Abstract:Background: Sex mismatch between donor and recipient has been considered a potential contributor to adverse outcomes after solid organ transplantation. However, the influence of sex mismatching in osteochondral allograft (OCA) transplantation has yet to be determined. Purpose: To evaluate whether donor-recipient sex mismatching affects graft survival after OCA transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: In this review of prospectively collected data, patients who underwent OCA t… Show more
“…Allograft failure was defined as the removal or revision of the primary OCA, conversion to any arthroplasty, or gross appearance of graft failure on second-look arthroscopy. 39,46,91,93 Any inconsistencies were discussed or resolved with a third author (W.D. ).…”
Section: Methodsmentioning
confidence: 99%
“…86,94 OCA is a restorative cartilage procedure for symptomatic focal cartilage defects that involves transplanting surviving mature hyaline cartilage and supporting subchondral bone into the area of the cartilage defect. 20,75,93,108 As a well-developed, single-stage restorative cartilage procedure, OCA has increasingly become the preferred treatment after cartilage repair surgery failures. OCA has many advantages compared with other cartilage repair techniques, such as simultaneously repairing the cartilage and subchondral bone, treating large or multisite cartilage defects, and supporting early weightbearing.…”
Background: Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results. Purpose: To comprehensively analyze the characteristics and clinical outcomes of OCA for treating articular cartilage defects. Study Design: Systematic review; Level of evidence, 4. Methods: We searched Embase, PubMed, Cochrane Database, and Web of Science for studies published between January 1, 2001, and December 31, 2020, on OCA for treating articular cartilage defects. Publication information, patient data, osteochondral allograft storage details, and clinical outcomes were extracted to conduct a comprehensive summative analysis. Results: In total, 105 studies involving 5952 patients were included. The annual reported number of patients treated with OCA increased from 69 in 2001 to 1065 in 2020, peaking at 1504 cases in 2018. Most studies (90.1%) were performed in the United States. The mean age at surgery was 34.2 years, and 60.8% of patients were male and had a mean body mass index of 26.7 kg/m2. The mean lesion area was 5.05 cm2, the mean follow-up duration was 54.39 months, the mean graft size was 6.85 cm2, and the number of grafts per patient was 54.7. The failure rate after OCA was 18.8%, and 83.1% of patients reported satisfactory results. Allograft survival rates at 2, 5, 10, 15, 20, and 25 years were 94%, 87.9%, 80%, 73%, 55%, and 59.4%, respectively. OCA was mainly performed on the knee (88.9%). The most common diagnosis in the knee was osteochondritis dissecans (37.9%), and the most common defect location was the medial femoral condyle (52%). The most common concomitant procedures were high tibial osteotomy (28.4%) and meniscal allograft transplantation (24.7%). After OCA failure, 54.7% of patients underwent revision with primary total knee arthroplasty. Conclusion: The annual reported number of patients who underwent OCA showed a significant upward trend, especially from 2016 to 2020. Patients receiving OCA were predominantly young male adults with a high body mass index. OCA was more established for knee cartilage than an injury at other sites, and its best indication was osteochondritis dissecans. This analysis demonstrated satisfactory long-term postoperative outcomes.
“…Allograft failure was defined as the removal or revision of the primary OCA, conversion to any arthroplasty, or gross appearance of graft failure on second-look arthroscopy. 39,46,91,93 Any inconsistencies were discussed or resolved with a third author (W.D. ).…”
Section: Methodsmentioning
confidence: 99%
“…86,94 OCA is a restorative cartilage procedure for symptomatic focal cartilage defects that involves transplanting surviving mature hyaline cartilage and supporting subchondral bone into the area of the cartilage defect. 20,75,93,108 As a well-developed, single-stage restorative cartilage procedure, OCA has increasingly become the preferred treatment after cartilage repair surgery failures. OCA has many advantages compared with other cartilage repair techniques, such as simultaneously repairing the cartilage and subchondral bone, treating large or multisite cartilage defects, and supporting early weightbearing.…”
Background: Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results. Purpose: To comprehensively analyze the characteristics and clinical outcomes of OCA for treating articular cartilage defects. Study Design: Systematic review; Level of evidence, 4. Methods: We searched Embase, PubMed, Cochrane Database, and Web of Science for studies published between January 1, 2001, and December 31, 2020, on OCA for treating articular cartilage defects. Publication information, patient data, osteochondral allograft storage details, and clinical outcomes were extracted to conduct a comprehensive summative analysis. Results: In total, 105 studies involving 5952 patients were included. The annual reported number of patients treated with OCA increased from 69 in 2001 to 1065 in 2020, peaking at 1504 cases in 2018. Most studies (90.1%) were performed in the United States. The mean age at surgery was 34.2 years, and 60.8% of patients were male and had a mean body mass index of 26.7 kg/m2. The mean lesion area was 5.05 cm2, the mean follow-up duration was 54.39 months, the mean graft size was 6.85 cm2, and the number of grafts per patient was 54.7. The failure rate after OCA was 18.8%, and 83.1% of patients reported satisfactory results. Allograft survival rates at 2, 5, 10, 15, 20, and 25 years were 94%, 87.9%, 80%, 73%, 55%, and 59.4%, respectively. OCA was mainly performed on the knee (88.9%). The most common diagnosis in the knee was osteochondritis dissecans (37.9%), and the most common defect location was the medial femoral condyle (52%). The most common concomitant procedures were high tibial osteotomy (28.4%) and meniscal allograft transplantation (24.7%). After OCA failure, 54.7% of patients underwent revision with primary total knee arthroplasty. Conclusion: The annual reported number of patients who underwent OCA showed a significant upward trend, especially from 2016 to 2020. Patients receiving OCA were predominantly young male adults with a high body mass index. OCA was more established for knee cartilage than an injury at other sites, and its best indication was osteochondritis dissecans. This analysis demonstrated satisfactory long-term postoperative outcomes.
