Abstract
Fresh osteochondral allografts are used to repair osteoarticular defects of the knee. For post-traumatic defects recent advances in other techniques for cartilage repair and resurfacing have reduced the role of allograft tissue transplantation to defects larger than 3 cm in diameter and 1 cm in depth.
A fresh osteochondral allograft that has been harvested from a donor within 24 h from death and preserved in 4°C for up to 4 days shows 100% viability of the cartilage. The avascular bone remains structurally intact and mechanically strong until it is replaced by host bone or until it is weakened or absorbed. The indications for fresh osteochondral allografts for reconstructive surgery of the articular surface of the knee do not justify the use of immunosuppressive drugs and we therefore believe that surgical vascularization of the grafts should not be carried out.
This clinical approach can provide a reconstructive solution for younger higher demand patients where implants are not desirable and arthrodesis is not acceptable. A clinical follow-up study as early as 1975 showed successful early outcomes. More recently, survival analysis found 95% survival at 5 years, 71% at 10 years, and 66% at 20 years. It was learned that older patients, bipolar transplants, improper loading of the graft, and grafts for osteoarthritis and steroid-induced avascular necrosis do not lead to good long-term outcomes.
We would like to describe here some of our long-term clinical experience concerning this surgery.
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References
Agnidis Z, Stimec J, Krajbich J, Hutchinson C and Gross AE Health related quality of life following fresh osteochondral allografts of the knee. Can. Orthop. Assoc. 53rd Annual meeting, Ottawa, Ontario, June 22, dy1998
Aubin PP, Cheah HK, Davis AM and Gross AE (2001) Long-term follow-up of fresh femoral osteochondral allografts for posttraumatic knee defects. Clin. Orthop. 391(Suppl): S318–S327
Bayne O, Langer F, Pritzker KP, Houpt J and Gross AE (1985) Osteochondral allografts in the treatment of osteonecrosis of the knee. Orthop. Clin. North Am. 16: 727–740
Beaver RJ, Mahomed M, Backstein D, Davis AM, Zukor DJ and Gross AE (1992) Fresh osteochondral allografts for posttraumatic defects in the knee. A survivorship analysis. J. Bone Joint Surg. 74(1): 105–110
Bellamy N (1995) Instruments to assess osteoarthritis-current status and future needs. Ann. Rheum. Dis. 54(9): 692–693
Bellamy N, Buchnan WW, Goldsmith CH, Campbell J and Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J. Rheumatol. 15(12): 1833–1840
Buckwalter JA and Mankin HJ (1998) Articular cartilage repair and transplantation. Arthritis Rheum. 41(8): 1331–1342
Campbell CJ, Ishida H, Takahashi H and Kelly F (1963) The transplantation of articular cartilage. An experimental study in dogs. J. Bone Joint Surg. (Am.) 45A: 1579–1592
Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A and Bell RS (1996) Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual. Life Res. 5(5): 508–516
DePalma AF, Tsaltas TT and Mauler GG (1963) Viability of osteochondral grafts as determined by uptake of S35. J. Bone Joint Surg. 45A: 1565–1578
Enneking WF and Mindell ER (1991) Observations on massive retrieved human allografts. J. Bone Joint Surg. (Am.) 73A: 1123–1142
Ghazavi MT, Pritzker KP, Davis AM and Gross AE (1997) Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J. Bone Joint Surg. Br. 79B: 1008–1013
Gibson T, Davis WB and Curran RC (1958) The long-term survival of cartilage homografts in man. Br. J. Plastic Surg. 11: 177–187
Gross AE (1992) Use of fresh osteochondral allografts to replace traumatic joint defects. In: Czitrom AA and Gross AE (eds) Allografts in Orthopaedic Practice. William & Wilkins, Baltimore
Gross AE, Silverstein EA, Falk J, Falk R and Langer F (1975) The allotransplantation of partial joints in the treatment of osteoarthritis of the knee. Clin. Orthop. 108: 7–14
Jacobs NJ (1987) Establishing a Surgical Bone Bank. In: Barr HR, Fawcett K. (eds). Tissue Banking. American Association of Blood Banks, Arlington Virginia
Kaplan EL and Meier P (1958) Nonparametric estimation from incomplete observations. J. Am. Stat. Assoc. 53: 457–481
Langer F and Gross AE (1974) Immunogenicity of allograft articular cartilage. J. Bone Joint Surg. (Am.) 56A: 297–304
Langer F, Czitrom AA, Pritzker KP and Gross AE (1975) The immunogenicity of fresh and frozen allogeneic bone. J. Bone Joint Surg. (Am.) 57A: 216–220
Langer F, Gross AE, West M and Urovitz MP (1978) The immunogenicity of allograft knee joint transplants. Clin. Orthop. 132: 155–162
Locht RC, Gross AE and Langer F (1984) Late osteochondral allograft resurfacing for tibial plateau fractures. J. Bone Joint Surg. 66A: 328–335
Mandelbaum BR, Browne JE, Fu F, Micheli L, Mosely JB Jr, Erggelet C, Minas T and Peterson L (1998) Articular cartilage lesions of the knee. Am. J. Sports Med. 26(6): 853–861
McDermott AG, Langer F, Pritzker KP and Gross AE (1985) Fresh small-fragment osteochondral allografts. Long-term follow-up study on first 100 cases. Clin. Orthop. 197: 96–102
McGoveran BM, Pritzker KPH, Shasha N, Price J and Gross AE (2002) Long-term chondrocyte viability in a fresh osteochondral allograft. Am. J. Knee Surg. 15(2): 97–100
Moran ME, Kim HK and Salter RB (1992) Biological resurfacing of full-thickness defects in patellar articular cartilage of the rabbit. Investigation of autogenous periosteal grafts subjected to continuous passive motion. J. Bone Joint Surg. (Br.) 74-B(5): 659–667
Newman AP (1998) Articular cartilage repair. Am. J. Sports Med. 26(2): 309–324
Oakshott RD, Farine I, Pritzker KPH, Langer F and Gross AE (1988) A clinical and histological analysis of failed fresh osteochondral allografts. Clin. Orthop. 233: 283–294
O'Driscoll SW (1998) The healing and regeneration of articular cartilage. J. Bone Joint Surg. (Am.) 80-A(12): 1795–1812
Rodrigo J, Thompson E and Travis C (1980) 4?C Preservation of avascular osteocartilaginous shell allografts in rats. Transact. Ortho. Res. Soc. 5: 72
Schreiber GB, Busch, MP, Kleinman, SH, et al. (1996) The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study. N. Engl. J. Med. 334(26): 1685–1690
Steadman JR, Rodkey WG, Singelton SB and Briggs KK (1997) Micro fracture technique for full thickness chondral defect: technique and clinical results. Operative Techniq. Orthop. 7(4): 300–305
Tomford WW (1995) Transmission of disease through transplantation of musculoskeletal allografts. J. Bone Joint Surg. 77A(11): 1742–1754
Ware JE (1993) Measuring patients' views: the optimum outcome measure. BMJ. 306(6890): 1429–1430
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Shasha, N., Aubin, P.P., Cheah, H.K. et al. Long-term clinical experience with fresh osteochondral allografts for articular knee defects in high demand patients. Cell Tissue Banking 3, 175–182 (2002). https://doi.org/10.1023/A:1023658832356
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DOI: https://doi.org/10.1023/A:1023658832356