Is autologous chondrocyte implantation (ACI) an adequate treatment option for repair of cartilage defects in paediatric patients?

•ACI seems beneficial over other cartilage repair methods in long-term outcome.•ACI has already been successfully applied in juvenile patients.•ACI seems eligible for paediatric patients, particularly for large lesions >4 cm2.•Prospective and retrospective data are essential for risk–benefit evaluation of ACI.•The quality of reporting outcome of ACI in paediatric patients needs improvement.

Cartilage lesions in the knee of juvenile patients require an effective repair to regain life-long functional activity of the joint. Autologous chondrocyte implantation (ACI) is discussed to be advantageous over other methods for cartilage repair regarding long-term outcome. ACI has successfully been applied in juvenile patients, although currently recommended for patients ≥18 years of age. Only few controlled clinical trials present evidence of efficacy and safety of ACI in adolescent patients. ACI products have to undergo the process of a marketing authorisation application, including the submission of a paediatric investigation plan (PIP). Data from prospective clinical studies or retrospective collection of long-term data in paediatric patients should be submitted for risk–benefit evaluation by the Paediatric Committee (PDCO).