Fresh Osteochondral Allograft Transplantation for Isolated Patellar Cartilage Injury. (April 2015)

• Record Type: Journal Article
• Authors: Gracitelli, Guilherme C.; Meric, Gokhan; Pulido, Pamela A.; Görtz, Simon; De Young, Allison J.; Bugbee, William D.
• Is Part Of: American journal of sports medicine. Volume 43:Number 4(2015:Apr.)
• Page Start: 879
• Page End: 884
• Publication Date: 2015-04
• Subjects: patella -- cartilage -- osteochondral allograft -- osteochondral defect -- osteochondral transplantation; Sports medicine -- Periodicals; Sports injuries -- Periodicals; Orthopedic surgery -- Periodicals; 617.102705
• DOI: 10.1177/0363546514564144
• Languages: English
• ISSNs: 0363-5465

Abstract

Background: The treatment of patellofemoral cartilage injuries can be challenging. Osteochondral allograft (OCA) transplantation has been used as a treatment option for a range of cartilage disorders. Purpose: To evaluate functional outcomes and survivorship of the grafts among patients who underwent OCA for patellar cartilage injuries. Study Design: Case series; Level of evidence, 4. Methods: An institutional review board–approved OCA database was used to identify 27 patients (28 knees) who underwent isolated OCA transplantation of the patella between 1983 and 2010. All patients had a minimum 2-year follow-up. The mean age of the patients was 33.7 years (range, 14-64 years); 54% were female. Twenty-six (92.9%) knees had previous surgery (mean, 3.2 procedures; range, 1-10 procedures). The mean allograft area was 10.1 cm 2 (range, 4.0-18.0 cm 2 ). Patients returned for clinical evaluation or were contacted via telephone for follow-up. The number and type of reoperations were assessed. Any reoperation resulting in removal of the allograft was considered a failure of the OCA transplantation. Patients were evaluated pre- and postoperatively using the modified Merle d'Aubigné-Postel (18-point) scale, the International Knee Documentation Committee (IKDC) pain, function, and total scores, and the Knee Society function (KS-F) score. Patient satisfaction was assessed at latest follow-up. Results: Seventeen of the 28 knees (60.7%) had further surgery after the OCA transplantation; 8 of the 28 knees (28.6%) were considered OCA failures (4 conversions to total knee arthroplasty, 2 conversions to patellofemoral knee arthroplasty, 1 revision OCA, 1 patellectomy). Patellar allografting survivorship was 78.1% at 5 and 10 years and 55.8% at 15 years. Among the 20 knees (71.4%) with grafts in situ, the mean follow-up duration was 9.7 years (range, 1.8-30.1 years). Pain and function improved from the preoperative visit to latest follow-up, and 89% of patients were extremely satisfied or satisfied with the results of the OCA transplantation. Conclusion: OCA transplantation was successful as a salvage treatment procedure for cartilage injuries of the patella.