Sage Journals: Discover world-class research

Abstract

Background:

Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results.

Purpose:

To comprehensively analyze the characteristics and clinical outcomes of OCA for treating articular cartilage defects.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

We searched Embase, PubMed, Cochrane Database, and Web of Science for studies published between January 1, 2001, and December 31, 2020, on OCA for treating articular cartilage defects. Publication information, patient data, osteochondral allograft storage details, and clinical outcomes were extracted to conduct a comprehensive summative analysis.

Results:

In total, 105 studies involving 5952 patients were included. The annual reported number of patients treated with OCA increased from 69 in 2001 to 1065 in 2020, peaking at 1504 cases in 2018. Most studies (90.1%) were performed in the United States. The mean age at surgery was 34.2 years, and 60.8% of patients were male and had a mean body mass index of 26.7 kg/m². The mean lesion area was 5.05 cm², the mean follow-up duration was 54.39 months, the mean graft size was 6.85 cm², and the number of grafts per patient was 54.7. The failure rate after OCA was 18.8%, and 83.1% of patients reported satisfactory results. Allograft survival rates at 2, 5, 10, 15, 20, and 25 years were 94%, 87.9%, 80%, 73%, 55%, and 59.4%, respectively. OCA was mainly performed on the knee (88.9%). The most common diagnosis in the knee was osteochondritis dissecans (37.9%), and the most common defect location was the medial femoral condyle (52%). The most common concomitant procedures were high tibial osteotomy (28.4%) and meniscal allograft transplantation (24.7%). After OCA failure, 54.7% of patients underwent revision with primary total knee arthroplasty.

Conclusion:

The annual reported number of patients who underwent OCA showed a significant upward trend, especially from 2016 to 2020. Patients receiving OCA were predominantly young male adults with a high body mass index. OCA was more established for knee cartilage than an injury at other sites, and its best indication was osteochondritis dissecans. This analysis demonstrated satisfactory long-term postoperative outcomes.

Keywords

osteochondral allograft transplantation articular cartilage defect cartilage repair systematic review

Articular cartilage covers the ends of the connected bones in joints. It lubricates the joint surface, reducing the joint surface friction and buffering against shocks and impacts during movement.²³ Articular cartilage lacks nerves and a vascular supply; therefore, its nutrition is supplied by the synovial fluid and arterial branches around the synovial membrane layer of the articular capsule.^31,33,106 Once the articular cartilage is damaged or degraded, its capacity to repair and heal is limited.^114,120,121 Articular cartilage defects can be caused by various causes, such as trauma, degeneration, avascular necrosis, osteochondritis dissecans, or osteoarthritis.⁸⁶ Studies have shown the prevalence of cartilage damage to be as high as 66%,¹²³ leading to a range of symptoms including swelling, pain, and limited mobility.^28,94 Cartilage damage may eventually lead to accelerated cartilage wear, increased pain, impaired joint stability, and further development into diffuse osteoarthritis, with ultimate loss of joint function.^46,62,86,99 At the same time, unstable injuries may cause progressive degeneration of the surrounding normal cartilage due to load transfer.²⁸ Since articular cartilage has limited inherent capacity for spontaneous healing after injury, symptomatic articular cartilage defects benefit from cartilage repair treatment. Therefore, it is necessary to study patients undergoing cartilage repair therapy with symptomatic articular cartilage injuries.

To delay the progression of osteoarthritis and obviate the implementation of arthroplasty, an appropriate cartilage repair protocol can be selected according to the characteristics of the cartilage injury.⁹⁴ Traditionally, surgical methods for treating cartilage injuries can be divided into palliative, reparative, and restorative treatments. Palliative treatments include chondral debridement and chondroplasty. Reparative and restorative treatments include marrow stimulation techniques (MSTs; subchondral drilling and microfracture), autologous chondrocyte implantation (ACI), osteochondral autograft transfer (OAT), and osteochondral allograft transplantation (OCA).^46,62,86 Although many factors should be considered in selecting appropriate cartilage repair surgery, research has shown that a small area of cartilage damage is more suitable for MST and OAT. In addition, the treatment effect was even more satisfactory than that of other cartilage repair surgery. In contrast, large cartilage defects >4 cm² are more suitable for ACI or OCA treatment.^86,94

OCA is a restorative cartilage procedure for symptomatic focal cartilage defects that involves transplanting surviving mature hyaline cartilage and supporting subchondral bone into the area of the cartilage defect.^20,75,93,108 As a well-developed, single-stage restorative cartilage procedure, OCA has increasingly become the preferred treatment after cartilage repair surgery failures. OCA has many advantages compared with other cartilage repair techniques, such as simultaneously repairing the cartilage and subchondral bone, treating large or multisite cartilage defects, and supporting early weightbearing.^46,108 Two studies have shown satisfactory long-term clinical results after OCA, with allograft survival rates at 10 to 25 years postoperatively as high as 59% to 91%.^86,136

The extensive application of OCA has rendered it 1 of the most common cartilage repair procedures in the United States.⁷⁵ However, the availability of allograft is limited because of the scarcity of donor grafts and duration of graft preservation.^48,116,119 Furthermore, there have not been any studies describing the use of OCA at different locations and the demographic data of patients undergoing this procedure. Therefore, we aimed to conduct a comprehensive systematic review and single-arm meta-analysis of the characteristics and clinical outcomes of OCA in treating articular cartilage defects over the past 2 decades (2001-2020) to better understand its research status in different countries, clarify the trends and clinical results of OCA in different sites, and provide clarification and data support for the clinical application of OCA.

Methods

Search Strategy

A comprehensive systematic literature search was completed per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.¹⁰⁵ The literature retrieval was conducted in October 2021 using the Embase, PubMed, Cochrane Database, and Web of Science databases for all the relevant English articles. The following search terms were used: (“osteochondral” or “cartilage” or “cartilages”) and (“allograft” or “allogeneic transplants” or “allogeneic transplant” or “transplant, allogeneic” or “transplants, allogeneic” or “allogeneic grafts” or “allogeneic graft” or “graft, allogeneic” or “grafts, allogeneic” or “homografts” or “homograft” or “homologous transplants” or “homologous transplant” or “transplant, homologous” or “transplants, homologous”). We searched the publication date range from January 1, 2001, to December 31, 2020.

Study Selection

The obtained studies were screened and selected using the following inclusion criteria: (1) the participants included were patients of all ages with a definite diagnosis of osteochondral injury, (2) all publicly published clinical studies were written in English and involved OCA for cartilage defects, and (3) the patients were evaluated at minimum 2-year follow-up. The exclusion criteria were as follows: (1) revision OCA procedures; (2) chondral defects treated with particulate juvenile articular allograft cartilage; and; (3) duplicate articles, literature reviews, meta-analyses, case reports, technical notes, editorial commentaries, expert consensus statements, conference abstracts and presentations, animal studies, biomechanical studies, and other nonclinical studies.

