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

Publication History

Publication Date:
13 March 2018 (online)

   Permissions and Reprints

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.

Keywords

knee - chondral lesion - osteochondral lesion - allograft - osteochondral allograft
 

  • References

  • 1 LaPrade RF, Botker J, Herzog M, Agel J. Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles. A prospective outcomes study. J Bone Joint Surg Am 2009; 91 (04) 805-811
    CrossrefPubMedGoogle Scholar
  • 2 Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13 (04) 456-460
    CrossrefPubMedGoogle Scholar
  • 3 Arøen A, Løken S, Heir S. , et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 2004; 32 (01) 211-215
    CrossrefPubMedGoogle Scholar
  • 4 Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 2002; 18 (07) 730-734
    CrossrefPubMedGoogle Scholar
  • 5 Harris JD, Brophy RH, Siston RA, Flanigan DC. Treatment of chondral defects in the athlete's knee. Arthroscopy 2010; 26 (06) 841-852
    CrossrefPubMedGoogle Scholar
  • 6 Gudas R, Gudaite A, Pocius A. , et al. Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes. Am J Sports Med 2012; 40 (11) 2499-2508
    CrossrefPubMedGoogle Scholar
  • 7 Knutsen G, Drogset JO, Engebretsen L. , et al. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 2007; 89 (10) 2105-2112
    CrossrefPubMedGoogle Scholar
  • 8 Alford JW, Cole BJ. Cartilage restoration, part 2: techniques, outcomes, and future directions. Am J Sports Med 2005; 33 (03) 443-460
    CrossrefPubMedGoogle Scholar
  • 9 Nehrer S, Spector M, Minas T. Histologic analysis of tissue after failed cartilage repair procedures. Clin Orthop Relat Res 1999; (365) 149-162
    PubMedGoogle Scholar
  • 10 Mithoefer K, Williams III RJ, Warren RF. , et al. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 2005; 87 (09) 1911-1920
    CrossrefPubMedGoogle Scholar
  • 11 Chow JC, Hantes ME, Houle JB, Zalavras CG. Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: a 2- to 5-year follow-up study. Arthroscopy 2004; 20 (07) 681-690
    CrossrefPubMedGoogle Scholar
  • 12 Murphy RT, Pennock AT, Bugbee WD. Osteochondral allograft transplantation of the knee in the pediatric and adolescent population. Am J Sports Med 2014; 42 (03) 635-640
    CrossrefPubMedGoogle Scholar
  • 13 Raz G, Safir OA, Backstein DJ, Lee PT, Gross AE. Distal femoral fresh osteochondral allografts. Follow-up at a mean of twenty-two-years. J Bone Joint Surg Am 2014; 96 (13) 1101-1107
    CrossrefPubMedGoogle Scholar
  • 14 Agneskirchner JD, Brucker P, Burkart A, Imhoff AB. Large osteochondral defects of the femoral condyle: press-fit transplantation of the posterior femoral condyle (MEGA-OATS). Knee Surg Sports Traumatol Arthrosc 2002; 10 (03) 160-168
    CrossrefPubMedGoogle Scholar
  • 15 Minas T. Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop Relat Res 2001; ;(391, Suppl): S349-S361
    PubMedGoogle Scholar
  • 16 Biant LC, McNicholas MJ, Sprowson AP, Spalding T. The surgical management of symptomatic articular cartilage defects of the knee: Consensus statements from United Kingdom knee surgeons. Knee 2015; 22 (05) 446-449
    CrossrefPubMedGoogle Scholar
  • 17 Chui K, Jeys L, Snow M. Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts. World J Orthop 2015; 6 (03) 340-350
    CrossrefPubMedGoogle Scholar
  • 18 Capeci CM, Turchiano M, Strauss EJ, Youm T. Osteochondral allografts: applications in treating articular cartilage defects in the knee. Bull Hosp Jt Dis (2013) 2013; 71 (01) 60-67
    PubMedGoogle Scholar
