Fresh Osteochondral Allograft Transplantation for Treatment of Large Cartilage Defects of the Femoral Head: A Minimum Two-Year Follow-Up Study of Twenty-Two Patients

2018 ◽  
Vol 33 (7) ◽  
pp. 2050-2056 ◽  
Author(s):  
Xin Y. Mei ◽  
Ibrahim S. Alshaygy ◽  
Oleg A. Safir ◽  
Allan E. Gross ◽  
Paul R. Kuzyk
Keyword(s):  
Femoral Head ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Follow Up Study ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft

scholarly journals A Systematic Review of Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
Gregory F. Pereira ◽  
John Steele ◽  
Amanda N. Fletcher ◽  
Samuel B. Adams ◽  
Ryan B. Clement
Keyword(s):  
Systematic Review ◽  
Survival Rate ◽  
Graft Survival ◽  
Graft Survival Rate ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Cochrane Central Register ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft

Category: Ankle Introduction/Purpose: The term osteochondral lesion of the talus (OLT) refers to any pathology of the talar articular cartilage and corresponding subchondral bone. In general, OLTs can pose a formidable treatment challenge to the orthopaedic surgeon due to the poor intrinsic ability of cartilage to heal as well as the tenuous vascular supply to the talus. Although many treatment options exist, including microfracture, retrograde drilling, autologous chondrocyte implantation (ACI), and osteochondral autograft transfer system (OATS) these options may be inadequate to treat large cartilage lesions. Osteochondral allografts have demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement. To our knowledge, this is the first systematic review of outcomes after fresh osteochondral allograft transplantation for OLTs. Methods: PudMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Medline were searched using PRISMA guidelines. Studies that evaluated outcomes in adult patients after fresh osteochondral allograft transplantation for chondral defects of the talus were included. Operative results, according to standardized scoring systems, such as the AOFAS Ankle/Hindfoot scale and the Visual Analog Scale were compared across various studies. The methodological quality of the included studies was assessed using the Coleman methodology score. Results: There were a total of 12 eligible studies reporting on 191 patients with OLTs with an average follow-up of 56.8 months (range 6-240). The mean age was 37.5 (range 17-74) years and the overall graft survival rate was 86.6%. The AOFAS Ankle/Hindfoot score was obtained pre- and postoperatively in 6 of the 12 studies and had significant improvements in each (P<0.05). Similarly, the VAS pain score was evaluated in 5 of the 12 studies and showed significant decreases (P<0.05) from pre- to postoperatively with an aggregate mean preoperative VAS score of 7.3 and an aggregate postoperative value of 2.6. The reported short-term complication rate was 0%. The overall failure rate was 13.4% and 21.6% percent of patients had subsequent procedures. Conclusion: The treatment of osteochondral lesions of the talus remains a challenge to orthopaedic surgeons. From this systematic review, one can conclude that osteochondral allograft transplantation for osteochondral lesions of the talus results in predictably favorable outcomes with an impressive graft survival rate and high satisfaction rates at intermediate follow-up. [Table: see text]

scholarly journals Osteochondral Allograft Transplantation of the Knee in Patients with an Elevated Body Mass Index

Cartilage ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. 214-221 ◽  
Author(s):  
Dean Wang ◽  
Brian J. Rebolledo ◽  
David M. Dare ◽  
Mollyann D. Pais ◽  
Matthew R. Cohn ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Short Form ◽  
International Knee Documentation Committee ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Elevated Body Mass Index ◽  
Allograft Transplantation ◽  
Patient Responses

Objective To characterize the graft survivorship and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee in patients with an elevated body mass index (BMI). Design Prospective data on 38 consecutive patients with a BMI ≥30 kg/m2 treated with OCA from 2000 to 2015 were reviewed. Complications, reoperations, and patient responses to validated outcome measures were examined. Failures were defined by any removal/revision of the allograft or conversion to arthroplasty. Results Thirty-one knees in 31 patients (mean age, 35.4 years [range, 17-61 years]; 87% male) met the inclusion criteria. Mean BMI was 32.9 kg/m2 (range, 30-39 kg/m2). Mean chondral defect size was 6.4 cm2 (range, 1.0-15.3 cm2). Prior to OCA, 23 patients (74%) had undergone previous surgery to the ipsilateral knee. Mean duration of follow-up was 4.1 years (range, 2-11 years). After OCA, 5 knees (13%) underwent conversion to unicompartmental (1) or total (4) knee arthroplasty. Two- and 5-year graft survivorship were 87% and 83%, respectively. At final follow-up, clinically significant improvements were noted in the pain (49.3-72.6) and physical functioning (52.9-81.3) subscales of the Short Form–36 ( P ≤ 0.001), International Knee Documentation Committee subjective form (43.5-67.0; P = 0.002), Knee Outcome Survey–Activities of Daily Living (58.2-80.4; P = 0.002), and overall condition subscale of the Cincinnati Knee Rating System (4.7-6.9; P = 0.046). Conclusions OCA can be a successful midterm treatment option for focal cartilage defects of the knee in select patients with a BMI ≥30 kg/m2.

