scholarly journals Fresh Osteochondral Allograft Transplantation for Uncontained, Elongated Osteochondritis Dissecans Lesions of the Medial Femoral Condyle

2019 ◽  
Vol 8 (3) ◽  
pp. e267-e273 ◽  
Author(s):  
Kristofer J. Jones ◽  
Brian M. Cash ◽  
Armin Arshi ◽  
Riley J. Williams
Keyword(s):  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft

Fresh Osteochondral Allografting in the Treatment of Osteochondritis Dissecans of the Femoral Condyle

2007 ◽  
Vol 35 (6) ◽  
pp. 907-914 ◽  
Author(s):  
Bryan C. Emmerson ◽  
Simon Görtz ◽  
Amir A. Jamali ◽  
Christine Chung ◽  
David Amiel ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Osteochondral Allograft ◽  
Patient Questionnaire ◽  
Comprehensive Treatment ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft ◽  
The Mean

Background The treatment of osteochondritis dissecans in the adult knee can be challenging. As part of our comprehensive treatment program, fresh osteochondral allografts have been used in the surgical management of osteochondritis dissecans of the femoral condyle. Hypothesis Fresh osteochondral allograft transplantation will provide a successful surgical treatment for osteochondritis dissecans of the femoral condyle. Study Design Case series; Level of evidence, 4. Methods Sixty-six knees in 64 patients underwent fresh osteochondral allografting for the treatment of osteochondritis dissecans. Each patient was evaluated both preoperatively and postoperatively using an 18-point modified D'Aubigné and Postel scale. Subjective assessment was performed using a patient questionnaire. Radiographs were evaluated preoperatively and postoperatively. Results Mean follow-up was 7.7 years (range, 2-22 years). There were 45 men and 19 women with a mean age of 28.6 years (range, 15-54 years). All patients had undergone previous surgery. Forty-one lesions involved the medial femoral condyle, and 25 involved the lateral femoral condyle. All were osteochondritis dissecans type 3 or 4. The mean allograft size was 7.5 cm2. One knee was lost to follow-up. Of the remaining 65 knees, 47 (72%) were rated good/excellent, 7 (11%) were rated fair, and 1 (2%) was rated poor. Ten patients (15%) underwent reoperation. The mean clinical score improved from 13.0 preoperatively to 16.4 postoperatively (P < .01). Fifty-nine of 64 patients completed questionnaires. Subjective knee function improved from a mean of 3.4 to 8.4 on a 10-point scale (P < .01). Conclusion With greater than 70% good or excellent results, fresh osteochondral allograft transplantation is a successful surgical treatment for osteochondritis dissecans of the femoral condyle.

scholarly journals Osteochondral Allograft Transplantation for Osteochondritis Dissecans of the Medial Femoral Condyle

2021 ◽  
Vol 1 (2) ◽  
pp. 263502542110013
Author(s):  
LeeAnne Torres ◽  
Eric Dennis ◽  
Lauren Dogariu ◽  
Brian R. Waterman
Keyword(s):  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Adult Population ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Proper Position ◽  
Allograft Transplantation ◽  
Primary Indication ◽  
Adolescent Patients ◽  
Donor Graft

Background: While the data are not as robust as in the adult population, osteochondral allograft transplantation has proven to be an effective treatment for osteochondritis dissecans (OCD) lesions of the knee in the pediatric and adolescent populations. Indications: The primary indication for osteochondral allograft transplantation is a symptomatic, full-thickness, localized cartilage lesion. Acceptable underlying causes include trauma, avascular necrosis, and OCD lesions. As these are pediatric and adolescent patients, they are not candidates for joint arthroplasty. In this case, the patient is a 16-year-old girl with a 1.5 cm × 1.2 cm OCD lesion of the medial femoral condyle. Technique Description: The patient was positioned supine with a tourniquet on the thigh. The lesion was identified on the medial femoral condyle and exposed. A guidepin was placed in the center of the lesion and a 15 mm reamer was used to ream to a depth of 6 to 7 mm. The wound was copiously irrigated. A corresponding 15 mm plug was harvested from the donor graft and prepared to match the morphology of the condyle. The 12 o’clock position was marked with a fresh marking pen to maintain orientation. The graft was lavaged with a pulsavac and bathed in autologous conditioned plasma. The recipient bed was prepared with 0.0045 K wire, and then the donor graft was placed in proper position and impacted with a tamp, flush with the surrounding cartilage. The tourniquet was deflated and the surgical site was closed in a layered fashion. Results: Studies of adult patients have demonstrated survival rates of greater than 80% for osteochondral allograft transplantation, with pain improvement of 74% to 85%, and return to competitive athletics of 88%. While there is a paucity of studies looking at osteochondral allograft transplantation in pediatric and adolescent populations, outcomes appear to be similar to that of the adult population. Discussion/Conclusion: Osteochondral allograft transplantation is a viable treatment option for pediatric and adolescent patients with symptomatic cartilage lesions. It allows for joint preservation and provides significant improvement of pain with high rates of return to athletics.

