Osteochondral allografts allow surgeons to transplant mature, hyaline cartilage with viable chondrocytes and subchondral bone in a single procedure. These grafts are typically used to treat focal cartilage defects and in many of the more advanced pathologies, offer the greatest chance of long-term repair for the patient with damaged hyaline cartilage.
Recognising the need for this treatment to be offered in the UK, Joint Operations are the first company to provide a complete fresh cartilage service in partnership with the leading fresh allograft suppliers, Allosource and JRF Ortho. The package of services includes cadaveric skills training, a broad range of tissue and dedicated instrumentation for the implantation.
The lower or upper limb surgeon is now able to match their patients’ anatomy with a corresponding graft and schedule the surgery. For smaller defects, JRF provide 10mm and 16mm viable osteochondral cores, which are both affordable and available off-the-shelf as they do not require the matching of curvature. For defects that are purely chondral in nature, Allosource offers a layer of viable hyaline cartilage called Prochondrix, which is glued into the location of the defect.
Referenced here is a recent paper from Dr William Bugbee on osteochondral grafting. For the full paper and to discuss this exciting treatment option, please contact your local Joint Operations representative.
Osteochondral Allograft transplantation for knee lesions after failure of cartilage repair surgery
Abstract: The objective of this study was to assess the outcome of osteochondral allograft (OCA) transplantation as a salvage procedure after various cartilage repair surgeries.
Design: One hundred and sixty-four knees in 163 patients (mean age = 32.6 years; range = 11-59 years; 55 per cent males) were treated with OCA transplantation after subchondral marrow stimulation (SMS), osteochondral autograft transplantation (OAT), and autologous chondrocyte implantation (ACI). The majority of previous procedures were isolated SMS in 145 knees (88.4 per cent). Mean reoperations on the operative knee were assessed. Failure of the OCA transplantation was defined as any reoperation resulting in removal of the allograft. Functional outcomes were evaluated.
Results: Sixty-eight knees had reoperations after OCA transplantation. Thirty-one knees (18.9 per cent) were classified as allograft failures. The median time to failure was 2.6 ± 6.8 years (range = 0.7-23.4 years). Survivorship of the graft was 82 per cent at 10 years and 74.9 per cent at 15 years. Patients whose grafts were still in situ had a mean of 8.5 ± 5.6 years of follow-up. Scores on all functional outcomes scales improved significantly from preoperatively to latest follow-up. Eighty-nine per cent of OCA transplantation patients reported being “extremely satisfied” or “satisfied.”
Conclusion: Despite the high reoperation rate, OCA transplantation is a successful salvage surgical treatment after cartilage repair procedures. This cohort showed improved survivorship and functional outcomes of OCA transplantation after SMS, ACI, and OAT.