The Evaluation of Refrigerated and Frozen Osteochondral Allografts in the Knee

Abstract

Between 1998 and 2002, 25 patients who were treated with a refrigerated or frozen allograft were evaluated. The mean patient age was 48 years. The mean lesion size was 4.5 cm2. Validated outcome instruments [Knee Society Score, Western Ontario and McMaster University Score] were used. Clinical and radiographic evaluations were performed pre-operatively and at the most recent follow-up. Histological and electron microscopic analysis was performed on grafts prior to implantation. Clinical follow-up averaged 46 months (range 24 - 60 months). The Western Ontario and McMaster University Score improved from 46 + 24 to 66 + 22 (p = 0.003). The Knee Society Score improved from 104 + 43 to 132 + 42 (p = 0.01). No correlation was noted between graft type and histological or electron microscopy scoring. Post-operative mechanical alignment was not correlated with an improvement in Western Ontario and McMaster University Score (p = 0.19) or Knee Society Score (0.27). Six patients (24%), all refrigerated allografts, were failures and underwent knee arthroplasty. Seventy-six percent of implanted frozen and refrigerated osteochondral allografts are in place 4 years after surgery. Frozen allografts appear to be surviving as well as refrigerated grafts. The use of magnetic resonance imaging may enable the evaluation of graft incorporation and articular cartilage integrity.

Share and Cite:

A. Pearsall IV, S. Madanagopal and J. Tucker, "The Evaluation of Refrigerated and Frozen Osteochondral Allografts in the Knee," Surgical Science, Vol. 2 No. 5, 2011, pp. 232-241. doi: 10.4236/ss.2011.25052.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] J. E. Browne and T. P. Branch, “Surgical Alternative for Treatment of Articular Cartilage Lesions,” Journal of the American Academy of Orthopaedic Surgeons, Vol. 8, No. 3, 2000, pp. 180-189.
[2] F. F. Parrish, “Allograft Replacement of All or Part of the End of a Long Bone Following Excision of a Tumor,” The Journal of Bone and Joint Surgery, Vol. 55, No. 1, 1973, pp. 1-22.
[3] A. W. Pearsall, J. A. Tucker, R. B. Hester and R. J. Heitman, “Osteochondral Transplantation of the Knee: An Assessment of Graft Viability, American Orthopaedic Society for Sports Medicine Specialty Day,” American Academy of Orthopaedic Surgeons, Dallas, 2002.
[4] K. P. H. Pritzker, A. E. Gross, F. Langer, S. C. Luk and J. B. Houpt, “Articular Cartilage Transplantation,” Human Pathology, Vol. 8, No. 6, 1977, pp. 635-651. doi:10.1016/S0046-8177(77)80093-2
[5] T. Furakawa, D. R. Eyre, S. Koide and M. J. Glimcher, “Biochemical Studies on Repair Cartilage Resurfacing Experimental Defects in the Rabbit Knee,” The Journal of Bone and Joint Surgery, Vol. 62, No. 1, 1980, pp. 79- 89.
[6] W. W. Curl, J. Krome, E. S. Gordon, J. Rushing, B. P. Smith and G. G. Poehling, “Cartilage Injuries: A Review of 31,516 Knee Arthroscopies,” Arthroscopy, Vol. 13, No. 4, 1997, pp. 456-460. doi:10.1016/S0749-8063(97)90124-9
[7] R. W. Jackson, “Arthroscopic Treatment of Degenerative Arthritis,” In: J. B. McGinty, Ed., Operative Arthroscopy, Raven Press, New York, 1991, pp. 319-323.
[8] L. Hangody and P. Füles, “Autologous Osteochondral Mosaicplasty for the Treatment of Full-Thickness Defects of Weight-Bearing Joints. Ten Years of Experimental and Clinical Experience,” The Journal of Bone and Joint Surgery, Vol. 85-A, Supplement 2, 2003, pp. 25-32.
[9] L. L. Johnson, “Surgical Arthroscopy: Principles and Practice,” Mosby, St Louis, 1986.
