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Osteochondral allograft

  • Cartilage Repair Techniques in the Knee (A Dhawan, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Over the past decade, osteochondral allograft transplantation has soared in popularity. Advances in storage techniques have demonstrated improved chondrocyte viability at longer intervals and allowed for potential of increased graft availability. Recent studies have stratified outcomes according to location and etiology of the chondral or osteochondral defect. Unipolar lesions generally have favorable outcomes with promising 10-year survival rates. Though those undergoing osteochondral allograft transplantation often require reoperation, patient satisfaction remains high.

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References

Papers of particular interest, and published recently, have been highlighted as: • Of importance •• Of major importance

  1. Arøen A, Løken S, Heir S, Alvik E, Ekeland A, Granlund OG, et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med. 2004;32(1):211–5.

    Article  PubMed  Google Scholar 

  2. Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997;13(4):456–60.

    Article  CAS  PubMed  Google Scholar 

  3. Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy. 2002;18(7):730–4.

    Article  PubMed  Google Scholar 

  4. Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 2007;14(3):177–82.

    Article  CAS  PubMed  Google Scholar 

  5. McCormick F, Harris JD, Abrams GD, Frank R, Gupta A, Hussey K, et al. Trends in the surgical treatment of articular cartilage lesions in the United States: an analysis of a large private-payer database over a period of 8 years. Arthroscopy. 2014;30(2):222–6.

    Article  PubMed  Google Scholar 

  6. Garrity JT, Stoker AM, Sims HJ, Cook JL. Improved osteochondral allograft preservation using serum-free media at body temperature. Am J Sports Med. 2012;40(11):2542–8.

    Article  PubMed  Google Scholar 

  7. Giannini S, Buda R, Ruffilli A, Pagliazzi G, Ensini A, Grigolo B, et al. Failures in bipolar fresh osteochondral allograft for the treatment of end-stage knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2081–9. Reported that within two years, 6 of 7 osteochondral allograft failed and required conversion to total knee arthroplasty.

    Article  CAS  PubMed  Google Scholar 

  8. Meric G, Gracitelli GC, Görtz S, De Young AJ, Bugbee WD. Fresh osteochondral allograft transplantation for bipolar reciprocal osteochondral lesions of the knee. Am J Sports Med. 2015;43(3):709–14. Reported bipolar allografts had 5-year survival rates of 64 %. At average 7 years follow-up, 65 % required additional surgery. Among those with surviving grafts, most were satisfied with his/her condition.

    Article  PubMed  Google Scholar 

  9. Pallante AL, Görtz S, Chen AC, Healey RM, Chase DC, Ball ST, et al. Treatment of articular cartilage defects in the goat with frozen versus fresh osteochondral allografts: effects on cartilage stiffness, zonal composition, and structure at six months. J Bone Joint Surg Am. 2012;94(21):1984–95.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Enneking WF, Campanacci DA. Retrieved human allografts: a clinicopathological study. J Bone Joint Surg Am. 2001;83-A(7):971–86.

    CAS  PubMed  Google Scholar 

  11. Enneking WF, Mindell ER. Observations on massive retrieved human allografts. J Bone Joint Surg Am. 1991;73-A:1123–42.

    Google Scholar 

  12. Czitrom AA, Keating S, Gross AE. The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation. J Bone Joint Surg. 1990;72-A:574–81.

    Google Scholar 

  13. Williams 3rd RJ, Dreese JC, Chen CT. Chondrocyte survival and material properties of hypothermically stored cartilage: an evaluation of tissue used for osteochondral allograft transplantation. Am J Sports Med. 2004;32(1):132–9.

    Article  PubMed  Google Scholar 

  14. LaPrade RF, Botker J, Herzog M, Agel J. Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles. A prospective outcomes study. J Bone Joint Surg Am. 2009;91(4):805–11.

    Article  PubMed  Google Scholar 

  15. Judas F, Rosa S, Teixeira L, Lopes C, Ferreira MA. Chondrocyte viability in fresh and frozen large human osteochondral allografts: effect of cryoprotective agents. Transplant Proc. 2007;39(8):2531–4.

    Article  CAS  PubMed  Google Scholar 

  16. Ohlendorf C, Tomford WW, Mankin HJ. Chondrocyte survival in cryopreserved osteochondral articular cartilage. J Orthop Res. 1996;14(3):413–6.

