Autologous Cartilage Implantation vs Arthroscopic Debridement (ACI)
Knee Injury, Cartilage Injury
About this trial
This is an interventional treatment trial for Knee Injury
Eligibility Criteria
Inclusion Criteria:
- Single symptomatic lesion of the trochlea, medial or lateral femoral condyle of the knee larger than 2 cm2.
- Cartilage lesion ICRS grade 3 or 4.
- More than 50 % of the menisci intact.
- Ligamentous stable knee
- Lysholm Score < 75
- Acceptable range of motion (5-105 degrees)
Exclusion Criteria:
- Osteoarthritis
- Malalignment > 5 degrees measured on HKA (hip-knee-ankle) radiographs
- Systemic arthritis
- Previous cartilage surgery
- Obesity BMI > 30
- Serious drig or alcohol abuse
- Inability to answer questionnaires or partake in rehabilitation
- Comorbidity that may influence surgery or rehabilitation
Sites / Locations
- Akershus University HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Sham Comparator
Autologous Chondrocyte Implantation
Arthroscopic Debridement
A diagnostic arthroscopy of the knee joint.The lesion is stabilized down to the subchondral bone, but not through it. Cartilage biopsy is taken from the medial femoral notch. The harvested cartilage is transported to the cell culture Laboratory and cultured for two weeks. The chondrocyte implantation: A mini-open arthrotomy is performed and the lesion is curetted down to subchondral bone, avoiding bleeding. The lesion is measured and a template of sterile aluminum foil is used to cut out a matching piece of collagen sheet which is used to contain the cells in the defect. The flap is sutured to the lesion and sealed with fibrin glue, leaving and opening at the upper part for injection of the cells. The last opening is then closed with a last stitch and fibrin glue.
The AD group will be subjected to a diagnostic arthroscopy with a full inspection of the knee joint to ensure the inclusion criteria are fulfilled. Lose bodies are removed, any meniscal pathology is addressed. Inflamed synovium is debrided. The lesion is stabilized by debridement around the edges and down to the subchondral bone using a ring curette, but not through it. Microfracture or any other cartilage treatment will not be performed. No intra-articular local anesthetics will be used due to the possible harmful effect on cartilage [41-43]. All the operating surgeons will receive proper training in the operative procedure before study start.