Abstract
Background: Minced Cartilage is increasingly used for treating focal acetabular and femoral cartilage defects. In this procedure, autologous cartilage is harvested from the femoral neck or from the chondral flap, minced into small pieces and re-implanted into the defect. The question is whether minced cartilage is already a standardized procedure. Methods: A systematic literature review was conducted in PubMed, Embase, and Google Scholar to include all studies (clinical trials, animal studies and basic research) investigating minced cartilage for the treatment of focal cartilage defects. Subsequently, the following surgical methods were compared: cartilage harvesting, cartilage mincing, cartilage fixation, cartilage coverage using matrices, and augmentation with autologous blood products. The aim of this systematic review is to identify which surgical method has the most evidence. Results: After applying the selection criteria, the following studies were included: 6 clinical trials, 8 animal studies, and 11 studies of basic research. Only one clinical study investigated the outcome of minced cartilage for acetabular cartilage defects, while all the other studies investigated cartilage from the knee joint. Among the 6 clinical trials, one was a randomized controlled trial (minced cartilage versus microfracture), while the other 5 studies were case series with a maximum of 28 included patients. In 3 studies, a matrix was used for defect coverage. In one study, cartilage was additionally augmented with autologous blood products. All studies used fibrin glue or autologous thrombin to seal the implanted cartilage. Cartilage harvesting and mincing were the same in 5 clinical trials (Shaver (2), Scalpel (3)). In one clinical trial, cartilage was harvested using a trephine and minced with surgical scissors (no animal studies or basic research available). The harvesting and mincing of cartilage using a scalpel are currently most scientifically investigated: 3 clinical trials, 7 animal studies, 10 studies from basic research. The harvesting and mincing of cartilage using a shaver are increasingly being studied scientifically (3 studies published since 2023). So far, there are 2 clinical trials, 1 animal study, and 2 studies from basic research. Conclusion: A standardized approach of the minced cartilage procedure has not yet emerged. There are differences in the method of cartilage mincing, cartilage fixation, cartilage coverage using matrices, and augmentation with autologous blood products. Scalpel mincing has been most thoroughly researched so far, although recent studies are increasingly investigating shaver mincing.