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Do Fresh Osteochondral Allografts Successfully Treat Femoral Condyle Lesions?

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Fresh osteochondral allograft transplantation is an increasingly common treatment option for chondral and osteochondral lesions in the knee, but the long-term outcome is unknown.

Questions/purposes

We determined (1) pain and function, (2) frequency and types of reoperations, (3) survivorship at a median of 13.5 years, and (4) predictors of osteochondral allograft failure in the distal femur.

Methods

We evaluated 122 patients (129 knees) who underwent osteochondral allograft transplantation of the femoral condyle. Mean age was 33 years and 53% were male. Clinical evaluation included the modified Merle d’Aubigné-Postel (18-point), IKDC, and Knee Society function (KS-F) scores. We defined graft failure as revision osteochondral allografting or conversion to arthroplasty. We determined whether patient characteristics or attributes of the graft influenced failure. Minimum followup was 2.4 years (median, 13.5 years); 91% had more than 10 years of followup.

Results

Mean modified Merle d’Aubigné-Postel score improved from 12.1 to 16, mean IKDC pain score from 7.0 to 3.8, mean IKDC function score from 3.4 to 7.2, and mean KS-F score from 65.6 to 82.5. Sixty-one knees (47%) underwent reoperations. Thirty-one knees (24%) failed at a mean of 7.2 years. Survivorship was 82% at 10 years, 74% at 15 years, and 66% at 20 years. Age of more than 30 years at time of surgery and having two or more previous surgeries for the operated knee were associated with allograft failure.

Conclusions

Followup of femoral condyle osteochondral allografting demonstrated durable improvement in pain and function, with graft survivorship of 82% at 10 years.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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References

  1. 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–S327.

  2. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331(14):889–895.

    Article  PubMed  CAS  Google Scholar 

  3. Bugbee WD. Fresh osteochondral allografts. J Knee Surg. 2002;15(3):191–195.

    PubMed  Google Scholar 

  4. Chu CR, Convery FR, Akeson WH, Meyers M, Amiel D. Articular cartilage transplantation. Clinical results in the knee. Clin Orthop Relat Res. 1999;(360):159–168.

  5. D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36-A(3):451–475.

    PubMed  Google Scholar 

  6. 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):1082–1090.

    Article  PubMed  Google Scholar 

  7. Davies-Tuck ML, Wluka AE, Wang Y, Teichtahl AJ, Jones G, Ding C, Cicuttini FM. The natural history of cartilage defects in people with knee osteoarthritis. Osteoarthritis Cartilage / OARS, Osteoarthritis Res Soc. 2008;16(3):337–342.

    Article  CAS  Google Scholar 

  8. Eickmann TH, Collier MB, Sukezaki F, McAuley JP, Engh GA. Survival of medial unicondylar arthroplasties placed by one surgeon 1984-1998. Clin Orthop Relat Res. 2006;452:143–149.

    Article  PubMed  Google Scholar 

  9. 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):907–914.

    Article  PubMed  Google Scholar 

  10. 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):33–37.

  11. 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):1008–1013.

    Article  PubMed  CAS  Google Scholar 

  12. Gortz S, Bugbee WD. Allografts in articular cartilage repair. J Bone Joint Surg Am. 2006;88(6):1374–1384.

    PubMed  Google Scholar 

  13. Gortz S, Bugbee WD. Allografts in articular cartilage repair. Instr Course Lect. 2007;56:469–480.

    PubMed  Google Scholar 

  14. Gortz S, De Young AJ, Bugbee WD. Fresh osteochondral allografting for steroid-associated osteonecrosis of the femoral condyles. Clin Orthop Relat Res. 2010;468(5):1269–1278.

    Article  PubMed  Google Scholar 

  15. Gross AE, Shasha N, Aubin P. Long-term followup of the use of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res. 2005;(435):79–87.

  16. 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):1863–1870.

    Article  PubMed  CAS  Google Scholar 

  17. Hangody L, Fules P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am. 2003;85-A(suppl 2):25–32.

    PubMed  Google Scholar 

  18. Hornicek FJ, Woll JE, Kasprisin D, eds. Standards for Tissue Banking. 10th ed. McLean, VA: American Association of Tissue Banks; 2002.

    Google Scholar 

  19. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;(248):13–14.

  20. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD. Development and validation of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2001;29(5):600–613.

    PubMed  CAS  Google Scholar 

  21. Jamali AA, Emmerson BC, Chung C, Convery FR, Bugbee WD. Fresh osteochondral allografts: results in the patellofemoral joint. Clin Orthop Relat Res. 2005;(437):176–185.

  22. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Statist Assoc. 1958;53(282):457–481.

