Osteochondral Allograft Transplants for Large Oval Defects of the Medial Femoral Condyle: Comparison of Lateral vs. Medial Femoral Condyle Donors and Single vs. Double Plug Constructs

Background: Spontaneous osteonecrosis of the knee (SONK) is a clinical entity identified by acute knee pain usually associated with joint effusion, with radiographic findings of a radiolucent defect on the weightbearing area of the femoral condyle. Conservative treatment is initially undertaken; however, surgical procedures are often necessary. Historically, surgical options have included core decompression, cartilage repair, high tibial osteotomy, or joint arthroplasty. Few studies in the literature have reported the use of fresh osteochondral allograft (OCA) for the treatment of SONK lesions. Hypothesis: OCA transplantation is an effective treatment for SONK lesions on the medial femoral condyle. Study Design: Case series; Level of evidence, 4. Methods: A case series was analyzed of 7 patients treated with OCA for large SONK lesions of the medial femoral condyle with a minimum 4-year follow-up. All patients experienced failure of at least 6 months of conservative treatment and declined arthroplasty as the form of definitive treatment for medial femoral condyle lesion. All patients underwent OCA of the medial femoral condyle. Mean lesion size was 4.6 cm2 (range, 3.24-6.25 cm2), with a mean condylar width of 41.7 mm (range, 35.4-48.6 mm), resulting in a median proportion (lesion size/condylar width) of 56.8% (range, 32.7%-62.6%). The median surface allograft area was 5.1 cm2 (range, 3.2-6.3 cm2). Results: The median follow-up was 7.1 years (range, 4.5-14.1 years). No patient had additional surgery following OCA transplant; the allograft failure rate was 0%. Subjective outcome scores from the International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, and modified Merle d’Aubigné-Postel scale improved from preoperative assessment to the latest follow-up. All patients were extremely satisfied with the results of the OCA transplant. Conclusion: Fresh OCA transplantation demonstrated excellent efficacy, durability, and satisfaction in this group of patients with isolated stage 2 and 3 SONK lesions who had experienced failure of conservative treatment. Fresh osteochondral allografts are an attractive method for surgical management of selected patients with spontaneous osteonecrosis of the knee.

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Return to Sport Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation

The American Journal of Sports Medicine ◽

10.1177/0363546520920626 ◽

2020 ◽

Vol 48 (8) ◽

pp. 1945-1952 ◽

Cited By ~ 1

Author(s):

Joseph N. Liu ◽

Avinesh Agarwalla ◽

David R. Christian ◽

Grant H. Garcia ◽

Michael L. Redondo ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Femoral Condyle ◽

Varus Deformity ◽

Medial Femoral Condyle ◽

Osteochondral Allograft ◽

Return To Sports ◽

Tibial Osteotomy ◽

Allograft Transplantation ◽

Chondral Defects

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

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Contralateral Lateral Femoral Condyle Allografts Provide an Acceptable Surface Match for Simulated Classic Osteochondritis Dissecans Lesions of the Medial Femoral Condyle

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119898413 ◽

2020 ◽

Vol 8 (1) ◽

pp. 232596711989841

Author(s):

Nabeel Salka ◽

John A. Grant

Keyword(s):

