Modern Osteochondral Allograft Transplantation: The “Gold Standard” for Femoral Condyle Cartilage Repair?

Objectives: Cartilage repair for femoral condyle lesions comprise the majority of the biological procedures performed in the knee joint. Treatment options have evolved but there is still uncertainty regarding longer-term clinical outcomes with current surgical techniques. The objective of this study was to evaluate outcome of osteochondral allograft (OCA) transplantation utilizing dowel type grafts for the treatment of isolated femoral condyle cartilage lesions. Methods: This study comprised 187 patients (200 knees) who underwent OCA transplantation for isolated cartilage lesions on the femoral condyle between 1999 and 2014. Mean patient age was 31.1 ± 11.6 years, 62.6% were male, and the medial femoral condyle was affected in 69% of the knees. For all cases, dowel technique was used with commercially available surgical instruments utilizing the minimum amount of bone necessary for fixation (modern technique). A single graft was used in 145 knees (72.5%), two grafts were used in 55 knees (27.5%). Average allograft area was 6.3 cm2 (range, 2.3 to 13 cm2) and graft thickness was 6.5 ± 1.4 mm (cartilage and bone combined). All patients had a minimum follow-up of 2 years. Evaluation included International Knee Documentation Committee (IKDC) scores; Knee injury and Osteoarthritis Outcome Score (KOOS), and patient satisfaction. The frequency and type of further surgery was assessed. OCA failure was defined as a further surgery that involved removal of the allograft. An additional subgroup analysis on location comparing medial to lateral femoral condyle grafts was performed Results: The average follow-up was 6.7 years (range, 1.9 to 16.5 years). IKDC scores improved from preoperatively to latest follow-up for pain (5.5 to 2.7), function (3.4 to 7.3) and total scores (43.7 to 76.2) (all p<0.001). KOOS pain and activities of daily living scores improved from 66.5 to 85.3 and 74.5 to 91.1, respectively (p<0.001). At latest follow-up, outcome scores did not differ by location on the femoral condyle (Table 1). The majority of patients (89%) reported satisfaction with the results of the OCA transplantation. Further surgery was required in 52 knees (26%), of which 16 knees (8% of entire cohort) were defined as OCA failures (4 OCA revisions, 1 arthrosurface, 6 unicompartmental knee arthroplasties, and 5 total knee arthroplasties). The median time to failure was 4.9 years (range, 0.3 to 16.1 years). Survivorship of the OCA was 95.6% at 5 years and 91.2% at 10 years (Figure 1). Conclusion: OCA transplantation utilizing a modern technique is a valuable procedure for the treatment of femoral condyle cartilage lesions, resulting in significant improvement in clinical scores, high patient satisfaction, and low reoperation and clinical failure rates. These results are similar or better than any other cartilage repair procedure for isolated femoral condyle lesions. [Table: see text][Figure: see text]

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Osteochondral Allograft Transplantation of the Femoral Condyle Utilizing a Thin Plug Graft Technique

The American Journal of Sports Medicine ◽

10.1177/0363546519844212 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1613-1620 ◽

Cited By ~ 1

Author(s):

Luís E.P. Tírico ◽

Julie C. McCauley ◽

Pamela A. Pulido ◽

William D. Bugbee

Keyword(s):

Patient Satisfaction ◽

Femoral Condyle ◽

Case Series ◽

Surgical Instruments ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Level Of Evidence ◽

