Articular cartilage is a unique tissue in joint that is constantly subjected to stress and is very vulnerable to traumatic injury or degenerative conditions. This is especially true it in large weight-bearing joints such as the knee. When a teenage, young adult, or middle-age adult has a localized area of a full thickness cartilage or a full thickness cartilage and bone defect, this is in affect a localized area of osteoarthritis, In patients with large defects, or in defects involving the bone, an effective treatment for the cartilage deficiency is a fresh osteoarticular allograft. These allografts are obtained from young donors who have the same size knee as the affected patient.
The workup for determining if a patient is a candidate for a fresh osteoarticular allograft is very important. Alignment must be assessed to make sure they are not putting extra stress on the affected compartment, the patient should have intact ligaments so there is no instability (or be able to have a concurrent ligament reconstruction), and it is important to determine that the patient has a normal amount of meniscus present to provide cushioning to the joint so that the joint is not overloaded. In addition, it is important that there not be cartilage lesions on the opposing articular cartilage surface, “a bipolar lesion”, because these types of lesions do not do as well with any type of cartilage resurfacing procedure. Another important piece of the workup is obtaining sizing xrays of the knee such that the appropriate size donor graft can be obtaining in the future.
The fresh osteoarticular allograft needs to be implanted via an open incision which allows access to the joint. In most locations of the knee, these incisions can be small, which helps to avoid any quadriceps muscle shutdown. However, there are times when they are in difficult to access locations where the incisions must be larger to make sure the graft can be properly placed. One of the keys for success of an osteoarticular allograft is transplanting a refrigerated allograft within the first 15-28 days postoperatively. It takes 14 days for assessment of the grafts to make sure there are no viral or bacterial contaminants. We strive to implant the grafts as soon as possible once they have passed testing to try and provide the most viable cells to the patient. Fresh osteoarticular allografts have been found to result in significant functional and clinical improvement after an average follow up of three years, in our patient who have been treated for a full thickness osteochondral defect to the femoral condyle, with similar outcomes to historical reports in other centers for patients treated with fresh osteoarticular allograft implants.
It is very important that a careful assessment be made as to whether a patient is a candidate for the surgery. In addition, while this procedure is not felt to be a cure for arthritis, many patients can get 10 years or more of significant improved outcomes with this surgery. In effect, this is a “biologic resurfacing” procedure and it is important to recognize that not all patients can return back to full impact activities after the surgery.
Dr. LaPrade is a pioneer behind the use of fresh osteoarticular allografts to treat localized articular cartilage defects of the knee. He closely examines and consults with each individual patient and provides the best options and best grafts to maximize each patient result and outcome.
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