Effects of Proud Large Osteochondral Plugs on Contact Forces and Knee Kinematics: A Robotic Study

Du, Peter Z.; Markolf, Keith L.; Boguszewski, Daniel V.; Yamaguchi, Kent T.; Lama, Christopher J; McAllister, David R.; Jones, Kristofer J.

doi:10.1177/0363546518770415

Cited by 19 publications

(19 citation statements)

References 23 publications

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“…They found significant increases in contact pressure with both sunken ( P < .01) and proud ( P < .01) grafts compared with intact cartilage at both 0.5 and 1 mm. In another study, Du et al 8 investigated how a large (>20 mm) proud graft influences tibiofemoral contact forces in a cadaveric model. They found that increasing the proudness of a medial OCA in 20° of flexion by 0.5, 1, and 1.5 mm resulted in an increase in contact pressures of 80 N (36%), 155 N (70%), and 193 N (87%), respectively.…”

Section: Discussionmentioning

confidence: 99%

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Overlapping Allografts Provide Superior and More Reliable Surface Topography Matching Than Oblong Allografts: A Computer-Simulated Model Study

et al. 2021

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Background: Osteochondral allograft transplantation is 1 treatment option for focal articular cartilage defects of the knee. Large irregular defects, which can be treated using an oblong allograft or multiple overlapping allografts, increase the procedure’s technical complexity and may provide suboptimal cartilage and subchondral surface matching between donor grafts and recipient sites. Purpose: To quantify and compare cartilage and subchondral surface topography mismatch and cartilage step-off for oblong and overlapping allografts using a 3-dimensional simulation model. Study Design: Controlled laboratory study. Methods: Human cadaveric medial femoral hemicondyles (n = 12) underwent computed tomography and were segmented into cartilage and bone components using 3-dimensional reconstruction and modeling software. Segments were then exported into point-cloud models. Modeled defect sizes of 17 × 30 mm were created on each recipient hemicondyle. There were 2 types of donor allografts from each condyle utilized: overlapping and oblong. Grafts were virtually harvested and implanted to optimally align with the defect to provide minimal cartilage surface topography mismatch. Least mean squares distances were used to measure cartilage and subchondral surface topography mismatch and cartilage step-off. Results: Cartilage and subchondral topography mismatch for the overlapping allograft group was 0.27 ± 0.02 mm and 0.80 ± 0.19 mm, respectively. In comparison, the oblong allograft group had significantly increased cartilage (0.62 ± 0.43 mm; P < .001) and subchondral (1.49 ± 1.10 mm; P < .001) mismatch. Cartilage step-off was also found to be significantly increased in the oblong group compared with the overlapping group ( P < .001). In addition, overlapping allografts more reliably provided a significantly higher percentage of clinically acceptable (0.5- and 1-mm thresholds) cartilage surface topography matching (overlapping: 100% for both 0.5 and 1 mm; oblong: 90% for 1 mm and 56% for 0.5 mm; P < .001) and cartilage step-off (overlapping: 100% for both 0.5 and 1 mm; oblong: 86% for 1 mm and 12% for 0.5 mm; P < .001). Conclusion: This computer simulation study demonstrated improved topography matching and decreased cartilage step-off with overlapping osteochondral allografts compared with oblong osteochondral allografts when using grafts from donors that were not matched to the recipient condyle by size or radius of curvature. These findings suggest that overlapping allografts may be superior in treating large, irregular osteochondral defects involving the femoral condyles with regard to technique. Clinical Relevance: This study suggests that overlapping allografts may provide superior articular cartilage surface topography matching compared with oblong allografts and do so in a more reliable fashion. Surgeons may consider overlapping allografts over oblong allografts because of the increased ease of topography matching during placement.

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Section: Discussionmentioning

confidence: 99%

“…The Fisher exact test was utilized to compare the number of minimal clinically adequate allografts (with thresholds of 0.5 and 1 mm) between the overlapping and oblong groups. 8,9,22 Finally, the F test was performed to analyze differences in variance between groups. Significance was set at P < .05.…”