The references for all included studies were assessed and screened to ensure integrity and thoroughness. Two authors (X.W. and Z.R.) independently reviewed the literature to determine the final inclusion criteria, and any disagreements were resolved between them or discussed with a third author (W.D.).

Data Extraction

All relevant study data were extracted by 2 independent reviewers (X.W. and Y.L.). The extracted data included publication information, sample size, patient characteristics (mean age, sex, mean body mass index (BMI), smoking, mean symptom duration, mean follow-up time), defect size and location, size and number of grafts, storage details of osteochondral allografts, mechanism of injury, previous and concomitant surgeries, failures, reoperations, survival of grafts, and satisfaction. Allograft failure was defined as the removal or revision of the primary OCA, conversion to any arthroplasty, or gross appearance of graft failure on second-look arthroscopy.^39,46,91,93 Any inconsistencies were discussed or resolved with a third author (W.D.).

Statistical Analysis

All extracted data were analyzed using SPSS (Version 19.0; IBM) and Stata/SE 12.0 (StataCorp). Continuous variable data were reported as means and standard deviations, whereas categorical variable data were reported as frequencies and percentages. If partial continuous variables were raw data, the calculation was converted into means and standard deviations to summarize the results consistently. If the mean or standard deviation was not given, it was calculated from the median, minimum, and maximum values.^64,134 Continuous variables were pooled by calculating the mean and 95% CIs, and dichotomous variables were pooled by calculating the proportion and 95% CI. The I² statistic was used to measure the heterogeneity among the included studies. The statistical heterogeneity between the studies was considered low, medium, and high when the I² thresholds were <25%, 25-75%, and >75%, respectively. The pooled analysis results were deemed statistically significant at P < .05.

Results

Search Results

A total of 1389 relevant articles were identified using the electronic database and search strategy. Of these, 798 were excluded after removing duplicates, and 591 articles remained for screening. Of these, 469 were excluded based on the exclusion criteria. We closely reviewed the full texts of the remaining 122 articles, of which 17 were excluded, leaving 105 studies^§ included in this review (Figure 1).

Figure 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of study inclusion.

Overall Characteristics and Clinical Outcomes of OCA

Temporal Trends and Country and Injury Site Distributions

The 105 studies included a total of 5952 patients. The annual reported number of patients treated with OCA showed a significant upward trend, from 69 patients in 2001 to 1065 cases in 2020, peaking in 2018 with 1504 cases. No cases were reported in 2002, 2003, and 2006 (Figure 2A). The country distribution of OCA procedures is summarized in Figure 2B. These studies were conducted in 8 countries, the majority of which were performed in the United States (90.12%), followed by Canada (6.23%). The most common location OCA was performed was the knee (88.9%), followed by the ankle (9.73%), shoulder (0.66%), hip (0.59%), and elbow (0.15%) (Figure 2C).

Figure 2.

Overall temporal trends, country and injury site distribution of osteochondral allograft transplantation. (A) Annual number of cases reported in studies. (B) The proportion and number of cases reported in studies in different countries. (C) The proportion and number of cases reported in studies in different injury sites.

Patient Characteristics

The characteristics of the patients are summarized in Table 1. The mean age of the patients at the time of surgery was 34.2 years. Most of the patients were male (60.8%). The mean BMI was 26.7 kg/m², and 21.1% of the patients were smokers. Right-sided surgery accounted for 53% of all patients. The mean lesion area was estimated at 5.05 cm². The mean symptom duration was 38.0 months, and the mean follow-up duration was 54.4 months. Most patients (77.4%) underwent ≥1 operation at the same surgical site before OCA surgery. The affected joints underwent a mean of 1.93 procedures before OCA surgery. OCA was performed alone in most patients (60.1%).

Table 1

Characteristics of the Patients in the Included Studies (N = 5952)

Characteristic	Patients, n	Mean or Proportion (95% CI)	P	I², %
Age, y	5938	34.2 (32.3-36.0)	<.001	98.8
Sex, %
Male	5854	60.8 (58.2-63.4)	<.001	74.9
Female	5854	39.2 (36.6-41.8)	<.001	74.9
Body mass index, kg/m²	4320	26.7 (26.4-27.1)	<.001	85.5
Smoker, %	1149	21.1 (13.4-28.9)	<.001	92.3
Side affected, %
Left	1108	47.0 (43.7-50.2)	.221	15
Right	1108	53.0 (49.8-56.3)	.221	15
Defect size, cm²	1872	5.05 (4.45-5.64)	<.001	98.9
Symptom duration, mo	419	38.0 (28.6-47.3)	<.001	96.6
Time to follow-up, mo	4268	54.4 (50.1-58.7)	<.001	99.6
Previous procedure on affected joint, %	2717	77.4 (73.0-81.7)	<.001	90.7
No. of previous surgeries	2788	1.93 (1.75-2.1)	<.001	91.7
Concomitant procedure, %	3318	39.9 (33.9-45.8)	<.001	93.7

Allograft Characteristics

The graft size was reported in 27 studies^‖ (n = 2244), with a mean graft size of 6.85 cm² (95% CI, 6.16-7.54 cm²). The mean number of grafts used per patient was 1.49 (95% CI, 1.41-1.57) in the 2655 patients reported. Additionally, 57 studies^¶ (n = 2648) mentioned allograft storage temperatures; 40 studies^# (n = 2026) indicated a preservation temperature of 4°C, 4 studies^6,7,57,103 (n = 47) mentioned temperatures between 2°C and 4°C, and 9 studies^{12,104,109,135,137-141} (n = 524) described cold storage. Only 3 studies^63,144,145 (n = 36) used freezing for osteochondral allograft preservation. Furthermore, the details of the storage solution and type of media were examined in 18 studies.^** Seven studies^{1,11,55,72,73,78,110} (n = 325) from Canada reported that osteochondral allografts were stored in Ringer’s lactate solution containing 1 g cefazoline and 50,000 units bacitracin per liter. Four studies^15,79,88,115 (n = 238) from the United States reported that grafts were stored in Ringer’s lactate solution containing 1 g/L cefazolin and 10 g/mL gentamicin. Four studies^42-45 (n = 113) from Italy reported that grafts were immersed in a solution containing l-glutamine, sodium bicarbonate, and antibiotics. Modified Eagle’s medium with different nutrients was included in 3 studies^47,67,142 (n = 45). Among 54 studies^†† mentioning graft preservation duration, except for 3 studies^100,109,142 indicating that the maximum graft preservation duration was 34, 35, and 42 days, all other studies used grafts for <30 days, most of which were between 2 and 4 weeks.

