Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure

Abstract

Objective To evaluate the outcome of patients who have undergone simultaneous osteotomy and osteochondral allograft (OCA) transplantation. Our hypothesis is that use of high tibial osteotomy and fresh OCA in a combined procedure is safe and effective without increasing morbidity in comparison to OCA alone. Design A case series of 17 patients underwent tibial osteotomy and simultaneous OCA during a single surgery. Osteotomy was indicated when axial alignment was within the affected compartment. Patients had a minimum of 2 years of follow-up after surgery. The mean graft size was 8.7 cm, with 82% located on the medial femoral condyle alone and 18% involving the medial femoral condyle and one or more other sites. Data collection included demographics, osteotomy correction, graft site(s) and area, and clinical evaluation. Failure was defined as conversion to arthroplasty. Results Two of 17 patients (12%) failed at a mean of 9.3 years. The remaining 15 patients (88%) had intact allografts with mean survival of 8.1 years (SD 3.3). Five patients (29%) had an additional procedure, all undergoing osteotomy hardware removal. Of those with surviving allografts, mean pain and function scores improved significantly from the preoperative to postoperative assessment and International Knee Documentation Committee total scores improved significantly from 40.9 ± 15.4 preoperative to 75.5 ± 24.0 at latest follow-up ( P = 0.003); 92% of patients were satisfied with the results of the surgery. No postoperative complications occurred. Conclusion Combining high tibial osteotomy and OCA in properly selected patients is safe and effective.

Patient-Reported Outcomes for Large Bipolar Osteochondral Allograft Transplantation in Combination with Realignment Osteotomies for the Knee

“…However, taken together with previous studies documenting safety and efficacy of concurrent or staged realignment osteotomies in conjunction with OCA transplantation, best current evidence suggests continued clinical use and evaluation toward optimizing osteotomy indications, type, and timing are warranted. 2,14,40,41 While decision-making regarding the type of realignment osteotomy, distal femoral, or proximal tibial is primarily governed by the nature and severity of the malalignment, understanding the relative advantages and disadvantages of each with respect to graft healing and integration, joint function and maintenance of corrected alignment, complications, and morbidity is informative for surgeons and patients. It is plausible that DFO might be best performed concurrent with bipolar OCA transplantation, while proximal femoral osteotomy might be best performed as a staged procedure, or vice versa.…”

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

“…Nevertheless, the role of specific previous or concurrent procedures on the final outcome is unknown, and prior published studies reported good outcomes after previous or concurrent osteotomies. 9,14 In conclusion, magnitude of graft-recipient AP mismatch was not associated with OCA failure or patientreported outcome scores at midterm follow-up. While commercial allograft vendors continue to provide the AP and ML dimensions of the hemicondyle grafts for surgeons to perform graft-recipient size matching, these results suggest that any AP length mismatch within the limits measured here is not a contraindication for graft acceptance.…”

Surgical Trends in Articular Cartilage Injuries of the Knee, Analysis of the Truven Health MarketScan Commercial Claims Database from 2005-2014

“…This may be secondary to multiple studies that have demonstrated mixed results with regard to outcomes, complication rates and reoperation rates following osteotomy. [27][28][29][30][31]…”