CC-BY-NC-ND 4.0 · Joints 2018; 06(01): 042-053
DOI: 10.1055/s-0038-1636925
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Large Osteochondral Allografts of the Knee: Surgical Technique and Indications

Gabriele Pisanu
Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
,
Umberto Cottino
Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
,
Federica Rosso
Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
,
Davide Blonna
Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
,
Antonio Giulio Marmotti
Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
,
Corrado Bertolo
Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
,
Roberto Rossi
Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
,
Davide E. Bonasia
Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
13 March 2018 (eFirst)

Abstract

Large osteochondral allograft (OCA) transplant has become a valid alternative to restore articular surface in challenging articular lesions in young and active patients, either in primary or in revision procedures. Several studies support the effectiveness and safety of OCA, but costs and graft availability limit their use. The indications are the treatment of symptomatic full-thickness cartilage lesions greater than 3 cm2, deep lesions with subchondral damage, or revision procedures when a previous treatment has failed. The goal of the transplant is to restore the articular surface with a biological implant, allow return to daily/sports activities, relieve symptoms, and delay knee arthroplasty. Grafts can be fresh, fresh-frozen, or cryopreserved; these different storage procedures significantly affect cell viability, immunogenicity, and duration of the storage. Dowel and shell technique are the two most commonly used procedures for OCA transplantation. While most cartilage lesions can be treated with the dowel technique, large and/or geometrically irregular lesions should be treated with the shell technique. OCA transplantation for the knee has demonstrated reliable mid- to long-term results in terms of graft survival and patient satisfaction. Best results are reported: in unipolar lesions, in patients younger than 30 years, in traumatic lesions and when the treatment is performed within 12 months from the onset of symptoms.