be successful for the repair of defects of the articular cartilage of the knee but there has been no comparative study of the two methods . A total of 100 patients with a mean age of 31.3 years ( 16 to 49 ) and with a symptomatic lesion of the articular cartilage in the knee which was suitable for cartilage repair was r and omised to undergo either  ACI or mosaicplasty ; 58 patients had ACI and 42 mosaicplasty .  Most lesions were post-traumatic and the mean size of the defect was 4.66 cm2 . The mean duration of symptoms was 7.2 years and the mean number of previous operations , excluding arthroscopy , was 1.5 . The mean follow-up was 19 months ( 12 to 26 ) . Functional assessment using the modified Cincinatti and Stanmore scores and objective clinical assessment showed that 88 % had excellent or good results after ACI compared with 69 % after mosaicplasty . Arthroscopy at one year demonstrated excellent or good repairs in 82 % after ACI and in 34 % after mosaicplasty . All five patellar mosaicplasties failed . Our prospect i ve , r and omised , clinical trial has shown significant superiority of ACI over mosaicplasty for the repair of articular defects in the knee . The results for ACI are comparable with those in other studies , but those for mosaicplasty suggest that its continued use is of dubious value BACKGROUND Efficacious treatment of chondral and osteochondral defects of weightbearing articular surfaces is a daily challenge in musculoskeletal care . Autogenous osteochondral transplantation represents a possible solution for creating hyaline or hyaline-like repair in the affected area that has a noninflammatory pathoorigin . This paper discusses the experimental background and over 15 years of clinical experience with autologous osteochondral mosaicplasty . METHODS Several series of animal studies and subsequent clinical practice of over 1,000 mosaicplasty patients were assessed to confirm the survival of transplanted hyaline cartilage and fibrocartilage filling of donor sites located on relatively less weightbearing surfaces , as well as donor-site disturbances and morbidity . Histological evaluations of dog and horse implantations as well as several series of clinical evaluations in the human material are summarized in this paper . Clinical scores , different types of imaging techniques , second-look arthroscopies , histological examination of biopsy sample s , and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage . RESULTS Analysis of clinical scores has shown good to excellent results in 92 % of patients with femoral condylar implantations , 87 % of tibial resurfacements , 74 % of patellar and /or trochlear mosaicplasties and 93 % of talar procedures . Longterm donor-site complaints measured by the B and i score were minor and present only in 3 % of patients . 81 out of the 98 control arthroscopies represented congruent and good gliding surfaces and histologically proven survival of the transplanted hyaline cartilage as well as fibrocartilage covering of the donor sites . Complications in the entire patient group were four deep infections and four deep venous thromboses . In nearly 8 % of the cases excessive intraarticular bleeding was observed in the early postoperative period , as a minor complication of the procedure . Multicentric , comparative , prospect i ve evaluation of 413 arthroscopic resurfacing procedures ( mosaicplasty , Pridie drilling , abrasion arthroplasty and microfracture cases in homogenised subgroups ) demonstrated that mosaicplasty result ed in favourable clinical outcome in the long-term follow-up compared to other three techniques . Durability of the early results was confirmed in long-term evaluations both of the femoral condylar implantations and talar mosaicplasties . CONCLUSIONS According to our encouraging results in this increasingly large series , supported by similar findings from other centres , it seems that autologous osteochondral mosaicplasty may be an alternative for small and medium-sized focal chondral and osteochondral defects of weightbearing surfaces of the knee and other weightbearing synovial joints The objective was to evaluate the functional performance over a 2-year period following autologous chondrocyte implantation ( ACI ) in an open knee procedure compared to microfracture . Objective functional outcome was studied as secondary analysis in a subgroup of patients , in a r and omized clinical trial , with concealed allocation and independent evaluators . Sixty-seven patients with local cartilage defect , with a mean size of 2.4 cm² ( SD 1.5 ) of the femoral condyle of the knee were included . Thirty-three patients underwent the microfracture and 34 the ACI procedure .  