Editorial Commentary: Osteochondral Allografts Are an Effective Treatment for Large Osteochondral Lesions
Abstract: Osteochondral (OC) allografts are an effective treatment for large OC lesions. OC allografts are hyaline. Allograft limitations and OC graft limitations are well known. Five year survivorship is similar to autologous chondrocyte implantation.
See related article on page 757
he commentary1 on the review by Lynch et al.2 regarding osteochondral (OC) autografts in this issue also relates to “Large fresh osteochondral allografts of the knee: A systematic clinical and basic science review of the literature,”3 by De Caro, Bisicchia, Amendola, and Lei Ding from Parma, Rome, and Iowa City. OC autograft versus allograft? Both are hyaline, and therefore maintain the miraculous microstructure of articular cartilage. Both have limitations. Allografts solve the dilemma of large defects. Survivorship at 5year follow-up is similar to autologous chondrocyte implantation as reported by Kon et al.4 Durability at 20 years is reported in a single study, and is approximately 60% at 20 years follow-up,5 and to put this in context, readers remember last month that abrasion arthroplasty was shown to result in approximately 66% survivorship at 20 years.6 Regarding OC allograft, De Caro et al. conclude with confidence that, “No other effective treatment exists at the moment for large osteochondral lesions.” Letters to the Editor, by experts who disagree that no other effective treatment exists for large lesions, could be expected, but if the defect is truly osseous as well as chondral, De Caro et al. may be correct.
T
James H. Lubowitz, M.D. Editor-in-Chief
References 1. Lubowitz JH. Editorial commentary. Osteoarticular transplant outcomes may deteriorate over time. Arthroscopy 2015;31:755-756. 2. Lynch TS, Patel RM, Benedick A, Amin NH, Jones MH, Miniaci A. Systematic review of autogenous osteochondral transplant outcomes. Arthroscopy 2015;31:746-754. 3. De Caro F, Bisicchia S, Amendola A, Ding L. Large fresh osteochondral allografts of the knee: A systematic clinical and basic science review of the literature. Arthroscopy 2015;31:757-765. 4. Kon E, Roffi A, Filardo G, Tesei G, Marcacci M. Scaffoldbased cartilage treatments: With or without cells? A systematic review of preclinical and clinical evidence. Arthroscopy 2015;31:767-775. 5. Levy YD, Görtz S, Pulido PA, McCauley JC, Bugbee WD. Do fresh osteochondral allografts successfully treat femoral condyle lesions? Clin Orthop Relat Res 2013;471:231-237. 6. Sansone V, de Girolamo L, Pascale W, Melato M, Pascale V. Long-term results of abrasion arthroplasty for fullthickness cartilage lesions of the medial femoral condyle. Arthroscopy 2015;31:396-403.
Ó 2015 by the Arthroscopy Association of North America 0749-8063/15144/$36.00 http://dx.doi.org/10.1016/j.arthro.2015.02.013
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Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 31, No 4 (April), 2015: p 766
Abstract: Osteochondral (OC) allografts are an effective treatment for large OC lesions. OC allografts are hyaline. Allograft limitations and OC graft limitations are well known. Five year survivorship is similar to autologous chondrocyte implantation.
See related article on page 757
he commentary1 on the review by Lynch et al.2 regarding osteochondral (OC) autografts in this issue also relates to “Large fresh osteochondral allografts of the knee: A systematic clinical and basic science review of the literature,”3 by De Caro, Bisicchia, Amendola, and Lei Ding from Parma, Rome, and Iowa City. OC autograft versus allograft? Both are hyaline, and therefore maintain the miraculous microstructure of articular cartilage. Both have limitations. Allografts solve the dilemma of large defects. Survivorship at 5year follow-up is similar to autologous chondrocyte implantation as reported by Kon et al.4 Durability at 20 years is reported in a single study, and is approximately 60% at 20 years follow-up,5 and to put this in context, readers remember last month that abrasion arthroplasty was shown to result in approximately 66% survivorship at 20 years.6 Regarding OC allograft, De Caro et al. conclude with confidence that, “No other effective treatment exists at the moment for large osteochondral lesions.” Letters to the Editor, by experts who disagree that no other effective treatment exists for large lesions, could be expected, but if the defect is truly osseous as well as chondral, De Caro et al. may be correct.
T
James H. Lubowitz, M.D. Editor-in-Chief
References 1. Lubowitz JH. Editorial commentary. Osteoarticular transplant outcomes may deteriorate over time. Arthroscopy 2015;31:755-756. 2. Lynch TS, Patel RM, Benedick A, Amin NH, Jones MH, Miniaci A. Systematic review of autogenous osteochondral transplant outcomes. Arthroscopy 2015;31:746-754. 3. De Caro F, Bisicchia S, Amendola A, Ding L. Large fresh osteochondral allografts of the knee: A systematic clinical and basic science review of the literature. Arthroscopy 2015;31:757-765. 4. Kon E, Roffi A, Filardo G, Tesei G, Marcacci M. Scaffoldbased cartilage treatments: With or without cells? A systematic review of preclinical and clinical evidence. Arthroscopy 2015;31:767-775. 5. Levy YD, Görtz S, Pulido PA, McCauley JC, Bugbee WD. Do fresh osteochondral allografts successfully treat femoral condyle lesions? Clin Orthop Relat Res 2013;471:231-237. 6. Sansone V, de Girolamo L, Pascale W, Melato M, Pascale V. Long-term results of abrasion arthroplasty for fullthickness cartilage lesions of the medial femoral condyle. Arthroscopy 2015;31:396-403.
Ó 2015 by the Arthroscopy Association of North America 0749-8063/15144/$36.00 http://dx.doi.org/10.1016/j.arthro.2015.02.013
766
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 31, No 4 (April), 2015: p 766
