Osteochondral Allograft Transplantation for Treatment of Medial Femoral Condyle Defect

Background: Young patients with symptomatic chondral defects in the medial compartment with varus malalignment may undergo opening wedge high tibial osteotomy (HTO) with concomitant osteochondral allograft transplantation (OCA) (HTO + OCA). Although patients have demonstrated favorable outcomes after HTO + OCA, limited information is available regarding return to sporting activities after this procedure. Purpose: To evaluate (1) the timeline to return to sports (RTS), (2) patient satisfaction, and (3) reasons for discontinuing sporting activity after HTO + OCA, and to identify predictive factors of RTS. Study Design: Case series; level of evidence, 4. Methods: Consecutive patients who underwent HTO + OCA for varus deformity and medial femoral condyle focal chondral defects with a minimum 2-year follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire, satisfaction questionnaire, visual analog scale for pain, and Single Assessment Numerical Evaluation. Results: Twenty-eight patients with a mean age of 36.97 ± 7.52 years were included at mean follow-up of 6.63 ± 4.06 years. Fourteen patients (50.0%) required reoperation during the follow-up period, with 3 (10.7%) undergoing knee arthroplasty. Twenty-four patients participated in sports within 3 years before surgery, with 19 patients (79.2%) able to return to at least 1 sport at a mean 11.41 ± 6.42 months postoperatively. However, only 41.7% (n = 10) were able to return to their preoperative level. The most common reasons for sports discontinuation (n = 20; 83.3%) were a desire to prevent further damage to the knee (70.0%), persistent pain (55.0%), persistent swelling (30.0%), and fear (25.0%). Conclusion: In young, active patients with varus deformity and focal medial femoral condyle chondral defects, HTO + OCA enabled 79.2% of patients to RTS by 11.41 ± 6.42 months postoperatively. However, only 41.7% of patients were able to return to their preinjury level or better. It is imperative that patients be appropriately educated to manage postoperative expectations regarding sports participation after HTO + OCA.

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Osteochondral Allograft Transplantation of the Medial Femoral Condyle With Orthobiologic Augmentation and Graft-Recipient Microfracture Preparation

Arthroscopy Techniques ◽

10.1016/j.eats.2018.11.008 ◽

2019 ◽

Vol 8 (3) ◽

pp. e321-e329 ◽

Cited By ~ 2

Author(s):

James Gwosdz ◽

Alexander Rosinski ◽

Moyukh Chakrabarti ◽

Brittany M. Woodall ◽

Nicholas Elena ◽

...

Keyword(s):

Femoral Condyle ◽

Medial Femoral Condyle ◽

Osteochondral Allograft ◽

Allograft Transplantation ◽

Graft Recipient

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Osteochondral Allograft Transplantation for Osteochondritis Dissecans of the Medial Femoral Condyle

Video Journal of Sports Medicine ◽

10.1177/26350254211001369 ◽

2021 ◽

Vol 1 (2) ◽

pp. 263502542110013

Author(s):

LeeAnne Torres ◽

Eric Dennis ◽

Lauren Dogariu ◽

Brian R. Waterman

Keyword(s):

