Fresh osteochondral knee allograft

CASE: A 24-year-old competitive rower suffered a severe road injury to the medial aspect of his knee. He was referred to us for a partial joint transplantation consisting of a medial tibiofemoral fresh osteochondral allograft (FOCA), medial collateral ligament, meniscal allograft, and osteotomy. Two years after reconstruction, the patient won a bronze medal in the Summer Paralympics. At the 6-year follow-up, he demonstrates excellent clinical and radiographic outcomes and high satisfaction...

OBJECTIVE: The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. DESIGN: A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups...

BACKGROUND: Fresh osteochondral allograft transplantation (OCA) is an effective method of treating symptomatic cartilage defects of the knee. This restoration technique involves the single-stage implantation of viable, mature hyaline cartilage into a chondral or osteochondral lesion. The extent to which preoperative imaging and patient factors predict achieving clinically meaningful outcomes among patients undergoing OCA for cartilage lesions of the knee remains unknown. PURPOSE: To determine the predictive relationship of preoperative imaging, preoperative patient-reported outcome measures (PROMs), and patient demographics with achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for functional and quality-of-life PROMs at 2 years after OCA for symptomatic cartilage defects of the knee...

BACKGROUND: Osteochondral allografts (OA) kept fresh for a long time, are presented as a viable option for the treatment of large chondral and osteochondral lesions. GOALS: Chondrocyte viability decreases substantially when allografts are stored for more than 15 days. The objective of this work is to validate the viability and clinical and functional results of OA transplantation stored at 37°C in a cell culture medium, applied in cartilage defects of the knee, defining the means and limits of allograft storage, among 15 and 28 days after extraction...

Fresh osteochondral allograft transplantation has been my preferred procedure for chondral and osteochondral lesions for many decades. This is particularly true for patients younger than 18 years of age, where diagnoses such as osteochondritis dissecans, osteochondral fractures, and osteonecrosis predominate, rendering the situation as much a "bone problem" as a "cartilage problem." In the universe of cartilage-repair techniques, osteochondral allografts are particularly useful when bone defects must be managed...

BACKGROUND: Fresh osteochondral allograft transplantation (OCA) is an effective method of treating symptomatic cartilage defects of the knee. This cartilage restoration technique involves the single-stage implantation of viable, mature hyaline cartilage into the chondral or osteochondral lesion. Predictive models for reaching the clinically meaningful outcome among patients undergoing OCA for cartilage lesions of the knee remain under investigation. PURPOSE: To apply machine learning to determine which preoperative variables are predictive for achieving the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) at 1 and 2 years after OCA for cartilage lesions of the knee...

Osteochondral autograft transfer (OAT) allows for the treatment of focal chondral lesions of the femoral condyles. Patients undergoing OAT have been shown to have the greatest rate and quickest return to sport of any cartilage-restoration procedure. Disadvantages encountered with the OAT procedure include limited donor sources, small treatable lesion size, and donor-site morbidity. Here, we describe our preferred technique of open OAT with donor-site back-filling using precut fresh osteochondral allograft plugs and micronized extracellular cartilage augmentation...

AIM OF THE STUDY: To describe a new semiquantitative computed tomography (CT) scoring system for multi-feature analysis of cartilage defect repair by osteochondral allografts for the knee and to assess its intra-observer and inter-observer variability. METHOD: A semiquantitative assessment CT osteochondral allograft (ACTOCA) scoring system was designed based on fresh osteochondral allograft transplantations for the knee. The system includes five CT features: density relative to host bone, integration at the host-graft junction, surface percentage with a discernible cleft at the host-graft junction, cystic changes, and intra-articular fragments...

BACKGROUND: Fresh osteochondral allograft transplant (OCA) has good outcomes in the knee. However, donor tissue for patellar OCA is limited. Outcomes after nonorthotopic OCA of the patella using more readily available femoral condylar allograft (FCA) tissue have not been previously reported. PURPOSE: To assess short-term magnetic resonance imaging (MRI) and minimum 2-year clinical outcomes of nonorthotopic patellar OCA using an FCA donor. STUDY DESIGN: Case series; Level of evidence, 4...

