Case Series With Histopathologic and Radiographic Analyses Following Failure of Fresh Osteochondral Allografts of the Talus

Pomajzl, Ryan J.; Baker, Erin A.; Baker, Kevin C.; Fleischer, Mackenzie M; Salisbury, Meagan R.; Phillips, Dylan M.; Fortin, Paul T.

doi:10.1177/1071100716651963

Cited by 20 publications

(15 citation statements)

References 27 publications

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“…A difference was found in the autograft versus the allograft procedure with success rates of 90 and 55%, respectively. Differences in these procedures have been previously highlighted in the literature [ 4 , 34 , 35 , 44 ]. Since an allograft procedure is typically used for larger defects, it is to be expected that a difference in success percentage was likely to be found.…”

Section: Discussionmentioning

confidence: 99%

No superior surgical treatment for secondary osteochondral defects of the talus

Lambers

Dahmen

Reilingh

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this systematic review was to identify the most effective surgical treatment for talar osteochondral defects after failed primary surgery.Methods A literature search was conducted to find studies published from January 1996 till July 2016 using PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL. Two authors screened the search results separately and conducted quality assessment independently using the Newcastle–Ottawa scale. Weighted success rates were calculated. Studies eligible for pooling were combined.ResultsTwenty-one studies with a total of 299 patients with 301 talar OCDs that failed primary surgery were investigated. Eight studies were retrospective case series, twelve were prospective case series and there was one randomized controlled trial. Calculated success percentages varied widely and ranged from 17 to 100%. Because of the low level of evidence and the scarce number of patients, no methodologically proper meta-analysis could be performed. A simplified pooling method resulted in a calculated mean success rate of 90% [CI 82–95%] for the osteochondral autograft transfer procedure, 65% [CI 46–81%] for mosaicplasty and 55% [CI 40–70%] for the osteochondral allograft transfer procedure. There was no significant difference between classic autologous chondrocyte implantation (success rate of 59% [CI 39–77%]) and matrix-associated chondrocyte implantation (success rate of 73% [CI 56–85%]).Conclusions Multiple surgical treatments are used for talar OCDs after primary surgical failure. More invasive methods are administered in comparison with primary treatment. No methodologically proper meta-analysis could be performed because of the low level of evidence and the limited number of patients. It is therefore inappropriate to draw firm conclusions from the collected results. Besides an expected difference in outcome between the autograft transfer procedure and the more extensive procedures of mosaicplasty and the use of an allograft, neither a clear nor a significant difference between treatment options could be demonstrated. The need for sufficiently powered prospective investigations in a randomized comparative clinical setting remains high. This present systematic review can be used in order to inform patients about expected outcome of the different treatment methods used after failed primary surgery.Level of evidenceIV.

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Section: Discussionmentioning

confidence: 99%

No superior surgical treatment for secondary osteochondral defects of the talus

Lambers

Dahmen

Reilingh

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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“…In addition, a CD4+ and CD8+ lymphocyte-mediated failure mechanism has recently been reported to be responsible for failure in a fresh osteochondral allograft of the talus. 13 However, no study has reported like rejection in the knee, and it seems that the subtle immune reaction does not carry any clinical consequence in most cases. 14 In this sense, a careful resection of the unnecessary soft tissue and pulsed lavage cleansing 9 of the graft for 5 to 10 minutes might help to decrease graft immunogenicity.…”

Section: Discussionmentioning

confidence: 99%

Fresh Osteochondral and Meniscus Allografting for Post-traumatic Tibial Plateau Defects

Gelber¹,

Erquicia

Ramírez-Bermejo³

et al. 2018

Arthroscopy Techniques

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Large post-traumatic osteochondral defects of the proximal tibia in young active patients can be challenging because total or partial arthroplasties are to be avoided. The use of a fresh osteochondral allograft including its meniscus is one of the few options to biologically treat these injuries. Although the use of a fresh allograft is not easily accessible in some places and carries considerable logistical limitations, it is an alternative that provides viable chondrocytes to the defect. The inclusion of the meniscus in the osteochondral graft improves the results but also makes the technique even more demanding. We present a thorough description of this allograft transplantation to make it as reproducible as possible.

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“…In a small case series of clinically failed, retrieved OCA grafts, histologic analysis showed the presence and colocalization of CD4+ and CD8+ T cells. 74…”

Section: Factors Influencing Failure Of Fresh Osteochondral Allograftmentioning

confidence: 99%

Review of Mechanical, Processing, and Immunologic Factors Associated With Outcomes of Fresh Osteochondral Allograft Transplantation of the Talus

et al. 2017

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Case Series With Histopathologic and Radiographic Analyses Following Failure of Fresh Osteochondral Allografts of the Talus

Abstract: Level IV, case series.

Cited by 20 publications

References 27 publications

No superior surgical treatment for secondary osteochondral defects of the talus

No superior surgical treatment for secondary osteochondral defects of the talus

Fresh Osteochondral and Meniscus Allografting for Post-traumatic Tibial Plateau Defects

Review of Mechanical, Processing, and Immunologic Factors Associated With Outcomes of Fresh Osteochondral Allograft Transplantation of the Talus

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