title: Osteochondral Allograft Transplantation for Knee Lesions after Failure of Cartilage Repair Surgery.
abstract: OBJECTIVE
  The objective of this study was to assess the outcome of osteochondral allograft (OCA) transplantation as a salvage procedure after various cartilage repair surgeries.
  
  
  METHODS
  One hundred sixty-four knees in 163 patients (mean age = 32.6 years; range = 11-59 years; 55% males) were treated with OCA transplantation after subchondral marrow stimulation (SMS), osteochondral autograft transplantation (OAT), and autologous chondrocyte implantation (ACI). The majority of previous procedures were isolated SMS in 145 knees (88.4%). Mean allograft size was 8.5 ± 7.9 cm(2). The most common location was in femoral condyle. The number and type of reoperations on the operative knee were assessed. Failure of the OCA transplantation was defined as any reoperation resulting in removal of the allograft. Functional outcomes were evaluated.
  
  
  RESULTS
  Sixty-eight knees had reoperations after OCA transplantation. Thirty-one knees (18.9%) were classified as allograft failures. The median time to failure was 2.6 ± 6.8 years (range = 0.7-23.4 years). Survivorship of the graft was 82% at 10 years and 74.9% at 15 years. Patients whose grafts were still in situ had a mean of 8.5 ± 5.6 years of follow-up. Scores on all functional outcomes scales improved significantly from preoperatively to latest follow-up. Eighty-nine percent of OCA transplantation patients reported being "extremely satisfied" or "satisfied."
  
  
  CONCLUSIONS
  Despite the high reoperation rate, OCA transplantation is a successful salvage surgical treatment after cartilage repair procedures. This cohort showed improved survivorship and functional outcomes of OCA transplantation after SMS, ACI, and OAT.
authors.affiliation: Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, 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: Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, 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 at Scripps Clinic, La Jolla, CA, USA.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Pulido
authors.affiliation: Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: McCauley
authors.affiliation: Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Bugbee
keywords: knee; osteochondral allograft; previous cartilage repair