Osteochondral Allograft Transplantation for Knee Lesions after Failure of Cartilage Repair Surgery

Abstract

Objective:The objective of this study was to assess the outcome of osteochondral allograft (OCA) transplantation as a salvage procedure after various cartilage repair surgeries.Design:One hundred sixty-four knees in 163 patients (mean age = 32.6 years; range = 11-59 years; 55% males) were treated with OCA transplantation after subchondral marrow stimulation (SMS), osteochondral autograft transplantation (OAT), and autologous chondrocyte implantation (ACI). The majority of previous procedures were isolated SMS in 145 knees (88.4%). Mean allograft size was 8.5 ± 7.9 cm2. The most common location was in femoral condyle. The number and type of reoperations on the operative knee were assessed. Failure of the OCA transplantation was defined as any reoperation resulting in removal of the allograft. Functional outcomes were evaluated.Results:Sixty-eight knees had reoperations after OCA transplantation. Thirty-one knees (18.9%) were classified as allograft failures. The median time to failure was 2.6 ± 6.8 years (range = 0.7-23.4 years). Survivorship of the graft was 82% at 10 years and 74.9% at 15 years. Patients whose grafts were still in situ had a mean of 8.5 ± 5.6 years of follow-up. Scores on all functional outcomes scales improved significantly from preoperatively to latest follow-up. Eighty-nine percent of OCA transplantation patients reported being “extremely satisfied” or “satisfied.”Conclusion:Despite the high reoperation rate, OCA transplantation is a successful salvage surgical treatment after cartilage repair procedures. This cohort showed improved survivorship and functional outcomes of OCA transplantation after SMS, ACI, and OAT.

An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint

“…7,35,78 Even though the sandwich technique has been described in the treatment of bone lesions concomitantly with ACI, there was no agreement on its utilization, and OCA was preferred for cases that include intralesional osteophytes, revision including prior failed microfracture, prior fracture malunion, significant subchondral stress reactions also known as "bone edema," significant subchondral cyst formation, and bone loss due to fractures or osteochondritis dissecans fragment excision. 21,31,36,38,60,62,75,79 In the patellofemoral joint, morphology matching makes OCA technically more demanding than ACI. This is because of the complex topography, with highly variable shapes of the patella and trochlea.…”

Tibial Allograft Transfer for Medial Tibial Plateau Resurfacing

“…8 In a similar study, Gracitelli et al demonstrated 82% osteochondral allograft survival at 5 years and 74.9% survival at 15 years in patients with prior failed cartilage repair surgeries. 9 These studies, combined with our own experiences, demonstrate that large OATs for tibial surface chondral defects are a viable treatment option in patients with severe, post-traumatic chondral defects.…”

Xenotransplantation of pig chondrocytes: therapeutic potential and barriers for cartilage repair

“…As described by Berta et al (2015), this technique offers effective management of small and medium-sized focal defects although it does not result in good hyaline cartilage. Allotransplantation is particularly considered for settings that require whole structures such as menisci, large number of cells and/or when other techniques of cartilage repair have failed Gracitelli et al, 2015). Despite the clinical benefit attained with meniscus allotransplantation and osteochondral allograft transplantation Gracitelli et al, 2015), some concerns have been raised about the potential detrimental effects of the elicited immune response.…”

“…Allotransplantation is particularly considered for settings that require whole structures such as menisci, large number of cells and/or when other techniques of cartilage repair have failed Gracitelli et al, 2015). Despite the clinical benefit attained with meniscus allotransplantation and osteochondral allograft transplantation Gracitelli et al, 2015), some concerns have been raised about the potential detrimental effects of the elicited immune response. Evidence is accumulating of the immune-privileged properties of cartilage, but isolated chondrocytes and especially the bony portion of the osteochondral grafts are more immunogenic (Smith et al, 2015).…”