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

• Published in: Archives of orthopaedic and trauma surgery Vol. 144; no. 8; pp. 3479 - 3489
• Main Authors: Soubih, Hesham Ossama, Al-Saed, Ahmed M., Ghazaly, Sherif A. El, Sobhy, Mohamed H., Kamel, Muhammad Elsayed, Ebied, Wessam Fakhry, Haroun, Haitham K.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2024; Springer Nature B.V
• Subjects: Adolescent; Adult; Allografts; Arthroscopy and Sports Medicine; Bone Transplantation - methods; Cartilage; Cartilage, Articular - surgery; Female; Femur Head - surgery; Femur Head - transplantation; Humans; Knee Joint - diagnostic imaging; Knee Joint - surgery; Living Donors; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Prospective Studies; Transplantation, Homologous - methods; Treatment Outcome; Young Adult; Femoral heads; Living donors; Osteochondral allografts
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-024-05413-3

Background
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.
Hypothesis
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.
Study Design
Prospective case series.
Methods
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).
Results
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.
Conclusion
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.
Key message
What is known about the subject
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.
What this study adds to existing knowledge
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.