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J Knee Surg 2020; 33(12): 1172-1179
DOI: 10.1055/s-0040-1714366
Special Focus Section

Fresh Osteochondral Allograft Transplants in the Knee: Bipolar and Beyond

James P. Stannard 
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
2   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
,
James T. Stannard
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
2   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
,
Anna J. Schreiner
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
2   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
3   BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
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Abstract

Knee patients who have sustained chondral and osteochondral lesions suffer from debilitating pain, which can ultimately lead to posttraumatic osteoarthritis and whole-joint disease. Older, nonactive patients are traditionally steered toward total knee arthroplasty (TKA), but younger, active patients are not good candidates for TKA based on implant longevity, complications, morbidity, and risk for revision, such that treatment strategies at restoring missing hyaline cartilage and bone are highly desired for this patient population. Over the past four decades, fresh osteochondral allograft (OCA) transplantation has been developed as a treatment method for large (> 2.5 cm2) focal full-thickness articular cartilage lesions. This article documents our own institutional OCA journey since 2016 through enhanced graft preservation techniques (the Missouri Osteochondral Preservation System, or MOPS), technical improvements in surgical techniques, use of bone marrow aspirate concentrate, bioabsorbable pins and nails, and prescribed and monitored patient-specific rehabilitation protocols. Further follow-up with documentation of long-term outcomes will provide insight for continued optimization for future applications for OCA transplantation, potentially including a broader spectrum of patients appropriate for this treatment. Ongoing translational research is necessary to blaze the trail in further optimizing this treatment option for patients.

Keywords

lesions - osteochondral allograft transplantation - allograft preservation methods - surgical techniques - patient-specific rehabilitation protocols

Authors' Contributions

All authors have read and approved the final submitted manuscript. J. P. S., J. T. S., and A. J. S.: substantial contributions to research design, acquisition, analysis, and interpretation of data; J. P. S., J. T. S., and A. J. S.: drafting the paper and revising it critically; all authors approved the submitted and final versions.




Publication History

Received: 21 April 2020

Accepted: 08 June 2020

Article published online:
20 July 2020

© 2020. Thieme. All rights reserved.

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