Fresh patellar allograft and osteochondral defects
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Published:
Apr 14, 2021
Keywords:
patella, chondral defect, allograft, fresh, joint preservation, viability
Main Article Content
Abstract
Introduction: Chondral lesions of the patella are a challenge for the surgeon, mainly in young and active patients. Most patellar chondral defects are superficial injuries and can be managed with joint preservation techniques; however, deep injuries may require other types of management. The objective of this article is to manage osteochondral defects of the patella in young patients, using the technique of fresh allograft from a cadaveric donor.
Materials and methods: Patients with anterior knee pain, with grade III - IV chondral lesion of the patella and who had or had not undergone some type of medical or surgical management were included. They received a fresh patellar allograft that sought to provide a solution and improvement of the functionality.
Results: In all cases, recovery of functionality and mobility, absence of pain and integration of the fresh allograft into the recipient area were achieved, without evidence of tissue rejection or infection.
Discussion: The use of fresh patellar allograft for the management of wide osteochondral defects is a valuable surgical technique, easy to implement, that does not require a long learning curve and that considerably improves pain and functionality in young patients.
Conclusions: The advent of fresh osteochondral grafts allows adequate management and evolution of patients, with the aim of favoring joint preservation and avoiding total knee arthroplasty over time.
Level of Evidence: IV
Materials and methods: Patients with anterior knee pain, with grade III - IV chondral lesion of the patella and who had or had not undergone some type of medical or surgical management were included. They received a fresh patellar allograft that sought to provide a solution and improvement of the functionality.
Results: In all cases, recovery of functionality and mobility, absence of pain and integration of the fresh allograft into the recipient area were achieved, without evidence of tissue rejection or infection.
Discussion: The use of fresh patellar allograft for the management of wide osteochondral defects is a valuable surgical technique, easy to implement, that does not require a long learning curve and that considerably improves pain and functionality in young patients.
Conclusions: The advent of fresh osteochondral grafts allows adequate management and evolution of patients, with the aim of favoring joint preservation and avoiding total knee arthroplasty over time.
Level of Evidence: IV
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How to Cite
Guzmán Benedek, R. D., Álvarez Torres, G., Correa Posada, J. R., Gómez Maya, S., López González , S., Mejía, L. A., & Restrepo Noriega, V. E. (2021). Fresh patellar allograft and osteochondral defects. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(2), 207-218. https://doi.org/10.15417/issn.1852-7434.2021.86.3.1088
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Clinical Research
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References
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posttraumatic knee defects. Clin Orthop Relat Res 2001;391:318-27.
https://doi.org/10.1097/00003086-200110001-00029
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5. Gracitelli GC, Tirico LE, McCauley JC, Pulido PA, Bugbee WD. Fresh osteochondral allograft transplantation for
fractures of the knee. Cartilage 2016;8(2):155-61. https://doi.org/10.1177/1947603516657640
6. Pallante-Kichura AL, Cory E, Bugbee WD, Sah RL. Bone cysts after osteochondral allograft repair of cartilage
defects in goats suggest abnormal interaction between subchondral bone and overlying synovial joint tissues. Bone 2013;57:259-68. https://doi.org/10.1016/j.bone.2013.08.011
7. Martínez-Cano JP, Arango AS, Castro AM, Piña AM, Martínez-Rondanelli A. Validación de la escala de Kujala para dolor patelofemoral en su versión en español. Rev CES Medicina 2017;31(1):47-57.
https://doi.org/10.21615/cesmedicina.31.1.5
8. Assenmacher AT, Pareek A, Reardon PJ, Macalena JA, Stuart MJ, Krych AJ. Long-term outcomes after
osteochondral allograft: a systematic review at long-term follow-up of 12.3 years. Arthroscopy 2016;32(10):2160-8. https://doi.org/10.1016/j.arthro.2016.04.020
9. Kusnick C, Hayward I, Sartoris DJ, Haghighi P, Meyers MH, Akeson W, Resnick D. Radiographic evaluation of
joints resurfaced with osteochondral shell allografts. AJR Am J Roentgenol 1987;149:743-8. https://doi.org/10.2214/ajr.149.4.743
10. Beaver RJ, Mahomed M, Backstein D, Davis A, Zukor DJ, Gross AE. Fresh osteochondral allografts for posttraumatic defects in the knee: a survivorship analysis. J Bone Joint Surg 1992;74:105-10.
https://doi.org/10.1302/0301-620X.74B1.1732235
11. Bugbee WD, Convery FR. Osteochondral allograft transplantation. Clin Sports Med 1999;18:67-75.
https://doi.org/10.1016/s0278-5919 (05) 70130-7
12. Gracitelli GC, Meric G, Pulido PA, Görtz S, De Young AJ, Bugbee WD. Fresh osteochondral allograft
transplantation for isolated patellar cartilage injury. Am J Sports Med 2015;43(4):879-84.
