scholarly journals Outcomes Associated With Osteochondral Allograft Transplantation in Dogs

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.

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

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0015
Author(s):  
Francesca R. Coxe ◽  
Dean Wang ◽  
George Christian Balazs ◽  
Brenda Chang ◽  
Kristofer J. Jones ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Graft Failure ◽  
Femoral Condyle ◽  
Long Term Results ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Allograft Transplantation

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.

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 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]

scholarly journals Osteochondral Allograft Transplantation for Treatment of Medial Femoral Condyle Defect

2017 ◽  
Vol 6 (4) ◽  
pp. e1239-e1244 ◽  
Author(s):  
Jonathan A. Godin ◽  
George Sanchez ◽  
Mark E. Cinque ◽  
Jorge Chahla ◽  
Nicholas I. Kennedy ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Allograft Transplantation

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

Cartilage ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. 214-221 ◽  
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.

scholarly journals Bipolar Fresh Osteochondral Allograft Transplantation and Joint Reconstruction for Patellar and Trochlear Cartilage Defects

2019 ◽  
Vol 8 (12) ◽  
pp. e1533-e1541
Author(s):  
Omid Jalali ◽  
Zachary Vredenburgh ◽  
John Prodromo ◽  
Neilen Benvegnu ◽  
George Frederick “Rick” Hatch
Keyword(s):  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Joint Reconstruction ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft

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.

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