One-Step Autologous Minced Cartilage Procedure for the Treatment of Knee Joint Chondral and Osteochondral Lesions: A Series of 27 Patients With 2-Year Follow-up

Abstract

Background: Chondral and osteochondral lesions are being detected with increasing frequency. For large-diameter lesions, cell-based treatment modalities are speculated to result in the best possible outcome. Purpose: To prospectively evaluate the 2-year clinical and radiological results after the treatment of chondral and osteochondral knee joint lesions by a single-step autologous minced cartilage procedure. Study Design: Case series; Level of evidence, 4. Methods: From February 2015 to June 2016, a total of 27 consecutive patients suffering from chondral or osteochondral lesions of the knee joint were treated using a single-step autologous minced cartilage procedure. All patients underwent preoperative and postoperative magnetic resonance imaging for the collection of AMADEUS (Area Measurement and Depth and Underlying Structures) and MOCART (magnetic resonance observation of cartilage repair tissue) scores. Clinical analysis was conducted by a numeric analog scale (NAS) for pain and knee function before the intervention and at 12 and 24 months postoperatively. Results: A total of 12 female and 15 male patients (mean age, 28.7 years) were evaluated for a mean of 28.2 ± 3.8 months. The mean cartilage defect size encountered intraoperatively was 3.1 ± 1.6 cm 2 . There was a significant decrease in pain from 7.2 ± 1.9 preoperatively to 1.8 ± 1.6 ( P < .001) at 2-year follow-up. Knee function improved from a mean of 7.2 ± 2.0 preoperatively to 2.1 ± 2.3 ( P < .001) at 2 years after surgery. The mean preoperative AMADEUS score was 57.4 ± 21.4. Postoperatively, the mean MOCART score was 40.6 ± 21.1 at 6-month follow-up. No correlation was observed between the clinical data and the MOCART or AMADEUS scores. Conclusion: Overall, the findings of this study demonstrated that patients undergoing a single-step autologous minced cartilage procedure had a satisfactory outcome at 2-year follow-up. As a result, the single-step autologous minced cartilage procedure does represent a possible alternative to standard autologous chondrocyte implantation. Longer follow-up and larger cohorts are required to define the benefits of this procedure.

Arthroscopic Minced Cartilage Implantation (MCI): A Technical Note

“… 23 Massen et al. 6 reported in a 2-year follow-up of second-generation MCI significant decrease in pain and improvement of knee function. However, clinical trials in a direct comparison with other cartilage repair methods are still required.…”

“… 22 and Massen et al. 6 described the use of scalpels to particulate the collected cartilage. However, the procedure is time consuming and results in a heterogenous and more block-like appearing particulation.…”

Osteochondral autograft transplantation versus autologous bone-cartilage paste grafting for the treatment of knee osteochondritis dissecans

“…Larger studies at longer follow-ups are needed, including also different surgical techniques to restore the articular surface and the osteochondral unit in patients affected by OCD, in order to understand the best surgical option to treat these young patients. More recently, other techniques based on autologous minced or particulated cartilage have been described [36][37][38] demonstrating the interest toward this autologous and low-cost treatment option. Nevertheless, while these approaches take advantage of the combination of biologics through the augmentation with other products such as fibrin glue, platelet-rich plasma, etc., only one study analysed the early results of eight patients affected by OCD lesions treated with autologous dual-tissue transplantation [38].…”

Surgical Fixation of Chondral-Only Fragments of the Knee: A Case Series With a Mean 4-Year Follow-up

“…Both minced autograft cartilage and particulated juvenile cartilage have been used successfully to fill cartilage lesions with “hyaline-like cartilage.” 10 , 17 , 18 , 41 , 42 Preclinical and clinical studies have demonstrated the ability of surface chondrocytes to escape from their lacunae, migrate, multiply, and form a cartilage extracellular matrix. 3 , 7 , 28 , 31 In both techniques, there is basilar integration of new hyaline-like cartilage to bone. This suggests a possible inherent ability of cartilage-to-bone healing.…”