Fresh osteochondral allograft transplantation for knee full-thickness articular cartilage lesions using femoral head of living donors: short-term results

Abstract

Background: Fresh osteochondral allograft transplantation is a good treatment option of cartilage defects. However, this treatment option is not available in all countries due to limited graft availability and tissue banks limitations. The purpose of this study is to assess the short term functional and imaging outcomes of fresh osteochondral allograft transplantation in the knee using the femoral head of living donors.

Hypothesis: Fresh osteochondral allografts from the femoral heads of living donors is a valid graft source for management of distal Femur cartilage defects. This technique can improve functional knee scores with good radiological outcomes.

Study design: Prospective case series.

Methods: Fifteen patients with full thickness cartilage defects of the distal femur underwent osteochondral allograft transplantation from the femoral heads of living donors. Grafts were transplanted by both shell and multiple dowels techniques. The average follow up duration was 18.3 months (range, 12-25 months). Patients were evaluated by Lysholm and International Knee Documentation Committee (IKDC) scores, radiography and MR imaging using Osteochondral Allograft MRI Scoring System (OCAMRISS).

Results: There was a statistically significant improvement (P < 0.001) in both Lysholm and IKDC average scores at 6 months and 12 months postoperative. Postoperative MRI was done at an average 6.8 months (range, 5-11 months) postoperative. The mean total OCAMRISS score was 3.4 (range, 1-7). A second look arthroscopy was done in four patients and showed intact articular cartilage in all three patients.

Conclusion: Femoral head of living donors is a valid new source for fresh osteochondral allograft transplantation of knee osteochondral lesions. Short term results showed improvement in clinical assessment scores. Follow up imaging showed graft incorporation and good MRI scores.

Keywords: Femoral heads; Living donors; Osteochondral allografts.

Fig. 1

Subchondral bone was cut to the depth of 6–8 mm by a burr (A: No. 7 patient, B: No. 3 patient)

Fig. 2

A and B: Subchondral bone was cut to match the same depth of the recipient defect. C: The graft was washed with saline to remove the marrow elements

Fig. 3

45 years old male presented 3 weeks after left knee trauma. A: Intraoperative image showing uncontained defect in the medial femoral condyle measuring 32 mm * 19 mm. B: Shell osteochondral allograft fixed by 2 headless compression screws. C and D: 3 months postoperative X-ray showing well contoured graft incorporation. E: 5 months postoperative CT scan showing well contoured graft incorporation. F and G: 5 months postoperative MRI showing 75–100% cartilage fill with good contour. H: 5 months postoperative second look arthroscopy showing intact hyaline cartilage

Fig. 4

A: The lesion was cut by the recipient dowel knife to a depth of 6 to 15 mm. B: A system tool was used to assess the cut dowel depth

Fig. 5

The femoral head was cut by the donor site dowel knife into a depth of one millimeter more than the recipient depth

Fig. 6

22 years old male Left knee. A: osteochondral defect lateral femoral condyle measuring 18 mm by 12 mm. B: 10 mm dowel donor site knife used on the femoral head. C: Two overlapping osteochondral allografts using the dowel technique

Fig. 7

Preoperative and postoperative Lysholm scores

Fig. 8

Preoperative and postoperative IKDC scores

Fig. 9

35 years old male right knee. A: Intraoperative image showing osteochondral defect of the medial femoral condyle measuring 27 mm * 23 mm. B: Shell osteochondral allograft fixed by two headless compression screws. C and D: 7 months postoperative MRI showing 75–100% cartilage fill with good contour

Fig. 10

39 years old female Left knee. A: osteochondral defect lateral femoral condyle measuring 29 mm * 20 mm. B: osteochondral allograft using the shell technique fixed by two mini-screws. C: 8 months post-operative MRI showing 100% cartilage filling and good contour

Fig. 11

Second look arthroscopies of patients No. 3 (A, B and C) and No. 5 (D, E and F) showing intact allograft hyaline cartilage