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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2015; 6(3): 340-350
Published online Apr 18, 2015. doi: 10.5312/wjo.v6.i3.340
Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts
Karen Chui, Lee Jeys, Martyn Snow
Karen Chui, Lee Jeys, Martyn Snow, the Royal Orthopaedic Hospital, Northfield, Birmingham B31 2AP, United Kingdom
Author contributions: Chui K, Jeys L and Snow M contributed to the manuscript.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Martyn Snow, the Royal Orthopaedic Hospital, Northfield, Birmingham B31 2AP, United Kingdom. snowmartyn@gmail.com
Telephone: +44-121-6854000
Received: September 29, 2014
Peer-review started: September 29, 2014
First decision: October 14, 2014
Revised: December 14, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: April 18, 2015
Processing time: 191 Days and 8 Hours
Abstract

The overall incidence of osteochondral defect in the general population is estimated to be 15 to 30 per 100000 people. These lesions can become symptomatic causing pain, swelling and decreased function of the knee, and may eventually progress to osteoarthritis. In the young and active population, partial or total knee arthroplasty (TKA) is rarely the treatment of choice due to risk of early failure. Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients. The treatment reduces pain, improves function and is a viable limb salvage procedure for patients, especially young and active patients for whom TKA is not recommended. Either large dowels generated with commercially available equipment or free hand shell allografts can be implanted in more posterior lesions. Current recommendations for fresh allografts stored at 4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability, following screening and testing protocols. Higher rates of successful allograft transplantation are observed in younger patients, unipolar lesions, normal or corrected malalignment, and defects that are treated within 12 mo of symptom onset. Patients with bipolar lesions, uncorrectable malalignment, advanced osteoarthritis, and those over 40 tend to have less favourable outcomes.

Keywords: Osteochondral allograft; Knee; Salvage; Shell; Dowel

Core tip: Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients. The treatment reduces pain, improves function and is a viable limb salvage procedure for patients, especially young and active patients for whom total knee arthroplasty is not recommended. Current recommendations for fresh allografts stored at 4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability, following screening and testing protocols. Higher rates of successful allograft transplantation are observed in younger patients, unipolar lesions, normal or corrected malalignment, and defects that are treated within 12 mo of symptom onset.