Common in my clinic now are discussions comparing cellular and acellular implants for chondral repair. I definitely started off with a bias towards cell based repair, for several reasons including a large experience with ACI (Carticel). However, all cell based methods prove to be (a) more expensive and (b) predicated on using the material based upon the order; that is you order it, you own it.
The virtue of an acellular product was demonstrated yet again this week when a potential patient for cartilage repair- and one with a very excellent pre-op MRI- proved NOT to require cartilage repair. Since the implant was returnable and has a long shelf life, no worries.
It may be far too simplistic to advise one product for all patients, but surely this is a consideration. When one combines the issues of cost and “returnability (or shelf life) “with efficacy over the long haul, we are certain to have to re-think how we best match a given implant to a given patient. the good news is that now in 2013 there are many more choices than just a few years ago, and clearly the field is advancing…although not always in a straight line!