Chapter 82 - Tissue-Engineered Cartilage Products: Clinical Experience

Abstract

Building upon the first clinical implantation of autologous cultured chondrocytes by Peterson and Brittberg just over 25 years ago, the field of articular cartilage repair continues to advance. The clinical applications of cell therapy tissue engineering to date have focused on autologous cultured chondrocytes. First-generation autologous chondrocyte implantation (ACI) has demonstrated successful clinical outcomes in challenging patients where other treatment modalities have been less successful. Significant clinical experience with advanced-generation ACI has been obtained in Europe and Australia. The clinical development of third-generation products has built on the earlier ACI experience by addressing some of the limitations of the original ACI and continuing to advance the field of cellular-based therapies for cartilage repair. These products were designed to remove the need for the harvest, placement, and suture of a periosteal flap and thereby provide implantation of autologous chondrocytes for cartilage repair with less invasive techniques. In general, studies of third-generation ACI have shown significant improvement in pain and function, structural evidence of repair tissue maintained in the longer-term, and few adverse safety findings. The clinical success with first- through third-generation ACI in patient populations with very symptomatic and challenging cartilage lesions has laid the foundation for further progress in cell-based orthopedic tissue engineering in general and cartilage repair in particular.