Fresh Osteochondral Allograft Research Articles

Effects of Autogenous Bone Marrow Aspirate Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts

Background: Transplantation of fresh osteochondral allografts (OCAs) is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Because the lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. Purpose: To determine if autogenous bone marrow aspirate concentrate (BMC) treatment of large femoral condylar OCAs would be associated with superior radiographic OCA bone integration compared with nontreated allografts during the critical first 6 months after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A review of patients enrolled in a prospective registry who were treated with transplantation of large OCAs to one or both femoral condyles at our institution from March 12, 2013 to March 14, 2016 was performed. Patients were stratified into 2 groups based on BMC treatment versus no BMC treatment; the treatment was nonrandomized and was rooted in a shift in practice and a continuing effort to optimize OCA transplantation at our institution. Patients were excluded if they did not have orthogonal view radiographs performed at 6 weeks, 3 months, and 6 months postoperatively. Each condyle undergoing OCA transplantation was assessed individually by an independent musculoskeletal radiologist, who was blinded to the treatment group and time point. OCAs were assessed with respect to graft integration (0%-100%; 0 = no integration, 100 = complete integration) and degree of sclerosis (0-3; 0 = normal, 1 = mild sclerosis, 2 = moderate sclerosis, and 3 = severe sclerosis) of the graft at each time point. Results: This study identified 17 condyles in 15 patients who underwent OCA transplantation without BMC and 29 condyles in 22 patients who underwent OCA transplantation with BMC. The BMC group had significantly (P = .033) higher graft integration scores at 6 weeks, 3 months, and 6 months after surgery. Graft sclerosis was significantly (P = .017) less in the BMC group at 6 weeks and 3 months, with no significant difference at 6 months after surgery. When combining the groups to examine the influence of smoking on graft integration, nonsmokers had significantly (P = .007) higher graft integration scores at 6 months. Conclusion: Large femoral condylar OCAs treated with autogenous BMC before implantation showed superior radiographic integration to bone and less sclerosis during the initial 6-month postoperative period. BMC treatment of OCAs may mitigate the failure of OCA bone healing.

Rehabilitation and Return to Play Following Osteochondral Allograft Transplantation in the Knee

Symptomatic articular cartilage lesions of the knee can be debilitating, particularly in athletic patient populations. For patients with focal articular chondral defects in the knee, fresh osteochondral allograft transplantation (OCA) has been shown to be an effective single-stage procedure, particularly for larger lesions (>2 cm 2 ) to restore the articular surface with hyaline cartilage. Indications for OCA continue to expand as a growing body of literature suggests good to excellent long-term clinical outcomes in appropriately selected patients as both a primary and salvage cartilage restoration procedure. In this review, a thorough summation of the most current literature regarding OCA in athletes, including associations between demographic and surgical variables and the ability to return to sport, and a detailed description of the senior author’s rehabilitation protocol with sport-specific considerations will be presented.

Moderate Return to High Impact Function after Fresh Osteochondral Allograft Transplantation for Chondral Defects of the Knee

