Minced cartilage graft procedure (Autocart)

What is minced cartilage graft procedure?

It is a surgical technique is for the treatment of symptomatic articular cartilage defects. It is also called Autocart, where the hyaline cartilage cells from the non-weight bearing areas of the same person’s knee are used to fill up circumscribed defects on the femoral condyles (the bone on the upper aspect of the knee) or under the patella (knee cap).

Autocart

The AutoCart surgical technique uses the patient’s own cells to create a high-quality scaffold for cartilage repair, in combination with the Thrombinator system to rapidly enhance the clotting cascade and produce a thrombin clot to seal the AutoCart graft into the defect, optimizing biologic potential.

Who is an ideal candidate for autocart?

The ideal person who can benefit from an MCG (Minced Cartilage Graft) or autocart procedure is which a 1. Circumscribed cartilage loss over the medial femoral condyle, or patella, Humeral head or glenoid of the shoulder joint or talus. It will not be useful for diffuse cartilage loss as seen in advanced osteoarthritis of the knee

2. Young arthritic knee – Satisfactory results with cartilage regenerative procedures are seen in person under 55 years

3. No mal-alignment of the limb. This has to be carefully studied in a hip-knee-ankle standing weigh bearing long limb xray. Any overloading of a particular compartment will eventually accelerate failure of cartilage regenerative procedure.

It is contra-indicated in the following conditions :

1. Inflammatory arthritis
2. Diffuse cartilage loss in a joint
3. Kissing lesions (cartilage loss on both the articulating surfaces of a joint)
4. Mal-alignment of the limb.

How is Autocart superior to microfracturing ?

The cartilage cells that form in the defect after autocart are near normal Hyaline cartilage. This type of cells are resilient to weight bearing and matures over time.

The tissue which form after microfracture are fibrous cells, which are not as as resilient to stress and eventually break down over a period of 5-8 years.

Results

Compared to microfracture alone, single-stage autograft cartilage implantation provides superior patient outcomes and fewer negative outcomes associated with osteophyte formation.¹ Additionally, the AutoCart procedure has shown a low reoperation rate and satisfactory patient-reported outcomes at 2 years.

Patient file

27 year old female Indian health care insurance office work in the United states. Came for a knee injury while playing tennis 1 month earlier. The knee was locked, preventing full extension. Effusion was present. Clinical examination revealed Lax Lachman test indicating ACL tear. MRI scan showed ACL injury with meniscus tear and a 15 x 12 mm sized circumscribed cartilage loss over the medial femoral condyle

Arthroscopy videos showing the cartilage lesion

MRI scan Before and After Arthroscopic MCG (Autocart) surgery

Clinical results after MSG (Autocart) procedure

Useful links >>

https://www.jointpreservation.arthrex.com/autocart-procedure#articles

References

1. Kulwin R, Watson TS, Rigby R, Coetzee JC, Vora A. Traditional modified Broström vs suture tape ligament augmentation. Foot Ankle Int. 2021;42(5):554-561. doi:10.1177/1071100720976071
2. Laflamme M, Belzile EL, Bédard L, van den Bekerom MP, Glazebrook M, Pelet S. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma. 2015;29(5):216-223. doi:10.1097/BOT.0000000000000245
3. Shimozono Y, Hurley ET, Myerson CL, Murawski CD, Kennedy JG. Suture button versus syndesmotic screw for syndesmosis injuries: a meta-analysis of randomized controlled trials. Am J Sports Med. 2019;47(11):2764-2771. doi:10.1177/0363546518804804
4. Andersen MR, Frihagen F, Hellund JC, Madsen JE, Figved W. Randomized trial comparing suture button with single syndesmotic screw for syndesmosis injury. J Bone Joint Surg Am. 2018;100(1):2-12. doi:10.2106/JBJS.16.01011