Summary

Fresh allograft transplantation in patients with large femoral osteochondral defects – A case series of a single center study

Abstract

Background

Damage to the articular cartilage of the knee can lead to chronic pain, swelling, and reduced physical activity in young, active individuals. It also elevates the risk of early-onset of osteoarthritis. Various treatment methods have demonstrated effectiveness in treating symptoms. These include microfracture, autologous cartilage transplantation procedures, and osteochondral transplantation using either autografts or allografts. Except for microfracture, all these techniques have shown comparable outcomes for small, isolated chondral lesions. However, osteochondral allograft transplantation (OATS) is the only method consistently suitable for treating large lesions or those extending into the subchondral or metaphyseal bone. The benefits of OATS have been demonstrated to maintain long-lasting structural integrity, restore the correct contour of the articular surface, and achieve excellent functional results in larger osteochondral defects. We present a case series involving patients who, following the failure of the conservative treatments, were proposed for fresh OATS. The grafting and storage of the allograft was done by our Institution's bone bank team and the surgical procedure included a press-fit single plug technique (BioUni, Arthrex, Naples, FL).

Hypothesis

Fresh OCA is a successful method for treating large osteochondral defects with good functional outcomes.

Methods

This study included 8 patients, treated with fresh OATS for the treatment of large osteochondral defects of the femoral condyle (6 medial; 2 lateral), diagnosed by magnetic resonance imaging (MRI), between 2020 and 2022, with a minimum follow-up of 2 years. The median age was 24.5 (range 18-39 years) and 62.5% were male. The evaluation included: failure of the graft; reoperation rate; International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) before and 2 years after surgery.

Results

The median follow-up was 2 years (2.0–4.5). A single patient needed revision surgery following OATS due to arthrofibrosis and the allograft failure rate was 0%. The mean IKDC score before surgery was 45.3 (27.6 – 92.0) and, after surgery, 85.63 (62.1- 95.4). The mean KOOS score before surgery was 44.6 (12.0 – 95.0), with a subtotal quality of life of 22.6 (0.0 – 88.0) and, 2 years post-operative, 89.6 (64.0 - 100), with a subtotal quality of life of 85.6 (63.0-100). All patients reported being satisfied with the outcomes of OATS.

Conclusion

Fresh osteochondral allograft transplantation is a well-known treatment option for large, unstable, osteochondral lesions in active individuals which demonstrated excellent efficacy, with no graft failure between 2-4 years follow-up. It demonstrated significant improvements in function scores with high patient satisfaction in this single center study who managed all the phases of the procedure, since the grafting, storage and transplantation of the allograft.