Objectives:The purpose of this investigation was to report the patient-reported and occupational outcomes of military servicemembers after fresh osteochondral allograft transplantation (OCA) of the knee at mid-term follow-up.Methods:A query of the Military Health System was performed to identify all United States Army service members undergoing OCA for Outerbridge grade 3 or 4 chondral lesions between January 2009 and June 2013 with minimum 2-year follow-up. Exclusion criteria were applied to individuals with the following: insufficient follow-up or documentation; treatment of bipolar lesions; and use of cryopreserved, fresh-frozen, or fresh osteochondral allografts used greater than 28 days after harvest. Demographic information, lesion characteristics, and clinical outcomes (Visual Analog Scale for pain, functional duty limitations, and/or revision rates) were extracted from the military electronic medical records system. Statistical measures such as the Chi square test and Poisson multivariable regression analysis were utilized to evaluate for variables associated with rate-limiting, knee disability and/or surgical revision.Results:At 3.8 follow-up, 61 patients met the inclusion criteria with an average age was 32 yrs±8.0. Medial femoral condyles were most common (n=40;65.6%), followed by the patella (n=11;18.0%), lateral femoral condyle (n=8;13.1%), and trochlea (3;5.0%). The average cross-sectional size of treated lesions was 364 mm2±193 (48-707 mm2). Thirty-seven knees (61.7%) were treated without concomitant procedure, and 21 knees (34.4%) had staged or simultaneous periarticular osteotomies. Average VAS pain scores significantly decreased from 4.1 to 2.5 postoperatively (p<0.01). At final follow up, 65.6% of patients returned to unrestricted or modified military function, whereas 21(34.4%) individuals were unable to return due to persistent knee limitations. Nine (14.7%) patients experienced preoperative complications, Seven patients (11.5%) required secondary revision after OCA, 3 patients underwent chondroplasty, and 1 patient (1.6%) underwent subsequent total knee arthroplasty. Lesion size was not associated with any adverse clinical or surgical outcomes (p>0.05), and lateral femoral condyle and trochlear lesions had a higher rates of revision, although this failed to achieve significance (p=0.22;p=0.26, respectively). Higher preoperative BMI (OR 1.15;p=0.045) and postoperative VAS(OR 1.36;p<0.01) values were associated with increased risk of knee disability.Conclusion:Fresh OCA can reliably decrease knee pain in a highly-active population, with nearly two-thirds of all patients return to military function. However, approximately one in eight individuals may undergo revision after return to preoperative activities, and individuals of high BMI may be at heightened risk of clinical failure.

Effects of Bone Marrow Aspirate Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts

Objectives:Symptomatic articular cartilage lesions of the femoral condyles are a common problem in athletes. For large (>2.5 cm2) lesions, fresh osteochondral allograft (OCA) transplantation is a good option based on 88% return to sport and >75% 10-year survival. Lack of graft survival typically results from loss of cartilage integrity or inadequate integration of graft bone into the patient. Because OCA bone integration occurs via creeping substitution, methods for speeding and enhancing OCA bone integration to mitigate failures are highly desirable. Bone marrow aspirate concentrate (BMAC), which contains osteoprogenitor cells and osteoinductive proteins, has the potential to accelerate and promote OCA bone integration. Therefore, this study was designed to test the hypothesis that BMAC treatment of large femoral condylar OCAs would be associated with superior radiographic OCA bone integration compared to non-treated allografts during the critical first 6 months after surgery.Methods:An IRB-approved review of patients enrolled in a prospective registry who were treated with large OCA transplants to one or both femoral condyles at our institution from March 12, 2013 to March 14, 2016 was performed. Patients were excluded if they did not have orthogonal view radiographs performed at 6 weeks, 3 months, and 6 months postoperatively. Each condyle undergoing OCA transplantation was assessed individually by an independent musculoskeletal radiologist blinded to treatment group and time point. OCAs were assessed with respect to graft integration (0-100% integrated into patient bone) and degree of sclerosis of the graft (0 - normal, 1 - mild sclerosis, 2 - moderate sclerosis, 3 - severe sclerosis) at each time point. Data were compiled into two groups based on treatment with BMAC (OCA bone saturated with autogenous BMAC immediately prior to implantation) versus no BMAC treatment and analyzed for statistically significant (p<0.05) differences.Results:This study identified 16 condyles in 15 patients receiving large OCA transplants without BMAC and 23 condyles in 21 patients receiving large OCA transplants with BMAC. There were no significant differences in patient age, gender, BMI, ASA or proportions of lateral versus medial condyles, patients with diabetes, or smokers. The BMAC group had significantly (p<0.033) higher graft integration scores at 6 weeks, 3 months and 6 months after surgery (Table). Graft sclerosis was significantly (p<0.017) less in the BMAC group at 6 weeks and 3 months with no significant difference 6 months after surgery (Table). When combining treatment cohorts to examine the influence of smoking on graft integration, non-smokers had significantly (p=0.007) higher graft integration scores at 6 months (Table). There were no statistically significant differences in graft integration between smokers and non-smokers in the BMAC group. One bone healing complication occurred in a smoker receiving an OCA that was not treated with BMAC, while no bone healing complications occurred in the BMAC group.Conclusion:Large femoral condylar osteochondral allografts treated with autogenous bone marrow aspirate concentrate prior to implantation showed superior radiographic integration to patient bone and less sclerosis during the initial 6-month postoperative period. BMAC treatment of osteochondral allografts may mitigate failure of osteochondral allograft bone healing.Table – Graft Integration ScoresCohortTime PointGraft IntegrationP-valueSclerosisP-value BMAC 6 weeks43.1 ± 22.8 0.03 1.4 ± 0.60.016 No BMAC 25.6 ± 251.9 ± 0.6 BMAC 3 months67.2 ± 17.9 0.033 1.2 ± 0.50.017 No BMAC 50.6 ± 28.91.7 ± 0.7 BMAC 6 months84.1 ± 8.4 0.017 0.9 ± 0.5> 0.05 No BMAC 74.4 ± 15.91.2 ± 0.5 Smokers 6 months83.7 ± 8.2 0.007 Non-Smokers 72.1 ± 17.5