Meaningful Improvement ◽

Unicompartmental Knee Arthroplasties

Background: Previous studies showed clinical benefit and durable results of osteochondral allograft (OCA) transplantation for the treatment of femoral condyle lesions. However, the majority of these studies are difficult to interpret owing to the mixed results of different techniques and anatomic locations. Purpose: To evaluate the outcome of OCA transplantation with thin plug grafts for treatment of isolated femoral condyle osteochondral lesions. Study Design: Case series; Level of evidence, 4. Methods: This study included 187 patients (200 knees) who underwent OCA transplantation for isolated osteochondral lesions on the femoral condyle between 1999 and 2014. For all cases, a thin plug technique was used with commercially available surgical instruments and the minimum amount of bone necessary for fixation. Evaluation included International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and patient satisfaction. Frequency and type of further surgery were assessed. Failure of the allograft was defined as further surgery involving removal of the allograft. Results: Mean follow-up was 6.7 years (range, 1.9-16.5 years). The mean age of patients at the time of surgery was 31 years, and 63% were male. The medial femoral condyle was affected in 69% of knees. A single thin plug graft was used in 145 knees (72.5%), and 2 grafts were used in 55 knees (27.5%). Mean allograft area was 6.3 cm2, and graft thickness was 6.5 mm (cartilage and bone combined). Further surgery was required for 52 knees (26%), of which 16 (8% of entire cohort) were defined as allograft failures (4 OCA revisions, 1 arthrosurface, 6 unicompartmental knee arthroplasties, and 5 total knee arthroplasties). Median time to failure was 4.9 years. Survivorship of the allograft was 95.6% at 5 years and 91.2% at 10 years. Among patients with grafts remaining in situ at latest follow-up, clinically meaningful improvement in pain, function, and quality of life was reported. Satisfaction was reported by 89% of patients. Conclusion: OCA transplantation with a thin plug graft technique is a valuable procedure for the treatment of femoral condyle osteochondral lesions, resulting in significant improvement in clinical scores, high patient satisfaction, and low reoperation and clinical failure rates.

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Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation

The American Journal of Sports Medicine ◽

10.1177/0363546517746106 ◽

2018 ◽

Vol 46 (4) ◽

pp. 900-907 ◽

Cited By ~ 15

Author(s):

Luis E.P. Tírico ◽

Julie C. McCauley ◽

Pamela A. Pulido ◽

William D. Bugbee

Keyword(s):

Cartilage Repair ◽

Femoral Condyle ◽

Relative Size ◽

Surgical Techniques ◽

Lesion Size ◽

Osteochondral Allograft ◽

Fresh Osteochondral Allograft ◽

Graft Area ◽

The Mean

Background: Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. Purpose: To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm2 (range, 2.3-11.5 cm2). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed. Results: The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%. Conclusion: The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee.

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Revision Surgery After Cartilage Repair: Data From the German Cartilage Registry (KnorpelRegister DGOU)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117752623 ◽

2018 ◽

Vol 6 (2) ◽

pp. 232596711775262 ◽

Cited By ~ 8

Author(s):

Jan M. Pestka ◽

Nam H. Luu ◽

Norbert P. Südkamp ◽

Peter Angele ◽

Gunther Spahn ◽

...

Keyword(s):

Cartilage Repair ◽

Revision Surgery ◽

Femoral Condyle ◽

Surgical Techniques ◽

Defect Size ◽

Level Of Evidence ◽

Large Patient ◽

Early Revision ◽

Chi Square Analysis

Background: Various operative strategies have been introduced to restore the integrity of articular cartilage when injured. The frequency of revision surgery after cartilage regenerative surgery remains incompletely understood. Purpose/Hypothesis: The purpose of this study was to identify the reasons for revision surgery after cartilage regenerative surgery of the knee. We hypothesized that in a large patient cohort, revision rates would differ from those in the current literature. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 2659 complete data sets from the German Cartilage Registry were available for analyses. In brief, baseline data were provided by the attending physician at the time of index surgery. Follow-up data were collected using a web-based questionnaire inquiring whether patients had needed revision surgery during follow-up, which was defined as the endpoint of the present analysis. Results: A total of 88 patients (3.3%) reported the need for revision surgery as early as 12 months postoperatively. Among the most common causes were arthrofibrosis (n = 27) and infection (n = 10). Female patients showed a significantly greater complication rate (4.5%) when compared with male patients (2.6%; P = .0071). The majority of cartilage lesions were located at the medial femoral condyle (40.2%), with a mean defect size of 3.5 ± 2.1 cm2. Neither the location nor defect size appeared to lead to an increased revision rate, which was greatest after osteochondral autografts (5.2%) and autologous chondrocyte implantation (4.6%). Revision rates did not differ significantly among surgical techniques. Chi-square analysis revealed significant correlations between the number of previous joint surgeries and the need for revision surgery ( P = .0203). Multivariate regression analysis further confirmed sex and the number of previous surgeries as variables predicting the need for early revision surgery. Conclusion: The low early revision rates found in this study underline that today’s cartilage repair surgeries are mostly safe. Although invasiveness and techniques differ greatly among the procedures, no differences in revision rates were observed. Specific factors such as sex and the number of previous surgeries seem to influence overall revision rates and were identified as relevant risk factors with regard to patient safety.

