BlueCross BlueShield of Tennessee Medical Policy Manual

Autologous Chondrocyte Implantation


Autologous chondrocyte implantation (ACI) is a form of tissue engineering that creates a graft from an individual’s own cartilage cells to repair defects in articular cartilage. The procedure involves surgical removal of a small piece of articular cartilage, harvesting of cells from the cartilage, growth of these cells in a specialized laboratory, and implanting the cultured cells over the cartilage lesion, with the goal of restoring resilient, durable cartilage at the site of injury.

Methods to improve the first-generation autologous chondrocyte implantation procedure include the use of a scaffold or matrix. There is currently one FDA approved matrix-induced autologous chondrocyte implantation product. In 2016, MACI® (matrix-induced autologous chondrocyte implantation [ACI]; Vericel Corporation) received FDA approval for the repair of symptomatic, full-thickness cartilage defects of the knee in adults. MACI is composed of biocompatible carbohydrates, protein polymers, or synthetics and is supplied in a sheet cut to size and fixed with fibrin glue. This procedure is considered technically easier and less time-consuming than the first-generation technique, which required suturing of a periosteal or collagen patch and injection of chondrocytes under the patch. The first-generation product, Carticel, is being phased out.





Well-designed, randomized, controlled trials with long-term follow-up are not available to determine long-term benefits of ACI for other conditions/diseases.


American Academy of Orthopaedic Surgeons. (2010, December). The diagnosis and treatment of osteochondritis dissecans: guideline and evidence report. Retrieved October 26, 2018

Basad, E., Wissing, F., Fehrenbach, P., Rickert, M., Steinmeyer, J., & Ishaque, B. (2015). Matrix-induced autologous chondrocyte implantation (MACI) in the knee: clinical outcomes and challenges. Knee Surgery, Sports Traumatology, Arthroscopy, 23 (12), 3729-3735. Abstract retrieved April 21, 2017 from PubMed database.

BlueCross BlueShield Association. Evidence Positioning System. (5:2020). Autologous chondrocyte implantation for focal articular cartilage lesions (7.01.48). Retrieved November 3, 2020 from (44 articles and/or guidelines reviewed)

Ebert, J., Smith, A., Fallon, M., Buitler, R., Nairn, R., Breidahl, W., & Wood, D. (2015). Incidence, degree and development of graft hypertrophy 24 months after matrix-induced autologous chondrocyte implantation: association with clinical outcomes. American Journal of Sports Medicine, 43 (9), 2208-2215. Abstract retrieved April 21, 2017 from PubMed database.

Guo, G.H., Tseng, F.J., Wang, S.H., Chen, P.J, Shyu, J.F., Weng, C.F., et al. (2020). Autologous chondrocyte implantation versus microfracture in the knee: A meta-analysis and systematic review. The Journal of Arthroscopic and Related Surgery, 36 (1), 289-303. (Level 2 evidence)

Li, Z., Zhu, T., & Fan, W. (2016). Osteochondral autograft transplantation or autologous chondrocyte implantation for large cartilage defects of the knee: a meta-analysis. Cell Tissue Bank, 17 (1), 59-67. Abstract retrieved October 3, 2016 from PubMed database.

Micheli, L., Moseley, B., Anderson, A., Browne, J., Erggelet, C., Arciero,R., et al. (2006). Articular cartilage defects of the distal femur in children and adolescents: treatment with autologous chondrocyte implantation. Journal of Pediatric Orthopedics, 26 (4), 455-460. (Level 4 evidence)

National Institute for Health and Clinical Excellence (NICE). (2017, October). Autologous chondrocyte implantation for the treating symptomatic articular cartilage defects of the knee.  Retrieved February 11, 2020 from

Niemeyer, P., Albrecht, D., Andereya, S., Angele, P., Ateschrang, A., Aurich, M., et al. (2016). Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: a guideline by the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Trauma (DGOU). The Knee, 426-435. (Level 2 evidence)

Oussedik, S., Tsitskaris, K., & Parker, D. (2015). Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy, 31 (4), 732-744. Abstract retrieved September 30, 2016 from PubMed database.

Riboh, J., Cvetanovich, G., Cole, B., & Yanke, A. (2016). Comparative efficacy of cartilage repair procedures in the knee: a network meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 25 (12), 3786-3799.  Abstract retrieved September 30, 2016 from PubMed database.

U. S. Food and Drug Administration. Vaccines, Blood & Biologics. 2016 Biological License Application Approvals. MACI. Retrieved April 21, 2017 from

Winifred S. Hayes, Inc. Medical Technology Directory. (2017, July; last reviewed August 2019). Comparative effectiveness review of first-generation autologous chondrocyte implantation. Retrieved February 11, 2020 from (82 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2017, July; last reviewed September 2019). Comparative effectiveness review of second- and third- generation autologous chondrocyte implantation. Retrieved May 11, 2018 from (84 articles and/or guidelines reviewed)




Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.