Cartilage repair by autologous chondrocyte transplantation (ACTIVE)
Lead Research Organisation:
Keele University
Department Name: Inst for Science and Tech in Medicine
Abstract
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Technical Summary
Injury to the articular surfaces of the knee can lead to decreased physical activity, a poorer quality of life and impaired employment prospects. Cartilage has limited capacity for self-repair and chondral damage may predispose to osteoarthritis in later life, eventually necessitating knee replacement. Currently there is no uniform approach to managing these injuries and a number of different treatments are used with varying success.
Autologous chondrocyte transplantation (ACT) is a procedure in which the defect is repaired with cells prepared from the patient?s own cartilage. ACT was first used in Sweden and follow up of the patients over 9 years has revealed good or excellent results. Over 5000 patients have now been treated with ACT, mainly in the US and numerous observational studies have been reported. However conclusive evidence that ACT offers a better long-term outcome than the traditional procedures is lacking. The present proposal is for a multicentre (12 UK and 2 Norway) prospective randomised trial of ACT (conventional periosteal method or the more recently introduced collagen membrane variation) against traditional treatments (debridement, microfracture/drilling, mosaicplasty). The trial will be carried out with 660 patients, each with a chondral defect on the femoral condyl of the knee, and for whom a previous procedure has not relieved symptoms. Outcome will be assessed by validated functional knee scores (Lysholm, IKDC) and quality of life measures (SF36) at pre-set intervals over 10 years, by resource usage and days of work and by time to further surgical intervention.
Autologous chondrocyte transplantation (ACT) is a procedure in which the defect is repaired with cells prepared from the patient?s own cartilage. ACT was first used in Sweden and follow up of the patients over 9 years has revealed good or excellent results. Over 5000 patients have now been treated with ACT, mainly in the US and numerous observational studies have been reported. However conclusive evidence that ACT offers a better long-term outcome than the traditional procedures is lacking. The present proposal is for a multicentre (12 UK and 2 Norway) prospective randomised trial of ACT (conventional periosteal method or the more recently introduced collagen membrane variation) against traditional treatments (debridement, microfracture/drilling, mosaicplasty). The trial will be carried out with 660 patients, each with a chondral defect on the femoral condyl of the knee, and for whom a previous procedure has not relieved symptoms. Outcome will be assessed by validated functional knee scores (Lysholm, IKDC) and quality of life measures (SF36) at pre-set intervals over 10 years, by resource usage and days of work and by time to further surgical intervention.
