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Autologous cartilage implantation for full thickness articular cartilage defects of the knee

  • Review
  • Intervention

Authors

  • J Wasiak,

  • E Villanueva


Jason Wasiak, Royal Australian & New Zealand College of Obstetrics and Gynaecology, 254-260 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA. jwasiak@ranzcog.edu.au.

Abstract

Background

A variety of strategies have been employed for managing articular cartilage defects of the knee, including drilling and abrasion arthroplasty. These treatments are not always effective and when they are, the benefits may only be transitory. Unsuccessfully treated cartilage damage may progress to degenerative disease states and result in the need for a total knee replacement. In recent years the surgical implantation of healthy cartilage cells (autologous cartilage implantation [ACI] ) into damaged areas has been seen as an alternative option and is currently under investigation as a potential improvement over the current strategies for the management and treatment of articular cartilage defects.

Objectives

To determine the effectiveness of ACI in patients with full thickness articular cartilage defects of the knee.

Search strategy

We searched the Cochrane Musculoskeletal Injuries Group specialised register (October 2002), Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2002), MEDLINE (1966 to June Week 4 2001), CINAHL (1982 to July Week 2 2001), EMBASE (1980 to 2001 Week 27), SPORTDiscus (1949 to June 2001), Current Contents (1993 Week 26 to 2001 Week 30) and the National Research Register (Issue 2, May 2002).

Selection criteria

Randomised and quasi-randomised trials comparing ACI with any other type of treatment (including no treatment or placebo) for symptomatic cartilage defects of the medial or lateral femoral condyle, trochlea or patella.

Data collection and analysis

Two independent reviewers applied the entry criteria to identified studies.

Main results

No completed randomised controlled trials investigating this treatment were identified through the above searches. Two possible trials have been placed in Studies Awaiting Assessment, awaiting publication of the full trial report. One possible trial was recently excluded. Ongoing trials currently underway will be incorporated in future updates of this review.

Authors' conclusions

No information is available from RCTs which can influence current practice. Therefore, since current evidence is subject to the inherent weaknesses of case series or reports, ACI must currently be considered as a technology under investigation whose effectiveness is yet to be determined in well designed and conducted clinical trials. The results of ongoing randomised clinical trials will help improve this situation.

Plain language summary

Plain language summary

Results awaited from cartilage implantation trials

Hyaline cartilage is a special type of tissue that covers joints and helps them to move easily. When this cartilage is damaged, joints can become swollen and painful. One new treatment is for healthy cartilage cells to be implanted in the damaged area, so the cartilage can grow back in a better condition. This is known as autologous cartilage or chondrocyte implantation (ACI). This review found no completed trials on ACI for knee defects but found some trials currently under way. Results from these trials will be added to this review in future.