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Osteochondral Allograft Transplantation for Treatment of Focal Patellar Osteochondral Lesion.

ABSTRACT: Patellar osteochondral lesions are common and particularly disabling injuries that can affect young and highly active patients. If enough functional impairment, ranging from difficulty climbing stairs to pain with squatting, is present, surgical treatment may be warranted. For the treatment of these lesions, various techniques have been described, including autologous osteochondral transplantation, as well as microfracture surgery. However, these are not without disadvantages. Although morbidity is noted in cases of autologous osteochondral transplantation, uncertain and possibly unsustainable results are associated with the microfracture procedure. Therefore, we present an alternative surgical treatment option for this pathology. The objective of this Technical Note is to describe our preferred approach for an osteochondral allograft transplant procedure to treat a focal patellar osteochondral lesion.

SUBMITTER: Ferrari MB

PROVIDER: S-EPMC5620468 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Osteochondral Allograft Transplantation for Treatment of Focal Patellar Osteochondral Lesion.

Ferrari Marcio B MB Sanchez George G Chang Angela A Sanchez Anthony A Ellera Gomes João L JL Provencher Matthew T MT

Arthroscopy techniques 20170703 4

Patellar osteochondral lesions are common and particularly disabling injuries that can affect young and highly active patients. If enough functional impairment, ranging from difficulty climbing stairs to pain with squatting, is present, surgical treatment may be warranted. For the treatment of these lesions, various techniques have been described, including autologous osteochondral transplantation, as well as microfracture surgery. However, these are not without disadvantages. Although morbidity ...[more]

PMID: 28970975

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Project description:IntroductionWe performed a survivorship analysis of patients treated with patellofemoral osteochondral allograft transplantation (OCA) using either a shell or plug technique and identified variables associated with graft failure.MethodsConsecutive patients at two institutions who underwent OCA of the patellofemoral compartment between March 1, 2001 to March 1, 2015, were retrospectively identified at minimum 2 years' follow-up. Demographic information, intraoperative findings, and postoperative data were collected. Patients were divided into two groups on the basis of surgical technique (plug group and shell group). Failure was defined as revision OCA, conversion to arthroplasty, or gross appearance of graft degeneration on second-look arthroscopy. Logistic regression analysis was performed to identify patient- and surgery-specific variables associated with survivorship.ResultsFifty patients were identified (36 women and 14 men; mean age 37.43 ± 8.87 years). Sixteen patients received plug allografts, whereas 34 received shell allografts. Forty percent of patients underwent a concomitant meniscal, ligamentous, malalignment, or chondral procedure. Five patients in the Plug Group (31.3%) underwent reoperation at a mean 1.37 ± 1.34 years, and 28 patients (82.4%) who received Shell OCA underwent reoperation at a mean 1.94 ± 1.92 years. Two patients in the plug group had graft failure at a mean 9.17 ± 0.93 years, whereas 13 patients in the shell group had graft failure at a mean 3.81 ± 2.78 years. Patients with plug allografts demonstrated 100% and 66% survival at 5 and 9.8 years, respectively. For the shell group, survivorship was 65.8% and 37% at 5 and 10.6 years, respectively. Increasing body mass index was associated with failure for the case series overall (odds ratio 1.33, P = .020). Traumatic cause was found to be protective of failure (odds ratio = 0.02, P = .035).ConclusionsPlug OCA of the patellofemoral compartment can be an efficacious procedure with quality mid-term outcomes. Shell OCA led to high failure rates at midterm outcomes. Increasing body mass index may predispose patients to failure, whereas traumatic cause of their lesion was associated with improved outcomes.Level of evidenceLevel IV, Therapeutic case series.

Dataset Information

Osteochondral Allograft Transplantation for Treatment of Focal Patellar Osteochondral Lesion.

Publications

Osteochondral Allograft Transplantation for Treatment of Focal Patellar Osteochondral Lesion.

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