Moderate Return to High Impact Function after Fresh Osteochondral Allograft Transplantation for Medium to Large Chondral Defects of the Knee

Moderate Return to High Impact Function after Fresh Osteochondral Allograft Transplantation for Medium to Large Chondral Defects of the Knee

Lactated Ringer-based storage solutions are equally well suited for the storage of fresh osteochondral allografts as cell culture medium-based storage solutions

BackgroundDue to the rising interest in Europe to treat large cartilage defects with osteochondrale allografts, research aims to find a suitable solution for long-term storage of osteochondral allografts. This is further encouraged by the fact that legal restrictions currently limit the use of the ingredients from animal or human sources that are being used in other regions of the world (e.g. in the USA). Therefore, the aim of this study was A) to analyze if a Lactated Ringer (LR) based solution is as efficient as a Dulbecco modified Eagle’s minimal essential medium (DMEM) in maintaining chondrocyte viability and B) at which storage temperature (4°C vs. 37°C) chondrocyte survival of the osteochondral allograft is optimally sustained. Methods300 cartilage grafts were collected from knees of ten one year‐old Black Head German Sheep. The grafts were stored in four different storage solutions (one of them DMEM-based, the other three based on Lactated Ringer Solution), at two different temperatures (4 and 37°C) for 14 and 56days. At both points in time, chondrocyte survival as well as death rate, Glycosaminoglycan (GAG) content, and Hydroxyproline (HP) concentration were measured and compared between the grafts stored in the different solutions and at the different temperatures. ResultsIndependent of the storage solutions tested, chondrocyte survival rates were higher when stored at 4°C compared to storage at 37°C both after short-term (14days) and long-term storage (56days). At no point in time did the DMEM-based solution show a superior chondrocyte survival compared to lactated Ringer based solution. GAG and HP content were comparable across all time points, temperatures and solutions. ConclusionLR based solutions that contain only substances that are approved in Germany may be just as efficient for storing grafts as the USA DMEM-based solution gold standard. Moreover, in the present experiment storage of osteochondral allografts at 4°C was superior to storage at 37°C.

Fresh Osteochondral Allograft Transplantation: Is Graft Storage Time Associated With Clinical Outcomes and Graft Survivorship?

