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Articular Cartilage Repair in the Adolescent Athlete: Is Autologous Chondrocyte Implantation the Answer?

Micheli, Lyle MD*†; Curtis, Christine BS*; Shervin, Nina MD

Clinical Journal of Sport Medicine: November 2006 - Volume 16 - Issue 6 - p 465-470
doi: 10.1097/01.jsm.0000248842.93755.e2
Thematic Issue

Objective: To determine the evidence base for recommendations regarding autologous chondryocyte implantation in adolescent athletes.

Materials and Methods: All literature on articular cartilage repair from MEDLINE search dated 1990 to 2006 was reviewed. The majority of articles describe surgical technique and indications. Three techniques for secondary articular cartilage repair have been identified: autologous chondrocyte implantation, autologous osteochondral implants, and marrow stimulation techniques. The initial literature search identified 4 studies that reported the effectiveness and durability of autologous chondrocyte implantation in adults and 2 studies that reported the outcomes of autologous chondrocyte implantation in adolescent athletes. No results of osteochondral implantation or marrow stimulation techniques in adolescent athletes have been published.

Results: Acceptable repair rates with all 3 techniques have been reported in adult athletes. Two studies reported high success using autolgous chondrocyte implantation (ACI) in children.

Conclusions: Articular cartilage injury in young athletes remains a difficult problem. The ideal situation is early diagnosis and primary repair, particularly with lesions of the knee, elbow, and ankle. In cases where primary repair is not possible or has been unsuccessful and the lesion is large or symptomatic, secondary repair with either marrow stimulation, microfracture, autologous chondrocyte implantation, or autologous osteochondral grafting may be used. However, at present only the results of ACI repair have been reported for adolescent athletes.

From the *Children's Hospital, Boston, Massachusetts; †Harvard Medical School, Boston, Massachusetts; and ‡Massachusetts General Hospital, Boston, Massachusetts.

The authors state that they have no proprietary interest in the products named in this article.

Reprints: Lyle Micheli, MD, 319 Longwood Avenue, Division of Sports Medicine, 2nd Floor, Boston, MA 02115 (e-mail: michelilyle@aol.com).

© 2006 Lippincott Williams & Wilkins, Inc.