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Osteochondral Allograft Transplantation for Treatment of Medial Femoral Condyle Defect.

ABSTRACT: Chondral lesions of the knee can affect the young, active population, thereby causing severe morbidity and a large economic burden. Although numerous approaches have been described in the literature, restoration of hyaline cartilage has yet to be shown. Specifically, larger, full-thickness cartilage defects remain a challenge. This Technical Note details our technique for biologic unicompartmental osteochondral allograft transplantation for the treatment of large femoral condyle articular cartilage defects.

SUBMITTER: Godin JA

PROVIDER: S-EPMC5621986 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Osteochondral Allograft Transplantation for Treatment of Medial Femoral Condyle Defect.

Godin Jonathan A JA Sanchez George G Cinque Mark E ME Chahla Jorge J Kennedy Nicholas I NI Provencher Matthew T MT

Arthroscopy techniques 20170807 4

Chondral lesions of the knee can affect the young, active population, thereby causing severe morbidity and a large economic burden. Although numerous approaches have been described in the literature, restoration of hyaline cartilage has yet to be shown. Specifically, larger, full-thickness cartilage defects remain a challenge. This Technical Note details our technique for biologic unicompartmental osteochondral allograft transplantation for the treatment of large femoral condyle articular cartil ...[more]

PMID: 29354423

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Fresh Osteochondral Allograft Transplantation for Uncontained, Elongated Osteochondritis Dissecans Lesions of the Medial Femoral Condyle.

Project description:Osteochondritis dissecans (OCD) lesions of the knee are a significant source of pain and disability. Although the pathologic process for this condition remains poorly understood, histologic studies suggest vascular insufficiency of the subchondral bone may be the underlying cause for focal necrosis and subsequent compromise of the overlying articular cartilage. These lesions most commonly affect the medial femoral condyle and can be found along the margins of the intercondylar notch. Because of significant bone involvement, osteochondral allograft (OCA) transplantation has emerged as a dominant treatment option for OCD lesions because it can accurately restore the entire osteochondral unit. Given the characteristic location and large, irregular shapes of these lesions, surgical management can be challenging. These lesions are often uncontained along the periphery of the condyle, which can compromise OCA graft fixation and healing. We describe our preferred technique for the treatment of large, uncontained OCD lesions of the medial femoral condyle using a unicompartmental OCA augmented with screw fixation.

| S-EPMC6470404 | biostudies-literature

Osteochondral Allograft Transplantation of the Medial Femoral Condyle With Orthobiologic Augmentation and Graft-Recipient Microfracture Preparation.

Project description:Osteochondritis dissecans (OCD) has been recognized for over 100 years yet still poses treatment challenges owing to both the avascular nature of articular cartilage and the inability to generate hyaline cartilage. The knee is most commonly involved, and without repair, patients have chronic knee pain, loose bodies, and early-onset osteoarthritis. There are a number of surgical techniques for repairing OCD, some of which are still being refined. Currently, common procedures used to treat OCD lesions include microfracture, autologous chondrocyte implantation, osteochondral autograft transplantation, and osteochondral allograft transplantation. In this Technical Note, we describe osteochondral allograft transplantation with the addition of platelet-rich plasma and graft-recipient microfracture. We believe the micropores augment the osteoconductive and osteoinductive properties of the allograft and aid in the incorporation of the allograft plug by improving angiogenesis, enhancing clot formation in the allograft, and providing a homogeneous environment for remodeling.

| S-EPMC6475622 | biostudies-literature

Revision Lateral Femoral Condyle Osteochondral Allograft Transplantation With the Snowman Technique After Failed Previous Oblong Osteochondral Allograft.

Project description:Osteochondral allograft transplantation provides components of both cartilage and subchondral bone and can be used in large and multifocal defects where autologous procedures are limited by donor-site morbidity. Osteochondral allograft transplantation is particularly appealing in the management of failed cartilage repair, as larger defects and subchondral bone involvement are often present, and the use of multiple overlapping plugs might be considered. The described technique provides our preoperative workup and reproducible surgical approach for patients who have undergone previous osteochondral transplantation with graft failure and are young, active patients who would not be otherwise suited for a knee arthroplasty procedure.

| S-EPMC10066260 | biostudies-literature

Maturation of the equine medial femoral condyle osteochondral unit

Project description:Summary Objective The juvenile equine medial femoral condyle (MFC) is frequently affected with radiographic changes (sclerosis and subchondral lucencies) that arise at a similar site to juvenile osteochondritis dissecans (JOCD) in children. There is little information on maturation of the MFC. To describe the normal development of the equine MFC osteochondral unit from birth to 2 years. Methods Micro CT, histology and immunohistochemistry were performed on healthy equine MFCs (n = 29) at sites where lesions occur. Parameters assessed included: cartilage thickness; the epiphyseal growth plate cartilage organization; the osteochondral junction and progression of endochondral ossification. Results From 0 to 6 months, chondrocytes near the articular surface are small and flat and have a characteristic hypertrophic appearance near the osteochondral junction but are not arranged in columns like physeal growth plates. The osteochondral junction is also crossed by cartilage canals containing vessels giving a porous appearance on 3D μCT images. At 7 months of age, a subchondral bone plate compact structure emerged histologically coincident with the end of endochondral ossification (absence of type X collagen immunostain and chondrocyte hypertrophy). Conclusion New information is provided on MFC osteochondral unit maturation that will improve our understanding of the development of juvenile equine orthopaedic disease. Equine MFC endochondral ossification is complete at 6 months of age. The immature osteochondral junction may be structurally fragile because of its microarchitecture and susceptible to focal traumatic events that induce developmental lesions.

| S-EPMC9718262 | biostudies-literature

Osteochondral Allograft Transplantation Of Posterior Femoral Condyle Lesions Utilizing An Open Posterior Approach To The Knee.

