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Fresh Osteochondral Allografting for Bipolar Reciprocal Osteochondral Lesions of the Knee


Gokhan Meric, Assoc. Prof.
TURKEY

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Fresh Osteochondral Allografting for Bipolar Reciprocal Osteochondral Lesions of the Knee

Gokhan Meric, Assoc. Prof., TURKEY Guilherme Gracitelli, MD, UNITED STATES Pamela Pulido, MD, UNITED STATES Simon Görtz, MD, UNITED STATES Allison De Young, MPA, PA-C, UNITED STATES William Bugbee, MD, UNITED STATES

Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA

2015 Congress   Paper Abstract   2015 Congress   Not yet rated

 

Anatomic Location

Knee

Anatomic Structure

Cartilage Meniscus

Diagnosis / Condition

Arthritis

Sports Medicine

Outcome Studies

Treatment / Technique

Allograft

Cartilage

Cartilage Treatment Cartilage Injuries

Summary: Fresh osteochondral allograft transplantation is a useful salvage treatment option for reciprocal bipolar cartilage lesions of the knee.

Introduction

Chondral lesions in the knee are common and potentially debilitating problems. Large or complex chondral or osteochondral lesions in particular present a difficult clinical challenge with few restorative treatment options. Failure is more common for bipolar, reciprocal (“kissing”) chondral lesions, which constitutes a relative contraindication to these particular cartilage repair procedures. Osteochondral allograft (OCA) transplantation has been recommended in recent treatment algorithms for reconstruction of complex osteochondral defects of the knee.

OBJECTIVES
To evaluate outcomes of patients who have undergone osteochondral allograft transplantation for reciprocal bipolar cartilage injuries (“kissing lesions”) of the knee.

Methods

Fresh osteochondral allografts were implanted for bipolar chondral lesions in 46 patients (48 knees) between 1983 and 2010. Twenty-one males and 25 females averaged 40 years of age (range, 15-66 years). Thirty-four lesions were tibiofemoral and 14 patellofemoral. Forty-two patients (88%) had an average of 3.4 previous surgeries (range, 1-8). Mean allograft area was 19.2 cm². Clinical evaluation included the modified Merle d’Aubigné-Postel (18-point), International Knee Documentation Committee (IKDC) pain and function, and Knee Society function (KS-F) scores. Further surgeries on the operative joint were documented. Failure of the bipolar OCA was defined as revision OCA or conversion to arthroplasty.

Results

Survivorship of the bipolar OCA was 64.1% at 5 years. Thirty knees had further surgery; 22 knees (46%) were considered failures (3 OCA revisions, 14 total knee arthroplasties, 2 unicondylar arthroplasties, 2 arthrodeses, and 1 patellectomy). Among patients whose OCA was still in situ at follow-up, the mean follow-up was 7 years (range, 2-19.7 years). The mean 18-point score improved from 12.1 to 16.1; 88% (23 of 26 knees) were considered successful with a score =15. The mean IKDC pain score improved from 7.5 to 4.7 and the mean IKDC function score improved from 3.4 to 7.0. The mean KS-F score improved from 70.5 to 84.1.

Conclusions

We conclude that OCA transplantation is a useful salvage treatment option for reciprocal bipolar cartilage lesions of the knee. A high reoperation rate was observed, but successful outcome was associated with significant clinical improvement.