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Background:Osteochondritis dissecans (OCD) of the knee can be difficult to treat. Cartilage restoration techniques are often indicated when the lesion or fragment cannot be salvaged and the patient remains symptomatic. Fresh osteochondral allograft (OCA) transplantation can restore both bone and cartilage defects characteristic of OCD.Hypothesis:We hypothesized that osteochondral allografting is a successful method for treating OCD of the knee.Study Design:Case series; Level of evidence, 4.Methods:This study comprised 135 patients (149 knees) who underwent OCA for OCD of the knee (type III or IV) between 1997 and 2013 and had a minimum follow-up of 2 years. The median age was 21 years (range, 12-55 years) and 75.8% of the patients were male. The mean allograft size was 7.3 cm2(range, 2.2-25 cm2). Evaluation included the following: frequency and type of reoperations; modified Merle d’Aubigné and Postel (18-point) scale; International Knee Documentation Committee (IKDC) pain, function, and total scores; and Knee Society function (KS-F) and knee (KS-K) scores. Clinical failure was defined as revision OCA or conversion to arthroplasty. Graft survivorship was determined.Results:The median follow-up time was 6.3 years (range, 1.9-16.8 years) and 62% of participants had more than 5-year follow-up. Thirty-four of 149 knees (23%) had reoperations, of which 12 (8%) were classified as allograft failures (7 OCA revisions, 3 unicompartmental knee arthroplasties, and 2 total knee arthroplasties). OCA survivorship was 95% at 5 years and 93% at 10 years. Of the 137 knees whose grafts were still in situ at the latest follow-up, the mean modified Merle d’Aubigné and Postel (18-point) score was 16.8; IKDC pain, function, and total scores were 2.1, 8.1, and 82.3; and KS-F and KS-K scores were 95.7 and 94.3, respectively. The majority of patients (95%) reported being satisfied with the outcome of their procedure.Conclusion:OCA transplantation was an effective treatment for OCD of the knee, with a low rate of graft failure, significant improvement in pain and function scores, and high patient satisfaction.

Background:Osteochondral allografting, a restorative treatment option for articular cartilage lesions in the knee, involves transplantation of fresh osteochondral tissue with no tissue matching. Although retrieval studies have not consistently shown evidence of immunologic response, development of anti–human leukocyte antigen class I cytotoxic antibodies has been observed in allograft recipients.Hypothesis:Postallograft antibody formation is related to graft size and may affect clinical outcome.Study Design:Case-control study; Level of evidence, 3.Methods:This study retrospectively compared 42 antibody-positive postallograft patients with 42 antibody-negative patients. Groups were matched for age, sex, and body mass index but not intra-articular disease severity. Seventeen patients (20%) were lost to follow-up. Of the remaining 67 patients (33 antibody-positive and 34 antibody-negative), average follow-up time was 50.3 months (range, 24-165 months). Mean age was 38.1 years (range, 15-68 years) with 58% being male. Graft area was categorized as small (2), medium (5-10 cm2), or large (>10 cm2). Graft survival and Knee Society function scores were used to measure clinical outcome.Results:Of the 84 patients, 80 had graft area data. Of 27 patients with large graft area, 19 (70%) had positive postoperative antibody screens, compared with 1 of 16 (6%) with small graft area ( P < .001). Graft survival rates in the antibody-positive and antibody-negative groups were 64% and 79%, respectively ( P = .152). Mean postoperative Knee Society function scores in surviving antibody-positive and antibody-negative groups were 88.3 and 84.6 points, respectively ( P = .482).Conclusion:Antibody development after fresh, non-tissue-matched osteochondral allograft transplants in the knee appears related to graft size. No difference was observed in clinical outcome between groups. Graft survival is multifactorial, and the effect that the immunologic response has on clinical outcome merits further investigation.

