scholarly journals Fresh Precut Osteochondral Allograft Core Transplantation for the Treatment of Capitellum Osteochondritis Dissecans

2020 ◽  
Vol 9 (6) ◽  
pp. e797-e802
Author(s):  
Sagar Chawla ◽  
Michael G. Saper
Keyword(s):  
Osteochondritis Dissecans ◽  
Osteochondral Allograft

Osteochondral Allograft Transplantation in Patients With Osteochondritis Dissecans of the Knee

2016 ◽  
Vol 44 (11) ◽  
pp. 2870-2875 ◽  
Author(s):  
Kamran N. Sadr ◽  
Pamela A. Pulido ◽  
Julie C. McCauley ◽  
William D. Bugbee
Keyword(s):  
Osteochondritis Dissecans ◽  
Osteochondral Allograft ◽  
Allograft Transplantation

Autologous Chondrocyte Implantation as Treatment for Unsalvageable Osteochondritis Dissecans: 10- to 25-Year Follow-up

2020 ◽  
Vol 48 (5) ◽  
pp. 1134-1140 ◽  
Author(s):  
James L. Carey ◽  
Kevin G. Shea ◽  
Anders Lindahl ◽  
Haris S. Vasiliadis ◽  
Carl Lindahl ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Open Surgery ◽  
Autologous Chondrocyte Implantation ◽  
Case Series ◽  
Activity Level ◽  
Osteochondral Allograft ◽  
Level Of Evidence ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI). Hypothesis: Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty. Study Design: Case series; Level of evidence, 4. Methods: All Swedish and Norwegian patients (59 patients with 67 OCD lesions) who underwent ACI for OCD under the direction of the senior author between 1990 and 2005 were identified through manual chart review. Features of the patient, OCD lesion, and surgery were extracted from the medical record and intraoperative photographs. Patients were sent questionnaires to assess the Knee injury and Osteoarthritis Outcome Score, Tegner-Wallgren activity score, and Lysholm score. In addition, patients were asked whether they had to undergo further surgery, including knee replacement, of the knee that underwent ACI. They were asked whether they would have the surgery again if in the same situation. Results: A total of 55 patients (93%) with 61 OCD lesions (91%) responded. The median follow-up duration was 19 years (range, 10-26 years) and the median age at follow-up was 43 years (range, 28-69 years). Subsequent arthroscopy was performed in the majority of cases, although many of these were scheduled “second looks” as part of a study. With respect to other subsequent surgery, 12 knees (20%) underwent any additional open surgery, but only 2 knees (3%) underwent arthroplasty. Eight knees (13%) underwent revision ACI. Most patients reached their preinjury activity level (62%) and would undergo ACI again if in the same situation (85%). If failure is defined as revision of the graft or conversion to arthroplasty, then survivorship after ACI for OCD in the current study would be 87% at 10 years, 85% at 15 years, and 82% at 20 years. Conclusion: ACI for OCD provides a durable treatment option. At a median follow-up of 19 years, there was a very low (~3%) conversion to total knee arthroplasty.

scholarly journals Osteochondral Allograft Transplantation of the Knee in “Ideal” Candidates: Clinical Outcomes and Graft Survivorship

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0050
Author(s):  
William Bugbee
Keyword(s):  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Young Patients ◽  
Osteochondral Allograft ◽  
Functional Improvement ◽  
Patient Specific ◽  
Osteochondral Lesions ◽  
Small Lesion

Objectives: Osteochondral allograft (OCA) transplantation of the knee is an effective treatment for chondral and osteochondral lesions, but graft survivorship and clinical outcomes vary by patient-specific factors. Fresh OCA are often used for large or complex lesions or in the revision cartilage repair setting, but recent literature suggests that the most ideal candidates for OCA transplantation may be young patients with a small lesion on the femoral condyle or trochlea due to osteochondritis dissecans or chondral trauma. The purpose of this study was to assess outcomes following OCA transplantation in a cohort of “ideal” candidates. Methods: We identified 91 patients (97 knees) who underwent primary OCA transplantation for osteochondritis dissecans (88%) or a traumatic chondral injury (12%), were age 30 years or younger, and had an isolated lesion(s) of the femoral condyle or trochlea less than 8 cm2. Mean age was 20 years and 70% were male. Lesions were located on the femoral condyle (85%) or trochlea (15%). One graft was used in 85% of knees and two grafts were used in 15%. Mean total graft area was 5.2 cm2. Evaluation included pain, function, satisfaction, and reoperations. OCA failure was defined as revision allografting or conversion to arthroplasty. Median follow-up was 5.7 years (range 2-17 years). Results: Seventeen knees (18%) underwent reoperations. Two knees (2%) were classified as OCA failures (one revision OCA at 2.7 years and one conversion to unicompartmental arthroplasty at 10.2 years). Survivorship was 99% at 5 and 10 years. Pain and function improved (Table 1.), and 93% of patients were satisfied with the results of the OCA transplantation. Conclusion: In this cohort of “ideal” cartilage repair patients undergoing OCA transplantation, graft survivorship and clinical outcomes were excellent, with high satisfaction, pain relief, and functional improvement. Outcomes were equal or superior to other cartilage repair techniques. [Table: see text]

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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