Autologous Chondrocyte Implantation in the Knee Joint: Open Compared with Arthroscopic Technique

Abstract

Autologous chondrocyte implantation is a widely used technique for treating cartilage lesions1-10. The technique, first introduced and described by Brittberg et al. in 199411, required an arthrotomy of the joint, debridement of the lesions, and the suturing of a periosteal flap to create a pocket to host the chondrocytes. Autologous chondrocyte implantation in the knee joint has provided hyaline-like repair tissue11-16, with satisfactory clinical results in 80% to 90% of patients1,7,17. Moreover, autologous chondrocyte implantation has been shown to be a valid alternative to the mosaicplasty and microfracture repair techniques used in the treatment of osteochondral lesions of the knee1,6,13,17-20. In the recent past, to simplify the autologous chondrocyte implantation surgical technique, a three-dimensional hyaluronic acid scaffold was developed to support the autologous chondrocytes13. This scaffold enables an arthroscopic implantation technique to be used21. Furthermore, the chondrocytes embedded on the hyaluronic acid scaffold tend to maintain their original phenotype22 with respect to dedifferentiation induced by the fluid medium23. Despite initial encouraging results with the use of arthroscopic autologous chondrocyte implantation in the treatment of osteochondral lesions of the knee24-26, open and arthroscopic autologous chondrocyte implantation techniques have been compared in only a few studies23,25,26, and these have included only short-term follow-up and limited and nonhomogeneous case series. The aim of this study was to compare the long-term results in two groups of patients in whom osteochondral lesions in the knee joint were treated with the two aforementioned procedures. Patients were evaluated clinically, histologically, and with magnetic resonance imaging, with a minimum five-year follow-up. Between 1997 and 2002, …