“…Targets for these improvement strategies include cell-, biologics-, and/or substrate-enhanced cellular repopulation and revascularization mechanisms for improved efficiency of creeping substitution; biologics, pharmaceuticals, and/or additional donor-recipient matching criteria for mitigating subrejection immune responses; supporting the osteoregenerative potential of surrounding recipient bone; and preimplantation, surgical, and postoperative techniques and protocols that protect transplanted OCAs during the prolonged integration period. 3,7,19,21,25,[49][50][51][52][53]…”
Section: Impact Of Preservation and Storage On Osteochondral Allograf...mentioning
Osteochondral allograft (OCA) transplantation has been largely successful in treating symptomatic articular cartilage lesions; however, treatment failures persist. While OCA biomechanics have been consistently cited as mechanisms of treatment failure, the relationships among mechanical and biological variables that contribute to success after OCA transplantation have yet to be fully characterized. The purpose of this systematic review was to synthesize the clinically relevant peer-reviewed evidence targeting the biomechanics of OCAs and the impact on graft integration and functional survival toward developing and implementing strategies for improving patient outcomes. The Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Google Scholar, and EMBASE were searched to identify articles for systematic review. This review of relevant peer-reviewed literature provided evidence that the biomechanics related to OCA transplantation in the knee have direct and indirect effects on functional graft survival and patient outcomes. The evidence suggests that biomechanical variables can be optimized further to enhance benefits and mitigate detrimental effects. Each of these modifiable variables should be considered regarding indications, patient selection criteria, graft preservation methodology, graft preparation, transplantation, fixation techniques, and prescribed postoperative restriction and rehabilitation protocols. Criteria, methods, techniques, and protocols should target OCA quality (chondrocyte viability, extracellular matrix integrity, material properties), favorable patient and joint characteristics, rigid fixation with protected loading, and innovative ways to foster rapid and complete OCA cartilage and bone integration to optimize outcomes for OCA transplant patients.
“… 17 , 24 , 61 , 63 In a retrospective study, sex mismatch between donor and recipient was associated with a 3-times greater likelihood to fail at 5 years compared to same-sex transplantation. 83 Figure 4 ( A ) Arthroscopic image at the time of revision surgery (one year after index surgery) of a transplanted osteochondral allograft (OCA) in the femoral condyle with shear delamination cartilage surface, which is being debrided by the arthroscopic shaver. ( B ) After debridement of the delaminated cartilage surface, only the underlying allograft bone is seen.…”
Section: Risk Factors For Failurementioning
confidence: 99%
“…17,24,61,63 In a retrospective study, sex mismatch between donor and recipient was associated with a 3-times greater likelihood to fail at 5 years compared to same-sex transplantation. 83 Regarding patient-specific factors, male sex has been identified as a significant risk factor for failure, with one study reporting that males were 4.18 times more likely to fail than females at a mean 3.6-year follow-up. 14 BMI is also an important factor to consider during the preoperative counseling period.…”
Knee articular cartilage defects can result in significant pain and loss of function in active patients. Osteochondral allograft (OCA) transplantation offers a single-stage solution to address large chondral and osteochondral defects by resurfacing focal cartilage defects with mature hyaline cartilage. To date, OCA transplantation of the knee has demonstrated excellent clinical outcomes and long-term survivorship. However, significant variability still exists among clinicians with regard to parameters for graft acceptance, surgical technique, and rehabilitation. Technologies to optimize graft viability during storage, improve osseous integration of the allograft, and shorten recovery timelines after surgery continue to evolve. The purpose of this review is to examine the latest evidence on treatment indications, graft storage and surgical technique, patient outcomes and survivorship, and rehabilitation after surgery.
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