Name: Planning for Success With Osteochondral Allograft Transplantation
Uploaded: 2026-09-15T00:00:00Z
Channel: Arthrex
Description: Rachel M. Frank, MD (Denver, CO), discusses considerations for osteochondral allograft transplantation cases, including her decision-making algorithm for who to treat, critical factors that inform her treatment plans, and what she considers during graft choice.

Knee

<p>Rachel M. Frank, MD (Denver, CO), discusses considerations for osteochondral allograft transplantation cases, including her decision-making algorithm for who to treat, critical factors that inform her treatment plans, and what she considers during graft choice.</p>

Not Hidden

English  - en

video

VID1-009987-en-US | A | Planning for Success With Osteochondral Allograft Transplantation

Rachel M. Frank

Human

Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

Videos von Fallpräsentationen

Case Presentation Videos

Cirurgiões que apresentam um ou mais casos clínicos.

Vídeos apresentações de casos

Cirujanos que presentan uno o más casos clínicos.

Video presentaciones de casos

Planning for Success With Osteochondral Allograft Transplantation

Speaker  My name is Rachel Frank. I'm the director of the Joint Preservation Program at the University of Colorado School of Medicine. And today we'll be discussing osteochondral allograft transplantation who, how, and why. When we think about osteochondral allograft transplantation as a component of joint preservation surgery, we have to ask ourselves why bother? And the obvious question and the obvious answer really centers on costs from a financial perspective, as well as some of the unmeasurable or difficult to measure costs from a patient perspective. Pain, dysfunction and depression. So many patients have joint problems but are not quite ready or quite old enough for joint replacement. And so we need an active search for joint preserving alternatives. When we think about cartilage pathology, we also have to appreciate that there are many cartilage defects within our patients knees at the time of arthroscopy. And not all of those lesions need treatment, but some of them do. And our task is to determine which cartilage lesions require treatment. And then how do we best treat those patients. When we evaluate these patients we take a thorough history. We do a physical examination and a variety of imaging studies which can include in-office needle arthroscopy. And then ultimately we think about their cartilage problem as part of the entire joint. We think about their alignment, their meniscus status, the ligament status, and the underlying subchondral bone, which really plays a role in clinical decision making for cartilage restoration and joint preservation patients. Speaker  When we determine that a patient is a candidate for cartilage restoration, we've got a variety of tools in our cartilage restoration toolbox, and we really separate the tools that we have into four unique categories. This first is the simple option, the palliative simple arthroscopy, debridement chondroplasty. Then we move on to reparative options including marrow stimulation, microfracture, etc. next, we move on to restorative options, which include cellular restorations such as AutoCart transplantation. And finally, we move into reconstructive options which include our osteoarticular or osteochondral, autograft and allograft transplantations. How do we decide? There's so many different factors, as you can see on the slide over here. But what we think about includes defect size, location, and containment. We think about the depth and the involvement of the underlying subchondral bone. The other factors within the knee that have been previously described, including alignment, meniscus status and overall ligamentous stability. We think about prior treatment that the patients had, including their current and future goals and expectations. And then for our high level athletes, where are they in the season? And certainly, we think about cost, safety and availability of the proper procedure that we're trying to do. It's also important to understand why do the patients hurt? We don't always know, even as expert surgeons. Is the pain coming from the bone? Is it coming from the cartilage? Is it coming from both the bone and cartilage? And that may impact how we decide to treat these patients, because we might want a solution that impacts not only the cartilage, which is clearly diseased in these patients, but also the bone, which may be more difficult to diagnose but also may be symptomatic. Speaker  With that in mind, let's talk about fresh osteochondral allograft transplantation. Fresh OCA is the workhorse of cartilage restoration treatments in my practice. We rely heavily on donors and tissue banks, and we're so grateful that we have the opportunity to use this tissue, this gift of life. We have incredible instrumentation to be able to do these techniques in a very slick and reproducible fashion, as you see here. And really, it's being able to treat any size defect in your patient with the gift of donor bone and cartilage. This video is showing you how we do this in a sped up version. But essentially