Research question:

The aim of the present investigation is the benefit assessment of the method of autologous chondrocyte implantation (with a periosteal flap, collagen-covered, matrix-induced) compared with standard treatment in adult patients with a specific symptomatic cartilage defect of the knee without advanced osteoarthritis. The focus of the assessment was on patient-relevant outcomes.

Conclusion:

When all 3 procedures of autologous chondrocyte implantation are considered together (matrix-induced [M-ACI], collagen-covered [ACI-C], with a periosteal flap [ACI-P]), the data provide no hint of benefit or harm versus standard treatment for any of the outcomes. At the medium-term time of analysis (11 to 24 months), heterogeneity between ACI procedures was evident for a large proportion of results, so each was considered separately

In the 7 studies comparing M-ACI with standard treatments, beneficial effects in favour of M-ACI were shown for the outcomes of function and health-related quality of life. Although the effects do not reach a clinically relevant magnitude, together with a qualitative examination of all other outcomes it can be assumed that M-ACI has a benefit at least comparable to that of current standard treatments.

Within each of the 2 studies comparing ACI-C and ACI-P with standard treatments, 1 study showed a statistically significant effect in favour of ACI-C for 1 outcome (treatment failure). However, no data on the harm of ACI-C are available from the studies, and all other outcomes on both ACI procedures show partly numerically inconsistent results. Therefore, the data provide no hint of a benefit or harm of ACI-C and ACI-P, and it cannot be estimated with sufficient certainty whether there is a benefit comparable to that of standard treatment.

The results of the 3 studies comparing the ACI procedures in pairs do not contradict the assessment presented above.

Publisher

Institute for Quality and Efficiency in Health Care

Topic

Autologous chondrocyte implantation in the knee joint

Commissioning agency

Federal Joint Committee

Commission awarded on

25 July 2019

Internal Commission No.

N19-02

Address of publisher

This report was prepared in collaboration with external experts.

The responsibility for the contents of the report lies solely with IQWiG.

According to §139b (3) No. 2 of Social Code Book (SGB) V, Statutory Health Insurance, external experts who are involved in the Institute’s research commissions must disclose “all connections to interest groups and contract organizations, particularly in the pharmaceutical and medical devices industries, including details on the type and amount of any remuneration received”. The Institute received the completed Form for disclosure of potential conflicts of interest from each external expert. The information provided was reviewed by a Committee of the Institute specifically established to assess conflicts of interests. The information on conflicts of interest provided by the external experts and external reviewers is presented in Chapter A8 of the full report. No conflicts of interest were detected that could endanger professional independence with regard to the work on the present commission.

External experts

• Nicole Skoetz, University Hospital Cologne, Cologne, Germany
• Alfred Hochrein, OCM Hospital, Munich, Germany

IQWiG thanks the external experts for their collaboration in the project.

IQWiG employees

• Gunnar Plinke
• Moritz Felsch
• Daniel Fleer
• Wolfram Groß
• Inga Overesch