Cartilage Repair with Autologous Chondrocytes (ACI Generations 1-4)

Chondral and osteochondral lesions are common after joint trauma and various cartilage lesion repair techniques have been explored. One such technique is autologous chondrocyte implantation (ACI). Most reports on ACI are on the 1st and 2nd generation ACI with cells in suspension under a sutured membrane. Today's 3rd generation ACI is opening up possibility for arthroscopic implantations. Arthroscopic surgery reduces patient morbidity and also accelerates the rehab process. Fourth generation ACI, a one stage procedure, has just recently attracted interest. This article reviews the indications, the technical considerations, and clinical findings, and addresses many of the questions raised about ACI.