An identical rehabilitation protocol was implemented for both groups . Active knee flexion and extension range , anterior laxity , knee extension strength ( concentric at 60 ° /s ) and single leg hop performance ( single hop , crossover triple hop and 6 m timed hop test ) were evaluated pre-surgery and at 6 , 9,12 and 24 months post-surgery . We calculated the symmetry index for individual and four performance tests pooled . Mixed linear model analyses were used with confidence interval set at 95 % . The change over 2 years for the pooled performance-based tests was comparable between the two treatment arms . At 2 years , 70 % ( 38/54 ) of all patients returned to > 85 % symmetry in overall functional performance . A decrease in functional performance at 6 months following ACI result ed in slower recovery at 9 and 12 months compared to microfracture . Rehabilitation following both cartilage repair procedures is a lengthy process . At 2 years after surgery , ACI patients have similar overall functional outcome compared to microfracture patients The purpose of this prospect i ve r and omized clinical study was to compare the outcomes of mosaic type autologous osteochondral transplantation ( OAT ) and microfracture ( MF ) procedures for the treatment of the articular cartilage defects of the knee joint in athletes . Between 1998 and 2002 , a total of 57 athletes with a mean age of 24.3 years and with a symptomatic lesion of the articular cartilage in the knee were r and omized to undergo either OAT or MF procedure . There were 28 athletes in OAT group and 29 in MF group . Patients were evaluated using a modified Hospital for Special Surgery ( HSS ) and International Cartilage Repair Society ( ICRS ) scores , MRI and clinical assessment after 6 , 12 , 24 and 36 months after the surgery . According to the modified HSS and ICRS scores , functional and objective assessment showed that 96 % had excellent or good results after OAT compared with 52 % after MF procedure ( P<0.001 ) . In 12 , 24 and 36 months after the operations , the HSS and ICRS showed statistically significantly better results in the OAT group ( P=0.03 ; P=0.006 ; P=0.006 ) . Twenty-six ( 93 % ) athletes following OAT and fifteen ( 52 % ) athletes following MF  returned to sports activities at the preinjury level at an average of 6.5 months ( range , 4–8 months ) after the operations . At an average of 37.1 months follow-up , our prospect i ve , r and omized , clinical study in athletes has shown significant superiority of the OAT over MF for the repair of articular cartilage defects in the knee Purpose The aim of this study was to compare the outcomes of the arthroscopic mosaic-type osteochondral autologous transplantation ( OAT ) and microfracture ( MF ) procedures for the treatment of osteochondritis dissecans ( OCD ) defects of the femoral condyles of the knee joint in children under the age of 18 years . Type of Study Prospect i ve , r and omized clinical study . Methods Between 2001 and 2005 , a total of 50 children with a mean age of 14.3 years ( 12 to 18 ) and with symptomatic lesions of the OCD in the femoral condyle of the knee were r and omized to undergo either the OAT or the MF procedure . Only those children with grade 3 or 4 ( OCD ) in the medial or lateral femoral condyle ( according to International Cartilage Repair Society , ICRS ) were included in the study . Forty-seven patients ( 94 % ) were available for follow-up . There were 25 patients in the OAT group and 22 patients in the MF group . The mean duration of symptoms was 23.54±4.24 months and the mean follow-up was 4.2 years ( range from 3 to 6 y ) , and none of the children had prior surgical interventions to the affected knee . Children were evaluated using ICRS score , x-rays , magnetic resonance imaging , and second-look arthroscopies . Results After 1 year , both groups had significant clinical improvement ( P<0.05 ) and the ICRS functional and objective assessment showed that 23 of 25 ( 92 % ) patients had excellent or good results after OAT compared with 19 of 22 ( 86 % ) after MF ( NS ) , but 19 of 23 ( 83 % ) after OAT and only 12 of 19 ( 63 % ) after MF procedure maintained