Osteochondral Autograft Transfer Research Articles

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

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. DesignForty-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.

Mosaicplasty/Osteochondral Autograft Transfer Remains a Durable Solution for Symptomatic Chondral Defects of the Knee: Two to Ten-Year Follow-up Analysis

Objectives: Little to no long-term data exist following mosaicplasty/osteochondral autograft transfer (OATS). The purpose was to assess the long-term outcomes of osteochondral autograft transfer in terms of patient-reported outcomes, reoperation rates, and conversion to arthroplasty. Methods: Between September 1999 through April 2021, 63 patients who underwent mosaicplasty were queried from an institutional cartilage registry with patient reported outcome measures (PROMs), including the 36-Item Short Form Survey (SF-36), the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS), and the International Knee Documentation Committee Subjective Knee Form (IKDC) for OATS surgical procedures from the practice of six fellowship-trained knee specialists. Inclusion criteria were patients treated with mosaicplasty with preoperative PROMs and minimum two-year follow-up. Exclusion criteria were prior ipsilateral surgical procedures, advanced osteoarthritis, revision cartilage procedures, inflammatory arthropathy, or loss to follow-up. The preoperative and minimum two-year clinical outcomes with respect to the SF-36 score, reoperation rates, and conversion to arthroplasty were analyzed Results: Mean age was 27.4 ± 12.4 years and 20/63 (31.7%) were female with a mean follow-up of 5.7 ± 3.2 years. The mean lesion size was 2.3 ± 1.6 cm2 requiring a mean of 2.2 ± 1.3 autograft plugs. Mean IKDC and KOS-ADL increased from 46.4 ± 15.1 and 64.4 ± 16.3 preoperatively to 70.4 ± 22.6 and 83.8 ± 11.7, respectively, at 10-year follow-up. A total of 69% and 67% surpassed the MCID and SCB1,2, respectively, for IKDC at 2-year follow-up; similarly, 60% and 33.3% surpassed MCID and SCB, respectively, for IKDC at 10-year follow-up. The overall reoperation rate was 28.6% at a mean of 43.8 years with partial meniscectomy, chondroplasty, and loose body removal most commonly performed. Two patients required arthroplasty conversion. Conclusions: OATS remains a durable knee preserving cartilage repair operation with low incidence of reoperation 10 years following index procedure.

Osteochondritis Dissecans Lesions of the Knee: Evidence-Based Treatment.

Osteochondritis dissecans (OCD) of the knee is a potentially disabling condition in adolescent and young adults, which is likely multifactorial in origin. In recent years, there have been notable improvements in identification and treatment. Clinical presentation varies based mostly on OCD lesion stability. Patients with stable lesions generally present with vague knee pain and altered gait while mechanical symptoms and effusion are more common with unstable lesions. Lesions most commonly occur on the lateral aspect of the medial femoral condyle in patients aged 10 to 20 years. Magnetic resonance imaging is vital to diagnose and predict clinical treatment, which is largely based on stability of the fragment. Conservative treatment of stable lesions in patients with open physis is recommended with protected weight-bearing and gradual progression of activities over the course of 3 to 6 months. Stable OCD lesions which failed a nonsurgical course can be treated with transarticular or retrograde drilling while unstable lesions usually require fixation, autologous chondrocyte implantation (ACI), osteochondral autograft transfer (OATS), or osteochondral allograft transplantation. This review highlights the most current understanding of knee OCD lesions and treatment options with the goal of optimizing outcomes in this difficult pathology.

