Osteochondral Autograft Transfer System Research Articles

Streamlining Iliac Bone Harvest for Maxillary Reconstruction With Novel Use of Arthrex Osteochondral Autograft Transfer System.

This study introduces a novel application of the Osteochondral Autograft Transfer System (OATS) for autologous bone grafting during alveolar cleft repair. Approximately 75% of patients with cleft lip and palate have an alveolar cleft, which often necessitates secondary bone grafting from common donor sites such as the iliac crest. Traditional harvesting techniques, although effective, can be labor-intensive and increase the risk of donor site injury. Here the authors describe the use of OATS, which has primarily been used in orthopedic procedures like anterior cruciate ligament reconstruction, for the first time in alveolar cleft repair. It involves a minimally invasive, single-use transfer system for harvesting osteochondral autografts from the anterior iliac crest, and thereby reduces harvest time compared with traditional open approaches. The procedure is detailed from pre-operative evaluation through long-term follow-up and highlights the technique's benefits related to surgical time, ease of use, and maintenance of sizable autograft volumes. Similarly, the authors discuss other advantages of OATS, including its single-use and cordless nature, which is believed to contribute to a lower contamination risk and better intraoperative ergonomics.

Osteochondral autograft and allograft for knee cartilage injuries—an international Delphi consensus statement

PurposeThe purpose of this study was to establish consensus statements via a Delphi process on osteochondral autograft transfer system (OATS) and osteochondral allograft (OCA) in the setting of cartilage defects in the knee. MethodsA consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Twenty-seven questions were generated on OATS and OCA, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. ResultsOf the 27 total questions and consensus statements on OATS and OCA developed from 3 rounds of voting, none achieved unanimous consensus, 11 achieved strong consensus, 7 achieved consensus, and 9 did not achieve consensus. ConclusionsThe statements that achieved strong consensus pertained to the contraindications of OATS and OCA, the preferred site for harvest, storage conditions and timeframe for grafting, site preparation, surgical approach, graft step-off, impact of multiple grafts on clinical outcome, and ways to minimize complications. The statements that did not reach consensus regarded indications for OATS, locations for OATS and OCA, backfilling, sizing, supplemental fixation, marrow venting, and the use of orthobiologics for OCA.

Autologous matrix-induced chondrogenesis versus osteochondral autograft transfer system in patellar chondral lesions: a comparative study with a 2-year follow-up

IntroductionFocal patellofemoral chondral lesions are clinically challenging, with unfavorable surgical results in the medium- and long-term; Although there is no golden standard technique to treat patellofemoral lesions, several patellar cartilage repair procedures are used with variable postoperative results. ObjectivesTo compare functional outcomes between patients who had undergone surgical treatment with osteochondral autograft transfer system (OATS) or autologous matrix-induced chondrogenesis (AMIC) for patellar chondral lesions preoperatively and after a 2-year follow-up. MethodsForty-six patients who underwent AMIC (n = 12) or OATS (n = 34), participated in this retrospective study. Outcome measures, including the Lysholm, Kujala, Fulkerson, and Tegner scores, were collected before surgery and 2 years after surgery. ResultsSex, age, laterality, or location of the patellar lesion were not significantly different between groups. The mean lesion size was greater in the AMIC group (2.18 cm2) than in the OATS group (1.13 cm2) (P < .001). There was no difference between groups in Lysholm, Fulkerson, and Kujala scores preoperatively, although the OATS group showed a more favorable Tegner score compared to the AMIC group (6.59 vs 3.45, P < .001). Postoperatively, the AMIC group had a higher mean Lysholm score than the OATS group, (88.3 vs 79.5, P = .025). Mean values of almost all clinical tests significantly increased at the end of the 2-year follow-up, in both groups, except for the Tegner score in the OATS group, which showed a mean reduction from 6.59 preoperatively to 5.47 postoperatively (P = .006). ConclusionOATS and AMIC are effective treatments for patellar chondral lesions, with sustainable results after a minimum follow-up period of 2 years. Patients who underwent AMIC had better clinical and functional outcomes than patients who underwent OATS for patellar chondral lesions during the follow-up period.

