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. 2013 Jan;471(1):231-7.
doi: 10.1007/s11999-012-2556-4.

Do fresh osteochondral allografts successfully treat femoral condyle lesions?

Yadin D Levy  1 , Simon Görtz, Pamela A Pulido, Julie C McCauley, William D Bugbee
Affiliations

Do fresh osteochondral allografts successfully treat femoral condyle lesions?

Yadin D Levy et al. Clin Orthop Relat Res. 2013 Jan.

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.

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Figures

Fig. 1A–C
Fig. 1A–C
(A) An intraoperative photograph shows the femoral condyle after removal of the diseased tissue and preparation of the graft bed for shell allograft. (B) A shell allograft matched for size and thickness is obtained from the donor tissue before transplantation. (C) The shell allograft is in place, fixed with bioabsorbable pins.
Fig. 2A–B
Fig. 2A–B
(A) An intraoperative photograph shows the femoral condyle after removal of the diseased tissue and preparation of the allograft bed with the cylindrical reamer, with the size-matched donor dowel allograft. (B) The dowel allograft is in place, secured by press-fit technique.
Fig. 3
Fig. 3
A graph shows the overall graft survivorship and 95% CIs with revision of the allograft or arthroplasty conversion as the end point. Survivorship rates were 89% (95% CI, 82%–94%) at 5 years, 82% (95% CI, 74%–88%) at 10 years, 74% (95% CI, 66%–81%) at 15 years, and 66% (95% CI, 57%–74%) at 20 years.
See this image and copyright information in PMC

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