Fresh osteochondral allograft transplantation for knee full-thickness articular cartilage lesions using femoral head of living donors: short-term results

TL;DR

This study shows that using femoral heads from living donors can successfully treat knee cartilage defects with fresh osteochondral allografts, improving patient outcomes.

Contribution

The study introduces the femoral head of living donors as a novel and viable source for fresh osteochondral allografts in knee cartilage repair.

Findings

Patients showed statistically significant improvement in Lysholm and IKDC scores at 6 and 12 months post-surgery.

MRI scans showed a mean OCAMRISS score of 3.4, indicating good graft integration.

Second-look arthroscopy confirmed intact cartilage in most patients.

Abstract

Fresh osteochondral allograft transplantation is a good treatment option of cartilage defects. However, this treatment option is not available in all countries due to limited graft availability and tissue banks limitations. The purpose of this study is to assess the short term functional and imaging outcomes of fresh osteochondral allograft transplantation in the knee using the femoral head of living donors.

Fresh osteochondral allografts from the femoral heads of living donors is a valid graft source for management of distal Femur cartilage defects. This technique can improve functional knee scores with good radiological outcomes.

Prospective case series.

Fifteen patients with full thickness cartilage defects of the distal femur underwent osteochondral allograft transplantation from the femoral heads of living donors. Grafts were transplanted by both shell and multiple dowels techniques. The average follow up duration was 18.3 months (range, 12–25 months). Patients were evaluated by Lysholm and International Knee Documentation Committee (IKDC) scores, radiography and MR imaging using Osteochondral Allograft MRI Scoring System (OCAMRISS).

There was a statistically significant improvement (P < 0.001) in both Lysholm and IKDC average scores at 6 months and 12 months postoperative. Postoperative MRI was done at an average 6.8 months (range, 5–11 months) postoperative. The mean total OCAMRISS score was 3.4 (range, 1–7). A second look arthroscopy was done in four patients and showed intact articular cartilage in all three patients.

Femoral head of living donors is a valid new source for fresh osteochondral allograft transplantation of knee osteochondral lesions. Short term results showed improvement in clinical assessment scores. Follow up imaging showed graft incorporation and good MRI scores.

Fresh osteochondral allograft transplantation is a successful treatment option for full thickness cartilage lesions in the knee. Osteochondral allografts are harvested from the knee of young deceased donors. There are limitations regarding the graft availability and postmortem tissue banks.

In our study, we used fresh osteochondral allografts from the femoral heads of living donors. The donor population is the non-arthritic patients who undergo hip replacement for traumatic neck femur fractures. This will provide a new source for fresh osteochondral allografts in countries who lack postmortem tissue banks. Even with available tissue banks, this provides an additional stable source of grafts which may expand the indications for osteochondral allografts and facilitate preoperative scheduling. To our knowledge, this is the first clinical study that used the femoral head of living donors as a source of fresh osteochondral allografts in the knee.

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