Hand-minced cartilage versus microfracture for the repair of articular cartilage defects: A propensity score matched-pair analysis with 2-year follow-up.

Objective: First-time evaluation and comparison of clinical and functional short-term outcomes and revision rates between single-stage autologous hand-minced cartilage (MC) and microfracture (MFX) for knee cartilage lesions.

Methods: All patients undergoing MC or MFX (2015-2021) at a single centre were retrospectively analysed from a prospectively maintained database. Propensity score matching was used for gender, age, body mass index (BMI), defect localization (patellofemoral, tibiofemoral), American Society of Anesthesiologists (ASA) classification and baseline Core Outcome Measures Index (COMI). Included were knee cartilage lesions regardless of size or concomitant procedures, with 2-year follow-up. COMI and subjective International Knee Documentation Committee (sIKDC) scores were assessed preoperatively and 6, 12 and 24 months postoperatively. Postoperative complications and revision surgeries were recorded.

Results: Thirty patients each were included in the MC (female: 11, age: 32 ± 10, body mass index [BMI]: 24.4 ± 4.7) and MFX (female: 11, age: 34 ± 8, BMI: 24.2 ± 3.2) groups. Isolated cartilage surgery was performed in 11 MC (37%) versus three MFX (10%) cases. In the MC group, 12 defects (40%; MFX 17, 57%) were tibiofemoral and 18 (60%; MFX 13, 43%) patellofemoral. The average defect size was 3.63 ± 2.02 for MC and 1.58 ± 1.12 for MFX (<0.001). At 24 months, the COMI decreased similarly after MC (change score: -3.20 ± 2.05) and MFX (change score: -2.51 ± 2.52), with comparable sIKDC improvements (change score: MC: 25 ± 17; MFX: 20 ± 21). No significant difference was detected in achieving the minimal clinically important difference (MCID) at 24 months. Complications occurred in two MC (6.7%; graft hypertrophy) and three MFX (10%; method failure) cases.

Conclusions: MC and MFX showed comparable short-term outcomes, despite larger defects in the MC group. Both are viable treatment options, though MFX showed limited durability in some cases. Methods: Level III.