Topographic Matching of Osteochondral Allograft Transplantation Using Lateral Femoral Condyle for the Treatment of Medial Femoral Condyle Lesions: A Computer-Simulated Model Study

Urita, Atsushi; Cvetanovich, Gregory L.; Madden, Brett; Verma, Nikhil N.; Inoue, Nozomu; Cole, Brian J.; Yanke, Adam B.

doi:10.1016/j.arthro.2018.05.039

Cited by 21 publications

(26 citation statements)

References 37 publications

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“…8,19,23,47 Location matching has been reported to improve the congruence between the graft and recipient surfaces. 86 Experts agreed that chondrocyte viability is crucial to graft survival. To this point, the preservation technique (fresh grafts have greater chondrocyte viability than cryopreserved grafts), 19,47 timing (implantation in <28 days), 2,6,95 and technique of implantation (avoiding impaction) 9,71 can significantly affect chondrocyte viability.…”

Section: Graft and Surgical Technique Considerationsmentioning

confidence: 99%

An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint

Chahla

Hinckel

Yanke

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Cartilage lesions of the patellofemoral joint constitute a frequent abnormality. Patellofemoral conditions are challenging to treat because of complex biomechanics and morphology. Purpose: To develop a consensus statement on the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint using a modified Delphi technique. Study Design: Consensus statement. Methods: A working group of 4 persons generated a list of statements related to the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint to form the basis of an initial survey for rating by a group of experts. The Metrics of Osteochondral Allografts (MOCA) expert group (composed of 28 high-volume cartilage experts) was surveyed on 3 occasions to establish a consensus on the statements. In addition to assessing agreement for each included statement, experts were invited to propose additional statements for inclusion or to suggest modifications of existing statements with each round. Predefined criteria were used to refine statement lists after each survey round. Statements reaching a consensus in round 3 were included within the final consensus document. Results: A total of 28 experts (100% response rate) completed 3 rounds of surveys. After 3 rounds, 36 statements achieved a consensus, with over 75% agreement and less than 20% disagreement. A consensus was reached in 100.00% of the statements relating to functional anatomy of the patellofemoral joint, 88.24% relating to surgical indications, 100.00% relating to surgical technical aspects, and 100.00% relating to rehabilitation, with an overall consensus of 95.5%. Conclusion: This study established a strong expert consensus document relating to the functional anatomy, surgical indications, donor graft considerations for osteochondral allografts, surgical technical aspects, and rehabilitation concepts for the management of large chondral and osteochondral defects in the patellofemoral joint. Further research is required to clinically validate the established consensus statements and better understand the precise indications for surgery as well as which techniques and graft processing/preparation methods should be used based on patient- and lesion-specific factors.

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Section: Graft and Surgical Technique Considerationsmentioning

confidence: 99%

An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint

Chahla

Hinckel

Yanke

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Second, only 20-mm defects were investigated. Prior work 42,45,46 has shown that LFC allografts for 25-mm centrally located lesions do not replicate the native surface geometry as well as for 20-mm lesions. However, since 75% of harvested MFCs are <25 mm in the mediolateral direction (JRF Ortho, oral personal communication, April 2017), larger lesions tend to extend more in the anteroposterior direction.…”

Section: Discussionmentioning

confidence: 99%

“…Contralateral LFC allografts have shown an excellent surface contour match when compared with MFC grafts for defects of 20 mm in diameter. 29 Yanke et al 42,45,46 have corroborated these findings with computer modeling, concluding that LFC allografts provide an acceptable topography match for 20-mm MFC defects, but the ability to match the topography decreases as the graft size increases to 25 mm. With a good surface topography match, acceptable clinical outcomes can be achieved.…”

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confidence: 86%

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Contralateral Lateral Femoral Condyle Allografts Provide an Acceptable Surface Match for Simulated Classic Osteochondritis Dissecans Lesions of the Medial Femoral Condyle

