Biologic principles of minced cartilage implantation: a narrative review

Abstract

Cartilage tissue has a very limited ability to regenerate. Symptomatic cartilage lesions are currently treated by various cartilage repair techniques. Multiple treatment techniques have been proposed in the last 30 years. Nevertheless, no single technique is accepted as a gold standard. Minced cartilage implantation is a newer technique that has garnered increasing attention. This procedure is attractive because it is autologous, can be performed in a single surgery, and is therefore given it is cost-effective. This narrative review provides an overview of the biological potential of current cartilage regenerative repair techniques with a focus on the translational evidence of minced cartilage implantation.

Keywords: Articular cartilage; Cartilage fragmentation; Cartilage regeneration; Chondron; Micronized cartilage; Minced cartilage implantation.

Fig. 1

(1) Schematic of a medial condylar cartilage defect, which could be addressed by autologous cartilage implantation (ACI) or minced cartilage implantation (MCI). (2) For MCI, cartilage is harvested by hand with a scalpel or arthroscopically with a shaver from the edge of the defect area or from a non-weight-bearing region (e.g., intercondylar notch). In an arthroscopic setting, cartilaginous particles are collected through a drainage and a sequentially arranged sieve. Harvested cartilage is processed either manually by usage of a scalpel, a commonly used shaver or manufactured mincing devices. (3) MCI can be performed by different techniques such as addition of fibrin, a combination of fibrin and a scaffold (collagen, proteoglycans or synthetic), or addition of platelet rich plasma (PRP)—each yielding different biological effects. While fibrin supports tissue integration and cell migration, PRP inhibits catabolic effects of chondral degradation. Scaffolds are claimed to support tissue integration and could theoretically be loaded with growth factors