scholarly journals Fresh Allograft Replacement for Osteochondral Lesions of the Talus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0013
Author(s):  
Samuel Adams ◽  
Nicholas Allen ◽  
James Nunley ◽  
Mark Easley
Keyword(s):  
Surface Roughness ◽  
Cartilage Repair ◽  
Subchondral Bone ◽  
Bone Destruction ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Normal Cartilage ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft ◽  
Osteochondral Allografts

Category: Basic Sciences/Biologics Introduction/Purpose: Large osteochondral lesion of the talus (OLT) can be difficult to treat. Although many treatment options exist, fresh osteochondral allograft transplantation has demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement as well as a secondary treatment option after failure of other cartilage repair techniques. Fresh osteochondral allografts are size-matched from organ donors and, in theory, have healthy articular cartilage and bone. However, the quality of allograft cartilage and bone has never been examined with respect to the OLT cartilage and bone being replaced. The purpose of this study was to perform a matched comparison of the cartilage and bone from patients OLTs to the fresh osteochondral allograft replacement. Methods: Discarded intact osteochondral specimens were collected from 8 patients undergoing surgery for an OLT. The specimens included the excised OLT and a portion of the fresh allograft replacement that the same patient received at the time of surgery. Histologic analysis was performed. The safranin-o histology was then scored using the International Cartilage Repair Society (ICRS) histopathology grading and staging system. In this system the grade determines cartilage and bone destruction on a scale of 0 to 6.5, the stage determines the percentage of involvement in the specimen on a scale of 0 to 4, and the total score is the grade multiplied by the stage. The surface roughness was also compared between the OLT and allograft cartilage using ImageJ software (NIH). Paired t-tests were performed on the ICRS grade, stage, and total score, and surface roughness comparing the OLTs and allografts. Significance was set at p<0.05. Results: Gross histological inspection of the samples demonstrated cartilage erosion and subchondral bone destruction in the OLTs. In constrast, the osteochondral allografts demonstrated intact cartilage surface and normal subchondral bone in the allografts (Figure 1). The ICRS grade, stage, and total score were significantly higher in the implanted allografts compared to the resected OLTs (Figure 2); indicating better cartilage and bone morphology for the allografts compared to the OLTs. In fact, the mean grade and stage for the allograft samples were both less than a score of 1 which corresponds to healthy cartilage and bone with less than 10% surface fibrillations. Moreover, the surface roughness of the allograft cartilage was significantly smoother than the OLT cartilage. Conclusion: This is the first study to demonstrate that the use of fresh allograft transplantation for the treatment of OLTs replaces the damaged cartilage and bone with normal or near normal cartilage and bone. The replacement of damaged cartilage and subchondral bone with normal or near normal cartilage and bone may be the reason for improved pain relief and functional outcomes after fresh allograft transplantation for OLTs.

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]

Fresh Osteochondral Allograft Transplantation for Bipolar Reciprocal Osteochondral Lesions of the Knee

2015 ◽  
Vol 43 (3) ◽  
pp. 709-714 ◽  
Author(s):  
Gokhan Meric ◽  
Guilherme C. Gracitelli ◽  
Simon Görtz ◽  
Allison J. De Young ◽  
William D. Bugbee
Keyword(s):  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft

Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation

2018 ◽  
Vol 46 (4) ◽  
pp. 900-907 ◽  
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.

Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus

2020 ◽  
pp. 107110072094986
Author(s):  
Chung-Hua Chu ◽  
Ing-Ho Chen ◽  
Kai-Chiang Yang ◽  
Chen-Chie Wang
Keyword(s):  
Short Form ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Midterm Results ◽  
Level Of Evidence ◽  
Allograft Transplantation ◽  
Fresh Frozen ◽  
The Mean

Background: Osteochondral lesions of the talus (OLT) are relatively common. Following the failure of conservative treatment, many operative options have yielded varied results. In this study, midterm outcomes after fresh-frozen osteochondral allograft transplantation for the treatment of OLT were evaluated. Methods: Twenty-five patients (12 women and 13 men) with a mean age 40.4 (range 18-70) years between 2009 and 2014 were enrolled. Of 25 ankles, 3, 13, 4, and 4 were involved with the talus at Raikin zone 3, 4, 6, and 7 as well as one coexisted with zone 4 and 6 lesion. The mean OLT area was 1.82 cm2 (range, 1.1-3.0). The mean follow-up period was 5.5 years (range, 4-9.3). Outcomes evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale score, and 12-item Short Form Health Survey (SF-12). Result: AOFAS ankle-hindfoot score increased from 74 preoperatively to 94 at 2 years postoperatively ( P < .001) and the SF-12 physical health component scores increased from 32 to 46 points ( P < .001). Incorporation was inspected in all patients in the latest follow-up, and graft subsidence and radiolucency were observed in 2 and 7 cases, respectively, whereas graft collapse and revision OLT graft were not observed. Bone sclerosis was found in 6 of 25 patients. Conclusion: With respect to midterm results, fresh, frozen-stored allograft transplantation might be an option in the management of symptomatic OLT. Level of Evidence: Level IV, retrospective case series.

scholarly journals Development of a Fresh Osteochondral Allograft Program Outside North America

Cartilage ◽  
2015 ◽  
Vol 7 (3) ◽  
pp. 222-228 ◽  
Author(s):  
Luís Eduardo Passarelli Tírico ◽  
Marco Kawamura Demange ◽  
Luiz Augusto Ubirajara Santos ◽  
Márcia Uchoa de Rezende ◽  
Camilo Partezani Helito ◽  
...  
Keyword(s):  
Culture Media ◽  
International Knee Documentation Committee ◽  
Osteochondral Allograft ◽  
Tissue Banks ◽  
Transplant Program ◽  
Process Modification ◽  
Fresh Osteochondral Allograft ◽  
Tissue Contamination ◽  
Osteochondral Allografts

Objective To standardize and to develop a fresh osteochondral allograft protocol of procurement, processing and surgical utilization in Brazil. This study describes the steps recommended to make fresh osteochondral allografts a viable treatment option in a country without previous fresh allograft availability. Design The process involves regulatory process modification, developing and establishing procurement, and processing and surgical protocols. Results Legislation: Fresh osteochondral allografts were not feasible in Brazil until 2009 because the law prohibited preservation of fresh grafts at tissue banks. We approved an amendment that made it legal to preserve fresh grafts for 30 days from 2°C to 6°C in tissue banks. Procurement: We changed the protocol of procurement to decrease tissue contamination. All tissues were procured in an operating room. Processing: Processing of the grafts took place within 12 hours of tissue recovery. A serum-free culture media with antibiotics was developed to store the grafts. Surgeries: We have performed 8 fresh osteochondral allografts on 8 knees obtaining grafts from 5 donors. Mean preoperative International Knee Documentation Committee (IKDC) score was 31.99 ± 13.4, improving to 81.26 ± 14.7 at an average of 24 months’ follow-up. Preoperative Knee Injury and Oseoarthritis Outcome Score (KOOS) score was 46.8 ± 20.9 and rose to 85.24 ± 13.9 after 24 months. Mean preoperative Merle D’Aubigne-Postel score was 8.75 ± 2.25 rising to 16.1 ± 2.59 at 24 months’ follow-up. Conclusion To our knowledge, this is the first report of fresh osteochondral allograft transplantation in South America. We believe that this experience may be of value for physicians in countries that are trying to establish an osteochondral allograft transplant program.

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