[10] Y. Matsusue, T. Yamamuro and H. Hama, “Arthroscopic Multiple Osteochondral Transplantation to the Chondral Defect in the Knee Associated with Anterior Cruciate Ligament Disruption,” Arthroscopy, Vol. 9, No. 3, 1993, pp. 318-321. doi:10.1016/S0749-8063(05)80428-1
[11] V. Bobi?, “Arthroscopic Osteochondral Autograft Trans-plantation in Anterior Cruciate Ligament Reconstruction: A Preliminary Clinical Study,” Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 3, No. 4, 1996, pp. 262- 264. doi:10.1007/BF01466630
[12] H. Laprell and W. Peterson, “Autologous Osteochondral Transplantation Using the Diamond Bone-Cutting System (DBCS): 6-12 Years’ Follow-Up of 35 Patients with Osteochondral Defects at the Knee Joint,” Archives of Orthopaedic and Trauma Surgery, Vol. 121, No. 5, 2001, pp. 248-253. doi:10.1007/s004020000217
[13] D. Koulalis, W. Schultz, M. Heyden and F. K?nig, “Au-tologous Osteochondral Grafts in the Treatment of Carti-lage Defects of the Knee Joint,” Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 12, No. 4, 2004, pp. 329-334. doi:10.1007/s00167-003-0392-5
[14] H. L. Ma, S. C. Hung, S. T. Wang, M. C. Chang and T. H. Chen, “Osteochondral Autografts Transfer for Post- -Traumatic Osteochondral Defect of the Knee-2 to 5 Years Follow-Up,” Injury, Vol. 35, No. 12, 2004, pp. 1286-1292. doi:10.1016/j.injury.2004.02.013
[15] H. J. Mankin, F. S. Fogelson, A. Z. Thrasher and F. Jaffer, “Massive Resection and Allograft Transplantation in the Treatment of Malignant Bone Tumors,” The New England Journal of Medicine, Vol. 294, No. 23, 1976, pp. 1247-1255. doi:10.1056/NEJM197606032942301
[16] L. Hangody, G. Kish, Z. Kárpáti, I. Udvarhelyi, I. Szigeti and M. Bély, “Mosaicplasty for the Treatment of Articular Cartilage Defects: Application in Clinical Practice,” Orthopedics, Vol. 21, No. 7, 1998, pp. 751-756.
[17] L. Hangody, P. Feczkó, L. Bartha, G. Bodó and G. Kish, “Mosiacplasty for the Treatment of Articular Defects of the Knee and Ankle,” Clinical Orthopedics and Related Research, Vol. 391, Supplement l, 2001, pp. 328-336. doi:10.1097/00003086-200110001-00030
[18] T. Minas and S. Nehrer, “Current Concepts in the Treat-ment of Articular Cartilage Defects,” Orthopedics, Vol. 20, No. 6, 1997, pp. 525-538.
[19] C. J. Campbell, “The Healing of Cartilage Defects,” Clinical Orthopedics and Related Research, Vol. 64, 1969, pp. 45-63.
[20] D. W. Jackson, M. J. Scheer and T. M. Simon, “Cartilage Substitutes: Overview of Basic Science and Treatment Options,” Journal of the American Academy of Ortho-paedic Surgeons, Vol. 9, No. 1, 2001, pp. 37-52.
[21] J. C. Garrett, “Fresh Osteochondral Allografts for Treat-ment of Articular Defects in Osteochondritis Dissecans of the Lateral Femoral Condyle in Adults,” Clinical Ortho-pedics and Related Research, Vol. 303, 1994, pp. 33-37.
[22] T. Gibson, “The Transplantation of Cartilage,” Journal of Clinical Pathology, Vol. 20, 1967, p. 513.
[23] J. P. Fulkerson, “Anteromedialization of the Tibial Tu-berosity for Patellofemoral Malalignment,” Clinical Or-thopedics and Related Research, Vol. 177, 1983, pp. 176- 181.
[24] U. Horas, D. Pelinkovic, G. Herr, T. Aigner and R. Schnettler, “Autologous Chondrocyte Implantation and Osteochondral Cylinder Transplantation in Cartilage Re-pair of the Knee Joint. A Prospective, Comparative Trial,” The Journal of Bone and Joint Surgery. American Volume, Vol. 85-A, No. 2, 2003, pp. 185-192.