Overall Clinical Outcomes of OCA

In 68 studies^‡‡ (n = 4355) that discussed failure rates, 18.8% of patients had a failed OCA. In total, 35.5% of 3094 patients returned to the operating room at least once for further treatment. The mean time to failure was 4.48 years (Table 2). The Kaplan-Meier survival analysis demonstrated an allograft survival rate of 94% (95% CI, 90.4%-97.5%) of 259 patients 2 years post-transplantation, 87.9% (95% CI, 85.4%-90.5%) of 2114 patients at 5 years, 80% (95% CI, 75.4%-84.6%) of 1860 patients at 10 years, 73% (95% CI, 68.1%-77.9%) of 639 patients at 15 years, 55% (95% CI, 41.3%-68.7%) of 387 patients at 20 years, and 59.4% (95% CI, 50.5%-68.3%) of 118 patients at 25 years (Figure 3A). A total of 33 studies^§§ (n = 2355) had available data regarding patient satisfaction with the results of the OCA procedure. Overall, 83.1% of patients reported being somewhat satisfied with the OCA results (Table 2). Overall trends for annual failures, reoperations, and satisfaction of patients treated with OCA showed no significant trend from 2001 to 2020 (Figure 3, B-D).

Table 2

Overall Clinical Outcomes of OCA^a

Characteristic	Patients, n	Mean or Proportion (95% CI)	P	I², %
Failure rate, %	4355	18.8 (16.3-21.3)	<.001	81.6
Time to failure, y	2825	4.48 (3.9-5.0)	<.001	99.5
Reoperation rate, %	3094	35.5 (32.5-38.4)	<.001	65.9
Patient satisfaction, %	2355	83.1 (79.7-86.4)	<.001	84.8

OCA, osteochondral allograft transplantation.

Figure 3.

Annual clinical outcomes and variation trends of osteochondral allograft transplantation. (A) Trends in graft survival at 2, 5, 10, 15, 20, and 25 years after transplantation. (B) Annual failure rate and its trends after transplantation. (C) Annual reoperation rate and its trends after transplantation. (D) Annual satisfaction rate and its trends after transplantation. The value of 0 only represents that no relevant study reported the result in that year.

OCA of the Knee

Patient Characteristics and Allograft Details of Knee OCA

Overall, 74 studies^{‖ ‖} reported 5290 patients who underwent knee OCA surgery. The mean age of the patients at the time of surgery was 33.7 years. Most patients were male (60.6%). The patients’ mean BMI was 26.7 kg/m², and the mean lesion area was estimated at 4.81 mm². The mean symptom duration was 28.2 months, and the mean follow-up duration was 58.4 months. Graft size was reported in 25 studies^¶¶ (n = 2213), with a mean graft size of 7.07 cm². The mean number of grafts per patient was 1.51 in 2630 patients (Table 3). The most common diagnosis that led to OCA treatment was osteochondral dissecans (37.9%), followed by focal degeneration (22.7%) and acute trauma (20.7%) (Figure 4A).

Table 3

Patient Characteristics and Allograft Details of Knee OCA^a

Characteristic	Patients, n	Mean or Proportion (95% CI)	P	I², %
Age, y	5276	33.7 (31.6-35.8)	<.001	98.8
Sex, %
Male	5210	60.6 (57.7-63.5)	<.001	77.5
Female	5210	39.4 (36.7-42.3)	<.001	77.5
Body mass index, kg/m²	4240	26.7 (26.3-27.1)	<.001	85.6
Smoker, %	1093	18.5 (10.1-26.9)	<.001	94.1
Side affected, %
Left	886	47.0 (43.8-50.3)	.641	0
Right	886	53.0 (49.7-56.2)	.641	0
Defect size, cm²	1732	4.81 (4.42-5.19)	<.001	95.3
Graft size, cm²	2213	7.07 (6.34-7.81)	<.001	97.1
No. of grafts	2630	1.51 (1.4-1.6)	<.001	92.5
Symptom duration, mo	353	28.2 (18.7-37.7)	<.001	96.4
Time to follow-up, mo	3658	58.4 (53.3-63.5)	<.001	99.7
Previous procedure on affected joint, %	2685	77.3 (72.9-81.6)	<.001	91.0
No. of previous surgeries	2690	1.96 (1.78-2.15)	<.001	92.3
Concomitant procedure, %	3194	39.6 (33.5-45.7)	<.001	93.8

OCA, osteochondral allograft transplantation.

Figure 4.

Classifications of knee surgery and specific defect sites in the knee and ankle. (A) The proportion and number of cases reported in studies for etiology of osteochondral allograft transplantation (OCA) performed on the knee. (B) The distribution and number of cases reported in studies for defect location in the knee. (C) The distribution and number of cases reported in studies for defect location in the ankle. LFC, lateral femoral condyle; MFC, medial femoral condyle.

The most common defect location was the medial femoral condyle (52%), followed by the lateral femoral condyle (27.5%), trochlea (6.9%), patella (6.9%), and tibial plateau (6.8%) (Figure 4B). Most patients (77.3%) underwent a mean of 1.96 procedures on the same knee before OCA surgery (Table 3). The surgical procedures included MST (27%), chondral debridement (17.1%), open reduction and internal fixation (12.2%), loose body removal (9.5%), meniscectomy (7.8%), ligament reconstruction (4.1%), osteotomy (3.9%), meniscal repair (2.9%), chondroplasty (2.4%), ACI (2.2%), OAT (1.7%), OCA (1.7%), hardware removal (1.7%), and others (5.8%) (Table 4).

Table 4

Types of Operations Performed Before Knee OCA (n = 1784)^a

Previous Procedure	Patients, n
MST	481
Chondral debridement	305
ORIF	218
Removal of loose bodies	169
Meniscectomy	139
Ligament reconstruction	74
Osteotomy	69
Meniscal repair	52
Chondroplasty	43
ACI	39
OAT	30
OCA	30
Removal of hardware	31
Other^b	104

ACI, autologous chondrocyte implantation; MST, marrow stimulation technique; OAT, osteochondral autograft transfer; OCA, osteochondral allograft transplantation; ORIF, open reduction and internal fixation.

Irrigation and debridement, n = 2; cartilage biopsy, 3; trochleoplasty, 1; arthroplasty, 1; bone allograft, 5; mosaicplasty, 2; synthetic scaffold, 12; meniscal allograft transplantation, 26; ligament repair, 6; lateral release, 9; lysis of adhesions, 7; bone grafting, 10; extensor mechanism surgery, 15; external fixation, 1; external fixation and fasciotomy, 1; incision and drainage, 1; incision and drainage of abscess, 1; partial patellectomy, 1.

