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      Arthroscopic Minced Cartilage Implantation for Chondral Lesion at the Glenoid in the Shoulder: Technical Note

      brief-report
      , M.D. a , b , c , , , M.Sc. a , , M.D. d , , M.D. c , , M.D. a , c , , P.D., M.D. c , , M.D., Ph.D., M.Sc. a , b
      Arthroscopy Techniques
      Elsevier

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          Abstract

          Joint cartilage damage is a common condition, and various approaches exist to address these defects. Whenever conservative treatments have been exhausted or are inadequate, surgery should be taken into consideration. However, it is essential to consider the size of the damage as well as the subchondral bone involvement. As joint replacement is not an appropriate treatment for young people, a joint-preserving technique should be preferred. One option is minced cartilage implantation. This surgical procedure is appropriate for defects of around 2 cm 2. Studies demonstrated exceptional short-term and midterm outcomes in the knee and hip. This description of technique focuses on the implementation of AutoCart augmentation on the glenoid. The purpose of this note is to gain technical evidence of an all-arthroscopic cartilage implantation technique performed within the glenoid cavity.

          Technique Video

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          Most cited references16

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          The Benefit of Minced Cartilage Over Isolated Chondrocytes in Atelocollagen Gel on Chondrocyte Proliferation and Migration.

          Objective Autologous chondrocyte implantation is a necessary procedure for the repair of articular cartilage defects; however, isolated chondrocyte implantation requires a 2-step procedure (for harvesting and implantation) and is limited by cytotoxicity due to enzymatic digestion. Therefore, in this in vitro study, we evaluated the possible benefit of using minced cartilage embedded in a 3-dimensional culture scaffold and fixed with fibrin glue, in comparison with isolated chondrocytes in atelocollagen, to induce cell migration, proliferation, and matrix production, using cartilage from patients with knee joint osteoarthritis. Design Cartilage fragments were obtained from 7 female patients with knee osteoarthritis (OA) and embedded in atelocollagen gels. As a control, chondrocytes were isolated and embedded in gels in the same manner. These composites were cultured for 3 weeks, and cell proliferation and matrix production were evaluated using histology and immunochemistry. Results Histologically, minced cartilage showed cell migration from the cartilage fragments into the gel, with the Bern score and cell count in the minced cartilage group being significantly higher than those in the control group. Immunohistochemistry revealed that the number of Ki67-positive cells, the expression of LECT-1 and TGF-β, and the glycosaminoglycan content were significantly higher in the minced cartilage than in the control group. Minced cartilage exhibited superior cell migration, proliferation, and glycosaminoglycan content than isolated chondrocytes. Conclusion Our findings support that minced cartilage has a favorable potential for cell proliferation and matrix production compared with the isolated chondrocytes after enzymatic treatment.
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            Arthroscopic Minced Cartilage Implantation (MCI): A Technical Note

            Articular cartilage lesions are identified with increasing frequency. Several cartilage repair techniques are available to treat symptomatic cartilage defects. The ultimate goal of any cartilage repair procedure is the prevention of premature osteoarthritis. Autologous chondrocyte implantation provides the best tissue quality. However, 2 operations and a resource-intense culturing process with high regulatory demands are disadvantages of this cartilage repair procedure. Furthermore, cellular dedifferentiation and senescence display further cell culture-associated drawbacks that hamper the procedure. Minced cartilage implantation is a relatively simple and cost-effective one-step procedure with promising biologic potential and satisfying clinical results. We present an arthroscopic surgical technique where the surgeon can apply autologous chondrocytes in a one-step procedure to treat articular cartilage defects at the knee joint.
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              Arthroscopic Minced Cartilage Implantation for Chondral Lesions at the Talus: A Technical Note

              In the past few years, autologous chondrocyte implantation has been shown to be the most suitable cartilage reconstructive technique with the best tissue quality. Although this method is part of the standard surgical repertoire in the knee joint, it has so far not been an established method in the ankle because there are no prospective randomized controlled studies to prove a significant advantage over alternative methods of cartilage repair. The methods most frequently used in this context (e.g., marrow stimulation techniques) can, however, at most generate hyaline-like and thus biomechanically inferior regenerates. Minced cartilage implantation, on the other hand, is a relatively simple and cost-effective 1-step procedure with promising biological potential and—at least in the knee joint—satisfactory clinical results. We present an arthroscopic surgical technique by which the surgeon can apply autologous chondrocytes in a 1-step procedure (AutoCart; Arthrex, Munich, Germany) to treat articular cartilage defects in the ankle joint. Video 1 Patient history and sagittal magnetic resonance imaging of ankle (20 seconds). Arthroscopy of ankle showing cartilage defect of lateral talar shoulder (30 seconds). Workflow of minced cartilage implantation procedure (49 seconds). Preparation (58 seconds). Autologous conditioned plasma (ACP)–platelet-rich plasma (PRP) production (1 minute 14 seconds). Defect preparation and cartilage harvesting (2 minutes 25 seconds). Necessary parts of technique (3 minutes 8 seconds). Defect filling and transplant fixation (4 minutes 33 seconds).

                Author and article information

                Contributors
                Journal
                Arthrosc Tech
                Arthrosc Tech
                Arthroscopy Techniques
                Elsevier
                2212-6287
                10 September 2024
                February 2025
                10 September 2024
                : 14
                : 2
                : 103218
                Affiliations
                [a ]Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
                [b ]Medical Faculty, Johannes Kepler University Linz, Linz, Austria
                [c ]Department of Orthopaedics and Traumatology, Klinik Diakonissen Schladming, Schladming, Austria
                [d ]Department of Orthopaedic Surgery, Universitätsklinik Balgrist, Zürich, Switzerland
                Author notes
                []Address correspondence to Martin Bischofreiter, M.D., Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, 4010 Linz, Austria. martin.bischofreiter@ 123456ordensklinikum.at
                Article
                S2212-6287(24)00358-X 103218
                10.1016/j.eats.2024.103218
                11873457
                40041364
                079224b7-3437-46b8-afd5-a7f729c64804
                © 2024 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 28 April 2024
                : 18 July 2024
                Categories
                Technical Note
                Shoulder

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