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Return to Sport After Large Single-Surface, Multisurface, or Bipolar Osteochondral Allograft Transplantation in the Knee Using Shell Grafts

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120967928 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712096792

Author(s):

James L. Cook ◽

Kylee Rucinski ◽

Cory R. Crecelius ◽

Richard Ma ◽

James P. Stannard

Keyword(s):

Femoral Condyle ◽

Case Series ◽

Return To Sport ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Osteochondral Allograft ◽

Level Of Evidence ◽

Recreational Athletes ◽

Patient Reported

Background: Return to sport (RTS) after osteochondral allograft (OCA) transplantation for large unipolar femoral condyle defects has been consistent, but many athletes are affected by more severe lesions. Purpose: To examine outcomes for athletes who have undergone large single-surface, multisurface, or bipolar shell OCA transplantation in the knee. Study Design: Case series; Level of evidence, 4. Methods: Data from a prospective OCA transplantation registry were assessed for athletes who underwent knee transplantation for the first time (primary transplant) between June 2015 and March 2018 for injury or overuse-related articular defects. Inclusion criteria were preinjury Tegner level ≥5 and documented type and level of sport (or elite unit active military duty); in addition, patients were required to have a minimum of 1-year follow-up outcomes, including RTS data. Patient characteristics, surgery type, Tegner level, RTS, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures were assessed and compared for statistically significant differences. Results: There were 37 included athletes (mean age, 34 years; range, 15-69 years; mean body mass index, 26.2 kg/m2; range, 18-35 kg/m2) who underwent large single-surface (n = 17), multisurface (n = 4), or bipolar (n = 16) OCA transplantation. The highest preinjury median Tegner level was 9 (mean, 7.9 ± 1.7; range, 5-10). At the final follow-up, 25 patients (68%) had returned to sport; 17 (68%) returned to the same or higher level of sport compared with the highest preinjury level. The median time to RTS was 16 months (range, 7-26 months). Elite unit military, competitive collegiate, and competitive high school athletes returned at a significantly higher proportion ( P < .046) than did recreational athletes. For all patients, the Tegner level at the final follow-up (median, 6; mean, 6.1 ± 2.7; range, 1-10) was significantly lower than that at the highest preinjury level ( P = .007). PROMs were significantly improved at the final follow-up compared with preoperative levels and reached or exceeded clinically meaningful differences. OCA revisions were performed in 2 patients (5%), and failures requiring total knee arthroplasty occurred in 2 patients (5%), all of whom were recreational athletes. Noncompliance was documented in 4 athletes (11%) and was 15.5 times more likely ( P = .049) to be associated with failure or a need for revision than for compliant patients. Conclusion: Large single-surface, multisurface, or bipolar shell OCA knee transplantations in athletes resulted in two-thirds of these patients returning to sport at 16 to 24 months after transplantation. Combined, the revision and failure rates were 10%; thus, 90% of patients were considered to have successful 2- to 4-year outcomes with significant improvements in pain and function, even when patients did not RTS.

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The Schulthess local Shoulder Arthroplasty Registry (SAR): cohort profile

BMJ Open ◽

10.1136/bmjopen-2020-040591 ◽

2020 ◽

Vol 10 (11) ◽

pp. e040591

Author(s):

Alex Marzel ◽

Hans-Kaspar Schwyzer ◽

Christoph Kolling ◽

Fabrizio Moro ◽

Matthias Flury ◽

...

