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J Knee Surg 2017; 30(02): 179-184
DOI: 10.1055/s-0036-1584183
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient Factors, Donor Age, and Graft Storage Duration Affect Osteochondral Allograft Outcomes in Knees with or without Comorbidities

Clayton W. Nuelle
1   Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
,
Julia A.V. Nuelle
1   Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
,
James L. Cook
1   Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
,
James P. Stannard
1   Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
› Author Affiliations
Further Information

Publication History

02 December 2015

03 April 2016

Publication Date:
26 May 2016 (online)

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Abstract

Limited data exists defining preoperative variables that affect outcomes after osteochondral allograft transplantation (OAT) in the knee. In this retrospective study, we examined 75 patients who underwent OAT for large (≥2 cm2) grade IV cartilage defects in the femoral condyle. Patient variables evaluated included the following: smoking, workers compensation, body mass index (BMI), pre-injury activity level, number, and the type of co-morbidities in the operated knee, lesion location and number of grafts placed. OCA donor age and graft storage duration from procurement were also evaluated. Preoperative and postoperative visual analogue scale (VAS) pain scores were the primary outcome measure. Overall, 53 patients (71%) had successful outcomes, with 81% of patients without co-morbidities having successful outcomes. Active patients were significantly (p = 0.023) more likely to have a successful outcome than low activity patients. Patients with BMI <35 were 4 times more likely to have a successful outcome (p = 0.01). There were no significant differences based on donor age. Patients with transplanted grafts stored >28 days were significantly (p = 0.048) and 2.6 times more likely to have an unsuccessful outcome. This study provides new evidence for preoperative patient factors and graft variables that may influence the overall outcome after osteochondral transplantation in the knee.

Keywords

osteochondral allograft - osteochondral transplant - cartilage defects - osteochondral storage
 

