Clinical Outcomes after Revision of Autologous Chondrocyte Implantation to Osteochondral Allograft Transplantation for Large Chondral Defects: A Comparative Matched-Group Analysis

Merkely, Gergő; Ogura, Takeshi; Ackermann, Jakob; Mestriner, Alexandre Barbieri; Gomoll, Andreas H.

doi:10.1177/1947603519833136

Cited by 15 publications

(17 citation statements)

References 29 publications

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“… c References 3 , 30 , 36 , 40 , 44 , 48 , 49 , 55 , 57 , 65 , 70 , 71 . d References 2 , 17 , 26 , 32 , 34 , 39 , 46 , 56 , 66 , 76 , 86 . …”

Section: Resultsunclassified

“…78 Additionally, a robust body of literature supported the statement that OCAs can be used to revise previously failed cartilage restoration procedures. 17,32,34,39,46,56,76,86 Of these studies, a comparison of outcomes after primary OCA versus revision OCA after a failed cartilage procedure showed no significant difference and similar survival rates between the 2 cohorts. 32,39,56 A recent systematic review investigating outcomes of revision cartilage restoration procedures demonstrated that revision OCA consistently had similar results to primary OCA transplantation, even if the subchondral bone was affected.…”

Section: Indications For Osteochondral Allograftingmentioning

confidence: 99%

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Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft

Görtz

Tabbaa

Jones³

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Osteochondral allograft (OCA) transplantation has evolved into a first-line treatment for large chondral and osteochondral defects, aided by advancements in storage protocols and a growing body of clinical evidence supporting successful clinical outcomes and long-term survivorship. Despite the body of literature supporting OCAs, there still remains controversy and debate in the surgical application of OCA, especially where high-level evidence is lacking. Purpose: To develop consensus among an expert group with extensive clinical and scientific experience in OCA, addressing controversies in the treatment of chondral and osteochondral defects with OCA transplantation. Study Design: Consensus statement. Methods: A focus group of clinical experts on OCA cartilage restoration participated in a 3-round modified Delphi process to generate a list of statements and establish consensus. Questions and statements were initially developed on specific topics that lack scientific evidence and lead to debate and controversy in the clinical community. In-person discussion occurred where statements were not agreed on after 2 rounds of voting. After final voting, the percentage of agreement and level of consensus were characterized. A systematic literature review was performed, and the level of evidence and grade were established for each statement. Results: Seventeen statements spanning surgical technique, graft matching, indications, and rehabilitation reached consensus after the final round of voting. Of the 17 statements that reached consensus, 11 received unanimous (100%) agreement, and 6 received strong (80%-99%) agreement. Conclusion: The outcomes of this study led to the establishment of consensus statements that provide guidance on surgical and perioperative management of OCAs. The findings also provided insights on topics requiring more research or high-quality studies to further establish consensus and provide stronger evidence.

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“… c References 3 , 30 , 36 , 40 , 44 , 48 , 49 , 55 , 57 , 65 , 70 , 71 . d References 2 , 17 , 26 , 32 , 34 , 39 , 46 , 56 , 66 , 76 , 86 . …”

Section: Resultsunclassified

Section: Indications For Osteochondral Allograftingmentioning

confidence: 99%

Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft

Görtz

Tabbaa

Jones³

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Two studies delayed RTP from 6 months to 8 to 12 months when MAT, HTO, DFO, TTO, or ACLR was performed in addition to OCA. 21,53 Twelve publications The Orthopaedic Journal of Sports Medicine Return-to-Play Criteria After OCA 5 included time to return to jumping or plyometric activity, with a mode of 6 months and a range of 6 months to 1 year. The timeline to return to sport/return to activity without restriction was reported in 37 studies, with a mode of 6 months and a range of 4 months to 1 year (Table 4).…”

Section: Rtp Criteriamentioning

confidence: 99%

Rehabilitation and Return-to-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review

