2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Standard Preservation Versus Extended Preservation Techniques for Osteochondral Allograft Transplantation of the Knee: A 16-week MRI Comparison of Osteochondral Integration

Kevin Chen, BA, Chicago, Illinois UNITED STATES
Lane Bailey, PT, PhD, DPT, CSCS, Houston, TX UNITED STATES
Manickam Kumaravel, MD, Houston, TX UNITED STATES
Paul G. Shupe, MD, Houston, Texas UNITED STATES
Walter Richard Lowe, MD, Houston, TX UNITED STATES

McGovern Medical School, University of Texas Health Sciences Center, Houston, TX, UNITED STATES

FDA Status Not Applicable

Summary

Osteochondral integration may be enhanced when using extended preservation over standard preservation techniques for OCA in the knee.

Abstract

Background

The flexibility offered by extended tissue preservation windows are preferred when considering osteochondral allograft transplant for large articular cartilage defects of the knee. However, few existing studies have objectively examined the postoperative osteochondral integration between extended (40-55 days) versus standard preservation (21-28 days) techniques.

Purpose/Hypothesis: To objectively compare osteochondral graft integration between Extended Preservation (EP) versus standard preservation (SP) allografts using 16-week postoperative MRIs following surgical transplantation.

Methods

A cross-sectional study was conducted for patients undergoing OCA, utilizing a single surgeon database (n = 2,041). Male and female patients (ages ≥18 years) receiving OCA with either ‘EP’ or ‘SP’ grafts were considered for study eligibility. Patient demographics and surgical data were obtained, including transplant location (medial femoral condyle, lateral femoral condyle, trochlea, or patella). All subjects completed a standard 16-week postoperative MRI of the involved limb. The Osteochondral Allograft Magnetic Resonance Imaging Scoring System (OCAMRISS) was utilized to objectively assess osteochondral integration. Concurrent International Knee Documentation Committee (IKDC) scores were obtained to assess self-reported knee function at 16-weeks. Independent t-tests and chi-square analyses were conducted using an alpha level of .05.

Results

One-hundred thirty-five patients (152 allografts) were included in this study (EP group, n = 92; SP group, n = 43) with a transplant distribution of; medial femoral condyle (50.4%), lateral femoral condyle (34.8%), trochlea (12.6%), and patella (2.2%). Baseline comparisons revealed no differences in age (P = .216), gender (P = .433), height (P = .549), weight (P = .943) or transplant location (P = .523) between EP and SP groups. No OCA graft failures were reported at the 16-week assessment period. The EP group demonstrated statistically lower OCAMRISS scores when compared to the SP group (3.5 ±1.7 vs 4.8 ±1.8, P < .001), however, no differences in self-reported IKDC scores (53.7 ±13.2 vs 51.5 ±16.7, P = .809) were observed.

Conclusions

The EP graft demonstrates statistically favorable osteochondral integration on 16-week postoperative MRI following surgical transplantation when compared to SP osteochondral allografts.

Clinical Relevance: Osteochondral integration may be enhanced when using EP over SP techniques for OCA in the knee.