    Article  CAS  PubMed  Google Scholar 

  17. Pallante AL, Bae WC, Chen AC, Görtz S, Bugbee WD, Sah RL. Chondrocyte viability is higher after prolonged storage at 37° C than at 4° C for osteochondral grafts. Am J Sports Med. 2009;37 Suppl 1:24S–32.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Sammarco VJ, Gorab R, Miller R, Brooks PJ. Human articular cartilage storage in cell culture medium: guidelines for storage of fresh osteochondral allografts. Orthopedics. 1997;20(6):497–500.

    CAS  PubMed  Google Scholar 

  19. Pennock AT, Wagner F, Robertson CM, Harwood FL, Bugbee WD, Amiel D. Prolonged storage of osteochondral allografts: does the addition of fetal bovine serum improve chondrocyte viability? J Knee Surg. 2006;19(4):265–72.

    Article  PubMed  Google Scholar 

  20. Görtz S, Bugbee WD. Fresh osteochondral allografts: graft processing and clinical applications. J Knee Surg. 2006;19:231–40.

    PubMed  Google Scholar 

  21. McAllister DR, Joyce MJ, Mann BJ, Vangsness Jr CT. Allograft update: the current status of tissue regulation, procurement, processing, and sterilization. Am J Sports Med. 2007;35(12):2148–58.

    Article  PubMed  Google Scholar 

  22. Ranawat AS, Vidal AF, Chen CT, Zelken JA, Turner AS, Williams RJ. Material properties of fresh cold-stored allografts for osteochondral defects at 1 year. Clin Orthop Relat Res. 2008;466:1826–36.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Robertson CM, Allen RT, Pennock AT, Bugbee WD, Amiel D. Upregulation of apoptotic and matrix-related gene expression during fresh osteochondral allograft storage. Clin Orthop Relat Res. 2006;442:260–6.

    Article  PubMed  Google Scholar 

  24. Linn MS, Chase DC, Healey RM, Harwood FL, Bugbee WD, Amiel D. Etanercept enhances preservation of osteochondral allograft viability. Am J Sports Med. 2011;39(7):1494–9.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Mologne TS, Cory E, Hansen BC, Naso AN, Chang N, Murphy MM, et al. Osteochondral allograft transplant to the medial femoral condyle using a medial or lateral femoral condyle allograft: is there a difference in graft sources? Am J Sports Med. 2014;42(9):2205–13. Demonstrated that osteochondral allografts taken from medial or lateral femoral condyle provide a similar articular surface match when used to fill medial femoral condyle lesions. In both cases, 12 % of the allograft area was proud.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Koh JL, Kowalski A, Lautenschlager E. The effect of angled osteochondral grafting on contact pressure: a biomechanical study. Am J Sports Med. 2006;34(1):116–9.

    Article  PubMed  Google Scholar 

  27. Koh JL, Wirsing K, Lautenschlager E, Zhang LO. The effect of graft height mismatch on contact pressure following osteochondral grafting: a biomechanical study. Am J Sports Med. 2004;32(2):317–20.

    Article  PubMed  Google Scholar 

  28. Pylawka TK, Wimmer M, Cole BJ, Virdi AS, Williams JM. Impaction affects cell viability in osteochondral tissues during transplantation. J Knee Surg. 2007;20(2):105–10.

    PubMed  Google Scholar 

  29. Levy YD, Gorts S, Pulido PA, McCauley JC, Bugbee WD. Do fresh osteochondral allografts successfully treat femoral condyle lesions? Clin Orthop Relat Res. 2013;471:231–7. Reported outcomes following osteochondral allograft transplantation for condylar chondral defects. Among the 129 knees included in the study, 91 % were followed more than 10 years and 47 % required further surgery. Graft survivorship reached 82 % at 10 years’ follow-up and declined to only 74 % by 15 years.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Davidson PA, Rivenburgh DW, Dawson PE, Rozin R. Clinical, histologic, and radiographic outcomes of distal femoral resurfacing with hypothermically stored osteoarticular allografts. Am J Sports Med. 2007;35(7):1082–90.

    Article  PubMed  Google Scholar 

  31. Emmerson BC, Gortz S, Jamali AA, Chung C, Amiel D, Bugbee WD. Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med. 2007;35(6):907–14.

  32. Aubin PP, Cheah HK, Davis AM, Gross AE. Long-term followup of fresh femoral osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res. 2001;391 Suppl:S318-27.

