Purpose of Technology: Autologous chondrocyte implantation (ACI) or transplantation is a form of tissue engineering that creates a graft from a patient’s own cartilage cells to repair defects in articular cartilage. The procedure involves the collection of cartilage cells, which are grown in a laboratory to create new cartilage tissue. This new tissue is then implanted into the defect, with the goal of improving the quality of cartilage repair.

Rationale: ACI places durable, living cartilage at sites within joints that have high levels of physical stress due to weight bearing and motion. 

Controversy: ACI requires surgery to collect cells and a second surgery to implant the laboratory-grown cartilage tissue. This loose tissue must be firmly attached to the bone during implantation, and cartilage grown in the laboratory may not be as durable as the hyaline cartilage normally found in the knee.

Relevant Questions:

  • How does first-generation ACI for cartilage defects of the knee compare with nonsurgical or surgical treatment options, including microfracture, mosaicplasty, and second- and third-generation ACI with respect to clinical outcome or quality-of-life measures?
  • Are first-generation ACI grafts durable over time?
  • Do first-generation ACI grafts pose any safety problems?
  • Have definitive patient selection criteria been established for first-generation ACI?

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