Osteochondral Allograft

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  • Symptomatic focal chondral lesion
  • Unipolar lesion
  • Lesion larger than 2.5 cm in diameter
  • Normal appearing surrounding articular cartilage
  • Age less than 45 years
  • Age over 45 years (relative contraindication)
  • Obvious chondromalacia of the surrounding cartilage
  • Abnormal mechanical alignment
  • Ligamentous instability of the knee
  • Mega-OATS set
  • Fresh allograft femoral condyle or hemicondyle
  • Drill
  • Ruler
  • Oscillating saw
  • Workstation and back table for allograft preparation
  • Mallet
  • Bony anatomy of the knee:
    • Distal femur: most common site of defects; larger medial condyle, smaller lateral condyle
    • Tibial plateau: concave, oval medial surface; convex, circular lateral surface
    • Patella: large sesamoid bone that articulates with the trochlea; chondral defects from direct anterior trauma
  • Articular cartilage: composed primarily of water, collagen, proteoglycans, and chondrocytes; layers include a superficial gliding zone, a middle transitional zone, and a deep radial zone.
  • Cortical bone (compact bone) and cancellous bone (spongy or trabecular bone) are found deep to the articular cartilage.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
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  • Immobilize the knee and allow only partial weight-bearing for 4 to 6 weeks.
  • Prescribe oral pain medication as needed.
  • Begin isometric quadriceps strengthening immediately with progression of weight-bearing exercise after 6 weeks.
  • Infection
  • Failure of graft to incorporate
  • Disease transmission from allograft tissue.
  • Continued symptoms
  • Vascular injury
  • Thrombophlebitis
  • Reflex sympathetic dystrophy
  • Neurologic injury

Osteochondral allograft transplantation has generally been found to be a successful salvage operation for large (greater than 2.5 cm) focal osteochondral defects of the knee with improvement in subjective scores in approximately 70% of patients.

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