    Article  Google Scholar 

  23. Keeney JA, Eunice S, Pashos G, Wright RW, Clohisy JC. What is the evidence for total knee arthroplasty in young patients?: a systematic review of the literature. Clin Orthop Relat Res. 2011;469(2):574–583.

    Article  PubMed  Google Scholar 

  24. 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):805–811.

    Article  PubMed  Google Scholar 

  25. Lonner JH, Hershman S, Mont M, Lotke PA. Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis. Clin Orthop Relat Res. 2000;(380):85–90.

  26. McCulloch PC, Kang RW, Sobhy MH, Hayden JK, Cole BJ. Prospective evaluation of prolonged fresh osteochondral allograft transplantation of the femoral condyle: minimum 2-year follow-up. Am J Sports Med. 2007;35(3):411–420.

    Article  PubMed  Google Scholar 

  27. McDermott AG, Langer F, Pritzker KP, Gross AE. Fresh small-fragment osteochondral allografts. Long-term follow-up study on first 100 cases. Clin Orthop Relat Res. 1985;(197):96–102.

  28. Miller BS, Steadman JR, Briggs KK, Rodrigo JJ, Rodkey WG. Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg. 2004;17(1):13–17.

    PubMed  Google Scholar 

  29. Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T. Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med. 2009;37(5):902–908.

    Article  PubMed  Google Scholar 

  30. Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005;87(9):1911–1920.

    Article  PubMed  Google Scholar 

  31. Mithofer K, Minas T, Peterson L, Yeon H, Micheli LJ. Functional outcome of knee articular cartilage repair in adolescent athletes. Am J Sports Med. 2005;33(8):1147–1153.

    Article  PubMed  Google Scholar 

  32. O’Driscoll SW. The healing and regeneration of articular cartilage. J Bone Joint Surg Am. 1998;80(12):1795–1812.

    PubMed  Google Scholar 

  33. Pearsall AW, Tucker JA, Hester RB, Heitman RJ. Chondrocyte viability in refrigerated osteochondral allografts used for transplantation within the knee. Am J Sports Med. 2004;32(1):125–131.

    Article  PubMed  Google Scholar 

  34. Peterson L, Minas T, Brittberg M, Lindahl A. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am. 2003;85-A(suppl 2):17–24.

    PubMed  Google Scholar 

  35. 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):33–39.

    PubMed  Google Scholar 

  36. Shelbourne KD, Jari S, Gray T. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J Bone Joint Surg Am. 2003;85-A(suppl 2):8–16.

    PubMed  Google Scholar 

  37. Steadman JR, Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJ. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg. 2003;16(2):83–86.

    PubMed  Google Scholar 

  38. Williams RJ 3rd, Ranawat AS, Potter HG, Carter T, Warren RF. Fresh stored allografts for the treatment of osteochondral defects of the knee. J Bone Joint Surg Am. 2007;89(4):718–726.

    Article  PubMed  Google Scholar 

  39. Williams SK, Amiel D, Ball ST, Allen RT, Tontz WL Jr, Emmerson BC, Badlani NM, Emery SC, Haghighi P, Bugbee WD. Analysis of cartilage tissue on a cellular level in fresh osteochondral allograft retrievals. Am J Sports Med. 2007;35(12):2022–2032.

    Article  PubMed  Google Scholar 

  40. Zaslav K, Cole B, Brewster R, DeBerardino T, Farr J, Fowler P, Nissen C. A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med. 2009;37(1):42–55.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA

    Yadin D. Levy MD, Pamela A. Pulido BSN & Julie C. McCauley MPHc

  2. Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, CA, USA

    Yadin D. Levy MD

  3. Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA

    Simon Görtz MD

  4. Division of Orthopaedic Surgery, Scripps Clinic, 10666 N Torrey Pines Road, MS 116, La Jolla, CA, 92037, USA

    William D. Bugbee MD

Authors
  1. Yadin D. Levy MD
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  2. Simon Görtz MD
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  3. Pamela A. Pulido BSN
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  4. Julie C. McCauley MPHc
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  5. William D. Bugbee MD
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Corresponding author

Correspondence to William D. Bugbee MD.

Additional information

The institution of one of the authors (WBD) has received, during the study period, funding from the Joint Restoration Foundation (Centennial, CO, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Scripps Clinic and Scripps Green Hospital (La Jolla, CA, USA).

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Levy, Y.D., Görtz, S., Pulido, P.A. et al. Do Fresh Osteochondral Allografts Successfully Treat Femoral Condyle Lesions?. Clin Orthop Relat Res 471, 231–237 (2013). https://doi.org/10.1007/s11999-012-2556-4

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  • DOI: https://doi.org/10.1007/s11999-012-2556-4

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