Stark

Rao

Gleason

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport. Purpose: To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature, SPORTDiscus, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies on knee OCA. Studies were included if they reported return-to-play data or postsurgical rehabilitation protocols. Results: A total of 62 studies met the inclusion criteria, with a total of 3451 knees in 3355 patients. Concomitant procedures were included in 30 of these studies (48.4%). The most commonly cited rehabilitation protocols included weightbearing restrictions and ROM guidelines in 100% and 90% of studies, respectively. ROM was most commonly initiated within the first postoperative week, with approximately half of studies utilizing continuous passive motion. Progression to weightbearing as tolerated was reported in 60 studies, most commonly at 6 weeks (range, immediately postoperatively to up to 1 year). Of the 62 studies, 37 (59.7%) included an expected timeline for either return to play or return to full activity, most commonly at 6 months (range, 4 months to 1 year). Overall, 13 studies (21.0%) included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. Conclusion: There is significant heterogeneity for postoperative rehabilitation guidelines and the return-to-play protocol after OCA of the knee in the literature, as nearly half of the included studies reported use of concomitant procedures. However, current protocols appear to be predominantly time-based without objective criteria or functional assessment. Therefore, the authors recommend the development of objective criteria for patient rehabilitation and return-to-play protocols after OCA of the knee.

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“…However, (M-)ACI has two main limitations: Due to the limited number of healthy and non-degenerated chondrocytes, cells have to be expanded in vitro to achieve sufficient number of cells needed for the implantation (ACI: 1 million cells per cm², M-ACI: 20 million cells per cm 3 ) [10][11][12]. Further, chondrocytebased cartilage treatments, as well as microfracture techniques, result in formation of fibrocartilage, characterized by its inferior mechanical properties and thus lacking functional restoration compared to healthy hyaline cartilage [4,[13][14][15][16][17]. One approach to overcome the limitation of cell number for (M-)ACI treatment are MSC-chondrocyte co-cultures, e.g., 80 % MSC and 20 % chondrocytes, that reduces autologous chondrocyte cell number at same total cell density.…”

Section: Introductionmentioning

confidence: 99%

Ex vivoosteochondral test system with control over cartilage defect depth – a pilot study to investigate the effect of oxygen tension and chondrocyte-based treatments in chondral and full thickness defects in an organ model

Schwab

Buss

Pullig

et al. 2020

Preprint

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Objective: High failure rates of (trauma induced) knee injuries highlight the need to improve current treatment strategies aiming to decrease the number of secondary osteoarthritis developed by patients in later stage. In this controlled laboratory study the stimulative effect of mesenchymal stromal cells (MSC) on chondrocyte (CHON) extracellular matrix production was investigated in an ex vivo cartilage defect model (chondral vs. full thickness defects) cultured under normoxic (20 % O2) and physioxic (2 % O2) conditions. Design: Porcine CHON or co-culture of 20 % CHON and 80 % MSC (MIX) were embedded in collagen type I hydrogel, implanted into 4 mm diameter cartilage defects of osteochondral explants and cultured with tissue specific media without addition of TGF-β under normoxia and physioxia. Chondral defects were induced automatically, while full thickness defects were created with biopsy punch. After 28 days of culture, samples were histologically processed, and treatments outcome was evaluated using international cartilage repair society (ICRS)-II scoring. Results: Under physioxic conditions, cartilage repair scoring results of the MIX treatment (chondral 8.67 ± 2.42, full thickness 5.67 ± 1.21) were close to those of CHON treatment (chondral 8.17 ± 0.75, full thickness 7.33 ± 1.21). Overall, scoring results were higher in physioxia compared to normoxia conditions in chondral defects, but less or no prevalent for full thickness defects. Conclusion: Co-culture of CHON with MSC represents a promising approach to stimulate chondrogenic repair and tissue formation in our ex vivo model and reduces total amount of CHON needed for cell-based treatment.

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Clinical Outcomes after Revision of Autologous Chondrocyte Implantation to Osteochondral Allograft Transplantation for Large Chondral Defects: A Comparative Matched-Group Analysis

Cited by 15 publications

References 29 publications

Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft

Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft

Rehabilitation and Return-to-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review

Ex vivoosteochondral test system with control over cartilage defect depth – a pilot study to investigate the effect of oxygen tension and chondrocyte-based treatments in chondral and full thickness defects in an organ model

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