this is what you're going to do to fill that pothole. You're going to take the Osteochondral allograft, prep it into the appropriate size and shape for the defect, and then you're going to put it into the defect size. And we're using the gift of life to really understand and then better treat these patients. So let's break this down a little bit. Fresh osteochondral allograft transplantation or OCA is a precious gift. Speaker  And we've got to acknowledge the donors and their families for allowing us to have this opportunity to help the next patient. It's an osteochondral solution that treats an osteochondral problem. So we're treating both the bone and the cartilage. We're using a graft that's fresh. It's got fresh hyaline cartilage with a lot of type two collagen, which is really nice from a biologic perspective. And the data would tell us that there are excellent outcomes with high return to sport rates, even in high level athletes combined with low complication rates. When we look at some of this data in more detail, this is a series of 180 osteochondral allograft patients with an average age of 34 years and an average follow up of five years. And these patients are complicated. A lot of them had prior knee surgery, including more than one prior knee surgery, as well as over half of this cohort having concurrent major knee surgeries such as meniscus transplantation. And we found when we did this study, is that at five years, the allograft survival rate is 86%, and patients do quite well with this surgery, even if they need a second operation for scar tissue. They're all doing quite well at that average follow up of five years. These outcomes have been replicated by other groups around the country, in the United States, and in some cases around the world, where they have access to fresh osteochondral allografts. Speaker  And so with the appropriate indications, appropriate instrumentation, and appropriate surgical technique patients are going to do really well with OCA transplantation. Now, what every patient and surgeon wants to know is how do I get my graft? Because it seems so easy when we're talking about it in a video like this. Well, let's look at the playbook. You need three things to get Osteochondral Allografts consistently. Number one, you've got to understand the system. Number two, communication as a team. And number three, you've got to consider the proven options. So what's in this playbook? Let's get into it. What happens is at day one of donor death, there's recovery of the tissue. And that happens within 24 hours of donor death. So this goes real quick. Then we have processing over days two and three. And this is with our tissue companies. Next between days three and seven the grafts are undergoing cultures to make sure the graft is safe. And if there's any concern the graft will not pass and you'll have to get another graft in our tissue. Banks are really good at helping us get a backup should this happen, and I trust that process from a safety perspective. Between days eight and ten there's a match. So your surgical coordinator or you as the surgeon, will have sent information to the tissue company to get that match. Speaker  And then we have a release just under three weeks from donor death. And before four weeks of donor death, we've got to get that graft into the patient. So you can see that there's a lot of coordination that's required. Now with all this coordination, there can be some troublesome points. And so we're going to try to help you understand how to avoid those challenges. The top reasons for graft decline are basically time related. The surgeon's not ready. The Or is not prepared. The patient suddenly has a cancellation. And that all happens after the graft has been ordered and the graft is ready. Sometimes the order can be cancelled without notification to the tissue bank that's often on the surgeon's side. And then sometimes the insurance authorization doesn't go all the way through. And these grafts can be expensive. So it's important to understand that process. You've got to contact the tissue bank. You've got to make sure that you have a very streamlined approach to your tissue bank. And then the tissue bank will do the work for you. But if you don't communicate or you rely on the hospital staff, you may be in trouble in terms of getting a fresh osteochondral allograft fast, there can be a few obstacles. You want to get the right match for your patient. You need to know when to schedule that patient into the operating room. Speaker  And sometimes that requires or historically required notifying the patient at the last minute that, hey, we have a match for you. No longer do we need to worry about all of these challenges. And that's due to the advancement of this entire process. So how can some of these challenges to obtaining a fresh osteochondral allograft be avoided? Well, it's all about communication and understanding what you want. So when you place your order, you're going to tell the tissue company what type of allograft you'd like and when you want it. So choosing your allograft and choosing your timing. When you choose your allograft, you have a couple