Kühle Jan, Wagner Ferdinand C, Beck Samuel, Klein Lukas, Bode Lisa, Izadpanah Kaywan, Schmal Hagen, Mühlenfeld Nils
University Medical Center Freiburg, Freiburg, Germany.
Odense University Hospital, Odense, Denmark.
Arch Orthop Trauma Surg. 2025 Jan 25;145(1):144. doi: 10.1007/s00402-025-05762-7.
Implantation of minced cartilage is a one-step-procedure that leads to satisfactory results in osteochondral defects.
A retrospective review was performed on a consecutive cohort of patients that received minced cartilage with fibrin (MCF), minced cartilage with membrane and fibrin (MCMF) and minced cartilage with the "AutoCart"-procedure (MCAC) between January 2019 and December 2023. Radiological outcome parameters were evaluated via Magnet-Resonance-Tomography (MRI) within one year using Ankle-Osteoarthritis-Scoring-System (AOSS).
Final data included 25 patients: 13 women and 12 men with a mean age of 28.2 years ± 10.9(range:18-51). Mean defect size was 103.6mm ± 59.0(95% CI = 79.2-128.0), mean depth 5.2 mm ± 3.6(3.7-6.6). Differences between groups in defect sizes were not significant (p = 0.999). MCF was carried out in 9(36.0%), MCMF in 7(28.0%) and MCAC in 9(36.0%) patients. Mean postoperative AOSS values were 2.6 ± 1.9(95%CI:1.1-4.1) for MCF-patients, 3.3 ± 2.9(0.6-5.9) for MCMF patients and 3.9 ± 2.8(1.7-6.1) for MCAC-patients, respectively. Differences were not significant (p = 0.639). Revision surgery because of symptomatic non-integration of the graft or ventral impingement occurred in 5(20%) of cases - all part of MCAC-patients that did not receive additional fibrin fixation as the top layer of transplant (p < 0.05).
Autologous minced cartilage implantation seems to be sufficient as a viable, one-step treatment for osteochondral lesions of the talus. It leads to low complication rates and excellent AOSS values within a 12-month period whereas the application of fibrin as the last fixation layer seems to be advisory, which demands further investigation.
植入切碎的软骨是一种一步法手术，可在距骨软骨缺损中取得满意的效果。
对2019年1月至2023年12月期间连续接受纤维蛋白切碎软骨（MCF）、膜和纤维蛋白切碎软骨（MCMF）以及“自动软骨”手术（MCAC）的患者队列进行回顾性研究。在一年内通过磁共振断层扫描（MRI）使用踝关节骨关节炎评分系统（AOSS）评估放射学结果参数。
最终数据包括25例患者：13名女性和12名男性，平均年龄28.2岁±10.9岁（范围：18 - 51岁）。平均缺损大小为103.6mm±59.0（95%CI = 79.2 - 128.0），平均深度5.2mm±3.6（3.7 - 6.6）。各组间缺损大小差异无统计学意义（p = 0.999）。9例（36.0%）患者接受了MCF，7例（28.0%）接受了MCMF，9例（36.0%）接受了MCAC。MCF患者术后平均AOSS值为2.6±1.9（95%CI：1.1 - 4.1），MCMF患者为3.3±2.9（0.6 - 5.9），MCAC患者为3.9±2.8（1.7 - 6.1），差异无统计学意义（p = 0.639）。5例（20%）病例因移植物症状性未融合或腹侧撞击而进行了翻修手术——所有这些病例均为未接受额外纤维蛋白固定作为移植顶层的MCAC患者（p < 0.05）。
自体切碎软骨植入作为距骨软骨损伤的一种可行的一步治疗方法似乎是足够的。它在12个月内导致低并发症发生率和优异的AOSS值，而应用纤维蛋白作为最后的固定层似乎是可取的，这需要进一步研究。
