Chondral cartilage lesions do not heal spontaneously and may progress to severe osteoarthritis. For cartilage repair, a variety of surgical techniques have been established over the years. Further research led to the development of current new one-step cell-free scaffold-assisted cartilage repair approaches based on the experience with scaffold materials in previous two-step autologous chondrocyte implantation procedures. Commercially available scaffold-based products for one-step chondral cartilage repair have been recently tested in first case series and showed promising clinical outcome in the short-term follow-up; however, medium- and long-term comparative studies are necessary to evaluate the regenerative potential of this new one-step cartilage repair procedure and to demonstrate its superiority over or adequacy to traditional approaches.
This critical review summarises the development from two-step cell-based autologous chondrocyte implantation procedures to new onestep cell-free cartilage repair and discusses the first clinical outcome of commercially available cell-free implants. This new approach, based on the principle of cell ingrowths and guidance towards tissue repair, showed promising first clinical results and is considered as an effective and safe treatment option for chondral cartilage repair.