https://doi.org/10.1177/0363546514564144
13. Jalali O, Vredenburgh Z, Prodromo J, Benvegnu N, Hatch GFR. Bipolar fresh osteochondral allograft
transplantation and joint reconstruction for patellar and trochlear cartilage defects. Arthrosc Tech
2019;8(12):e1533-e1541. https://doi.org/10.1016/j.eats.2019.08.003
14. Rodrigo JJ, Thompson E, Travis C. Deep-freezing versus 4 degrees preservation of avascular osteocartilaginous shell allografts in rats. Clin Orthop Relat Res 1987;218:268-75. https://doi.org/10.1097/00003086-198705000-00036
15. Farr J, Gomoll A. Ostechondral allograft. En: Farr J, Gomoll A (eds). Cartilage restoration: Practical clinical
applications. New York, NY: Springer; 2014:131-41.
2. De Caro F, Bisicchia S, Amendola A, Ding L. Large fresh osteochondral allografts of the knee: systematic clinical
and basis science review of the literature. Arthroscopy 2015;31(4):757-65. https://doi.org/10.1016/j.arthro.2014.11.025
3. Aubin PP, Cheah HK, Davis AM, Gross AE. Long-term follow up of fresh femoral osteochondral allografts for
posttraumatic knee defects. Clin Orthop Relat Res 2001;391:318-27.
https://doi.org/10.1097/00003086-200110001-00029
4. Chow JC, Hantes ME, Houle JB, Zalavras CG. Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: a 2- to 5-year follow-up. Arthroscopy 2004;20(7):681-90. https://doi.org/10.1016/j.arthro.2004.06.005
5. Gracitelli GC, Tirico LE, McCauley JC, Pulido PA, Bugbee WD. Fresh osteochondral allograft transplantation for
fractures of the knee. Cartilage 2016;8(2):155-61. https://doi.org/10.1177/1947603516657640
6. Pallante-Kichura AL, Cory E, Bugbee WD, Sah RL. Bone cysts after osteochondral allograft repair of cartilage
defects in goats suggest abnormal interaction between subchondral bone and overlying synovial joint tissues. Bone 2013;57:259-68. https://doi.org/10.1016/j.bone.2013.08.011
7. Martínez-Cano JP, Arango AS, Castro AM, Piña AM, Martínez-Rondanelli A. Validación de la escala de Kujala para dolor patelofemoral en su versión en español. Rev CES Medicina 2017;31(1):47-57.
https://doi.org/10.21615/cesmedicina.31.1.5
8. Assenmacher AT, Pareek A, Reardon PJ, Macalena JA, Stuart MJ, Krych AJ. Long-term outcomes after
osteochondral allograft: a systematic review at long-term follow-up of 12.3 years. Arthroscopy 2016;32(10):2160-8. https://doi.org/10.1016/j.arthro.2016.04.020
9. Kusnick C, Hayward I, Sartoris DJ, Haghighi P, Meyers MH, Akeson W, Resnick D. Radiographic evaluation of
joints resurfaced with osteochondral shell allografts. AJR Am J Roentgenol 1987;149:743-8. https://doi.org/10.2214/ajr.149.4.743
10. Beaver RJ, Mahomed M, Backstein D, Davis A, Zukor DJ, Gross AE. Fresh osteochondral allografts for posttraumatic defects in the knee: a survivorship analysis. J Bone Joint Surg 1992;74:105-10.
https://doi.org/10.1302/0301-620X.74B1.1732235
11. Bugbee WD, Convery FR. Osteochondral allograft transplantation. Clin Sports Med 1999;18:67-75.
https://doi.org/10.1016/s0278-5919 (05) 70130-7
12. Gracitelli GC, Meric G, Pulido PA, Görtz S, De Young AJ, Bugbee WD. Fresh osteochondral allograft
transplantation for isolated patellar cartilage injury. Am J Sports Med 2015;43(4):879-84.
https://doi.org/10.1177/0363546514564144
13. Jalali O, Vredenburgh Z, Prodromo J, Benvegnu N, Hatch GFR. Bipolar fresh osteochondral allograft
transplantation and joint reconstruction for patellar and trochlear cartilage defects. Arthrosc Tech
2019;8(12):e1533-e1541. https://doi.org/10.1016/j.eats.2019.08.003
14. Rodrigo JJ, Thompson E, Travis C. Deep-freezing versus 4 degrees preservation of avascular osteocartilaginous shell allografts in rats. Clin Orthop Relat Res 1987;218:268-75. https://doi.org/10.1097/00003086-198705000-00036
15. Farr J, Gomoll A. Ostechondral allograft. En: Farr J, Gomoll A (eds). Cartilage restoration: Practical clinical
applications. New York, NY: Springer; 2014:131-41.