Use of Fresh Osteochondral Allografts in the Patellofemoral Joint

Abstract

Fresh osteochondral allograft (OCA) transplantation has become a mainstay for the treatment of osteochondral defects in the tibiofemoral joint. With excellent outcomes and high survival times, this technology has recently become more interesting for use in the patellofemoral (PF) joint. This review article will point out the historical difficulties that the use of fresh OCA poses. With newer surgical approaches and a better understanding of the mechanical requirements of the PF joint, the use of OCA transplantation has shown increasingly better results. Illustrating the technique for the preparation and implantation of single plug allografts and bulk allografts to the trochlea and patella as well as the analysis of the available literature, we point out the current state of the art as well as potentially achievable long-term results. Finally, we will point out emerging technology seeking to further develop the use of allograft technology in patellofemoral chondral defects.

Keywords

patellofemoral surgery - cartilage - allograft

• References

• 1 Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 2002; 18 (07) 730-734
• 2 Stefanik JJ, Guermazi A, Zhu Y. , et al. Quadriceps weakness, patella alta, and structural features of patellofemoral osteoarthritis. Arthritis Care Res (Hoboken) 2011; 63 (10) 1391-1397
• 3 Gomoll AH, Gillogly SD, Cole BJ. , et al. Autologous chondrocyte implantation in the patella: a multicenter experience. Am J Sports Med 2014; 42 (05) 1074-1081
• 4 Bartlett W, Gooding CR, Carrington RW, Skinner JA, Briggs TW, Bentley G. Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft. A preliminary report. J Bone Joint Surg Br 2005; 87 (03) 330-332
• 5 Krishnan SP, Skinner JA, Bartlett W. , et al. Who is the ideal candidate for autologous chondrocyte implantation?. J Bone Joint Surg Br 2006; 88 (01) 61-64
• 6 Görtz S, Bugbee WD. Allografts in articular cartilage repair. Instr Course Lect 2007; 56: 469-480
• 7 Pagenstert G, Wolf N, Bachmann M. , et al. Open lateral patellar retinacular lengthening versus open retinacular release in lateral patellar hypercompression syndrome: a prospective double-blinded comparative study on complications and outcome. Arthroscopy 2012; 28 (06) 788-797
• 8 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
• 9 Vasiliadis HS, Lindahl A, Georgoulis AD, Peterson L. Malalignment and cartilage lesions in the patellofemoral joint treated with autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 2011; 19 (03) 452-457
• 10 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
• 11 Torga Spak R, Teitge RA. Fresh osteochondral allografts for patellofemoral arthritis: long-term followup. Clin Orthop Relat Res 2006; 444 (444) 193-200
• 12 Farr J, Covell DJ, Lattermann C. Cartilage lesions in patellofemoral dislocations: incidents/locations/when to treat. Sports Med Arthrosc Rev 2012; 20 (03) 181-186
• 13 Cameron JI, Pulido PA, McCauley JC, Bugbee WD. Osteochondral allograft transplantation of the femoral trochlea. Am J Sports Med 2016; 44 (03) 633-638
• 14 Hoffman JK, Geraghty S, Protzman NM. Articular cartilage repair using marrow stimulation augmented with a viable chondral allograft: 9-month postoperative histological evaluation. Case Rep Orthop 2015; 2015 (15) 617365
• 15 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