Authors' objectives:

The object of this review is to assess the efficacy and safety of autologous chondrocyte implantation (ACI). ACI has been used experimentally since 1987 to treat localised deep chondral tissue defects in the weight-bearing zone in young subjects.

Authors' results and conclusions: (i) Description: Originally a 3-step technique: 1) biopsy of cartilage from a healthy, non-weight-bearing zone; 2) in vitro culture of chondrocytes; 3) injection of cultured cells under a periosteal flap. The technique is still being developed (advances in tissue engineering and use of matrices). (ii) Clinical trials: Overall,12 clinical trials have been published since the 2001 NHS report used as a reference: 3 randomised trials (level of evidence 2 according to the ANAES classification) and 9 case series (level of evidence 4). (iii) Efficacy: Short-term efficacy results for ACI are similar to those for the alternative techniques (mosaicplasty and microfracture), with approximately 87% improvement in clinical scores after one year. These results were maintained at 3 years in a prospective series. The ACI failure rate is between 5 and 16%. (iv) Safety: Data are often missing from publications. Specific complications include periosteal hypertrophy (up to 20% of cases) and adhesions (up to 5% of cases). (v) Benefit/risk ratio: It is difficult to determine either the benefit/risk ratio or the role of the technique in managing isolated chondral tissue defects in young subjects, as there are insufficient comparative trials of a good level of evidence or long-term follow-up. ACI is an emerging technique which is still very much in the development stage.

Authors' recommendations: Looking ahead : (i) Support clinical research into ACI, particularly in relation to choice of matrix. (ii) Carry out research into: chondrocyte dedifferentiation; the required qualitative and quantitative criteria for using chondrocyte cultures; use of stem cells; use of gene therapy for cartilage repair.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.has-Sante.fr/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: Haute Autorité de Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: has.seap.secretariat@has-sante.fr

Contact Email: has.seap.secretariat@has-sante.fr

Copyright: Haute Autorite de Sante/French National Authority for Health (HAS)