Fresh osteochondral knee allografts in Brazil with a minimum two-year follow-up

Tírico, Luis Eduardo Passarelli; Demange, Marco Kawamura; Santos, Luiz Alberto dos; Pécora, José Ricardo; Croci, Alberto Tesconi; Camanho, Gilberto Luís

doi:10.1016/j.rboe.2016.12.009

Cited by 1 publication

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References 29 publications

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“…F or osteochondral defects of the knee in relatively young and active patients, FOCA is an attractive treatment option because it may postpone or eliminate the need for TKA. Although smaller, contained lesions may be treated with newer techniques such as trephined plug grafts, the use of bulk FOCA to treat large chondral defects (i.e., >3 cm) in the knee has been documented in a number of studies [9][10][11][12][22][23][24] . A systematic review of knee FOCA studies found good durability and survival in 75.0% of 291 patients at a mean of 12.3 years postoperatively 19 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Bulk Fresh Osteochondral Allografts for Cartilage Restoration in the Knee

Daud

Safir

Gross

et al. 2021

Journal of Bone and Joint Surgery

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Background: Symptomatic osteochondral defects of the knee in young patients can cause substantial disability and predispose to osteoarthritis. Fresh osteochondral allografts (FOCAs) are a treatment option for such defects. With our institution having one of the longest-running FOCA programs, we investigated the longterm outcomes of bulk FOCA in the knee, focusing on graft survivorship, function, complications, and reoperation.Methods: A total of 244 patients underwent bulk FOCA in the knee from 1972 to 2018, with a mean age of 37.8 years (range, 10 to 75 years) and a mean follow-up of 9.0 years (range, 1.0 to 29.8 years). Cartilage defects were very large and uncontained, such that they were not amenable to plug transplantation. Survivorship according to Kaplan-Meier analysis was the primary outcome, and failure was defined as conversion to total knee arthroplasty, repeat allograft, graft removal, knee arthrodesis, or amputation. Functional outcome was evaluated with use of the modified Hospital for Special Surgery (mHSS) score, and radiographic evidence of osteoarthritis was classified with use of the Kellgren-Lawrence grading scale.Results: Graft survivorship was 86.6% at 5 years, 73.3% at 10 years, 58.1% at 15 years, 43.7% at 20 years, 31.9% at 25 years, and 22.6% at 30 years. The most common complications were pain (14.8%), malalignment (13.9%), and stiffness (5.8%). A total of 93 grafts (38.1%) failed at a mean of 11.0 years (range, 0.5 to 34.0 years). The mean mHSS score improved significantly, from 68.7 (range, 19 to 91) preoperatively to 80.3 (range, 52 to 100) at the time of the latest follow-up (p < 0.001). Preoperative mHSS score had a negative correlation with Kellgren-Lawrence grade at the time of the latest follow-up. Multivariate analysis revealed that graft location (i.e., medial-sided or multiple grafts) and increased age were significantly negatively associated with survival. Ten-year survival was >80% in patients below 50 years old, but <40% in patients >60 years old.Conclusions: Bulk FOCA provided promising long-term graft survival and functional improvement in patients <50 years old. It can delay or prevent the need for total knee arthroplasty in young patients. Older patients and patients with a medialsided graft, or multiple grafts within the same knee, had a less favorable prognosis.

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