Autologous minced cartilage implantation in osteochondral lesions of the talus-does fibrin make the difference?

Introduction: Implantation of minced cartilage is a one-step-procedure that leads to satisfactory results in osteochondral defects.

Material And Methods: 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).

Results: 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).

Conclusions: 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.