scholarly journals Bipolar Fresh Osteochondral Allograft Transplantation and Joint Reconstruction for Patellar and Trochlear Cartilage Defects

2019 ◽  
Vol 8 (12) ◽  
pp. e1533-e1541
Author(s):  
Omid Jalali ◽  
Zachary Vredenburgh ◽  
John Prodromo ◽  
Neilen Benvegnu ◽  
George Frederick “Rick” Hatch
Keyword(s):  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Joint Reconstruction ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft

Osteochondral Allograft Transplantation of the Knee in Patients Aged 40 Years and Older

2017 ◽  
Vol 46 (3) ◽  
pp. 581-589 ◽  
Author(s):  
Dean Wang ◽  
Vivek Kalia ◽  
Claire D. Eliasberg ◽  
Tim Wang ◽  
Francesca R. Coxe ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Rating Scale ◽  
Short Form ◽  
Case Series ◽  
Hazard Ratio ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Level Of Evidence ◽  
Allograft Transplantation

Background: Treatment of large chondral defects of the knee among patients aged ≥40 years remains a difficult clinical challenge owing to preexisting joint degeneration and the lack of treatment options short of arthroplasty. Purpose: To characterize the survivorship, predictors of failure, and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee among patients aged ≥40 years. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were reviewed for 54 consecutive patients aged ≥40 years who were treated with OCA. Preoperative levels of osteoarthritis (according to Kellgren-Lawrence classification) and meniscal volume and quality were graded from review of radiographs and magnetic resonance imaging. Complications, reoperations, and patient responses to validated outcome measures were reviewed. A minimum follow-up of 2 years was required for analysis. Failure was defined by any removal or revision of the allograft or conversion to arthroplasty. Results: Among 51 patients (mean age, 48 years; range, 40-63 years; 65% male), a total of 52 knees had symptomatic focal cartilage lesions (up to 2 affected areas) that were classified as Outerbridge grade 4 at the time of OCA and did not involve substantial bone loss requiring shell allografts or additional bone grafting. Mean duration of follow-up was 3.6 years (range, 2-11 years). After OCA, 21 knees (40%) underwent reoperation, including 14 failures (27%) consisting of revision OCA (n = 1), unicompartmental knee arthroplasty (n = 5), and total knee arthroplasty (n = 8). Mean time to failure was 33 months, and 2- and 4-year survivorship rates were 88% and 73%, respectively. Male sex (hazard ratio = 4.18, 95% CI = 1.12-27.13) and a higher number of previous ipsilateral knee operations (hazard ratio = 1.70 per increase in 1 surgical procedure, 95% CI = 1.03-2.83) were predictors of failure. A higher Kellgren-Lawrence osteoarthritis grade on preoperative radiographs was associated with higher failure rates in the Kaplan-Meier analysis but not the multivariate model. At final follow-up, clinically significant improvements were noted in the pain (mean score, 47.8 to 67.6) and physical functioning (56.8 to 79.1) subscales of the Short Form-36, as well as the International Knee Documentation Committee subjective form (45.0 to 63.6), Knee Outcome Survey–Activities of Daily Living (64.5 to 80.1), and overall condition statement (4.5 to 6.8) ( P < .001). No significant changes were noted for the Marx Activity Rating Scale (5.1 to 3.9, P = .789). Conclusion: A higher failure rate was found in this series of patients aged ≥40 years who were treated with OCA as compared with other studies of younger populations. However, for select older patients, OCA can be a good midterm treatment option for cartilage defects of the knee.

