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Luk J, Troyer L, Guess TM, Teixeiro E, Stannard JP, Cook JL. Characterizing Osteochondral Allograft Biomechanics for Optimizing Transplant Success: A Systematic Review. J Knee Surg 2024; 37:227-237. [PMID: 36940706 DOI: 10.1055/s-0043-1764403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Osteochondral allograft (OCA) transplantation has been largely successful in treating symptomatic articular cartilage lesions; however, treatment failures persist. While OCA biomechanics have been consistently cited as mechanisms of treatment failure, the relationships among mechanical and biological variables that contribute to success after OCA transplantation have yet to be fully characterized. The purpose of this systematic review was to synthesize the clinically relevant peer-reviewed evidence targeting the biomechanics of OCAs and the impact on graft integration and functional survival toward developing and implementing strategies for improving patient outcomes. The Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Google Scholar, and EMBASE were searched to identify articles for systematic review. This review of relevant peer-reviewed literature provided evidence that the biomechanics related to OCA transplantation in the knee have direct and indirect effects on functional graft survival and patient outcomes. The evidence suggests that biomechanical variables can be optimized further to enhance benefits and mitigate detrimental effects. Each of these modifiable variables should be considered regarding indications, patient selection criteria, graft preservation methodology, graft preparation, transplantation, fixation techniques, and prescribed postoperative restriction and rehabilitation protocols. Criteria, methods, techniques, and protocols should target OCA quality (chondrocyte viability, extracellular matrix integrity, material properties), favorable patient and joint characteristics, rigid fixation with protected loading, and innovative ways to foster rapid and complete OCA cartilage and bone integration to optimize outcomes for OCA transplant patients.
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Affiliation(s)
- Josephine Luk
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Luke Troyer
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Trent M Guess
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Emma Teixeiro
- School of Medicine, University of Missouri, Columbia, Missouri
- University of Missouri, Molecular Microbiology & Immunology, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Kunze KN, Ramkumar PN, Manzi JE, Wright-Chisem J, Nwachukwu BU, Williams RJ. Risk Factors for Failure After Osteochondral Allograft Transplantation of the Knee: A Systematic Review and Exploratory Meta-analysis. Am J Sports Med 2022; 51:1356-1367. [PMID: 35049404 DOI: 10.1177/03635465211063901] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Graft failure after osteochondral allograft transplantation (OCA) of the knee is a devastating outcome, often necessitating subsequent interventions. A comprehensive understanding of the risk factors for failure after OCA of the knee may provide enhanced prognostic data for the knee surgeon and facilitate more informed shared decision-making discussions before surgery. PURPOSE To perform a systematic review and meta-analysis of risk factors associated with graft failure after OCA of the knee. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS The PubMed, Ovid/MEDLINE, and Cochrane databases were queried in April 2021. Data pertaining to study characteristics and risk factors associated with failure after OCA were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs, while mean differences (MDs) were calculated for continuous data. Qualitative analysis was performed to describe risk factors that were variably reported. RESULTS A total of 16 studies consisting of 1401 patients were included. The overall pooled prevalence of failure was 18.9% (range, 10%-46%). There were 44 risk factors identified, of which 9 were explored quantitatively. There was strong evidence to support that the presence of bipolar chondral defects (OR, 4.20 [95% CI, 1.17-15.08]; P = .028) and male sex (OR, 2.04 [95% CI, 1.17-3.55]; P = .012) were significant risk factors for failure after OCA. Older age (MD, 5.06 years [95% CI, 1.44-8.70]; P = .006) and greater body mass index (MD, 1.75 kg/m2 [95% CI, 0.48-3.03]; P = .007) at the time of surgery were also significant risk factors for failure after OCA. There was no statistically significant evidence to incontrovertibly support that concomitant procedures, chondral defect size, and defect location were associated with an increased risk of failure after OCA. CONCLUSION Bipolar chondral defects, male sex, older age, and greater body mass index were significantly associated with an increased failure rate after OCA of the knee. No statistically significant evidence presently exists to support that chondral defect size and location or concomitant procedures are associated with an increased graft failure rate after OCA of the knee. Additional studies are needed to evaluate these associations.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Prem N Ramkumar
