Background
Treatments for managing articular cartilage defects of the knee, including drilling and abrasion arthroplasty, are not always effective. When they are, long-term benefits may not be maintained and osteoarthritis may develop. An alternative is autologous chondrocyte implantation (ACI), the surgical implantation of healthy cartilage cells into the damaged areas.

Objectives
To determine the efficacy and safety of ACI in people with full thickness articular cartilage defects of the knee.

Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (14 January 2011), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4), MEDLINE (1948 to January Week 1 2011), EMBASE (1980 to Week 1 2011), SPORTDiscus (1985 to 14 January 2011), the WHO International Clinical Trials Registry Platform (26 January 2011), and Current Controlled Trials (26 January 2011).

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, femoral trochlea or patella.

Data collection and analysis
Review authors selected studies for inclusion independently. We assessed risk of bias based on adequacy of the randomisation and allocation concealment process, potential for selection bias after allocation and level of masking. We did not pool data due to clinical and methodological heterogeneity.

Main results
Six heterogeneous trials were identified with 442 participants. Methodological flaws of the included trials included incomplete follow-up and inadequate reporting of outcomes. Three trials compared ACI versus mosaicplasty. One reported statistically significant results in favour of ACI at one year in the numbers of people with 'good' or 'excellent' functional results. Conversely, another trial found significant improvement for the mosaicplasty group when assessed using one functional scoring system at two years, but no statistically significant differences based on two other scoring systems. A third trial found no difference between ACI and mosaicplasty, 10 months on average after the surgery.

There was no statistically significant difference in functional outcomes at two years in a single trial comparing ACI with microfracture nor in the functional results at 18 months of a single trial comparing characterised chondrocyte implantation versus microfracture. However, the results at 36 months for this trial seemed to indicate better functional results for characterised chondrocyte implantation compared with those for microfracture. The sixth trial comparing matrix-guided ACI versus microfracture found significantly better results for functional outcomes at two year follow-up in the MACI group.

Authors' conclusions
There is insufficient evidence to draw conclusions on the use of ACI for treating full thickness articular cartilage defects in the knee. Further good quality randomised controlled trials with long-term functional outcomes are required.

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

Background Treatments for managing articular cartilage defects of the knee, including drilling and abrasion arthroplasty, are not always effective. When they are, long-term benefits may not be maintained and osteoarthritis may develop, resulting in the need for a total knee replacement. An alternative is the surgical implantation of healthy cartilage cells into damaged areas (autologous cartilage implantation).Objectives To determine the effectiveness of autologous cartilage implantation (ACI) in people with full thickness articular cartilage defects of the knee.Search strategy We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (15 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2005), MEDLINE (1966 to December 2005), CINAHL (1982 to December Week 2, 2004), EMBASE (1988 to 2005 Week 50), SPORTDiscus (1830 to January 2005) and the National Research Register Issue 3, 2005.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, femoral trochlea or patella.Data collection and analysis Two review authors selected studies for inclusion independently. We assessed study quality based on adequacy of the randomisation process, adequacy of the allocation concealment process, potential for selection bias after allocation and level of masking. Data was not pooled due to clinical and methodological heterogeneity in the studies.Main results We included four randomised controlled trials (266 participants). One trial of ACI versus mosaicplasty reported statistically significant results for ACI at one year, but only in a post-hoc subgroup analysis of participants with medial condylar defects; 88% had excellent or good results with ACI versus 69% with mosaicplasty. A second trial of ACI versus mosaicplasty found no statistically significant difference in clinical outcomes at two years. There was no statistically significant difference in outcomes at two years in a trial comparing ACI with microfracture. In addition, one trial of matrix-guided ACI versus microfracture did not contain enough long-term results to reach definitive conclusions.Authors' conclusions The use of ACI and other chondral resurfacing techniques is becoming increasingly widespread. However, there is at present no evidence of significant difference between ACI and other interventions. Additional good quality randomised controlled trials with long-term functional outcomes are required.

Autologous Cartilage Implantation For Full Thickness Articular Cartilage Defects Of The Knee

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Innovation I - Die am besten beurteilten Innovationsbeiträge