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]

Osteochondral Allograft Transplantation in the Patellofemoral Joint: A Systematic Review

2018 ◽  
Vol 47 (12) ◽  
pp. 3009-3018 ◽  
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.

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 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.

Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

2017 ◽  
Vol 39 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Samuel B. Adams ◽  
Travis J. Dekker ◽  
Adam P. Schiff ◽  
Christopher P. Gross ◽  
James A. Nunley ◽  
...  
Keyword(s):  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Salvage Procedure ◽  
Prospective Evaluation ◽  
Allograft Transplantation ◽  
Structural Allograft ◽  
Additional Surgery ◽  
Sf 36 ◽  
Patient Reported

Background: Structural or bulk osteochondral allograft transplantation for shoulder talar osteochondral lesions as a salvage procedure has demonstrated efficacy in several retrospective reviews. The purpose of this study was to evaluate prospectively patients who received fresh structural allograft transplantation to the talus. Methods: Prospective evaluation of a consecutive series of patients who underwent fresh structural allograft transplantation for an osteochondral lesion of the talus (OLT) was performed. Preoperative magnetic resonance imaging (MRI) and/or computed tomography (CT) and plain radiographs were obtained on all patients. The following patient-reported outcomes questionnaires were administered preoperatively and yearly after surgery: 100-mm visual analog scale (VAS) pain scale, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Short Form 36 (SF-36), and the Short Musculoskeletal Functional Assessment (SMFA). Preoperative and postoperative radiographs were assessed for allograft incorporation and subsequent arthritis. Fourteen patients with an average age of 40 years (range, 18-69) and a mean follow-up of 55 months (range, 24-97) underwent structural fresh osteochondral allograft transplantation to the talar shoulder. Results: The average size of the OLT was 2269 mm3 (range, 813-8366) based on CT imaging and 5797 mm3 (range, 1136-12 489) based on MRI imaging. There was significant ( P < .05) improvement in the VAS pain, AOFAS scale, SF-36, and SMFA scores. Five (36%) of the patients required additional surgery for pain and stiffness. Two patients had cartilage delamination and were considered treatment failures. Therefore, the success rate was 86% (12/14). Conclusion: Significant improvement in pain and function was achieved with structural allograft transplantation for large OLTs at midterm follow-up. This was a safe and effective treatment option in this small series for large OLTs. Level of Evidence: Level IV, prospective case series.

scholarly journals Fresh Osteochondral Allograft Transplantation for Fractures of the Knee

Cartilage ◽  
2016 ◽  
Vol 8 (2) ◽  
pp. 155-161 ◽  
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.

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

Clinical Outcomes and Failure Rates of Osteochondral Allograft Transplantation in the Knee: A Systematic Review

2017 ◽  
Vol 46 (14) ◽  
pp. 3541-3549 ◽  
Author(s):  
Filippo Familiari ◽  
Mark E. Cinque ◽  
Jorge Chahla ◽  
Jonathan A. Godin ◽  
Morten Lykke Olesen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Survival Rate ◽  
Clinical Outcomes ◽  
Survival Rates ◽  
Osteochondral Allograft ◽  
Failure Rates ◽  
Weighted Mean ◽  
Chondral Defects ◽  
The Mean

Background: Cartilage lesions are a significant cause of morbidity and impaired knee function; however, cartilage repair procedures have failed to reproduce native cartilage to date. Thus, osteochondral allograft (OCA) transplantation represents a 1-step procedure to repair large chondral defects without the donor site morbidity of osteochondral autograft transplantation. Purpose: To perform a systematic review of clinical outcomes and failure rates after OCA transplantation in the knee at a minimum mean 2 years’ 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 transplantation in the knee joint was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1980 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCAs for the treatment of chondral defects in the knee joint, English language, mean follow-up of 2 years and minimum follow-up of 18 months, minimum study size of 20 patients, and human studies. The methodological quality of each study was assessed using a modified version of the Coleman methodology score. Results: The systematic search identified 19 studies with a total of 1036 patients. The mean 5-year survival rate across the studies included in this review was 86.7% (range, 64.1%-100.0%), while the mean 10-year survival rate was 78.7% (range, 39.0%-93.0%). The mean survival rate was 72.8% at 15 years (range, 55.8%-84.0%) and 67.5% at 20 years (range, 66.0%-69.0%). The weighted mean patient age was 31.5 years (range, 10-82 years), and the weighted mean follow-up was 8.7 years (range, 2-32 years). The following outcome measures showed significant improvement from preoperatively to postoperatively: d’Aubigné-Postel, International Knee Documentation Committee, Knee Society function, and Lysholm scores. The weighted mean reoperation rate was 30.2% (range, 0%-63%). The weighted mean failure rate was 18.2% (range, 0%-31%). Of note, revision cases, patellar lesions, and bipolar lesions demonstrated worse survival rates. Conclusion: Improved patient-reported outcomes can be expected after OCA transplantation, with a survival rate of 78.7% at 10 years. Revision cases, patellar lesions, and bipolar lesions were associated with worse survival rates; therefore, utilization of the most appropriate index cartilage restoration procedure and proper patient selection are key to improving results.

scholarly journals Penetrating keratoplasty in children under 3 years old with congenital corneal opacities

2022 ◽  
Vol 15 (1) ◽  
pp. 45-51
Author(s):  
Made Susiyanti ◽  
◽  
Florence M. Manurung ◽  
Keyword(s):  
Visual Acuity ◽  
Survival Rate ◽  
Graft Survival ◽  
Penetrating Keratoplasty ◽  
Graft Survival Rate ◽  
Wilcoxon Test ◽  
Corneal Surgery ◽  
Visual Outcomes ◽  
Corneal Opacities

AIM: To evaluate the graft rejection and visual outcomes after penetrating keratoplasty (PK) in the presence of various congenital corneal opacities in children. METHODS: In this retrospective cohort study, children who underwent PK were then followed for 5y. The patient's medical records were collected from June 2014 until June 2019 and analyzed in December 2019. All patients were children under three years old with congenital corneal opacities with or without microcornea who came to a pediatric ophthalmologist and underwent PK in Jakarta Eye Center (JEC). Beforehand, all children have participated in a thorough evaluation for PK. In the case of severe microcornea was not advised to undergo surgery. The visual outcomes and graft survival rate were described in percentages. The graft survival plot was presented with Kaplan-Meier, while the visual acuity was analyzed using the Wilcoxon signed ranks test. RESULTS: Sixteen eyes from eleven patients (seven girls and four boys) underwent PK. The graft survival rate of the first 6, 12, and 18 mo later of keratoplasty was 100%, 83.3%, and 66.7%, respectively. The overall mean survival time is 22mo (standard error 2.419), and no significant difference between the patients underwent PK before and after 36mo of their age (P=0.52). The graft failure was 50%, and post-surgery complications included cataract 43.7%, band keratopathy 12.5%, and scleromalasia 6.25%. Wilcoxon test analysis of visual acuity post keratoplasty was not statistically significant (P=0.34), while overall showed 44% improvements of visual outcome for 5y of follow-up. With a good survival at one year up to 22mo (83.3%), the visual acuity could be achieved (63%), and showed improvements (44%) during follow-up. CONCLUSION: The complications are frequent for pediatric PK. Thus, corneal surgery on infants requires careful case selection, adequate pre-operative evaluation, skilled surgery (optical correction), very close cooperation family–physician, intensive post-operation care, and amblyopia management in the future.

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