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A Journal on Orthopedics and Traumatology

Official Journal of the Piedmontese-Ligurian-Lombard Society of Orthopedics and Traumatology
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Minerva Ortopedica e Traumatologica 2011 June;62(3):171-86

language: English

Knee microfracture and autologous chondrocyte implantation

Von Keudell A. 1, Proffen B. 2, Vavken P. 2,3

1 Cartilage Repair Center Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
2 Sports Medicine Research Laboratory, Department of Orthopedic Surgery, Children’s Hospital Boston, Boston, MA, USA
3 Harvard Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA, USA


Recent years have seen a move from replacement to regeneration in the management of cartilage defects. Two very popular regenerative treatments are autologous chondrocyte implantation (ACI) and microfracture. It is the objective of this review to describe and compare these treatments and to present an evidence-based treatment algorithm for focal cartilage defects. Both treatments have been shown to be effective in long-term longitudinal studies, with microfracture showing improvement in up to 95% of patients and ACI 92% of the patients in five and two-nine year follow-up, respectively. Treatment success depends on a number of factors such as defect location, concomitant problems and age of the patient. Associated complications are poor tissue differentation and intra-lesional osteophyte formation in microfracture, and hyperthrophy and the need for two procedures in ACI. Few studies provide detailed information on comparative assessment, showing widely similar clinical outcomes but better histological results for ACI, which are likely to translate into better long-term outcomes.

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