excellent or good results after 4.2 years ( range from 3 to 6 y ) . The MF group showed significant deterioration over the 4.2 years follow-up ( P<0.05 ) , but still had significant clinical improvement compared with pretreatment evaluation ( P=0.004 ) . There were 9 of 22 ( 41 % ) failures in the MF group , and none in the OAT group . Magnetic resonance imaging evaluation according to the ICRS evaluation system showed excellent or good repairs in 19 of 21 patients ( 91 % ) after OAT compared with 10 of 18 ( 56 % ) after MF . Conclusions At an average of 4.2 years follow-up , our prospect i ve , r and omized , clinical study in children under the age of 18 years has shown significant superiority of the mosaic-type OAT over MF for the treatment of osteochondritis dissecans defects in the knee . However , our study has shown that both MF and OAT give encouraging clinical results for children under the age of 18 years . Level of Evidence Level 1 : r and omized controlled trial , significant difference 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 : Various techniques have proven to be effective for treating articular cartilage defect ( ACD ) and osteochondral defect ( OCD ) of the knee joint , but knowledge regarding which method is best still remains uncertain . Purpose : To evaluate and compare the outcomes of mosaic-type osteochondral autologous transplantation ( OAT ) and microfracture ( MF ) procedures for the treatment of articular cartilage defects of the knee joint in young active athletes . This article represents an up date of the clinical results at 10 years . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Between 1998 and 2002 , a total of 60 athletes with a mean age of 24.3 years ( range , 15 - 40 years ) and with a symptomatic ACD or OCD in the knee were r and omized to undergo either OAT or MF . Patients were then evaluated postoperatively using the International Cartilage Repair Society ( ICRS ) score , Tegner activity score , radiographs , and magnetic resonance imaging . The mean follow-up time was 10.4 years ( range , 9 - 11 years ) . Results : Three to 10 years after the OAT and MF procedures , patients had lower ICRS and Tegner scores ( P < .05 ) , but both groups still had significant clinical improvement over presurgery scores according to ICRS scores at 10-year follow-up . Statistically significantly better results were detected in patients in the OAT group compared with those in the MF group at 10 years ( P < .005 ) . At 10-year follow-up , there were 15 failures ( 26 % ) , including 4 failures ( 14 % ) of the OAT and 11 failures ( 38 % ) of MF treatment ( P < .05 ) . Seven patients ( 25 % ) from the OAT group and 14 patients ( 48 % ) from the MF group had radiographic evidence of Kellgren-Lawrence grade I osteoarthritis at 10 years , but these differences were not significant ( P = .083 ) or related to the clinical results . The ICRS and Tegner scores of younger athletes ( < 25 years at the time of primary surgery ) remained significantly higher after 10 years compared with older patients ( P < .05 ) ; 15 of 20 patients ( 75 % ) in the OAT group and 8 of 22 patients ( 37 % ) in the MF group maintained the same physical activity level . Conclusion : The OAT technique for ACD or OCD repair in the athletic population allows for a higher rate of return to and maintenance of sports at the preinjury level compared with MF PURPOSE The purpose of this study was to compare outcomes of chondroplasty versus microfracture versus osteochondral autologous transplantation ( OAT ) in patients with osteochondral lesions of the talus ( OLT ) . METHODS After prospect i ve sample size analysis , patients with symptomatic , recalcitrant Ferkel class 2b , 3 , and 4 OLT were r and omized to chondroplasty , microfracture , or OAT treatment groups . Outcomes were measured with use of the American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle-Hindfoot Scale ( AHS ) , the Subjective Assessment Numeric Evaluation ( SANE ) rating , Numeric Pain Intensity ( NPI ) , and magnetic resonance imaging ( MRI ) . RESULTS Eleven patients had chondroplasty , 10 ankles ( 9 patients ) had microfracture , and 12 patients had OAT .  