Background: Regulatory concerns and the popularity of fresh osteochondral allograft (OCA) transplantation have led to a need for prolonged viable storage of osteochondral grafts. Tissue culture media allow a longer storage time but lead to chondrocyte death within the tissue. The long-term clinical consequence of prolonged storage is unknown. Hypothesis: Patients transplanted with OCAs with a shorter storage time would have lower failure rates and better clinical outcomes than those transplanted with OCAs with prolonged storage. Study Design: Cohort study; Level of evidence, 3. Methods: A matched-pair study was performed of 75 patients who received early release grafts (mean storage, 6.3 days [range, 1-14 days]) between 1997 and 2002, matched 1:1 by age, diagnosis, and graft size, with 75 patients who received late release grafts (mean storage time, 20.0 days [range, 16-28 days]) from 2002 to 2008. The mean age was 33.5 years, and the median graft size was 6.3 cm2. All patients had a minimum 2-year follow-up. Evaluations included pain, satisfaction, function, failures, and reoperations. Outcome measures included the modified Merle d’Aubigné-Postel (18-point) scale, International Knee Documentation Committee (IKDC) form, and Knee Society function (KS-F) scale. Clinical failure was defined as revision OCA transplantation or conversion to arthroplasty. Results: Among patients with grafts remaining in situ, the mean follow-up was 11.9 years (range, 2.0-16.8 years) and 7.8 years (range, 2.3-11.1 years) for the early and late release groups, respectively. OCA failure occurred in 25.3% (19/75) of patients in the early release group and 12.0% (9/75) of patients in the late release group (P = .036). The median time to failure was 3.5 years (range, 1.7-13.8 years) and 2.7 years (range, 0.3-11.1 years) for the early and late release groups, respectively. The 5-year survivorship of OCAs was 85% for the early release group and 90% for the late release group (P = .321). No differences in postoperative pain and function were noted between the groups. Ninety-one percent of the early release group and 93% of the late release group reported satisfaction with OCA results. Conclusion: The transplantation of OCA tissue with prolonged storage is safe and effective for large osteochondral lesions of the knee and has similar clinical outcomes and satisfaction to the transplantation of early release grafts.

Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure.

Objective To evaluate the outcome of patients who have undergone simultaneous osteotomy and osteochondral allograft (OCA) transplantation. Our hypothesis is that use of high tibial osteotomy and fresh OCA in a combined procedure is safe and effective without increasing morbidity in comparison to OCA alone. Design A case series of 17 patients underwent tibial osteotomy and simultaneous OCA during a single surgery. Osteotomy was indicated when axial alignment was within the affected compartment. Patients had a minimum of 2 years of follow-up after surgery. The mean graft size was 8.7 cm2, with 82% located on the medial femoral condyle alone and 18% involving the medial femoral condyle and one or more other sites. Data collection included demographics, osteotomy correction, graft site(s) and area, and clinical evaluation. Failure was defined as conversion to arthroplasty. Results Two of 17 patients (12%) failed at a mean of 9.3 years. The remaining 15 patients (88%) had intact allografts with mean survival of 8.1 years (SD 3.3). Five patients (29%) had an additional procedure, all undergoing osteotomy hardware removal. Of those with surviving allografts, mean pain and function scores improved significantly from the preoperative to postoperative assessment and International Knee Documentation Committee total scores improved significantly from 40.9 ± 15.4 preoperative to 75.5 ± 24.0 at latest follow-up ( P = 0.003); 92% of patients were satisfied with the results of the surgery. No postoperative complications occurred. Conclusion Combining high tibial osteotomy and OCA in properly selected patients is safe and effective.

Fresh osteochondral allografts-procurement and tissue donation in Europe

Fresh osteochondral allografts are a well-established treatment for large, full-thickness cartilage defects. The clinical outcome for carefully selected patients is very favorable, especially for the young and active and graft survival up to 25 years has been described in the literature. Furthermore, a high patient satisfaction rate has been reported, but the biggest obstacle to overcome is the availability of tissue for transplantation. Large fresh bone allografts for cartilage damage repair only can be harvested from organ donors following organ removal or cadaveric donors, preferably in the setting of an operation room to minimize possible contamination of the tissue. Apart from the logistic challenges this entails, an experienced recovery team is needed. Furthermore, the public as well as medical staff is much less aware of the possibility and requirements of tissue donation than organ donation and families of deceased are rarely approached for bone and cartilage donation.This review aims to highlight the current situation of organ and tissue donation in Europe with special focus on the processing of bones and possible safety and quality concerns. We analyze what may prevent consent and what might be done to improve the situation of tissue donation.

