Dr. Stone's cartilage graft paste

[Robert Lloyd]

https://www.stoneclinic.com/

https://www.stoneclinic.com/articular-cartilage

Dr. Stone's cartilage graft technique is a "super microfracture" technique.
Dr. Stone creates a morselized full bloody bed.  Cartilage and bone have stem cells.
Dr. Stone states in his video that his technique creates mixture of hyaline and fibrocartilage.

Our goal should be near 100% hyaline cartilage with any cartilage repair procedure.

How do other technologies compare to Stone's cartilage paste such as MACI, Novocart 3D, Denovo, etc.?
Regular microfracture is mostly scar cartilage and somehow it's become the gold standard of cartilage regeneration.

[gaoshanfelix]

I kinda guess the procedure is not the same anymore - because progress has been made and things are known better now than 30 years ago. It surely was revolutionary and I think up to 7-8 years ago a good technique as described.
It uses microfacture - which is not actually needed with minced cartilage and according to Gian Salzman provides worse results.
It does not use the cartilage gathered from debriding the damaged area - but from non weight bearing parts. Non weight bearing cartilage is by now known to be inferior in quality. This should only be done if the debriding does not gather enough cartilage for mincing.

Mind though - both points above have been long part of the process with minced cartilage. If you remove those two and work according to modern knowledge - you actually have Arthrex Autocart/Minced Cartilage 2nd generation procedure and likely Dr. Stone also developed some tools to mince the cartilage (instead of cutting it small with manual tools as before).


The point about Arthrex Autocart is not that it is leading edge technology - it isnt - according to Arthrex. It simply is a set of tools to make minced cartilage surgery easy and reproducible based on current knowledge of cartilage surgeries. There is a mincing device so you don't have to use a scalpel or scissors to cut down the cartilage. There are some common tools developed for the surgery itself - and the fibrin glue is produced by a simple centrifuge as used for PRP...

[Robert Lloyd]

I kinda guess the procedure is not the same anymore - because progress has been made and things are known better now than 30 years ago.

I doubt it.  His video was made not too long ago.  He came up with a great idea 30 years ago and really hasn't changed it.
This is where Vericel really shines.  They recognized Carticel was a great idea, but a difficult surgery and they realized that using a matrix was the only way for the product to gain traction and Vericel innovated.  I don't see that Dr. Stone has innovated much.  With that being said, he does a lot of great things.  He has a physical therapy gym on site.  He does knee replacements himself instead of having a large staff and pawning patients off to a less experienced surgeon.

Dr. Stone even talks about MACI on his website and recognizes it as a cartilage growing technology.  Recognizing MACI even though he doesn't offer it himself shows a high level of integrity.
https://www.stoneclinic.com/blog/failed-microfracture

It surely was revolutionary and I think up to 7-8 years ago a good technique as described.

But it's still growing a lot of fibrocartilage, but yes it's still better than microfracture and at least it's not a scam like dead umbilical cord stem cells and Dr. Dunn's IAGH.

It uses microfacture - which is not actually needed with minced cartilage and according to Gian Salzman provides worse results.

Now that is interesting.  Dr. Stone should test his procedure without microfracturing.

It does not use the cartilage gathered from debriding the damaged area - but from non weight bearing parts. Non weight bearing cartilage is by now known to be inferior in quality.

MACI and Novocart both obtain a cartilage sample from a non weight bearing area.

The point about Arthrex Autocart is not that it is leading edge technology - it isnt - according to Arthrex. It simply is a set of tools to make minced cartilage surgery easy and reproducible based on current knowledge of cartilage surgeries. There is a mincing device so you don't have to use a scalpel or scissors to cut down the cartilage. There are some common tools developed for the surgery itself - and the fibrin glue is produced by a simple centrifuge as used for PRP...

At least it grows real hyaline cartilage unlike microfracture and Dr. Dunn's IAGH scam.

[gaoshanfelix]

MACI and Novocart both obtain a cartilage sample from a non weight bearing area.

Yes I would expect them to change that soon. It's hard to see why they cannot just use cartilage from the edge of the damage in the 1. step. Because I think debriding the area is done in step 2 surgery.

Nearly all doctors that offer Autocart have also done surgeries with Novocart before. I know my doctor - Marlovits - did so but since 2021 is doing autocart instead of MACI now in all cases less complicated, cheaper and better or as good results from his opinion (and yes he does quite a lot of them every week - he mainly does cartilage and related surgeries. So yes also PKR/TKR if Autcoart isn't an option. or ACL in combination with cartilage). But yes he never did dr Stones cartilage paste grafting.