Mean time to follow-up was 53 months ( range , 24 to 119 months ) . AHS scores showed no differences at 12 and 24 months , and SANE ratings showed no differences at final follow-up . NPI was significantly lower ( P < .001 ) in chondroplasty and microfracture cases as compared with OAT at 24 hours postoperatively . Pearson 's correlation analysis demonstrated an inverse relation between microfracture and OAT groups in that better outcome was associated with smaller lesions , compared with the chondroplasty group , which revealed mixed results with no particular trend . MRI revealed incomplete fill and edema after chondroplasty or microfracture and chondral gaps after OAT . CONCLUSION Our results demonstrate no difference between chondroplasty , microfracture , and OAT with regard to AHS and SANE ratings in patients with OLT . However , NPI at 24 hours postoperatively was significantly lower in patients who had chondroplasty and microfracture . LEVEL OF EVIDENCE Level I , Therapeutic study , high- quality r and omized controlled trial with no statistically significant differences but narrow confidence interval Background : Characterized chondrocyte implantation ( CCI ) results in significantly better early structural tissue regeneration than microfracture ( MF ) , and CCI has a midterm clinical benefit over microfracture . Purpose : This study was undertaken to evaluate the 5-year clinical outcome of CCI in a r and omized comparison with MF for the treatment of symptomatic cartilage defects of the femoral condyles of the knee . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Participants aged 18 to 50 years with a symptomatic isolated International Cartilage Repair Society ( ICRS ) grade III or IV cartilage lesion of the femoral condyles between 1 and 5 cm2 were r and omized to either  CCI or MF .  Clinical outcomes were measured up to 60 months after surgery using the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) . The main outcome parameter was change from baseline in overall KOOS ( oKOOS ) . Adverse events were monitored . Results : Fifty-one participants were treated with CCI and 61 with MF . On average , clinical benefit was maintained through the 60-month follow-up period . The average change from baseline in oKOOS was not different between both groups ( least squares [ LS ] mean ± st and ard error [ SE ] 18.84 ± 3.58 for CCI vs 13.21 ± 5.63 for MF ; P = .116 ) . Treatment failures were comparable ( n = 7 in CCI vs n = 10 in MF ) , although MF failures tended to occur earlier . Subgroup analysis revealed that CCI result ed in better outcome in participants with time since symptom onset of less than 3 years , which was statistically significant and clinical ly relevant ( change in oKOOS <3 years mean ± SE 25.96 ± 3.45 for CCI vs 15.28 ± 3.17 for MF ; P = .026 vs oKOOS > 3 years mean ± SE 13.09 ± 4.78 for CCI vs 17.02 ± 4.50 for MF , P = .554 ) . Other subgroup analyses such as age ( cutoff 35 years ) did not show a difference . Female patients showed more failures irrespective of treatment . Conclusion : At 5 years after treatment , clinical outcomes for CCI and MF were comparable . In the early treatment group , CCI obtained statistically significant and clinical ly relevant better results than MF . Delayed treatment result ed in less predictable outcomes for CCI . These results provide strong evidence that time since onset of symptoms is an essential variable that should be taken into account in future treatment algorithms for  cartilage repair  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 PURPOSE The purpose of this study was to compare the outcomes of mosaic-type osteochondral autologous transplantation ( OAT ) and microfracture ( MF ) procedures for the treatment of the articular cartilage defects of the knee joint in young active athletes . TYPE OF STUDY Prospect i ve r and omized clinical study . METHODS Between 1998 and 2002 , a total of 60 athletes with a mean age of 24.3 years ( range , 15 to 40 years ) and with a symptomatic lesion of the articular cartilage in the knee were r and omized to undergo either an OAT or an MF procedure . Only those athletes playing in competitive sports at regional or national levels were included in the study . Fifty-seven athletes ( 95 % ) were available for a follow-up . There were 28 athletes in the OAT group and 29 athletes in the MF group . The mean duration of symptoms was 21.32 + /- 5.57 months and the mean follow-up was 37.1 months ( range , 36 to 38 months ) , and none of the athletes had prior surgical interventions to the affected knee . Patients were evaluated using modified Hospital for Special Surgery ( HSS ) and International Cartilage