Improving Technical Outcome in Osteochondral Allograft Transplantation of the Femoral Trochlea: The Role of Contoured Guides, Experience Level, Graft Size, and Graft Position.

Background: The use of coring instrumentation for osteochondral allograft (OCA) transplantation of the femoral trochlea is challenging due to the complex topography of this anatomical area.
Purpose: We sought to determine the effect of flat guides versus guides contoured to the surface of the trochlea on graft step-off in trochlear OCAs performed on a foam bone model. We also determined the effect of surgeon experience level and graft size on step-off.
Study Design: Controlled laboratory study.
Methods: Allograft harvesters were produced in 3 different sequential sizes with either a flat or a contoured undersurface. The guides matched one another in all aspects of shape and size except for the undersurface contour. The contoured undersurface generally matched the surface of the bone model trochlea but was not customized to that surface. A total of 72 foam femora were obtained. Identical trochlear stellate lesions of 3 different sizes (small, medium, and large) were created using 3-dimensional printed surface templates. A total of 6 surgeons (3 attending and 3 resident surgeons) performed OCAs of each trochlear lesion. Each surgeon performed 1 graft for each size and each guide type (n = 6 per surgeon). A specialized digital caliper was prepared that allowed the measurement of graft step-off to within 0.01 mm at a distance of 5 mm between the 2 sensors. The measurements were performed at 8 positions around the clockface of the grafts.
Results: Grafts performed with the contoured guides had a mean step-off of 0.43 ± 0.37 mm. Grafts performed with the flat guides had a mean step-off of 0.74 ± 0.78 mm ( P < .0001). Experience level did not have a significant effect on graft step-off ( P = .81). There was no identifiable pattern indicating higher step-off at any one position on the clockface.
Conclusion: In this study, contoured grafts had significantly lower step-offs compared with flat guides. Experience level, clockface position, and graft size did not affect step-off.
Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH; grant UL1 TR001860). C.M.D. and M.H. have received education payments from Sequoia Surgical. Z.C.L. has received education payments from Sequoia Surgical and hospitality payments from Stryker. A.A.J. is the principal shareholder of Joint Preservation Solutions, which holds intellectual property rights related to the contoured guides used in this study; is a scientific advisor and has stock options in Roam Robotics; has received education payments from Evolution Surgical; and has received hospitality payments from Encore Medical, Linvatec, Stryker, and Zimmer Biomet. C.A.L. has received education payments from Sequoia Surgical; consulting fees from Hyalex, KCI, Ossur, Smith & Nephew, and Vericel; speaking fees from Smith & Nephew; honoraria from Fidia Pharma; and hospitality payments from Aesculap Biologics and RTI Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
(© The Author(s) 2023.)