Does Autologous Chondrocyte Implantation Provide Better Outcomes Than Microfracture in the Repair of Articular Knee Defects?

OBJECTIVE: The objectives of this selective EBM review is to determine whether or not Autologous Chondrocyte Implantation is more effective than microfracture in the repair of articular knee defects. STUDY DESIGN: Review of three English language primary studies published in 2009 and 2010. DATA SOURCES: Randomized controlled trials comparing Autologous Chondrocyte Implantation and Microfracture found using PubMed, MedLine and Cochrane Database. OUTCOMES MEASURED: Clinical outcome measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary measure of outcome was evaluated using the KOOS questionnaire with subdomains of ADL’s, pain, symptoms, stiffness and quality of life. KOOS data was compared between treatment groups for patients with symptom onset less than 2 years vs more than 2 years and less or more than 3 years. Serial MRI scans were scored using Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) system. A rehabilitation protocol was implemented where components were evaluated pre surgery and at 6, 9, 12 and 24 months post surgery. Patients are followed up 8-12, 22-26, 50-54 weeks post operatively for efficacy and safety evaluations. RESULTS: Three randomized controlled trials were included in this review. The study by Basad indicated ACI as having significantly more effective outcomes over 2 years compared to microfracture. Saris’ study provided similar conclusions, offering improved outcomes with ACI after 36 months. However, Van Assche’s study had similar overall functional outcomes for both ACI and MF. CONCLUSIONS: Based on findings upon analysis of three RCT’s, Autologous chondrocyte implantation provides significant improvement in articular knee defects allowing improved function, mobilitiy and activity as compared to that of microfracture