  • 19 Dean CS, Chahla J, Serra Cruz R, LaPrade RF. Fresh osteochondral allograft transplantation for treatment of articular cartilage defects of the knee. Arthrosc Tech 2016; 5 (01) e157-e161
    CrossrefPubMedGoogle Scholar
  • 20 Sherman SL, Garrity J, Bauer K, Cook J, Stannard J, Bugbee W. Fresh osteochondral allograft transplantation for the knee: current concepts. J Am Acad Orthop Surg 2014; 22 (02) 121-133
    PubMedGoogle Scholar
  • 21 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) 2160-2168
    CrossrefPubMedGoogle Scholar
  • 22 Chahal J, Gross AE, Gross C. , et al. Outcomes of osteochondral allograft transplantation in the knee. Arthroscopy 2013; 29 (03) 575-588
    CrossrefPubMedGoogle Scholar
  • 23 Gross AE, Shasha N, Aubin P. Long-term followup of the use of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res 2005; (435) 79-87
    PubMedGoogle Scholar
  • 24 Williams III RJ, Ranawat AS, Potter HG, Carter T, Warren RF. Fresh stored allografts for the treatment of osteochondral defects of the knee. J Bone Joint Surg Am 2007; 89 (04) 718-726
    PubMedGoogle Scholar
  • 25 McCulloch PC, Kang RW, Sobhy MH, Hayden JK, Cole BJ. Prospective evaluation of prolonged fresh osteochondral allograft transplantation of the femoral condyle: minimum 2-year follow-up. Am J Sports Med 2007; 35 (03) 411-420
    CrossrefPubMedGoogle Scholar
  • 26 Görtz S, De Young AJ, Bugbee WD. Fresh osteochondral allografting for steroid-associated osteonecrosis of the femoral condyles. Clin Orthop Relat Res 2010; 468 (05) 1269-1278
    CrossrefPubMedGoogle Scholar
  • 27 Levy YD, Görtz S, Pulido PA, McCauley JC, Bugbee WD. Do fresh osteochondral allografts successfully treat femoral condyle lesions?. Clin Orthop Relat Res 2013; 471 (01) 231-237
    CrossrefPubMedGoogle Scholar
  • 28 De Caro F, Bisicchia S, Amendola A, Ding L. Large fresh osteochondral allografts of the knee: a systematic clinical and basic science review of the literature. Arthroscopy 2015; 31 (04) 757-765
    CrossrefPubMedGoogle Scholar
  • 29 Bugbee WD. Fresh osteochondral allografts. J Knee Surg 2002; 15 (03) 191-195
    PubMedGoogle Scholar
  • 30 Gross AE. Use of fresh osteochondral allografts to replace traumatic joint defects. In: Gross AE, Czitrom AA. , eds. Allografts in Orthopaedic Practice. Baltimore, MD: Lippincott Williams & Wilkins; 1992: 67-82
    Google Scholar
  • 31 Shasha N, Aubin PP, Cheah HK, Davis AM, Agnidis Z, Gross AE. Long-term clinical experience with fresh osteochondral allografts for articular knee defects in high demand patients. Cell Tissue Bank 2002; 3 (03) 175-182
    CrossrefPubMedGoogle Scholar
  • 32 Cole BJ, Pascual-Garrido C, Grumet RC. Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 2009; 91 (07) 1778-1790
    PubMedGoogle Scholar
  • 33 Demange M, Gomoll AH. The use of osteochondral allografts in the management of cartilage defects. Curr Rev Musculoskelet Med 2012; 5 (03) 229-235
    CrossrefPubMedGoogle Scholar
  • 34 Ghazavi MT, Pritzker KP, Davis AM, Gross AE. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br 1997; 79 (06) 1008-1013
    CrossrefPubMedGoogle Scholar
  • 35 Garrett JC. Osteochondral allografts for reconstruction of articular defects of the knee. Instr Course Lect 1998; 47: 517-522
    PubMedGoogle Scholar
  • 36 Görtz S, Bugbee WD. Fresh osteochondral allografts: graft processing and clinical applications. J Knee Surg 2006; 19 (03) 231-240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Krych AJ, Robertson CM, Williams III RJ. ; Cartilage Study Group. Return to athletic activity after osteochondral allograft transplantation in the knee. Am J Sports Med 2012; 40 (05) 1053-1059
