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J Knee Surg 2012; 25(02): 109-116
DOI: 10.1055/s-0032-1313743
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Osteochondral Allograft Transplantation in the Knee

William Bugbee
1   Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
,
Marco Cavallo
2   II Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
,
Sandro Giannini
2   II Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
› Author Affiliations
Further Information

Publication History

27 October 2011

27 November 2011

Publication Date:
15 May 2012 (online)

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Abstract

Fresh osteochondral allograft (OCA) transplantation has over a 100-year clinical history. Many clinical and basic scientific studies have been performed with the result that allografting is now a part of the “cartilage repair paradigm” for the treatment of chondral or osteochondral lesions. In the knee joint, allografting has also been successfully used in complex joint reconstruction for the treatment of osteonecrosis, fracture malunion, and selected cases of osteoarthritis. Unlike many other cartilage repair techniques, OCA have the ability to restore mature, hyaline articular cartilage to the affected area. By virtue of their composite structure (cartilage and bone), allografts also can restore diseased or damaged bone often present in large or complex lesions. Nevertheless, OCA present unique and important difficulties in their clinical application, such as allograft tissue availability, safety issues, and immunologic response to the graft. Ongoing investigations continue to clarify the indications, surgical techniques, and clinical outcomes of fresh OCA.

Keywords

osteochondral allograft - knee - cartilage defect - osteochondral lesion
 

  • References

  • 1 Lexer E. Substitution of whole or half joints from freshly amputated extremities by free plastic operation. Surg Gynecol Obstet 1908; 6: 601-607
    PubMedGoogle Scholar
  • 2 Lexer E. Joint transplantations and arthroplasty. Surg Gynecol Obstet 1925; 40: 782-809
    PubMedGoogle Scholar
  • 3 Campbell CJ, Ishida H, Takahashi H, Kelly F. The transplantation of articular cartilage: an experimental study in dogs. J Bone Joint Surg Am 1963; 45: 1579-1592
    PubMedGoogle Scholar
  • 4 Craigmyle MBL. An autoradiographic and histochemical study of long-term cartilage grafts in the rabbit. J Anat 1958; 92 (3) 467-472
    PubMedGoogle Scholar
  • 5 Depalma AF, Tsaltas TT, Mauler GG. Viability of osteochondral grafts as determined by uptake of S35. J Bone Joint Surg Am 1963; 45: 1565-1578
    PubMedGoogle Scholar
  • 6 Locht RC, Gross AE, Langer F. Late osteochondral allograft resurfacing for tibial plateau fractures. J Bone Joint Surg Am 1984; 66 (3) 328-335
    PubMedGoogle Scholar
  • 7 Bell RS, Davis A, Allan DG, Langer F, Czitrom AA, Gross AE. Fresh osteochondral allografts for advanced giant cell tumors at the knee. J Arthroplasty 1994; 9 (6) 603-609
    CrossrefPubMedGoogle Scholar
  • 8 Meyers MH, Akeson W, Convery FR. Resurfacing of the knee with fresh osteochondral allograft. J Bone Joint Surg Am 1989; 71 (5) 704-713
    PubMedGoogle Scholar
  • 9 Garrett JC. Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults. Clin Orthop Relat Res 1994; (303) 33-37
    PubMedGoogle Scholar
  • 10 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
    Google Scholar
  • 11 Görtz S, Bugbee WD. Allografts in articular cartilage repair. J Bone Joint Surg Am 2006; 88 (6) 1374-1384
    PubMedGoogle Scholar
  • 12 Sgaglione NA, Chen E, Bert JM, Amendola A, Bugbee WD. Current strategies for nonsurgical, arthroscopic, and minimally invasive surgical treatment of knee cartilage pathology. Instr Course Lect 2010; 59: 157-180
    PubMedGoogle Scholar
  • 13 Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res 1983; 174 (174) 28-42
    PubMedGoogle Scholar
  • 14 Williams SK, Amiel D, Ball ST , et al. Prolonged storage effects on the articular cartilage of fresh human osteochondral allografts. J Bone Joint Surg Am 2003; 85–A (11) 2111-2120
    PubMedGoogle Scholar
  • 15 Allen RT, Robertson CM, Pennock AT , et al. Analysis of stored osteochondral allografts at the time of surgical implantation. Am J Sports Med 2005; 33 (10) 1479-1484
    CrossrefPubMedGoogle Scholar
