Autologous chondrocyte implantation.
Rationale for the treatment of cartilage damage in younger patients depends on a thorough understanding of the predisposing factors for the chondrosis and the stage of disease. Implantation with autologous cultured chondrocytes allows for resurfacing of larger defect areas with reproducibly good/excellent results in 90% of patients with isolated lesions of the femoral condyle. Patellar lesions also may be successfully treated (approximately 75% improved) but strict attention must be given to correction of malalignment. Results in patients with tibial and salvage lesions are encouraging; however, these results should be viewed with caution due to the small number of patients with 2-year follow-up. Autologous chondrocyte implantation involves an open technique with the inherent disadvantages of adhesions and a more prolonged recovery. However, these disadvantages must be weighed against the procedure's ability to produce a hyaline-type tissue with greater durability than fibrocartilage repairs produced by traditional marrow-stimulation techniques. We recommended matching the treatment procedure to patient expectations and lesion/demographic characteristics. Based on the available literature. algorithms have been published that recommend autologous chondrocyte implantation be reserved as first-line treatment for high-demand patients with large lesions (>2 cm2) and as revision therapy in patients with lesions of all sizes, regardless of patient demand, who have failed alternative marrow stimulation techniques.
Minas
T
T
Department of Orthopedic Surgery, Brigham and Women's Hospital and the New England Baptist Hospital, Boston, Mass 02115, USA.
Chiu
R
R
D000465:Algorithms; D002358:Cartilage, Articular / Q000293:injuries* / Q000637:transplantation*; D019902:Chondrocytes / Q000637:transplantation*; D003362:Cost-Benefit Analysis; D006801:Humans; D007718:Knee Injuries / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D014182:Transplantation, Autologous / Q000191:economics; D016896:Treatment Outcome; D014481:United States