    CrossrefPubMedGoogle Scholar
  • 38 Getgood A, Gelber J, Gortz S, De Young A, Bugbee W. Combined osteochondral allograft and meniscal allograft transplantation: a survivorship analysis. Knee Surg Sports Traumatol Arthrosc 2015; 23 (04) 946-953
    CrossrefPubMedGoogle Scholar
  • 39 Convery FR, Akeson WH, Meyers MH. The operative technique of fresh osteochondral allografting of the knee. Oper Tech Orthop 1997; 7: 340-344
    CrossrefPubMedGoogle Scholar
  • 40 Bakay A, Csönge L, Papp G, Fekete L. Osteochondral resurfacing of the knee joint with allograft. Clinical analysis of 33 cases. Int Orthop 1998; 22 (05) 277-281
    CrossrefPubMedGoogle Scholar
  • 41 Beaver RJ, Mahomed M, Backstein D, Davis A, Zukor DJ, Gross AE. Fresh osteochondral allografts for post-traumatic defects in the knee. A survivorship analysis. J Bone Joint Surg Br 1992; 74 (01) 105-110
    CrossrefPubMedGoogle Scholar
  • 42 Campbell AB, Knopp MV, Kolovich GP. , et al. Preoperative MRI underestimates articular cartilage defect size compared with findings at arthroscopic knee surgery. Am J Sports Med 2013; 41 (03) 590-595
    CrossrefPubMedGoogle Scholar
  • 43 Gomoll AH, Yoshioka H, Watanabe A, Dunn JC, Minas T. Preoperative measurement of cartilage defects by MRI underestimates lesion size. Cartilage 2011; 2 (04) 389-393
    CrossrefPubMedGoogle Scholar
  • 44 Bonasia DE, Castoldi F, Dragoni M, Amendola A. Management of the complications following fractures around the knee (malalignment and unicompartimental arthritis). In: Castoldi F, Bonasia DE. , eds. Fractures around the Knee, Fracture Management Joint by Joint. Cham, Switzerland: Springer International; 2016: 129-149
    Google Scholar
  • 45 Pallante AL, Chen AC, Ball ST. , et al. The in vivo performance of osteochondral allografts in the goat is diminished with extended storage and decreased cartilage cellularity. Am J Sports Med 2012; 40 (08) 1814-1823
    CrossrefPubMedGoogle Scholar
  • 46 Pallante AL, Görtz S, Chen AC. , et al. Treatment of articular cartilage defects in the goat with frozen versus fresh osteochondral allografts: effects on cartilage stiffness, zonal composition, and structure at six months. J Bone Joint Surg Am 2012; 94 (21) 1984-1995
    CrossrefPubMedGoogle Scholar
  • 47 Williams III RJ, Dreese JC, Chen CT. Chondrocyte survival and material properties of hypothermically stored cartilage: an evaluation of tissue used for osteochondral allograft transplantation. Am J Sports Med 2004; 32 (01) 132-139
    CrossrefPubMedGoogle Scholar
  • 48 Ball ST, Amiel D, Williams SK. , et al. The effects of storage on fresh human osteochondral allografts. Clin Orthop Relat Res 2004; (418) 246-252
    PubMedGoogle Scholar
  • 49 Gole MD, Poulsen D, Marzo JM, Ko SH, Ziv I. Chondrocyte viability in press-fit cryopreserved osteochondral allografts. J Orthop Res 2004; 22 (04) 781-787
    CrossrefPubMedGoogle Scholar
  • 50 Schachar NS, Novak K, Hurtig M. , et al. Transplantation of cryopreserved osteochondral Dowel allografts for repair of focal articular defects in an ovine model. J Orthop Res 1999; 17 (06) 909-919
    CrossrefPubMedGoogle Scholar
  • 51 Enneking WF, Campanacci DA. Retrieved human allografts: a clinicopathological study. J Bone Joint Surg Am 2001; 83-A (07) 971-986
    PubMedGoogle Scholar
  • 52 Judas F, Rosa S, Teixeira L, Lopes C, Ferreira Mendes A. Chondrocyte viability in fresh and frozen large human osteochondral allografts: effect of cryoprotective agents. Transplant Proc 2007; 39 (08) 2531-2534
