This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the exams for this article:
 Sports Test 3: Knee
CME 1: January, February, March 2004
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Knutsen, G.
Right arrow Articles by Johansen, O.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Knutsen, G.
Right arrow Articles by Johansen, O.
Related Collections
Right arrow Sports
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American) 86:455-464 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Autologous Chondrocyte Implantation Compared with Microfracture in the Knee

A Randomized Trial

Gunnar Knutsen, MD1, Lars Engebretsen, MD, PhD2, Tom C. Ludvigsen, MD2, Jon Olav Drogset, MD3, Torbjørn Grøntvedt, MD, PhD3, Eirik Solheim, MD, PhD4, Torbjørn Strand, MD4, Sally Roberts, PhD5, Vidar Isaksen, MD1 and Oddmund Johansen, MD, PhD1

1 Department of Orthopaedic Surgery, University Hospital Tromsø, 9038 Tromsø, Norway. E-mail address for G. Knutsen: gunnar.knutsen{at}unn.no
2 Oslo Orthopaedic University Clinic, 0407 Oslo, Norway
3 University Hospital Trondheim, 7006 Trondheim, Norway
4 Deaconess University Hospital Bergen, 5009 Bergen, Norway
5 Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, United Kingdom

Investigation performed at University Hospital Tromsø, Tromsø, Oslo Orthopaedic University Clinic, University Hospital Trondheim, Trondheim, Deaconess University Hospital Bergen, Bergen, Norway, and Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire, United Kingdom

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Norwegian Ministry of Health. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: New methods have been used, with promising results, to treat full-thickness cartilage defects. The objective of the present study was to compare autologous chondrocyte implantation with microfracture in a randomized trial. We are not aware of any previous randomized studies comparing these methods.

Methods: Eighty patients without general osteoarthritis who had a single symptomatic cartilage defect on the femoral condyle in a stable knee were treated with autologous chondrocyte implantation or microfracture (forty in each group). We used the International Cartilage Repair Society, Lysholm, Short Form-36 (SF-36), and Tegner forms to collect data. An independent observer performed a follow-up examination at twelve and twenty-four months. Two years postoperatively, arthroscopy with biopsy for histological evaluation was carried out. The histological evaluation was done by a pathologist and a clinical scientist, both of whom were blinded to each patient's treatment.

Results: In general, there were small differences between the two treatment groups. At two years, both groups had significant clinical improvement. According to the SF-36 physical component score at two years postoperatively, the improvement in the microfracture group was significantly better than that in the autologous chondrocyte implantation group (p = 0.004). Younger and more active patients did better in both groups. There were two failures in the autologous chondrocyte implantation group and one in the microfracture group. No serious complications were reported. Biopsy specimens were obtained from 84% of the patients, and histological evaluation of repair tissues showed no significant differences between the two groups. We did not find any association between the histological quality of the tissue and the clinical outcome according to the scores on the Lysholm or SF-36 form or the visual analog scale.

Conclusions: Both methods had acceptable short-term clinical results. There was no significant difference in macroscopic or histological results between the two treatment groups and no association between the histological findings and the clinical outcome at the two-year time-point.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
G. Knutsen, J. O. Drogset, L. Engebretsen, T. Grontvedt, T. C. Ludvigsen, E. Solheim, T. Strand, and O. Johansen
A Randomized Trial Comparing Autologous Chondrocyte Implantation with Microfracture
J. Bone Joint Surg. Am., May 1, 2008; 90(5): 1165 - 1166.
[Full Text] [PDF]

Home page
 RadiologyHome page
G. H. Welsch, T. C. Mamisch, S. E. Domayer, R. Dorotka, F. Kutscha-Lissberg, S. Marlovits, L. M. White, and S. Trattnig
Cartilage T2 Assessment at 3-T MR Imaging: In Vivo Differentiation of Normal Hyaline Cartilage from Reparative Tissue after Two Cartilage Repair Procedures--Initial Experience
Radiology, April 1, 2008; 247(1): 154 - 161.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
B. Reider
The Next Generation
Am. J. Sports Med., February 1, 2008; 36(2): 233 - 234.
[Full Text] [PDF]

