Graft-Recipient Anteroposterior Mismatch Does Not Affect the Midterm Clinical Outcomes of Osteochondral Allograft Transplantation of the Femoral Condyle

Wang, Dean; Coxe, Francesca R.; Balazs, George C.; Chang, Brenda; Jones, Kristofer J.; Rodeo, Scott A.; Williams, Riley J.

doi:10.1177/0363546518782939

Cited by 14 publications

(18 citation statements)

References 41 publications

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“…A recent clinical study showed that graftrecipient anteroposterior mismatch was not associated with OCA failure or patient outcomes, suggesting that anteroposterior length mismatch is not an absolute contraindication for graft acceptance. 82 With regard to cartilage viability, all experts concurred that a standardized method for testing cartilage viability and metabolic activity should be established. Chondrocyte viability is considered critical for durable osteochondral restoration, survivorship, and long-term outcomes.…”

Section: Graft Matchingmentioning

confidence: 99%

“…20,58,80,83,88 0 0 1 0 4 5 C Femoral condylar OCAs can be adequately size matched using condylar and/or tibial width measured on radiographs with magnification marker or MRI/CT. 20,82 0 respondents agreed that rehabilitation after OCA reconstruction of the patellofemoral region should include weightbearing as tolerated in conjunction with extension bracing (up to 6 weeks). This consensus group agreed that time (minimum 12 weeks from surgery) and functional recovery should both be used as criteria to return to loading activities.…”

Section: Rehabilitation and Return To Sportsmentioning

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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Section: Graft Matchingmentioning

confidence: 99%

Section: Rehabilitation and Return To Sportsmentioning

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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“…29 Knowledge surrounding OCAs and cartilage restoration techniques for the knee continues to grow. As an example, Wang et al 26,27 demonstrated that condyle-specific matching and a graft-recipient anteroposterior mismatch of 6.7 mm were not associated with midterm OCA failure rates or inferior patient-reported outcome measures (PROMs). Beyond evaluating the success of OCAs in terms of technique, graft survival rate, or statistical changes in PROMs, Williams et al 29 first quantitatively defined clinical significance after mosaicplasty (osteochondral autograft transfer) and OCA of the knee in terms of clinically meaningful improvements: the minimal clinically important difference (MCID) and substantial clinical benefit (SCB).…”

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confidence: 99%

Association Between Preoperative Mental Health and Clinically Meaningful Outcomes After Osteochondral Allograft for Cartilage Defects of the Knee: A Machine Learning Analysis

et al. 2021

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Background: Fresh osteochondral allograft transplantation (OCA) is an effective method of treating symptomatic cartilage defects of the knee. This cartilage restoration technique involves the single-stage implantation of viable, mature hyaline cartilage into the chondral or osteochondral lesion. Predictive models for reaching the clinically meaningful outcome among patients undergoing OCA for cartilage lesions of the knee remain under investigation. Purpose: To apply machine learning to determine which preoperative variables are predictive for achieving the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) at 1 and 2 years after OCA for cartilage lesions of the knee. Study Design: Case-control study; Level of evidence, 3. Methods: Data were analyzed for patients who underwent OCA of the knee by 2 high-volume fellowship-trained cartilage surgeons before May 1, 2018. The International Knee Documentation Committee questionnaire (IKDC), Knee Outcome Survey–Activities of Daily Living (KOS-ADL), and Mental Component (MCS) and Physical Component (PCS) Summaries of the 36-Item Short Form Health Survey (SF-36) were administered preoperatively and at 1 and 2 years postoperatively. A total of 84 predictive models were created using 7 unique architectures to detect achievement of the MCID for each of the 4 outcome measures and the SCB for the IKDC and KOS-ADL at both time points. Data inputted into the models included previous and concomitant surgical history, laterality, sex, age, body mass index (BMI), intraoperative findings, and patient-reported outcome measures (PROMs). Shapley Additive Explanations (SHAP) analysis identified predictors of reaching the MCID and SCB. Results: Of the 185 patients who underwent OCA for the knee and met eligibility criteria from an institutional cartilage registry, 135 (73%) patients were available for the 1-year follow-up and 153 (83%) patients for the 2-year follow-up. In predicting outcomes after OCA in terms of the IKDC, KOS-ADL, MCS, and PCS at 1 and 2 years, areas under the receiver operating characteristic curve (AUCs) of the top-performing models ranged from fair (0.72) to excellent (0.94). Lower baseline mental health (MCS), higher baseline physical health (PCS) and knee function scores (KOS-ADL, IKDC Subjective), lower baseline activity demand (Marx, Cincinnati sports), worse pain symptoms (Cincinnati pain, SF-36 pain), and higher BMI were thematic predictors contributing to failure to achieve the MCID or SCB at 1 and 2 years postoperatively. Conclusion: Our machine learning models were effective in predicting outcomes and elucidating the relationships between baseline factors contributing to achieving the MCID for OCA of the knee. Patients who preoperatively report poor mental health, catastrophize pain symptoms, compensate with higher physical health and knee function, and exhibit lower activity demands are at risk for failing to reach clinically meaningful outcomes after OCA of the knee.

