Abstract
Purpose
This study aimed to determine the magnitude of local curvature matching in the sagittal plane between an implanted graft and the condylar region receiving the graft and to analyze its effect on clinical outcomes in patients undergoing osteochondral allograft transplantation (OCA).
Methods
Patients who underwent knee OCA between 2016 and 2019 without circumferential step-off and were matched with a donor in accordance with the conventional matching process were included. The magnitude of donor-host local curvature matching was measured using postoperative sagittal magnetic resonance imaging data with Syngo (Siemens Medical Solutions, Forchheim, Germany) and GeoGebra (GeoGebra GmbH, Linz, AU) software. In addition to radiological evaluation, ROC analysis was performed to compare the patient-reported outcome measures (PROMs) obtained during the 2-year follow-up period among the patients in the SagA group, who had a graft match in the sagittal plane; SagB group, who had low convexity of the graft in the sagittal plane; and SagC group, who had high convexity of the graft in the sagittal plane in accordance with the determined indices.
Results
The study included 27 patients who fulfilled the inclusion criteria, and the mean clinical scores of the SagC group were not statistically significantly higher than those of the other groups at any timepoint during the follow-up. The mean Tegner, IKDC, total KOOS and SF-12 physical and mental health scores of the SagC group were lower than those of the other two groups at various follow-up time points, particularly at month 24 (p < 0.05). There were no significant differences between the SagA and SagB groups in the PROMs at any of the follow-up time points (n.s.). The significant differences observed between the SagC group and the other groups in the mean KOOS scores for function in daily living and function in sport and recreation were also observed between the SagA and SagB groups at the follow-ups (p < 0.05).
Conclusion
During OCA, a local curvature mismatch between the donor and the host involving large graft convexity may have a negative impact on midterm clinical outcomes. A preoperative analysis of the convexity relationship between the defect site and the graft region in the hemicondylar allograft to be used may enhance donor-host matching. The local analysis method described in the current study may also facilitate graft supply by ensuring donor-host matching without condyle-side and size matching.
Level of evidence
III.
Similar content being viewed by others
References
Agneskirchner JD, Brucker P, Burkart A, Imhoff AB (2002) Large osteochondral defects of the femoral condyle: press-fit transplantation of the posterior femoral condyle (MEGA-OATS). Knee Surg Sports Traumatol Arthrosc 10:160–168
Bachhal V, Saini G, Jindal N, Sament R, Dadra A (2020) GeoGebra: a reliable and free software for measuring acetabular cup anteversion on digitalized plain radiographs. J Clin Orthop Trauma 11:S201–S205
Bernstein DT, O'Neill CA, Kim RS, Jones HL, Noble PC, Harris JD et al (2017) Osteochondral allograft Donor-Host matching by the femoral condyle radius of curvature. Am J Sports Med 45:403–409
Eckstein F, Winzheimer M, Hohe J, Englmeier KH, Reiser M (2001) Interindividual variability and correlation among morphological parameters of knee joint cartilage plates: analysis with three-dimensional MR imaging. Osteoart Cartilage 9:101–111
Fagan R, Furey AJ (2014) Use of large osteochondral allografts in reconstruction of traumatic uncontained distal femoral defects. J Orthop 11:43–47
Frank RM, Lee S, Levy D, Poland S, Smith M, Scalise N et al (2017) Osteochondral allograft transplantation of the knee: analysis of failures at 5 years. Am J Sports Med 45:864–874
Gomoll AH, Filardo G, Almqvist FK, Bugbee WD, Jelic M, Monllau JC et al (2012) Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc 20:468–486
Gross AE, Shasha N, Aubin P (2005) Long-term followup of the use of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res 435:79–87. https://doi.org/10.1097/01.blo.0000165845.21735.05
Haber DB, Logan CA, Murphy CP, Sanchez A, LaPrade RF, Provencher MT (2019) Osteochondral allograft transplantation for the knee: post-operative rehabilitation. Int J Sports Phys Ther 14:487–499
Kock NB, Smolders JM, van Susante JL, Buma P, van Kampen A, Verdonschot N (2008) A cadaveric analysis of contact stress restoration after osteochondral transplantation of a cylindrical cartilage defect. Knee Surg Sports Traumatol Arthrosc 16:461–468
