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

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.

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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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Clinical Outcomes of Multiple Osteochondral Allograft Transplantation of the Knee: An Analysis of Snowman Technique and Multifocal Lesions

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00093 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0009 ◽

Cited By ~ 1

Author(s):

Eric J. Cotter ◽

Charles P. Hannon ◽

Drew A. Lansdown ◽

Rachel M. Frank ◽

Brian Robert Waterman ◽

...

Keyword(s):

Clinical Outcomes ◽

Short Form ◽

Femoral Condyle ◽

Survival Rates ◽

International Knee Documentation Committee ◽

High Rate ◽

Osteochondral Allograft ◽

Allograft Transplantation ◽

Rate Of Failure

Objectives: To report the clinical outcomes of snowman technique osteochondral allograft transplantation (OCA) and clinical outcomes of multifocal OCA. Methods: Consecutive patients who underwent either a primary snowman OCA or multifocal (i.e. bipolar patellofemoral, patellofemoral and a condyle or bicondylar) with a minimum 2-year follow-up by a single surgeon from 4/2003 to 4/2015 were isolated. Failure was defined as revision OCA, conversion to arthroplasty, or gross appearance of graft degeneration on 2nd look arthroscopy. Results: Twenty-six patients (28 knees) were isolated with 22 patients (24 knees; 85.7%) having 2-year clinical follow-up. Nine of 11 patients (81.8%) who underwent isolated condylar snowman allografts met inclusion criteria at mean follow-up of 7.4±3.6 years, while 13 additional patients (15 knees; 88.2%) underwent multifocal OCA at mean follow-up of 6.4±3.9 years. All 9 patients who received isolated snowman OCA were to the medial femoral condyle. Reoperations were common with 44.4% (N=4) of the snowman group and 20% of multifocal OCA (N=3) undergoing at least 1 reoperation. There were 3 failures (33.3%) in the snowman technique group at a mean 7.7±5.5 years and 1 failure in the multifocal OCA group at 4.5 years. All 4 failures underwent TKA. Patients who underwent multifocal OCA demonstrated significant improvements in the International Knee Documentation Committee score, Knee Injury and Osteoarthritis subscores, Western Ontario and McMaster Universities Osteoarthritis Index subscores, and the Short-Form-12 physical component (P <0.05 for all). Patients who underwent snowman OCA demonstrated significant improvement in KOOS pain subscore and WOMAC overall scores (P<0.05 for both) Table 1]. Conclusion: While in a small cohort, patients who underwent snowman OCA had a high rate of reoperation (44.4%) and a high rate of failure (33.3%). Comparatively, patients who underwent multifocal OCA had reoperation and graft survival rates comparable to published literature for focal OCA. [Table: see text]

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Midterm Safety of Carbon Dioxide Insufflation of the Knee During Arthroscopic Cartilage–Based Procedures

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211035454 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110354

Author(s):

Judson L. Penton ◽

Travis R. Flick ◽

Felix H. Savoie ◽

Wendell M. Heard ◽

William F. Sherman

Keyword(s):

Carbon Dioxide ◽

Clinical Outcomes ◽

Electronic Medical Records ◽

Medical Records ◽

Knee Arthroscopy ◽

Case Series ◽

Osteochondral Allograft ◽

Systemic Complications ◽

Allograft Transplantation

Background: When compared with fluid arthroscopy, carbon dioxide (CO2) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon’s view. Despite the advantages of CO2 insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety. Purpose/Hypothesis: To investigate the safety profile of CO2 insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO2 insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field. Study Design: Case series; level of evidence, 4. Methods: A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO2 insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO2 insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients’ electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes. Results: We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO2 insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema. Conclusion: The results of this case series suggest CO2 insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.

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

Cartilage ◽

10.1177/1947603518754630 ◽

2018 ◽

Vol 10 (2) ◽

pp. 214-221 ◽

Cited By ~ 5

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.