Repair Society ( ICRS ) scores , radiograph , magnetic resonance imaging ( MRI ) , and clinical assessment . An independent observer performed a follow-up examination after 6 , 12 , 24 , and 36 months . At 12.4 months postoperatively , arthroscopy with biopsy for histologic evaluation was carried out . A radiologist and a pathologist , both of whom were blinded to each patient 's treatment , did the radiologic and histologic evaluations . RESULTS After 37.1 months , both groups had significant clinical improvement ( P < .05 ) . According to the modified HSS and ICRS scores , functional and objective assessment showed that 96 % had excellent or good results after OAT compared with 52 % for the MF procedure ( P < .001 ) . At 12 , 24 , and 36 months after surgery , the HSS and ICRS showed statistically significantly better results in the OAT group ( P = .03 ; P = .006 ; P = .006 ) . Younger athletes did better in both groups . No serious complications were reported . There was 1 failure in the OAT group and 9 in the MF group . The ICRS Cartilage Repair Assessment for macroscopic evaluation during arthroscopy at 12.4 months showed excellent or good repairs in 84 % after OAT and in 57 % after MF . Biopsy specimens were obtained from 58 % of the patients and histologic evaluation of repair showed better scores ( according to ICRS ) for the OAT group ( P < .05 ) . MRI evaluation showed excellent or good repairs in 94 % after OAT compared with 49 % after MF . Twenty-six ( 93 % ) OAT patients and 15 ( 52 % ) MF patients returned to sports activities at the preinjury level at an average of 6.5 months ( range , 4 to 8 months ) . Others showed a decline in sports activity level . CONCLUSIONS At an average of 37.1 months ( range , 36 to 38 months ) follow-up , our prospect i ve , r and omized , clinical study in young active athletes under the age of 40 has shown significant superiority of OAT over MF for the repair of articular cartilage defects in the knee . We found that only 52 % of MF athletes could return to sports at the preinjury level . Limitations of our study included a small number of athletes and a relatively short ( 3-year ) follow-up . A long-term follow-up is needed to assess the durability of articular cartilage repair using these methods in young active athletes . LEVEL OF EVIDENCE Level I , Therapeutic study , r and omized controlled trial , significant difference ( a ) Background : While structured postoperative rehabilitation after matrix-induced autologous chondrocyte implantation ( MACI ) is considered critical , very little has been made available on how best to progressively increase weightbearing and exercise after surgery . Hypothesis : A significant improvement will exist in clinical and magnetic resonance imaging (MRI)–based scoring measures to 5 years after surgery . Furthermore , there will be no significant differences in outcomes in MACI patients at 5 years when comparing a traditional and an accelerated postoperative weightbearing regimen . Finally , patient demographics , cartilage defect parameters , and injury/surgery history will be associated with graft outcome . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Clinical and radiological outcomes were studied in 70 patients who underwent MACI to the medial or lateral femoral condyle , in conjunction with either an “ accelerated ” or a “ traditional ” approach to postoperative weightbearing rehabilitation .  Under the accelerated protocol , patients reached full weightbearing at 8 weeks after surgery , compared with 11 weeks for the traditional group . Clinical measures ( Knee Injury and Osteoarthritis Outcome Score [ KOOS ] , Short-Form Health Survey [ SF-36 ] , visual analog scale [ VAS ] , 6-minute walk test , and knee range of motion ) were assessed before surgery and at 3 , 6 , 12 , and 24 months and 5 years after surgery . High-resolution MRI was undertaken at 3 , 12 , and 24 months and 5 years after surgery and assessed 8 previously defined pertinent parameters of graft repair as well as a combined MRI composite score . The association between clinical and MRI-based outcomes , patient demographics , chondral defect parameters , and injury/surgery history was investigated . Results : Of the 70 patients recruited , 63 ( 31 accelerated , 32 traditional ) underwent clinical follow-up at 5 years ; 58 ( 29 accelerated , 29 traditional ) also underwent radiological assessment . A significant time