OCA transplantation was an effective treatment for OCD of the knee, with a low rate of graft failure, significant improvement in pain and function scores, and high patient satisfaction.

Objective:To assess the outcome of osteochondral allograft (OCA) transplantation as the primary treatment for cartilage injury in patients with no previous surgical treatment.Study Design:Case series. Patients were identified in our outcomes database. Patients undergoing primary OCA transplantation with no prior surgical treatment and a minimum of 2 years follow-up were selected. Pain and function were evaluated preoperatively and postoperatively. Patient satisfaction was assessed. Reoperations following OCA transplantation were captured. Failure was defined as revision OCA or conversion to arthroplasty.Results:Fifty-five patients (61 knees) were included in the analysis. The study consisted of 30 males and 25 females (mean age = 32.9 years; range = 15.7-67.8 years). The most common diagnoses for the OCA transplantation were osteochondritis dissecans (44.3%) and avascular necrosis (31.1%). Pain and function improved preoperatively to postoperatively on all outcome scales (P < 0.01). The majority of patients (86%) were “extremely satisfied” or “satisfied.” OCA survivorship was 89.5% at 5 years and 74.7% at 10 years. At latest follow-up (mean = 7.6 years; range = 1.9-22.6 years), OCA remained in situ in 50 knees (82%). Eighteen knees (29.5%) had further surgery; 11 OCA failures and 7 other surgical procedure(s). Of the failed knees (mean time to failure = 3.5 years; range = 0.5-13.7 years), 8 were converted to arthroplasty, 2 had OCA revisions, and 1 had a patellectomy.Conclusions:OCA transplantation is an acceptable primary treatment method for some chondral and osteochondral defects of the knee. Failure of previous treatment(s) is not a prerequisite for OCA transplantation.

Antibody development after fresh, non-tissue-matched osteochondral allograft transplants in the knee appears related to graft size. No difference was observed in clinical outcome between groups. Graft survival is multifactorial, and the effect that the immunologic response has on clinical outcome merits further investigation.

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Objectives:Osteochondritis dissecans (OCD) of the knee can be difficult to treat. Cartilage restoration techniques are often indicated when the lesion or fragment cannot be salvaged. Fresh osteochondral allograft (OCA) transplantation can restore both bone and cartilage defect as a treatment modality. We hypothesize that osteochondral allografting is a successful method for treating osteochondritis dissecans of the knee.Methods:Between 1983 and 2010, 164 patients (181 knees) underwent OCA for OCD of the femoral condyle(s) (type III or IV). Minimum two-year follow-up was available on 149 patients (165 knees). Median age was 25 years (range, 14 to 55) and 73% were male. Mean allograft size was 7.2 cm2(range, 2 to 23 cm2). Evaluation included frequency and type of reoperations, modified Merle d’Aubigné-Postel (18-point) scale, International Knee Documentation Committee (IKDC) pain and function scores, and Knee Society function (KS-F) score. Clinical failure was defined as revision OCA or conversion to arthroplasty. Graft survivorship was determined.Results:Median follow-up time was 7.7 years (range, 2 to 28.4 years). 78% had more than 5-year follow-up. Fifty-one of 165 knees (31%) had reoperations, of which 21 (13%) were classified as allograft failures (13 OCA revisions, 5 UKA, and 3 TKA). OCA survivorship was 93% at 5 years, 87% at 10 years, and 77% at 20 years. Of the 144 knees whose grafts were still in situ, 91% were rated good/excellent, 8% were rated fair, and 1% was rated poor. Mean modified Merle d’Aubigné-Postel (18-point) scale was 17, mean IKDC pain and function scores were 2 and 8, and mean KS-F score was 93. 88% of patients reported satisfaction.Conclusion:Osteochondral allograft transplantation was an effective treatment for osteochondritis dissecans of the knee, with significant improvement in pain and function scores and high patient satisfaction. Graft survivorship was 87% at 10 years.

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