Young Age and Concomitant or Prior Bony Realignment Procedures are Associated with Decreased Risk of Failure of Osteochondral Allograft Transplantation in the Knee: A Nationwide Database Study.

Osteochondral allograft (OCA) transplantation is a restorative surgical option for large, full-thickness chondral or osteochondral defects in the knee. Variability in outcomes reporting has led to a broad range of graft survival rates. Using rate of salvage surgery following OCA as a failure metric, the purpose of this study was to analyze the incidence and risk factors for failure in a nationwide cohort. The M151Ortho PearlDiver database was queried for patients aged 20 to 59 who underwent primary OCA between 2010 and 2020. Patients with prior cartilage procedures or arthroplasty were excluded. Kaplan-Meier survival analysis was performed to characterize cumulative rate of salvage surgery, defined as any patient subsequently undergoing revision OCA, autologous chondrocyte implantation (ACI), osteochondral autograft transfer system (OATS), unicompartmental knee arthroplasty (UKA), or total knee arthroplasty (TKA). Multivariable logistic regression was used to determine the effect of several variables on odds of salvage surgery. Around 6,391 patients met inclusion criteria. Cumulative 5-year salvage rate was 1.71%, with 68.8% in the first 2 years. Age 20 to 29 and concomitant or prior bony realignment procedures were associated with significantly decreased rate of salvage surgery (age-adjusted odds ratio [aOR] = 0.49, 95% confidence interval [CI], 0.24-0.99, P = 0.046; realignment-aOR = 0.24, 95% CI, 0.04-0.75, P = 0.046). In the largest OCA cohort studied to date, less than 2% of patients required salvage surgery. Young age and bony realignment were protective. These findings suggest that OCA in the knee is a durable cartilage-restoration procedure, especially in young patients with corrected alignment.

Cartilage Restoration Prior to Primary Total Knee Arthroplasty.

Cartilage restoration procedures are effective for articular defects of the knee. However, studies suggest decreased clinical improvements after total knee arthroplasty (TKA). The purpose of this study was to compare patients who had a prior cartilage restoration undergoing TKA with patients who had TKA without a prior cartilage restoration procedure. We specifically assessed (1) 90-day and 1-year medical/surgical complications; (2) 90-day and 1-year revision rates; and (3) 90-day costs. A search using a national, all-payer database examined matched cohorts of patients who underwent cartilage restoration procedures prior to TKA (n=22,072) and controls who did not (n=220,364) between January 1, 2010, and April 30, 2020. Cartilage restoration procedures included autologous chondrocyte implantation, microfracture, osteochondral autograft transfer system operations, or open and arthroscopic osteochondral allograft transplantation. Outcomes studied included lengths of stay, 30-day readmission rates, 90-day costs, and medical and surgical complications to include 90-day and 1-year prosthetic joint infections, pathologic fractures, dislocations, knee manipulations, and revisions. Comparable rates of 90-day and 1-year medical and surgical complications were found for TKAs after cartilage restoration. Additionally, 90-day and 1-year revision surgery rates were similar. These patients were also found to have 90-day costs almost identical to those of patients who did not have cartilage restoration. This large analysis of patients with cartilage restoration procedures prior to TKA demonstrated that the complication rates may be similar to those of patients who do not have these operations before TKA. These findings provide valuable information to surgeons and patients when deciding to proceed with TKA after cartilage restoration. [Orthopedics. 2023;46(4):250-255.].

The Effectiveness of Osteochondral Autograft Transfer in the Management of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis.