effect ( P < .05 ) was demonstrated for all clinical and MRI-based scores over the 5-year period . While the VAS demonstrated significantly less frequent pain at 5 years in the accelerated group , there were no other significant differences between the 2 groups . Between 24 months and 5 years , a significant improvement ( P < .05 ) in both groups was observed for the sport and recreation subscale of the KOOS as well as a significant decrease ( P < .05 ) in active knee extension for the traditional group . There were no significant differences ( P > .05 ) in the MRI-based scores between 24 months and 5 years after surgery . Patient age and defect size exhibited significant negative correlations ( P < .05 ) with several MRI-based outcomes at 5 years , while there were no significant correlations ( P > .05 ) between clinical and MRI-based outcomes . At 5 years after surgery , 94 % and 95 % were satisfied with the ability of MACI to relieve their knee pain and improve their ability to undertake daily activities , respectively . Conclusion : The outcomes of this r and omized trial demonstrate a safe and effective accelerated rehabilitation protocol as well as a regimen that provides comparable , if not superior , clinical outcomes to patients throughout the postoperative timeline PURPOSE To compare the concomitant treatment of articular cartilage damage in the medial femoral condyle with osteochondral autologous transplantation ( OAT ) , microfracture , or debridement procedures at the time of  anterior cruciate ligament ( ACL ) reconstruction . METHODS Between 2006 and 2009 , 102 patients with a mean age of 34.1 years and with an ACL rupture and articular cartilage damage in the medial femoral condyle of the knee were r and omized to undergo OAT , microfractures , or debridement at the time of ACL reconstruction . A matched control group was included , comprising 34 patients with intact articular cartilage at the time of ACL reconstruction . There were 34 patients in the OAT-ACL group , 34 in the microfracture (MF)-ACL group , 34 in the debridement (D)-ACL group , and 34 in the control group with intact articular cartilage ( IAC-ACL group ) . The mean time from ACL injury to operation was 19.32 ± 3.43 months , and the mean follow-up was 36.1 months ( range , 34 to 37 months ) . Patients were evaluated with the International Knee Documentation Committee ( IKDC ) score , Tegner activity score , and clinical assessment . RESULTS Of 102 patients , 97 ( 95 % ) were available for the final follow-up . According to the subjective IKDC score , all 4 groups fared significantly better at the 3-year follow-up than preoperatively ( P < .005 ) . The OAT-ACL group 's IKDC subjective knee evaluation was significantly better than that of the MF-ACL group ( P = .024 ) and D-ACL group ( P = .018 ) . However , the IKDC subjective score of the IAC-ACL group was significantly better than the OAT-ACL group 's IKDC evaluation ( P = .043 ) . There was no significant difference between the MF-ACL and D-ACL  groups ' IKDC subjective scores ( P = .058 ) . Evaluation of manual pivot-shift knee laxity according to the IKDC knee examination form showed similar findings for the 4 groups immediately postoperatively and at 3-year follow-up , and the findings were rated as normal or nearly normal ( IKDC grade A or B ) in 29 of 33 patients ( 88 % ) in the OAT-ACL group , 28 of 32 patients ( 88 % ) in the MF-ACL group , 27 of 32 patients ( 84 % ) in the D-ACL group , and 31 of 34 patients ( 91 % ) in the IAC-ACL group . CONCLUSIONS Our study shows that intact articular cartilage during ACL reconstruction yields more favorable IKDC subjective scores compared with any other articular cartilage surgery type . However , if an articular defect is present , the subjective IKDC scores are significantly better for OAT versus microfracture or debridement after a mean period of 3 years . Anterior knee stability results were not significantly affected by the different articular cartilage treatment methods . LEVEL OF EVIDENCE Level II , prospect i ve comparative study 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 Objective : To compare the respective performance and effectiveness of autologous chondrocyte implantation ( ACI ) and mosaicplasty at resurfacing local full-thickness chondral defects of the knee . Design : R and omized clinical trial . Setting : Multicenter trial at orthopedic clinics and university hospitals