  33. Garrett JC. Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults. Clin Orthop Relat Res. 1994;303:33–7.

  34. Marco F, Lopez-Oliva F, Fernández Fernández-Arroyo JM, de Pedro JA, Perez AJ, Leon C, et al. Osteochondral allografts for osteochondritis dissecans and osteonecrosis of the femoral condyles. Int Orthop. 1993;17(2):104–8.

  35. Drexler M, Gross A, Dwyer T, Safir O, Backstein D, Chaudhry H, et al. Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2015;23(5):1317–23. Reported long-term outcomes following combined osteochondral tibial allograft and distal femoral osteotomy. While survival rates approached 90 % at ten years, the durability decreased to 24 % at 20 years.

    Article  PubMed  Google Scholar 

  36. Shasha N, Krywulak S, Backstein D, Pressman A, Gross AE. Long-term follow-up of fresh tibial osteochondral allografts for failed tibial plateau fractures. J Bone Joint Surg Am. 2003;85-A Suppl 2:33–9.

    PubMed  Google Scholar 

  37. Locht RC, Gross AE, Langer F. Late osteochondral allograft resurfacing for tibial plateau fractures. J Bone Joint Surg Am. 1984;66(3):328–35.

    CAS  PubMed  Google Scholar 

  38. Gracitelli GC, Meric G, Pulido PA, Görtz S, De Young AJ, Bugbee WD. Fresh osteochondral allograft transplantation for isolated patellar cartilage injury. Am J Sports Med. 2015;43(4):879–84. Reported outcomes following osteochondral allograft transplantation for isolated patellar chondral defects. Among the 28 knees included in the study, 60.7 % required further surgery yet 89 % were satisfied or extremely satisfied with the procedure. Graft survivorship reached 78.1 % at 5 and 10 years’ follow-up but declined to 55.8 % by 15 years.

    Article  PubMed  Google Scholar 

  39. Torga Spak R, Teitge RA. Fresh osteochondral allografts for patellofemoral arthritis: long-term followup. Clin Orthop Relat Res. 2006;444:193–200.

  40. Jamali AA, Emmerson BC, Chung C, Convery FR, Bugbee WD. Fresh osteochondral allografts: results in the patellofemoral joint. Clin Orthop Relat Res. 2005;437:176–85.

    Article  PubMed  Google Scholar 

  41. Zukor DJ, Oakeshott RD, Gross AE. Osteochondral allograft reconstruction of the knee: part 2. Experience with successful and failed fresh osteochondral allografts. Am J Knee Surg. 1989;2:182–91.

    Google Scholar 

  42. Friedlaender GE, Strong DM, Tomford WW, Mankin HJ. Long-term follow-up of patients with osteochondral allografts. A correlation between immunologic responses and clinical outcome. Orthop Clin North Am. 1999;30(4):583–8.

    Article  CAS  PubMed  Google Scholar 

  43. Gross AE, Kim W, Las Heras F, Backstein D, Safir O, Pritzker KP. Fresh osteochondral allografts for posttraumatic knee defects: long-term followup. Clin Orthop Relat Res. 2008;466(8):1863–70.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. Beaver RJ, Mahomed M, Backstein D, Davis A, Zukor DJ, Gross AE. Fresh osteochondral allografts for post-traumatic defects in the knee. A survivorship analysis. J Bone Joint Surg Br. 1992;74(1):105–10.

    CAS  PubMed  Google Scholar 

  45. Ghazavi MT, Pritzker KP, Davis AM, Gross AE. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br. 1997;79(6):1008–13.

    Article  CAS  PubMed  Google Scholar 

  46. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. Lateral opening-wedge distal femoral osteotomy: pain relief, functional improvement, and survivorship at 5 years. Clin Orthop Relat Res. 2015;473(6):2009–15. Reported on outcomes of 40 patients undergoing lateral opening-wedge distal femoral osteotomy for either osteoarthritis or unloading cartilage in a restoration procedure. In this series, 74 % in the osteoarthritis group and 92 % in the joint restoration group were able to avoid arthroplasty within the first five years post-operatively.

    Article  PubMed  Google Scholar 

  47. Abrams GD, Hussey KE, Harris JD, Cole BJ. Clinical results of combined meniscus and femoral osteochondral allograft transplantation: minimum 2-year follow-up. Arthroscopy. 2014;30(8):964–70. e1. Reported on outcomes of 32 patients undergoing osteochondral allograft and meniscal allograft transplantations. At average 4 years follow-up, 25 % had re-operations and 82 % were satisfied with the procedure.