Project description:Osteochondral allograft transplantation is a viable option for large chondral defects >2 cm squared, as well as in a revision setting after failure of a previous surface chondral restoration procedure. Osteochondral lesions involving the posterior aspect of the femoral condyle, however, are less common and easily underappreciated. Treatment of posterior osteochondral lesions is more technically demanding because they cannot be adequately addressed through standard arthroscopic approaches or an anterior arthrotomy. The challenges of the posterior approach include the relative unfamiliarity for many surgeons and the inherent risks due to the proximity of the neurovascular structures. The following technique reviews relevant anatomy and approach to osteochondral allograft transplant involving the posterior femoral condyles.

| S-EPMC9437611 | biostudies-literature

Treatment of Malalignment and Cartilage Injury: High Tibial Osteotomy With a Concomitant Osteochondral Allograft to the Medial Femoral Condyle and Lateral and Medial Partial Meniscectomy.

Project description:In patients with full-thickness focal cartilage defects, osteochondral allograft is a technique for restoration of hyaline cartilage; however, in patients with genu varum, the diseased compartment of the knee is generally offloaded as well. A high tibial osteotomy presents a biomechanical solution to malalignment of the knee and offloading of the diseased compartment of the knee. The purpose of this Technical Note is to present our preferred technique to treat focal cartilage damage in a varus misaligned knee coupling a high tibial osteotomy with an osteochondral allograft to the medial femoral condyle, along with partial medial and lateral meniscectomy.

| S-EPMC9051978 | biostudies-literature

Osteochondral Allograft Transplantation of the Lateral Femoral Condyle and Distal Femoral Osteotomy in the Setting of Failed Osteochondritis Dissecans Fixation.

Project description:Osteochondritis dissecans (OCD) is a pathologic condition, most commonly affecting the knee joint in adolescents and young adults, although pathology can also be found at the elbow and ankle. Lesions to the medial femoral condyle are classically associated with varus alignment, while lesions to the lateral femoral condyle are seen in patients with valgus malalignment. Common risk factors for failed fixation of OCD lesions include unstable lesions to the lateral femoral condyle, screw breakage, older age, and closed physes. The purpose of this technical note is to describe the preoperative planning and step-by-step surgical approach for treatment of failed fixation of an OCD lesion of the posterior aspect of the lateral femoral condyle in young, active patients using an osteochondral allograft, a lateral opening wedge distal femoral osteotomy to correct malalignment, and a tibial tubercle osteotomy to facilitate access to the lesion.

| S-EPMC9353333 | biostudies-literature

Posterior Approach for the Treatment of an Osteochondral Defect on the Posterior Lateral Femoral Condyle.

Project description:Osteochondral defects of the knee often occur as a result of traumatic injury, repetitive microtrauma, or genetic predisposition. Smaller lesions can be treated nonoperatively in younger patient populations; however, large symptomatic lesions require surgical intervention using a fresh osteochondral allograft transplant. Although osteochondral defects classically appear on the lateral aspect of the medial femoral condyle, there have been cases in which the lesion is located on the posterior aspect of the lateral femoral condyle. To access these posteriorly located lesions, the surgeon must utilize a complex posterior approach in order to successfully manage these lesions. While care must be taken to protect the neurovascular bundle in this area, this technique allows for excellent exposure and optimal graft placement.

| S-EPMC8897601 | biostudies-literature

Suture bridge fixation of a femoral condyle traumatic osteochondral defect.

Project description:Internal fixation of a traumatic osteochondral defect presents a challenge in terms of obtaining anatomic reduction, fixation, and adequate compression for healing. Fixation with countersunk intraarticular screws, Herbert screws, bioabsorbable screws and pins, mini-cancellous screws, and glue tissue adhesive have been reported with varying results. We present an alternative fixation method used in two patients for femoral condylar defects that achieved anatomic reduction with compression via a cruciate-shaped suture bridge construct tied down over a bony bridge. This fixation method allowed early passive range of motion and permitted high-quality MRI for followup of fracture healing and articular cartilage integrity. Arthroscopic examination of one of two patients at 6 months followup showed the gross appearance of a healed, anatomically reduced fracture. With 1 year followup for one patient and 2 years for the other, the patients have resumed activity as tolerated with full, painless range of motion at the knee. Longer-term outcomes are unknown. However, the suture bridge is an alternative means of fixation with encouraging early results for treatment of traumatic osteochondral fragments in the knee.Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

| S-EPMC2493009 | biostudies-other

Arthroscopic Treatment of Medial Femoral Knee Osteochondral Defect Using Subchondroplasty and Chitosan-Based Scaffold.

Project description:Osteochondral defects of the knee are highly common, cause significant pain, and reduce function. Standard articular cartilage repair treatments include microfracture alone or in conjunction with subchondroplasty or CarGel (chitosan-based scaffold) application (Piramal Life Sciences). Combining such cartilage regenerative techniques with microfracture yields better long-term outcomes than microfracture alone. The purpose of this Technical Note was to describe the surgical technique of applying CarGel after subchondroplasty and microfracture to repair a medial femoral knee osteochondral defect.

| S-EPMC6510704 | biostudies-literature

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