What does this research mean for the field?

Autologous Chondrocyte Implantation (ACI) results in superior knee function at 10 years follow-up compared to alternative surgical treatments for cartilage management. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

The aim is to evaluate the long-term effectiveness of ACI compared to alternative surgical treatments for knee cartilage defects after failed previous treatment.

March 16, 2026Open Access

Ten Year Follow-up of a randomized Trial of Autologous Chondrocyte Implantation Versus Alternative Forms of Surgical Cartilage Management in in the Knee

Key Points

The aim is to evaluate the long-term effectiveness of ACI compared to alternative surgical treatments for knee cartilage defects after failed previous treatment.
390 patients were randomized to either ACI or alternative cartilage management.
Patients aged 18-55 with symptomatic cartilage defects after one failed surgery were included.
Randomization considered factors such as age, defect size, location, and baseline scores.
The primary outcome was the Lysholm knee score, assessed at 10 years using intention-to-treat analysis.
At 10 years, ACI group had a mean Lysholm score higher by 7.3 points compared to alternative treatments.
70% of patients completed all Lysholm scores, with 94% providing at least one response for analysis.
Treatment failure rates were 29% for ACI and 25% for alternative management, indicating comparable outcomes.
Mean scores for ACI were not affected by previous marrow stimulation, while alternative treatments showed significantly worse scores.

Abstract

To determine at 10 years whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee.Methods 390 patients were randomly assigned to receive either ACI or alternative management.Patients aged 18-55 years with symptomatic cartilage defects who had failed one previous therapeutic surgical procedure were included.Randomization was stratified by age, defect size, defect location, chosen intended alternative treatment and baseline Lysholm knee score.The primary outcome was a patient-completed Lysholm knee score.The main secondary outcome was time to treatment failure.Analysis was performed on all available data and the intention-to-treat principle using a mixed linear model. ResultsThe average age was 35.4 (SD 9) years, with 64% being male.88% of defects were femoral, and the mean defect size was 3.2cm 2 in both groups .At 10 years, 70% completed all patient Lysholm scores, however 94% provided 1 response and contributed to the analysis.The mean Lysholm score in those randomised to ACI was significantly higher (mean difference 7.3 points; 95% CI 2.5 to 12.1).Sensitivity analysis on the impact of further operations following treatment failure suggests a treatment effect that still favours ACI but was somewhat reduced (mean difference 3.8 points, 95%CI: -1.8 to 9.5).Ten-year treatment failure rates were comparable (29% and 25%, HR 1.04, 95%CI 0.69 to 1.6).In the ACI arm, mean scores were not affected by previous marrow stimulation, whereas in the alternative arm, mean scores were significantly worse. Interpretation:ACI results in superior knee function at 10 years follow-up compared to alternate surgical treatments.The results of ACI were not impacted by prior marrow stimulation.

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Cite This Study

Snow et al. (Sun,) studied this question.

synapsesocial.com/papers/69b79e398166e15b153ab33e https://doi.org/https://doi.org/10.1016/j.joca.2026.03.112

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