Minced Autologous Chondral Fragments with Fibrin Glue as a Simple Promising One-Step Cartilage Repair Procedure: A Clinical and MRI Study at 12-Month Follow-Up

Abstract

Objective The aim of this study was to investigate early radiological and clinical outcome of autologous minced cartilage treatment as a single-step treatment option in patients with a chondral or osteochondral lesion (OCL) in the knee. Design Eighteen patients with an OCL in the knee were included. Cartilage from healthy-appearing loose bodies and/or the periphery of the defect were minced into small chips and sealed in the defect using fibrin glue. Preoperatively, and at 3 ( n = 14) and 12 ( n = 18) months follow-up, magnetic resonance imaging (MRI) was performed. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score was used to assess the cartilage repair tissue on MRI at 12 months. The International Knee Documentation Score, Knee Injury and Osteoarthritis Outcome Score, EuroQoL-5D, and Visual Analogue Scale pain were collected preoperatively and 12 months after surgery. Results Three months postoperative, MRI showed complete defect filling in 11 out of 14 patients. Mean MOCART 2.0 score at 12 months was 65.0 ± 18.9 with higher scores for lateral femoral chondral lesions compared to medial femoral chondral lesions (75.8 ± 14.3, 52.5 ± 15.8 respectively, P = 0.02). Clinical and statistical significant improvements were observed in the patient-reported outcome measures at 12 months postoperatively compared to preoperatively. Conclusion Treatment of OCLs using the autologous minced cartilage procedure resulted in good cartilage repair measured by MOCART 2.0. Clinically relevant improvements were observed in the clinical scores. This study suggests autologous minced cartilage as a promising, single-step treatment for OCLs.

Mincing bovine articular cartilage with commercially available shavers reduces the viability of chondrocytes compared to scalpel mincing

“…Even if the method was proven safe, the product is currently unavailable for clinical use. Three other clinical studies have shown promising results with improved clinical and radiological (MOCART) scores [ 5 , 16 , 25 ]. The clinical relevance of the present study becomes clear when the clinical studies are looked in detail.…”

“…However, it was not until two decades later that further studies on animal models were published [ 8 , 14 ]. Finally, the first clinical studies have been published, showing promising results in outcome scores [ 5 , 16 , 25 ]. Medical companies have recognized the potential of this method and are investing in standardized products such as shavers or cartilage harvesting devices.…”

Marrow stimulation procedures for high‐grade cartilage lesions during surgical repair of medial meniscus root tear yielded suboptimal outcomes, whilst small lesions showed surgical eligibility

“…Second, microfracture/microdrilling may not have been effective enough to overcome the existing degenerative changes in the knee. Although patients included in this study showed good cartilage restoration with a mean MOCART score of 65 [24, 39], it is assumed that the effect of such cartilage restoration did not last long. In fact, the mid‐to‐long‐term effects of MSP are known to be relatively limited [10].…”

Comparison of Minced Cartilage Implantation with Autologous Chondrocyte Transplantation in an In Vitro Inflammation Model

“…This pericellular matrix plays an important role in preserving joint homeostasis [ 10 , 11 ]. The initial clinical studies show a promising outcome of MCI at up to 2 years of follow-up [ 12 , 13 , 14 ] with limited evidence. Cartilage repair is performed in a majority (60%) of degenerative, non-traumatic defects (data from the German Society for Orthopaedics and Trauma cartilage registry) [ 15 ].…”