Fresh osteochondral allotransplants: Outcomes, failures and future developments

Osteochondral allografts are used to treat many different conditions as acute traumatic large-sized lesions, degenerative osteoarthritis, osteochondritis dissecans, avascular necrosis or in case of failure of previous procedures particularly in young patients for whom primary prosthesis is not desirable. Fresh allografts present the advantage of having mature viable hyaline cartilage, not causing donor morbidity, allowing the restoration of even large defects in a single surgical session. Conversely, they could account for risks of disease transmission, immunologic reactions, and for limited availability. The present review aimed to analyze published studies of the last decade in which patients received fresh osteochondral allografts by dividing them for knee or ankle regenerative purposes. We wish to report the observed failure rates and particularly to collect any other reported side effect or outcome for identifying major problems and limits linked to the procedure and for delineating possible future researches and approaches. The overall success rates resulted ranging from 5.3% to 48.3% in the ankle at a mean follow up of 3.3 years and from 0% to 85.7% in the knee at a mean follow up of 7.1 years. Among other outcomes, occurrence or progression of arthritis, osteolysis, graft instability, fractures, nonunions, edema and infections were recorded. Overall, the lack of well designed randomized and controlled clinical trials, of immunological determination of the anti-donor antibodies development and of local and systemic biomarkers to detect reaction to the graft seems to be the major drawback. Improvements in these limiting factors might be desirable in order to enhance the clinical scenario of a well-established and successful procedure to give, especially for young patients, a real regeneration of the joint.

Paper #1 - Minimum 2-year results for all-arthroscopic fresh osteochondral allograft resurfacing of the humerus and glenoid in the treatment of osteoarthritis in the young patient

Paper #1 - Minimum 2-year results for all-arthroscopic fresh osteochondral allograft resurfacing of the humerus and glenoid in the treatment of osteoarthritis in the young patient

Review of Mechanical, Processing, and Immunologic Factors Associated With Outcomes of Fresh Osteochondral Allograft Transplantation of the Talus.

Level V, expert opinion.

Anatomical Glenoid Reconstruction Using Fresh Osteochondral Distal Tibia Allograft After Failed Latarjet Procedure

In the treatment of recurrent anterior glenohumeral instability, the Latarjet procedure has been shown to fail. This results in a need for viable revisional procedures for patients who present with this challenging pathology. We report our preferred technique for anatomical glenoid reconstruction using a fresh osteochondral distal tibia allograft after a failed Latarjet procedure. This bony augmentation technique employs a readily available dense, weight-bearing osseous tissue source that has excellent conformity, as well as the added benefit of a cartilaginous surface to correct chondral deficiencies. Given its effectiveness in the Latarjet revision setting and low complication rate, the distal tibia allograft is a reasonable treatment option.

Use of a Cutting Instrument for Fresh Osteochondral Distal Tibia Allograft Preparation: Treatment of Glenoid Bone Loss

Glenoid bone loss presents a major risk for glenohumeral instability that has been well recognized as a cause of instability recurrence after attempted Bankart repair, and although most surgeons consider the Latarjet procedure as the gold standard, failures can occur with this technique as well and the search for alternative grafts to address glenoid bone loss is a major topic of ongoing research in the field. Of these techniques, the distal tibia allograft (DTA) has been shown to provide an excellent option to restore glenoid biomechanics, due to its congruency with the humeral head, dense bony quality, and the facility of harvest. The correct preparation of the DTA is essential to provide the most anatomic reconstruction possible and to avoid damage to the graft. The purpose of this Technical Note is to present our technique for cutting the DTA in detail, using a special workstation to optimize this procedure.

Patellofemoral Osteochondral Allografts: Can We Improve the Matching Process?

