Minced Cartilage Transplantation Demonstrated Improved Cartilage Repair Healing Compared to Bone Marrow Aspirate Concentrate on Hyaluronic Acid (HA-BMAC) for Full-Thickness Knee Cartilage Lesions: Clinical And Biological Outcomes in a Matched Cohort

PurposeTo compare the clinical and biological outcomes of minced autologous cartilage transplantation versus hyaluronic acid-based scaffold with bone marrow aspirate concentrate (HA-BMAC) in the treatment of full-thickness cartilage lesions of the knee.MethodsA total of 41 patients treated with minced autologous cartilage transplantation were retrospectively analyzed. Using propensity score matching, a control group of 41 patients was selected from a large cohort treated with HA-BMAC-based cartilage repair. Minced cartilage was harvested from unloaded cartilage and fibrin-glued into the defect. Bone marrow aspirate concentrate (BMAC) was obtained from the iliac crest, centrifuge concentrated, and seeded onto a hyaluronic acid scaffold. Clinical outcomes were assessed using the Knee Injury Outcome Score (KOOS) score. Magnetic resonance imaging (MRI) evaluations were performed preoperatively with AMADEUS score and at 1-year follow-up using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART)-2 score.ResultsThe groups were comparable in terms of age, sex, lesion size, and location. Significant improvements were observed in all KOOS subscales in both cartilage repair groups, with no statistical difference between them at 1-year follow-up. MOCART-2 scores showed a trend toward superior biological healing in the minced cartilage group (mean score: 77) compared to the BMAC group (mean score: 73). Excellent healing (MOCART >80) was observed in 51% of minced cartilage cases versus 38% of BMAC cases.ConclusionBoth minced cartilage transplantation and HA-BMAC treatments resulted in comparable subjective clinical outcomes. However, minced cartilage transplantation demonstrated a tendency for enhanced biological healing based on MRI compared to HA-BMAC. This suggests potential advantages of minced cartilage transplantation over HA-BMAC cartilage repair.