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Osteochondral allograft transplantation for large Hill-Sachs lesions: a retrospective case series with a minimum 2-year follow-up

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1366-8 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Hongwu Zhuo ◽

Yangkai Xu ◽

Fugui Zhu ◽

Ling Pan ◽

Jian Li

Keyword(s):

Clinical Outcomes ◽

Case Series ◽

Osteochondral Allograft ◽

Satisfaction Rate ◽

Allograft Transplantation ◽

Constant Murley Score ◽

Significant Difference ◽

The Mean ◽

Graft Resorption

Abstract Purpose To investigate the clinical outcomes after osteochondral allograft transplantation for large Hill-Sachs lesions. Methods Patients who underwent osteochondral allograft transplantation for large Hill-Sachs lesions were identified. Clinical assessment consisted of active range of motion (ROM), American Shoulder and Elbow Surgeons score (ASES), Constant-Murley score, Rowe score, and patient satisfaction rate. Radiographic assessment was performed with CT scan. Results Nineteen patients met the inclusion criteria. The mean age was 21.7 years. The mean preoperative size of the Hill-Sachs lesion was 35.70 ± 3.02%. The mean follow-up was 27.8 months. All grafts achieved union at an average of 3.47 months after surgery. At the final follow-up, graft resorption was observed in 43.1% of patients. The average size of residual humeral head articular arc loss was 12.31 ± 2.79%. Significant improvements (P < .001) were observed for the active ROM, ASES score, Constant-Murley score, and Rowe score. The overall satisfaction rate was 94.7%. No significant difference was found between the resorption group and the nonresorption group in postoperative clinical outcomes. Conclusion Osteochondral allograft transplantation is a useful treatment option for patients with large Hill-Sachs lesions. Although the incidence of graft resorption may be relatively high, the clinical outcomes at a minimum 2-year follow-up are favorable. Level of evidence Level IV, case series

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Midterm and Long-term Results of Medial Versus Lateral Meniscal Allograft Transplantation: A Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546517709777 ◽

2017 ◽

Vol 46 (5) ◽

pp. 1243-1250 ◽

Cited By ~ 21

Author(s):

Seong-Il Bin ◽

Kyung-Wook Nha ◽

Ji-Young Cheong ◽

Young-Soo Shin

Keyword(s):

Clinical Outcomes ◽

Meta Analysis ◽

Survival Rates ◽

Long Term Results ◽

Functional Improvement ◽

Meniscal Allograft Transplantation ◽

Allograft Transplantation ◽

Meniscal Allograft

Background: It is unclear whether lateral meniscal allograft transplantation (MAT) procedures lead to better clinical outcomes than medial MAT. Hypothesis: The survival rates are similar between medial and lateral MAT, but the clinical outcomes of lateral MAT are better than those of medial MAT at final follow-up. Study Design: Meta-analysis. Methods: In this meta-analysis, we reviewed studies that assessed survival rates in patients who underwent medial or lateral MAT with more than 5 years of follow-up and that used assessments such as pain and Lysholm scores to compare postoperative scores on knee outcome scales. The survival time was considered as the time to conversion to knee arthroplasty and/or subtotal resection of the allograft. Results: A total of 9 studies (including 287 knees undergoing surgery using medial MAT and 407 with lateral MAT) met the inclusion criteria and were analyzed in detail. The proportion of knees in which midterm (5-10 years) survival rates (medial, 97/113; lateral, 108/121; odds ratio [OR] 0.71; 95% CI, 0.31-1.64; P = .42) and long-term (>10 years) survival rates (medial, 303/576; lateral, 456/805; OR 0.78; 95% CI, 0.52-1.17; P = .22) were evaluated did not differ significantly between medial and lateral MAT. In addition, both groups had substantial proportions of knees exhibiting midterm survivorship (85.8% for medial MAT and 89.2% for lateral MAT) but much lower proportions of knees exhibiting long-term survivorship (52.6% for medial MAT and 56.6% for lateral MAT). In contrast, overall pain score (medial, 65.6 points; lateral, 71.3 points; 95% CI, −3.95 to −0.87; P = .002) and Lysholm score (medial, 67.5 points; lateral, 72.0 points; 95% CI, −10.17 to −3.94; P < .00001) were significantly higher for lateral MAT compared with medial MAT. Conclusion: Meta-analysis indicated that 85.8% of medial and 89.2% of lateral meniscal allograft transplants survive at midterm (5-10 years) while 52.6% of medial and 56.6% of lateral meniscal allograft transplants survive long term (>10 years). Patients undergoing lateral meniscal allograft transplantation demonstrated greater pain relief and functional improvement than patients undergoing medial meniscal allograft transplantations.