The most common concomitant procedures were high tibial osteotomy (HTO; 29.4%) and meniscal allograft transplantation (MAT; 25.6%), followed by distal femoral osteotomy (7.9%), tibial tubercle osteotomy (7.0%), ligament reconstruction (7.7%), meniscectomy (6.2%), hardware removal (3.4%), lateral release (3.0%), loose body removal (2.6%), arthroscopy (2.6%), and others (5.7%) (Table 5).

Table 5

Procedures Concomitant to Knee OCA (n = 1048)^a

Concomitant Procedure	Patients, n
HTO	308
MAT	268
DFO	83
TTO	73
Ligament reconstruction	70
Meniscectomy	65
Removal of hardware	36
Lateral release	31
Removal of loose bodies	27
Arthroscopy	27
Other^b	60

DFO, distal femoral osteotomy; HTO, high tibial osteotomy; MAT, meniscal allograft transplantation; OCA, osteochondral allograft transplantation; TTO, tibial tubercle osteotomy.

microfracture, n = 19; realignment osteotomy, 11; anteromedialization, 6; meniscal repair, 5; trochleoplasty, 5; marrow stimulation technique, 3; proximal patellofemoral realignment, 3; anterior release, 2; epiphysiodesis, 2; debridement, 1; posterolateral corner reconstruction, 1; synovectomy, 1; lateral imbrication, 1.

Clinical Outcomes of Knee OCA

According to our analysis, 16.8% of patients failed after OCA of the knee in the 49 included studies (n = 3849); the mean time to failure was 4.53 years (Table 6). Of all failures (n = 472), 258 patients (54.7%) underwent total knee arthroplasty, 133 (28.2%) underwent revision OCA, and 39 (8.3%) underwent unicompartmental knee arthroplasty (Table 7). In total, 35.2% of 2843 patients returned to the operating room at least once. The Kaplan-Meier survival analysis demonstrated an allograft survivorship of 94% (95% CI, 90.4%-97.5%) of 259 patients at 2 years after transplantation, 89% of 1923 patients at 5 years (95% CI, 86.6%-91.5%), 83.4% of 1621 patients at 10 years (95% CI, 79.6%-87.2%), 73% of 639 patients at 15 years (95% CI, 68.1%-77.9%), 55% of 387 patients at 20 years (95% CI, 41.3%-68.7%), and 59.4% of 118 patients at 25 years (95% CI, 50.5%-68.3%). A total of 23 studies (n = 1990) had patient satisfaction data regarding the results of the knee OCA procedure; 84.7% of patients reported being at least somewhat satisfied with the results of knee OCA (Table 6).

Table 6

Clinical Outcomes of Knee OCA^a

Characteristic	Patients, n	Mean or Proportion (95% CI)	P	I², %
Failure rate, %	3849	16.8 (14.3-19.4)	<.001	81.6
Time to failure, y	2598	4.53 (3.87-5.18)	<.001	99.6
Reoperation rate, %	2843	35.2 (32.2-38.3)	<.001	64.2
Patient satisfaction, %	1990	84.7 (81.1-88.3)	<.001	85.3

OCA, osteochondral allograft transplantation.

Table 7

Reoperations in Knee After OCA Failure (n = 472)^a

Procedure	Patients, n
TKA	258
Revision OCA	133
UKA	39
Chondroplasty	12
Graft removal	9
Patellofemoral arthroplasty	7
Repeat OCA	5
Patellectomy	5
PKA	3
Arthrodesis	1

OCA, osteochondral allograft transplantation; PKA, partial knee arthroplasty; TKA, total knee arthroplasty; UKA, unicompartmental knee arthroplasty.

OCA of the Ankle

Patient Characteristics and Allograft Details of Ankle OCA

A total of 25 studies^## reported 579 patients who underwent ankle OCA. The mean age of the patients at the time of surgery was 38.6 years. Most patients were men (61.4%). The mean BMI was 26.9 kg/m², and the mean lesion area was 1.48 mm². The mean symptom duration was 57.8 months, and the mean follow-up duration was 47.6 months. Graft size was reported in 2 studies^40,49 (n = 31), with a mean graft size of 3.64 cm². The most common defect location was the medial talus (68.9%), followed by the lateral (29%) and central talus (2.1%) (Figure 4C). Most patients (78.9%) underwent ≥1 operation on the same ankle. The affected joints underwent a mean of 1.59 procedures before OCA surgery. OCA was performed alone in most patients (71.3%), and other concomitant procedures were performed in 28.7% of patients (Table 8).

Table 8

Characteristics and Clinical Outcomes of Ankle OCA^a

Characteristic	Patients, n	Mean or Proportion (95% CI)	P	I², %
Age, y	579	38.6 (37.0-40.1)	<.001	85.6
Sex, %
Male	570	61.4 (54.3-68.5)	<.001	68.1
Female	570	38.6 (31.5-45.7)	<.001	68.1
Body mass index, kg/m²	70	26.9 (24.5-29.4)	<.001	89.6
Smoker, %	27	22.0 (6.4-37.6)	.758	0
Side affected, %
Left	178	49.7 (39.5-60.0)	.033	50.4
Right	178	50.3 (40.0-60.5)	.033	50.4
Defect size, cm²	121	1.48 (1.31-1.65)	.055	53.7
Graft size, cm²	31	3.64 (3.41-3.87)	.494	0
Symptom duration, mo	38	57.8 (20.5-95.1)	<.001	96.6
Time to follow-up, mo	547	47.6 (38.9-56.3)	<.001	99.3
Previous procedure on affected joint, %	32	78.9 (45.7-12.2)	.014	83.5
No. of previous surgeries	78	1.59 (1.08-2.09)	.004	77.7
Concomitant procedure, %	105	28.7 (19.0-38.3)	.29	20.0
Failure rate, %	470	26.2 (18.6-33.8)	<.001	73.1
Time to failure, y	217	3.41 (1.86-4.97)	<.001	98.6
Reoperation rate, %	251	36.5 (23.9-49.2)	.001	75.7
Patient satisfaction, %	328	76.7 (67.2-86.3)	<.001	77.3

OCA, osteochondral allograft transplantation.

Clinical Outcomes of Ankle OCA

According to this analysis, 26.2% of patients had failed after ankle OCA in the 16 included studies^a (n = 470). The mean time to failure was 3.41 years. In total, 36.5% of 251 patients returned to the operating room at least once for further treatment. The Kaplan-Meier survival analysis demonstrated an allograft survivorship rate of 78.1% (95% CI, 71%-85.2%) in 191 patients at 5 years after transplantation and 62% (95% CI, 46.9%-77%) in 239 patients at 10 years post-transplantation. Eight studies^b (n = 328) had available data regarding patient satisfaction with ankle OCA, with 76.7% of patients being at least somewhat satisfied with the results (Table 8).