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Joshua Wright-Chisem
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Patel K, Salka NS, Ramme A, Scott JC, Grant JA. Does the Symmetry of Patellar Morphology Matter When Matching Osteochondral Allografts for Osteochondral Defects Involving the Central Ridge of the Patella? Cartilage 2021; 13:703S-712S. [PMID: 32819146 PMCID: PMC8804836 DOI: 10.1177/1947603520951624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine if differences in Wiberg classification play a role in the ability of donor patellar osteochondral allografts to match the native patellar surface when treating osteochondral defects of the patellar apex. DESIGN Twenty (10 Wiberg I and 10 Wiberg II/III) human patellae were designated as the recipient. Each recipient was size-matched to both a Wiberg I and a Wiberg II/III patellar donor. A 16-mm circular osteochondral "defect" was created on the central ridge of the recipient patella. The randomly ordered donor Wiberg I or Wiberg II/III plug was harvested from a homologous location and transplanted into the recipient. The recipient was then nano-CT (computed tomography) scanned, digitally reconstructed, registered to the initial nano-CT scan of the recipient patella, and processed to determine root mean squared circumferential step-off heights as well as surface height deviation. The process was then repeated for the other allograft plug. RESULTS There was no significant difference in mean step-off height between matched and unmatched Wiberg plugs; however, there was a statistically significant difference in surface height deviation over the whole surface (0.50 mm and 0.64 mm respectively, P = 0.03). This difference of 0.14 mm is not felt to be clinically significant. Tibial width was correlated to patellar width (r = 0.82) and patellar height (r = 0.68). CONCLUSIONS For osteochondral allograft sizes up to 16 mm there appears to be no advantage to match donor and recipient patellar morphology. Further study is warranted to evaluate defects requiring larger graft sizes.
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Affiliation(s)
- Karan Patel
- Department of Orthopaedic Surgery, Mayo
Clinic, Phoenix, AZ, USA
| | | | | | - Jaron C. Scott
- Department of Orthopaedic Surgery,
University of Michigan, Ann Arbor, MI, USA
| | - John A. Grant
- MedSport, Department of Orthopedic
Surgery, University of Michigan, Ann Arbor, MI, USA,John A. Grant, Department of Orthopedic
Surgery, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor,
MI 48106, USA.
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Huddleston HP, Urita A, Cregar WM, Wolfson TM, Cole BJ, Inoue N, Yanke AB. Overlapping Allografts Provide Superior and More Reliable Surface Topography Matching Than Oblong Allografts: A Computer-Simulated Model Study. Am J Sports Med 2021; 49:1505-1511. [PMID: 33831318 DOI: 10.1177/03635465211003074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral allograft transplantation is 1 treatment option for focal articular cartilage defects of the knee. Large irregular defects, which can be treated using an oblong allograft or multiple overlapping allografts, increase the procedure's technical complexity and may provide suboptimal cartilage and subchondral surface matching between donor grafts and recipient sites. PURPOSE To quantify and compare cartilage and subchondral surface topography mismatch and cartilage step-off for oblong and overlapping allografts using a 3-dimensional simulation model. STUDY DESIGN Controlled laboratory study. METHODS Human cadaveric medial femoral hemicondyles (n = 12) underwent computed tomography and were segmented into cartilage and bone components using 3-dimensional reconstruction and modeling software. Segments were then exported into point-cloud models. Modeled defect sizes of 17 × 30 mm were created on each recipient hemicondyle. There were 2 types of donor allografts from each condyle utilized: overlapping and oblong. Grafts were virtually harvested and implanted to optimally align with the defect to provide minimal cartilage surface topography mismatch. Least mean squares distances were used to measure cartilage and subchondral surface