Resources / Publications
Nabeel Salka (1), John A. Grant (2)
Orthopaedic Journal of Sports Medicine, 8, Issue 1, January 2020. DOI: 10.1177/2325967119898413
osteochondral allograft transplant, osteochondritis dissecans, knee articular cartilage, allografts
Background : Osteochondral allograft transplantation is an effective technique for repairing large lesions of the medial femoral condyle (MFC), but its use is limited by graft availability. Purpose/Hypothesis : The present study aimed to determine whether contralateral lateral femoral condyle (LFC) allografts can provide an acceptable surface match for posterolateral MFC lesions characteristic of classic osteochondritis dissecans (OCD). The hypothesis was that LFC and MFC allografts will provide similar surface contour matches in all 4 quadrants of the graft for posterolateral MFC lesions characteristic of OCD. Methods : Ten fresh-frozen recipient human MFCs were each size-matched to 1 ipsilateral medial and 1 contralateral LFC donor (N = 30 condyles). After a nano–computed tomography (nano-CT) scan of the native recipient condyle, a 20-mm circular osteochondral “defect” was created 1 cm posterior and 1 cm medial to the roof of the intercondylar notch (n = 10). A size-matched, random-order donor MFC or LFC plug was then harvested, transplanted, and scanned with nano-CT. Nano-CT scans were then reconstructed, registered to the initial scan of the recipient MFC, and processed in MATLAB to determine the height deviation (d RMS) between the native and donor surfaces and percentage area unacceptably (>1 mm) proud (%A proud) and sunken (%A sunk). Circumferential step-off height (h RMS) and percentage circumference unacceptably (>1 mm) proud (%C proud) and sunken (%C sunk) were measured using DragonFly software. The process was then repeated for the other allograft plug. Results : Both MFC and LFC plugs showed acceptable step-off heights in all 4 quadrants (range, 0.53-0.94 mm). Neither allograft type nor location within the defect had a significant effect on step-off height (h RMS), surface deviation (d RMS), %A proud, or %A sunk. In general, plugs were more unacceptably sunken than proud (MFC, 13.4% vs 2.4%; LFC, 13.2% vs 8.1%), although no significant differences in %C sunk were seen between allograft types or locations within the defect. In LFC plugs, %C proud in the lateral quadrant (28.0% ± 26.1%) was significantly greater compared with all other quadrants (P = .0002). Conclusion : The present study demonstrates that 20-mm contralateral LFC allografts provide an acceptable surface match for posterolateral MFC lesions characteristic of OCD. Clinical Relevance : With comparable surface matching, MFC and LFC allografts can be expected to present similar stresses on the knee joint and achieve predictably positive clinical outcomes, thus improving donor availability and reducing surgical wait times for matches.
Dragonfly was used to crop images of the native and transplanted condylese to isolate the location of the osteochondral defect/plug.
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