Second-generation autologous chondrocyte implantation: Results in patients older than 40 years

Elizaveta Kon, Giuseppe Filardo, Vincenzo Condello, Marco Collarile, Alessandro Di Martino, Claudio Zorzi, Maurilio Marcacci

Research output: Contribution to journalArticlepeer-review


Background: Aging is responsible for degenerative changes in all cartilage elements, thus impairing its properties and healing potential. Most studies on surgical procedures for cartilage focus on young patients because these procedures are generally not considered suitable for older patients. Purpose: To analyze the clinical outcome of cartilage lesion treatment using second-generation autologous chondrocyte implantation (ACI) techniques in patients more than 40 years old with no clear signs of osteoarthritis, to understand their real potential in relation to aging, the failure rate, and complications in older patients. Study Design: Case series; Level of evidence, 4. Methods: Sixty-one patients with grade III to IV cartilaginous lesions of the condyles with no clear signs of osteoarthritis and a minimum age of 40 years were treated with second-generation ACI and prospectively evaluated at 5 years' follow-up. Twenty-two patients were treated with arthroscopic Hyalograft C implantation, and 39 underwent the open Chondro-Gide MACI procedure. Results: A significant improvement in both subjective and objective evaluations was observed. The International Knee Documentation Committee (IKDC) subjective score improved from 36.8 6 8.4 to 68.1 6 21.8 at the final evaluation. The failure rate was 20%. A faster improvement was observed in the group treated with the arthroscopic Hyalograft C technique, whereas similar scores were found at the 24-month follow-up and final evaluation. Conclusion: A clinical improvement was found in patients more than 40 years old, who in most cases benefited from secondgeneration ACI with good results lasting at medium-term follow-up. However, the results were inferior with respect to those previously found for younger populations, and the failure rate at medium-term follow-up was also higher. These findings were consistent in the 2 treatment groups. The only difference was the faster recovery when the arthroscopic approach was used.

Original languageEnglish
Pages (from-to)1668-1675
Number of pages8
JournalAmerican Journal of Sports Medicine
Issue number8
Publication statusPublished - Aug 2011


  • Age
  • Cartilage
  • Knee
  • Second-generation autologous chondrocyte implantation

ASJC Scopus subject areas

  • Medicine(all)
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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