Tissue engineering in orthopaedic surgery--clinical effectiveness and cost effectiveness of autologous chondrocyte transplantation

Tissue engineering applications are spreading in orthopaedic surgery. The best known example is autologous chondrocyte transplantation (ACT). The objective of this work is to compare ACT with alternative treatment options concerning long-term effects and cost-effectiveness. Data on clinical effectiveness, long-term effects, and cost-effectiveness are systematically reviewed. Due to the high clinical and statistical heterogeneity between studies a descriptive analysis has been done. 6 randomised controlled studies have assessed the effectiveness of ACT compared with microfrature or mosaic plasty. 4 studies report on no or only insignificant differences - one recently presented 5-year results - whereas 2 studies observed better results with ACT. Long-term results are good throughout, but the high quality of the regenerative tissue is a clear advantage of ACT. Cost-effectiveness models support ACT for the longevity of its results and thus relatively lower costs in the long-term. ACT is an expensive and complex procedure. In direct comparison with alternative treatments ACT produces results at least as good in the short-term, and most likely better in the long-term due to the high quality repair tissue. Thus higher initial costs are compensated for with time.