Fresh osteochondral allograft transplantation for isolated patellar cartilage injury

Guilherme C Gracitelli; Gokhan Meric; Pamela A Pulido; Simon Görtz; Allison J De Young; William D Bugbee

doi:10.1177/0363546514564144

Fresh osteochondral allograft transplantation for isolated patellar cartilage injury

Am J Sports Med. 2015 Apr;43(4):879-84. doi: 10.1177/0363546514564144. Epub 2015 Jan 16.

Authors

Guilherme C Gracitelli¹, Gokhan Meric², Pamela A Pulido³, Simon Görtz⁴, Allison J De Young³, William D Bugbee⁵

Affiliations

¹ Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA Department of Orthopaedic Surgery, Federal University of São Paulo, Brazil.
² Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA Department of Orthopaedic Surgery, Balikesir University, Balikesir, Turkey.
³ Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA.
⁴ Department of Orthopaedic Surgery, University of California, San Diego School of Medicine, La Jolla, California, USA Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA.
⁵ Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA Bugbee.william@scrippshealth.org.

PMID: 25596614
DOI: 10.1177/0363546514564144

Abstract

Background: The treatment of patellofemoral cartilage injuries can be challenging. Osteochondral allograft (OCA) transplantation has been used as a treatment option for a range of cartilage disorders.

Purpose: To evaluate functional outcomes and survivorship of the grafts among patients who underwent OCA for patellar cartilage injuries.

Study design: Case series; Level of evidence, 4.

Methods: An institutional review board-approved OCA database was used to identify 27 patients (28 knees) who underwent isolated OCA transplantation of the patella between 1983 and 2010. All patients had a minimum 2-year follow-up. The mean age of the patients was 33.7 years (range, 14-64 years); 54% were female. Twenty-six (92.9%) knees had previous surgery (mean, 3.2 procedures; range, 1-10 procedures). The mean allograft area was 10.1 cm(2) (range, 4.0-18.0 cm(2)). Patients returned for clinical evaluation or were contacted via telephone for follow-up. The number and type of reoperations were assessed. Any reoperation resulting in removal of the allograft was considered a failure of the OCA transplantation. Patients were evaluated pre- and postoperatively using the modified Merle d'Aubigné-Postel (18-point) scale, the International Knee Documentation Committee (IKDC) pain, function, and total scores, and the Knee Society function (KS-F) score. Patient satisfaction was assessed at latest follow-up.

Results: Seventeen of the 28 knees (60.7%) had further surgery after the OCA transplantation; 8 of the 28 knees (28.6%) were considered OCA failures (4 conversions to total knee arthroplasty, 2 conversions to patellofemoral knee arthroplasty, 1 revision OCA, 1 patellectomy). Patellar allografting survivorship was 78.1% at 5 and 10 years and 55.8% at 15 years. Among the 20 knees (71.4%) with grafts in situ, the mean follow-up duration was 9.7 years (range, 1.8-30.1 years). Pain and function improved from the preoperative visit to latest follow-up, and 89% of patients were extremely satisfied or satisfied with the results of the OCA transplantation.

Conclusion: OCA transplantation was successful as a salvage treatment procedure for cartilage injuries of the patella.

Keywords: cartilage; osteochondral allograft; osteochondral defect; osteochondral transplantation; patella.

MeSH terms

Adolescent
Adult
Arthroplasty, Replacement, Knee
Bone Transplantation / methods*
Cartilage / injuries
Cartilage / transplantation*
Female
Follow-Up Studies
Humans
Knee Joint / pathology
Knee Joint / surgery*
Male
Middle Aged
Orthopedic Procedures / methods
Patella / injuries
Patella / surgery*
Patient Satisfaction
Reoperation
Transplantation, Homologous
Young Adult