Osteochondral lesions of the talus (OLT) are common following ankle trauma. Operative treatment is often required, with osteochondral autografting frequently performed for large or cystic lesions, or following failed primary surgery. The aim of this systematic review was to evaluate the current evidence for osteochondral autograft transfer system (OATS) in the management of OLT. A systematic search of the PubMed, EMBASE, Scopus, and Cochrane Library databases was performed based on the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Study quality was assessed using the modified Coleman Methodology Score (CMS). Meta-analysis was carried out using RevMan, version 5.4 (The Cochrane Collaboration, 2020). A total of 23 studies were included. The mean modified CMS was 48.1±7.47. Fourteen studies reported preoperative and postoperative Visual Analog Scale (VAS) and American Orthopaedic Foot & Ankle Score (AOFAS). The aggregate mean preoperative and postoperative VAS scoreacross 14 studies was 6.47±1.35 and 1.98±1.18, respectively. Meta-analysis of seven studies on 210 patients found that OATS resulted in a significant reduction in VAS score compared to baseline (Mean Difference {MD} -4.22, 95% Confidence Interval {CI} -4.54 to -3.90, P < 0.0001). The aggregate mean preoperative and postoperative AOFAS scores across 14 studies were 56.41±8.52 and 87.14±4.8, respectively. Based on eight studies on 224 patients, OATS resulted in a significant improvement in AOFAS score compared to baseline (MD 29.70, 95% CI 25.68 to 33.73, P = < 0.0001). Donor site pain occurred in 9% of cases. Current evidence from low-quality studies suggests that OATS is a safe and effective treatment option for OLT, though it is associated with a risk of donor site morbidity.

Long Term Outcome Measures Following Arthroscopically Assisted Particulated Juvenile Allograft Cartilage Implantation for Treatment of Difficult to Treat Osteochondral Lesions of the Talus

Category:Ankle; Arthroscopy; SportsIntroduction/Purpose:Conventional methods are not suitable for difficult to treat osteochondral lesions of the talus (OCLT) such as those defects that are large, shoulder lesions, failed previous surgery, or certain patient factors. Osteochondral autograft transfer system (OATS) has been accepted as the primary method of treatment for these more difficult defects, however, complications such as residual knee pain from the graft site, a multiday procedure, and the necessity for a malleolar osteotomy have made this technique not devoid of complications. Particulated juvenile articular cartilage transplantation for these lesions has theoretical advantage of performing the procedure arthroscopically, without need for an osteotomy or autograft. The purpose of this study is to determine long term patient reported outcomes for this procedure.Methods:Thirteen patients with difficult to treat OCLT underwent arthroscopic assisted implantation of DeNovo NT graft into defects from 2010-2012 by the same surgeon. 'Difficult to treat’ was defined as having at least three of the following features or two if both variables described lesion characteristics: 1) lesions size of 107mm2 or greater, 2) shoulder lesions, 3) patients who failed microfracture, 4) patient age over 40, or 5) patient BMI>25kg/m2. Patients were evaluated using physical examination, patient interviews, and pre and postoperative outcome score measures utilizing Visual Analogue Scale, Short Form 36 and Foot and Ankle Ability Measurement questionnaires, and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale. Patients had follow-up at 2 years, 4 years, and between 6-9 years at their most recent follow-up. Differences in functional outcome scores were compared before and after surgery.Results:Patients (Age: 46.5+-11.8years, Body Mass Index: 28.5 +-6.1kg/m2) had on average, most recent follow-up of 8.0 years (range 72-113 months). Average VAS pain score decreased for patients by 3.9 points, 95% CI [2.18, 5.60], when compared to preoperative assessment. FAAM ADL and Sports scores also showed improvement from 46.5 to 80.9, 95% CI [21.35, 47.43] and from 18.8 to 57.9, 95% CI [21.05, 57.10], respectively. SF-36 physical component scores showed significant improvement by an average of 45.5 points, 95% CI [32.42, 58.50]. AOFAS scores improved from 55.2 to 80.3, 95% CI [12.459, 37.741]. Patient demographics and results are seen in Tables 1 and 2 respectively.Conclusion:These results demonstrate clinically positive long-term outcomes for a cohort of patients with difficult OCLT, followed over the course of 6-8 years after treatment with arthroscopic assisted DeNovo NT implantation. Understanding the longevity of this intervention can better aid clinicians in deciding if this treatment option is appropriate for patients and should ultimately be included as part of the orthopedics’ armamentarium.

