Most series exploring outcomes following combined meniscal transplant and cartilage restoration include a myriad of techniques, including osteochondral autografts and allografts, microfracture, and autologous cartilage implantation [ 49 ].
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In this series, 48 patients were followed for an average of 6. The mean time to failure was 3.
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When osteochondral allografts fail, there remain two options, revision osteochondral allograft or conversion to a prosthetic arthroplasty. Unfortunately, there is a paucity of data on the survivorship and clinical improvement of revision osteochondral allografts to guide surgeons and patients. More research is needed to assess long-term results of revision allografts. Osteochondral allografts have been found to be an alternative to arthroplasty. Compared to other types of cartilage restoration such as autologous chondrocyte implantation ACI , osteochondral allografts have the theoretical advantage of addressing the osseous and chondral components concomitantly by replacing the juxaarticular necrotic lesions with a structural graft [ 52 ].
Opponents to osteochondral allograft for treatment of osteonecrosis cite two limitations: a potential impaired healing of the underlying bone, b lesions often involve multiple condyles [ 51 ]. For maximal benefit of osteochondral allografts, steroid use must be discontinued or the underlying disease causing the osteonecrosis must be resolved or in remission. In particular, Gortz et al. If steroid use is avoided and the underlying disease process is not active, favorable outcomes can be expected when osteochondral allografts are used to treat osteonecrotic lesions.
Gortz et al. Stable fixation, removal and supplemental grafting of deep necrotic lesions, and protected weight-bearing are important concepts to facilitate graft incorporation in this potentially unfavorable environment [ 52 ]. Unlike the other options, osteochondral allografts have the unique potential to reconstruct large defects of the subchondral bone. Emmerson et al. In this retrospective study with a mean age of When assessing patient satisfaction and clinical outcomes, knee function improved from a mean of 3. Giannini et al. Unfortunately, the studies reporting outcomes following osteochondral allograft procedures are hindered by significant limitations.
Second, nearly all studies of osteochondral allograft procedures have been level IV or V evidence. To date, no large randomized, controlled studies have been published comparing osteochondral allografts to other methods of cartilage restoration. Third, there is no uniformity in scoring systems used to report outcomes. There is limited data documenting return to athletics following osteochondral allograft transplantation.
Krych et al. At an average of 2. Athletes returned to sports at an average of 9. Failure of the osteochondral allografts has been linked to age at time of primary allograft, number of previous surgeries, size of defects, and bicondylar involvement. Similarly, those who underwent two or more previous surgeries in the operative knee were 2. One of the most common causes of graft failure is lack of incorporation.
Potential signs of failed incorporation include sclerosis, narrowing or obliteration of the joint space, and the formation of osteophytes [ 56 ]. While not a sign of poor graft incorporation, subchondral cyst formation is another sign of graft failure.
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Immunogenic causes of complications are considered rare. Theoretically, the thick matrix polysaccharides of the hyaline cartilage prevent exposure of the graft chondrocytes to the tissue and fluids of the host [ 41 ]. Articular cartilage and subchondral bone are thought to be immune-privileged, and no anti-immunogenic drugs are required [ 58 ]. Disease transmission remains a potential complication associated with osteochondral allografts.
Meaning of "autologous" in the English dictionary
However, with modern screening practices, including a minimum day waiting period to allow for serologic and microbiologic testing, the risk of catastrophic disease transmission has been minimized. Osteochondral allograft transplantation has become an increasingly popular method to reconcile chondral and osteochondral defects.
Curr Rev Musculoskelet Med. Published online Oct PMID: Arissa M. Torrie , William W. Kesler , Joshua Elkin , and Robert A. William W. Robert A. Corresponding author. This article has been cited by other articles in PMC. Abstract Over the past decade, osteochondral allograft transplantation has soared in popularity. Keywords: Osteochondral allograft, Articular cartilage restoration.
Background Articular cartilage lesions involving the knee are common among young, active patients. Adjunctive therapy Recently, in an attempt to enhance chondrocyte viability, investigators have sought to modulate factors that contribute to cell apoptosis. Surgical considerations Two surgical options, shell and dowel techniques, have been developed to implant osteochondral allografts. Outcomes Based on location Femoral condyle While osteochondral allograft procedures have been described for most regions of the knee, the femoral condyles are the most extensively studied.
Table 1 Studies of osteochondral allograft to treat femoral condyle articular cartilage lesions. Author Year No. Open in a separate window. Tibial plateau Unlike lesions involving the femoral condyles which tend to be secondary to osteochondritis dissecans or degenerative etiology and are amenable to dowel techniques, chondral damage to the tibial plateau is usually post-traumatic and often must be reconciled with shell-type osteochondral allografts.
Table 2 Studies of osteochondral allograft to treat tibial plateau articular cartilage lesions. Table 3 Studies of osteochondral allograft to treat patellofemoral articular cartilage lesions. Effects of adjuvant procedures Osteotomy Mechanical overload of osteochondral allograft during the healing phase is thought to be a contributor to graft failure [ 44 ]. Meniscal transplantation Many with osteochondral defects have co-existing meniscal pathology. Revision osteochondral allografts When osteochondral allografts fail, there remain two options, revision osteochondral allograft or conversion to a prosthetic arthroplasty.
Return to athletic activity There is limited data documenting return to athletics following osteochondral allograft transplantation. Complications Failure of the osteochondral allografts has been linked to age at time of primary allograft, number of previous surgeries, size of defects, and bicondylar involvement.
Conclusions Osteochondral allograft transplantation has become an increasingly popular method to reconcile chondral and osteochondral defects. Compliance with ethics guidelines Conflict of interest Dr. Human and animal rights and informed consent This article does not contain any studies with human or animal subjects performed by any of the authors. Articular cartilage lesions in consecutive knee arthroscopies.
Am J Sports Med. Cartilage injuries: a review of 31, knee arthroscopies. Articular cartilage defects in 1, knee arthroscopies. Articular cartilage defects: study of 25, knee arthroscopies.
Improved osteochondral allograft preservation using serum-free media at body temperature. Failures in bipolar fresh osteochondral allograft for the treatment of end-stage knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. Fresh osteochondral allograft transplantation for bipolar reciprocal osteochondral lesions of the knee. Treatment of articular cartilage defects in the goat with frozen versus fresh osteochondral allografts: effects on cartilage stiffness, zonal composition, and structure at six months.
J Bone Joint Surg Am.
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Retrieved human allografts: a clinicopathological study. Observations on massive retrieved human allografts. The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation. J Bone Joint Surg.
Chondrocyte survival and material properties of hypothermically stored cartilage: an evaluation of tissue used for osteochondral allograft transplantation. Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles. A prospective outcomes study. Chondrocyte viability in fresh and frozen large human osteochondral allografts: effect of cryoprotective agents.
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