title: Fresh osteochondral allograft transplantation for isolated patellar cartilage injury.
abstract: BACKGROUND
  The treatment of patellofemoral cartilage injuries can be challenging. Osteochondral allograft (OCA) transplantation has been used as a treatment option for a range of cartilage disorders.
  
  
  OBJECTIVE
  To evaluate functional outcomes and survivorship of the grafts among patients who underwent OCA for patellar cartilage injuries.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  An institutional review board-approved OCA database was used to identify 27 patients (28 knees) who underwent isolated OCA transplantation of the patella between 1983 and 2010. All patients had a minimum 2-year follow-up. The mean age of the patients was 33.7 years (range, 14-64 years); 54% were female. Twenty-six (92.9%) knees had previous surgery (mean, 3.2 procedures; range, 1-10 procedures). The mean allograft area was 10.1 cm(2) (range, 4.0-18.0 cm(2)). Patients returned for clinical evaluation or were contacted via telephone for follow-up. The number and type of reoperations were assessed. Any reoperation resulting in removal of the allograft was considered a failure of the OCA transplantation. Patients were evaluated pre- and postoperatively using the modified Merle d'Aubigné-Postel (18-point) scale, the International Knee Documentation Committee (IKDC) pain, function, and total scores, and the Knee Society function (KS-F) score. Patient satisfaction was assessed at latest follow-up.
  
  
  RESULTS
  Seventeen of the 28 knees (60.7%) had further surgery after the OCA transplantation; 8 of the 28 knees (28.6%) were considered OCA failures (4 conversions to total knee arthroplasty, 2 conversions to patellofemoral knee arthroplasty, 1 revision OCA, 1 patellectomy). Patellar allografting survivorship was 78.1% at 5 and 10 years and 55.8% at 15 years. Among the 20 knees (71.4%) with grafts in situ, the mean follow-up duration was 9.7 years (range, 1.8-30.1 years). Pain and function improved from the preoperative visit to latest follow-up, and 89% of patients were extremely satisfied or satisfied with the results of the OCA transplantation.
  
  
  CONCLUSIONS
  OCA transplantation was successful as a salvage treatment procedure for cartilage injuries of the patella.
authors.affiliation: Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA Department of Orthopaedic Surgery, Federal University of São Paulo, Brazil.
authors.forename: Guilherme C
authors.initials: GC
authors.lastname: Gracitelli
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.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Pulido
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Diego School of Medicine, La Jolla, California, USA Department of Orthopaedic Surgery, Scripps Clinic, 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: Department 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; D019645:Arthroplasty, Replacement, Knee; D016025:Bone Transplantation / Q000379:methods*; D002356:Cartilage / Q000293:injuries / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D010329:Patella / Q000293:injuries / Q000601:surgery*; D017060:Patient Satisfaction; D012086:Reoperation; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: cartilage; osteochondral allograft; osteochondral defect; osteochondral transplantation; patella