Osteochondral Allografts for Large Osteochondral Lesions of the Knee Joint: Indications, Surgical Techniques and Results
Publish place: The Archives of Bone and Joint Surgery، Vol: 10، Issue: 3
Publish Year: 1401
نوع سند: مقاله ژورنالی
زبان: English
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شناسه ملی سند علمی:
JR_TABO-10-3_003
تاریخ نمایه سازی: 22 اسفند 1400
Abstract:
The main indications for osteochondral allografts (OCA) transplantation of the knee are the following: Symptomatic full-thickness cartilage lesions greater than ۳ cm۲; deep lesions with subchondral damage; and revision techniques when a previous surgical procedure has failed. Dowel and shell t echniques are the two most commonly used for OCA transplantation. The dowel technique is appropriate in most cartilage lesions; however, geometrically irregular lesions may need the shell technique. Factors related to better outcomes after OCA transplantation are the following: unipolar lesions; patients younger than ۳۰ years; traumatic lesions; and when the treatment is carried out within ۱۲ months from the onset of symptoms. A systematic review found a survivorship rate of ۸۹% at ۵ years. Other systematic review showed a mean failure rate of ۲۵% at ۱۲ years with a reoperation rate of ۳۶%. Seventy -two per cent of the failures were conversion to total knee arthroplasty (TKA) (۶۸%) or unicompartmental knee arthroplasty (UKA) (۴%). Twenty-eight per cent of failures were graft removal, graft fixation, and graft revision. In this systematic review, patellofemoral lesions (۸۳%) had a higher reoperation rate than lesions affecting the tibial plateau or the femoral condyles. Overall, OCA transplantation showed a successful result in ۷۵% of patients at ۱۲ years follow-up.Level of evidence: III
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Authors
E. Carlos RODRIGUEZ-MERCHAN
Department of Orthopedic Surgery, “La Paz” University Hospital-IdiPaz, Madrid, Spain.
Carlos A. Encinas-Ullan
Department of Orthopedic Surgery, “La Paz” University Hospital-IdiPaz, Madrid, Spain.
Alexander D. Liddle
MSK Lab, Imperial College London, UK