Bentley ACI vs mosaicplasty

A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee

Bentley G, Biant LC, Carrington RW, et al. The Journal of bone and joint surgery. British volume 2003 · PMID 12678357 · doi:10.1302/0301-620x.85b2.13543

Question

Is ACI better than mosaicplasty (osteochondral autograft transfer) for symptomatic chondral and osteochondral knee defects?

Design

Single-centre prospective randomised trial at the Royal National Orthopaedic Hospital, Stanmore.

Patients

Adults with symptomatic chondral or osteochondral defects of the knee, many after previous failed surgery.

Intervention

Autologous chondrocyte implantation

Comparison

Mosaicplasty

Primary outcome

Modified Cincinnati and Stanmore functional scores, and arthroscopic grading of repair at 1 year

Key result

ACI gave better functional results and a higher proportion of excellent or good arthroscopic repairs than mosaicplasty at 1 year; mosaicplasty performed particularly poorly in patellar defects.

Limitations

Single centre, heterogeneous lesions and previous surgery, short primary follow-up and no blinding of surgeons or patients.

Impact on practice

A key UK trial supporting ACI over mosaicplasty for larger defects; its long-term follow-up showed lower failure rates with ACI and it underpinned NICE appraisal of ACI.