OCA of the Shoulder, Hip, and Elbow

For the shoulder, 2 studies^112,145 reported 39 patients who underwent shoulder OCA. Patients with OCA for reverse Hill-Sachs lesions after acute locked posterior shoulder joint dislocation have significantly improved function, a low degree of osteoarthritis, and excellent clinical outcomes compared with preoperative results.^84,145 Riff et al¹¹² concluded that OCA was a feasible treatment option for humeral head osteochondral defects. Regarding OCA of the hip, Oladeji et al¹⁰⁰ (n = 10), Khanna et al⁷² (n = 17), and Kosashvili et al⁷³ (n = 8) analyzed the clinical and radiological results of OCA in patients with sizable femoral head osteochondral defects and considered fresh OCA (OCA using a freshly preserved graft) a reasonable choice for young patients with hip cartilage defects. For OCA of the elbow, Mirzayan⁹⁶ (n = 9) first reported fresh OCA to treat osteochondritis dissecans of the capitellum in 2016 in 9 male baseball players, showing that OCA significantly improved throwing function, reduced pain, and allowed all patients to resume sports.

Discussion

OCA has become increasingly established and used clinically for >40 years as a cartilage restoration technique for treating focal articular cartilage defects.^20,82,123 The past 2 decades have shown an increase in research related to damaged articular cartilage repair with OCA.³⁵ This review demonstrated an increasing trend in the number of English-published articles on OCA from 2001 to 2020. The number of published articles in 2018 was 8 times greater than in 2000. The number of included cases was approximately 21.8 times greater, reflecting the growing interest of cartilage repair researchers in OCA. This analysis presented the cases studied in the United States, the dominant location among clinical studies of OCA, with 90.1% of global cases over the past 20 years. The widespread use of OCA programs in the United States may be due to the adequate development of OCA technology, the commercial availability of freshly stored osteochondral allografts, and reported clinical success.^20,35,82,122 In contrast, the availability of OCA in other countries is lower, which is most likely due to the meager donor rates resulting from cultural and educational differences among the populations, making OCA grafts scarce and expensive.^{54,116,119,120}

OCA is a restorative cartilage technique that can restore joint function in the knee, hip, ankle, and shoulder joints in patients with symptomatic articular cartilage defects and is currently used in treating knee cartilage injury.^35,82,122 Our study showed that the number of cases studied in the knee accounted for 88.9% of all cases over the past 20 years. OCA is primarily used to repair knee and ankle cartilage damage; however, there are fewer data on OCA for cartilage repair in the shoulder, hip, and elbow than in the knee or ankle. Therefore, future clinical research with long-term follow-up is needed to evaluate this technique’s indications and clinical efficacy in shoulder, hip, and elbow cartilage injuries.

Since OCA is mainly used for knee cartilage defects, the overall clinical characteristics and results of OCA are similar to the knee. For OCA of the knee, our analysis showed the mean age of the patients was 34 years, and 61% were male. Therefore, OCA is suitable for young, athletic male patients, because they want to restore high activity levels. Studies have shown less effective outcomes in patients with OCA >30 years of age.^24,124 OCA grafts are likely to fail in older adults due to other combined confounders, such as concurrent disease and prior surgeries; therefore, surgeons tend to perform total knee arthroplasty to achieve generally good results for these patients.^38,85,123 The studies we reviewed showed that patients treated with knee OCA had a mean BMI of 26.7 kg/m². For some obese patients, OCA can also provide a successful option for the medium-term treatment of knee cartilage defects.¹⁴⁰ Our analysis showed that knee cartilage defects mainly occurred in the medial femoral condyle.

Articular cartilage defects in the knee can be caused by various factors such as trauma, degeneration, avascular necrosis, osteochondritis dissecans, or osteoarthritis. The principal diagnosis in patients treated with OCA is osteochondritis dissecans. Therefore, osteochondritis dissecans is the best indication for OCA, followed by degenerative lesions and acute trauma.⁸⁶ Furthermore, we found that common surgical procedures included chondral debridement and MSTs before knee OCA surgery. Traditionally, because of the expensive and complicated nature of OCA, it is often considered a second-line treatment after debridement or MST failures, and some authors believe that previous debridement and MST affects the outcome of OCA and suggest considering OCA as the preferred first-line treatment.¹¹¹ Studies analyzing the impact of various previous cartilage repair surgeries on the outcomes of OCA concluded that OCA can be a salvage surgical treatment after the failure of previous cartilage repair surgery.^51,141

We found that the most common concomitant procedures were HTO and MAT. As knee joints with varus deformity accelerate the degeneration of the surrounding cartilage and joints by increasing their mechanical load, HTO is increasingly used as an auxiliary surgery for cartilage repair by optimizing the biomechanical microenvironment in the medial compartment. Several studies have shown that combining HTO and OCA is safe and effective for treating knee cartilage injury and has achieved satisfactory clinical results.^3,8,65,81 Meniscal loss leads to the development of cartilage lesions, and MAT and OCA are considered symbiotic surgeries due to their complementary indications and contraindications.⁴¹ Most patients who had failed knee OCA underwent total knee arthroplasty. This suggests that total knee arthroplasty is the preferred treatment after cartilage repair failure.⁶⁹ Our data analysis showed a mean failure rate after knee OCA of 16.8%. Matthews et al⁸⁶ described 5- and 10-year survival rates of 95% and 85%, respectively, after knee OCA, consistent with the results of this review. Studies have reported overall satisfaction with 88.1% of knee OCA, and the satisfaction of patients who underwent OCA for osteochondritis dissecans could be as high as 95.6%.¹³²

For OCA of the ankle, our analysis showed the mean age of the patients was 39 years, and 61% were male. Ankle cartilage defects mainly occurred in the medial talus, followed by the lateral, with the fewest cases concerning the central region. The distribution pattern of talar osteochondral lesions described by Dahmen et al²⁷ and van Diepen et al¹³³ agrees with the analysis in this review. Our data analysis showed that the mean failure rate after ankle OCA reached 26.2%.