conducted from 1997 to 2000 . Patients : A population of patients selected according to eligibility criteria of age , traumatic origin of the defect , its localization , size , and gravity , and above all , no previous surgical treatment of the lesion . Forty-seven patients were r and omly assigned to ACI or mosaicplasty  and subjected to arthroscopic debridement of the lesion at the time of enrollment . They were called for surgery 6 months after the initial debridement . Main Outcome : Improved knee functionality as assessed by repeated clinical evaluation based on the International Knee Documentation Committee Scale and the Lysholm Knee Scoring Scale . Results : Fourteen patients ( 31.8 % ) experienced substantial improvement following the initial debridement and , being clinical ly cured , received no further treatment . Seven patients ( 15.9 % ) were lost to follow-up . Among the 23 patients ( 52.3 % ) who could effectively be evaluated , a complete recovery ( ie , Lysholm Knee Scoring Scale score , 90 - 100 ) was observed upon clinical examination in 88 % of the mosaicplasty-treated patients and in 68 % of the ACI-treated ones ( P = 0.093 ) . Conclusions : Although the low power of our study prevents definitive conclusions , ACI and mosaicplasty are cartilage repair techniques that are clinical ly equivalent and similar in performance . The high percentage of spontaneous improvement ( ⅓ of the patients ) observed after simple debridement calls into question the need for prompt surgical treatment of patients with lesions similar to those included in this clinical trial . Moreover , this finding warrants further investigation , ideally through r and omized clinical trials in which patients subjected to debridement alone are compared with patients undergoing reconstructive surgery 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 Background Autologous chondrocyte implantation ( ACI ) is an accepted surgical treatment in patients with isolated cartilage defects of the knee . Age has been considered as a limiting factor and the technique has not been recommended in patients older than 40 to 50 years . Nevertheless , some more recent studies report satisfying clinical results in middle-aged patients . Hypothesis Analogous to the microfracture technique , age over 40 years is associated with inferior clinical outcome after ACI . Study Design Cohort study ; Level of evidence , 2 . Methods Thirty-seven patients with an average age of 47.8 years ( group 1 ) were matched with 37 patients with an average age of 31 years ( group 2 ) . Both groups underwent ACI for treatment of isolated cartilage defects of the knee . All patients were enrolled prospect ively and followed for a period of 24 months using International Knee Documentation Committee ( IKDC ) , Lysholm scale , Cincinnati sports scale , and Tegner activity evaluation instruments . Results Statistical analysis revealed a significant increase in function after ACI in both groups as early as 6 months after surgery until the end of the study period . There was only a slight tendency for better clinical outcome in younger patients ( IKDC at 24 months : group 1 , 72.2 ± 15.8 [ st and ard deviation ] ; group 2 : 76.1 ± 14.1 ; P = .261 ; Lysholm at 24 months : group 1 : 80.42 ± 15.37 ; group 2 : 80.65 ± 12.01 ) , no statistical significant differences were found between patients of group 1 and group 2 at any of the time points investigated . Conclusion In contrast to other cartilage repair techniques , patients 40 years and older do not have an inferior outcome up to 24 months after ACI for isolated cartilage defects when compared with younger patients 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 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 Background As the natural healing capacity of damaged articular cartilage is poor , joint surface injuries are a prime target for regenerative medicine . Characterized chondrocyte implantation uses an autologous cartilage cell therapy product that has been optimized for its biological potency to form stable cartilage tissue in vivo . Purpose To determine whether , in symptomatic cartilage defects of the femoral condyle , structural regeneration with characterized chondrocyte implantation is superior to repair with microfracture . Study Design R and omized controlled trial ; Level of evidence , 1 . Methods Characterized chondrocyte implantation was compared with