Clinical evaluation of autologous chondrocytes for joint repair

Autologous cultured chondrocyte transplantation was introduced in Sweden in 1987 for the treatment of full thickness chondral defects of the knee. The results from the first 219 patients with a follow up of 2–10 years treated using this technique are reported. Patients were assessed with three types of endpoints: patient and physician derived clinical rating scales, arthroscopy assessments of cartilage fill, integration, and surface hardness and histology of graft biopsies. There was a high percentage of good to excellent results (84–90%) in patients with different types of single femoral condyle lesions, while other types of lesions had a lower degree of success (mean 74%). Furthermore, the long-term durability of the grafted area has been evaluated in a group of 61 patients with femoral condyle and patellar lesions who where followed for a mean of 7.4 (range 5–11) years and where the durability was calculated as the comparison between the long-term follow up and clinical status at 2 years post surgery. At 2 years, 50 of 61 patients treated were classified as satisfactory and at mean 7.4 years follow up, 51 of 61 were graded satisfactory. Twelve defects tested biomechanically demonstrated stiffness values ≥ 90% of normal in 67% of the patients and 8/12 graft biopsies showed hyaline-like characteristics. The good clinical long-term outcomes of autologous chondrocyte transplantation in these studies are encouraging. Future research programs contain a series of randomized studies on the different clinical repair methods available and more research on the cell sources, matrices and repair tissue evaluation.