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Prospective Evaluation of Prolonged Fresh Osteochondral Allograft Transplantation of the Femoral Condyle

Minimum 2-Year Follow-Up

Patrick C. McCulloch, MD^*, Richard W. Kang, Mohamed H. Sobhy, MD, Jennifer K. Hayden, MS and Brian J. Cole, MD, MBA^,,||

From the ^* Department of Orthopedics, Baylor College of Medicine, Houston, Texas, Department of Anatomy & Cell Biology and Department of Orthopedics, Rush University Medical Center, Chicago, Illinois; and Cairo, Egypt

^|| Address correspondence to Brian J. Cole, MD, MBA, Section Head, Cartilage Restoration Center at Rush, Departments of Orthopedics and Anatomy & Cell Biology, Rush University Medical Center, 1725 W. Harrison St, POB Ste 1063, Chicago, IL 60612 (e-mail: bcole{at}rushortho.com).

Background: Focal articular cartilage lesions of the knee in young patients present a therapeutic challenge. Little information is available pertaining to the results after implantation of prolonged fresh grafts.

Hypothesis: Prolonged fresh osteochondral allografts present a viable option for treating large full-thickness articular cartilage lesions.

Study Design: Case series; Level of evidence, 4.

Methods: This study presents the results of 25 consecutive patients who underwent prolonged fresh osteochondral allograft transplantation for defects in the femoral condyle. The average patient age was 35 years (range, 17–49 years). The average length of follow-up was 35 months (range, 24–67 months). Prospective data were collected using several subjective scoring systems, as well as objective and radiographic assessments.

Results: Statistically significant improvements (P < .05) were seen for the Lysholm (39 to 67), International Knee Documentation Committee scores (29 to 58), all 5 components of the Knee injury and Osteoarthritis Outcome Score (Pain, 43 to 73; Other Disease-Specific Symptoms, 46 to 64; Activities of Daily Living Function, 56 to 83; Sport and Recreation Function, 18 to 46; Knee-Related Quality of Life, 22 to 50), and the Short Form-12 physical component score (36 to 40). Overall, patients reported 84% (range, 25% to 100%) satisfaction with their results and believed that the knee functioned at 79% (range, 35% to 100%) of their unaffected knee. Radiographically, 22 of the grafts (88%) were incorporated into host bone.

Conclusion: Fresh osteochondral allograft transplantation is an acceptable intermediate procedure for treatment of localized osteochondral defects of the femur. At 2-year follow-up, it is well incorporated and offered consistent improvements in pain and function.

Clinical Relevance: Prolonged fresh allograft transplantation is a safe and effective technique for addressing symptomatic osteoarticular lesions in the knees of young patients.

Key Words: osteochondral allograft • prolonged fresh • clinical outcomes • femoral condyle