Distal Femoral Fresh Osteochondral Allografts

Raz, Guy; Safir, Oleg; Backstein, David; Lee, Paul T. H.; Gross, Allan E.

doi:10.2106/jbjs.m.00769

Cited by 94 publications

(33 citation statements)

References 38 publications

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“…The study also showed that risk factors affecting the ability to return to sport were age more than 25 years (P = 0.04) and pre-operative duration of symptoms more than 12 mo (P = 0.003). Raz et al [29] reviewed 58 cases of osteochondral allograft transplantation to the distal femur with an average follow up of 21.8 years. 13 of 58 cases required further surgery of graft removal or TKA, and 1 case underwent multiple debridements before above-the-knee amputation.…”

Section: Shell Allograftmentioning

confidence: 99%

“…Colangeli et al [31] - Raz et al [29] Young, active patients Post-traumatic; OCD MFC, LFC 58 58 28 21.8 yr 22%…”

Section: Bipolarmentioning

confidence: 99%

“…Graft fragmentation and collapse are the main causes of failure, commonly presenting as new onset of pain, joint effusion, and mechanical symptoms. Failure of allograft transplantation Bakay et al [6] MFC, LFC, T, P, bipolar 33 -----Ghazavi et al [30] MFC, LFC, T, bipolar, P 126 95 71 66 --Langer et al [4] MFC, LFC 60 95 85 ---Gross et al [5] T 65 95 80 ---Jamali et al [35] P, FT 20 -67 ---Colangeli et al [31] T 8 -----Davidson et al [19] MFC, FT 10 -----Emmerson et al [24] MFC, LFC 66 91 76 76 --McCulloch et al [21] MFC, LFC 25 -----Williams et al [8] MFC, LFC 19 -----Pearsall et al [3] MFC, LFC, FT, P 24 -----Muscolo et al [32] T 58 65 65 ---Krych et al [28] MFC, LFC, FT, multiple sites 43 -----Murphy et al [27] MFC, LFC, FT, P, T, multiple sites 43 -----Raz et al [29] MFC, LFC 58 Bakay et al [6] MFC, LFC, T, P, bipolar…”

Section: Risks and Complicationsmentioning

confidence: 99%

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Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Chui

Jeys

Snow

2015

WJO

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The overall incidence of osteochondral defect in the general population is estimated to be 15 to 30 per 100000 people. These lesions can become symptomatic causing pain, swelling and decreased function of the knee, and may eventually progress to osteoarthritis. In the young and active population, partial or total knee arthroplasty (TKA) is rarely the treatment of choice due to risk of early failure. Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients. The treatment reduces pain, improves function and is a viable limb salvage procedure for patients, especially young and active patients for whom TKA is not recommended. Either large dowels generated with commercially available equipment or free hand shell allografts can be implanted in more posterior lesions. Current recommendations for fresh allografts stored at 4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability, following screening and testing protocols. Higher rates of successful allograft transplantation are observed in younger patients, unipolar lesions, normal or corrected malalignment, and defects that are treated within 12 mo of symptom onset. Patients with bipolar lesions, uncorrectable malalignment, advanced osteoarthritis, and those over 40 tend to have less favourable outcomes. Core tip:Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients. The treatment reduces pain, improves function and is a viable limb salvage procedure for patients, especially young and active patients for whom total knee arthroplasty is not recommended. Current recommendations for fresh allografts stored at 4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability, following screening and testing protocols. Higher rates of successful allograft transplantation are observed in younger patients, unipolar lesions, normal or corrected malalignment, and defects that are treated within 12 mo of symptom onset.

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Section: Shell Allograftmentioning

confidence: 99%

“…Colangeli et al [31] - Raz et al [29] Young, active patients Post-traumatic; OCD MFC, LFC 58 58 28 21.8 yr 22%…”

Section: Bipolarmentioning

confidence: 99%

Section: Risks and Complicationsmentioning

confidence: 99%

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Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Chui

Jeys

Snow

2015

WJO

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“…Efficacy of osteochondral allograft transplantation (OCA) has already been previously established [ 18 – 25 ]. However, its application is limited by the need for infectious disease screening, which requires extended allograft storage [ 26 , 27 ]. Long-term in vitro maintenance of osteochondral allograft tissue poses a very big challenge, especially for cell viability.…”