And analysis demonstrated allograft survivorship of 78.1% at 5 years and 62% at 10 years, with an overall patient satisfaction rate of 76.7%. Higher failure rates and lower allograft survival rates were observed in the ankle than in the knee at 5 and 10 years after OCA. Further extensive studies are needed to analyze the causes of ankle osteochondral allograft postoperative failure compared with the knee.¹¹⁸

Many studies have described graft storage methods, but there is a lack of consensus regarding the optimal storage conditions for osteochondral allografts. Regarding the graft preservation temperature, frozen allografts are thought to lack chondrocyte activity and decrease cartilage viability, leading to inferior clinical outcomes compared with fresh allografts. Therefore, freshly stored grafts are the preferred surgical choice.^{20,61,119,126} We found that the most commonly used preservation protocol for clinical grafts is the standard hypothermic protocol (4°C). It has been shown that the grafts were significantly improved when stored at 22°C to 25°C or 37°C compared with a storage temperature of 4°C, yet some studies have also shown opposing results^60,125; thus, these temperatures cannot be used to determine the optimal preservation temperature.¹²⁶ Regarding allograft storage and methodology, different countries have different conservation programs. The optimal approach for allograft preservation before OCA remains controversial; studies have shown that chondrocyte viability is greatly reduced when the allograft is stored beyond 15 days, and chondrocytes survive up to 28 days before implantation.^20,91 The short allograft preservation period causes logistical problems, such as donor tissue acquisition, transportation, processing, and time constraints. These logistical problems before the donor graft transplant and the high cost of the graft have seriously limited the use of OCA.^48,86,126 Therefore, more intensive scientific research on safe and effective storage processes and methods of allografts can improve current practices, thus improving the clinical availability of OCA surgery.

Limitations

This study has some limitations. The primary limitation was the high heterogeneity of included studies. Due to limited available data, clinical control studies comparing OCA and other surgical procedures, follow-up studies on clinical outcomes solely on OCA, and all other clinical studies related to OCA were included in the analysis. Therefore, the overall quality of the included studies was relatively low. Second, due to the different focuses of clinical outcomes of OCA in different studies, the evaluation protocol for clinical outcomes could not be precisely quantified. Finally, data on failure details and complications were lacking, and the causes of failure could not be analyzed separately. Therefore, more high-quality, high-sample, multicenter randomized controlled trials for the clinical application of OCA could provide a more accurate evaluation of OCA’s clinical efficacy.

Conclusion

OCA has attracted significant research interest over the past 20 years, and the overall annual number of patients undergoing the procedure showed a significant upward trend, especially from 2016 to 2020. A majority of studies have been conducted in the United States. Patients receiving OCA were predominantly overweight, young adults, with most having had previous surgery at the same surgical site. The use of OCA is more established for cartilage injury in the knee than in other sites, and its best indication based on outcomes is osteochondritis dissecans. The results of our analysis demonstrated satisfactory long-term postoperative outcomes of OCA at all locations. More basic and clinical scientific research can improve the availability of OCA surgery in clinics and articular cartilage at other sites.

Footnotes

Final revision submitted April 6, 2023; accepted May 3, 2023.

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by the National Natural Science Foundation of China (grants U21A20353 and 82172503), the Central Government Guides Local Science and Technology Development Funds (grant YDZJSX2022B011), and the Key Research and Development Program of Shanxi Province (grant 201903D421019). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

§

References 1 -19, 21, 22, 25, 26, 29, 30, 32, 34, 36 -45, 47, 49 -53, 55 -59, 63, 65 -68, 70 -74, 76 -81, 83, 87 -92, 95 -98, 100 -104, 107, 109 -113, 115, 117, 118, 127 -132, 135, 137 -.

‖

References 4, 5, 15, 16, 18, 21, 29, 40, 41, 49 -53, 59, 65, 79, 90, 97, 102, 113, 115, 128, 129, 130 -.

¶

References 1, 4, 6, 7, 10 -12, 15 -17, 19, 21, 34, 39 -45, 47, 49, 53, 55, 57, 63, 72, 73, 76, 78, 79, 87, 88, 90, 95, 97, 100, 103, 104, 107, 109, 110, 113, 115, 128 -131, 135, 137 -142, 144, .

#

References 1, 4, 10, 11, 15 -17, 19, 21, 34, 39 -45, 47, 49, 53, 55, 72, 73, 76, 78, 79, 87, 88, 90, 97, 100, 107, 110, 113, 115, 128 -131, .

**

References 1, 11, 15, 42 -45, 47, 55, 67, 72, 73, 78, 79, 88, 110, 115, .

††

References 4, 6 -8, 10 -13, 15, 17, 19, 21, 39 -45, 47, 51, 57, 58, 67, 68, 71, 76, 78, 79, 83, 87, 88, 90, 91, 95, 97, 98, 100, 104, 107, 109, 110, 113, 115, 128, 131, 135, 137 -142, .

‡‡

References 1, 3, 6, 8 -13, 15, 19, 21, 25, 26, 32, 34, 36 -45, 47, 49 -53, 57, 59, 65, 68, 70, 77 -79, 88 -92, 95, 97, 98, 100 -103, 109, 111 -113, 115, 118, 127, 129 -131, 137 -.

§§

References 2, 8, 15, 19, 21, 25, 34, 39 -41, 44, 45, 49 -53, 65, 68, , 90, 97, 107, 111-113, 115, 129-132, 143, 145.

‖ ‖

References 1 -5, 8, 10 -12, 15 -18, 21, 25, 26, 29, 30, 32, 36 -38, 41, 44, 47, 50 -53, 56, 59, 63, 65, 70, 71, 74, 76 -81, 83, 87, 89 -92, 95, 97, 98, 101, 102, 104, 109 -111, 113, 115, 117, 127 -132, 135, 137 -.

¶¶

References 4, 5, 15, 16, 18, 21, 29, 41, 50 -53, 59, 65, 79, 90, 97, 102, 113, 115, 128, 129, 130 -.

##

References 6, 7, 9, 13, 14, 19, 22, 34, 39, 40, 42, 43, 45, 49, 55, 57, 58, 66 -68, 88, 103, 107, 118, .

a

References 6, 9, 13, 19, 34, 39, 40, 42, 43, 45, 49, 57, 68, 88, 103, .

b

References 19, 34, 39, 40, 45, 49, 68, .

