Long-term clinical experience with fresh osteochondral allografts for articular knee defects in high demand patients

Fresh osteochondral allografts are used to repair osteoarticular defects of the knee. For post-traumatic defects recent advances in other techniques for cartilage repair and resurfacing have reduced the role of allograft tissue transplantation to defects larger than 3 cm in diameter and 1 cm in depth.A fresh osteochondral allograft that has been harvested from a donor within 24 h from death and preserved in 4 degrees C for up to 4 days shows 100% viability of the cartilage. The avascular bone remains structurally intact and mechanically strong until it is replaced by host bone or until it is weakened or absorbed. The indications for fresh osteochondral allografts for reconstructive surgery of the articular surface of the knee do not justify the use of immunosuppressive drugs and we therefore believe that surgical vascularization of the grafts should not be carried out.This clinical approach can provide a reconstructive solution for younger higher demand patients where implants are not desirable and arthrodesis is not acceptable. A clinical follow-up study as early as 1975 showed successful early outcomes. More recently, survival analysis found 95% survival at 5 years, 71% at 10 years, and 66% at 20 years. It was learned that older patients, bipolar transplants, improper loading of the graft, and grafts for osteoarthritis and steroid-induced avascular necrosis do not lead to good long-term outcomes.We would like to describe here some of our long-term clinical experience concerning this surgery.