Salka

Grant

2020

Orthopaedic Journal of Sports Medicine

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Background: Osteochondral allograft transplantation is an effective technique for repairing large lesions of the medial femoral condyle (MFC), but its use is limited by graft availability. Purpose/Hypothesis: The present study aimed to determine whether contralateral lateral femoral condyle (LFC) allografts can provide an acceptable surface match for posterolateral MFC lesions characteristic of classic osteochondritis dissecans (OCD). The hypothesis was that LFC and MFC allografts will provide similar surface contour matches in all 4 quadrants of the graft for posterolateral MFC lesions characteristic of OCD. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen recipient human MFCs were each size-matched to 1 ipsilateral medial and 1 contralateral LFC donor (N = 30 condyles). After a nano–computed tomography (nano-CT) scan of the native recipient condyle, a 20-mm circular osteochondral “defect” was created 1 cm posterior and 1 cm medial to the roof of the intercondylar notch (n = 10). A size-matched, random-order donor MFC or LFC plug was then harvested, transplanted, and scanned with nano-CT. Nano-CT scans were then reconstructed, registered to the initial scan of the recipient MFC, and processed in MATLAB to determine the height deviation ( d RMS) between the native and donor surfaces and percentage area unacceptably (>1 mm) proud (% A proud) and sunken (% A sunk). Circumferential step-off height ( h RMS) and percentage circumference unacceptably (>1 mm) proud (% C proud) and sunken (% C sunk) were measured using DragonFly software. The process was then repeated for the other allograft plug. Results: Both MFC and LFC plugs showed acceptable step-off heights in all 4 quadrants (range, 0.53-0.94 mm). Neither allograft type nor location within the defect had a significant effect on step-off height ( h RMS), surface deviation ( d RMS), % A proud, or % A sunk. In general, plugs were more unacceptably sunken than proud (MFC, 13.4% vs 2.4%; LFC, 13.2% vs 8.1%), although no significant differences in % C sunk were seen between allograft types or locations within the defect. In LFC plugs, % C proud in the lateral quadrant (28.0% ± 26.1%) was significantly greater compared with all other quadrants ( P = .0002). Conclusion: The present study demonstrates that 20-mm contralateral LFC allografts provide an acceptable surface match for posterolateral MFC lesions characteristic of OCD. Clinical Relevance: With comparable surface matching, MFC and LFC allografts can be expected to present similar stresses on the knee joint and achieve predictably positive clinical outcomes, thus improving donor availability and reducing surgical wait times for matches.

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“…This is the context in which I considered the article "Topographic Matching of Osteochondral Allograft Transplantation Using Lateral Femoral Condyle for the Treatment of Medial Femoral Condyle Lesions: A Computer Simulated Model Study" by Urita, Cvetanovich, Madden, Verma, Inoue, Cole, and Yanke. 7 In this article, the authors performed a sophisticated study using 3dimensional computed tomography models of MFC and LFC cadaveric specimens to determine if LFC OCAs can accurately restore the articular surface of MFC defects. This is the most common clinical scenario in which I find myself using nonorthotopic grafts (i.e., LFC graft for medial defect), because MFC cartilage lesions are more commonly observed and, thus, MFC OCAs are in higher demand.…”

Section: See Related Article On Page 3033mentioning

confidence: 99%

Editorial Commentary: Osteochondral Allograft Transplantation of the Knee Using Nonorthotopic Grafts: A “Mismatch” Made in Heaven

Jones

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Topographic Matching of Osteochondral Allograft Transplantation Using Lateral Femoral Condyle for the Treatment of Medial Femoral Condyle Lesions: A Computer-Simulated Model Study

Cited by 21 publications

References 37 publications

An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint

An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint

Contralateral Lateral Femoral Condyle Allografts Provide an Acceptable Surface Match for Simulated Classic Osteochondritis Dissecans Lesions of the Medial Femoral Condyle

Editorial Commentary: Osteochondral Allograft Transplantation of the Knee Using Nonorthotopic Grafts: A “Mismatch” Made in Heaven

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