Skip to main content
SpringerLink
Log in

Fresh Osteochondral Allografts for Posttraumatic Knee Defects: Long-term Followup

  • Symposium: New Approaches to Allograft Transplantation
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Fresh osteochondral allograft transplantation has been an effective treatment option with promising long-term clinical outcomes for focal posttraumatic defects in the knee for young, active individuals. We examined histologic features of 35 fresh osteochondral allograft specimens retrieved at the time of subsequent graft revision, osteotomy, or TKA. Graft survival time ranged from 1 to 25 years based on their time to reoperation. Histologic features of early graft failures were lack of chondrocyte viability and loss of matrix cationic staining. Histologic features of late graft failures were fracture through the graft, active and incomplete remodeling of the graft bone by the host bone, and resorption of the graft tissue by synovial inflammatory activity at graft edges. Histologic features associated with long-term allograft survival included viable chondrocytes, functional preservation of matrix, and complete replacement of the graft bone with the host bone. Given chondrocyte viability, long-term allograft survival depends on graft stability by rigid fixation of host bone to graft bone. With the stable osseous graft base, the hyaline cartilage portion of the allograft can survive and function for 25 years or more.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–C
Fig. 2A–E

Similar content being viewed by others

References

  1. Aubin PP, Cheah HK, Davis AM, Gross AE. Long-term follow-up of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res. 2001;391:318–327.

    Article  Google Scholar 

  2. Bakay A, Csonge L, Papp G, Fekete L. Osteochondral resurfacing of the knee joint with allograft: clinical analysis of 33 cases. Int Orthop. 1998;22:277–281.

    Article  PubMed  CAS  Google Scholar 

  3. 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;87:330–332.

    Article  PubMed  CAS  Google Scholar 

  4. Bayne O, Langer F, Pritzker KP, Houpt J, Gross AE. Osteochondral allografts in the treatment of osteonecrosis of the knee. Orthop Clin North Am. 1985;16:727–740.

    PubMed  CAS  Google Scholar 

  5. 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;74:105–110.

    PubMed  CAS  Google Scholar 

  6. Blevins FT, Steadman JR, Rodrigo JJ, Silliman J. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics. 1998;21:761–768.

    PubMed  CAS  Google Scholar 

  7. Bobic V, Carter T. Osteochondral autologous graft transfer. Oper Tech Sports Med. 2000;8:168–178.

    Article  Google Scholar 

  8. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331:889–895.

    Article  PubMed  CAS  Google Scholar 

  9. Brittberg M, Peterson L, Sjogren-Jansson E, Tallheden T, Lindahl A. Articular cartilage engineering with autologous chondrocyte transplantation: a review of recent developments. J Bone Joint Surg Am. 2003;85(Suppl 3):109–115.

    PubMed  Google Scholar 

  10. 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.

    PubMed  Google Scholar 

  11. Buckwalter JA, Lohmander S. Operative treatment of osteoarthrosis: current practice and future development. J Bone Joint Surg Am. 1994;76:1405–1418.

    PubMed  CAS  Google Scholar 

  12. Buckwalter JA, Mankin HJ. Articular cartilage repair and transplantation. Arthritis Rheum. 1998;41:1331–1342.

    Article  PubMed  CAS  Google Scholar 

  13. Bugbee WD, Convery FR. Osteochondral allograft transplantation. Clin Sports Med. 1999;18:67–75.

    Article  PubMed  CAS  Google Scholar 

  14. Campbell CJ, Ishida H, Takahashi H, Kelly F. The transplantation of articular cartilage: an experimental study in dogs. J Bone Joint Surg Am. 1963;45:1579–1592.

    PubMed  CAS  Google Scholar 

  15. Chu CR, Convery FR, Akeson WH, Meyers M, Amiel D. Articular cartilage transplantation: clinical results in the knee. Clin Orthop Relat Res. 1999;360:159–168.

    Article  PubMed  Google Scholar 

  16. Convery FR, Meyers MH, Akeson WH. Fresh osteochondral allografting of the femoral condyle. Clin Orthop Relat Res. 1991;273:139–145.

    PubMed  Google Scholar 

  17. Czitrom AA, Keating S, Gross AE. The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation. J Bone Joint Surg Am. 1990;72:574–581.

    PubMed  CAS  Google Scholar 

  18. Enneking WF, Mindell ER. Observations on massive retrieved human allografts. J Bone Joint Surg Am. 1991;73:1123–1142.

    PubMed  CAS  Google Scholar 

  19. Fitzpatrick PL, Morgan DA. Fresh osteochondral allografts: a 6–10-year review. Aust N Z J Surg. 1998;68:573–579.

    Article  PubMed  CAS  Google Scholar 

  20. Flynn JM, Springfield DS, Mankin HJ. Osteoarticular allografts to treat distal femoral osteonecrosis. Clin Orthop Relat Res. 1994;303:38–43.

