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Background:In most treatment algorithms, osteochondral allograft (OCA) transplantation is regarded as an alternative salvage procedure when other, previous reparative treatments have failed.Purpose:To compare the outcomes of a retrospective matched-pair cohort of (1) primary OCA transplantation and (2) OCA transplantation after failure of previous subchondral marrow stimulation.Study Design:Cohort study; Level of evidence, 3.Methods:An OCA database was used to identify 46 knees that had OCA transplantation performed as a primary treatment (group 1) and 46 knees that underwent OCA transplantation after failure of previous subchondral marrow stimulation (group 2). All patients had a minimum of 2 years’ follow-up. Patients in each group were matched for age (±5 years), diagnosis (osteochondral lesion, degenerative chondral lesion, traumatic chondral injury), and graft size (small, 2; medium, 5-10 cm2; large, >10 cm2). The groups had similar body mass indexes, sex distributions, and graft locations (femoral condyle, patella, and trochlea. The number and type of further surgeries after the OCA transplantation were assessed; failure was defined as any reoperation resulting in removal of the graft. Functional outcomes were evaluated by use of the modified Merle d’Aubigné-Postel (18-point) scale, International Knee Documentation Committee (IKDC) subjective knee evaluation form, Knee injury and Osteoarthritis Outcomes Score (KOOS), and the Knee Society function (KS-F) scale. Patient satisfaction, according to a 5-point scale from “extremely satisfied” to “dissatisfied,” was recorded at the latest follow-up.Results:Eleven of 46 knees (24%) in group 1 had reoperations, compared with 20 of 46 knees (44%) in group 2 ( P = .04). The OCA was classified as a failure in 5 knees (11%) in group 1 and 7 knees (15%) in group 2 ( P = .53). At 10 years of follow-up, survivorship of the graft was 87.4% and 86% in groups 1 and 2, respectively. Both groups showed improvement in pain and function on all subjective scores from preoperatively to the latest follow-up (all P < .001). Results showed that 87% of patients in group 1 and 97% in group 2 were “satisfied” or “extremely satisfied” with the OCA transplantation.Conclusion:Favorable results were shown in both groups with significant improvement of functional scores and excellent survivorship. Despite the higher reoperation rate in the previously treated group, previous subchondral marrow stimulation did not adversely affect the survivorship and functional outcome of OCA transplantation.

Complement has been implicated as a potential effector mechanism in neurodegeneration; yet the precise role of complement in this process remains elusive. In this report, we have utilized the cuprizone model of demyelination-remyelination to examine the contribution of complement to disease. C1q deposition was observed in the corpus callosum of C57BL/6 mice during demyelination, suggesting complement activation by apoptotic oligodendrocyte debris. Simultaneously, these mice lost expression of the rodent complement regulatory protein, Crry. A soluble CNS-specific form of the Crry protein (sCrry) expressed in a transgenic mouse under the control of an astrocyte-specific promoter was induced in the corpus callosum during cuprizone treatment. Expression of this protein completely protected the mice from demyelination. Interestingly, sCrry mice had low levels of demyelination at later times when control mice were remyelinating. Although the sCrry transgenic mice had lower levels of demyelination, there was no decrease in overall cellularity, however there were decreased numbers of microglia in the sCrry mice relative to controls. Strikingly, sCrry mice had early recovery of mature oligodendrocytes, although they later disappeared. TUNEL staining suggested that production of the sCrry protein in the transgenic mice protected from a late apoptosis event at 3 weeks of cuprizone treatment. Our data suggest complement provides some protection of mature oligodendrocytes during cuprizone treatment but may be critical for subsequent remyelination events. These data suggest that temporal restriction of complement inhibition may be required in some disease settings. © 2007 Wiley-Liss, Inc.

Objective: To assess the outcome of osteochondral allograft (OCA) transplantation as the primary treatment for cartilage injury in patients with no previous surgical treatment. Study Design: Case series. Patients were identified in our outcomes database. Patients undergoing primary OCA transplantation with no prior surgical treatment and a minimum of 2 years follow-up were selected. Pain and function were evaluated preoperatively and postoperatively. Patient satisfaction was assessed. Reoperations following OCA transplantation were captured. Failure was defined as revision OCA or conversion to arthroplasty. Results: Fifty-five patients (61 knees) were included in the analysis. The study consisted of 30 males and 25 females (mean age = 32.9 years; range = 15.7-67.8 years). The most common diagnoses for the OCA transplantation were osteochondritis dissecans (44.3%) and avascular necrosis (31.1%). Pain and function improved preoperatively to postoperatively on all outcome scales ( P < 0.01). The majority of patients (86%) were “extremely satisfied” or “satisfied.” OCA survivorship was 89.5% at 5 years and 74.7% at 10 years. At latest follow-up (mean = 7.6 years; range = 1.9-22.6 years), OCA remained in situ in 50 knees (82%). Eighteen knees (29.5%) had further surgery; 11 OCA failures and 7 other surgical procedure(s). Of the failed knees (mean time to failure = 3.5 years; range = 0.5-13.7 years), 8 were converted to arthroplasty, 2 had OCA revisions, and 1 had a patellectomy. Conclusions: OCA transplantation is an acceptable primary treatment method for some chondral and osteochondral defects of the knee. Failure of previous treatment(s) is not a prerequisite for OCA transplantation.

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.