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Autologous chondrocyte transplantation in treating cartilage damage in the knee

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SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

Findings by SBU Alert

This is a translation of version 1, published on June 17, 1999. The latest version of this report is not available in English.

Autologous chondrocyte transplantation (ACT) is a new treatment method for localized cartilage damage in the knee. No method within this field has been documented as being effective. The ACT method has demonstrated promising results in open, uncontrolled studies. There is moderate* evidence that the method, in certain patients, is effective in the short term. There is poor* evidence concerning the methods long-term effects, patient benefits, and cost-effectiveness.

Until further experience is gained from ongoing, controlled, randomized trials, application of this method should be limited to a few users and only within the framework of the ongoing, scientifically controlled studies. These studies should elucidate patient benefits, risks, and cost-effectiveness.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Mats Brittberg, MD PhD, Kungsbacka Hospital, Assoc Prof Anders Lindahl, MD PhD, Sahlgrenska University Hospital, and Assoc Prof Lars Peterson, MD PhD, Gothenburg Medical Center. It has been reviewed by Assoc Prof Stefan Lohmander, MD PhD, Lund University Hospital.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

  1. Angermann P, Riegels-Nielsen, Pedersen H. Osteochondritis dissecans of the femoral condyle treated with periosteal transplantation. Poor outcome in 14 patients followed for 6-9 years. Acta Orthop Scand 1998 69:595-597.
  2. Brittberg M. Cartilage Repair. On cartilaginous tissue engineering with the emphasis on chondrocyte transplantation. Avhandling. Göteborgs Universitet. 1996. ISBN 91-628-1968-2.
  3. Brittberg M, Lindahl A, Homminga G, Nilson A, Isaksson O, Peterson L, A critical analysis of cartilage repair. Acta Orthop Scand 1997 68:186-191.
  4. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Sjögren-Jansson E, Peterson L, Autolog broskcellstransplantation. Smärtlindring och återställd ledfunktion är målet. Läkartidningen 1994 92:3315-3320.
  5. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 1994 331:889-895.
  6. Bobic V. Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Knee Surg Sports Traumatol Arthrosc 1996 3:2-4.
  7. Carticel Patient Registry Report. On internet: http://genzyme.shore.net/prodserv/tissue/repair/carticel/patreg.htm
  8. Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997 13: 456-460.
  9. Lohmander LS. Cell-based cartilage repair: do we need it, can we do it, is it good, can we prove it. Curr Opin in Orthopedics Dec 9(6)1998; 38-42.
  10. Lorentzon R, Alfredson H, Hildingsson C. Treatment of deep cartilage defects of the patella with periosteal transplantation. Knee Surg Sports Traumatol Arthrosc 1998;6(4):202-8.
  11. Messner K, Gillquist J. Cartilage repair. A critical review. Acta Orthop Scan 1996 67: 53-529.
  12. Messner K, Maletius W. The long-term prognosis for severe damage to weight-bearing cartilage in knee. A 14-year clinical radiographic follow-up in 28 young atheltes. Acta Orthop Scand 1996;767:165-8.
  13. Minas T. Chondrocyte implantation in the repair of chondral lesions of the knee: economics and quality of life. Am J Orthop 1998 27:739-744.
  14. Peterson L, Brittberg M, Nilsson A, Sjögren-Jansson E, Lindahl A. Behandling av skadat ledbrosk med broskcellstransplantation-resultat från långtidsuppföljning. Abstracts från Svenska Läkarsällskapets Riksstämma 24-26 november 1998:301.
  15. Terry GC, Flandry F, Van Mannen JW, Norwod LA. Isolated chondral fractures of the knee. Clin Orthop Rel Res 1988 54: 170-177.
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Published: Revised: 4/3/2000
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