Abstract: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 oste… Show more
“…Absolute contraindications include early and multicompartmental osteoarthritis (OA), inflammatory arthropathies, and altered bone metabolism (i.e., smokers, alcohol abusers, and chronic steroid users). 17 …”
Section: Indicationsmentioning
confidence: 99%
“… 39 40 41 Ligamentous instability, malalignment, and the absence of >50% of the ipsilateral meniscus are relative contraindications that may require concomitant surgical procedures. 17 …”
Section: Indicationsmentioning
confidence: 99%
“…Allograft subsidence may be a milder complication causing persistent slight pain due to a low-grade chronic inflammatory reaction to the graft. 17 Immunological reactions could be the main cause of failure in large OCA with associated soft tissue transplant, as in bipolar OCA of the knee. Progressive OA and instability make these specific knee OCAs unsuitable for the treatment of posttraumatic end-stage OA.…”
Section: Complicationsmentioning
confidence: 99%
“…Osteochondral allograft (OCA) represents a solution for the treatment of large and deep osteochondral lesions, in both primary and revision procedures, with different advantages: possibility of covering virtually all sizes of defects, presence of subchondral bone, possibility of restoring complex surfaces and uncontained lesions, and absence of donor-site morbidity. 17 18 19 20 21 22 23 24 25 26 27 28 The main limitations of OCA are costs and graft availability. 29…”
Large osteochondral allograft (OCA) transplant has become a valid alternative to restore articular surface in challenging articular lesions in young and active patients, either in primary or in revision procedures. Several studies support the effectiveness and safety of OCA, but costs and graft availability limit their use. The indications are the treatment of symptomatic full-thickness cartilage lesions greater than 3 cm
2
, deep lesions with subchondral damage, or revision procedures when a previous treatment has failed. The goal of the transplant is to restore the articular surface with a biological implant, allow return to daily/sports activities, relieve symptoms, and delay knee arthroplasty. Grafts can be fresh, fresh-frozen, or cryopreserved; these different storage procedures significantly affect cell viability, immunogenicity, and duration of the storage. Dowel and shell technique are the two most commonly used procedures for OCA transplantation. While most cartilage lesions can be treated with the dowel technique, large and/or geometrically irregular lesions should be treated with the shell technique. OCA transplantation for the knee has demonstrated reliable mid- to long-term results in terms of graft survival and patient satisfaction. Best results are reported: in unipolar lesions, in patients younger than 30 years, in traumatic lesions and when the treatment is performed within 12 months from the onset of symptoms.
“…Absolute contraindications include early and multicompartmental osteoarthritis (OA), inflammatory arthropathies, and altered bone metabolism (i.e., smokers, alcohol abusers, and chronic steroid users). 17 …”
Section: Indicationsmentioning
confidence: 99%
“… 39 40 41 Ligamentous instability, malalignment, and the absence of >50% of the ipsilateral meniscus are relative contraindications that may require concomitant surgical procedures. 17 …”
Section: Indicationsmentioning
confidence: 99%
“…Allograft subsidence may be a milder complication causing persistent slight pain due to a low-grade chronic inflammatory reaction to the graft. 17 Immunological reactions could be the main cause of failure in large OCA with associated soft tissue transplant, as in bipolar OCA of the knee. Progressive OA and instability make these specific knee OCAs unsuitable for the treatment of posttraumatic end-stage OA.…”
Section: Complicationsmentioning
confidence: 99%
“…Osteochondral allograft (OCA) represents a solution for the treatment of large and deep osteochondral lesions, in both primary and revision procedures, with different advantages: possibility of covering virtually all sizes of defects, presence of subchondral bone, possibility of restoring complex surfaces and uncontained lesions, and absence of donor-site morbidity. 17 18 19 20 21 22 23 24 25 26 27 28 The main limitations of OCA are costs and graft availability. 29…”
Large osteochondral allograft (OCA) transplant has become a valid alternative to restore articular surface in challenging articular lesions in young and active patients, either in primary or in revision procedures. Several studies support the effectiveness and safety of OCA, but costs and graft availability limit their use. The indications are the treatment of symptomatic full-thickness cartilage lesions greater than 3 cm
2
, deep lesions with subchondral damage, or revision procedures when a previous treatment has failed. The goal of the transplant is to restore the articular surface with a biological implant, allow return to daily/sports activities, relieve symptoms, and delay knee arthroplasty. Grafts can be fresh, fresh-frozen, or cryopreserved; these different storage procedures significantly affect cell viability, immunogenicity, and duration of the storage. Dowel and shell technique are the two most commonly used procedures for OCA transplantation. While most cartilage lesions can be treated with the dowel technique, large and/or geometrically irregular lesions should be treated with the shell technique. OCA transplantation for the knee has demonstrated reliable mid- to long-term results in terms of graft survival and patient satisfaction. Best results are reported: in unipolar lesions, in patients younger than 30 years, in traumatic lesions and when the treatment is performed within 12 months from the onset of symptoms.
“…In addition, osteochondral integration is accomplished because of a creeping substitution phenomenon only in the first 8 to 12 mm layer of bone tissue. 14 , 15 Fig 1 Right knee. A standard short medial parapatellar approach is preferably used.…”
The treatment of articular cartilage lesions in young patients is certainly a complex matter and subject of continuous research, particularly for those located at the patellofemoral joint, given its peculiar biomechanical characteristics. Osteochondral grafts can be of relatively small size when the defect is focal and in an area that allows good stability and consequently the graft's integration. In case of large or multifocal lesions, it is possible to consider an osteochondral transplantation of the entire articular surface of the patella. We present a simple and reproducible technique to perform a patellar fresh osteochondral allograft resurfacing attempting to reduce the symptoms and delay a prosthetic implant in young patients with advanced patellar chondral injuries.
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