Fresh osteochondral allografting of the femoral condyle

Fresh osteochondral shell allografting is conceived as an interim response to the localized loss of articular cartilage in young patients for whom there is no reasonable alternative after conservative procedures have failed. The concept is not new and has been investigated extensively in in vivo animal investigations. The functional and anatomic results of these studies, however, have been consistently unsatisfactory because of technical deficiencies and supposed immunogenic responses. The results of early clinical studies were variable, and despite more recent clinical work, the procedure has been considered at least investigational by some. The purpose of this study is to retrospectively review a series of patients treated with osteochondral allografting of the femoral condyle with particular emphasis on those done more than five years ago. No tissue-typing blood-group matching or gender distinction was made and immunosuppressant agents were not used. Size matching of the donor and recipient were essential to provide an orthotopic graft. Twelve knees were operated on more than five years ago. Of these twelve, three are not available for review. Nine knees have been observed for an average of 66 months and eight are rated good or excellent by a standardized rating scale. One knee rated poor seems to be the result of a technical deficiency. Since 1983, 37 fresh osteochondral allografts of the femoral condyle have been performed in 36 patients. Twenty-five of these have been performed in the last five years and the results to date are summarized.