Koh JL, Kowalski A, Lautenschlager E (2006) The effect of angled osteochondral grafting on contact pressure: a biomechanical study. Am J Sports Med 34:116–119
Koh JL, Wirsing K, Lautenschlager E, Zhang LO (2004) The effect of graft height mismatch on contact pressure following osteochondral grafting: a biomechanical study. Am J Sports Med 32:317–320
Kosel J, Giouroudi I, Scheffer C, Dillon E, Erasmus P (2010) Anatomical study of the radius and center of curvature of the distal femoral condyle. J Biomech Eng 132:091002
LaPrade RF, Botker J, Herzog M, Agel J (2009) Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles. A prospective outcomes study. J Bone Joint Surg Am 91:805–811
Li G, Park SE, DeFrate LE, Schutzer ME, Ji L, Gill TJ et al (2005) The cartilage thickness distribution in the tibiofemoral joint and its correlation with cartilage-to-cartilage contact. Clin Biomech (Bristol, Avon) 20:736–744
McCormick F, Harris JD, Abrams GD, Frank R, Gupta A, Hussey K et al (2014) 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 30:222–226
Mologne TS, Cory E, Hansen BC, Naso AN, Chang N, Murphy MM et al (2014) 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 42:2205–2213
Nakagawa Y, Suzuki T, Kuroki H, Kobayashi M, Okamoto Y, Nakamura T (2007) The effect of surface incongruity of grafted plugs in osteochondral grafting: a report of five cases. Knee Surg Sports Traumatol Arthrosc 15:591–596
Nishizawa Y, Matsumoto T, Araki D, Nagamune K, Matsushita T, Kurosaka M et al (2014) Matching articular surfaces of selected donor and recipient sites for cylindrical osteochondral grafts of the femur: quantitative evaluation using a 3-dimensional laser scanner. Am J Sports Med 42:658–664
Nuno N, Ahmed AM (2003) Three-dimensional morphometry of the femoral condyles. Clin Biomech (Bristol, Avon) 18:924–932
Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64
Rossi MJ, Lubowitz JH, Guttmann D (2002) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 30:152
Sherman SL, Garrity J, Bauer K, Cook J, Stannard J, Bugbee W (2014) Fresh osteochondral allograft transplantation for the knee: current concepts. J Am Acad Orthop Surg 22:121–133
Shin JJ, Haro M, Yanke AB, Mascarenhas R, Romeo AA, Cole BJ et al (2015) Topographic analysis of the capitellum and distal femoral condyle: finding the best match for treating osteochondral defects of the humeral capitellum. Arthroscopy 31:843–849
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Thaunat M, Couchon S, Lunn J, Charrois O, Fallet L, Beaufils P (2007) Cartilage thickness matching of selected donor and recipient sites for osteochondral autografting of the medial femoral condyle. Knee Surg Sports Traumatol Arthrosc 15:381–386
Wang D, Jones KJ, Eliasberg CD, Pais MD, Rodeo SA, Williams RJ 3rd (2017) Condyle-specific matching does not improve midterm clinical outcomes of osteochondral allograft transplantation in the knee. J Bone Joint Surg Am 99:1614–1620
Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233
Williams RJ 3rd, Ranawat AS, Potter HG, Carter T, Warren RF (2007) Fresh stored allografts for the treatment of osteochondral defects of the knee. J Bone Joint Surg Am 89:718–726
Wu JZ, Herzog W, Hasler EM (2002) Inadequate placement of osteochondral plugs may induce abnormal stress-strain distributions in articular cartilage –finite element simulations. Med Eng Phys 24:85–97
Yanke AB, Urita A, Shin JJ, Cvetanovich GL, Moran EK, Bach BR Jr et al (2019) Topographic analysis of the distal femoral condyle articular cartilage surface: adequacy of the graft from opposite condyles of the same or different size for the osteochondral allograft transplantation. Cartilage 10:205–213
Funding
None.
Author information
Authors and Affiliations
Contributions
S.G.; Wrote the manuscript, collected data, analysed data; M.E.S.; Analysed data and co-wrote the paper. M.A.; Performed bioinformatic analyses. O.K.; Mathematical calculations, analysed data. M.B.; Supervised the research.
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical approval
This study was approved by the Yıldırım Beyazit University Ethics Committee (approval no. B.30.2.YBU.006.06.01/108).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gursoy, S., Simsek, M.E., Akkaya, M. et al. Local curvature mismatch may worsen the midterm functional outcomes of osteochondral allograft transplantation. Knee Surg Sports Traumatol Arthrosc 29, 2948–2957 (2021). https://doi.org/10.1007/s00167-020-06319-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-020-06319-4