Abstract
Knee patients who have sustained chondral and osteochondral lesions suffer from debilitating
pain, which can ultimately lead to posttraumatic osteoarthritis and whole-joint disease.
Older, nonactive patients are traditionally steered toward total knee arthroplasty
(TKA), but younger, active patients are not good candidates for TKA based on implant
longevity, complications, morbidity, and risk for revision, such that treatment strategies
at restoring missing hyaline cartilage and bone are highly desired for this patient
population. Over the past four decades, fresh osteochondral allograft (OCA) transplantation
has been developed as a treatment method for large (> 2.5 cm2) focal full-thickness articular cartilage lesions. This article documents our own
institutional OCA journey since 2016 through enhanced graft preservation techniques
(the Missouri Osteochondral Preservation System, or MOPS), technical improvements
in surgical techniques, use of bone marrow aspirate concentrate, bioabsorbable pins
and nails, and prescribed and monitored patient-specific rehabilitation protocols.
Further follow-up with documentation of long-term outcomes will provide insight for
continued optimization for future applications for OCA transplantation, potentially
including a broader spectrum of patients appropriate for this treatment. Ongoing translational
research is necessary to blaze the trail in further optimizing this treatment option
for patients.
Keywords
lesions - osteochondral allograft transplantation - allograft preservation methods
- surgical techniques - patient-specific rehabilitation protocols