Age influences the efficacy of osteochondral autograft transfer: Promising results for patients under 40

BackgroundPrevious research using osteochondral autograft transfer (OAT) has shown poorer outcomes with increasing patient age. The aim of this article is to evaluate a cohort of patients that received an OAT and to correlate their clinical results with their age at procedure. MethodsPatients that underwent an OAT to treat an osteochondral (OC) lesion with a minimum 24-month follow-up were included. Patients were categorized into two groups based on their age at procedure (<40 years and ≥40 years). Postoperatively, each patient completed the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and Lysholm scales. Results51 patients were included (35<40 years, 16≥40 years). Mean follow-up was 4.2 years (2–7). For patients<40 years, IKDC averaged 80.8 (SD 15.9) versus 71.2 (SD 19.4) in ≥40 years (p=0.03). For patients <40 years, Lysholm averaged 85.9 (SD 10.8) versus 77.0 (SD 21.6) in ≥40 years (p=0.02). For patients<40 years, KOOS averaged 78.3 (SD 11.8) versus 68.9 (SD 18.5) in ≥40 years (p=0.01). There was a 100% sensibility in identifying all the patients with a poor IKDC and Lysholm from 34 years old (AUC 0.76 and 0.8). ConclusionsOAT has better outcomes in patients younger than 40 years compared to patients older than 40 years. Based on the prognostic capacity of age, the ideal candidate for an OAT is a patient younger than 34 years old.

Early Complication Rates Are Equivalent Between Isolated Cartilage Restoration and Concomitant Cartilage Restoration and Osteotomy of the Knee.

Realignment osteotomy performed concomitantly with cartilage restoration typically requires early restricted weightbearing and can add significant morbidity, potentially leading to an increased risk of early perioperative complications. The purpose of this study was to compare the 30-day complication rates after isolated cartilage restoration (ICR) versus concomitant cartilage restoration and osteotomy (CRO) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing ICR (autologous chondrocyte implantation, osteochondral autograft transfer, or osteochondral allograft transplantation) and CRO (with concomitant high tibial osteotomy, distal femoral osteotomy, and/or tibial tubercle osteotomy). Complications rates between treatment groups were compared using multivariate logistic regression analyses adjusted for sex, age, steroid use, and respiratory status. A total of 773 ICR and 97 CRO surgical procedures were identified. Mean patient ages were 35.9 years for the ICR group and 31.2 years for the CRO group. Operative time was significantly longer in the CRO group (170.8 min) compared with the ICR group (97.8 min). Multivariate analysis demonstrated no significant differences in rates of PE, VTE, and all-cause readmission between the ICR and CRO groups. No events of wound disruption, SSI and reoperation were found in the CRO group, while the ICR group was characterized by low rates of wound disruption, reoperation, and SSI (<1.1%). These findings further support concomitant osteotomy with cartilage restoration when appropriate and aid surgeons in the preoperative counseling of patients undergoing cartilage restoration treatment.

Surface repair of the femoral head using press-osteochondral autograft transfer

AimsHyaline cartilage has a low capacity for regeneration. Untreated osteochondral lesions of the femoral head can lead to progressive and symptomatic osteoarthritis of the hip. The purpose of this study is to analyze the clinical and radiological long-term outcome of patients treated with osteochondral autograft transfer. To our knowledge, this study represents a series of osteochondral autograft transfer of the hip with the longest follow-up.MethodsWe retrospectively evaluated 11 hips in 11 patients who underwent osteochondral autograft transfer in our institution between 1996 and 2012. The mean age at the time of surgery was 28.6 years (8 to 45). Outcome measurement included standardized scores and conventional radiographs. Kaplan-Meier survival curve was used to determine the failure of the procedures, with conversion to total hip arthroplasty (THA) defined as the endpoint.ResultsThe mean follow-up of patients treated with osteochondral autograft transfer was 18.5 years (9.3 to 24.7). Six patients developed osteoarthritis and had a THA at a mean of 10.3 years (1.1 to 17.3). The cumulative survivorship of the native hips was 91% (95% confidence interval (CI) 74 to 100) at five years, 62% (95% CI 33 to 92) at ten years, and 37% (95% CI 6 to 70) at 20 years.ConclusionThis is the first study analyzing the long-term results of osteochondral autograft transfer of the femoral head. Although most patients underwent conversion to THA in the long term, over half of them survived more than ten years. Osteochondral autograft transfer could be a time-saving procedure for young patients with devastating hip conditions who have virtually no other surgical options. A larger series or a similar matched cohort would be necessary to confirm these results which, in view of the heterogeneity of our series, seems difficult to achieve.Cite this article: Bone Jt Open 2023;4(7):523–531.