[25] G. N. Homminga, S. K. Bulstra, P. S. M. Bouwmeester and A. J. van der Linden, “Perichondral Grafting for Car-tilage Lesions of the Knee,” The Journal of Bone and Joint Surgery. British Volume, Vol. 72, No. 6, 1990, pp. 1003-1007.
[26] R. Lorentzon, H. Alfredson and C. Hildingsson, “Treat-ment of Deep Cartilage Defects of the Patella with Pe-riosteal Transplantation,” Knee Surgery, Sports Trauma-tology, Arthroscopy, Vol. 6, No. 4, 1998, pp. 202-208. doi:10.1007/s001670050100
[27] F. R. Noyes, R. W. Bassett, E. S. Grood and D. L. Butler, “Arthroscopy in Acute Traumatic Hemarthrosis of the Knee: Incidence of Anterior Cruciate Tears and Other Injuries,” The Journal of Bone and Joint Surgery. Amer-ican Volume, Vol. 62, No. 5, 1980, pp. 687-695.
[28] S. K. Williams, D. Amiel, S. T. Ball, R. T. Allen, V. W. Wong, A. C. Chen, R. L. Sah and W. D. Bugbee, “Pro-longed Storage Effects on the Articular Cartilage of Fresh Human Osteochondral Allografts,” The Journal of Bone and Joint Surgery. American Volume, Vol. 85-A, No. 11, 2003, pp. 2111-2120.
[29] A. E. Gross, F. Langer, J. Houpt, K. Pritzker and G. Friedlaender, “Allotransplantation of Partial Joints in the Treatment of Osteoarthritis of the Knee,” Transplant Proceedings, Vol. 8, Supplement 1, 1976, pp. 129-132.
[30] C. H. Herndon and S. W. Chase, “The Fate of Massive Autogenous and Homogenous Bone Grafts Including Ar-ticular Surfaces,” Surgery, Gynecology & Obstetrics, Vol. 98, No. 3, 1954, pp. 273-290.
[31] F. Langer, A. E. Gross, M. West and E. P. Urovitz, “The Immunogenicity of Allograft Knee Joint Transplants,” Clinical Orthopedics and Related Research, Vol. 132, 1978, pp. 155-162.
[32] H. J. Mankin, S. Doppelt and W. Tomford, “Clinical Experience with Allograft Implantation. The First Ten Years,” Clinical Orthopedics and Related Research, Vol. 174, 1983, pp. 69-86.
[33] D. W. Jackson, J. Halbrecht, C. Proctor, et al. “Assess-ment of Donor Cell and Matrix Survival in Fresh Articular Cartilage Allografts in a Goat Model,” Journal of Or-thopaedic Research, Vol. 14, No. 2, 1996, pp. 255-264. doi:10.1002/jor.1100140214
[34] F. R. Convery, M. H. Meyers and W. H. Akeson, “Fresh Osteochondral Allografting of the Femoral Condyle,” Clinical Orthopedics and Related Research, Vol. 273, 1991, pp. 139-145.
[35] F. R. Convery, W. H. Akeson and M. H. Meyers, “The Operative Technique of Fresh Osteochondral Allografting of the Knee,” Operative Techniques in Orthopaedics, Vol. 7, No. 4, 1997, pp. 340-344. doi:10.1016/S1048-6666(97)80038-9
[36] J. C. Garrett, “Osteochondral Allografts for Reconstruc-tion of Articular Defects of the Knee,” Instructional Course Lectures, Vol. 47, 1998, pp. 517-522.
[37] A. E. Gross, “Fresh Osteochondral Allografts for Post-Tra- umatic Knee Defects: Surgical Technique,” Operative Techniques in Orthopedics, Vol. 7, No. 4, 1997, pp. 334-339.
[38] G. L. Bonney and M. Laurence, “Allograft Arthroplasty of the Knee,” Proceedings of the Royal Society of Medicine, Vol. 62, No. 6, 1969, pp. 583-585.