Description of atechnique that uses Lapidus arthrodesis plus osteochondral autotransplantation in the treatment of severe hallux rigidus

The objective of this technique is the treatment asevere hallux rigidus deformity by reorientation of an elevated first metatarsal using arthrodesis of the first tarsometatarsal joint and performing aone-step transplantation of an osteochondral graft, which is harvested from the first cuneiform, to the head of the first metatarsal bone. Severe arthritis of the first metatarsophalangeal joint (MTP) stage3 and4 in the Vanore classification. General contraindications for afoot surgery; ankylosis of MTP joint; severe arthritis of the sesamoid joint; osteonecrosis; short first metatarsal; previous infection in the metatarsophalangeal joint; large cysts at the head of the first metatarsal. The first step is the preparation of the metatarsophalangeal and the first tarsometatarsal joint. After mobilizing the first metatarsal in amedioplantar direction, acartilage-bone cylinder is removed from the articular surface of the medial cuneiform using special osteochondral autograft transfer system (OATS) instruments (Small Joint OATS, Arthrex medical instruments GmbH, Munich, Germany). This is followed by the arthrodesis of the first tarsometatarsal joint with reorientation of the position of the first metatarsal bone. Then the removed osteochondral cylinder is implanted into the articular surface of the first metatarsal head. After that the capsule is closed and the skin sutured. Postoperative management is guided mainly by the requirements of the first tarsometatarsal arthrodesis. When aplantar plate is used pain orientated full weightbearing is allowed in apostoperative shoe with astiffened sole for 6-8weeks. Physiotherapy is prescribed to exercise the first metatarsophalangeal joint. In the study, 5 patients were treated with the method described in the years 2011-2012 and were followed up for aperiod of 2years. All of these patients were subjectively satisfied with the outcome of the operation. There were no relevant surgery-associated complications.

Arthroscopic Osteochondral Autograft Transfer System Procedure of the Lateral Femoral Condyle with Donor-Site Backfill Using Osteochondral Allograft Plug

The osteochondral autograft transfer system (OATS) procedure is at the forefront of cartilage restoration surgeries of the knee, offering superior return to sport rates and long-term functionality. This technique reports an arthroscopic OATS procedure of the lateral femoral condyle with donor-site backfill using an osteochondral allograft plug. Potential complications from unfilled donor site sockets are eliminated through donor site backfill with an allograft plug.

A Systematic Review of Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus

Category:AnkleIntroduction/Purpose:The term osteochondral lesion of the talus (OLT) refers to any pathology of the talar articular cartilage and corresponding subchondral bone. In general, OLTs can pose a formidable treatment challenge to the orthopaedic surgeon due to the poor intrinsic ability of cartilage to heal as well as the tenuous vascular supply to the talus. Although many treatment options exist, including microfracture, retrograde drilling, autologous chondrocyte implantation (ACI), and osteochondral autograft transfer system (OATS) these options may be inadequate to treat large cartilage lesions. Osteochondral allografts have demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement. To our knowledge, this is the first systematic review of outcomes after fresh osteochondral allograft transplantation for OLTs.Methods:PudMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Medline were searched using PRISMA guidelines. Studies that evaluated outcomes in adult patients after fresh osteochondral allograft transplantation for chondral defects of the talus were included. Operative results, according to standardized scoring systems, such as the AOFAS Ankle/Hindfoot scale and the Visual Analog Scale were compared across various studies. The methodological quality of the included studies was assessed using the Coleman methodology score.Results:There were a total of 12 eligible studies reporting on 191 patients with OLTs with an average follow-up of 56.8 months (range 6-240). The mean age was 37.5 (range 17-74) years and the overall graft survival rate was 86.6%. The AOFAS Ankle/Hindfoot score was obtained pre- and postoperatively in 6 of the 12 studies and had significant improvements in each (P<0.05). Similarly, the VAS pain score was evaluated in 5 of the 12 studies and showed significant decreases (P<0.05) from pre- to postoperatively with an aggregate mean preoperative VAS score of 7.3 and an aggregate postoperative value of 2.6. The reported short-term complication rate was 0%. The overall failure rate was 13.4% and 21.6% percent of patients had subsequent procedures.Conclusion:The treatment of osteochondral lesions of the talus remains a challenge to orthopaedic surgeons. From this systematic review, one can conclude that osteochondral allograft transplantation for osteochondral lesions of the talus results in predictably favorable outcomes with an impressive graft survival rate and high satisfaction rates at intermediate follow-up.

Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016.

Management of cartilage lesions of the knee can be complex, time consuming, and controversial, especially without a widely agreed upon "gold-standard" management. The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of cartilage lesions specified by Current Procedure Terminology (CPT) codes: 29877, chondroplasty; 29879, microfracture/drilling; 29866, arthroscopic osteochondral autograft; 29867, arthroscopic osteochondral allograft; 27412, autologous chondrocyte implantation (ACI); 27415, open osteochondral allograft; or 27416, open osteochondral autograft. Procedures were categorized as palliative (chondroplasty), microfracture/drilling, or restorative (arthroscopic osteochondral autograft; arthroscopic osteochondral allograft; ACI; open osteochondral allograft; or open osteochondral autograft). Linear regression was performed to determine the significance of yearly trend across each procedure.From 2007 to 2016, a total of 35,506 surgical procedures were performed. The average yearly incidence was 7.8 per 10,000 patients. Overall, palliative techniques (chondroplasty) were more common (1.8:1 ratio for chondroplasty to microfracture and 34:1 ratio chondroplasty to restoration procedure). There was a trend of decreasing incidence of palliative procedures seen by a significant decrease in the ratio of palliative to microfracture/restorative procedures of 0.2512 each year from 2007 to 2016 (p < 0.001). This decrease followed a linear trend (R 2 = 0.9123). In 2013, the number and incidence of the palliative procedures declined below that of microfracture procedures, with microfracture being most common from 2013 to 2016. Palliative chondroplasty was no longer the most commonly performed procedure for cartilage lesions in the United States from 2007 to 2016, as more surgeons opted for microfracture procedures instead. Restorative procedures (ACI, osteochondral autograft transfer system) remained unchanged over the study period, in accordance with the sports medicine literature; however, early functional outcomes studies do show the equivalency and in some cases superiority compared with microfracture. This is Level III study.

Current solutions for the treatment of chronic articular cartilage defects in the knee.

Chondral and osteochondral defects in the knee are common and may lead to degenerative joint disease if treated inappropriately.Conventional treatments such as microfracture often result in fibrocartilage formation and are associated with inferior results. Additionally, microfracture is generally unsuitable for the treatment of defects larger than 2–4 cm2.The osteochondral autograft transfer system (OATS) has been shown to produce superior clinical outcomes to microfracture but is technically difficult and may be associated with donor-site morbidity. Osteochondral allograft use is limited by graft availability and failure of cartilage incorporation is an issue.Autologous chondrocyte implantation (ACI) has been shown to result in repair with hyaline-like cartilage but involves a two-stage procedure and is relatively expensive.Rehabilitation after ACI takes 12 months, which is inconvenient and not feasible for athletic patients.Newer methods to regenerate cartilage include autologous stem cell transplantation, which may be performed as a single-stage procedure, can have a shorter rehabilitation period and is less expensive than ACI. Longer-term studies of these methods are needed.Cite this article: EFORT Open Rev 2020;5:156-163. DOI: 10.1302/2058-5241.5.190031

