Osteochondral Allograft Transplantation of the Knee in Patients Aged 40 Years and Older

Background:Osteochondral allograft transplantation (OCA) is a recognized option for full-thickness articular cartilage defects of the knee, especially in the setting of large lesions or those involving the subchondral bone. Previous heterogenous studies of athletes have shown a 75% to 79% rate of return to play after the procedure.Purpose:To define return-to-play rates in a cohort of elite collegiate and professional basketball players following osteochondral allograft of the knee.Study Design:Case series; Level of evidence, 4.Methods:Prospectively collected data from an institutional cartilage repair registry were retrospectively reviewed. Patients were eligible for inclusion if they were collegiate or professional basketball players at the time of surgery. Patient demographics, lesion size and location, and surgical details were collected. Postoperative magnetic resonance imaging scans were scored with the OCAMRISS system. Time to return to play and pre- versus postoperative player performance were determined with publicly available internet resources.Results:Eleven athletes (4 professional, 7 collegiate) with a total of 14 treated lesions (1 to the medial femoral condyle, 6 to the lateral femoral condyle, 5 to the trochlea, and 2 to the patella) were eligible for study inclusion. Mean lesion size was 509 mm2. All patients underwent OCA through an arthrotomy, with fresh grafts. The overall rate of return to play at the same level of competition was 80%. Median time to return to play was 14 months (range, 6-26 months). Among players with available statistics, there was no significant reduction in any performance category.Conclusion:OCA in elite basketball players results in an 80% return to previous level of competition, which is consistent with previous reports of athletes playing other sports. Osteochondral allografting is a reasonable option to consider for full-thickness cartilage lesions of the knee, even for elite jumping athletes.

show abstract

“… 42 OCA has shown excellent clinical results throughout the knee in a variety of patient populations. 2 , 6 , 10 , 37 , 43 …”

Section: Discussionmentioning

confidence: 99%

Return to Play Among Elite Basketball Players After Osteochondral Allograft Transplantation of Full-Thickness Cartilage Lesions

Balazs

Wang

Burge

et al. 2018

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…They have provided a series of papers looking at subgroups, showing that results of OCA are no worse in patients who have had anterior cruciate ligament reconstruction (ACLR) [ 64 ] or in those with Body Mass Index (BMIs) over 30 (graft survival 83% at 5 years) [ 49 ]. They also found that results in patients aged over 40 (mean age 48, range 40–63 years) were also good, with graft survival 73% at 4 years [ 65 ].…”

Section: Evidence: Primary Studiesmentioning

confidence: 99%

The cost-effectiveness of osteochondral allograft transplantation in the knee

Mistry

Metcalfe

Smith

et al. 2019

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. They are used to repair combined defects of articular cartilage and bone. Such defects often occur in people far too young to have knee arthroplasty, for whom the main alternative to OCA is conservative symptomatic care, which will not prevent development of osteoarthritis. The aim of this report was to assess the cost-effectiveness of osteochondral allograft transplantation in the knee. Methods Systematic review of evidence on clinical effectiveness and economic modelling. Results The evidence on osteochondral allograft transplantation comes from observational studies, but often based on good quality prospective registries of all patients having such surgery. Without controlled trials, it was necessary to use historical cohorts to assess the effect of osteochondral grafts. There is good evidence that OCA are clinically effective with a high graft survival rate over 20 years. If an OCA graft fails, there is some evidence that revision with a second OCA is also effective, though less so than primary OCA. Economic modelling showed that osteochondral allograft transplantation was highly cost-effective, with costs per quality adjusted life year much lower than many other treatments considered cost effective. Conclusions Osteochondral allograft transplantation appears highly cost-effective though the cost per quality adjusted life year varies according to the widely varying costs of allografts. Based on one small study, revision OCA also appears very cost-effective, but more evidence is needed. Level of evidence II. Electronic supplementary material The online version of this article (10.1007/s00167-019-05392-8) contains supplementary material, which is available to authorized users.

show abstract

“…Eighty percent of the patients reported satisfactory results at a median follow-up of 6.6 years; the reported survivorship was 80% at 5 years and 70% at 10 years. Wang et al 86 treated 54 patients aged >40 years with OCA to treat femoral and patella osteochondral defects. They reported higher failure and reoperation rates compared with other series of younger patients and a 4-year survivorship rate of 73%.…”

Section: Literature Reviewmentioning

confidence: 99%

Large Osteochondral Allografts of the Knee: Surgical Technique and Indications

Pisanu

Cottino

Rosso

et al. 2018

Joints

View full text Add to dashboard Cite

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.

show abstract

Osteochondral Allograft Transplantation of the Knee in Patients Aged 40 Years and Older

Abstract: A higher failure rate was found in this series of patients aged ≥40 years who were treated with OCA as compared with other studies of younger populations. However, for select older patients, OCA can be a good midterm treatment option for cartilage defects of the knee.

Cited by 50 publications

References 36 publications

Return to Play Among Elite Basketball Players After Osteochondral Allograft Transplantation of Full-Thickness Cartilage Lesions

Return to Play Among Elite Basketball Players After Osteochondral Allograft Transplantation of Full-Thickness Cartilage Lesions

The cost-effectiveness of osteochondral allograft transplantation in the knee

Large Osteochondral Allografts of the Knee: Surgical Technique and Indications

Contact Info

Product

Resources

About