Donor Cell Survival in a Fresh Osteochondral Allograft at Twenty-nine Years

Abstract

Fresh osteochondral allografting is a nonvascularized organ transplantation with a clinical use dating back to the early twentieth century. The procedure, in its current form, involves transplantation of a small segment of bone as a carrier with its overlying cartilage. As the bone is remodeled and revascularized by the recipient, the donor cartilage continues to function mechanically, produces matrix, and receives nutrition from the synovial fluid. The cartilage has traditionally been considered a so-called immunoprivileged tissue, avoiding the immune surveillance of the host presumably because of its paucity of vascular channels and its hypo-cellular matrix1. These qualities make fresh osteochondral allografting unique in the field of transplantation and preclude the need for systemic immunosuppression after this procedure. Although histologically normal articular cartilage has been reported in retrieved fresh osteochondral allografts, we know of no report that has definitively confirmed the specific survival of the donor cells for any length of time. Furthermore, the source of cells in retrieved transplants has not been confirmed as being from the donor or the recipient. The patient was informed that data concerning his case would be submitted for publication. Atwenty-two-year-old man with a large defect on the articular surface of the lateral femoral condyle of the knee underwent fresh osteochondral allografting from a female donor. He recovered well from the allograft procedure and had a relatively pain-free knee for the next twenty-five years. He presented to us with knee pain on the lateral side and tricompartmental arthritis predominantly in the lateral compartment (Fig. 1). A magnetic resonance imaging scan was acquired, and it demonstrated a tear of the posterior horn of the lateral meniscus with loss of the articular cartilage thickness along the posterior aspect of the lateral femoral condyle (Fig. 2). He ultimately requested total knee …