Acute Delamination of Commercially Available Decellularized Osteochondral Allograft Plugs

Abstract

Articular cartilage injuries, and corresponding surgical procedures, are occurring with increasing frequency as identified by a review of recent surgical trends. Concerns have grown in recent years regarding the longevity of results following microfracture, with a shift toward cartilage restoration procedures in recent years. This case report describes 2 cases of acute failure following the use of commercially available osteochondral allograft plugs used for the treatment of osteochondral defects of the distal femur. In both cases the chondral surface of the plug delaminated from the underlying cancellous bone, resulting in persistent pain and swelling requiring reoperation and removal of the loose fragments. Caution should be employed when considering use of these plugs for the treatment of osteochondral lesions, as similar outcomes have not been noted with other cartilage restoration techniques.

Chondral Delamination of Fresh Osteochondral Allografts after Implantation in the Knee: A Matched Cohort Analysis

“…13,16 There has only been one prior study of two cases describing delamination of the donor cartilage from the underlying subchondral surface, but this occurred in decellularized osteochondral allograft plugs, not fresh OCAs. 12 The role chondrocyte viability plays in delamination has not been defined, but given the results of our study, it may not play a significant role in this particular type of failure. Rather than chondrocyte viability, delamination may be the result of the different mechanical properties between the chondral and osseous portion of the graft.…”

“…This mechanism of failure has not been explicitly investigated or well described in the literature. 12 A recent study performed in a canine model demonstrated that all successfully integrated OCAs had >70% viability of chondrocytes at time of implantation, and no graft with <70% chondrocyte viability had a successful outcome. 13 Additional in vivo studies have demonstrated that diminished cellularity in OCA correlated negatively with cartilage structure and health.…”

“…This mechanism of failure has not been explicitly investigated or well described in the literature. 12…”

Biphasic hierarchical extracellular matrix scaffold for osteochondral defect regeneration

“…Finally, the junctional region of the scaffold is enriched with calcium and phosphorus, which enhance osteogenesis and cartilage regeneration. In previous clinical studies, the effect of commercially available sources of such materials was unsatisfactory 37,40 , which indicated limitations and scope for improvement in the technology. Therefore, this study may facilitate further, more detailed evaluation of decellularized osteochondral products.…”

Osteochondral Peg Fixation for Chondral Fragment of the Knee in Adolescent Patients: A Report of Two Cases

“…Several surgical techniques have been reported for treat-ing pure chondral lesions, including fixation with absorbable screws, suture, bone pegs, fibrin glue, and chondral darts [5][6][7][8][9][10][11][12]. Although they are not employed for cartilage fragment fixation, allograft plug techniques and osteochondral autologous transplantation (OAT) have been used as treatment methods for osteochondritis dissecans [13][14][15][16][17]. The technique involving the use of autogenous osteochondral plugs for the fixation of osteochondral fragments (mosaicplasty) has been reported to be associated with good clinical outcomes [13][14][15].…”