Cell-Based Cartilage Repair Using the Hyalograft Transplant

Autologous chondrocyte implantation (ACI) is an effective means of treating symptomatic articular cartilage defects. This two-stage cartilage repair strategy relies on the cultured expansion of harvested chondrocytes; these cells are subsequently reimplanted into the host defect and covered (periosteum, collagen patch). The ACI technique has been shown by many authors to result in improved clinical outcomes by facilitating the creation of a hyaline-like cartilage repair tissue. However, it has been demonstrated that defect fill can be variable, and that the procedure itself is technically demanding. Over the past few years, so called “second generation” ACI techniques have been available for clinical use in many parts of the world. These second generation techniques rely on the combination of autologous chondrocytes with absorbable scaffolds. It is believed that the addition of a stable matrix scaffold facilitates the creation of a more hyaline-like cartilage repair tissue. We describe, herein, such a technique. The Hyalograft C implant has been used to treat symptomatic cartilage defects at our institution for many years. This implant consists of autologous chondrocytes that are seeded on a hyaluronan-based scaffold. Implantation of the Hyalograft C scaffold simplifies the method by which autologous chondrocytes may be used to repair a cartilage defect. Moreover, we believe this is the first method by which autologous chondrocytes may be implanted using minimally invasive arthroscopic techniques. The Hyalograft C implant effectively treats symptomatic cartilage defects in a manner that is less morbid, simpler, and more predictable than first-generation ACI methods.