Osteochondritis Dissecans ◽

Femoral Condyle ◽

Random Order ◽

Medial Femoral Condyle ◽

Lateral Femoral Condyle ◽

Osteochondral Allograft ◽

Effective Technique ◽

Percentage Area ◽

Surface Deviation ◽

Fresh Frozen

Background: Osteochondral allograft transplantation is an effective technique for repairing large lesions of the medial femoral condyle (MFC), but its use is limited by graft availability. Purpose/Hypothesis: The present study aimed to determine whether contralateral lateral femoral condyle (LFC) allografts can provide an acceptable surface match for posterolateral MFC lesions characteristic of classic osteochondritis dissecans (OCD). The hypothesis was that LFC and MFC allografts will provide similar surface contour matches in all 4 quadrants of the graft for posterolateral MFC lesions characteristic of OCD. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen recipient human MFCs were each size-matched to 1 ipsilateral medial and 1 contralateral LFC donor (N = 30 condyles). After a nano–computed tomography (nano-CT) scan of the native recipient condyle, a 20-mm circular osteochondral “defect” was created 1 cm posterior and 1 cm medial to the roof of the intercondylar notch (n = 10). A size-matched, random-order donor MFC or LFC plug was then harvested, transplanted, and scanned with nano-CT. Nano-CT scans were then reconstructed, registered to the initial scan of the recipient MFC, and processed in MATLAB to determine the height deviation ( d RMS) between the native and donor surfaces and percentage area unacceptably (>1 mm) proud (% A proud) and sunken (% A sunk). Circumferential step-off height ( h RMS) and percentage circumference unacceptably (>1 mm) proud (% C proud) and sunken (% C sunk) were measured using DragonFly software. The process was then repeated for the other allograft plug. Results: Both MFC and LFC plugs showed acceptable step-off heights in all 4 quadrants (range, 0.53-0.94 mm). Neither allograft type nor location within the defect had a significant effect on step-off height ( h RMS), surface deviation ( d RMS), % A proud, or % A sunk. In general, plugs were more unacceptably sunken than proud (MFC, 13.4% vs 2.4%; LFC, 13.2% vs 8.1%), although no significant differences in % C sunk were seen between allograft types or locations within the defect. In LFC plugs, % C proud in the lateral quadrant (28.0% ± 26.1%) was significantly greater compared with all other quadrants ( P = .0002). Conclusion: The present study demonstrates that 20-mm contralateral LFC allografts provide an acceptable surface match for posterolateral MFC lesions characteristic of OCD. Clinical Relevance: With comparable surface matching, MFC and LFC allografts can be expected to present similar stresses on the knee joint and achieve predictably positive clinical outcomes, thus improving donor availability and reducing surgical wait times for matches.

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Osteochondral Allograft Transplant to the Medial Femoral Condyle Using a Medial or Lateral Femoral Condyle Allograft

The American Journal of Sports Medicine ◽

10.1177/0363546514540446 ◽

2014 ◽

Vol 42 (9) ◽

pp. 2205-2213 ◽

Cited By ~ 20

Author(s):

Timothy S. Mologne ◽

Esther Cory ◽

Bradley C. Hansen ◽

Angela N. Naso ◽

Neil Chang ◽

...

Keyword(s):

Femoral Condyle ◽

Medial Femoral Condyle ◽

Lateral Femoral Condyle ◽

Osteochondral Allograft

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Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure

Cartilage ◽

10.1177/1947603517710307 ◽

2017 ◽

Vol 9 (3) ◽

pp. 248-254 ◽

Cited By ~ 15

Author(s):

Albert C. Hsu ◽

Luis E. P. Tirico ◽

Abraham G. Lin ◽

Pamela A. Pulido ◽

William D. Bugbee

Keyword(s):

High Tibial Osteotomy ◽

Femoral Condyle ◽

Case Series ◽

International Knee Documentation Committee ◽

Clinical Results ◽

Medial Femoral Condyle ◽

Osteochondral Allograft ◽

Tibial Osteotomy ◽

Opening Wedge

Objective To evaluate the outcome of patients who have undergone simultaneous osteotomy and osteochondral allograft (OCA) transplantation. Our hypothesis is that use of high tibial osteotomy and fresh OCA in a combined procedure is safe and effective without increasing morbidity in comparison to OCA alone. Design A case series of 17 patients underwent tibial osteotomy and simultaneous OCA during a single surgery. Osteotomy was indicated when axial alignment was within the affected compartment. Patients had a minimum of 2 years of follow-up after surgery. The mean graft size was 8.7 cm2, with 82% located on the medial femoral condyle alone and 18% involving the medial femoral condyle and one or more other sites. Data collection included demographics, osteotomy correction, graft site(s) and area, and clinical evaluation. Failure was defined as conversion to arthroplasty. Results Two of 17 patients (12%) failed at a mean of 9.3 years. The remaining 15 patients (88%) had intact allografts with mean survival of 8.1 years (SD 3.3). Five patients (29%) had an additional procedure, all undergoing osteotomy hardware removal. Of those with surviving allografts, mean pain and function scores improved significantly from the preoperative to postoperative assessment and International Knee Documentation Committee total scores improved significantly from 40.9 ± 15.4 preoperative to 75.5 ± 24.0 at latest follow-up ( P = 0.003); 92% of patients were satisfied with the results of the surgery. No postoperative complications occurred. Conclusion Combining high tibial osteotomy and OCA in properly selected patients is safe and effective.

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