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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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Clinical Outcomes of ProChondrix® Osteochondral Allograft in the Knee: A Case Series

10.21203/rs.3.rs-625313/v1 ◽

2021 ◽

Author(s):

Michael S. Barnum ◽

Evan D. Boyd ◽

Annabelle P. Davey ◽

Andrew Slauterbeck ◽

James R. Slauterbeck

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Cartilage Defect ◽

Femoral Condyle ◽

Case Series ◽

Activity Level ◽

Osteochondral Allograft ◽

Cartilage Restoration ◽

Patient Reported

Abstract PurposeFocal articular cartilage injuries are common and may lead to progression of osteoarthritis. The complications associated with traditional treatment strategies have influenced the development of new biotechnologies, such as the ProChondrix® osteochondral allograft. Clinical evidence on the outcomes associated with ProChondrix® osteochondral allografts are limited. Thus, the primary purpose of this study was to evaluate the clinical outcomes following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant.MethodsRetrospective analysis of patients who underwent a cartilage restoration procedure using ProChondrix® osteochondral allograft has been performed. Patients completed patient-reported outcome surveys which included the Knee injury and Osteoarthritis Outcome Score (KOOS), consisting of the 5 subscales of Pain, Symptoms, Activities of Daily Living, Sports and Recreation, and Quality of Life, the Marx Activity Scale, and the visual analog pain scale.ResultsSix patients underwent a cartilage restoration procedure using ProChondrix® between January 2016 and December 2019. Three males and three females were included with a median age of 33.5 years (range 18–48 years). The median follow-up duration was 15 months (range 9–24 months). There were 4 patellar grafts, 1 medial femoral condyle graft, and 1 lateral femoral condyle graft, with a median defect size of 18.5mm (range 13-20mm). At the most recent clinical follow-up, all six patients were pain free and all patients had returned to pre-op activity level.ConclusionTo our knowledge, this is the first study to report the clinical outcome, activity level, and patient orientated outcomes in a case series of patients following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant. Our study demonstrates promising short-term results in patient reported clinical outcome scores.

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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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Osteochondral Allograft Transplantation in the Patellofemoral Joint: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546518814236 ◽

2018 ◽

Vol 47 (12) ◽

pp. 3009-3018 ◽

Cited By ~ 5

Author(s):

Jorge Chahla ◽

Matthew C. Sweet ◽

Kelechi R. Okoroha ◽

Benedict U. Nwachukwu ◽

Betina Hinckel ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Patellofemoral Joint ◽

Osteochondral Allograft ◽

Cochrane Central Register ◽

Failure Rates ◽

Allograft Transplantation ◽

Chondral Defects ◽

Patient Reported

Background: The initial focus of cartilage restoration algorithms has been on the femur; however, the patellofemoral compartment accounts for 20% to 30% of significant symptomatic chondral pathologies. While patellofemoral compartment treatment involves a completely unique subset of comorbidities, with a comprehensive and thoughtful approach many patients may benefit from osteochondral allograft treatment. Purpose: To perform a systematic review of clinical outcomes and failure rates after osteochondral allograft transplantation (OCA) of the patellofemoral joint at a minimum 18-month follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature regarding the existing evidence for clinical outcomes and failure rates of OCA for patellofemoral joint chondral defects was performed with the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1990 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCA for the treatment of chondral defects in the patellofemoral joint, English language, minimum follow-up of 18 months, minimum study size of 5 patients, and human studies. The methodological quality of each study was assessed with a modified version of the Coleman methodology score. Results: The systematic search identified 8 studies with a total of 129 patients. The methods of graft procurement and storage time included fresh (121 patients, 93.8%), and cryopreserved (8 patients, 6.2%) grafts. The mean survival rate was 87.9% at 5 years and 77.2% at 10 years. The following outcome scores showed significant improvement from pre- to postoperative status: modified d’Aubigné-Postel, International Knee Documentation Committee, Knee Society Score–Function, and Lysholm Knee Score. Conclusion: OCA of the patellofemoral joint results in improved patient-reported outcome measures with high patient satisfaction rates. Five- and 10-year survival rates of 87.9% and 77.2%, respectively, can be expected after this procedure. These findings should be taken with caution, as a high percentage of patellofemoral osteochondral allografts were associated with concomitant procedures; therefore, further research is warranted to determine the effect of isolated osteochondral transplantations.

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