    PubMed  Google Scholar 

  21. Garrett JC. Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults. Clin Orthop Relat Res. 1994;303:33–37.

    PubMed  Google Scholar 

  22. 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;79:1008–1013.

    Article  PubMed  CAS  Google Scholar 

  23. Gooding CR, Bartlett W, Bentley G, Skinner JA, Carrington R, Flanagan A. A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: periosteum covered versus type I/III collagen covered. Knee. 2006;13:203–210.

    Article  PubMed  CAS  Google Scholar 

  24. Gross AE, McKee NH, Pritzker KP, Langer F. Reconstruction of skeletal deficits at the knee: a comprehensive osteochondral transplant program. Clin Orthop Relat Res. 1983;174:96–106.

    PubMed  Google Scholar 

  25. Gross AE, Shasha N, Aubin P. Long-term follow-up of the use of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res. 2005;435:79–87.

    Article  PubMed  Google Scholar 

  26. Gross AE, Silverstein EA, Falk J, Falk R, Langer F. The allotransplantation of partial joints in the treatment of osteoarthritis of the knee. Clin Orthop Relat Res. 1975;108:7–14.

    Article  PubMed  Google Scholar 

  27. Hangody LK, Karpati Z. Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. Knee Surg Sports Traumatol Arthrosc. 1997;4:262–269.

    Article  Google Scholar 

  28. Insall JN, Joseph DM, Msika C. High tibial osteotomy for varus gonarthrosis: a long-term follow-up study. J Bone Joint Surg Am. 1984;66:1040–1048.

    PubMed  CAS  Google Scholar 

  29. Jacobs NJ. Establishing a surgical bone bank. In Fawcett K, Barr HR, eds. Tissue Banking. Arlington VA: American Association of Blood Banks; 1987;67–96.

    Google Scholar 

  30. 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.

    PubMed  Google Scholar 

  31. Langer F, Czitrom A, Pritzker KP, Gross AE. The immunogenicity of fresh and frozen allogeneic bone. J Bone Joint Surg Am. 1975;57:216–220.

    PubMed  CAS  Google Scholar 

  32. Langer F, Gross AE. Immunogenicity of allograft articular cartilage. J Bone Joint Surg Am. 1974;56:297–304.

    PubMed  CAS  Google Scholar 

  33. Langer F, Gross AE, Greaves MF. The auto-immunogenicity of articular cortical. Clin Exp Immunol. 1974:12:31–37.

    Google Scholar 

  34. Langer F, Gross AE, West M, Urovitz EP. The immunogenicity of allograft knee joint transplants. Clin Orthop Relat Res. 1978;132:155–162.

    PubMed  Google Scholar 

  35. Locht RC, Gross AE, Langer F. Late osteochondral allograft resurfacing for tibial plateau fractures. J Bone Joint Surg Am. 1984;66:328–335.

    PubMed  CAS  Google Scholar 

  36. Mandelbaum BR, Browne JE, Fu F, Micheli L, Mosely JB Jr, Erggelet C, Minas T, Peterson L. Articular cartilage lesions of the knee. Am J Sports Med. 1998;26:853–861.

    PubMed  CAS  Google Scholar 

  37. Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H. Proximal tibial osteotomy: factors that influence the duration of satisfactory function. Clin Orthop Relat Res. 1988;229:193–200.

    PubMed  Google Scholar 

  38. Maury AC, Safir O, Las Heras F, Pritzker KP, Gross AE. Twenty-five year chondrocyte viability in fresh osteochondral allograft. J Bone Joint Surg Am. 2007;89:159–165.

    Article  PubMed  CAS  Google Scholar 

  39. McDermott AG, Langer F, Pritzker KP, Gross AE. Fresh small-fragment osteochondral allografts: long-term follow-up study on first 100 cases. Clin Orthop Relat Res. 1985;197:96–102.

    PubMed  Google Scholar 

  40. McGoveran BM, Pritzker KP, Shasha N, Price J, Gross AE. Long term chondrocyte viability in a fresh osteochondral allograft. Am J Knee Surg. 2002;15:97–100.

    Google Scholar 

  41. Meyers MH, Akeson W, Convery FR. Resurfacing of the knee with fresh osteochondral allograft. J Bone Joint Surg Am. 1989;71:704–713.

    PubMed  CAS  Google Scholar 

  42. Minas T. Clinical methods of cartilage repair: autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop Relat Res. 2001;391(Suppl):S349–S361.

    Article  PubMed  Google Scholar 

  43. Minas TP. Autologous chondrocyte transplantation. Oper Tech Sports Med. 2000;8:144–157.

    Article  Google Scholar 

  44. Moran ME, Kim HK, Salter RB. Biological resurfacing of full-thickness defects in patellar articular cartilage of the rabbit: investigation of autogenous periosteal grafts subjected to continuous passive motion. J Bone Joint Surg Br. 1992;74:659–667.