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Functional Recovery ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Surgical Techniques ◽

Rotator Cuff Tears ◽

Arthroplasty Registry

PurposeClinical registries are essential for evaluation of surgical outcomes. The Schulthess Shoulder Arthroplasty Registry (SAR) was established in 2006 to evaluate safety, function, quality-of-life and patient satisfaction in patients undergoing shoulder arthroplasty.ParticipantsAdult patients undergoing anatomic or reverse shoulder joint replacement at the Schulthess Klinik, a high-volume, leading orthopaedic surgery centre in Zürich, Switzerland.Findings to dateBetween March 2006 and December 2019, the registry covered 98% of eligible operations. Overall, 2332 patients were enrolled with a total of 2796 operations and 11 147 person-years of follow-up. Mean age at baseline was 71 (range: 20–95), 65% were women. Most common indication was rotator cuff tears with osteoarthritis (42%) and the mean preoperative Constant Score was 31 (±15). The most frequent arthroplasty type was reverse, increasing from 61% in 2006–2010 to 86% in 2015–2019. Functional recovery peaked at 12-month postoperatively and did not show a clinically relevant deterioration during the first ten follow-up years. Since its establishment, the registry was used to address multiple pertinent clinical and methodological questions. Primary focus was on comparing different implant configurations (eg, glenosphere diameter) and surgical techniques (eg, latissimus dorsi transfer) to maximise functional recovery. Additionally, the cohort contributed to the determination of the clinical relevance and validity of radiological monitoring of cortical bone resorption and scapular notching. Finally, SAR data helped to demonstrate that returning to sports was among key patient expectations after reverse shoulder arthroplasty.Future plansAs first patients are approaching the 15 years follow-up landmark, the registry will continue providing essential data on long-term functional outcomes, implant stability, revision rates and aetiologies as well as patient satisfaction and quality-of-life. In addition to research and quality-control, the cohort data will be brought back to the patients by bolstering real-time clinical decision support.

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Comparative Effectiveness of Cartilage Repair With Respect to the Minimal Clinically Important Difference

The American Journal of Sports Medicine ◽

10.1177/0363546518824552 ◽

2019 ◽

Vol 47 (13) ◽

pp. 3284-3293 ◽

Cited By ~ 11

Author(s):

Kristofer J. Jones ◽

Benjamin V. Kelley ◽

Armin Arshi ◽

David R. McAllister ◽

Peter D. Fabricant

Keyword(s):

Clinical Outcomes ◽

Cartilage Repair ◽

Meta Analysis ◽

Osteochondral Allograft ◽

Time Points ◽

Outcome Scores ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

Background: Recent studies demonstrated a 5% increase in cartilage repair procedures annually in the United States. There is currently no consensus regarding a superior technique, nor has there been a comprehensive evaluation of postoperative clinical outcomes with respect to a minimal clinically important difference (MCID). Purpose: To determine the proportion of available cartilage repair studies that meet or exceed MCID values for clinical outcomes improvement over short-, mid-, and long-term follow-up. Study Design: Systematic review and meta-analysis. Methods: A systematic review was performed via the Medline, Scopus, and Cochrane Library databases. Available studies were included that investigated clinical outcomes for microfracture (MFX), osteoarticular transfer system (OATS), osteochondral allograft transplantation, and autologous chondrocyte implantation/matrix-induced autologous chondrocyte implantation (ACI/MACI) for the treatment of symptomatic knee chondral defects. Cohorts were combined on the basis of surgical intervention by performing a meta-analysis that utilized inverse-variance weighting in a DerSimonian-Laird random effects model. Weighted mean improvements in International Knee Documentation Committee (IKDC), Lysholm, and visual analog scale for pain (VAS pain) scores were calculated from preoperative to short- (1-4 years), mid- (5-9 years), and long-term (≥10 years) postoperative follow-up. Mean values were compared with established MCID values per 2-tailed 1-sample Student t tests. Results: A total of 89 studies with 3894 unique patients were analyzed after full-text review. MFX met MCID values for all outcome scores at short- and midterm follow-up with the exception of VAS pain in the midterm. OATS met MCID values for all outcome scores at all available time points; however, long-term data were not available for VAS pain. Osteochondral allograft transplantation met MCID values for IKDC at short- and midterm follow-up and for Lysholm at short-term follow-up, although data were not available for other time points or for VAS pain. ACI/MACI met MCID values for all outcome scores (IKDC, Lysholm, and VAS pain) at all time points. Conclusion: In the age of informed consent, it is important to critically evaluate the clinical outcomes and durability of cartilage surgery with respect to well-established standards of clinical improvement. MFX failed to maintain VAS pain improvements above MCID thresholds with follow-up from 5 to 9 years. All cartilage repair procedures met MCID values at short- and midterm follow-up for IKDC and Lysholm scores; ACI/MACI and OATS additionally met MCID values in the long term, demonstrating extended maintenance of clinical benefits for patients undergoing these surgical interventions as compared with MFX.

