Osteochondral transfer -vs- Osteoarticular Allograft:
This type of transfer is also best in small defects It may be used when a microfracture may not be indicated, such as in patients who have bone cysts below a small area of a cartilage defect. In this case, replacing both of the bone and cartilage would be indicated. Larger cartilage defects are best treated by more advanced surgeries, which often involve replacing all of the cartilage surface or the bony cartilage surface. The current gold standard is a fresh osteoarticular allograft. In this procedure, the bone and cartilage units are replaced by somebody who has recently died (an allograft), and replacing the whole bone and cartilage unit. This type of surgery is considered the “gold standard” because the cartilage has an excellent chance of healing and if one follows a proper rehabilitation program with low impact activities only for the first year after implantation, there are excellent outcomes described in the literature for this procedure. It is important to recognize that one has to be matched to a donor, which means somebody has to die for one to obtain a fresh osteoarticular allograft, and that the basic principles of placement are carefully followed, such as ensuring that the depth of the bone for the fresh allograft are as little as possible, and certainly no more than 1 cm of total bone, or there is a higher risk that the bone will not heal in and ultimately the graft will fail. Other potential cartilage replacement procedures include growing one’s cartilage and re-implantation, called a autogenous cartilage implantation procedure, and using other types of allograft or autograft cartilage pieces for implantation. These surgeries certainly may be indicated in some areas, but the gold standard is still the fresh osteoarticular allograft if possible.