    CrossrefPubMedGoogle Scholar
  • 53 Czitrom AA, Keating S, Gross AE. The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation. J Bone Joint Surg Am 1990; 72 (04) 574-581
    CrossrefPubMedGoogle Scholar
  • 54 Williams SK, Amiel D, Ball ST. , et al. Prolonged storage effects on the articular cartilage of fresh human osteochondral allografts. J Bone Joint Surg Am 2003; 85-A (11) 2111-2120
    PubMedGoogle Scholar
  • 55 Pallante AL, Bae WC, Chen AC, Görtz S, Bugbee WD, Sah RL. Chondrocyte viability is higher after prolonged storage at 37 degrees C than at 4 degrees C for osteochondral grafts. Am J Sports Med 2009; 37 (Suppl. 01) 24S-32S
    CrossrefPubMedGoogle Scholar
  • 56 Garrity JT, Stoker AM, Sims HJ, Cook JL. Improved osteochondral allograft preservation using serum-free media at body temperature. Am J Sports Med 2012; 40 (11) 2542-2548
    CrossrefPubMedGoogle Scholar
  • 57 Strauss EJ, Sershon R, Barker JU, Kercher J, Salata M, Verma NN. The basic science and clinical applications of osteochondral allografts. Bull NYU Hosp Jt Dis 2012; 70 (04) 217-223
    PubMedGoogle Scholar
  • 58 Ranawat AS, Vidal AF, Chen CT, Zelken JA, Turner AS, Williams III RJ. Material properties of fresh cold-stored allografts for osteochondral defects at 1 year. Clin Orthop Relat Res 2008; 466 (08) 1826-1836
    CrossrefPubMedGoogle Scholar
  • 59 Oakeshott RD, Farine I, Pritzker KP, Langer F, Gross AE. A clinical and histologic analysis of failed fresh osteochondral allografts. Clin Orthop Relat Res 1988; (233) 283-294
    PubMedGoogle Scholar
  • 60 Kandel RA, Gross AE, Ganel A, McDermott AG, Langer F, Pritzker KP. Histopathology of failed osteoarticular shell allografts. Clin Orthop Relat Res 1985; (197) 103-110
    PubMedGoogle Scholar
  • 61 Langer F, Gross AE. Immunogenicity of allograft articular cartilage. J Bone Joint Surg Am 1974; 56 (02) 297-304
    CrossrefPubMedGoogle Scholar
  • 62 Mandelbaum B, Gortz S, Bugbee WD. Osteochondral allograft transplantation. In: Berry DJ, Azar FM, Lieberman JR. , eds. Advanced Reconstruction Knee. Rosemont, IL: American Academy of Orthopaedic Surgeon; 2011: 503-510
    Google Scholar
  • 63 Farr J, Gomoll AH. Osteochondral allograft. In: Farr J, Gomoll AH. , eds. Cartilage Restoration. New York, NY: Springer; 2014: 1-141
    CrossrefGoogle Scholar
  • 64 Pylawka TK, Wimmer M, Cole BJ, Virdi AS, Williams JM. Impaction affects cell viability in osteochondral tissues during transplantation. J Knee Surg 2007; 20 (02) 105-110
    Article in Thieme ConnectPubMedGoogle Scholar
  • 65 Burnett RS, Berger RA, Paprosky WG, Della Valle CJ, Jacobs JJ, Rosenberg AG. Extensor mechanism allograft reconstruction after total knee arthroplasty. A comparison of two techniques. J Bone Joint Surg Am 2004; 86-A (12) 2694-2699
    PubMedGoogle Scholar
  • 66 Nazarian DG, Booth Jr RE. Extensor mechanism allografts in total knee arthroplasty. Clin Orthop Relat Res 1999; (367) 123-129
    PubMedGoogle Scholar
  • 67 Rue JP, Yanke AB, Busam ML, McNickle AG, Cole BJ. Prospective evaluation of concurrent meniscus transplantation and articular cartilage repair: minimum 2-year follow-up. Am J Sports Med 2008; 36 (09) 1770-1778
    CrossrefPubMedGoogle Scholar
  • 68 Harris JD, Hussey K, Wilson H. , et al. Biological knee reconstruction for combined malalignment, meniscal deficiency, and articular cartilage disease. Arthroscopy 2015; 31 (02) 275-282
    CrossrefPubMedGoogle Scholar