[39] R. C. Locht, A. E. Gross and F. Langer, “Late Osteo-chondral Allograft Resurfacing for Tibial Plateau Frac-tures,” The Journal of Bone and Joint Surgery. American Volume, Vol. 66, No. 3, 1984, pp. 328-335.
[40] M. H. Meyers and S. N. Chatterjee, “Osteochondral Transplantation,” The Surgical Clinics of North America, Vol. 58, No. 2, 1978, pp. 429-434.
[41] M. H. Meyers, R. E. Jones, R. W. Bucholz, et al., “Fresh Autogenous Grafts and Osteochondral Allografts for the Treatment of Segmental Collapse in Osteonecrosis of the Hip,” Clinical Orthopedics and Related Research, Vol. 174, 1983, pp. 107-112.
[42] K. Pap and S. Krompecher, “Arthroplasty of the Knee: Experimental and Clinical Experiences,” The Journal of Bone and Joint Surgery. American Volume, Vol. 43, No. 4, 1961, pp. 523-537.
[43] B. C. Emmerson, S. G?rtz, A. A. Jamali, C. Chung, D. Amiel and W. D. Bugbee, “Fresh Osteochondral Allo-grafting in the Treatment of Osteochondritis Dissecans of the Femoral Condyle,” The American Journal of Sports Medicine, Vol. 35, No. 6, 2007, pp. 907-914. doi:10.1177/0363546507299932
[44] P. C. McCulloch, R. W. Kang, M. H. Sobhy, J. K. Hay-den and B. J. Cole, “Prospective Evaluation of Prolonged Fresh Osteochondral Allograft Transplantation of the Femoral Condyle: Minimum 2-Year Follow-Up,” The American Journal of Sports Medicine, Vol. 35, No. 3, 2007, pp. 411-420. doi:10.1177/0363546506295178
[45] R. J. Williams, A. S. Ranawat, H. G. Potter, T. Carter and R. F. Warren, “Fresh Stored Allografts for the Treatment of Osteochondral Defects of the Knee,” The Journal of Bone and Joint Surgery. American Volume, Vol. 89, No. 4, 2007, pp. 718-726. doi:10.2106/JBJS.F.00625
[46] N. Bellamy and W. W. Buchanan, “Outcome Measurement in Osteoarthritis Clinical Trials: The Case for Stan-dardisation,” Clinical Rheumatology, Vol. 3, No. 3, 1984, pp. 293-303. doi:10.1007/BF02032334
[47] A. Pace, N. Orpen, H. Doll and E. J. Crawfurd, “Outcome Scoring System Evaluation of Knee Osteoarthritis in Pa-tients Awaiting TKA,” The Journal of Knee Surgery, Vol. 19, No. 2, 2006, pp. 85-88.
[48] M. A. Ritter, A. E. Thong, K. E. Davis, M. E. Berend, J. B. Meding and P. M. Faris, “Long-Term Deterioration of Joint Evaluation Scores,” The Journal of Bone and Joint Surgery. British Volume, Vol. 86, No. 3, 2004, pp. 438- 442. doi:10.1302/0301-620X.86B3.14243
[49] N. Bellamy, W. W. Buchanan, C. H. Goldsmith, J. Cam- pbell and L. W. Stitt, “Validation Study of WOMAC: A Health Status Instrument for Measuring Clinically Im-portant Patient Relevant Outcomes to Antirheumatic Drug Therapy in Patients with Osteoarthritis of the Hip or Knee,” Journal of Rheumatology, Vol. 15, No. 12, 1988, pp. 1833-1840.
[50] N. Bellamy, W. F. Kean, W. W. Buchanan, E. Ge-recz-Simon and J. Campbell, “Double Blind Randomized Controlled Trial of Sodium Meclofenamate (Meclomen) and Diclofenac Sodium (Voltaren): Post Validation Reapplication of the WOMAC Osteoarthritis Index,” Journal of Rheumatology, Vol. 19, No. 1, 1992, pp. 153- 159.