  • 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
    PubMedSearch in Google Scholar
  • 2 Chui K, Jeys L, Snow M. Knee salvage procedures: the indications, techniques and outcomes of large osteochondral allografts. World J Orthod 2015; 6 (3) 340-350
    CrossrefPubMedSearch in Google Scholar
  • 3 Davies-Tuck ML, Wluka AE, Wang Y , et al. The natural history of cartilage defects in people with knee osteoarthritis. Osteoarthritis Cartilage 2008; 16 (3) 337-342
    CrossrefPubMedSearch in Google Scholar
  • 4 Görtz 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
    CrossrefPubMedSearch in Google Scholar
  • 5 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
    Search in Google Scholar
  • 6 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
    PubMedSearch in Google Scholar
  • 7 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
    CrossrefPubMedSearch in Google Scholar
  • 8 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. 02) 8-16
    PubMedSearch in Google Scholar
  • 9 Williams III RJ, 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
    CrossrefPubMedSearch in Google Scholar
  • 10 Heir S, Nerhus TK, Røtterud JH , et al. Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 2010; 38 (2) 231-237
    Search in Google Scholar
  • 11 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
    CrossrefPubMedSearch in Google Scholar
  • 12 Bugbee WD. Fresh osteochondral allografts. J Knee Surg 2002; 15 (3) 191-195
    PubMedSearch in Google Scholar
  • 13 Emmerson BC, Görtz 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
    Search in Google Scholar
  • 14 Hangody L, Füles 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. 02) 25-32
    PubMedSearch in Google Scholar
  • 15 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
    CrossrefPubMedSearch in Google Scholar
  • 16 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Mithoefer K, Williams III RJ, Warren RF , et al. 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
    CrossrefPubMedSearch in Google Scholar
  • 18 Zaslav K, Cole B, Brewster R , et al; STAR Study Principal Investigators. 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
    CrossrefPubMedSearch in Google Scholar
  • 19 Gudas R, Gudaite A, Pocius A , et al. Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes. Am J Sports Med 2012; 40 (11) 2499-2508
    CrossrefPubMedSearch in Google Scholar
  • 20 Gudas R, Kalesinskas RJ, Kimtys V , et al. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy 2005; 21 (9) 1066-1075
    Search in Google Scholar
  • 21 Harris JD, Siston RA, Pan X, Flanigan DC. Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am 2010; 92 (12) 2220-2233
    CrossrefPubMedSearch in Google Scholar
  • 22 Knutsen G, Drogset JO, Engebretsen L , et al. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 2007; 89 (10) 2105-2112
    CrossrefPubMedSearch in Google Scholar
  • 23 Levy YD, Görtz S, Pulido PA, McCauley JC, Bugbee WD. Do fresh osteochondral allografts successfully treat femoral condyle lesions?. Clin Orthop Relat Res 2013; 471 (1) 231-237
    CrossrefPubMedSearch in Google Scholar
  • 24 Cole BJ, Pascual-Garrido C, Grumet RC. Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 2009; 91 (7) 1778-1790
    PubMedSearch in Google Scholar
  • 25 Görtz S, Bugbee WD. Allografts in articular cartilage repair. J Bone Joint Surg Am 2006; 88 (6) 1374-1384
    CrossrefPubMedSearch in Google Scholar
  • 26 Görtz S, Bugbee WD. Allografts in articular cartilage repair. Instr Course Lect 2007; 56: 469-480
    PubMedSearch in Google Scholar
  • 27 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) 265-272
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Schachar N, McAllister D, Stevenson M, Novak K, McGann L. Metabolic and biochemical status of articular cartilage following cryopreservation and transplantation: a rabbit model. J Orthop Res 1992; 10 (5) 603-609
    CrossrefPubMedSearch in Google Scholar
  • 29 Cook JL, Stoker AM, Stannard JP , et al. A novel system improves preservation of osteochondral allografts. Clin Orthop Relat Res 2014; 472 (11) 3404-3414
    CrossrefPubMedSearch in Google Scholar
  • 30 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) 2542-2548
    CrossrefPubMedSearch in Google Scholar
  • 31 Stoker A, Garrity JT, Hung CT, Stannard JP, Cook J. Improved preservation of fresh osteochondral allografts for clinical use. J Knee Surg 2012; 25 (2) 117-125
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Cook JL, Stannard JP, Stoker AM , et al. Importance of donor chondrocyte viability in osteochondral allografting. Am J Sports Med 2016 (e-pub ahead of print)
    PubMed
  • 33 Pallante-Kichura AL, Cory E, Bugbee WD, Sah RL. Bone cysts after osteochondral allograft repair of cartilage defects in goats suggest abnormal interaction between subchondral bone and overlying synovial joint tissues. Bone 2013; 57 (1) 259-268
    CrossrefPubMedSearch in Google Scholar
  • 34 Bugbee W, Cavallo M, Giannini S. Osteochondral allograft transplantation in the knee. J Knee Surg 2012; 25 (2) 109-116
    Thieme ConnectPubMedSearch in Google Scholar
  • 35 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
    CrossrefPubMedSearch in Google Scholar
  • 36 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
    PubMedSearch in Google Scholar
  • 37 Raz G, Safir OA, Backstein DJ, Lee PTH, Gross AE. Distal femoral fresh osteochondral allografts: follow-up at a mean of twenty-two years. J Bone Joint Surg Am 2014; 96 (13) 1101-1107
    CrossrefPubMedSearch in Google Scholar
  • 38 Hornicek FJ, Woll JE, Kasprisin D , eds. Standards for Tissue Banking. 10th ed. McLean, VA: American Association of Tissue Banks; 2002
    Search in Google Scholar
  • 39 Vince KG. You can do arthroplasty in a young patient, but...: Commentary on articles by John P. Meehan, MD, et al.: “Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty,” and Vinay K. Aggarwal, et al.: “Revision total knee arthroplasty in the young patient: is there trouble on the horizon?”. J Bone Joint Surg Am 2014; 96 (7) e58
    CrossrefPubMedSearch in Google Scholar
  • 40 Wainwright C, Theis JC, Garneti N, Melloh M. Age at hip or knee joint replacement surgery predicts likelihood of revision surgery. J Bone Joint Surg Br 2011; 93 (10) 1411-1415
    CrossrefPubMedSearch in Google Scholar
  • 41 Pallante AL, Chen AC, Ball ST , et al. The in vivo performance of osteochondral allografts in the goat is diminished with extended storage and decreased cartilage cellularity. Am J Sports Med 2012; 40 (8) 1814-1823
    CrossrefPubMedSearch in Google Scholar
  • 42 Krych AJ, Robertson CM, Williams III RJ ; Cartilage Study Group. Return to athletic activity after osteochondral allograft transplantation in the knee. Am J Sports Med 2012; 40 (5) 1053-1059
    CrossrefPubMedSearch in Google Scholar
  • 43 Grilo RM, Treves R, Preux PM, Vergne-Salle P, Bertin P. Clinically relevant VAS pain score change in patients with acute rheumatic conditions. Joint Bone Spine 2007; 74 (4) 358-361
    CrossrefPubMedSearch in Google Scholar
  • 44 Tubach F, Ravaud P, Baron G , et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis 2005; 64 (1) 29-33
    CrossrefPubMedSearch in Google Scholar