scholarly journals Graft-Recipient Anteroposterior Mismatch Does Not Affect the Clinical Outcomes of Osteochondral Allograft Transplantation of the Femoral Condyle

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0015
Author(s):  
Francesca R. Coxe ◽  
Dean Wang ◽  
George Christian Balazs ◽  
Brenda Chang ◽  
Kristofer J. Jones ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Graft Failure ◽  
Femoral Condyle ◽  
Long Term Results ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Allograft Transplantation

Objectives: For the treatment of femoral condyle cartilage defects, anteroposterior (AP) and mediolateral (ML) dimension matching in osteochondral allograft transplantation (OCA) pairs donor and recipient condyles to minimize articular incongruity. This aims to reduce the potential risk of graft failure and improve clinical outcomes. However, size matching restricts the number of compatible osteochondral allografts, which has a number of disadvantages including delayed surgical treatment and prolonged graft storage. Some surgeons match donor-to-recipient exclusively using the ML dimension to ensure that an adequately sized dowel can be harvested, while ignoring AP mismatch. Because a large AP mismatch can lead to radius of curvature differences between graft and host and potential articular incongruity after implantation, this study aimed to evaluate the association between AP mismatch and clinical outcomes of OCA. Methods: A retrospective review of patients treated with OCA for femoral condyle cartilage defects from 2000 to 2015 was conducted. A minimum follow-up of 2 years was required for analysis. Graft characteristics, including AP and ML dimensions, were gathered from vendor-specific allograft offering documents. Patient condyle dimensions were measured from preoperative magnetic resonance imaging (Figure 1). Reoperations and patient responses to validated outcome measures were reviewed. Failure was defined by any partial removal/revision of the allograft or conversion to knee arthroplasty. A multivariable logistic regression model was fitted to examine the association of AP mismatch with OCA failure while adjusting for patient age, sex, number of previous ipsilateral knee surgeries, and number of lesions treated. Results: A total of 69 knees (mean age, 35.7 years) met the inclusion criteria. Mean duration of follow-up was 4 years (range, 2-16 years). The average absolute AP mismatch between graft and patient was 6.7 mm (range, 0-20 mm) (P <0.01). In contrast, the average absolute ML mismatch between graft and patient was 2.3 mm (range, 0-10 mm) (P = 0.33). At final follow-up, 19 knees had failed. There was no significant difference in the average absolute AP mismatch between failures (8.1 mm) and non-failures (6.2 mm) (P = 0.17). Multivariate logistic regression revealed that AP mismatch was not associated with graft failure (P = 0.15) (Table 1). At final follow-up, clinically significant improvements were noted in the pain (52.0 to 73.2) and physical functioning (60.1 to 80.1) subscales of the Short Form-36 (P <0.01 for both), International Knee Documentation Committee subjective form (47.8 to 65.9; P <0.01), and Knee Outcome Survey-Activities of Daily Living (64.2 to 82.0; P <0.01). Conclusion: OCA has consistently shown excellent long-term results in patients, including high-level athletes, with large chondral defects. Widespread use of OCA, however, is limited by the practice of procuring an appropriately sized allograft that matches the recipient hemicondyle in ML and AP dimensions. The results of the present study show no association between the magnitude of graft-patient AP mismatch and OCA failure. Most importantly, patient-reported outcome measures improved significantly over the course of follow-up, despite a wide range of AP mismatch between graft and patient. Our results suggest that AP length matching within the limits measured here is not a contraindication for graft acceptance.

scholarly journals Eight-Year Follow-Up Using a Fresh Osteochondral Allograft for a Femoral Head Chondroblastoma in a 17-Year-Old Patient

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Louis-Charles Moreau ◽  
Philippe Beauchamp-Chalifour ◽  
Etienne L. Belzile ◽  
Norbert Dion
Keyword(s):  
Femoral Head ◽  
Case Reports ◽  
Hip Dislocation ◽  
Postoperative Outcome ◽  
Osteochondral Allograft ◽  
Uneventful Recovery ◽  
Fresh Osteochondral Allograft ◽  
Hip Disease ◽  
Rare Benign Tumor

Chondroblastoma is a rare benign tumor that affects the epiphysis of long bones in adolescents. Chondroblastoma located in the femoral head is associated with a higher recurrence rate and carries the additional risks of head collapse and degenerative hip disease. Aggressive curettage followed by bone grafting is the current mainstay of treatment. To our knowledge, the long-term postoperative outcome of this technique remains unknown due to the short follow-up of previous case reports. We present the case of a 17-year-old male who underwent fresh osteochondral allograft following curettage of a femoral head chondroblastoma, using a Ganz surgical hip dislocation. He made an uneventful recovery without tumor recurrence. The patient was followed up to 8 years postoperatively. However, there were clinical and radiographic degenerative changes at 6 years of follow-up.