Arthroscopic treatment of scaphoid nonunion with humpback deformity and DISI with corticocancellous bone grafting: Technical note

For two decades, scaphoid nonunion has been treated arthroscopically. However, compressed cancellous bone graft does not have the same mechanical properties as corticocancellous bone graft for reducing the scaphoid humpback deformity and DISI tilt. Here, we describe an arthroscopic technique to treat Alnot stage IIB scaphoid nonunion. We treated a 27-year-old male patient for scaphoid waist nonunion with humpback deformity and DISI. A 8×8×10 mm cylindrical corticocancellous bone graft was harvested from the dorsal aspect of the radius using a single-use osteochondral autograft transfer system (OATS®, Arthrex Inc., Naples, USA). It was inserted in the nonunion site through an arthroscopic volar approach. Bone union was obtained at 3 months with lasting correction of the scaphoid humpback deformity and DISI. The functional result at 6 months was excellent. There were no complications. Scaphoid nonunion with humpback deformity and DISI may be treated arthroscopically with a corticocancellous bone graft.

Bipolar Cartilage Lesions of the Knee: A Systematic Review of Techniques, Outcomes, and Complications.

The purpose of this systematic review was to determine (1) treatment options for bipolar cartilage lesions of the knee, (2) patient-reported outcomes following various surgical treatments, and (3) complication and failure rates following surgery. A literature search of PubMed, the Cochrane Library, and CINHAL was performed using PRISMA guidelines. Patients were included if they had bipolar cartilage lesions of the knee treated surgically. Lesion characteristics, surgical technique, patient-reported outcomes, complication rates, failure rates, and survivorship were recorded. Fourteen studies yielded 301 knees treated surgically. Patient age ranged from 15 to 74 years. Surgical techniques included 138 autologous chondrocyte implantation (ACI), 156 osteochondral allograft transplantation (OCA), and 7 osteochondral autograft transfer system (OATS). Seven studies reported a concomitant procedure rate that ranged from 0% to 88%. Eight studies reported that both reciprocal lesions received surgical treatment, while 6 studies did not specify. Lesion size ranged from 1 to 41 cm2. All reported postoperative improvements in patient-reported outcomes, but the measures were very heterogeneous. There were no major complications and the rate of minor complications ranged from 0% to 50%. Survivorship ranged from 40% to 100% for OCA, 76% to 95% for ACI, and 100% for the 1 study evaluating OATS. Bipolar cartilage lesions of the knee typically involve a large surface area and are most commonly treated with ACI or OCA, while OATS may be an option for smaller lesions. Improvements in mid-term patient-reported outcomes were reported for all surgical procedures and they can be performed safely with a low rate of major complications.

Tibial Plateau Cartilage Lesions: A Systematic Review of Techniques, Outcomes, and Complications.

The purpose of this systematic review is to determine (1) current reported treatment options for isolated tibial plateau (TP) cartilage lesions, (2) patient reported outcomes following various treatments, and (3) complication rate and survivorship following various treatments. A literature search of PubMed, the Cochrane Library, and CINAHL was conducted adhering to PRISMA guidelines. Patients were included if they had TP cartilage lesions treated with surgery. Lesion characteristics, surgical procedure details, patient reported outcomes, complication, and failure rates were collected. Thirteen studies yielded 205 knees with TP cartilage lesions treated surgically. Ages ranged from 12 to 77 years. Surgical techniques included 138 treated with osteochondral allograft transplantation (OCA), 37 treated with osteochondral autograft transfer system (OATS), 11 treated with microfracture, 11 treated with an osteochondral scaffold, and 8 treated with autologous chondrocyte implantation (ACI). The patient-reported outcome measures were heterogeneous, but all reported improvements with the notable exception of one study evaluating microfracture. The rate of complications ranged from 0% to 4.6%. Failure rate ranged from 22% to 46% for OCA and 0% to 16% for OATS. No failures were reported for the additional techniques. Various surgical techniques have been utilized for the treatment of TP cartilage lesions. Patient-reported outcome measures were heterogeneous, but improvements were reported following all surgical treatments except for microfracture, which resulted in decreased scores at mid-term follow-up. The complication rate was low for all techniques described. However, the failure rate was higher following unicondylar OCA for salvage treatment of posttraumatic deformities.