topography mismatch and cartilage step-off. RESULTS Cartilage and subchondral topography mismatch for the overlapping allograft group was 0.27 ± 0.02 mm and 0.80 ± 0.19 mm, respectively. In comparison, the oblong allograft group had significantly increased cartilage (0.62 ± 0.43 mm; P < .001) and subchondral (1.49 ± 1.10 mm; P < .001) mismatch. Cartilage step-off was also found to be significantly increased in the oblong group compared with the overlapping group (P < .001). In addition, overlapping allografts more reliably provided a significantly higher percentage of clinically acceptable (0.5- and 1-mm thresholds) cartilage surface topography matching (overlapping: 100% for both 0.5 and 1 mm; oblong: 90% for 1 mm and 56% for 0.5 mm; P < .001) and cartilage step-off (overlapping: 100% for both 0.5 and 1 mm; oblong: 86% for 1 mm and 12% for 0.5 mm; P < .001). CONCLUSION This computer simulation study demonstrated improved topography matching and decreased cartilage step-off with overlapping osteochondral allografts compared with oblong osteochondral allografts when using grafts from donors that were not matched to the recipient condyle by size or radius of curvature. These findings suggest that overlapping allografts may be superior in treating large, irregular osteochondral defects involving the femoral condyles with regard to technique. CLINICAL RELEVANCE This study suggests that overlapping allografts may provide superior articular cartilage surface topography matching compared with oblong allografts and do so in a more reliable fashion. Surgeons may consider overlapping allografts over oblong allografts because of the increased ease of topography matching during placement.
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Affiliation(s)
| | - Atsushi Urita
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
| | - Nozomu Inoue
- Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Rush University Medical Center, Chicago, Illinois, USA
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Lin KM, Wang D, Burge AJ, Warner T, Jones KJ, Williams RJ. Osteochondral Allograft Transplant of the Patella Using Femoral Condylar Allografts: Response. Orthop J Sports Med 2021; 9:23259671211000096. [PMID: 34019037 PMCID: PMC8114256 DOI: 10.1177/23259671211000096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yanke AB, Huddleston HP, Bodendorfer BM. Osteochondral Allograft Transplant of the Patella Using Femoral Condylar Allografts: Letter to the Editor. Orthop J Sports Med 2021; 9:23259671211000099. [PMID: 34017875 PMCID: PMC8114269 DOI: 10.1177/23259671211000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Markolf KL, Du PZ, McAllister DR. Changes in knee kinematics from applied external Tibial torque: Implications for stabilizing an anterior cruciate ligament deficient knee. Clin Biomech (Bristol, Avon) 2021; 81:105230. [PMID: 33261893 DOI: 10.1016/j.clinbiomech.2020.105230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Changes in knee kinematics from internal tibial torque under tibiofemoral compression force have been studied, but the potentially stabilizing effects of external tibial torque have not been reported. We hypothesized that for a given knee flexion angle, 1) external torque would significantly reduce anterior tibial translation, internal tibial rotation, and valgus tibial rotation before and after sectioning the anterior cruciate ligament and 2) changes in kinematics from applied external torque would be significantly greater with the cruciate cut. METHODS A robotic test system was used to flex intact human knees continuously from 0° to 50° under 200 N compression, without and with 5 Nm external torque. Tests were repeated after cruciate section. FINDINGS With the cruciate intact, external torque had no significant effect on anterior translation, and significantly reduced internal and valgus rotations at all flexion angles. With the cruciate cut, external torque significantly reduced anterior translation beyond 25° flexion, significantly reduced internal rotation at all flexion angles, and significantly reduced valgus rotation beyond 15° flexion. Although external torque had no significant effect on anterior translation with the ACL intact, external torque produced relatively large decreases in anterior translation with the cruciate sectioned (-11.6 mm at 50° flexion). Reductions in valgus rotation from applied external torque were significantly greater for cruciate deficient knees beyond 25° flexion. INTERPRETATION We conclude that external tibial torque may be important for controlling the abnormal kinematics associated with an anterior cruciate ligament deficient knee, and possibly help stabilize the knee during in vivo activities.
