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 Sports Test 3: Knee
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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.


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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.
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 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.
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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.
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 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.
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M. Moffat
Braving New Worlds: To Conquer, to Endure
Physical Therapy, November 1, 2004; 84(11): 1056 - 1086.
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