Second-Generation Autologous Chondrocyte Implantation: What to Expect

Chondral lesions are a challenging problem for the orthopaedic surgeon, and regenerative techniques have been widely studied in this field as ambitious solutions to restore the articular surface. Even though the clinical efficacy of autologous chondrocyte implantation (ACI) has been well demonstrated in the literature long-term follow-up, this technique presents some biological and surgical drawbacks. Second-generation ACI procedures have been developed to address these shortcomings. Different types of scaffolds have been applied clinically in numerous studies with promising results, but well-designed studies with long-term evaluation are still lacking. The versatility of the second-generation ACI approach has been shown by several studies that have successfully applied this procedure not only in the management of cartilage damage in young, active patients, but also in patients with OCD, patients over 40 years old, or in cases of degenerative lesions. However, besides overall good results, its superiority with respect to other surgical approaches is still controversial. Further studies are necessary to support the potential of second-generation ACI and to define better the correct indications for those patients who can have a real benefit from this regenerative treatment.