Section: Methodsmentioning

confidence: 99%

Overlapping Allografts Provide Superior and More Reliable Surface Topography Matching Than Oblong Allografts: A Computer-Simulated Model Study

et al. 2021

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“…The deleterious effects of an incongruous OCA graft, either proud or recessed, are well documented in several biomechanics studies, including a recent cadaveric study from our biomechanics laboratory that revealed graft contact forces for proud medial femoral condyle (MFC) grafts were increased 36% (0.5 mm) and 70% (1 mm) and contact forces for proud lateral femoral condyle (LFC) grafts increased 14% (0.5 mm) and 29% (1 mm). [4][5][6] However, as my referral practice for cartilage restoration procedures matured, I found both myself and my patients were not entirely happy with the protracted wait times and the need to add cases on unexpectedly at the last minute to take advantage of a potential graft before it expired. Ultimately, I decided to become adept at using nonorthotopic OCA grafts because I knew I had to somehow make the supply meet the demand.…”

Section: See Related Article On Page 3033mentioning

confidence: 99%

Editorial Commentary: Osteochondral Allograft Transplantation of the Knee Using Nonorthotopic Grafts: A “Mismatch” Made in Heaven

Jones

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The threshold of 0.5 mm of incongruity resulting in significantly increased contact pressures has been supported in other cadaveric studies. 3,4 These studies demonstrate the importance of ensuring that the osteochondral allograft is flush with the surrounding articular surface; one of the main issues that leads to graft incongruity is differences between donor and recipient radius of curvature.…”

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confidence: 99%

Osteochondral Allograft Transplant of the Patella Using Femoral Condylar Allografts: Letter to the Editor

Yanke¹,

Huddleston²,

Bodendorfer³

2021

Orthopaedic Journal of Sports Medicine

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OCA) transplantations are a useful treatment for International Cartilage Repair Society (ICRS) grade 3 to 4 focal chondral defects (FCD) of the knee. Prior case series have demonstrated high success rates after this procedure. Despite having slightly inferior outcomes compared to their tibiofemoral counterpart, patellar OCA transplantations can significantly improve patientreported outcomes (PROs), with 10-and 15-year survivorships of 78.1% and 55.8%, respectively. 5,6 For this reason, patellar OCAs are becoming increasingly popular as a joint preservation option, but grafts remain more scarce than distal femoral condyle grafts.We congratulate Lin et al 10 on their recent study entitled "Osteochondral Allograft Transplant of the Patella Using Femoral Condylar Allografts: Magnetic Resonance Imaging and Clinical Outcomes at Minimum 2-Year Follow-up." In this case series, minimum 2-year follow-up PROs and minimum 6month postoperative magnetic resonance imaging (MRI) findings were assessed in 25 and 20 patients, respectively, who underwent OCA to the patella or patella and trochlea using a femoral condyle allograft (FCA). The rationale for this approach is based on the scarcity of patellar grafts compared to that of the femoral condyle. Along with this, many lateral femoral condyles are wasted because transplants in that compartment are less common. Therefore, the use of FCA for patellar OCA might improve the ability to treat patients in a timely manner. In the study, patients demonstrated significant improvements in both pain-and function-related PROs, with differences in IKDC and Knee Outcomes Survey-Activities of Daily Living scores above the previously defined minimal clinically important difference values. In addition, MRI analysis demonstrated that the mean total Osteochondral Allograft MRI Scoring System (OCAMRISS) score was 9.1 (range of 7-11), with the majority of grafts having 76%-100% cartilage fill and osseous integration. These imaging findings provide insightful and promising results on the postoperative status of the graft, perhaps even more so than PROs, which are a blunter instrument of operative success. The Lin et al article adds to the limited literature on patellar OCA transplantation and suggests short-term patient success.Although the results of this study are promising, we have some reservations for orthopaedic surgeons who are

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Effects of Proud Large Osteochondral Plugs on Contact Forces and Knee Kinematics: A Robotic Study

Abstract: Increased CF and altered knee kinematics from a proud femoral plug could affect graft viability. Plug proudness of only 0.5 mm produced significant changes in CF and knee kinematics, and the clinically accepted 1-mm tolerance may need to be reexamined in view of our findings.

Cited by 19 publications

References 23 publications

Overlapping Allografts Provide Superior and More Reliable Surface Topography Matching Than Oblong Allografts: A Computer-Simulated Model Study

Overlapping Allografts Provide Superior and More Reliable Surface Topography Matching Than Oblong Allografts: A Computer-Simulated Model Study

Editorial Commentary: Osteochondral Allograft Transplantation of the Knee Using Nonorthotopic Grafts: A “Mismatch” Made in Heaven

Osteochondral Allograft Transplant of the Patella Using Femoral Condylar Allografts: Letter to the Editor

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