Concomittant Bipolar Fresh Osteochondral Allograft Transplantation of Patella and Trochlea
Author(s):
Mirzayan R. (United States of America)
,
Mirzayan R. (United States of America)
Affiliations:
Charles M.
,
Charles M.
Affiliations:
Batech M.
,
Batech M.
Affiliations:
Suh B.
,
Suh B.
Affiliations:
Dewitt D.
Dewitt D.
Affiliations:
ESSKA Academy. Mirzayan R. 05/09/18; 209708; P12-411 Topic: Sports Related Injuries
Dr. Raffy Mirzayan
Dr. Raffy Mirzayan
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Abstract
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Objectives: Osteochondral allograft (OCA) is a well-established treatment for large cartilage defects of the knee. To date, there is little evidence documenting outcomes of OCAs in the patellofemoral joint (PFJ), especially in bipolar (concomitant patella and trochlea) transplantation. We evaluated the clinical and radiographic outcomes of patients who underwent simultaneous fresh OCA of the patella and trochlea.

Methods: We retrospectively reviewed prospectively collected data on 18 knees in 17 patients who underwent fresh OCA transplantation of the patella and trochlea by a single surgeon. Inclusion criteria were patients with documented degenerative grade III or IV chondral lesions (Group1) of the PFJ on diagnostic arthroscopy (5 knees), or recurrent patella dislocations (Group 2) with trochlear dysplasia and chondral injury to the patella and/or trochlea (13 patients). Both grafts were from the same donor, procured from the same tissue bank, and kept fresh in a medium. All were transplanted before 28 days from time of death. The patella was fixated with headless compression screws and the trochlea was press-fit. All patients in Group 2 also underwent MPFL reconstruction. Pre-operative and post-operative Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), Oxford, Cincinnati, Tenger-Lysholm, Visual Analogue Scale (VAS), and Single Assesment Numeric Evaluation (SANE) were obtained. Post-operative MRIs were obtained and Osteochondral Allograft MRI Scoring System (OCAMRISS) was used to evaluate the osteochondral grafts.

Results: Three patients were lost to follow up, leaving 4 knees in 3 patients in Group 1, and 11 knees/patients in Group2. The average age was 28.9 years (range 16-52). There were 12 males. The average follow-up was 33.2 months (range 12-64). There was significant improvement of KOOS (38.7 to 83.1), IKDC (28.2 to 76.6), Tegner-Lysholm (38.3 to 88.3), Oxford (22.7 to 42.9), Cincinnati (35.1 to 83.6), VAS (71 to 17.9.), and SANE (43.3 to 83) (P<0.0001 for all). The OCAMRISS score for the patellae was 2.23 and for the trochleae 4.69. There were no revisions or conversions to arthroplasty. Two patients required re-operation, one for lysis of adhesions and screw removal and one for screw removal. No were no re-dislocations in any of the patients in Group 2.

Conclusions: Concomitant, bipolar patella and trochlea fresh OCA transplantation provided significant improvement in functional outcomes, relief from pain, activity level, and prevented recurrent instability in mid-term results with excellent graft survivorship.

Keywords:
fresh osteochondral allograft transplantation patella trochlea dysplasia
Objectives: Osteochondral allograft (OCA) is a well-established treatment for large cartilage defects of the knee. To date, there is little evidence documenting outcomes of OCAs in the patellofemoral joint (PFJ), especially in bipolar (concomitant patella and trochlea) transplantation. We evaluated the clinical and radiographic outcomes of patients who underwent simultaneous fresh OCA of the patella and trochlea.

Methods: We retrospectively reviewed prospectively collected data on 18 knees in 17 patients who underwent fresh OCA transplantation of the patella and trochlea by a single surgeon. Inclusion criteria were patients with documented degenerative grade III or IV chondral lesions (Group1) of the PFJ on diagnostic arthroscopy (5 knees), or recurrent patella dislocations (Group 2) with trochlear dysplasia and chondral injury to the patella and/or trochlea (13 patients). Both grafts were from the same donor, procured from the same tissue bank, and kept fresh in a medium. All were transplanted before 28 days from time of death. The patella was fixated with headless compression screws and the trochlea was press-fit. All patients in Group 2 also underwent MPFL reconstruction. Pre-operative and post-operative Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), Oxford, Cincinnati, Tenger-Lysholm, Visual Analogue Scale (VAS), and Single Assesment Numeric Evaluation (SANE) were obtained. Post-operative MRIs were obtained and Osteochondral Allograft MRI Scoring System (OCAMRISS) was used to evaluate the osteochondral grafts.

Results: Three patients were lost to follow up, leaving 4 knees in 3 patients in Group 1, and 11 knees/patients in Group2. The average age was 28.9 years (range 16-52). There were 12 males. The average follow-up was 33.2 months (range 12-64). There was significant improvement of KOOS (38.7 to 83.1), IKDC (28.2 to 76.6), Tegner-Lysholm (38.3 to 88.3), Oxford (22.7 to 42.9), Cincinnati (35.1 to 83.6), VAS (71 to 17.9.), and SANE (43.3 to 83) (P<0.0001 for all). The OCAMRISS score for the patellae was 2.23 and for the trochleae 4.69. There were no revisions or conversions to arthroplasty. Two patients required re-operation, one for lysis of adhesions and screw removal and one for screw removal. No were no re-dislocations in any of the patients in Group 2.

Conclusions: Concomitant, bipolar patella and trochlea fresh OCA transplantation provided significant improvement in functional outcomes, relief from pain, activity level, and prevented recurrent instability in mid-term results with excellent graft survivorship.

Keywords:
fresh osteochondral allograft transplantation patella trochlea dysplasia
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