Cartilage restoration has flourished since the 1990s. The early pioneering work included cell therapy by Peterson, marrow stimulation by Johnson, osteochondral autograft treatments by Hangody, and osteochondral allografts by Gross. Since those early days, many scientists and clinicians have created "variations on a theme", markedly expanding the potential options for treating patients with symptomatic chondral lesions. Nevertheless, a variety of barriers exist between these new cartilage products and their clinical applications. These barriers may be categorized as cost, regulatory, insurance, and logistical issues. While absolute solutions will remain elusive, the current goal is to define these barriers as the first step toward solving these problems.
Keywords: ACI, autologous chondrocyte implantation; AMIC, autologous matrix-induced chondrogenesis; Cartilage; Cost; ICRS, International Cartilage Repair Society; Insurance; Logistics; MACI, matrix-induced autologous chondrocyte implantation; NICE, United Kingdom National Institute for Health and Care Excellence; QALY, quality-adjusted life year; RCTs, randomized controlled trials; Regulation.