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Affiliation(s)
- Keith L Markolf
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Peter Z Du
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Du PZ, Markolf KL, Boguszewski DV, McAllister DR. Femoral Contact Forces in the Anterior Cruciate Ligament Deficient Knee: A Robotic Study. Arthroscopy 2018; 34:3226-3233. [PMID: 30396801 DOI: 10.1016/j.arthro.2018.06.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To measure contact forces (CFs) at standardized locations representative of clinical articular cartilage defects on the medial and lateral femoral condyles during robotic tests with simulated weightbearing knee flexion. METHODS Eleven human knees had 20-mm-diameter cylinders of native bone/cartilage cored from both femoral condyles at standardized locations, with each cylinder attached to a custom-built load cell that maintained the plug in its precise anatomic position. A robotic test system was used to flex the knee from 0° to 50° under 200-N tibiofemoral compression without and with a 2 Nm internal tibial torque, 5 Nm external tibial torque, and 45 N anterior tibial force (AF). CFs and knee kinematics were recorded before and after cutting the anterior cruciate ligament (ACL). RESULTS ACL sectioning did not significantly increase medial or lateral CFs for any loading condition, with the exception of AF, in which increases in medial CF ranged from 38 N (at 15° flexion, P < .01) to 77 N (at 50° flexion, P < .002). Compared with the intact condition, ACL sectioning significantly increased anterior tibial translation by 12.33 mm (at 15° flexion, P < .001) and 17.4 mm (at 50° flexion, P < .001), and increased valgus rotation by 2.4° (at 15° flexion, P < .001) and 3.8° (at 50° flexion, P < .001). CONCLUSIONS Our hypothesis that CF would increase after ACL section was confirmed for the AF test condition only, and only for the medial condyle beyond 10° flexion. With the ACL sectioned, it appeared that the increased CF was owing to the medial condyle riding up over the posterior tibial plateau resulting from the large anterior tibial displacements. CLINICAL RELEVANCE Aside from our limited finding with AF, we concluded that CFs were generally unaffected by ACL section.
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Affiliation(s)
- Peter Z Du
- Department of Orthopaedic Surgery, University of Arizona - Tucson (P.Z.D.), Tucson, Arizona; Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A..
| | - Keith L Markolf
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Daniel V Boguszewski
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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Du PZ, Markolf KL, Levine BD, McAllister DR, Jones KJ. Differences in the Radius of Curvature Between Femoral Condyles: Implications for Osteochondral Allograft Matching. J Bone Joint Surg Am 2018; 100:1326-1331. [PMID: 30063595 DOI: 10.2106/jbjs.17.01509] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The radius of curvature (ROC) is an important variable related to potential cartilage incongruities in the transplantation of a large femoral osteochondral allograft. The anterior-posterior length (APL) of a condyle is used as a criterion for donor-graft acceptance. We hypothesized that there would be a linear correlation between the ROC and APL of a condyle, that the ROC and APL would differ significantly between the medial femoral condyle (MFC) and the lateral femoral condyle (LFC), and that a donor graft from the LFC would be suitable for an MFC defect. METHODS Knee magnetic resonance imaging scans of 147 patients with no cartilage defects were analyzed. Best-fit circles in the sagittal plane were determined at standardized locations on each condyle. Assuming the use of a 20-mm graft that was flush to the edges of the native cartilage, the central graft prominence was calculated for potential donor-host differences in the ROC. RESULTS There was a linear correlation between the ROC and APL. There were significant differences in the mean ROC and APL between the MFC and LFC. Based on calculations of the central graft prominence among all ROC combinations within the patient group, 100% of potential medial-to-medial, 97.8% of lateral-to-lateral, and 92.5% of lateral-to-medial transplantations would produce a central graft prominence of <1 mm. On average, an allograft harvested from an LFC (mean ROC, 25.7 mm; mean APL, 69.8 mm) implanted into an MFC defect site (mean ROC, 31.9 mm; mean APL, 66.6 mm) would have a central graft prominence of 0.4 ± 0.3 mm. CONCLUSIONS Assuming a maximum central graft prominence tolerance of +1 mm, our findings demonstrate that matching the ROC or APL would not be necessary for potential medial-to-medial or lateral-to-lateral allograft transplants within this patient group. Implantation of an LFC donor allograft into an MFC defect is also supported by our findings.