Osteochondral Autograft Transfer Procedure: Arthroscopic Technique and Technical Pearls

The Osteochondral Autograft Transfer System (OATS; Arthrex, Naples, FL) is an excellent option for the treatment of articular cartilage lesions within the knee. Current literature suggests that at early-term to midterm follow-up, patients experience improved function, alleviation of pain, and good satisfaction with acceptable complication rates. Although long-term data are lacking, studies in athletes have shown that the OATS can provide an adequate rate of return to sports. The OATS procedure has traditionally been considered an open procedure. However, with the advancement of arthroscopic techniques, the procedure can now be completed arthroscopically. We discuss this modern operation.

Cartilage repair surgery prevents progression of knee degeneration.

To investigate, whether cartilage repair surgery for focal osteochondral defects at the knee results in less degenerative changes over 6years in a MR imaging follow-up than morphologically initially identical defects in non-operated control subjects from the osteoarthritis initiative (OAI). A total of 32 individuals received baseline and follow-up MRI. In n = 16 patients with cartilage repair [osteochondral autograft transfer system (OATS), n = 12; spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI), n = 4] MRI was performed preoperatively and after 5.7 ± 2.3year follow-up. Baseline MRIs of non-operated subjects from the OAI were screened for initially identical cartilage defects (n = 16). Morphological knee abnormalities were assessed using WORMS, AMADEUS and MOCART scores. A sagittal 2D MSME sequence was implemented for quantitative cartilage T2 relaxation time measurements in all (0, 2, 4, 6 and 8-years) follow-ups from the OAI and in the postoperative MRI protocol. For both groups, focal osteochondral defects were located at the femoral condyle in 8/16 cases (5 medial, 3 lateral) and at the patella in 8/16 cases. At baseline, the mean cartilage defect size ± SD was 1.4 ± 1.3cm2 for the control group and 1.3 ± 1.2cm2 for the cartilage repair group (n.s.). WORMS scores were not significantly different between the cartilage repair group and the control group at baseline [mean difference ± SEM (95%CI); 0.5 ± 2.5 (- 4.7, 5.7), n.s.]. During identical follow-up times, the progression of total WORMS scores [19.9 ± 2.3 (15.0, 24.9), P < 0.001] and of cartilage defects scores in the affected (P < 0.001) and in the opposing (P = 0.029) compartment was significantly more severe in non-operated individuals (P < 0.05). In non-operated subjects, T2 values increased continuously from baseline to the 8-year follow-up (P = 0.001). Patients with cartilage repair showed less progression of degenerative MRI changes at 6-year follow-up than a control cohort from the OAI with initially identical osteochondral defects. Patients with focal cartilage defects may profit from cartilage repair surgery since it may prevent progression of early osteoarthritis at the knee joint. Prognostic study, Level II.

A large knee osteochondral lesion treated using a combination of osteochondral autograft transfer and second-generation autologous chondrocyte implantation: A case report.