References

Abolghasemian

León

Lee

, et al. Long-term results of treating large posttraumatic tibial plateau lesions with fresh osteochondral allograft transplantation. J Bone Joint Surg Am. 2019;101(12):1102-1108. doi:10.2106/JBJS.18.00802

Abrams

Hussey

Harris

Cole

. Clinical results of combined meniscus and femoral osteochondral allograft transplantation: minimum 2-year follow-up. Arthroscopy. 2014;30(8):964-970.e961. doi:10.1016/j.arthro.2014.03.010

Ackermann

Merkely

Arango

Mestriner

Gomoll

. The effect of mechanical leg alignment on cartilage restoration with and without concomitant high tibial osteotomy. Arthroscopy. 2020;36(8):2204-2214. doi:10.1016/j.arthro.2020.04.019

Ackermann

Mestriner

Shah

Gomoll

. Effect of autogenous bone marrow aspirate treatment on magnetic resonance imaging integration of osteochondral allografts in the knee: a matched comparative imaging analysis. Arthroscopy. 2019;35(8):2436-2444. doi:10.1016/j.arthro.2019.03.033

Ackermann

Ogura

Duerr

Mestriner

Gomoll

. Mental health has no predictive association with self-assessed knee outcome scores in patients after osteochondral allograft transplantation of the knee. Orthop J Sports Med. 2018;6(12):2325967118812363. doi:10.1177/2325967118812363

Adams

Dekker

Schiff

, et al. Prospective evaluation of structural allograft transplantation for osteochondral lesions of the talar shoulder. Foot Ankle Int. 2018;39(1):28-34. doi:10.1177/1071100717732342

Adams

Viens

Easley

Stinnett

Nunley

. Midterm results of osteochondral lesions of the talar shoulder treated with fresh osteochondral allograft transplantation. J Bone Joint Surg Am. 2011;93(7):648-654. doi:10.2106/JBJS.J.00141

Agarwalla

Christian

Liu

, et al. Return to work following high tibial osteotomy with concomitant osteochondral allograft transplantation. Arthroscopy. 2020;36(3):808-815. doi:10.1016/j.arthro.2019.08.046

Ahmad

Jones

. Comparison of osteochondral autografts and allografts for treatment of recurrent or large talar osteochondral lesions. Foot Ankle Int. 2016;37(1):40-50. doi:10.1177/1071100715603191

10.

Anderson

Robinson

Wiedrick

Crawford

. Efficacy of fresh osteochondral allograft transplantation in the knee for adults 40 years and older. Orthop J Sports Med. 2018;6(11):2325967118805441. doi:10.1177/2325967118805441

11.

Aubin

Cheah

Davis

Gross

. Long-term followup of fresh femoral osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res. 2001;391(suppl):S318-S327. doi:10.1097/00003086-200110001-00029

12.

Balazs

Wang

Burge

, et al. Return to play among elite basketball players after osteochondral allograft transplantation of full-thickness cartilage lesions. Orthop J Sports Med. 2018;6(7):2325967118786941. doi:10.1177/2325967118786941

13.

Berlet

Hyer

Philbin

Hartman

Wright

. Does fresh osteochondral allograft transplantation of talar osteochondral defects improve function? Clin Orthop Relat Res. 2011;469(8):2356-2366. doi:10.1007/s11999-011-1813-2

14.

Berti

Vannini

Lullini

, et al. Functional evaluation of patients treated with osteochondral allograft transplantation for post-traumatic ankle arthritis: one year follow-up. Gait Posture. 2013;38(4):945-950. doi:10.1016/j.gaitpost.2013.04.020

15.

Briggs

Sadr

Pulido

Bugbee

. The use of osteochondral allograft transplantation for primary treatment of cartilage lesions in the knee. Cartilage. 2015;6(4):203-207. doi:10.1177/1947603515595072

16.

Brown

Durkan

Foss

Szumowski

Crawford

. Temporal in vivo assessment of fresh osteochondral allograft transplants to the distal aspect of the femur by dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) and zonal T2 mapping MRI. J Bone Joint Surg Am. 2014;96(7):564-572. doi:10.2106/JBJS.K.01456

17.

Brown

Shirzad

Lavigne

Crawford

. Osseous integration after fresh osteochondral allograft transplantation to the distal femur: a prospective evaluation using computed tomography. Cartilage. 2011;2(4):337-345. doi:10.1177/1947603511410418

18.

Brown

McCauley

Gracitelli

Bugbee

. Osteochondritis dissecans lesion location is highly concordant with mechanical axis deviation. Am J Sports Med. 2020;48(4):871-875. doi:10.1177/0363546520905567

19.

Bugbee

Khanna

Cavallo

, et al. Bipolar fresh osteochondral allografting of the tibiotalar joint. J Bone Joint Surg Am. 2013;95(5):426-432. doi:10.2106/JBJS.L.00165

20.

Calcei

Ray

Sherman

Farr

. Management of large focal chondral and osteochondral defects in the knee. J Knee Surg. 2020;33(12):1187-1200. doi:10.1055/s-0040-1721053

21.

Cameron

Pulido

McCauley

Bugbee

. Osteochondral allograft transplantation of the femoral trochlea. Am J Sports Med. 2016;44(3):633-638. doi:10.1177/0363546515620193

22.

Caravaggi

Lullini

Leardini

, et al. Functional and clinical evaluation at 5-year follow-up of a three-component prosthesis and osteochondral allograft transplantation for total ankle replacement. Clin Biomech (Bristol, Avon). 2015;30(1):59-65. doi:10.1016/j.clinbiomech.2014.11.003

23.

Carballo

Nakagawa

Sekiya

Rodeo

. Basic science of articular cartilage. Clin Sports Med. 2017;36(3):413-425. doi:10.1016/j.csm.2017.02.001

24.

Cavendish

Everhart

Peters

Sommerfeldt

Flanigan

. Osteochondral allograft transplantation for knee cartilage and osteochondral defects: a review of indications, technique, rehabilitation, and outcomes. JBJS Rev. 2019;7(6):e7. doi:10.2106/JBJS.RVW.18.00123

25.

Cotter

Frank

Wang

, et al. Clinical outcomes of osteochondral allograft transplantation for secondary treatment of osteochondritis dissecans of the knee in skeletally mature patients. Arthroscopy. 2018;34(4):1105-1112. doi:10.1016/j.arthro.2017.10.043

26.

Cotter

Hannon

Christian

, et al. Clinical outcomes of multifocal osteochondral allograft transplantation of the knee: an analysis of overlapping grafts and multifocal lesions. Am J Sports Med. 2018;46(12):2884-2893. doi:10.1177/0363546518793405

27.

Dahmen

Lambers

Reilingh

, et al. No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):2142-2157. doi:10.1007/s00167-017-4616-5

28.

DeFroda

Bokshan

Yang

Daniels

Owens

. Trends in the surgical treatment of articular cartilage lesions in the United States from 2007 to 2016. J Knee Surg. 2021;34(14):1609-1616. doi:10.1055/s-0040-1712946

29.

Degen

Coleman

Chang

, et al. Outcomes following structural grafting of distal femoral osteochondral injuries in patients aged 40 years and older. J Knee Surg. 2017;30(3):244-251. doi:10.1055/s-0036-1584534

30.

Degen

Coleman

Tetreault

, et al. Outcomes of patellofemoral osteochondral lesions treated with structural grafts in patients older than 40 years. Cartilage. 2017;8(3):255-262. doi:10.1177/1947603516665441

31.