  • 16 Pennock AT, Robertson CM, Wagner F, Harwood FL, Bugbee WD, Amiel D. Does subchondral bone affect the fate of osteochondral allografts during storage?. Am J Sports Med 2006; 34 (4) 586-591
    CrossrefPubMedGoogle Scholar
  • 17 Robertson CM, Allen RT, Pennock AT, Bugbee WD, Amiel D. Upregulation of apoptotic and matrix-related gene expression during fresh osteochondral allograft storage. Clin Orthop Relat Res 2006; 442: 260-266
    CrossrefPubMedGoogle Scholar
  • 18 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Pallante AL, Bae WC, Chen AC, Görtz S, Bugbee WD, Sah RL. Chondrocyte viability is higher after prolonged storage at 37°C than at 4°C for osteochondral grafts. Am J Sports Med 2009; 37 (Suppl. 01) 24S-32S
    CrossrefPubMedGoogle Scholar
  • 20 Enneking WF, Mindell ER. Observations on massive retrieved human allografts. J Bone Joint Surg Am 1991; 73 (8) 1123-1142
    PubMedGoogle Scholar
  • 21 Enneking WF, Campanacci DA. Retrieved human allografts: a clinicopathological study. J Bone Joint Surg Am 2001; 83–A (7) 971-986
    PubMedGoogle Scholar
  • 22 Acosta CA, Izal I, Ripalda P, Forriol F. Cell viability and protein composition in cryopreserved cartilage. Clin Orthop Relat Res 2007; 460: 234-239
    PubMedGoogle Scholar
  • 23 Görtz S, Bugbee WD. Allografts in articular cartilage repair. Instr Course Lect 2007; 56: 469-480
    PubMedGoogle Scholar
  • 24 Rodrigo JJ, Thompson E, Travis C. Deep-freezing versus 4 degrees preservation of avascular osteocartilaginous shell allografts in rats. Clin Orthop Relat Res 1987; 218 (218) 268-275
    PubMedGoogle Scholar
  • 25 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
    CrossrefPubMedGoogle Scholar
  • 26 Jamali AA, Hatcher SL, You Z. Donor cell survival in a fresh osteochondral allograft at twenty-nine years. A case report. J Bone Joint Surg Am 2007; 89 (1) 166-169
    CrossrefPubMedGoogle Scholar
  • 27 Bobić V. Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Knee Surg Sports Traumatol Arthrosc 1996; 3 (4) 262-264
    CrossrefPubMedGoogle Scholar
  • 28 Judas F, Rosa S, Teixeira L, Lopes C, Ferreira Mendes A. Chondrocyte viability in fresh and frozen large human osteochondral allografts: effect of cryoprotective agents. Transplant Proc 2007; 39 (8) 2531-2534
    CrossrefPubMedGoogle Scholar
  • 29 Malinin TI, Wagner JL, Pita JC, Lo H. Hypothermic storage and cryopreservation of cartilage. An experimental study. Clin Orthop Relat Res 1985; 187 (197) 15-26
    PubMedGoogle Scholar
  • 30 Bugbee WD, Convery FR. Osteochondral allograft transplantation. Clin Sports Med 1999; 18 (1) 67-75
    CrossrefPubMedGoogle Scholar
  • 31 Sammarco VJ, Gorab R, Miller R, Brooks PJ. Human articular cartilage storage in cell culture medium: guidelines for storage of fresh osteochondral allografts. Orthopedics 1997; 20 (6) 497-500
    PubMedGoogle Scholar
  • 32 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 (435) 79-87
    Google Scholar
  • 33 Ball ST, Amiel D, Williams SK , et al. The effects of storage on fresh human osteochondral allografts. Clin Orthop Relat Res 2004; 418 (418) 246-252
    CrossrefPubMedGoogle Scholar
  • 34 Pearsall IV AW, Tucker JA, Hester RB, Heitman RJ. Chondrocyte viability in refrigerated osteochondral allografts used for transplantation within the knee. Am J Sports Med 2004; 32 (1) 125-131
    CrossrefPubMedGoogle Scholar
  • 35 Malinin T, Temple HT, Buck BE. Transplantation of osteochondral allografts after cold storage. J Bone Joint Surg Am 2006; 88 (4) 762-770
    CrossrefPubMedGoogle Scholar
  • 36 Vangsness Jr CT, Garcia IA, Mills CR, Kainer MA, Roberts MR, Moore TM. Allograft transplantation in the knee: tissue regulation, procurement, processing, and sterilization. Am J Sports Med 2003; 31 (3) 474-481
    PubMedGoogle Scholar
  • 37 Gross AE. Use of fresh osteochondral allografts to replace traumatic joint defects. In: Czitrom AA, Gross AE, eds. Allografts in Orthopaedic Practice. Baltimore: Williams & Wilkins; 1992: 67-82
    Google Scholar
  • 38 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
    PubMedGoogle Scholar
  • 39 Stevenson S, Shaffer JW, Goldberg VM. The humoral response to vascular and nonvascular allografts of bone. Clin Orthop Relat Res 1996; (326) 86-95
    PubMedGoogle Scholar
  • 40 Ghazavi MT, Pritzker KP, Davis AM, Gross AE. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br 1997; 79 (6) 1008-1013
    CrossrefPubMedGoogle Scholar