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Affiliation(s)
- Peter Z Du
- New York Medical College School of Medicine, Valhalla, New York
| | - Keith L Markolf
- Departments of Orthopaedic Surgery (K.L.M., D.R.M., and K.J.J.) and Radiology (B.D.L.), David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Benjamin D Levine
- Departments of Orthopaedic Surgery (K.L.M., D.R.M., and K.J.J.) and Radiology (B.D.L.), David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David R McAllister
- Departments of Orthopaedic Surgery (K.L.M., D.R.M., and K.J.J.) and Radiology (B.D.L.), David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kristofer J Jones
- Departments of Orthopaedic Surgery (K.L.M., D.R.M., and K.J.J.) and Radiology (B.D.L.), David Geffen School of Medicine at UCLA, Los Angeles, California
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Du PZ, Markolf KL, Boguszewski DV, Yamaguchi KT, Lama CJ, McAllister DR, Jones KJ. Effects of Proud Large Osteochondral Plugs on Contact Forces and Knee Kinematics: A Robotic Study. Am J Sports Med 2018; 46:2122-2127. [PMID: 29741957 DOI: 10.1177/0363546518770415] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral allograft (OCA) transplantation is used to treat large focal femoral condylar articular cartilage defects. A proud plug could affect graft survival by altering contact forces (CFs) and knee kinematics. HYPOTHESIS A proud OCA plug will significantly increase CF and significantly alter knee kinematics throughout controlled knee flexion. STUDY DESIGN Controlled laboratory study. METHODS Human cadaver knees had miniature load cells, each with a 20-mm-diameter cylinder of native bone/cartilage attached at its exact anatomic position, installed in both femoral condyles at standardized locations representative of clinical defects. Spacers were inserted to create proud plug conditions of +0.5, +1.0, and +1.5 mm. CFs and knee kinematics were recorded as a robot flexed the knee continuously from 0° to 50° under 1000 N of tibiofemoral compression. RESULTS CFs were increased significantly (vs flush) for all proudness conditions between 0° and 45° of flexion (medial) and 0° to 50° of flexion (lateral). At 20°, the average increases in medial CF for +0.5-mm, +1-mm, and +1.5-mm proudness were +80 N (+36%), +155 N (+70%), and +193 N (+87%), respectively. Corresponding increases with proud lateral plugs were +44 N (+14%), +90 N (+29%), and +118 N (+38%). CF increases for medial plugs at 20° of flexion were significantly greater than those for lateral plugs at all proudness conditions. At 50°, a 1-mm proud lateral plug significantly decreased internal tibial rotation by 15.4° and decreased valgus rotation by 2.5°. CONCLUSION A proud medial or lateral plug significantly increased CF between 0° and 45° of flexion. Our results suggest that a medial plug at 20° may be more sensitive to graft incongruity than a lateral plug. The changes in rotational kinematics with proud lateral plugs were attributed to earlier contact between the proud plug's surface and the lateral meniscus, leading to rim impingement with decreased tibial rotation. CLINICAL RELEVANCE Increased CF and altered knee kinematics from a proud femoral plug could affect graft viability. Plug proudness of only 0.5 mm produced significant changes in CF and knee kinematics, and the clinically accepted 1-mm tolerance may need to be reexamined in view of our findings.
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Affiliation(s)
- Peter Z Du
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Keith L Markolf
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Daniel V Boguszewski
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kent T Yamaguchi
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christopher J Lama
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kristofer J Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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