Objectives: Osteochondritis dissecans (OCD) of the knee can be difficult to treat. Cartilage restoration techniques are often indicated when the lesion or fragment cannot be salvaged. Fresh osteochondral allograft (OCA) transplantation can restore both bone and cartilage defect as a treatment modality. We hypothesize that osteochondral allografting is a successful method for treating osteochondritis dissecans of the knee. Methods: Between 1983 and 2010, 164 patients (181 knees) underwent OCA for OCD of the femoral condyle(s) (type III or IV). Minimum two-year follow-up was available on 149 patients (165 knees). Median age was 25 years (range, 14 to 55) and 73% were male. Mean allograft size was 7.2 cm2(range, 2 to 23 cm2). Evaluation included frequency and type of reoperations, modified Merle d’Aubigné-Postel (18-point) scale, International Knee Documentation Committee (IKDC) pain and function scores, and Knee Society function (KS-F) score. Clinical failure was defined as revision OCA or conversion to arthroplasty. Graft survivorship was determined. Results: Median follow-up time was 7.7 years (range, 2 to 28.4 years). 78% had more than 5-year follow-up. Fifty-one of 165 knees (31%) had reoperations, of which 21 (13%) were classified as allograft failures (13 OCA revisions, 5 UKA, and 3 TKA). OCA survivorship was 93% at 5 years, 87% at 10 years, and 77% at 20 years. Of the 144 knees whose grafts were still in situ, 91% were rated good/excellent, 8% were rated fair, and 1% was rated poor. Mean modified Merle d’Aubigné-Postel (18-point) scale was 17, mean IKDC pain and function scores were 2 and 8, and mean KS-F score was 93. 88% of patients reported satisfaction. Conclusion: Osteochondral allograft transplantation was an effective treatment for osteochondritis dissecans of the knee, with significant improvement in pain and function scores and high patient satisfaction. Graft survivorship was 87% at 10 years.

Objectives: To assess the clinical outcome of OCA transplantation used as primary treatment for chondral and osteochondral lesions in the knee. In most treatment algorithms, osteochondral allograft (OCA) transplantation is regarded as a salvage procedure when previous treatments have failed. No publications have assessed the outcome of OCA transplantation used as primary treatment for cartilage lesions in the knee. Methods: Our OCA outcomes database was used to identify 61 patients who underwent OCA transplantation as primary treatment for a chondral or osteochondral defect and had a minimum follow-up of two years. None of the patients had previous surgery on the involved knee prior to the OCA. Included in the analysis were 32 males and 29 females with a mean age of 32.9 years (range 15.7-67.8 years). The most common diagnoses were osteochondritis dissecans (44.3%) and avascular necrosis (31.1%), followed by osteoarthritis (8.2%), degenerative chondral lesion (6.6%), traumatic chondral injury (6.6%), and fracture (3.2%). The mean graft area was 9.6 cm2. The majority of grafts were located on the medial (47.5%) and lateral (24.6%) femoral condyles. Thirty-five patients (57.4%) had one graft, 22 (36.2%) had two grafts, and 4 (6.6%) had three grafts. Each patient was evaluated pre- and postoperatively with the International Knee Documentation Committee (IKDC), a modified Merle d’Aubigné-Postel (18-point) scale, and Knee Society function (KS-F) score. Patients came in for a clinical evaluation or were contacted via telephone for follow-up. The number and type of reoperations following the OCA transplantation was captured. Failure was defined as revision OCA or conversion to arthroplasty. Patient satisfaction was assessed. Results: The mean follow-up duration was 7.6 years (range, 1.9 to 22.6 years). Eighteen knees (29.5%) had further surgery following the OCA transplantation. Seven knees (11.5%) had procedures unrelated to the allograft and 11 knees (18%) were considered OCA failures with eight conversions to arthroplasty, two revision OCA, and one patellectomy. The mean time to failure was 5.9 years (range, 0.5-13.7 years). OCA survivorship was 89.5% at 5 years and 74.7% at 10 years. Forty-three (70.5%) knees had their OCA still in situ at latest follow-up. Thirty-eight (84.5%) were rated good/excellent on the 18-point scale. The mean IKDC scores improved from 36.9 preoperatively to 80.4 postoperatively. The KS-F scores improved from 66.5 to 89.7. Eighty-six percent of patients reported being “extremely satisfied” or “satisfied.” Conclusion: OCA transplantation is an acceptable primary treatment method for some chondral and osteochondral defects of the knee. Failure of previous surgical treatment is not a prerequisite for OCA surgery. Outcomes in this group are comparable to other cartilage repair treatment options.