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

Felix Kurt Massen, Cyril Raphael Inauen, Laurent Pascale Harder, Armin Runer, Stefan Preiss, Gian Max Salzmann, Felix Kurt Massen, Cyril Raphael Inauen, Laurent Pascale Harder, Armin Runer, Stefan Preiss, Gian Max Salzmann

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 cm2. 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.

Keywords: articular cartilage; articular cartilage resurfacing; cartilage lesion; chondral lesion; knee; minced cartilage.

Conflict of interest statement

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Intraoperative images of an exemplary case at the medial femoral condyle treated with the autologous minced cartilage procedure. (A) Cartilage lesion after debridement. (B) Minced cartilage chips after fibrin glue fixation within the defect. (C) Final result after (optional) coverage with the Chondro-Gide membrane.
Figure 2.
Figure 2.
Mean numeric analog scale (NAS) scores for subjective pain and function preoperatively and at 1- and 2-year follow-up. Pain: 0 = no pain, 10 = worst imaginable pain. Function: 0 = normal function, 10 = no function. Error bars indicate standard deviations. ***P < .001, difference compared to preoperatively.
Figure 3.
Figure 3.
Comparison of preoperative AMADEUS (Area Measurement and Depth and Underlying Structures) score and postoperative MOCART (magnetic resonance observation of cartilage repair tissue) score. AMADEUS: 0 = most severe cartilage defect, 100 = no cartilage defect. MOCART: 0 = poor/no repair tissue, 100 = optimal repair tissue. Error bars indicate standard deviations.

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