  • 69 Drexler M, Gross A, Dwyer T. , et al. Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23 (05) 1317-1323
    CrossrefPubMedGoogle Scholar
  • 70 Shasha N, Krywulak S, Backstein D, Pressman A, Gross AE. Long-term follow-up of fresh tibial osteochondral allografts for failed tibial plateau fractures. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 33-39
    PubMedGoogle Scholar
  • 71 Jamali AA, Emmerson BC, Chung C, Convery FR, Bugbee WD. Fresh osteochondral allografts: results in the patellofemoral joint. Clin Orthop Relat Res 2005; (437) 176-185
    PubMedGoogle Scholar
  • 72 Noyes FR, Barber-Westin SD, Rankin M. Meniscal transplantation in symptomatic patients less than fifty years old. J Bone Joint Surg Am 2004; 86-A (07) 1392-1404
    PubMedGoogle Scholar
  • 73 Lattermann C, Romine SE. Osteochondral allografts: state of the art. Clin Sports Med 2009; 28 (02) 285-301
    CrossrefPubMedGoogle Scholar
  • 74 Krych AJ, Pareek A, King AH, Johnson NR, Stuart MJ, Williams III RJ. Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2017; 25 (10) 3186-3196
    CrossrefPubMedGoogle Scholar
  • 75 Tírico LEP, McCauley JC, Pulido PA, Bugbee WD. Lesion size does not predict outcomes in fresh osteochondral allograft transplantation. Am J Sports Med 2018; DOI: 10.1177/0363546517746106.
    PubMedGoogle Scholar
  • 76 Giannini S, Buda R, Ruffilli A. , et al. Failures in bipolar fresh osteochondral allograft for the treatment of end-stage knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2015; 23 (07) 2081-2089
    CrossrefPubMedGoogle Scholar
  • 77 Zou S, Dodd RY, Stramer SL, Strong DM. ; Tissue Safety Study Group. Probability of viremia with HBV, HCV, HIV, and HTLV among tissue donors in the United States. N Engl J Med 2004; 351 (08) 751-759
    CrossrefPubMedGoogle Scholar
  • 78 Buck BE, Malinin TI, Brown MD. Bone transplantation and human immunodeficiency virus. An estimate of risk of acquired immunodeficiency syndrome (AIDS). Clin Orthop Relat Res 1989; (240) 129-136
    PubMedGoogle Scholar
  • 79 Tomford WW. Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 1995; 77 (11) 1742-1754
    CrossrefPubMedGoogle Scholar
  • 80 Simonds RJ, Holmberg SD, Hurwitz RL. , et al. Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med 1992; 326 (11) 726-732
    CrossrefPubMedGoogle Scholar
  • 81 Davidson PA, Rivenburgh DW, Dawson PE, Rozin R. Clinical, histologic, and radiographic outcomes of distal femoral resurfacing with hypothermically stored osteoarticular allografts. Am J Sports Med 2007; 35 (07) 1082-1090
    CrossrefPubMedGoogle Scholar
  • 82 Nielsen ES, McCauley JC, Pulido PA, Bugbee WD. Return to sport and recreational activity after osteochondral allograft transplantation in the knee. Am J Sports Med 2017; 45 (07) 1608-1614
    CrossrefPubMedGoogle Scholar
  • 83 McCarthy MA, Meyer MA, Weber AE. , et al. Can competitive athletes return to high-level play after osteochondral allograft transplantation of the knee?. Arthroscopy 2017; 33 (09) 1712-1717
    CrossrefPubMedGoogle Scholar
  • 84 Emmerson BC, Görtz S, Jamali AA, Chung C, Amiel D, Bugbee WD. Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med 2007; 35 (06) 907-914
    CrossrefPubMedGoogle Scholar
  • 85 Gracitelli GC, Tírico LE, McCauley JC, Pulido PA, Bugbee WD. Fresh osteochondral allograft transplantation for fractures of the knee. Cartilage 2017; 8 (02) 155-161
    CrossrefPubMedGoogle Scholar
  • 86 Wang D, Kalia V, Eliasberg CD. , et al. Osteochondral allograft transplantation of the knee in patients aged 40 years and older. Am J Sports Med 2017; DOI: 10.1177/0363546517741465.