Fresh Osteochondral Allografting in the Treatment of Osteochondritis Dissecans of the Femoral Condyle

2007 ◽  
Vol 35 (6) ◽  
pp. 907-914 ◽  
Author(s):  
Bryan C. Emmerson ◽  
Simon Görtz ◽  
Amir A. Jamali ◽  
Christine Chung ◽  
David Amiel ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Osteochondral Allograft ◽  
Patient Questionnaire ◽  
Comprehensive Treatment ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft ◽  
The Mean

Background The treatment of osteochondritis dissecans in the adult knee can be challenging. As part of our comprehensive treatment program, fresh osteochondral allografts have been used in the surgical management of osteochondritis dissecans of the femoral condyle. Hypothesis Fresh osteochondral allograft transplantation will provide a successful surgical treatment for osteochondritis dissecans of the femoral condyle. Study Design Case series; Level of evidence, 4. Methods Sixty-six knees in 64 patients underwent fresh osteochondral allografting for the treatment of osteochondritis dissecans. Each patient was evaluated both preoperatively and postoperatively using an 18-point modified D'Aubigné and Postel scale. Subjective assessment was performed using a patient questionnaire. Radiographs were evaluated preoperatively and postoperatively. Results Mean follow-up was 7.7 years (range, 2-22 years). There were 45 men and 19 women with a mean age of 28.6 years (range, 15-54 years). All patients had undergone previous surgery. Forty-one lesions involved the medial femoral condyle, and 25 involved the lateral femoral condyle. All were osteochondritis dissecans type 3 or 4. The mean allograft size was 7.5 cm2. One knee was lost to follow-up. Of the remaining 65 knees, 47 (72%) were rated good/excellent, 7 (11%) were rated fair, and 1 (2%) was rated poor. Ten patients (15%) underwent reoperation. The mean clinical score improved from 13.0 preoperatively to 16.4 postoperatively (P < .01). Fifty-nine of 64 patients completed questionnaires. Subjective knee function improved from a mean of 3.4 to 8.4 on a 10-point scale (P < .01). Conclusion With greater than 70% good or excellent results, fresh osteochondral allograft transplantation is a successful surgical treatment for osteochondritis dissecans of the femoral condyle.

scholarly journals Early Clinical Outcomes Associated with a Novel Osteochondral Allograft Transplantation System in the Knee

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
William J. Long ◽  
Joseph W. Greene ◽  
Fred D. Cushner
Keyword(s):  
Subchondral Bone ◽  
Articular Surface ◽  
Case Series ◽  
Activity Level ◽  
Osteochondral Allograft ◽  
Common Finding ◽  
Cartilage Defects ◽  
Allograft Transplantation ◽  
Pain Symptoms

Background. Osteochondral defects of the knee are a common finding at the time of arthroscopic intervention. Purpose/Hypothesis. To report our outcomes after utilizing a new technique of osteochondral allograft transplantation for focal cartilage defects. Study Design. Case series. Methods. All patients treated with osteochondral allograft transplantation with a Zimmer Chondrofix plug (Zimmer Inc., Warsaw, IN) for focal cartilage defects over a 12-month period were followed up at a minimum of 24 months. Failures were documented and radiographs were evaluated. Results. 61 knees (58 patients) underwent grafting. Three cases were lost to follow-up. In the remaining 58 cases the average age was 40 (range 18–59). At a mean follow-up of 28 months (range 24–36), there were 5 failures requiring further surgery. Mean KOOS scores in the Pain, Symptoms, ADL, Sports, and Quality of Life dimensions were 82, 79, 84, 66, and 58, respectively. Radiographs demonstrated maintenance of the subchondral bone without graft absorption or subsidence. Conclusions. Our observations suggest that osteochondral allograft transplantation leads to a satisfactory activity level and function at early follow-up while avoiding the inherent complexities associated with other cartilage restoration techniques. Longer follow-up is warranted to monitor the subchondral bone, articular surface, and patient outcome measures.

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