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 Sports Test 1: The Knee
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The Journal of Bone and Joint Surgery (American) 85:185-192 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Articles

Autologous Chondrocyte Implantation and Osteochondral Cylinder Transplantation in Cartilage Repair of the Knee Joint

A Prospective, Comparative Trial

U. Horas, MD, D. Pelinkovic, MD, G. Herr, DSc, T. Aigner, MD and R. Schnettler, MD

Investigation performed at the Department of Trauma Surgery, University of Giessen, Giessen, Germany

U. Horas, MD
R. Schnettler, MD
Department of Trauma Surgery, University of Giessen, Rudolf-Buchheim-Strasse 7, D-35385 Giessen, Germany

D. Pelinkovic, MD
Creighton University, Creighton Medical Center, 601 North 30th Street, Suite 1609, Omaha, NE 68131. E-mail address: peli99{at}hotmail.com

G. Herr, DSc
Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, University of Giessen, Kerkrader Strasse 9, D-35394 Giessen, Germany

T. Aigner, MD
Department of Pathology, University of Nürnberg/Erlangen, Krankenhausstrasse 8-10, D-91054 Erlangen, Germany

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

Background: Current methods used to restore the joint surface in patients with localized articular cartilage defects include transplantation of an autologous osteochondral cylinder and implantation of autologous chondrocytes. The purpose of this study was to evaluate the clinical and histological outcomes of these two techniques.

Methods: We performed a prospective clinical study to investigate the two-year outcomes in forty patients with an articular cartilage lesion of the femoral condyle who had been randomly treated with either transplantation of an autologous osteochondral cylinder or implantation of autologous chondrocytes. Biopsy specimens from representative patients of both groups were evaluated with histological staining, immunohistochemistry, and scanning electron microscopy.

Results: According to the postoperative Lysholm score, the recovery after autologous chondrocyte implantation was slower than that after osteochondral transplantation at six months (p <= 0.015), twelve months (p <= 0.001), and twenty-four months (p <= 0.012). On the basis of the Meyers score and the Tegner activity score, the results were equally good with the two methods two years after treatment. Histomorphological evaluation of biopsy specimens within two years after autologous chondrocyte implantation demonstrated a complete, mechanically stable resurfacing of the defect in all patients. The tissue consisted mainly of fibrocartilage, while localized areas of hyaline-like regenerative cartilage could be detected close to the subchondral bone. Although a gap remained at the site of the transplantation in all five biopsy specimens examined as long as two years after osteochondral cylinder transplantation, histomorphological analysis and scanning electron microscopy revealed no differences between the osteochondral transplants and the surrounding original cartilage.

Conclusions: Both treatments resulted in a decrease in symptoms. However, the improvement provided by the autologous chondrocyte implantation lagged behind that provided by the osteochondral cylinder transplantation. Histologically, the defects treated with autologous chondrocyte implantation were primarily filled with fibrocartilage, whereas the osteochondral cylinder transplants retained their hyaline character, although there was a persistent interface between the transplant and the surrounding original cartilage. Limitations of our study included the small number of patients, the relatively short (two-year) follow-up, and the absence of a control group.

Level of Evidence: Therapeutic study, Level II-2 (poor-quality randomized controlled trial [e.g., <80% follow-up]). See Instructions to Authors for a complete description of levels of evidence.



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