Articular (chondral) cartilage is a thin layer of connective tissue. A damage of the cartilage can occur due to traumatic events, degeneration of the joint or due to osteochondritis dissecans. In this report, we analysed whether single-step/two-step scaffold-based cartilage repair (AMIC/MACI) is more effective and safer in comparison to microfracturing (MFx) or as effective but safer in comparison to autologous chondrocyte implantation.

In total, for the knee joint data from six controlled trials for AMIC and five randomised controlled trials for MACI that met our inclusion criteria were extracted. No controlled trials for the ankle joint were identified. Overall, the level of evidence was rated as "very low" to "low" for the outcomes of clinical effectiveness and safety. The current evidence is not sufficient to conclude that AMIC or MACI is more effective and safer than MFx or as effective, but safer than ACI.

We currently do not recommend the inclusion of the procedures in the Austrian hospital benefit catalogue. A re-evaluation of AMIC is recommended not before 2022 and of MACI not before 2021, as the publication of ongoing RCTs is to be awaited.