Gooding, C.R.; (2008) A clinical and histopathological review of autologous chondrocyte implantation in the knee. Doctoral thesis , University of London.

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Abstract

Osteochondral defects in the knee can be disabling causing persistent pain, giving way, locking, catching and swelling and a reduction in activities including sport. Traditionally symptomatic defects were treated with marrow stimulation techniques such as drilling, abrasion and microfracture of the subchondral bone which have had limited success with usually the production of a fibrocartilage repair. This repair tissue tends to be soft and degenerates over a period of time. Autologous chondrocyte implantation (ACI) has produced hyaline or hyaline-like repair tissue in experimental models and in the clinical setting in early studies, with the potential for permanent regeneration of articular cartilage, thus preventing early onset osteoarthritis. This study reviews the clinical results of 3 techniques of autologous chondrocyte implantation (ACI): the more traditional periosteum covered ACI (ACI-P) implant, the collagen-covered ACI (ACI-C) and the matrix carried autologous chondrocyte implantation (MACI). Single cohort studies of ACI-P and ACI-C over a 4 year period were made together with the provisional results of the MACI procedure at 1 year. Then 2 prospectively randomized studies were performed to compare ACI-C with ACI-P and MACI with ACI-C. Finally a small series of patients were reviewed who had a chondrocyte implantation combined with other surgical techniques such as an anterior cruciate ligament reconstruction or tibial osteotomy. A review of these patients revealed a significant improvement in their clinical scores over 4 years for the ACI-C and ACI-P technique in keeping with previously published data and also for the MACI technique at 1 year. Interestingly, a large number of the ACI-P patients developed graft hypertrophy which required arthroscopic debridement since patients complained of pain and catching. However, the ACI-C and MACI patients rarely developed this problem. The prospectively randomised study did not show any difference in terms of clinical and histological assessment at 2 years between the ACI-C and ACI-P patients. The early results for the MACI technique are also comparable. Based on this data it is proposed that collagen-covered ACI is the present 'gold standard' in chondrocyte implantation rather than periosteum-covered ACI.

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