microfracture in patients with single grade III to IV symptomatic cartilage defects of the femoral condyles in a multicenter trial . Patients aged 18 to 50 years were r and omized to characterized chondrocyte implantation  ( n = 57 ) or  microfracture  ( n = 61 ) . Structural repair was blindly assessed in biopsy specimens taken at 1 year using ( 1 ) computerized histomorphometry and ( 2 ) evaluation of overall histological components of structural repair . Clinical outcome was measured using the self administered Knee injury and Osteoarthritis Outcome Score . Adverse events were recorded throughout the study . Results Characterized chondrocyte implantation result ed in better structural repair , as assessed by histomorphometry ( P = .003 ) and overall histologic evaluation ( P = .012 ) . Aspects of structural repair relating to chondrocyte phenotype and tissue structure were superior with characterized chondrocyte implantation . Clinical outcome as measured by the Knee injury and Osteoarthritis Outcome Score at 12 to 18 months after characterized chondrocyte implantation was comparable with microfracture at this stage . Both treatment groups had a similar mean baseline overall Knee injury and Osteoarthritis Outcome Score ( 56.30 ± 13.61 and 59.53 ± 14.95 for microfracture and characterized chondrocyte implantation , respectively ) , which increased in both groups to 70.56 ± 12.39 and 72.63 ± 15.55 at 6 months , 73.26 ± 14.66 and 73.10 ± 16.01 at 12 months , and 74.73 ± 17.01 and 75.04 ± 14.50 at 18 months , respectively . Both techniques were generally well tolerated ; the incidence of adverse events after characterized chondrocyte implantation was not markedly increased compared with that for microfracture . Conclusion One year after treatment , characterized chondrocyte implantation was associated with a tissue regenerate that was superior to that after microfracture . Short-term clinical outcome was similar for both treatments . The superior structural outcome may result in improved long-term clinical benefit with characterized chondrocyte implantation . Long-term follow-up is needed to confirm these findings Background : Several methods are used to treat focal chondral and osteochondral defects on the weightbearing surfaces of synovial joints . Autologous osteochondral grafting is 1 option used to replace hyaline cartilage in the defect . Hypothesis : Mosaicplasty is effective in returning elite athletes to participation in sports . Study Design : Case series ; Level of evidence , 4 . Methods : In 3 institutes , 354 of 383 patients were followed from 2 to 17 years ( average , 9.6 years ) . The results of mosaicplasty were prospect ively evaluated at 6 weeks , 3 months , 6 months , and yearly with patient-reported outcomes measures and radiographs . Results : Slight or moderate degenerative changes ( Fairbank grade I or II ) were detected preoperatively in 27 % of the cases and in 36 % of the cases at follow-up . Fairbank grade III changes were observed in 5 cases . An average radiographic deterioration of 0.32 on the Fairbank scale was detected ( preoperative , 0.34 ; postoperative , 0.66 ) . Good to excellent results were found in 91 % of femoral mosaicplasties , 86 % of tibial , and 74 % of patellofemoral ; 92 % of talar mosaicplasties had similar results ( Hannover ankle scoring system ) . Patellofemoral pain related to graft harvest was observed in 5 % of cases . Second-look arthroscopies revealed good , congruent , gliding surfaces of the transplants and acceptable fibrocartilage coverage of donor sites in 16 patients and degenerative changes of the transplants in 5 cases . Histological evaluation revealed good graft incorporation in all 11 cases . Two infections and 3 deep venous thromboses occurred . Conclusion : Despite a higher rate of preoperative osteoarthritic changes in the athletic patients , clinical outcomes of mosaicplasty in this group demonstrated a success rate similar to that of less athletic patients . Higher motivation result ed in better subjective evaluation . Slight deterioration in results occurred during the 9.6-year follow-up ; thus , autologous osteochondral mosaicplasty may be a useful alternative for the treatment of 1.0- to 4.0-cm2 focal chondral and osteochondral lesions in competitive athletes
PURPOSE Our purpose was to examine the Level I and II evidence for the use of osteochondral cylinder transfer technique ( OCT ) for cartilage repair .