Osteochondral allograft transplantation: Surgical technique and results

Abstract

Hyaline articular cartilage is an avascular and insensate tissue with a distinct structural organization, which provides a low-friction and wear-resistant interface for weight-bearing surface articulation in diarthrodial joints. Ideally, articular cartilage is maintained in homeostasis over the lifetime of an individual, with its biomechanical properties inherently suited to transmit a wide variety of physiologic loads through a functional range of motion. Although its viscoelastic characteristics make it ideally suited to transmit a wide variety of physiologic loads through a functional range of motion while maintaining homeostasis, it also displays an intrinsic inability to heal when injured in the skeletally mature individual. Thus, articular cartilage lesions commonly lead to significant disability, joint dysfunction and ultimately osteoarthritis. Current treatment options are limited and often ineffective at restoring healthy articular cartilage, especially in complex cartilage defects involving large areas of damage and associated subchondral bone loss. While several options for repair of articular cartilage defects do exist, fresh osteochondralallografting currently remains the only technique that restores anatomically appropriate, mature hyaline cartilage in large articular defects. Osteochondralallografting is a valuable and uniquely versatile cartilage restoration technique that can address even complex or multiple lesions in topographically challenging environments by restoring the anatomy of the native joint both macroscopically and microscopically with a solid orthotopic replacement. As a result, osteochondralallografts have emerged to play an increasingly vital role in the clinical algorithm of cartilage restoration.