- Discussion:
- see
allograft menu and
ocd menu;
- indicated for larger chondral or osteochondral defects (larger than 2 cm);
- donor characteristics:
- donors should be less than 30 years of age, with the graft harvesting the intact knee within 24 hrs of death;
- knee should be stored in RL at 4 deg;
-
effect of storage and time:
- references:
-
Prolonged Storage Effects on the Articular Cartilage of Fresh Human Osteochondral Allografts.
-
The Effects of Storage on Fresh Human Osteochondral Allografts
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Analysis of Stored Osteochondral Allografts at the Time of Surgical Implantation.
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Transplantation of Osteochondral Allografts After Cold Storage.
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Cell Viability and Protein Composition in Cryopreserved Cartilage.
-
Fluorescent Viability Stains Overestimate Chondrocyte Viability in Osteoarticular Allografts
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Material properties of fresh cold-stored allografts for osteochondral defects at 1 year.
-
Enhancing osteochondral allograft viability: effects of storage media composition.
- Outcome Studies:
- in the study by MT Ghazavi et al 1997, there was an 85% success rate at 7.5 years;
- in cases of damaged tibial plateau and meniscus, donor knee tibial plateau can be transfered along w/ its attached meniscus (sutured to the knee capsule);
- in cases where gross malalignment of the knee was present, osteotomy was performed (
HTO or
DFO);
- factors prognostic for poor results include age over 50, malalignment of the knee, workers compensation, and bipolar chondral injuries;
- these authors noted viability of cartilage cells retrieved even after 12 years;
- bone healing and incorporation takes place by 6 months, and bone replacement takes place afte one year;
- in the report by PP. Aubin et al, fresh osteochondral allografts were used to repair articular defects in the distal femur in 72 patients;
- 60 patients were available for long-term followup (mean, 10 years) to determine graft survivorship and patient
outcomes using a modified Hospital for Special Surgery score;
- 12 of 60 grafts have failed with three having graft removal alone and 9 being converted to total knee replacement;
- Kaplan-Meier survivorship analysis showed 85% graft survival at 10 years and 74% survival at 15 years;
- patients with surviving grafts had good function, with a mean HHS score of 83 points at 10 years followup;
- 10 patients (17%) required meniscal transplantation whereas 41 (68%) required realignment osteotomy done simultaneously with the osteochondral allograft;
- patients requiring meniscal transplantation, limb realignment, or both, had equally good outcomes at 10 years
as those who underwent osteochondral transplantation alone;
- transplantation to the medial or the lateral condyle had no bearing on long-term outcomes;
- radiographs were available for 38 patients.
- these radiographs showed that 18 (48%) patients had no or mild arthritis, 10 (26%) had moderate,
and 10 (26%) had severe arthritis.
- references:
-
The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation.
-
The fate of articular cartilage after transplantation of fresh and cryopreserved tissue-antigen-matched and mismatched osteochondral allografts in dogs.
- Free osteochondral allografts for post traumatic defects in the knee: a survivorship analysis. RJ Beaver et al. JBJS Br. Vol 74. 1992. p 105.
-
Resurfacing of the knee with fresh osteochondral allograft.
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The immune response to osteochondral allografts in dogs.
- Treatment of osteochondritis dissecans of the distal femur with fresh osteochondral allografts. JC Garrett. Arthroscopy. Vol 2. 1986. p 222.
- Fresh OCD allografts for the treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults. Garrett. CORR Vol 303. 1994. p 33.
- Fresh osteochondral allografts for post traumatic OCD defects of the knee. MT Ghazavi et al. JBJS. Vol 79-B. No 6. Nov 1997. p 108.
- Effect of tissue culture storage on the in vivo survival of canine osteochondral allografts. Oates KM, Chen AC, Young EP, et al: J Orthop Res 13:562-569, 1995
- Long-Term Followup of Fresh Femoral Osteochondral Allografts for Posttraumatic Knee Defects. PP. Aubin, MD. CORR 2001;2001:S318-S327
Isolated chondral fractures of the knee.
Characteristics of the Immediate Postoperative Blood Clot Formation in the Knee Joint.
LL Johnson MD Arthroscopy: The Journal of Arthroscopic and Related Surgery. Vol 7(1), 1991. p 14-23.
The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage: An experimental investigation in the rabbit.
Salter RB, Simmonds DF, Malcolm BW, et al: J Bone Joint Surg 1980;62A:1232.
Isolated chondral fractures of the knee.
Mesenchymal Cell Based Repair of Large Full Thickness Defects in Articluar Cartilage. S Wakitani. JBJS Vol 76-A. 1994. p 579-592.
Restoration of injured or degenerated articular cartilage. JA Buckwalter et al. J. Am. Acad of Orthopaedic Surgeons. 1994. 192-201.
Spontaneous repair of superficial defects in articular cartilage in a fetal lamb model. RS Namba MD et al. JBJS. Vol 80-A. No 1. Jan 1988.
Fresh Stored Allografts for the Treatment of Osteochondral Defects of the Knee.
Unicondylar Osteoarticular Allografts of the Knee