An important consideration for the successful use of fresh osteochondral allografts for the patellofemoral joint is selection of appropriately sized donor allografts. This is particularly challenging for matching grafts to the patella because of the substantial variability in articular contour that exists. At present, selection of donor patellae is based only on the width of the proximal tibia, with no established means of quantifying basic patellar size, facet configuration, or articular contour. We hypothesized that using a combination of standard radiographic measurements to generate an accurate profile of the recipients native patella would result in a more accurate donor graft. We radiographically measured seven dimensions of 30 fresh frozen cadaveric patellar specimens, and then, following dissection, accurate ex vivo measurements of patellar morphology were taken. Measurements obtained on the merchant view included total width, width of the medial and lateral facets, central ridge height (CRH) and location, as well as the patellar angle. The lateral view was obtained to measure the articular length. Ex vivo measurements were subsequently taken using a standard ruler, caliper, and goniometer following removal of all soft tissue attachments. To simulate a larger population of knees, we then used bootstrapping methods with simple random selection and replacement to generate a sample of measurements from 4,500 knees. In the bootstrapping process, measurements from one random specimen are added to the "population" at each iteration until the target sample size is reached. Data from this bootstrapped population were subsequently used to calculate statistically significant radiographic predictors of each ex vivo measurement, using a multivariate regression model with backward elimination. These predictors were then used to compare the calculated values to the actual ex vivo measurements for each dimension in our original 30 specimens' sample. Overall, these formulas were very successful in predicting ex vivo measurements. While further validation is warranted, we propose that these formulas can be utilized to select a more accurate donor.

Anatomic Humeral Head Reconstruction With Fresh Osteochondral Talus Allograft for Recurrent Glenohumeral Instability With Reverse Hill-Sachs Lesion

The treatment of recurrent glenohumeral instability, especially with a concomitant bony lesion, remains challenging. This is especially true in the case of posterior instability given its less common incidence. Moreover, the presence of an engaging reverse Hill-Sachs lesion in combination with posterior instability will result in the need for a more aggressive treatment option. In comparison with a Hill-Sachs lesion, a reverse Hill-Sachs lesion features greater chondral deficiency that must be addressed during treatment. We propose the talus allograft as a potential allograft for treatment of an engaging reverse Hill-Sachs lesion. The superior articular surface of the talus may be used to reconstruct the articular surface of the humeral head. In this technical note, we describe our preferred primary technique for treatment of an engaging reverse Hill-Sachs lesion with recurrent glenohumeral instability through use of a fresh osteochondral talus allograft, as well as discuss the advantages and disadvantages of this allograft option.

Fresh osteochondral knee allografts in Brazil with a minimum two-year follow-up

ObjectiveThe present study aimed to report the results of the first series of cases of fresh ostechondral allografts in the knee joint in Brazil with a minimum follow-up of two years. MethodsA protocol of procurement, harvesting, processing, and utilization of fresh osteochondral allografts in the knee joint was established, beginning with legislation modifications, graft harvesting techniques, immediate processing, storage of fresh grafts, and utilization of two surgical techniques of osteochondral transplantation. Eight patients were treated and followed-up for a minimum of two years. ResultsPatients were evaluated with subjective IKDC, KOOS, and modified Merle D’Aubigne and Postel questionnaires. Mean subjective IKDC score was 31.99±13.4 preoperative and 81.26±14.7 at the latest follow-up; preoperative KOOS score was 46.8±20.9 and postoperative was 85.24±13.9, indicating a significant improvement over time (p<0.01). Mean modified Merle D’Aubigne-Postel score was 8.75±2.25, preoperatively, and 16.1±2.59 postoperatively. Friedman test for non-parametric samples demonstrated a significant improvement in postoperative scores (p<0.01). ConclusionThe use of fresh osteochondral allografts in Brazil is a safe procedure, with good clinical results in the short- and medium-term for the treatment of osteochondral lesions greater than 4cm2 in the knee joint.

Osteochondral Allografts in Shoulder Surgical Procedures.

The use of fresh osteochondral allografts has become popular in many joint-preserving orthopaedic procedures and shows early promising results within the shoulder. Distal tibial allograft contains a stout cartilaginous layer that appears to have highly congruent curvature and concavity to the glenoid, which makes for an optimal allograft option for instability. In the setting of large Hill-Sachs lesions, the use of a humeral-head osteochondral allograft is essential to restore geometry, stability, and mechanics of the native glenohumeral joint. One must be cautious with the treatment of glenoid chondral lesions with osteoarticular grafting procedures because of the depth of the glenoid compared with the depth of subchondral bone on the graft necessary to achieve a press fit, and advanced imaging is recommended when planning an operative intervention. Optimizing joint-preservation treatment with osteochondral allografts will rely on the long-term results of these procedures, and careful patient selection, preoperative discussion, and realistic expectations are necessary.