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.

Survivorship After Lateral Meniscal Allograft Transplantation Plus Concurrent Cartilage Procedure in Patients With Poor Cartilage Status: A Comparative Study

Background: The effect of a concurrent cartilage procedure in lateral meniscal allograft transplantation (MAT) in patients with bipolar cartilage lesions (high-grade lesions on both the femoral and the tibial side) is not well studied. An objective evaluation of graft status after MAT and a concurrent cartilage procedure has not been reported. Purpose: To investigate the effect of concurrent cartilage procedures and lateral MAT on objective and clinical outcomes, including survival, in patients with bipolar cartilage lesions. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 149 patients with high-grade (International Cartilage Regeneration & Joint Preservation Society grade 3 or 4) cartilage lesions were enrolled and assigned to 1 of 3 groups based on the cartilage procedure and cartilage status at the time of MAT. Femoral cartilage procedures (microfracture, n = 18; osteochondral autograft transfer, n = 13) and lateral MAT were performed in 31 patients with bipolar cartilage lesions (cartilage procedure group). Another 70 patients with bipolar lesions underwent only lateral MAT without cartilage procedure (bipolar lesion group). The remaining 48 patients, who had high-grade lesions only on the tibial side and underwent lateral MAT without a cartilage procedure, were selected as a control group (unipolar lesion group). Anatomic survival was objectively assessed by follow-up magnetic resonance imaging and second-look arthroscopy. Clinical survivorship was determined with a Lysholm score <65 or need for additional surgery, such as revision MAT. Results: The mean Lysholm score improved from 67.2 ± 15.9 preoperatively to 86.7 ± 11.1 with a mean follow-up of 78.0 ± 51.2 months (P < .001). The postoperative scores were not significantly different between the 3 groups. The estimated 5-year anatomic survival rate in the cartilage procedure group (86.7%) was higher than that in the bipolar lesion group (65.0%; P = .043) but comparable with that in the unipolar lesion group (90.2%; P = .572). The estimated 5-year clinical survival rates were not significantly different between the groups (P = .187). Conclusion: A concurrent femoral cartilage procedure improved the anatomic survival rate in patients with bipolar chondral lesions who underwent lateral MAT. This finding suggests that the cartilage procedure is an effective treatment choice and may improve the status of an allograft after lateral MAT for patients with bipolar cartilage lesions.

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.].

Compressibility of Osteochondral Autograft Transfer Donor Grafts: A Comparison of Different Donor Regions and How Much Shortening Occurs of Plugs After Impaction.

Osteochondral autograft transfer (OAT) is a useful technique for full-thickness cartilage lesions of the distal femur. Various techniques recommend harvesting a plug 2 mm longer than the recipient hole to allow for graft impaction. Grafts with limited compressibility may not sit flush when impacted. To compare the compressibility/shortening of OAT donor plug regions from the distal femur of human cadaveric knees after impaction. Controlled laboratory study. A total of 20 cadaveric knees (mean age, 70.3 ± 8.4 years) were divided into 4 donor regions: medial intercondylar (IC) notch, lateral IC notch, medial trochlea, and lateral trochlea. Each region was subdivided into 4 zones: far superior (FSZ), middle superior (MSZ), middle inferior (MIZ), and far inferior (FIZ). A total of 320 grafts (6-mm diameter, 15-mm depth) were extracted, and a custom-built machine was used to strike the graft 5 times using a predetermined energy of 0.11 J. The graft length was measured initially and after each impact. Statistical analysis of the compressibility for each of the 4 regions and all 16 zones was performed utilizing analysis of variance, with post hoc testing using the Fisher's least significant difference. Compression in the lateral IC notch, medial IC notch, medial trochlea, and lateral trochlea was 2.4 ± 1.5, 2.1 ± 0.7, 3.1 ± 2.2, and 2.1 ± 0.6 mm, respectively, with significant differences between the 4 regions (P < .01) and the most compression in the medial trochlea (P < .01). Subgroup analysis showed that the lateral trochlea had higher compressibility for FIZ versus MIZ (P = .02) and the lateral IC notch had higher compressibility for FSZ versus FIZ and MIZ (P < .05 for both). Compressibility varied between OAT donor sites in the distal femur. OAT donor grafts showed the highest compressibility in the medial trochlea (3.1 mm) and lateral IC notch FSZ (3.0 mm). The lateral trochlea, medial IC notch, and the lower zones of the lateral IC notch grafts should not be oversized more than 2 mm in length, as these grafts may not compress adequately.