Knee patients who have sustained chondral and osteochondral lesions suffer from debilitating pain, which can ultimately lead to posttraumatic osteoarthritis and whole-joint disease. Older, nonactive patients are traditionally steered toward total knee arthroplasty (TKA), but younger, active patients are not good candidates for TKA based on implant longevity, complications, morbidity, and risk for revision, such that treatment strategies at restoring missing hyaline cartilage and bone are highly desired for this patient population...

Meniscal allograft transplantation (MAT) can be a safe, effective treatment for meniscal deficiency resulting in knee dysfunction, leading to osteoarthritis (OA) without proper treatment with 5-year functional success rates (75%-90%). While different grafts and techniques have generally proven safe and effective, complications include shrinkage, extrusion, progression of joint pathology, and failure. The objective of this study was to assess the functional outcomes after MAT using three different clinically-relevant methods in a preclinical canine model...

BACKGROUND: An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI). HYPOTHESIS: Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty...

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...

Cartilage lesions of the knee pose a difficult challenge for orthopaedic surgeons. Osteochondral allograft transplantation is an option in the setting of large chondral or osseous defects, or after failure of other treatment options1-3 . The use of allograft offers the benefit of utilizing both viable hyaline cartilage and bone4 . Fresh allografts are usually transplanted into the femoral condyle, although they can also be used in the patella, tibial plateau, or femoral trochlea1 . Research has shown that patients who undergo this procedure for the treatment of focal and diffuse chondral defects have favorable outcomes and satisfaction scores1 ...

Cartilage lesions of the knee pose a difficult challenge for orthopaedic surgeons. Osteochondral allograft transplantation is an option in the setting of large chondral or osseous defects, or after failure of other treatment options1-3 . The use of allograft offers the benefit of utilizing both viable hyaline cartilage and bone4 . Fresh allografts are usually transplanted into the femoral condyle, although they can also be used in the patella, tibial plateau, or femoral trochlea1 . Research has shown that patients who undergo this procedure for the treatment of focal and diffuse chondral defects have favorable outcomes and satisfaction scores1 ...

Large osteochondral lesions of the knee in young patients continue to be a challenge for orthopaedic surgeons and the focus of continual research. This is particularly true if the injury is a consequence of a dysplastic trochlea and involves both articular surfaces of the biomechanically complex patellofemoral joint. To obtain a healthy and congruent patellofemoral joint, the use of a bipolar fresh osteochondral allograft transplantation of the patella and trochlea is one of the few options to biologically treat these injuries...

Objective . Osteochondral allograft (OCA) transplantation has demonstrated good long-term outcomes in treatment of cartilage defects. Viability, a key factor in clinical success, decreases with peri-implantation storage at 4°C during pathogen testing, matching logistics, and transportation. Modern, physiologic storage conditions may improve viability and enhance outcomes. Design . Osteochondral specimens from total knee arthroplasty patients (6 males, 5 females, age 56.4 ± 2.2 years) were stored in media and incubated at normoxia (21% O2 ) at 22°C or 37°C, and hypoxia (2% O2 ) at 37°C...

OBJECTIVE: This study aims to (1) determine and validate living cartilage allograft transplantation as a novel source for viable osteochondral allograft (OCA) tissues and (2) perform histologic and viability comparisons of living donor cartilage tissues to currently available clinical-grade standard processed grafts. DESIGN: Using healthy cartilage from well-preserved contralateral compartments in 27 patients undergoing total knee arthroplasty (TKA) and 10 clinical-grade OCA specimens obtained immediately following operative implantation, standard and living donor OCA quality was evaluated at the time of harvest and following up to 3 weeks of storage on the basis of macroscopic International Cartilage Repair Society grade, histology, and viability...

Although small cartilage injuries are commonly found in knee arthroscopy procedures, significant chondral and osteochondral injuries are relatively infrequent. Incidence of cartilage injury rises when considering traumatic origin, especially when approaching significant ligamentous or meniscal pathology. Options for restoration span the gamut from benign neglect to open procedures that restore both cartilage and subchondral bone. The best choice of procedure largely depends on lesion size, depth, and location...

BACKGROUND: The use of fresh osteochondral allograft (FOCA) transplantation is a treatment option for large posttraumatic tibial osteochondral defects in young, high-demand patients. We aimed to assess the long-term outcomes of this procedure and factors impacting graft survivorship. METHODS: Evaluated were patients with a posttraumatic tibial plateau defect of >3 cm in diameter and >1 cm in depth who were treated with use of a FOCA, with or without a realignment osteotomy, before September 2007...