Spanish Experience in Autologous Chondrocyte Implantation

Santiago Pérez-Cachafeiro1, Alberto Ruano-Raviña1, 2, José Couceiro-Follente3, Jose Antonio Benedí-Alcaine4, Ignacio Nebot-Sanchis5, Ciriaco Casquete-Román1, Santiago Bello-Prats6, Gonzalo Couceiro-Sánchez7, Francisco J. Blanco*, 8
1 Galician Agency for Health Technology Assessment, Santiago de Compostela, Spain
2 Department of Preventive Medicine and Public Health, Santiago de Compostela University, Spain
3 Orthopaedic Department, Santiago de Compostela University Hospital, Spain
4 Orthopaedic Department, Miguel Servet University Hospital, Zaragoza, Spain
5 Orthopaedic Department, Dr. Peset Hospital, Valencia, Spain
6 Orthopaedic Department, La Paz Hospital, Madrid, Spain
7 Orthopaedic Department, Santa Teresa Hospital, A Coruña, Spain
8 Rheumatology Unit, Cartilage Research Unit, Hospital Juan Canalejo, A Coruña, Spain

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© Pérez-Cachafeiroe et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the INIBIC-Hospital Universitario A Coruña, 15006- A Coruña, Spain; E-mail:



The Spanish Ministry of Health commissioned the Galician Agency for Health Technology Assessment to monitor and follow-up Autologous Chondrocyte Implantation (ACI) used to treat chondral lesions of the knee in Spain. The objective of this monitoring was to assess efficacy and safety of the technique.


One-hundred and eleven consecutive patients with knee chondral lesions were included in a multi-center study between January 2001 and January 2005. ACI was used in these patients as a second-line treatment option (or a first-line treatment option if the cause was Osteocondritis dissecans). The Cincinnati score and the Short Form 36 (SF-36) questionnaire were used to assess the patients’ self-reported satisfaction with the outcomes of ACI. A descriptive analysis was performed and non-parametric tests were used to establish correlations and compare results among subgroups. A multivariate analysis was also performed to measure the effect of different variables on changes in the condition of the knee.


Eighty men (72%) and 31 women (21%) with an age range from 16 to 49 years, underwent ACI surgery. Among these subjects, the most common previous first-line treatment was debridement (64 individuals, 74.4%). The mean size of the lesion treated with ACI was 3.82 cm2, and the most frequent location of the lesion was the inner femoral condyle (53.6%). The patient satisfaction was high or very high in 36 subjects (66.7%). Overall knee joint assessment improved from 4.32 points to 6.78. All SF-36 questionnaire categories improved, notably those related to physical condition.


The results of this study indicate that ACI is safe; however, further studies are mandated to assess the efficacy of ACI compared to alternative treatment options.

Keywords: Chondrocytes, cartilage, clinical trial, implantation, ACI, transplant..