Minced Cartilage Techniques

Minced articular cartilage techniques are viable one-stage, off-the-shelf cartilage repair procedures for treatment of focal chondral defects in the knee. In the United States, DeNovo natural tissue (NT) is the only particulated juvenile allograft one-stage articular cartilage technique currently available that does not violate the subchondral bone. DeNovo NT is composed of 1 mm3 fragments of juvenile (donor age is less than 13 years) articular cartilage, embedded within fibrin adhesive at the time of implantation. DeNovo NT is a chondroconductive, chondroinductive, and chondrogenic product. Given that it is “minimally manipulated,” it does not require US Food and Drug Administration premarket approval. DeNovo NT has been available in the United States since May 2007, and approximately 7500 cases have been performed to date. The basic science and clinical outcome literature supporting minced articular cartilage techniques in treatment of focal chondral defects of the knee is early and short term, but nonetheless promising. Juvenile cells are advantageous over adult cells in that they have a greater migration and proliferation capacity without immunogenicity. Clinical outcomes, at up to 2.5 years of follow-up, have demonstrated a significant improvement in validated cartilage outcome scores, reductions in pain, and improvements in function and activity in patients with both patellofemoral and tibiofemoral lesions treated with DeNovo NT.