Subsequent Surgery Up to 10 Years After Osteochondral Allograft and Osteochondral Autograft: An Analysis of More Than 2000 Patients.

Osteochondral allograft transplant (OCA) and osteochondral autograft transfer (OAT) replace damaged cartilage with a plug of bone and overlying articular cartilage; however, limited research is available regarding the survival of these osteoarticular grafting procedures. We hypothesized that patients who underwent OCA would have a higher rate of subsequent surgery over the course of 5 years compared with patients who underwent OAT. Cohort study; Level of evidence, 3. The PearlDiver Mariner administrative database was used to identify patients 10 to 59 years old who had undergone OCA or OAT between 2010 and 2018. All included patients were assessed for subsequent knee surgeries, defined by the occurrence of a subsequent osteochondral procedure (OCA or OAT) or any type of knee arthroplasty for the duration of the time they were included in the data set (maximum of 10 years). Analyses were performed for the total population and those with allograft versus autograft (compared using the Fisher exact test). The 5-year Kaplan-Meier survival curves for operation-free survival were compared using a Mantel-Cox log-rank test. In total, 2598 patients were identified: 1631 patients who underwent OCA (34.5 ± 12.1 years old; 51.6% female) and 967 patients who underwent OAT (32.1 ± 12.9 years old; 51.0% female). Both groups had similarly high rates of subsequent knee surgeries (23.9% vs 21.9%, respectively; P = .249), with no statistical differences in rates of subsequent surgery between groups. Kaplan-Meier survival curves comparing operation-free survival at 5 years indicated no significant difference between the groups (OCA, 88.0% vs OAT, 89.5%; P = .235). Both osteochondral grafting procedures carried a relatively high rate of secondary surgery, which increased with time. The 5-year survival analysis revealed similarly high rates of subsequent surgery.

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.

Effect of platelet-rich plasma scaffolding combined with osteochondral autograft transfer for full-thickness articular cartilage defects of the femoral condyle

We aimed to investigate the local application methods of platelet-rich plasma (PRP) and the effect and safety of PRP scaffolding combined with osteochondral autograft transfer (OAT) in the treatment of full-thickness articular cartilage defects of the femoral condyle. Patients with cartilage defects of the femoral condyle were treated with OAT combined with PRP scaffolding between July 2017 and December 2020. Preoperative magnetic resonance imaging (MRI) and computed tomography were utilized to assess the size, location, and severity of the osteochondral defects. X-ray and MRI images of the knee were obtained at the final follow-up to assess the osseointegration and integrity of the implanted articular cartilage. Osteoarthritic changes in the knee joint were evaluated using the Kellgren–Lawrence grading system. Clinical status was assessed using the visual analog scale (VAS), International Knee Documentation Committee (IKDC), and Lysholm scores before the treatment and at the final follow-up. Complications and patient satisfaction were recorded to assess the safety of this combination therapy. Twenty-one patients were recruited, with a mean follow-up duration of 18.23 ± 6.84 months. The mean lesion size was 2.3 ± 0.59 cm2. The mean platelet concentration in PRP at baseline was 6.27 ± 0.63 times greater than that in the peripheral blood. The VAS, IKDC, and Lysholm scores had improved significantly at the final follow-up (P < 0.001). No serious complications such as joint infection, deep venous thrombosis, or hematoma were observed. Eighteen patients (85.72%) were satisfied with their knee function and quality of life at the final follow-up. Three patients (14.28%) complained of mild anterior knee pain, which was relieved by oral administration of nonsteroidal anti-inflammatory drugs. MRI examinations of all patients showed bony consolidation and the defect surface was covered with cartilage-like tissue. X-ray evaluations indicated that osteoarthritis in two knees (9.5%) had progressed from grade 1 to grade 2 at the final follow-up. The preliminary results showed that OAT combined with PRP may be a safe and effective technique for the treatment of full-thickness articular cartilage defects in the knee.