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Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00018 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0001

Author(s):

Jack Allport ◽

Adam Bennett ◽

Jayasree Ramaskandhan ◽

Malik Siddique

Keyword(s):

Patient Satisfaction ◽

Weight Bearing ◽

Surgical Techniques ◽

Womac Pain ◽

Ankle Arthritis ◽

Ankle Arthroplasty ◽

Patient Reported ◽

Equinus Deformity ◽

Clinical Records

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be an effective treatment for end stage ankle arthritis. Achieving normal anatomical alignment has been shown to be important in long term outcomes and revision rates. Recent data from the British NJR has shown that revision rates are higher in patients with pre-operative fixed equinus. Although there is literature about surgical techniques to deal with pre-operative equinus we are not aware of any papers presenting patient outcomes. We present patient reported outcomes for our cohort of patients with pre-operative fixed equinus compared to those able to achieve a plantigrade ankle. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. A mobile bearing prosthesis was used (Mobility TAA system, DePuy, Raynham, Massachusetts, USA). Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual intervals post-operatively. Patients undergoing primary TAA between March 2006 and June 2014 were included, revision procedures along with those with inadequate PROMS data were excluded. PROMS scores used were FAOS (WOMAC Pain, Function and Stiffness), SF-36 scores and patient satisfaction. All pre-operative lateral weight bearing xrays were reviewed to screen for potential fixed equinus deformity (tibia-sole angle >90 degrees). Clinical records were then reviewed to confirm clinical diagnosis of fixed equinus deformity. Results: 259 cases were identified, 95 cases were excluded based on our criteria leaving 164 cases for analysis (mean follow up 61.6 months). 144 were classified as neutral and 20 as fixed equinus. The fixed equinus group were significantly younger (neutral 64.2 vs equinus 53.9, p=0.0002), there was no difference in BMI or length of follow up. There was no difference in baseline scores except WOMAC stiffness, with the fixed equinus group significantly worse (36.9 vs 25.6, p=0.0014). Final PROMS score, change from baseline and patient satisfaction was the same in all domains for both groups. There was no difference in revision rates. Conclusion: A pre-operative fixed equinus deformity does not negatively impact on clinical outcomes in patients undergoing TAA. We are not aware of any previous studies to compare results. As expected the equinus group showed higher levels of stiffness pre-operatively. Contrary to the British NJR dataset we did not find a difference in revision rates.

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High-Density Autologous Chondrocyte Implantation as Treatment for Ankle Osteochondral Defects

Cartilage ◽

10.1177/1947603519835898 ◽

2019 ◽

pp. 194760351983589 ◽

Cited By ~ 3

Author(s):

Juan Manuel López-Alcorocho ◽

Isabel Guillén-Vicente ◽

Elena Rodríguez-Iñigo ◽

Ramón Navarro ◽

Rosa Caballero-Santos ◽

...