[51] D. Amiel, F. L. Harwood, J. A. Hoover, et al., “A Histo-logical and Biomechanical Assessment of the Cartilage Matrix Obtained from in Vitro Storage of Osteochondral Allografts,” Connective Tissue Research, Vol. 23, No. 1, 1989, pp. 89-99. doi:10.3109/03008208909103906
[52] M. K. Kwan, J. S. Wayne, et al., “Histological and Bio-mechanical Assessment of Articular Cartilage from St- ored Osteochondral Shell Allografts,” Journal of Ortho-paedic Research, Vol. 7, No. 5, 1989, pp. 637-644. doi:10.1002/jor.1100070503
[53] K. M. Oates, A. C. Chen, E. P. Young, et al., “Effects of Tissue Culture Storage on the in Vivo Survival of Canine Osteochondral Allografts,” Journal of Orthopaedic Re-search, Vol. 13, No. 4, 1995, pp. 526-569. doi:10.1002/jor.1100130411
[54] J. S. Wayne, D. Amiel, M. K. Kwan, et al., “Long-Term Storage Effects on Canine Osteochrondral Allografts,” ACTA Orthopaedica Scandinavian, Vol. 61, No. 6, 1990, pp. 539-545. doi:10.3109/17453679008993578
[55] A. W. Pearsall, J. A. Tucker, R. B. Hester and R. J. Heit- man, “Chondrocyte Viability in Refrigerated Osteochon-dral Allografts Used for Transplantation within the Knee,” The American Journal of Sports Medicine, Vol. 32, No. 1, 2004, pp. 125-131. doi:10.1177/0095399703258614
[56] V. M. Goldberg and S. Stevenson, “Natural History of Autografts and Allografts,” Clinical Orthopedics and Re- lated Research, Vol. 225, 1987, pp. 7-16.
[57] W. H. Simon and W. T. Green, “Experimental Production of Cartilage Necrosis by Cold Injury: Failure to Cause Degenerative Joint Disease,” The American Journal of Pathology, Vol. 64, No. 1, 1971, pp. 145-154.
[58] W. H. Simon, S. Richardson, W. Herman, et al., “Long- -Term Effects of Chondrocyte Death on Rabbit Articular Cartilage in Vivo,” Journal of the American Academy of Orthopaedic Surgeons, Vol. 58, No. 4, 1976, pp. 517- 526.
[59] C. B. Sirlin, J. Brossmann, R. D. Boutin, M. N. Pathria, F. R. Convery, W. Bugbee, R. Deutsch, L. K. Lebeck and D. Resnick, “Shell Osteochondral Allografts of the Knee: Comparison of MR Imaging Findings and Immunologic Responses,” Radiology, Vol. 219, No. 1, 2001, pp. 35-43.
[60] J. H. Dashefsky, “Arthroscopic Measurement of Chon-dromalacia of Patella Cartilage Using a Microminiature Pressure Transducer,” Arthroscopy, Vol. 3, No. 2, 1987, pp. 80- 85. doi:10.1016/S0749-8063(87)80021-X
[61] G. E. Kempson, H. Muir, vS. A. Swanson and M. A. Free- man, “Correlations between Stiffness and the Chemical Constituents of Cartilage on the Human Femoral Head,” Biochimica et Biophysica Acta, Vol. 215, No. 1, 1970, pp. 70-77.
[62] T. Lyyra, J. Jurvelin, P. Pitk?nen, U. V??t?inen and I. Kviranta, “Indentation Instrument for the Measurement of Cartilage Stiffness under Arthroscopic Control,” Medical Engineering & Physics, Vol. 17, No. 5, 1995, pp. 395- 399. doi:10.1016/1350-4533(95)97322-G
[63] L. Hangody, L. Sük?sd, I. Szigeti and Z. Kárpáti, “Arth-roscopic Autogenous Osteochondral Mosaicplasty,” Hungarian Journal of Traumatology and Orthopaedics, Vol. 39, 1996, pp. 49-54.
[64] W. D. Bugbee and B. Khadivi, “Fresh Osteochondral Allografting in the Treatment of Osteonecrosis of the Knee, Paper No. 108,” American Academy of Orthopaedic Surgeons, 71st Annual Meeting, San Francisco, Mar- ch 2
[65] T. Gibson, “Viability of Cartilage after Freezing,” Pro-ceedings of the Royal Society B: Biological Sciences, Vol. 147, No. 929, 1957, pp. 528-529.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.