Reoperation After Osteochondral Autograft and Allograft Transfer in the Pediatric Knee.

Osteochondral autograft (OAU) transfer and osteochondral allograft (OAL) transfer are options for treating sizable articular cartilage lesions in the knee, but there is little evidence to support one technique over another. The goal of this study is to compare the rate of reoperation among children and adolescents undergoing OAU or OAL of the knee. In this retrospective cohort study, the Pediatric Health Information System, a national database consisting of 49 children's hospitals, was queried for all patients undergoing OAU and OAL between 2012 and 2018. A total of 732 subjects with a mean age of 15.4±2.4 years were included. Of these, 393 (53.7%) initially underwent OAL and 339 (46.3%) underwent OAU. The overall reoperation rate was 144 of 732 (19.7%) at a median of 6.6 months (range, 0.6-53.5 months) after the index operation. This rate was similar for OAL and OAU. For 18 subjects (2.5%), OAU, OAL, or autologous chondrocyte implantation (ACI) was performed at the time of revision surgery. When analyzing only open procedures, we found that the reoperation rate was 25.5% for open OAU compared with 16.5% for open OAL (P=.03). When adjusting for covariates in multivariate regression, we found that those who underwent open OAU had 1.7 times higher odds of requiring a future reoperation than those who underwent open OAL (95% CI, 1.1-2.8; P=.04). Although the rate of reoperation after OAU or OAL among children and adolescents is relatively high, few require revision OAU, OAL, or ACI. Patients undergoing open OAU have higher odds of ultimately requiring reoperation than those undergoing open OAL. [Orthopedics. 2022;45(6):378-383.].

Incidence, Timing, and Risk Factors for 5-Year Revision Surgery After Autologous Chondrocyte Implantation in 533 Patients

Background: Autologous chondrocyte implantation (ACI) can be used to treat focal, full-thickness chondral defects of the knee. However, there is limited large-sample evidence available regarding the incidence, timing, and risk factors for revision surgery after ACI. Purpose: To assess the 5-year incidence, timing, and risk factors for revision surgery after ACI in a large national cohort. Study Design: Case series; Level of evidence, 4. Methods: The 2010-2020 PearlDiver database was queried for patients aged 20 to 59 years who underwent primary ACI of the knee without previous chondral procedures or knee arthroplasty. Revision surgery was defined as subsequent revision ACI, osteochondral allograft transplantation, osteochondral autograft transfer, unicompartmental knee arthroplasty, or total knee arthroplasty within 5 years. Kaplan-Meier analysis was used to assess both incidence and timing of revision surgery. Risk factors evaluated for revision surgery included patient age, sex, body mass index (BMI), Elixhauser Comorbidity Index (ECI) score, and previous or concomitant bony realignment procedures. Results: In total, 533 patients underwent primary ACI and met inclusion criteria. The 5-year incidence of revision surgery was 10.3%, with 63% of revisions occurring in the first 2 years after surgery. Risk factors associated with revision surgery included female sex (odds ratio, 2.58; 95% CI, 1.22-5.45; P = .013) and BMI ≥35 (odds ratio, 2.24; 95% CI, 1.01-4.94; P = .047). There was no relationship between age, ECI score, or previous or concomitant bony realignment procedures and revision surgery at 5 years (P > .05). Conclusion: In an analysis of 533 patients who underwent ACI, 10.3% required a subsequent articular cartilage procedure or conversion to knee arthroplasty in the first 5 postoperative years. Revision surgery was greatest in the first 2 postoperative years. Female sex and severe obesity (BMI, ≥35) were associated with increased risk of revision surgery, while age, ECI score, and previous or concomitant bony realignment procedures were not. These findings suggest that treatment of chondral defects of the knee with ACI is associated with durable outcomes at the 5-year follow-up.

