What is the role of osteochondral allografting in the treatment of patellofemoral arthritis?

Updated: Dec 11, 2019
  • Author: Dinesh Patel, MD, FACS; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

Osteochondral plugs or wafers can also be obtained from allografts, which limit damage to the articular surface and increase the size of defect that can be repaired. Fresh allografts of articular cartilage and subchondral bone are implanted into the defect. The allograft bone is reabsorbed and remodeled, but the transplanted chondrocytes survive. [36, 37]

Chu et al reported that in 55 consecutive patients, [38] about 84% with unipolar transplants, but only 50% with bipolar transplants, had good-to-excellent results. They also reported that 11 (73%) of 15 patients had good-to-excellent clinical results at 10-year follow-up.

In a long-term follow-up study of osteochondral grafting for isolated posttraumatic tibial plateau defects, by Shasha et al, [39] Kaplan-Meier analysis revealed a survival of 95% at 5 years, 80% at 10 years, and 65% at 15 years, with an endpoint of knee arthroplasty, revision of graft, or a Hospital for Special Surgery knee score of less than 70.

A case series by Gracitelli et al of fresh osteochondral allograft transplantation for isolated patellar cartilage injury in 28 knees concluded that transplantation was successful as a salvage treatment procedure. Eight of the 28 knees (28.6%) were considered treatment failures. Graft survival was 78.1% at 5 and 10 years and 55.8% at 15 years. [40]

Although this technique does not violate the native hyaline cartilage of the knee, fresh allografts must be used, as freezing or other processing destroys the viability of the chondrocytes. This limitation has limited enthusiasm for this procedure because, despite precautions, the risk of bacterial, viral, or fungal disease transmission remained increased with this type of transplant.


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