    PubMed  CAS  Google Scholar 

  45. Newman AP. Articular cartilage repair. Am J Sports Med. 1998;26:309–324.

    PubMed  CAS  Google Scholar 

  46. 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.

    PubMed  Google Scholar 

  47. O’Driscoll SW. The healing and regeneration of articular cartilage. J Bone Joint Surg Am. 1998;80:1795–1812.

    PubMed  CAS  Google Scholar 

  48. O’Driscoll SW, Salter RB. The induction of neochondrogenesis in free intra-articular periosteal autografts under the influence of continuous passive motion: an experimental investigation in the rabbit. J Bone Joint Surg Am. 1984;66:1248–1257.

    PubMed  CAS  Google Scholar 

  49. Parrish FF. Allograft replacement of all or part of the end of a long bone following excision of a tumor. J Bone Joint Surg Am. 1973;55:1–22.

    PubMed  CAS  Google Scholar 

  50. Pritzker KP, Gross AE, Langer F, Luk SC, Houpt JB. Articular cartilage transplantation. Hum Pathol. 1977; 8:635–51.

    Article  PubMed  CAS  Google Scholar 

  51. Rodrigo J, Thompson E., Travis C. 4 degree C preservation of avascular osteocartilaginous shell allografts in rats. Trans Orthop Res Soc. 1980;5:72.

    Google Scholar 

  52. Salai M, Ganel A, Horoszowski H. Fresh osteochondral allografts at the knee joint: good functional results in a follow-up study of more than 15 years. Arch Orthop Trauma Surg. 1997;116:423–425.

    PubMed  CAS  Google Scholar 

  53. Schachar N, McAllister D, Stevenson M, Novak K, McGann L. Metabolic and biochemical status of articular cartilage following cryopreservation and transplantation: a rabbit model. J Orthop Res. 1992;10:603–609.

    Article  PubMed  CAS  Google Scholar 

  54. Schachar NS, McGann LE. Investigations of low-temperature storage of articular cartilage for transplantation. Clin Orthop Relat Res. 1986;208:146–150.

    PubMed  Google Scholar 

  55. Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ. The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study. N Engl J Med. 1996;334:1685–1690.

    Article  PubMed  CAS  Google Scholar 

  56. 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(Suppl 2):33–39.

    PubMed  Google Scholar 

  57. Steadman JR, Rodkey WG, Singelton SB, Briggs KK. Microfracture technique for full-thickness chondral defects: technique and clinical results. Oper Tech Orthop. 1997;7:300–305.

    Article  Google Scholar 

  58. Stevenson S, Dannucci GA, Sharkey NA, Pool RR. The fate of articular cartilage after transplantation of fresh and cryopreserved tissue-antigen-matched and mismatched osteochondral allografts in dogs. J Bone Joint Surg Am. 1989;71:1297–1307.

    PubMed  CAS  Google Scholar 

  59. Tallheden T, Bengtsson C, Brantsing C, Sjogren-Jansson E, Carlsson L, Peterson L, Brittberg M, Lindahl A. Proliferation and differentiation potential of chondrocytes from osteoarthritic patients. Arthritis Res Ther. 2005;7:R560–R568.

    Article  PubMed  CAS  Google Scholar 

  60. Tomford WW, Duff GP, Mankin HJ. Experimental freeze-preservation of chondrocytes. Clin Orthop Relat Res. 1985;97:11–14.

    Google Scholar 

  61. Ulutas K, Menderes A, Karaca C, Ozkal S. Repair of cartilage defects with periosteal grafts. Br J Plast Surg. 2005;58:65–72.

    Article  PubMed  Google Scholar 

  62. Volkov M. Allotransplantation of joints. J Bone Joint Surg Br. 1970;52:49–53.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Mount Sinai Hospital, Pathology and Laboratory Medicine, Suite 476A, 600 University Ave., Toronto, ON, Canada, M5G 1X5

    A. E. Gross MD, FRCSC, O.Ont, W. Kim MD, F. Las Heras MD, D. Backstein D, MD, MEd, FRCSC, O. Safir MD, FRCSC & K. P. H. Pritzker MD, FRCPC

Authors
  1. A. E. Gross MD, FRCSC, O.Ont
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Las Heras MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Backstein D, MD, MEd, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. O. Safir MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. P. H. Pritzker MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. E. Gross MD, FRCSC, O.Ont.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

About this article

Cite this article

Gross, A.E., Kim, W., Las Heras, F. et al. Fresh Osteochondral Allografts for Posttraumatic Knee Defects: Long-term Followup. Clin Orthop Relat Res 466, 1863–1870 (2008). https://doi.org/10.1007/s11999-008-0282-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-008-0282-8

Keywords

Search

Navigation