Treatment of Osteochondral Defects of the Knee Joint by Osteochondral Autograft Transfer

Treatment of Osteochondral Defects of the Knee Joint by Osteochondral Autograft Transfer

A New Concept of Mosaicplasty: Autologous Osteoperiosteal Cylinder Graft Covered With Cellularized Scaffold

A concern regarding osteochondral autograft transfer for chondral defects is donor-site morbidity of the knee, the most common source of the autograft. To avoid the drawbacks of osteochondral autograft transfer, a cylindrical osteoperiosteal graft harvested from the iliac crest covered by a same-sized cylinder of hyaluronic acid–based polymer scaffold pretreated with bone marrow aspirate concentrate and transferred to the chondral defect recipient site in the exact size for restoration of the subchondral bone and the articular cartilage.

A New Generation of Osteochondral Autograft Transfer System for the Treatment of Osteochondritis Dissecans of the Femoral Condyle: Clinical Experience in 18 Dogs.

The aim of this study was to describe the clinical application and outcome of osteochondral autograft transfer using the COR system (COR; DePuy Synthes, Warsaw, Indiana, United States) for the treatment of osteochondritis dissecans (OCD) of the femoral condyle in dogs. Medical records of dogs that were treated for OCD of the femoral condyle using the COR system between February 2013 and March 2020 were retrospectively reviewed. The results of pre- and postoperative clinical and radiographic examinations were evaluated. Twenty stifles (18 dogs; 15 lateral and 5 medial femoral condyles) met the inclusion criteria. A single graft transfer was done in six stifle joints and mosaicplasty in 14 (2 grafts in 9/14 stifles; 3 grafts in 5/14 stifles). Proper anatomic reconstruction was confirmed intraoperatively and radiographically in all dogs. There were no major and three minor postoperative complications. At 3 months, 15 of 20 stifles (14 of 18 dogs) had no lameness or radiographic signs of inflammation. At 6 months, 12 of 13 dogs had no lameness or discomfort, and four of 13 stifles had radiographic evidence of moderate osteoarthritis. Treatment of OCD of the femoral condyle using the COR system is feasible in dogs, with low complications and provides a satisfactory short-term outcome.

Surgical therapy in osteoarthritis

To provide an evidence-based overview of the different surgical procedures in osteoarthritis (OA). This narrative review reports on surgical therapies (1) for severe, end stage OA and (2) of surgical options aiming to possibly reduce OA development earlier in the course of the disease. Surgical practice guidelines provide evidence-based recommendations to assist in the clinical decision-making. Total joint arthroplasty represents the only valuable, established surgical option for severe, end stage OA. For hip and knee OA, it is by far the most common surgical procedure and provides considerable pain relief, functional restoration, and improved quality of life. Surgical therapy aiming to postpone OA essentially addresses extra- or intraarticular pre-osteoarthritic deformities, defined as congenital or acquired disturbances of the joint structure that adversely affect its function. Approaches in this category include osteotomies and different cartilage repair procedures such as osteochondral autograft and allograft transfer, marrow stimulation techniques, and autologous chondrocyte implantation. However, they are not only less commonly performed than arthroplasty, but the scientific clinical evidence in favour of this type of surgery to reduce the long-term risk of developing OA is considerably reduced. Total knee and hip arthroplasty are two of the most successful procedures in all of medicine. As the progression of this insidious disease is often asymptomatic and slow, it is imperative to judge reparative procedures at their potential to reduce OA development at long-term, besides their primary clinical outcomes. Evidence-based guidelines provide a valuable tool for high-quality surgical decision making in OA.

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.