Allograft Compared with Autograft in Osteochondral Transplantation for the Treatment of Osteochondral Lesions of the Talus

Abstract

Background: There is a paucity of clinical studies that compare the efficacy of autograft and allograft in osteochondral transplantation for treatment of osteochondral lesions of the talus (OLT). The purpose of the present study was to compare the clinical and radiographic outcomes following osteochondral transplantation with autograft or allograft for OLT. Methods: A retrospective analysis comparing patients treated with autograft or allograft for OLT was performed. Clinical outcomes were evaluated with use of the Foot and Ankle Outcome Score (FAOS) and the Short Form-12 (SF-12) score. Magnetic resonance imaging (MRI) was evaluated with use of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. The rates of cyst occurrence, graft degradation, graft failure, and revision surgeries were also evaluated. Results: Twenty-five nonrandomized patients with autograft and 16 with allograft were included, with a mean follow-up of 26 months in the autograft group and 22 months in the allograft group. There were no significant differences among all demographic variables between the autograft and allograft groups. The mean postoperative FAOS was significantly higher in the autograft group (81.9; 95% confidence interval [CI]: 78.6 to 85.2) than in the allograft group (70.1; 95% CI: 63.7 to 76.5; p = 0.006). Similarly, the mean postoperative SF-12 scores were significantly higher in the autograft group (74.7; 95% CI: 71.0 to 78.4) than in the allograft group (66.1; 95% CI: 61.2 to 71.0; p = 0.021). MOCART scores were significantly better in the autograft group (87.1) than in the allograft group (75.5; p = 0.005). The rate of chondral wear on MRI was higher in the allograft group (53%) than in the autograft group (4%; p < 0.001). Cyst formation in the graft itself was more likely to occur in the allograft group (47%) than in the autograft group (8%; p = 0.017). The rate of secondary procedures for the graft was higher in the allograft group (25%) than in the autograft group (0%; p = 0.009). Conclusions: In this small nonrandomized cohort study, the procedures performed with use of an autograft provided better clinical and MRI outcomes than the allograft procedures. The rate of chondral wear on MRI was higher with allograft than with autograft, and allograft-treated patients had a higher rate of clinical failure. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cyst formation in the subchondral bone following cartilage repair

“…65 Interestingly, autograft OCT also yielded a significantly improved ankle function and superior Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score compared with allograft OCT at about 2 years postoperatively, in good agreement with the significantly higher rate of clinical failures following allograft (25%, 4/16) compared with autograft OCT (0%, 0/25). 65 Shimozono et al also compared the postoperative incidence of cysts in ankle autograft OCT without or with concentrated BMA with a 60 months' follow-up. 66 The cyst incidence was significantly lower in autograft OCT with concentrated BMA (46.4%, 13/28) than in OCT without concentrated BMA (76.9%, 20/26).…”

“…Due to its high incidence (38.5% in microfracture 58 ; 38.8% in ACI 59 ; 38.9% in allograft OCT 62 ; 62.5% in allograft OCT 65 ; 76.9% in autograft OCT 66 ) and lasting presence (over 12 years reported for ACI 59 ), subchondral bone cyst formation following articular cartilage repair merits serious attention. Its appearance as early as 6 months postoperatively in over 15% of patients treated with microfracture 58 and 20% of patients treated with OCT 63,64 highlights the clinical importance.…”

“…The presence of a sclerotic rim is reflected in the higher peri‐cyst bone volume fraction than in the normal subarticular spongiosa 119 . Allograft 65 or autograft 66 OCTs have been associated with the occurrence of cysts in the ankle joint. Most cysts are located peripheral to or within the grafts.…”

Clinical Outcomes of Osteochondral Lesions of the Talus With Large Subchondral Cysts Treated With Osteotomy and Autologous Chondral Grafts: Minimum 2-Year Follow-up and Second-Look Evaluation

“…Hu et al 11 used osteoperiosteal cylinder grafts from the iliac crest, which also resulted in good clinical outcomes. Shimozono et al 23 retrospectively reviewed the use of autologous grafts in 25 patients and the use of allogeneic bone in 16 patients. Over an average follow-up of 2 years, the autografts provided better clinical and MRI outcomes than the allografts.…”

Bioactivating a bone substitute accelerates graft incorporation in a murine model of vertical ridge augmentation

“…Collectively, these disadvantages have made way for the development of bone graft extenders (reviewed in [ 9 ]). Their ease of use and unlimited quantities are two major advantages, but all allogeneic bone graft extenders must undergo deproteinization and decellularization to ensure immune-compatibility [ 10 ], Since they are devoid of stem/osteoprogenitor cells, and pro-osteogenic proteins, new bone tends to form very slowly around allografts [ 11 , 12 ]. This delayed graft incorporation is problematic and contributes to greater variability in clinical outcomes when allografts are used [ 13 ].…”