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Objectives and questions: The goal of cartilage repair is to create the highest quality repair tissue, which is linked to better clinical outcomes, sports recovery, and long-term durability. Microfracturing (MFX) is a common surgical technique used to repair cartilage defects in the knee. It involves creating small fractures in the underlying bone (subchondral bone), which stimulates the release of bone marrow cells. However, the quality of the repair tissue is often not as durable as healthy hyaline cartilage, and it may degrade over time. Autologous Chondrocyte Implantation (MACI) is often referred to as the ‘gold standard’ for cartilage treatment. Minced Cartilage Implantation (MCI), uses cartilage fragments to cover the defect. This technique has further evolved towards an arthroscopic approach, with the first technical notes published by Schneider and Salzmann (2020). This Analysis aimed to compare the patient reported outcomes for all three techniques up to five years.

Material and methods: In this retrospective analysis, the data of 12 patients (7m/ 5f; age: 39.6 ±11.7) treated with Microfracturing from 2015 to 2018 was compared to the data of 11 patients treated with MACI (11m/ 0f; age: 36.4 ± 3.3) and 12 patients treated with MCI between 2019 and 2020 (7m/ 5f; age: 36.1 ± 8.7). The data were collected by an established online data register Surgical Outcomes System (SOS) (Arthrex). Primary outcomes were VAS and KOOS-Pain. Secondary outcomes were KOOS-ADL and KOOS-QOL collected pre- , 3-, 6-, 12-, 24-, and 60 months after surgery. 2-Factor ANOVA (group*time) was performed to statistically compare the results of the primary and secondary outcomes.

Results: The primary and secondary outcomes significantly improved in all groups. A main effect of time was found on the VAS (p = .05), the KOOS-Pain (p < .001, KOOS-ADL (p < .001) and KOOS-QOL (p< .001). There was no interaction between group and time for all outcomes. Descriptively, the highest improvements were gained in the MCI Group in all four outcomes followed by MACI and MFX. The SANE increased from initially 52.0 ± 17.1 to 64 ± 21 in the MFX group, 52.5 ± 16.8 to 72.6 ± 14.2 and from 50.4 ± 21.0 to 79.8 ± 12.0 in the MCI Group. The Tegner reached the preoperative level (3.9) after 2 years in the MFX group and in the MACI group (3.6), and after 6 months in the MCI group (3.7).

Discussion and conclusions: All three methods can contribute to pain relief and improvement of joint function. Although the data show favourable results for the procedure with Minced Cartilage implantation, the small sample size and the relatively high standard deviations did not lead to a statistically reliable conclusion.