Section: Introductionmentioning

confidence: 99%

Impact of storage conditions on electromechanical, histological and histochemical properties of osteochondral allografts

Mickevičius

Pockevičius

Kučinskas

et al. 2015

BMC Musculoskelet Disord

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BackgroundOsteochondral allograft transplantation has a good clinical outcome, however, there is still debate on optimization of allograft storage protocol. Storage temperature and nutrient medium composition are the most critical factors for sustained biological activity of grafts before implantation. In this study, we performed a time-dependent in vitro experiment to investigate the effect of various storage conditions on electromechanical, histological and histochemical properties of articular cartilage.MethodsOsteochondral grafts derived from goat femoral condyles were frozen at −70 °C or stored at 4 °C and 37 °C in the medium supplemented with or without insulin-like growth factor-1 (IGF-1). After 14 and 28 days the cartilage samples were quantitatively analysed for electromechanical properties, glycosaminoglycan distribution, histological structure, chondrocyte viability and apoptosis. The results were compared between the experimental groups and correlations among different evaluation methods were determined.ResultsStorage at −70 °C and 37 °C significantly deteriorated cartilage electromechanical, histological and histochemical properties. Storage at 4 °C maintained the electromechanical quantitative parameter (QP) and glycosaminoglycan expression near the normal levels for 14 days. Although hypothermic storage revealed reduced chondrocyte viability and increased apoptosis, these parameters were superior compared with the storage at −70 °C and 37 °C. IGF-1 supplementation improved the electromechanical QP, chondrocyte viability and histological properties at 37 °C, but the effect lasted only 14 days. Electromechanical properties correlated with the histological grading score (r = 0.673, p < 0.001), chondrocyte viability (r = −0.654, p < 0.001) and apoptosis (r = 0.416, p < 0.02). In addition, apoptosis correlated with glycosaminoglycan distribution (r = −0.644, p < 0.001) and the histological grading score (r = 0.493, p = 0.006).ConclusionsOur results indicate that quality of allografts is better preserved at currently established 4 °C storage temperature. Storage at −70 °C or at 37 °C is unable to maintain cartilage function and metabolic activity. IGF-1 supplementation at 37 °C can enhance chondrocyte viability and improve electromechanical and histological properties of the cartilage, but the impact persists only 14 days. The correlations between cartilage electromechanical quantitative parameter (QP) and metabolic activity were detected. Our findings indicate that non-destructive assessment of cartilage by Arthro-BST is a simple and reliable method to evaluate allograft quality, and could be routinely used before implantation.

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“… 12 , 13 OCA may be used as primary treatment of focal, medium to large cartilage defects that are less amenable to marrow stimulation and in patients not ideally indicated for arthroplasty procedures. 8 , 14 Conversely, significant osteoarthritis or diffuse, nonfocal chondral pathology remains a contraindication to OCA. Symptomatic concomitant pathology such as malalignment (i.e., coronal and rotational), meniscal insufficiency, ligamentous injury, or adjacent compartment chondral disease may be treated simultaneously to optimize clinical outcomes.…”

Section: Techniquementioning

confidence: 99%

Multiple Osteochondral Allograft Transplantation with Concomitant Tibial Tubercle Osteotomy for Multifocal Chondral Disease of the Knee

Cotter

Waterman

Kelly

et al. 2017

Arthroscopy Techniques

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Symptomatic patellofemoral chondral lesions are a challenging clinical entity, as these defects may result from persistent lateral patellar maltracking or repetitive microtrauma. Anteromedializing tibial tubercle osteotomy has been shown to be an effective strategy for primary and adjunctive treatment of focal or diffuse patellofemoral disease to improve the biomechanical loading environment. Similarly, osteochondral allograft transplantation has proven efficacy in physiologically young, high-demand patients with condylar or patellofemoral lesions, particularly without early arthritic progression. The authors present the surgical management of a young athlete with symptomatic tricompartmental focal chondral defects with fresh osteochondral allograft transplantation and anteromedializing tibial tubercle osteotomy.

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Distal Femoral Fresh Osteochondral Allografts

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 94 publications

References 38 publications

Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Impact of storage conditions on electromechanical, histological and histochemical properties of osteochondral allografts

Multiple Osteochondral Allograft Transplantation with Concomitant Tibial Tubercle Osteotomy for Multifocal Chondral Disease of the Knee

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