Osteochondral Allograft Donor-Host Matching by the Femoral Condyle Radius of Curvature

Background: Conventional osteochondral allograft (OCA) matching, requiring orthotopic, size-matched condyles, and narrow surgical time windows often prohibit timely transplantation. Hypothesis: The femoral condyle radius of curvature (RoC) is an appropriate, isolated criterion for donor-host matching in fresh OCAs, potentially enhancing matching efficiency when compared with conventional matching techniques. Study Design: Descriptive laboratory study. Methods: In part 1 of this study, 3-dimensional digital reconstructions of 14 randomly selected, cadaveric distal femoral hemicondyles were performed. Each condyle was divided into anterior, middle, and posterior zones. A virtual best-fit grid was applied to each, and each zone’s sagittal- and coronal-plane RoCs were determined. Seven nonorthotopic OCA transplantations were performed based on RoC matching with 1-mm tolerance, and the preoperative and postoperative surface geometry were quantified to assess the accuracy of articular surface restoration. Of note, each donor-host pair did not match by the conventional method. In part 2 of this study, 12 cadaveric distal femora were categorized by size and digitized in the aforementioned manner. Simulated circular defects measuring 20, 25, and 30 mm in diameter were introduced into each zone. OCA matches were determined based on donor and host RoCs, and the total number of potential matches (of 71 total comparisons) was recorded as a percentage for each simulated defect. Finally, the results of RoC matching were compared with the conventional method for simulated defects in all zones of both the medial and lateral femoral condyles. Results: Part 1: The mean surface deviation after OCA transplantation was −0.09 mm, with a mean maximum protrusion at any point of 0.59 mm. Part 2: Using the RoC, 20-mm defects had a 100% chance of being matched. Defects of 25 and 30 mm had a 91% and 64% chance of being matched, respectively. Compared with the conventional method, the RoC method yielded a 3.2-fold greater match rate for lesions of the medial and lateral femoral condyles (P = .02). Conclusion: This investigation shows that femoral condyle RoCs in the sagittal and coronal planes may be useful, alternative matching criteria, expanding on current standards. Clinical Relevance: These matching criteria may increase the number of available matches, reduce wait times for patients, and reduce the number of wasted grafts.

Fresh osteochondral allograft transplantation for osteochondritis dissecans of the capitellum in baseball players

Osteochondritis dissecans (OCD) of the capitellum is a rare yet debilitating injury seen in young athletes. This is the first report in the literature describing fresh osteochondral allograft transplantation (FOCAT) to treat OCD of the capitellum. Nine male baseball players (mean age, 15.3; range, 14-18 years), with OCD of the capitellum were treated with FOCAT. There were 6 pitchers and 3 position players. A ligament-sparing, mini-open approach was used. A fresh femoral hemicondyle was used as a donor source. Of the 9 patients, 7 required 1 plug and 2 required 2 plugs. The average plug diameter was 11 mm (range, 8-18 mm). Five plugs were press fit, and 4 required additional fixation. Clinical outcomes were evaluated at a mean follow-up of 48.4 months (range, 11-90 months). Preoperative and postoperative outcome scores were calculated using the paired t test. The Mayo Elbow Performance score improved from an average 57.8 to 98.9 (P < .01). The Oxford Elbow Score improved from 22.4 to 44.8 (P < .01). The Disabilities of the Arm, Shoulder and Hand score improved from 35.2 to 5.4 (P < .01). The visual analog scale score improved from 7.8 to 0.5 (P < .01). The Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score improved from 32.6 to 82.5 (P < .01). All patients returned to throwing and were still active in their sport or played at least 2 years of baseball before leaving the sport unrelated to the elbow. FOCAT for OCD of the capitellum in properly selected cases is a viable treatment with significant functional improvement and pain reduction in throwers.