The relative differences in effectiveness of subchondral stimulation, osteochondral grafts, and autologous chondrocyte implantation (ACI) are still unclear. It is the objective of this study to systematically review the literature on ACI compared to other treatments by clinical outcome and the quality of the repair tissue, including an assessment of the validity of these findings.
The online databases PubMed, EMBASE, Cochrane Controlled Trial Register, CENTRAL, CINAHL, and BioMed were searched. Controlled trials comparing ACI with other methods of cartilage repair or placebo were included. Data on clinical outcome and the quality of the repair tissue was abstracted in duplicate. Study validity was assessed by individual components (randomization, blinded outcome assessment, sample size, attrition, percentage biopsies).
Nine studies were included. The internal validity of most of these studies was poor. Studies comparing ACI with subchondral stimulation have a higher quality and show no differences in clinical outcomes, but suggest better results in tissue quality. The high quality evidence comparing ACI with osteochondral grafts shows better clinical outcomes and higher tissue quality after ACI.
Among the included studies there is much inconsistency in methodological quality and findings. Regardless of these problems, the absolute differences between groups are fairly small, thus raising questions about their clinical importance. Future studies will be needed to answer the question of benefits of ACI compared to other treatments, and could profit from addressing and avoiding the problems seen in this group. Finally conclusions concerning long-term effects are still difficult.