Brittberg ACI 1994

Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation

Brittberg M, Lindahl A, Nilsson A, et al. The New England journal of medicine 1994 · PMID 8078550 · doi:10.1056/nejm199410063311401

Question

Can cultured autologous chondrocytes implanted under a periosteal patch repair full-thickness chondral defects of the knee?

Design

Prospective case series from Gothenburg, Sweden, with clinical review and second-look arthroscopy and biopsy.

Patients

Adolescents and young adults with symptomatic full-thickness cartilage defects of the femoral condyle or patella.

Intervention

Two-stage autologous chondrocyte implantation (harvest, culture expansion, implantation under a sutured periosteal flap)

Comparison

None (uncontrolled series)

Primary outcome

Clinical grading and arthroscopic/histological appearance of repair tissue over a mean follow-up of about 3 years

Key result

Most femoral condyle lesions had good or excellent clinical results with repair tissue resembling hyaline-like cartilage on biopsy; results for patellar lesions were noticeably poorer.

Limitations

Small uncontrolled case series with short follow-up and subjective grading; periosteal patch technique associated with hypertrophy and has since been superseded by membrane-based techniques.

Impact on practice

Introduced ACI as the first cell-based cartilage repair technique and established the concept of regenerating hyaline-like cartilage rather than fibrocartilage; the founding reference for all later ACI and MACI work.