scholarly journals Osteochondral Allograft Transplantation for Treatment of Medial Femoral Condyle Defect

2017 ◽  
Vol 6 (4) ◽  
pp. e1239-e1244 ◽  
Author(s):  
Jonathan A. Godin ◽  
George Sanchez ◽  
Mark E. Cinque ◽  
Jorge Chahla ◽  
Nicholas I. Kennedy ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Allograft Transplantation

scholarly journals Fresh Osteochondral Allograft Transplantation for Spontaneous Osteonecrosis of the Knee: A Case Series

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773054 ◽  
Author(s):  
Luís E.P. Tírico ◽  
Samuel A. Early ◽  
Julie C. McCauley ◽  
William D. Bugbee
Keyword(s):  
Conservative Treatment ◽  
Femoral Condyle ◽  
Case Series ◽  
Lesion Size ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Definitive Treatment ◽  
Spontaneous Osteonecrosis ◽  
Fresh Osteochondral Allograft

Background: Spontaneous osteonecrosis of the knee (SONK) is a clinical entity identified by acute knee pain usually associated with joint effusion, with radiographic findings of a radiolucent defect on the weightbearing area of the femoral condyle. Conservative treatment is initially undertaken; however, surgical procedures are often necessary. Historically, surgical options have included core decompression, cartilage repair, high tibial osteotomy, or joint arthroplasty. Few studies in the literature have reported the use of fresh osteochondral allograft (OCA) for the treatment of SONK lesions. Hypothesis: OCA transplantation is an effective treatment for SONK lesions on the medial femoral condyle. Study Design: Case series; Level of evidence, 4. Methods: A case series was analyzed of 7 patients treated with OCA for large SONK lesions of the medial femoral condyle with a minimum 4-year follow-up. All patients experienced failure of at least 6 months of conservative treatment and declined arthroplasty as the form of definitive treatment for medial femoral condyle lesion. All patients underwent OCA of the medial femoral condyle. Mean lesion size was 4.6 cm2 (range, 3.24-6.25 cm2), with a mean condylar width of 41.7 mm (range, 35.4-48.6 mm), resulting in a median proportion (lesion size/condylar width) of 56.8% (range, 32.7%-62.6%). The median surface allograft area was 5.1 cm2 (range, 3.2-6.3 cm2). Results: The median follow-up was 7.1 years (range, 4.5-14.1 years). No patient had additional surgery following OCA transplant; the allograft failure rate was 0%. Subjective outcome scores from the International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, and modified Merle d’Aubigné-Postel scale improved from preoperative assessment to the latest follow-up. All patients were extremely satisfied with the results of the OCA transplant. Conclusion: Fresh OCA transplantation demonstrated excellent efficacy, durability, and satisfaction in this group of patients with isolated stage 2 and 3 SONK lesions who had experienced failure of conservative treatment. Fresh osteochondral allografts are an attractive method for surgical management of selected patients with spontaneous osteonecrosis of the knee.

Return to Sport Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation

2020 ◽  
Vol 48 (8) ◽  
pp. 1945-1952 ◽  
Author(s):  
Joseph N. Liu ◽  
Avinesh Agarwalla ◽  
David R. Christian ◽  
Grant H. Garcia ◽  
Michael L. Redondo ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Femoral Condyle ◽  
Varus Deformity ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Return To Sports ◽  
Tibial Osteotomy ◽  
Allograft Transplantation ◽  
Chondral Defects