Keyword(s):

Cartilage Repair ◽

Autologous Chondrocyte Implantation ◽

Histological Study ◽

High Density ◽

Osteochondral Lesions ◽

Type I ◽

Cartilage Lesions ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

Purpose Two-year follow-up to assess efficacy and safety of high-density autologous chondrocyte implantation (HD-ACI) in patients with cartilage lesions in the ankle. Design Twenty-four consecutive patients with International Cartilage repair Society (ICRS) grade 3-4 cartilage lesions of the ankle were included. Five million chondrocytes per cm2 of lesion were implanted using a type I/III collagen membrane as a carrier and treatment effectiveness was assessed by evaluating pain with the visual analogue scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at baseline, 12-month, and 24-month follow-up, together with dorsal and plantar flexion. Magnetic resonance observation for cartilage repair tissue (MOCART) score was used to evaluate cartilage healing. Histological study was possible in 5 cases. Results Patients’ median age was 31 years (range 18-55 years). Median VAS score was 8 (range 5-10) at baseline, 1.5 (range 0-8) at 12-month follow-up, and 2 (rang e0-5) at 24-month follow-up ( P < 0.001). Median AOFAS score was 39.5 (range 29-48) at baseline, 90 (range 38-100) at 12-month follow-up, and 90 (range 40-100) at 24-month follow-up ( P < 0.001). Complete dorsal flexion significantly increased at 12 months (16/24, 66.7%) and 24 months (17/24, 70.8%) with regard to baseline (13/24, 54.2%) ( P = 0.002). MOCART at 12- and 24-month follow-ups were 73.71 ± 15.99 and 72.33 ± 16.21. Histological study confirmed that neosynthetized tissue was cartilage with hyaline extracellular matrix and numerous viable chondrocytes. Conclusion HD-ACI is a safe and effective technique to treat osteochondral lesions in the talus, providing good clinical and histological results at short- and mid-term follow-ups.

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Fresh Osteochondral Allograft Transplantation for Fractures of the Knee

Cartilage ◽

10.1177/1947603516657640 ◽

2016 ◽

Vol 8 (2) ◽

pp. 155-161 ◽

Cited By ~ 9

Author(s):

Guilherme C. Gracitelli ◽

Luis Eduardo Passarelli Tirico ◽

Julie C. McCauley ◽

Pamela A. Pulido ◽

William D. Bugbee

Keyword(s):

Treatment Option ◽

Femoral Condyle ◽

International Knee Documentation Committee ◽

Salvage Treatment ◽

Osteochondral Allograft ◽

Successful Outcome ◽

Osteochondral Lesions ◽

Knee Fracture ◽

Fresh Osteochondral Allograft

Objective The purpose of this study was to evaluate functional outcomes and allograft survivorship among patients with knee fracture who underwent fresh osteochondral allograft (OCA) transplantation as a salvage treatment option. Design Retrospective analysis of prospectively collected data. Setting Department of Orthopaedic Surgery at one hospital. Patients Fresh OCAs were implanted for osteochondral lesions after knee fracture in 24 males and 15 females with an average age of 34 years. Twenty-nine lesions (74%) were tibial plateau fractures, 6 (15%) were femoral condyle fractures, and 4 (10%) were patella fractures. Main Outcome Measurements Clinical evaluation included modified Merle d’Aubigné-Postel (18-point), International Knee Documentation Committee, and Knee Society function scores, and patient satisfaction. Failure of OCA was defined as revision OCA or conversion to total knee arthroplasty (TKA). Results Nineteen of 39 knees (49%) had further surgery. Ten knees (26%) were considered OCA failures (3 OCA revisions, 6 TKA, and 1 patellectomy). Survivorship of the OCA was 82.6% at 5 years and 69.6% at 10 years. Among the 29 knees (74%) that had the OCA still in situ, median follow-up was 6.6 years. Pain and function improved from preoperative to latest follow-up; 83% of patients reported satisfaction with OCA results. Conclusion OCA transplantation is a useful salvage treatment option for osteochondral lesions caused by knee fracture. Although the reoperation rate was high, successful outcome was associated with significant clinical improvement.

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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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