    PubMedGoogle Scholar
  • 87 Frank RM, Lee S, Cotter EJ, Hannon CP, Leroux T, Cole BJ. Outcomes of osteochondral allograft transplantation with and without concomitant meniscus allograft transplantation: a comparative matched group analysis. Am J Sports Med 2018; DOI: 10.1177/0363546517744202.
    PubMedGoogle Scholar
  • 88 Colangeli M, Donati D, Benedetti MG. , et al. Total knee replacement versus osteochondral allograft in proximal tibia bone tumours. Int Orthop 2007; 31 (06) 823-829
    CrossrefPubMedGoogle Scholar
  • 89 Muscolo DL, Ayerza MA, Farfalli G, Aponte-Tinao LA. Proximal tibia osteoarticular allografts in tumor limb salvage surgery. Clin Orthop Relat Res 2010; 468 (05) 1396-1404
    CrossrefPubMedGoogle Scholar
  • 90 Hornicek Jr FJ, Mnaymneh W, Lackman RD, Exner GU, Malinin TI. Limb salvage with osteoarticular allografts after resection of proximal tibia bone tumors. Clin Orthop Relat Res 1998; (352) 179-186
    PubMedGoogle Scholar
  • 91 Shi X, Wu S, Zhao J. Limb salvage with osteoarticular allografts after resection of proximal tibia bone [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2006; 20 (10) 966-969
    PubMedGoogle Scholar
  • 92 Imanishi J, Grinsell D, Choong PF. Bone-patellar tendon-bone allograft reconstruction for peri-patellar tendon sarcomas: case series. Springerplus 2015; 4: 740
    CrossrefPubMedGoogle Scholar
  • 93 Drexler M, Blumberg N, Haim A, Arbel R, Morag G. Extensor mechanism reconstruction: a novel technique for bone patella allograft post partial patellectomy failure. J Knee Surg 2011; 24 (02) 129-135
    Article in Thieme ConnectPubMedGoogle Scholar
  • 94 Rosenberg AG. Management of extensor mechanism rupture after TKA. J Bone Joint Surg Br 2012; 94 (11, Suppl A): 116-119
    CrossrefPubMedGoogle Scholar
  • 95 Malhotra R, Garg B, Logani V, Bhan S. Management of extensor mechanism deficit as a consequence of patellar tendon loss in total knee arthroplasty: a new surgical technique. J Arthroplasty 2008; 23 (08) 1146-1151
    CrossrefPubMedGoogle Scholar
  • 96 Springer BD, Della Valle CJ. Extensor mechanism allograft reconstruction after total knee arthroplasty. J Arthroplasty 2008; 23 (7, Suppl): 35-38
    CrossrefPubMedGoogle Scholar
  • 97 Torga Spak R, Teitge RA. Fresh osteochondral allografts for patellofemoral arthritis: long-term followup. Clin Orthop Relat Res 2006; 444 (444) 193-200
    PubMedGoogle Scholar
  • 98 Lattermann C, Kremser V, Altintas B. Use of fresh osteochondral allografts in the patellofemoral joint. J Knee Surg 2017; DOI: 10.1055/s-0037-1607324.
    PubMedGoogle Scholar
  • 99 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 (04) 879-884
    CrossrefPubMedGoogle Scholar
  • 100 Farr J, Gracitelli GC, Shah N, Chang EY, Gomoll AH. High failure rate of a decellularized osteochondral allograft for the treatment of cartilage lesions. Am J Sports Med 2016; 44 (08) 2015-2022
    CrossrefPubMedGoogle Scholar