Autologous minced cartilage implantation for focal cartilage lesions of the humeral capitellum

• Published in: Operative Orthopädie und Traumatologie 2024-08, Vol.36 (3-4), p.188
• Main Authors: Ott, Nadine, Hackl, Michael, Müller, Lars Peter, Leschinger, Tim
• Format: Article
• Language: ger
• Subjects: Adult; Arthroscopy - methods; Cartilage, Articular - diagnostic imaging; Cartilage, Articular - surgery; Elbow Injuries; Elbow Joint - diagnostic imaging; Elbow Joint - surgery; Female; Humans; Humerus - diagnostic imaging; Humerus - surgery; Male; Middle Aged; Treatment Outcome
• ISSN: 1439-0981; 1439-0981
• DOI: 10.1007/s00064-024-00849-7

The goal of minced cartilage implantation (MCI) is to restore an intact cartilage surface in focal osteochondral lesions of the humeral capitellum. The indications for MCI are limited osteochondral lesions at the humeral capitellum, also at the head of the radius, with intact cartilage border as well as in situ or a completely detached fragment, and free joint bodies (grade II-grade V according to Hefti). Contraindications for MCI are already concomitant or associated cartilage damage as well as bilateral osteochondral lesions and insufficient available cartilage material. After diagnostic arthroscopy to detect possible concomitant pathologies and to exclude already corresponding cartilage lesions, the arthroscope is flipped posterolaterally over the high posterolateral portal and a second portal is created under visualization via the soft spot. Initially, debridement of the focal cartilage defect, assessment of the marginal zone, and/or salvage of free joint bodies. Using a smooth shaver and the filter provided, the partially or even completely detached cartilage fragment is unidirectionally fragmented under continuous suction. The remaining defect with a stable marginal zone is cleanly curetted, and the joint is completely dried. The fragmented cartilage collected in the filter is bonded to a membrane using autologous conditioned plasma (ACP) and then arthroscopically applied to the defect via a cannula, sealed using thrombin and fibrin. Postoperative immobilization in a cast for at least 24 h is required. Afterwards, free exercise of the joint is possible, but no loading should be maintained for 6 weeks. Return to sport after 3 months. Good to very good clinical and MRI morphologic results are already evident in the short-term course. Prospective and retrospective multicenter studies are needed to evaluate future long-term results.