BackgroundFull-thickness knee cartilage defects greater than 4 cm2 are best treated with autologous chondrocyte implantation (ACI). Since the articular cartilage surrounding the site of implantation does not always have the normal thickness desirable for successful engraftment, there may be benefit in combining ACI with osteochondral autograft transfer, which provides immediate restoration of condylar contour and mechanical function.Case presentationA 19 year-old male who sustained a traumatic anterolateral femoral condyle osteochondral fracture underwent arthroscopic knee surgery three months after injury to harvest healthy cartilage to be sent to the Japan Tissue Engineering Co., Ltd. (J-TEC) for cartilage culture. The patient was re-admitted after four weeks to undergo a procedure using the Osteochondral Autograft Transfer System (OATS®) and the J-TEC autologous cultured cartilage (JACC®) system. Three 4.75-mm osteochondral cylindrical cores were harvested from non-weight-bearing areas of the knee and were transplanted to the lateral periphery of the lateral femoral condyle defect. The cultured cartilage was implanted to the remaining defect with a periosteal cover harvested from the anterolateral ridge of the lateral femoral condyle. Continuous passive range of motion exercises and gait retraining were immediately initiated, with strict no weight-bearing precaution on the operated limb. Partial weight-bearing was allowed four weeks after surgery, which was progressed to full weight-bearing after another two weeks.ConclusionACI must be viewed as a complementary procedure to osteochondral transplantation and this hybrid technique appears to be a promising surgical approach and treatment option for large cartilage lesions, especially in the younger population.

OSTEOCHONDRAL AUTOGRAFT TRANSFER FOR TREATMENT OF STIFLE OSTEOCHONDRITIS DISSECANS IN TWO RELATED SNOW LEOPARDS ( PANTHERA UNCIA).

Two related female snow leopards ( Panthera uncia) were diagnosed with osteochondritis dissecans of the lateral femoral condyle via radiographs and computed tomography. Lesions were either bilateral (Patient 1) or unilateral (Patient 2). Surgical treatment was performed using an osteochondral autograft transfer system following cartilage flap removal. After a 6-wk recovery period, both animals had a markedly improved gait with mild pelvic limb stiffness. Patient 1 developed intermittent lameness 9 mo postsurgery and Patient 2 had mild lameness 3 yr postsurgery. Because of recurrent lameness, both animals were treated with platelet-rich plasma intra-articular injections and oral gabapentin (Patient 1) or oral meloxicam (Patient 2). Full incorporation of autografts was confirmed with computed tomography (both patients) and arthroscopy (Patient 1 only). Osteochondritis dissecans has been previously reported in snow leopards and these cases represent the first reported use of osteochondral autograft repair and platelet-rich plasma to treat the condition.

Long-term evaluation of Primary Osteochondral Autograft Transfer System (OATS) for large cystic type osteochondral lesion of talus

Category: Ankle Introduction/Purpose: Osteochondral lesions of talus (OLTs) are often treated primarily by fragment excision, abrasion, drilling, or microfracture. However, OLT accompanying with large cyst has been challenged to yield good outcome nevertheless of many surgical options. Recent study showed significant high failure rate of arthroscopic marrow stimulation treatment larger than 150mm2. The current study is to investigate the outcome of the primary osteochondral autograft transfer system (OATS) for large cystic type OLT (&gt;150mm2). Methods: This retrospective analysis included 19 talus (19 patients) with diagnosed large cystic type OLT (&gt;150mm2) who received primary OATS between September 2009 and March 2013. Defect size area was measured on magnetic resonance imaging (MRI) by the ellipse formula from coronal and sagittal length. The patients completed the visual analog scale (VAS) and the American Orthopaedic Foot &amp; Ankle Society (AOFAS) score preoperatively and at follow-up. Plain radiographs were used to show the improvement of radiolucency postoperatively. Results: The mean follow up period was 83.9 months (57 – 99) and the average defect size area was 169.4 mm2 (151.3 – 392.6). The Mean VAS score decreased from 6.95 preoperatively to 2.6 postoperatively. Average AOFAS score improved from 66.8 preoperatively to 88.7 postoperatively. Eighty percent of patients rated their result excellent or good. The radiolucent area of the cysts disappeared on the plain radiographs in all cases. Conclusion: Long-term clinical results of primary OATS in large cystic type OLT showed good outcomes and patients could significantly benefit from this surgery.