different options. You can get a fresh pre-cut osteochondral allograft core plug, or you can ask for a specific type of osteochondral allograft. And then with respect to timing, you can choose simply the first available. That's your fastest option to getting into the operating room. Or perhaps you want to select a date. Maybe you have an athlete in college coming home for spring break or winter break, or a prescheduled date based on everyone's availability. So when we think about that first option of choosing my allograft, this is where we talk about those fresh pre-cut osteochondral allograft cores. These are wonderful options from our tissue companies. And they come in variable different sizes including size ten, 12, 16, and 20mm. These are ready to go. Speaker  So if you have a good plan from your diagnostic scope, if you did a staging scope or from your MRI and you know exactly what graft you want to transplant, from a sizing perspective, you can get a pre-cut core and you don't have to wait for a donor because the tissue companies have these ready to go. Alternatively, you can get a graft that's custom for your patient based on the anatomy that you're treating as you see here. Most commonly, people are ordering a Hemi condyle such as a medial or lateral distal femoral condyle. You can also get a whole trochlea. You can get a bi compartment graft with a Hemi condyle plus BioTrochlea. You can get an isolated trochlea, a patella, etc.. A common question I get is can you mix and match? Especially if you're waiting for a graft. The answer is yes with a couple caveats. For example, you can use a lateral femoral condyle for a medial femoral condyle defect. But I'd be very careful with big lesions or very posterior lesions, because the radius of curvature of the two condyles is not exactly the same. In addition, I typically will only accept a patella graft for a patella defect because of the unique anatomy of the patella. Specifically, when we're talking about treating the medial femoral condyle, that's the most common area of damage that we treat with osteochondral allograft. Speaker  So as you can imagine, it may be difficult to get those specific medial femoral condyle grafts. Fortunately, lateral femoral condyles are readily available the vast majority of the time. And when you look at these studies and several others, it is okay to use a lateral condyle for a medial defect, provided your defect is not huge, meaning not greater than 20 to 25mm. Beyond that, we really want to use the same anatomy for the same type of problem. So in terms of an algorithm for my patients undergoing cartilage restoration as part of a joint preservation strategy, we really can divide up our treatment options into those four categories that we discussed earlier, which specifically boil down into debridement osteoarticular autograft transfer. So that's your OATS surface or cellular transplants such as AutoCart. And really my workhorse, which is fresh osteochondral allograft transplantation. I'll take you through a quick case. This is a patient who had multiple defects along his distal femur, two along the medial femoral condyle and one along the trochlea failed non-surgical treatment. I was able to talk to my tissue company. We planned a date. I needed a special graft. An entire distal femoral distal femur, including both condyles and the trochlea. With good coordination, we were able to get a beautiful donor graft, an entire distal femur, and use one donor in a timely fashion to treat this entire patient's knee. Speaker  And he did very well. Another example of how working with your tissue company can be very advantageous for the patient and the surgeon, as illustrated by this case. 40 year old male with pretty damaged patellofemoral compartment, but not quite ready for a partial or total knee replacement yet. We talked about the risks and benefits of doing a biologic approach to joint reconstruction. And in this case, I had to coordinate with the tissue company to get a matching patella and distal femur so that I could do essentially a biologic joint preserving reconstruction. And that's exactly what we did. So we ordered a distal femur plus a patella from the same donor. And we were able to get a beautiful graft for this patient and basically do a biologic joint preservation approach for him. And he also did quite well. So when we think about all of the osteochondral allograft transplantation surgeries that we do, whether it's the complex cases that I just showed you, or more simple cases with a focal defect on the distal femoral condyle, through choosing your allograft and providing the timing of surgery to the tissue bank, you're prepared for success by getting your allograft in a timely fashion. I think it's key to remember that availability of the Allografts is no longer an issue. It's simply a variable, and it's something that can be streamlined through excellent communication and preparation and speaking with your tissue banks.

Planning for Success With Osteochondral Allograft Transplantation

Related Pages

Knee

Cartiform® vitales osteochondrales Allograft

Product

Foot and Ankle

Osteochondrales Allotransplantat

Procedure