Abstract
PURPOSE: Treating large cartilage lesions in the knee remains a challenge. While matrix-associated autologous chondrocyte implantation (MACI) is the gold standard for medium to large lesions, the minced cartilage technique has shown promise in smaller defects. Enhancing this technique with biomaterials has been suggested for larger lesions, but its effectiveness remains unclear due to limited data. This study aimed to evaluate the outcomes of the minced cartilage technique with autologous synovial flap coverage in large knee cartilage lesions and compare the results with MACI. METHODS: Twenty patients with large Grade III-IV cartilage defects (>6 cm²) at the knee were included. Ten patients underwent the autologous minced cartilage procedure (AutoCart™) with synovial flap (Group A), and ten received the MACI procedure (Group B). Clinical outcomes were assessed using the Tegner score, visual analog scale (VAS), the International Knee Documentation Committee (IKDC) forms, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). MRI evaluations were performed using the MOCART 2.0 score before surgery and 24 months postoperatively. RESULTS: Clinical scores significantly improved in Group A after surgery, while Group B showed improvement only in the VAS, pain, and sports/recreation levels. Postoperative MRI revealed similar results between groups, with Group A showing significantly better cartilage defect volume fill and fewer subchondral changes compared to Group B (p < 0.05). The mean MOCART 2.0 score at the final follow-up was 76.0 ± 15.4 for Group A and 65.6 ± 17.6 for Group B, though without statistical significance. CONCLUSION: The study suggests that the all-autologous minced cartilage technique with synovial flap is an effective treatment for large chondral lesions, yielding outcomes similar to or better compared to the MACI technique. LEVEL OF EVIDENCE: Level III.