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“…6 Matching a graft to its donor site with respect to size and topography is important to minimizing articular step-off and maintaining near-normal contact pressure. 26 Studies have shown that an elevation of even 0.5 mm to 1 mm over the adjacent articular cartilage at the distal femur can increase contact pressures on the graft up to 50%. 27,28 In an effort to optimize articular congruity, many surgeons therefore seek hemicondyle grafts matched to the host laterality, mediolateral dimension, and anteroposterior dimension.…”

Section: Discussionmentioning

confidence: 99%

“…27,28 In an effort to optimize articular congruity, many surgeons therefore seek hemicondyle grafts matched to the host laterality, mediolateral dimension, and anteroposterior dimension. 26,29 A few studies have investigated the role of graft subchondral bony thickness in outcomes of OCA. Ackerman et al 30 showed that grafts with bony thickness <5 mm had 4.9 times greater odds of demonstrating subchondral cystic changes at short-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Articular Cartilage Thickness in Pediatric and Adolescent Knees: A Magnetic Resonance Imaging–Based Study

Sidharthan

Yau

Almeida

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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To establish normative values for articular cartilage thickness in pediatric and adolescent knees using magnetic resonance imaging (MRI) and investigate for any associations with age and skeletal maturity. Methods: MRI scans were analyzed in patients 7 to 18 years old without osteochondral lesions, chondral wear/pathology, intra-articular fractures, or history of knee surgery. Measurements of articular cartilage thickness at the patella (medial facet, lateral facet, median ridge), femur (medial condyle, lateral condyle, lateral trochlea), and tibia (medial plateau, lateral plateau) were made on axial, coronal, and sagittal MRI. Descriptive statistics were used to calculate mean cartilage thickness by age and sex. Analysis of variance with repeated measures, analysis of covariance, independent samples t test, and linear regression were performed to determine differences in mean cartilage thickness by anatomic location, sex, physeal status, and age, respectively. Results: A total of 240 knee MRI scans were included. Articular cartilage was thickest at the patella and did not vary with age or skeletal maturity. On the femur, articular cartilage was thickest at the lateral trochlea with mean cartilage thickness of 4.4 AE 1.4 mm in male patients and 3.6 AE 1.3 mm in female patients (P < .001). Patients with open distal femoral physes had significantly thicker cartilage at the medial femoral condyle, lateral femoral condyle, and lateral trochlea compared to patients with closing/closed physes (P < .001). Linear regression analysis revealed a significant inverse association between cartilage thickness at the femur and age. Conclusions: In pediatric and adolescent knees, articular cartilage is thickest at the patella, where it does not strongly correlate with age. In contrast, there is a strong inverse association between increasing age and articular cartilage thickness of the distal femoral condyles. Clinical Relevance: The longitudinal reference data presented in this study can aid in pre-operative interpretation of knee cartilage under pathologic conditions in pediatric and adolescent patients. F ocal articular cartilage lesions of the knee are challenging problems faced by sports medicine and pediatric orthopaedic surgeons alike. In children and adolescents, these injuries are commonly due to osteochondritis dissecans, avascular necrosis, patellofemoral dislocation, or trauma. 1,2 Growing participation From the Divisions of Pediatric Orthopaedic Surgery (A.Y., B.A.A., P.D.F.

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Graft-Recipient Anteroposterior Mismatch Does Not Affect the Midterm Clinical Outcomes of Osteochondral Allograft Transplantation of the Femoral Condyle

Cited by 14 publications

References 41 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

Association Between Preoperative Mental Health and Clinically Meaningful Outcomes After Osteochondral Allograft for Cartilage Defects of the Knee: A Machine Learning Analysis

Patterns of Articular Cartilage Thickness in Pediatric and Adolescent Knees: A Magnetic Resonance Imaging–Based Study

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