Fresh Osteochondral Allograft Transplantation for Bipolar Reciprocal Osteochondral Lesions of the Knee. (March 2015)

• Record Type: Journal Article
• Authors: Meric, Gokhan; Gracitelli, Guilherme C.; Görtz, Simon; De Young, Allison J.; Bugbee, William D.
• Is Part Of: American journal of sports medicine. Volume 43:Number 3(2015:Mar.)
• Page Start: 709
• Page End: 714
• Publication Date: 2015-03
• Subjects: knee -- cartilage -- osteochondral allograft -- osteochondral defect -- osteochondral transplantation; Sports medicine -- Periodicals; Sports injuries -- Periodicals; Orthopedic surgery -- Periodicals; 617.102705
• DOI: 10.1177/0363546514562549
• Languages: English
• ISSNs: 0363-5465

Abstract

Background: Osteochondral allograft (OCA) transplantation is an effective treatment option for chondral and osteochondral defects of the knee. Hypothesis: Patients treated with OCAs for reciprocal bipolar lesions of the knee would demonstrate significant clinical improvement. Study Design: Case series; Level of evidence, 4. Methods: Between 1983 and 2010, OCAs were implanted for bipolar chondral lesions in 46 patients (48 knees). The 21 male and 25 female patients averaged 40 years of age (range, 15-66 years). Thirty-four lesions were tibiofemoral, and 14 were patellofemoral. Forty-two knees (88%) had undergone a mean of 3.4 previous surgeries (range, 1-8). The mean allograft area was 19.2 cm 2 . Clinical evaluation included the modified Merle d'Aubigné-Postel (18-point), International Knee Documentation Committee (IKDC) pain and function, and Knee Society function (KS-F) scores. Further surgeries on the operative joint were documented. Results: Survivorship of the bipolar OCA was 64.1% at 5 years. Thirty knees underwent further surgery; 22 knees (46%) were considered failures (3 OCA revisions, 14 total knee arthroplasties, 2 unicondylar arthroplasties, 2 arthrodeses, and 1 patellectomy). Among patients whose OCA was still in situ at follow-up, the mean follow-up was 7 years (range, 2.0-19.7 years). The mean 18-point score improved from 12.1 to 16.1; 88% (23/26 knees) of surviving allografts scored ≥15. The mean IKDC pain score improved from 7.5 to 4.7, and the mean IKDC function score improved from 3.4 to 7.0. The mean KS-F score improved from 70.5 to 84.1. Conclusion: Osteochondral allograft transplantation is a useful salvage treatment option for reciprocal bipolar cartilage lesions of the knee. High reoperation and failure rates were observed, but patients with surviving allografts showed significant clinical improvement.