  • 41 Shasha N, Krywulak S, Backstein D, Pressman A, Gross AE. Long-term follow-up of fresh tibial osteochondral allografts for failed tibial plateau fractures. J Bone Joint Surg Am 2003; 85–A (Suppl. 02) 33-39
    PubMedGoogle Scholar
  • 42 Jamali AA, Emmerson BC, Chung C, Convery FR, Bugbee WD. Fresh osteochondral allografts: results in the patellofemoral joint. Clin Orthop Relat Res 2005; 437 (437) 176-185
    PubMedGoogle Scholar
  • 43 Gross AE, Silverstein EA, Falk J, Falk R, Langer F. The allotransplantation of partial joints in the treatment of osteoarthritis of the knee. Clin Orthop Relat Res 1975; 108 (108) 7-14
    CrossrefPubMedGoogle Scholar
  • 44 Beaver RJ, Mahomed M, Backstein D, Davis A, Zukor DJ, Gross AE. Fresh osteochondral allografts for post-traumatic defects in the knee. A survivorship analysis. J Bone Joint Surg Br 1992; 74 (1) 105-110
    PubMedGoogle Scholar
  • 45 Flynn JM, Springfield DS, Mankin HJ. Osteoarticular allografts to treat distal femoral osteonecrosis. Clin Orthop Relat Res 1994; 303 (303) 38-43
    PubMedGoogle Scholar
  • 46 Gross AE, Agnidis Z, Hutchison CR. Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation. Foot Ankle Int 2001; 22 (5) 385-391
    PubMedGoogle Scholar
  • 47 Raikin SM. Fresh osteochondral allografts for large-volume cystic osteochondral defects of the talus. J Bone Joint Surg Am 2009; 91 (12) 2818-2826
    CrossrefPubMedGoogle Scholar
  • 48 Görtz S, De Young AJ, Bugbee WD. Fresh osteochondral allografting for osteochondral lesions of the talus. Foot Ankle Int 2010; 31 (4) 283-290
    CrossrefPubMedGoogle Scholar
  • 49 Hahn DB, Aanstoos ME, Wilkins RM. Osteochondral lesions of the talus treated with fresh talar allografts. Foot Ankle Int 2010; 31 (4) 277-282
    CrossrefPubMedGoogle Scholar
  • 50 El-Rashidy H, Villacis D, Omar I, Kelikian AS. Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am 2011; 93 (17) 1634-1640
    CrossrefPubMedGoogle Scholar
  • 51 Meehan R, McFarlin S, Bugbee W, Brage M. Fresh ankle osteochondral allograft transplantation for tibiotalar joint arthritis. Foot Ankle Int 2005; 26 (10) 793-802
    PubMedGoogle Scholar
  • 52 Giannini S, Buda R, Grigolo B , et al. Bipolar fresh osteochondral allograft of the ankle. Foot Ankle Int 2010; 31 (1) 38-46
    CrossrefPubMedGoogle Scholar
  • 53 Meyers MH. Resurfacing of the femoral head with fresh osteochondral allografts. Long-term results. Clin Orthop Relat Res 1985; 197 (197) 111-114
    PubMedGoogle Scholar
  • 54 Johnson DL, Warner JJ. Osteochondritis dissecans of the humeral head: treatment with a matched osteochondral allograft. J Shoulder Elbow Surg 1997; 6 (2) 160-163
    CrossrefPubMedGoogle Scholar
  • 55 Chapovsky F, Kelly IV JD. Osteochondral allograft transplantation for treatment of glenohumeral instability. Arthroscopy 2005; 21 (8) 1007
    PubMedGoogle Scholar
  • 56 Pylawka TK, Wimmer M, Cole BJ, Virdi AS, Williams JM. Impaction affects cell viability in osteochondral tissues during transplantation. J Knee Surg 2007; 20 (2) 105-110
    Article in Thieme ConnectPubMedGoogle Scholar
  • 57 Borazjani BH, Chen AC, Bae WC , et al. Effect of impact on chondrocyte viability during insertion of human osteochondral grafts. J Bone Joint Surg Am 2006; 88 (9) 1934-1943
    CrossrefPubMedGoogle Scholar
  • 58 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
    CrossrefPubMedGoogle Scholar
  • 59 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
    CrossrefPubMedGoogle Scholar
  • 60 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
    CrossrefPubMedGoogle Scholar
  • 61 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
    CrossrefPubMedGoogle Scholar
  • 62 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
    CrossrefPubMedGoogle Scholar
  • 63 Levy YD, Görtz S, Pulido PA, McCauley JC, Bugbee WD. Long-tem follow-up of fresh osteochondral allografting of the femoral condyle. Paper No. 709, presented at the annual meeting of the American Academy of Orthopaedic Surgeons; San Francisco, CA; February 7–11, 2012
    PubMedGoogle Scholar
  • 64 D'Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954; 36–A (3) 451-475
    PubMedGoogle Scholar
  • 65 Irrgang JJ, Anderson AF, Boland AL , et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 2001; 29 (5) 600-613
    CrossrefPubMedGoogle Scholar
  • 66 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
    PubMedGoogle Scholar