[Autologous minced cartilage implantation for focal cartilage lesions of the humeral capitellum].

OBJECTIVE: The goal of minced cartilage implantation (MCI) is to restore an intact cartilage surface in focal osteochondral lesions of the humeral capitellum.

INDICATIONS: The indications for MCI are limited osteochondral lesions at the humeral capitellum, also at the head of the radius, with intact cartilage border as well as in situ or a completely detached fragment, and free joint bodies (grade II-grade V according to Hefti).

CONTRAINDICATIONS: Contraindications for MCI are already concomitant or associated cartilage damage as well as bilateral osteochondral lesions and insufficient available cartilage material.

SURGICAL TECHNIQUE: After diagnostic arthroscopy to detect possible concomitant pathologies and to exclude already corresponding cartilage lesions, the arthroscope is flipped posterolaterally over the high posterolateral portal and a second portal is created under visualization via the soft spot. Initially, debridement of the focal cartilage defect, assessment of the marginal zone, and/or salvage of free joint bodies. Using a smooth shaver and the filter provided, the partially or even completely detached cartilage fragment is unidirectionally fragmented under continuous suction. The remaining defect with a stable marginal zone is cleanly curetted, and the joint is completely dried. The fragmented cartilage collected in the filter is bonded to a membrane using autologous conditioned plasma (ACP) and then arthroscopically applied to the defect via a cannula, sealed using thrombin and fibrin.

POSTOPERATIVE MANAGEMENT: Postoperative immobilization in a cast for at least 24 h is required. Afterwards, free exercise of the joint is possible, but no loading should be maintained for 6 weeks. Return to sport after 3 months.

RESULTS: Good to very good clinical and MRI morphologic results are already evident in the short-term course. Prospective and retrospective multicenter studies are needed to evaluate future long-term results.