Home page
 Am J Sports MedHome page
D. B. F. Saris, J. Vanlauwe, J. Victor, M. Haspl, M. Bohnsack, Y. Fortems, B. Vandekerckhove, K. F. Almqvist, T. Claes, F. Handelberg, et al.
Characterized Chondrocyte Implantation Results in Better Structural Repair When Treating Symptomatic Cartilage Defects of the Knee in a Randomized Controlled Trial Versus Microfracture
Am. J. Sports Med., February 1, 2008; 36(2): 235 - 246.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
R. F. LaPrade, L. S. Bursch, E. J. Olson, V. Havlas, and C. S. Carlson
Histologic and Immunohistochemical Characteristics of Failed Articular Cartilage Resurfacing Procedures for Osteochondritis of the Knee: A Case Series
Am. J. Sports Med., February 1, 2008; 36(2): 360 - 368.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
T. E. Patterson, K. Kumagai, L. Griffith, and G. F. Muschler
Cellular Strategies for Enhancement of Fracture Repair
J. Bone Joint Surg. Am., February 1, 2008; 90(Supplement_1): 111 - 119.
[Abstract] [Full Text] [PDF]

Home page
 J Am Acad Orthop SurgHome page
W. Wu, D. P. Fyhrie, and F. Guilak
On the Horizon From the ORS
J. Am. Acad. Ortho. Surg., January 1, 2008; 16(1): 57 - 60.
[Full Text] [PDF]

Home page
 Stem CellsHome page
A. Scharstuhl, B. Schewe, K. Benz, C. Gaissmaier, H.-J. Buhring, and R. Stoop
Chondrogenic Potential of Human Adult Mesenchymal Stem Cells Is Independent of Age or Osteoarthritis Etiology
Stem Cells, December 1, 2007; 25(12): 3244 - 3251.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
J. H. Lubowitz, D. Appleby, J. M. Centeno, S. K. Woolf, and J. B. Reid III
The Relationship Between the Outcome of Studies of Autologous Chondrocyte Implantation and the Presence of Commercial Funding
Am. J. Sports Med., November 1, 2007; 35(11): 1809 - 1816.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
G. Knutsen, J. O. Drogset, L. Engebretsen, T. Grontvedt, V. Isaksen, T. C. Ludvigsen, S. Roberts, E. Solheim, T. Strand, and O. Johansen
A Randomized Trial Comparing Autologous Chondrocyte Implantation with Microfracture. Findings at Five Years
J. Bone Joint Surg. Am., October 1, 2007; 89(10): 2105 - 2112.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
L. S. Lohmander, P. M. Englund, L. L. Dahl, and E. M. Roos
The Long-term Consequence of Anterior Cruciate Ligament and Meniscus Injuries: Osteoarthritis
Am. J. Sports Med., October 1, 2007; 35(10): 1756 - 1769.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
J. Farr, A. Rawal, and K. M. Marberry
Concomitant Meniscal Allograft Transplantation and Autologous Chondrocyte Implantation: Minimum 2-Year Follow-up
Am. J. Sports Med., September 1, 2007; 35(9): 1459 - 1466.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
B. C. Emmerson, S. Gortz, A. A. Jamali, C. Chung, D. Amiel, and W. D. Bugbee
Fresh Osteochondral Allografting in the Treatment of Osteochondritis Dissecans of the Femoral Condyle
Am. J. Sports Med., June 1, 2007; 35(6): 907 - 914.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
B. Mandelbaum, J. E. Browne, F. Fu, L. J. Micheli, J. B. Moseley Jr, C. Erggelet, and A. F. Anderson
Treatment Outcomes of Autologous Chondrocyte Implantation for Full-Thickness Articular Cartilage Defects of the Trochlea
Am. J. Sports Med., June 1, 2007; 35(6): 915 - 921.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
R. J. Williams III, A. S. Ranawat, H. G. Potter, T. Carter, and R. F. Warren
Fresh Stored Allografts for the Treatment of Osteochondral Defects of the Knee
J. Bone Joint Surg. Am., April 1, 2007; 89(4): 718 - 726.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
D. G. Jones and L. Peterson
Autologous Chondrocyte Implantation
J. Bone Joint Surg. Am., November 1, 2006; 88(11): 2501 - 2520.
[Full Text] [PDF]