Background: Young patients with symptomatic chondral defects in the medial compartment with varus malalignment may undergo opening wedge high tibial osteotomy (HTO) with concomitant osteochondral allograft transplantation (OCA) (HTO + OCA). Although patients have demonstrated favorable outcomes after HTO + OCA, limited information is available regarding return to sporting activities after this procedure. Purpose: To evaluate (1) the timeline to return to sports (RTS), (2) patient satisfaction, and (3) reasons for discontinuing sporting activity after HTO + OCA, and to identify predictive factors of RTS. Study Design: Case series; level of evidence, 4. Methods: Consecutive patients who underwent HTO + OCA for varus deformity and medial femoral condyle focal chondral defects with a minimum 2-year follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire, satisfaction questionnaire, visual analog scale for pain, and Single Assessment Numerical Evaluation. Results: Twenty-eight patients with a mean age of 36.97 ± 7.52 years were included at mean follow-up of 6.63 ± 4.06 years. Fourteen patients (50.0%) required reoperation during the follow-up period, with 3 (10.7%) undergoing knee arthroplasty. Twenty-four patients participated in sports within 3 years before surgery, with 19 patients (79.2%) able to return to at least 1 sport at a mean 11.41 ± 6.42 months postoperatively. However, only 41.7% (n = 10) were able to return to their preoperative level. The most common reasons for sports discontinuation (n = 20; 83.3%) were a desire to prevent further damage to the knee (70.0%), persistent pain (55.0%), persistent swelling (30.0%), and fear (25.0%). Conclusion: In young, active patients with varus deformity and focal medial femoral condyle chondral defects, HTO + OCA enabled 79.2% of patients to RTS by 11.41 ± 6.42 months postoperatively. However, only 41.7% of patients were able to return to their preinjury level or better. It is imperative that patients be appropriately educated to manage postoperative expectations regarding sports participation after HTO + OCA.

scholarly journals Contralateral Lateral Femoral Condyle Allografts Provide an Acceptable Surface Match for Simulated Classic Osteochondritis Dissecans Lesions of the Medial Femoral Condyle

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989841
Author(s):  
Nabeel Salka ◽  
John A. Grant
Keyword(s):  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Random Order ◽  
Medial Femoral Condyle ◽  
Lateral Femoral Condyle ◽  
Osteochondral Allograft ◽  
Effective Technique ◽  
Percentage Area ◽  
Surface Deviation ◽  
Fresh Frozen

Background: Osteochondral allograft transplantation is an effective technique for repairing large lesions of the medial femoral condyle (MFC), but its use is limited by graft availability. Purpose/Hypothesis: The present study aimed to determine whether contralateral lateral femoral condyle (LFC) allografts can provide an acceptable surface match for posterolateral MFC lesions characteristic of classic osteochondritis dissecans (OCD). The hypothesis was that LFC and MFC allografts will provide similar surface contour matches in all 4 quadrants of the graft for posterolateral MFC lesions characteristic of OCD. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen recipient human MFCs were each size-matched to 1 ipsilateral medial and 1 contralateral LFC donor (N = 30 condyles). After a nano–computed tomography (nano-CT) scan of the native recipient condyle, a 20-mm circular osteochondral “defect” was created 1 cm posterior and 1 cm medial to the roof of the intercondylar notch (n = 10). A size-matched, random-order donor MFC or LFC plug was then harvested, transplanted, and scanned with nano-CT. Nano-CT scans were then reconstructed, registered to the initial scan of the recipient MFC, and processed in MATLAB to determine the height deviation ( d RMS) between the native and donor surfaces and percentage area unacceptably (>1 mm) proud (% A proud) and sunken (% A sunk). Circumferential step-off height ( h RMS) and percentage circumference unacceptably (>1 mm) proud (% C proud) and sunken (% C sunk) were measured using DragonFly software. The process was then repeated for the other allograft plug. Results: Both MFC and LFC plugs showed acceptable step-off heights in all 4 quadrants (range, 0.53-0.94 mm). Neither allograft type nor location within the defect had a significant effect on step-off height ( h RMS), surface deviation ( d RMS), % A proud, or % A sunk. In general, plugs were more unacceptably sunken than proud (MFC, 13.4% vs 2.4%; LFC, 13.2% vs 8.1%), although no significant differences in % C sunk were seen between allograft types or locations within the defect. In LFC plugs, % C proud in the lateral quadrant (28.0% ± 26.1%) was significantly greater compared with all other quadrants ( P = .0002). Conclusion: The present study demonstrates that 20-mm contralateral LFC allografts provide an acceptable surface match for posterolateral MFC lesions characteristic of OCD. Clinical Relevance: With comparable surface matching, MFC and LFC allografts can be expected to present similar stresses on the knee joint and achieve predictably positive clinical outcomes, thus improving donor availability and reducing surgical wait times for matches.

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