title: Fresh osteochondral allograft transplantation for bipolar reciprocal osteochondral lesions of the knee.
abstract: BACKGROUND
  Osteochondral allograft (OCA) transplantation is an effective treatment option for chondral and osteochondral defects of the knee.
  
  
  OBJECTIVE
  Patients treated with OCAs for reciprocal bipolar lesions of the knee would demonstrate significant clinical improvement.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Between 1983 and 2010, OCAs were implanted for bipolar chondral lesions in 46 patients (48 knees). The 21 male and 25 female patients averaged 40 years of age (range, 15-66 years). Thirty-four lesions were tibiofemoral, and 14 were patellofemoral. Forty-two knees (88%) had undergone a mean of 3.4 previous surgeries (range, 1-8). The mean allograft area was 19.2 cm(2). Clinical evaluation included the modified Merle d'Aubigné-Postel (18-point), International Knee Documentation Committee (IKDC) pain and function, and Knee Society function (KS-F) scores. Further surgeries on the operative joint were documented.
  
  
  RESULTS
  Survivorship of the bipolar OCA was 64.1% at 5 years. Thirty knees underwent further surgery; 22 knees (46%) were considered failures (3 OCA revisions, 14 total knee arthroplasties, 2 unicondylar arthroplasties, 2 arthrodeses, and 1 patellectomy). Among patients whose OCA was still in situ at follow-up, the mean follow-up was 7 years (range, 2.0-19.7 years). The mean 18-point score improved from 12.1 to 16.1; 88% (23/26 knees) of surviving allografts scored ≥15. The mean IKDC pain score improved from 7.5 to 4.7, and the mean IKDC function score improved from 3.4 to 7.0. The mean KS-F score improved from 70.5 to 84.1.
  
  
  CONCLUSIONS
  Osteochondral allograft transplantation is a useful salvage treatment option for reciprocal bipolar cartilage lesions of the knee. High reoperation and failure rates were observed, but patients with surviving allografts showed significant clinical improvement.
authors.affiliation: Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA Department of Orthopaedic Surgery, Balikesir University, Balikesir, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Meric
authors.affiliation: Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA Department of Orthopaedic Surgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Guilherme C
authors.initials: GC
authors.lastname: Gracitelli
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Görtz
authors.affiliation: Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: De Young
authors.affiliation: Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA Bugbee.William@scrippshealth.org.
authors.forename: William D
authors.initials: WD
authors.lastname: Bugbee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D019645:Arthroplasty, Replacement, Knee; D016025:Bone Transplantation; D002356:Cartilage / Q000637:transplantation*; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D010147:Pain Measurement; D057071:Patellofemoral Joint / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D017211:Treatment Failure; D055815:Young Adult
keywords: cartilage; knee; osteochondral allograft; osteochondral defect; osteochondral transplantation