Osteochondral allograft transplantation effective for certain knee cartilage repairs

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By JRF Ortho

Isolated femoral condyle lesions account for 75% of the cartilage repair procedures performed in the knee joint, and physicians have a variety of techniques to consider as part of surgical treatment. Osteochondral allograft transplantation (OCA) is a valuable and successful approach for this condition, as described by research presented today at the American Orthopaedic Society for Sports Medicine‘s Specialty Day in New Orleans.

“Our study demonstrated that the modern OCA transplantation technique, which utilizes thin, dowel type grafts, was very effective in treating patients with femoral condyle cartilage lesions,” noted Luís E. Tírico, MD, who is currently with the University of Sao Paulo in Sao Paulo, Brazil and served as the research fellow and lead author on the presentation under Dr. William Bugbee, Director of Clinical Research and Head of the Scripps Cartilage Restoration and Transplant Program at Scripps Clinic in La Jolla, CA. “In 200 cases, we noted an 89% satisfaction rate with those treated by this method, along with significant improvements in clinical scores and a low graft failure rate.”

The study, which represents the largest reported cohort of isolated femoral condyle lesions treated with the modern, dowel technique for OCA transplantation included 187 patients (200 knees) who underwent OCA transplantation between June 1999 and August 2014. At a minimum follow-up of two and average of 6.7 years, International Knee Documentation Committee (IKDC) total scores improved from 43.7 to 76.2 on average, and Knee injury and Osteoarthritis Outcome Score (KOOS) for pain improved from 66.5 to 85.3, and 74.5 to 91.1 for activities of daily living. Further surgery was required in 52 knees (26%), of which 16 (8%) were considered failures, as defined by removal or revision of the allograft.

“The modern technique of OCA transplantation for treating isolated femoral condyle lesions offers patient better results over other cartilage repair procedures,” commented Tírico. “These results appear to be equal or superior to any other cartilage repair procedure for the treatment of femoral condyle lesions and leads us to consider whether fresh OCA should be viewed as the current gold standard in cartilage repair for focal femoral condyle lesions.

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Donation Comes Full Circle For Tissue Recipient Turned Doctor

As a soccer player for the University of Illinois, Rachel constantly pushed herself. Being active was crucial to her lifestyle both on and off the soccer field. She was also passionate about medicine, but didn’t know yet that she would eventually be on both sides of the operating table.

After a partial lateral meniscus tear put her on the sidelines, she underwent an arthroscopic partial lateral meniscectomy. She returned to soccer and her pre-injury level of play until she tore her remaining meniscus.

Her pain subsided after an arthroscopic procedure to have the non-viable tissue removed, but then her knee issues returned. “Being unable to remain physically fit, or lead an active lifestyle, became a huge problem for me,” she said. “As sports and fitness, particularly soccer, were such huge components of my life, I was extremely frustrated with my knee.”

When Rachel met with Dr. Brian Cole of Rush University Medical Center, she learned she was a candidate for a meniscus transplant. Since donor meniscus tissue is matched to the recipient by size, she was placed on a waiting list. Three weeks before starting medical school, she received her match.

In addition to balancing her recovery and a strict physical therapy regimen, Rachel focused on medical school.  She also began running again and completed the Chicago Triathlon in 2008.

Throughout the course of medical school, Rachel’s experience with allograft transplantation stayed with her and would eventually help shape the course of her career. “As a direct reflection of my fascination with musculoskeletal function laid against the backdrop of my own patient experiences, I pursued a yearlong Orthopaedic Research Fellowship within the Division of Sports Medicine in the Department of Orthopaedic Surgery at Rush University Medical Center,” she explained.

During her research year, Rachel started training for and subsequently completed the Hawaii Half-Ironman. While she was preparing for the race, some of her knee symptoms came back. After the race, she required a revision of the meniscus allograft and received a lateral femoral condyle osteochondral allograft. “Ever since the revision surgery, I have been functioning at an incredibly high level,” Rachel said.

Now an orthopedic surgery resident at Rush University Medical Center, Rachel works alongside Dr. Cole, the surgeon who helped her heal. Many of her research projects involve allograft applications and her experience as an allograft recipient provides a unique connection to her patients in need of a tissue transplant.  “The allograft has allowed me to be a surgeon, permitting me to stand for over 12 hours in the operating room without thinking about my knee because I have literally no pain or swelling,” she said. “Before the allograft transplantation, there is no way I would have been able to do this. I am incredibly grateful for my tissue donors and their families. This gift has inspired me to pursue my passion for orthopaedic and sports medicine and to help my future patients the same way Dr. Cole and his team helped me.”

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Older Patients with Knee Pain May Benefit from Allograft Transplant Technique

By JRF Ortho

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Knee pain in active patients over 40 is often difficult to treat but according to researchers presenting their work today at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting in San Diego, utilizing a special kind of allograft may be a step in the right direction.

“Our findings note that patients older than 40 may benefit from using a fresh osteochondral allograft transplantation to treat focal cartilage defects, a common cause of knee pain in adults,” said lead author, Dennis Crawford, MD, PhD from the Oregon Health and Science University in Portland, Oregon.

Crawford and his colleagues looked at a total of 80 patients broken into two groups. The study group consisted of 38 patients, 10 women and 28 men who were at least 40 years of age and a control group with 42 patients (27 men and 15 women) who were 39 years of age or younger.

A statistically significant improvement for both groups was noted for the final follow-up for IKDC and all five KOOS sub-scores. Greatest changes were seen in the ability of patients to perform Sports and with improvement in healthful daily activity. Previous surgical treatment was performed on 31 of 38 knees in the study group and 37 of the 42 knees in the control group.


“This type of osteochondral allograft transplantation has traditionally been used in younger active patients with cartilage disorders. However, seeing this type of success allows sports medicine physicians another option in older patients and serves as a predictable biologic joint preservation technique,” said Crawford.


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Allografts offer cost, healing benefits in sports medicine

From JRF Ortho News– “Allograft use is one of the hottest topics [in the United States] right now,” said Christopher Harner, MD, of Pittsburgh, U.S.A., in a special symposium on allografts at the 7th European Federation of National Associations of Orthopaedics and Traumatology Congress (EFORT). Harner was joined by fellow orthopaedic surgeons Gary G. Poehling, MD, of Winston-Salem, U.S.A., and René Verdonk, MD, PhD, of Gent, Belgium, a member of the Orthopaedics Today International Editorial Advisory Board.

“There has been an explosion in the use of musculoskeletal allografts in sports medicine, and last year more than 1 million graphs were distributed,” Harner said. “Although the tissues improved in safety in the last 10 to 15 years and disease transmission is rare, it still exists.”

Harner said the advantages of allografts include low donor site mobility, decreased operating time and less pain in the first six weeks. He called it the preferred procedure in complex cases such as multiple ligament revision cases. He said the disadvantages include disease transmission and slow incorporation.

Click here to read the entire article.

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