Osteochondritis Dissecans ◽

Femoral Condyle ◽

Adult Population ◽

Medial Femoral Condyle ◽

Osteochondral Allograft ◽

Proper Position ◽

Allograft Transplantation ◽

Primary Indication ◽

Adolescent Patients ◽

Donor Graft

Background: While the data are not as robust as in the adult population, osteochondral allograft transplantation has proven to be an effective treatment for osteochondritis dissecans (OCD) lesions of the knee in the pediatric and adolescent populations. Indications: The primary indication for osteochondral allograft transplantation is a symptomatic, full-thickness, localized cartilage lesion. Acceptable underlying causes include trauma, avascular necrosis, and OCD lesions. As these are pediatric and adolescent patients, they are not candidates for joint arthroplasty. In this case, the patient is a 16-year-old girl with a 1.5 cm × 1.2 cm OCD lesion of the medial femoral condyle. Technique Description: The patient was positioned supine with a tourniquet on the thigh. The lesion was identified on the medial femoral condyle and exposed. A guidepin was placed in the center of the lesion and a 15 mm reamer was used to ream to a depth of 6 to 7 mm. The wound was copiously irrigated. A corresponding 15 mm plug was harvested from the donor graft and prepared to match the morphology of the condyle. The 12 o’clock position was marked with a fresh marking pen to maintain orientation. The graft was lavaged with a pulsavac and bathed in autologous conditioned plasma. The recipient bed was prepared with 0.0045 K wire, and then the donor graft was placed in proper position and impacted with a tamp, flush with the surrounding cartilage. The tourniquet was deflated and the surgical site was closed in a layered fashion. Results: Studies of adult patients have demonstrated survival rates of greater than 80% for osteochondral allograft transplantation, with pain improvement of 74% to 85%, and return to competitive athletics of 88%. While there is a paucity of studies looking at osteochondral allograft transplantation in pediatric and adolescent populations, outcomes appear to be similar to that of the adult population. Discussion/Conclusion: Osteochondral allograft transplantation is a viable treatment option for pediatric and adolescent patients with symptomatic cartilage lesions. It allows for joint preservation and provides significant improvement of pain with high rates of return to athletics.

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Outcomes of Osteochondral Allograft Transplantation With and Without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546517744202 ◽

2018 ◽

Vol 46 (3) ◽

pp. 573-580 ◽

Cited By ~ 18

Author(s):

Rachel M. Frank ◽

Simon Lee ◽

Eric J. Cotter ◽

Charles P. Hannon ◽

Timothy Leroux ◽

...

Keyword(s):

Femoral Condyle ◽

Lateral Femoral Condyle ◽

Osteochondral Allograft ◽

Failure Rates ◽

Meniscus Allograft Transplantation ◽

Joint Preservation ◽

Allograft Transplantation ◽

Meniscus Allograft ◽

Patient Reported

Background: Osteochondral allograft transplantation (OCA) is often performed with concomitant meniscus allograft transplantation (MAT) as a strategy for knee joint preservation, although to date, the effect of concomitant MAT on outcomes and failure rates after OCA has not been assessed. Purpose: To determine clinical outcomes for patients undergoing OCA with MAT as compared with a matched cohort of patients undergoing isolated OCA. Study Design: Control study; Level of evidence, 3. Methods: Patients who underwent OCA of the medial or lateral femoral condyle without concomitant MAT by a single surgeon were compared with a matched group of patients who underwent OCA with concomitant MAT (ipsilateral compartment). The patients were matched per age, sex, body mass index, and number of previous ipsilateral knee operations ±1. Patient-reported outcomes, complications, reoperations, and survival rates were compared between groups. Results: One hundred patients undergoing OCA (50 isolated, 50 with MAT) with a mean ± SD follow-up of 4.9 ± 2.7 years (minimum, 2 years) were included (age, 31.7 ± 9.8 years; 52% male). Significantly more patients underwent OCA to the medial femoral condyle (n = 59) than the lateral femoral condyle (n = 41, P < .0001). Patients underwent 2.7 ± 1.7 operations on the ipsilateral knee before OCA. There were no significant differences between the groups regarding reoperation rate (n = 18 for OCA with MAT, n = 17 for OCA without MAT, P = .834), time to reoperation (2.2 ± 2.4 years for OCA with MAT, 3.4 ± 2.7 years for OCA without MAT, P = .149), or failure rates (n = 7 [14%] for OCA with MAT, n = 7 [14%] for OCA without MAT, P > .999). There were no significant differences in patient-reported clinical outcome scores between the groups at final follow-up. There was no significant difference in failure rates between patients undergoing medial femoral condyle OCA (n = 12, 15.3%) and lateral femoral condyle OCA (n = 5, 12.2%, P = .665). Conclusion: These results imply that with appropriate surgical indications to address meniscus deficiency in patients otherwise indicated for OCA and despite the added surgical time and complexity of concomitant MAT, outcomes are favorable, with an 86% OCA graft survivorship at 5 years. This information can be used to counsel patients undergoing OCA with concomitant MAT as part of a knee joint preservation strategy.

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

The American Journal of Sports Medicine ◽

10.1177/0363546518782939 ◽

2018 ◽

Vol 46 (10) ◽

pp. 2441-2448 ◽

Cited By ~ 2

Author(s):

Dean Wang ◽

Francesca R. Coxe ◽

George C. Balazs ◽

Brenda Chang ◽

Kristofer J. Jones ◽

...