Home page
 Am J Sports MedHome page
A. Gobbi, E. Kon, M. Berruto, R. Francisco, G. Filardo, and M. Marcacci
Patellofemoral Full-Thickness Chondral Defects Treated With Hyalograft-C: A Clinical, Arthroscopic, and Histologic Review
Am. J. Sports Med., November 1, 2006; 34(11): 1763 - 1773.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
D. D. Frisbie, S. Morisset, C. P. Ho, W. G. Rodkey, J. R. Steadman, and C. W. McIlwraith
Effects of Calcified Cartilage on Healing of Chondral Defects Treated With Microfracture in Horses
Am. J. Sports Med., November 1, 2006; 34(11): 1824 - 1831.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
K. Mithoefer, R. J. Williams III, R. F. Warren, T. L. Wickiewicz, and R. G. Marx
High-Impact Athletics After Knee Articular Cartilage Repair: A Prospective Evaluation of the Microfracture Technique
Am. J. Sports Med., September 1, 2006; 34(9): 1413 - 1418.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
N. Iwasaki, H. Kato, J. Ishikawa, S. Saitoh, and A. Minami
Autologous Osteochondral Mosaicplasty for Capitellar Osteochondritis Dissecans in Teenaged Patients
Am. J. Sports Med., August 1, 2006; 34(8): 1233 - 1239.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
H. G. Potter and L. F. Foo
Magnetic Resonance Imaging of Articular Cartilage: Trauma, Degeneration, and Repair
Am. J. Sports Med., April 1, 2006; 34(4): 661 - 677.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
J. J. Wood, M. A. Malek, F. J. Frassica, J. A. Polder, A. K. Mohan, E. T. Bloom, M. M. Braun, and T. R. Cote
Autologous Cultured Chondrocytes: Adverse Events Reported to the United States Food and Drug Administration
J. Bone Joint Surg. Am., March 1, 2006; 88(3): 503 - 507.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
P. C.M. Verdonk, A. Demurie, K. F. Almqvist, E. M. Veys, G. Verbruggen, and R. Verdonk
Transplantation of Viable Meniscal Allograft
J. Bone Joint Surg. Am., March 1, 2006; 88(1_suppl_1): 109 - 118.
[Abstract] [Full Text] [PDF]

Home page
 J Am Acad Orthop SurgHome page
W. R. Post
Anterior Knee Pain: Diagnosis and Treatment
J. Am. Acad. Ortho. Surg., December 1, 2005; 13(8): 534 - 543.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
C. D. Hoemann, M. Hurtig, E. Rossomacha, J. Sun, A. Chevrier, M. S. Shive, and M. D. Buschmann
Chitosan-Glycerol Phosphate/Blood Implants Improve Hyaline Cartilage Repair in Ovine Microfracture Defects
J. Bone Joint Surg. Am., December 1, 2005; 87(12): 2671 - 2686.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
F. H. Fu, D. Zurakowski, J. E. Browne, B. Mandelbaum, C. Erggelet, J. B. Moseley Jr, A. F. Anderson, and L. J. Micheli
Autologous Chondrocyte Implantation Versus Debridement for Treatment of Full-Thickness Chondral Defects of the Knee: An Observational Cohort Study With 3-Year Follow-up
Am. J. Sports Med., November 1, 2005; 33(11): 1658 - 1666.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
R. B. Jakobsen, L. Engebretsen, and J. R. Slauterbeck
An Analysis of the Quality of Cartilage Repair Studies
J. Bone Joint Surg. Am., October 1, 2005; 87(10): 2232 - 2239.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
K. Mithoefer, R. J. Williams III, R. F. Warren, H. G. Potter, C. R. Spock, E. C. Jones, T. L. Wickiewicz, and R. G. Marx
The Microfracture Technique for the Treatment of Articular Cartilage Lesions in the Knee. A Prospective Cohort Study
J. Bone Joint Surg. Am., September 1, 2005; 87(9): 1911 - 1920.
[Abstract] [Full Text] [PDF]

Home page
 J Bone Joint Surg BrHome page
W. Bartlett, J. A. Skinner, C. R. Gooding, R. W. J. Carrington, A. M. Flanagan, T. W. R. Briggs, and G. Bentley
Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: A PROSPECTIVE, RANDOMISED STUDY
J Bone Joint Surg Br, May 1, 2005; 87-B(5): 640 - 645.
[Abstract] [Full Text] [PDF]

Home page
 J Bone Joint Surg BrHome page
G. D. Smith, G. Knutsen, and J. B. Richardson
A clinical review of cartilage repair techniques
J Bone Joint Surg Br, April 1, 2005; 87-B(4): 445 - 449.
[Full Text] [PDF]

Home page
 JBJSHome page
S. C. Montgomery and M. D. Miller
What's New in Sports Medicine
J. Bone Joint Surg. Am., March 1, 2005; 87(3): 686 - 694.
[Full Text] [PDF]

Home page
 Am J Sports MedHome page
J. W. Alford and B. J. Cole
Cartilage Restoration, Part 2: Techniques, Outcomes, and Future Directions
Am. J. Sports Med., March 1, 2005; 33(3): 443 - 460.
[Abstract] [Full Text] [PDF]

Home page
 ptjournalHome page
M. Moffat
Braving New Worlds: To Conquer, to Endure
Physical Therapy, November 1, 2004; 84(11): 1056 - 1086.
[Abstract] [Full Text] [PDF]