    Article  PubMed  Google Scholar 

  48. Getgood A, Gelber J, Gortz S, De Young A, Bugbee W. Combined osteochondral allograft and meniscal allograft transplantation: a survivorship analysis. Knee Surg Sports Traumatol Arthrosc. 2015;23(4):946–53. Reported on outcomes of 48 patients undergoing osteochondral allograft and meniscal allograft transplantations. At average 6.8 years follow-up, 54.2 % had re-operations and 22.9 % had failure of the meniscus and/or osteochondral allograft. 78 % were satisfied with the procedure.

    Article  PubMed  Google Scholar 

  49. Harris JD, Cavo M, Brophy R, Siston R, Flanigan D. Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration. Arthroscopy. 2011;27(3):409–18.

    Article  PubMed  Google Scholar 

  50. Horton MT, Pulido PA, McCauley JC, Bugbee WD. Revision osteochondral allograft transplantations: do they work? Am J Sports Med. 2013;41(11):2507–11. Reported outcomes following revision osteochondral allograft transplantation. Among the 33 knees included in the study, 75 % were followed for 10 years. Graft survivorship reached 61 % at 10 years’ follow-up.

    Article  PubMed  Google Scholar 

  51. Mont MA, Marker DR, Zywiel MG, Carrino JA. Osteonecrosis of the knee and related conditions. J Am Acad Orthop Surg. 2011;19(8):482–94.

    PubMed  Google Scholar 

  52. Gortz S, De Young AJ, Bugbee WD. Fresh osteochodnral allografting for steroid-associated osteonecrosis of the femoral condyles. Clin Orthop Relat Res. 2010;468:1269–78.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Bayne O, Langer F, Pritzker KP, Houpt J, Gross AE. Osteochondral allografts in the treatment of osteonecrosis of the knee. Orthop Clin North Am. 1985;16(4):727–40.

    CAS  PubMed  Google Scholar 

  54. Chahal J, Gross AE, Gross C, Mall N, Chahal A, Whelan DB, et al. Outcomes of osteochondral allograft transplantation. Arthroscopy. 2013;29(3):575–88. Systematic review that included 19 studies and 644 knees with an average follow-up of 58 months. While 18 % failure rate was reported, 86 % of patients remained satisfied with osteochondral allograft transplantation.

    Article  PubMed  Google Scholar 

  55. Krych AJ, Robertson CM, 3rd Williams RJ. Cartilage study group. Return to athletic activity after osteochondral allograft transplantation in the knee. Am J Sports Med. 2012;40(5):1053–9.

    Article  PubMed  Google Scholar 

  56. Bakay A, Csonge L, Papp G, Fekete L. Osteochondral resurfacing of the knee joint with allograft. Int Orthopaed (SICOT). 1998;22(5):277–81.

    Article  CAS  Google Scholar 

  57. Kandel RA, Gross AE, Ganel A, McDermott AG, Langer F, Prtizker KP. Histopathology of failed osteoarticular shell allografts. Clin Orthop Relat Res. 1985;197:103–10.

    PubMed  Google Scholar 

  58. Taylor DW, Bohm CK, Taylor JE, Gross AE. Use of fresh osteochodnral allograft in repair of distal femur after trauma. Mcgill J Med. 2011;13(1):22–7.

    PubMed Central  PubMed  Google Scholar 

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Conflict of interest

Dr. Torrie, Dr. Kesler, and Dr. Elkin have not received (or agreed to receive) from a commercial entity something of value (exceeding the equivalent of US$500) related in any way to this manuscript.

Dr. Gallo’s institution has received research support from Aesculap, Melsungen, Germany, for cartilage implant.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Orthopaedics, Bone and Joint Institute, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA, 17033, USA

    Arissa M. Torrie, William W. Kesler, Joshua Elkin & Robert A. Gallo

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  1. Arissa M. Torrie
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  2. William W. Kesler
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  3. Joshua Elkin
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  4. Robert A. Gallo
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Correspondence to Robert A. Gallo.

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This article is part of the Topical Collection on Cartilage Repair Techniques in the Knee

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Torrie, A.M., Kesler, W.W., Elkin, J. et al. Osteochondral allograft. Curr Rev Musculoskelet Med 8, 413–422 (2015). https://doi.org/10.1007/s12178-015-9298-3

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