Keyword(s):

Logistic Regression ◽

Clinical Outcomes ◽

Femoral Condyle ◽

Osteochondral Allograft ◽

Radius Of Curvature ◽

Allograft Transplantation ◽

Outcome Scores ◽

The Mean ◽

Graft Recipient

Background: For the treatment of femoral condyle cartilage defects with osteochondral allograft transplantation (OCA), many surgeons have relaxed their graft-recipient size-matching criteria given the limited allograft supply. However, since the anteroposterior (AP) length is typically correlated with the radius of curvature for a given condyle, a large mismatch in graft-recipient AP length can indicate a corresponding mismatch in the radius of curvature, leading to articular incongruity after implantation. Purpose: To evaluate the association between femoral condyle graft–recipient AP mismatch and clinical outcomes of OCA. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted of patients treated with OCA for femoral condyle chondral defects from 2000 to 2015. Graft characteristics, including AP and mediolateral dimensions, were gathered from vendor-specific allograft offering documents. Patient condyle dimensions were measured on preoperative magnetic resonance imaging. 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 and number of previous ipsilateral knee surgical procedures. Results: A total of 69 knees from 69 patients (mean age, 35.7 years; 71% male) met the inclusion criteria. Mean duration of follow-up was 4 years (range, 2-16 years). The mean absolute graft-recipient AP mismatch was 6.7 mm (range, 0-20 mm; P < .01). At final follow-up, 19 knees had failed. There was no significant difference in the mean absolute AP mismatch between failures (8.1 mm) and nonfailures (6.2 mm; P = .17). Multivariate logistic regression revealed that AP mismatch was not associated with graft failure ( P = .14). At final follow-up, significant improvements were noted in the 36-Item Short Form Health Survey, International Knee Documentation Committee subjective form, and Knee Outcome Survey–Activities of Daily Living ( P < .01 for all). Magnitude of AP mismatch was not associated with postoperative outcome scores or achievement of minimal clinically significant differences in outcome scores. Conclusion: Magnitude of graft-recipient AP mismatch was not associated with midterm OCA failure rates or patient-reported outcome scores, suggesting that AP length mismatch within the limits measured here is not a contraindication for graft acceptance.

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Outcomes Associated With Osteochondral Allograft Transplantation in Dogs

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.759610 ◽

2021 ◽

Vol 8 ◽

Author(s):

Samuel P. Franklin ◽

Aaron M. Stoker ◽

Sean M. Murphy ◽

Michael P. Kowaleski ◽

Mitchell Gillick ◽

...

Keyword(s):

Surgical Complication ◽

Femoral Condyle ◽

Treatment Options ◽

Osteochondral Allograft ◽

Cartilage Defects ◽

Osteochondral Lesions ◽

Allograft Transplantation ◽

Major Complications ◽

Type Size ◽

Successful Outcomes

The purpose of this study was to retrospectively characterize outcomes and complications associated with osteochondral allograft transplantation for treating chondral and osteochondral lesions in a group of client-owned dogs with naturally-occurring disease. Records were reviewed for information on signalment, treated joint, underlying pathology (e.g., osteochondritis dissecans; OCD), and type, size, and number of grafts used. Complications were classified as “trivial” if no treatment was provided, “non-surgical” if non-surgical treatment were needed, “minor surgical” if a minor surgical procedure such as pin removal were needed but the graft survived and function was acceptable, or “major” if the graft failed and revision surgery were needed. Outcomes were classified as unacceptable, acceptable, or full function. Thirty-five joints in 33 dogs were treated including nine stifles with lateral femoral condyle (LFC) OCD and 10 stifles with medial femoral condyle (MFC) OCD treated with osteochondral cylinders or “plugs.” There were 16 “complex” procedures of the shoulder, elbow, hip, stifle, and tarsus using custom-cut grafts. In total there were eight trivial complications, one non-surgical complication, two minor surgical complications, and five major complications for a total of 16/35 cases with complications. Accordingly, there were five cases with unacceptable outcomes, all of whom had major complications while the other 30 cases had successful outcomes. Of the 30 cases with successful outcomes, 15 had full function and 15 had acceptable function. Based on these subjective outcome assessments, it appears osteochondral allograft transplantation is a viable treatment option in dogs with focal or complex cartilage defects. However, no conclusions can be made regarding the inferiority or superiority of allograft transplantation in comparison to other treatment options based upon these data.

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