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Objectives and questions: Autologous chondrocyte implantation (ACI) using spheroids of human autologous matrix-associated chondrocytes is an established treatment for focal cartilage defects, but evidence for its use in the hip remains limited. For CAM-type femoroacetabular impingement (CAM-FAI), acetabular cartilage lesions can also be managed with bone-marrow–stimulated debridement (BMSD). This study compared the clinical and radiological outcomes of ACI with chondrosphere implantation versus BMSD for the treatment of CAM-FAI–related acetabular cartilage defects.

Material and methods: This matched-pair study retrospectively identified adult patients treated with either ACI using spheroids of autologous matrix-associated chondrocytes (CO.DON AG) or BMSD for CAM-FAI–associated acetabular cartilage defects and prospectively evaluated them at a follow-up ≥2 years post-treatment. A 1:1 matched-pair design was applied using strict matching criteria. Clinical outcomes included iHOT-33, mHHS, HOOS, and VAS pain. Radiological outcomes were assessed by MRI using the MOCART score. Descriptive and matched-pair statistical analyses were performed.

Results: A total of 31 (5/31 females) matched patient pairs (62 patients) were included in the analysis. The mean age at treatment was 34 ± 10 years in the ACI group and 35 ± 12 years in the BMSD group, and the mean follow-up interval was 7.8 ± 1.8 and 8.2 ± 1.7 years, respectively. Mean defect size measured 5.1 ± 0.9 cm² in the ACI group and 4.2 ± 1.3 cm² in the BMSD group. iHOT-33, mHHS, HOOS, and VAS pain scores did not differ statistically between ACI and BMSD. MRI evaluation indicated superior cartilage repair quality after ACI. MOCART scores were 80 ± 15 for ACI and 50 ± 15 for BMSD (p < 0.001).

Discussion and conclusions: ACI and BMSD resulted in comparable clinical outcomes, but MRI findings indicated superior cartilage repair quality after ACI. These results suggest a potential structural advantage of ACI, warranting longitudinal studies to evaluate its impact on cartilage preservation and osteoarthritis progression.