Demange

Gomoll

. The use of osteochondral allografts in the management of cartilage defects. Curr Rev Musculoskelet Med. 2012;5(3):229-235. doi:10.1007/s12178-012-9132-0

32.

Drexler

Gross

Dwyer

, et al. Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2015;23(5):1317-1323. doi:10.1007/s00167-013-2828-x

33.

Duan

Huang

Dong

, et al. Studies of articular cartilage repair from 2009 to 2018: a bibliometric analysis of articles. Orthop Surg. 2021;13(2):608-615. doi:10.1111/os.12888

34.

El-Rashidy

Villacis

Omar

Kelikian

. Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am. 2011;93(17):1634-1640. doi:10.2106/JBJS.J.00900

35.

Familiari

Cinque

Chahla

, et al. Clinical outcomes and failure rates of osteochondral allograft transplantation in the knee: a systematic review. Am J Sports Med. 2018;46(14):3541-3549. doi:10.1177/0363546517732531

36.

Farr

Gracitelli

Shah

Chang

Gomoll

. High failure rate of a decellularized osteochondral allograft for the treatment of cartilage lesions. Am J Sports Med. 2016;44(8):2015-2022. doi:10.1177/0363546516645086

37.

Frank

Cotter

Lee

Poland

Cole

. Do outcomes of osteochondral allograft transplantation differ based on age and sex? A comparative matched group analysis. Am J Sports Med. 2018;46(1):181-191. doi:10.1177/0363546517739625

38.

Frank

Lee

Levy

, et al. Osteochondral allograft transplantation of the knee: analysis of failures at 5 years. Am J Sports Med. 2017;45(4):864-874. doi:10.1177/0363546516676072

39.

French

McCauley

Pulido

Brage

Bugbee

. Bipolar fresh osteochondral allograft transplantation of the tibiotalar joint: a concise mid-term follow-up of a previous report★. J Bone Joint Surg Am. 2019;101(9):821-825. doi:10.2106/JBJS.18.01001

40.

Gaul

Tírico

McCauley

Pulido

Bugbee

. Osteochondral allograft transplantation for osteochondral lesions of the talus: midterm follow-up. Foot Ankle Int. 2019;40(2):202-209. doi:10.1177/1071100718805064

41.

Getgood

Gelber

Gortz

De Young

Bugbee

. Combined osteochondral allograft and meniscal allograft transplantation: a survivorship analysis. Knee Surg Sports Traumatol Arthrosc. 2015;23(4):946-953. doi:10.1007/s00167-015-3525-8

42.

Giannini

Buda

Grigolo

, et al. Bipolar fresh osteochondral allograft of the ankle. Foot Ankle Int. 2010;31(1):38-46. doi:10.3113/FAI.2010.0038

43.

Giannini

Buda

Pagliazzi

, et al. Survivorship of bipolar fresh total osteochondral ankle allograft. Foot Ankle Int. 2014;35(3):243-251. doi:10.1177/1071100713518503

44.

Giannini

Buda

Ruffilli

, et al. Failures in bipolar fresh osteochondral allograft for the treatment of end-stage knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2081-2089. doi:10.1007/s00167-014-2961-1

45.

Giannini

Mazzotti

Vannini

. Bipolar fresh total osteochondral allograft in the ankle: is it a successful long-term solution? Injury. 2017;48(7):1319-1324. doi:10.1016/j.injury.2017.05.011

46.

Gilat

Haunschild

Huddleston

, et al. Osteochondral allograft transplant for focal cartilage defects of the femoral condyles: clinically significant outcomes, failures, and survival at a minimum 5-year follow-up. Am J Sports Med. 2021;49(2):467-475. doi:10.1177/0363546520980087

47.

Giorgini

Donati

Cevolani

, et al. Fresh osteochondral allograft is a suitable alternative for wide cartilage defect in the knee. Injury. 2013;44(suppl 1):S16-S20. doi:10.1016/S0020-1383(13)70005-6

48.

Goodfriend

Essilfie

Jones

Vangsness

. Fresh osteochondral grafting in the United States: the current status of tissue banking processing. Cell Tissue Bank. 2019;20(3):331-337. doi:10.1007/s10561-019-09768-5

49.

Görtz

De Young

Bugbee

. Fresh osteochondral allografting for osteochondral lesions of the talus. Foot Ankle Int. 2010;31(4):283-290. doi:10.3113/FAI.2010.0283

50.

Gracitelli

Meric

Briggs

, et al. Fresh osteochondral allografts in the knee: comparison of primary transplantation versus transplantation after failure of previous subchondral marrow stimulation. Am J Sports Med. 2015;43(4):885-891. doi:10.1177/0363546514565770

51.

Gracitelli

Meric

Pulido

, et al. Fresh osteochondral allograft transplantation for isolated patellar cartilage injury. Am J Sports Med. 2015;43(4):879-884. doi:10.1177/0363546514564144

52.

Gracitelli

Meric

Pulido

McCauley

Bugbee

. Osteochondral allograft transplantation for knee lesions after failure of cartilage repair surgery. Cartilage. 2015;6(2):98-105. doi:10.1177/1947603514566298

53.

Gracitelli

Tirico

McCauley

Pulido

Bugbee

. Fresh osteochondral allograft transplantation for fractures of the knee. Cartilage. 2017;8(2):155-161. doi:10.1177/1947603516657640

54.

Grant

. Outcomes associated with return to sports following osteochondral allograft transplant in the knee: a scoping review. Curr Rev Musculoskelet Med. 2019;12(2):181-189. doi:10.1007/s12178-019-09557-3

55.

Gross

Agnidis

Hutchison

. Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation. Foot Ankle Int. 2001;22(5):385-391. doi:10.1177/107110070102200505

56.

Gursoy

Simsek

Akkaya

Kaya

Bozkurt

. Local curvature mismatch may worsen the midterm functional outcomes of osteochondral allograft transplantation. Knee Surg Sports Traumatol Arthrosc. 2021;29(9):2948-2957. doi:10.1007/s00167-020-06319-4

57.

Haene

Qamirani

Story

Pinsker

Daniels

. Intermediate outcomes of fresh talar osteochondral allografts for treatment of large osteochondral lesions of the talus. J Bone Joint Surg Am. 2012;94(12):1105-1110. doi:10.2106/JBJS.J.02010

58.

Hahn

Aanstoos

Wilkins

. Osteochondral lesions of the talus treated with fresh talar allografts. Foot Ankle Int. 2010;31(4):277-282. doi:10.3113/FAI.2010.0277

59.

Hannon

Weber

Gitelis

, et al. Does treatment of the tibia matter in bipolar chondral defects of the knee? Clinical outcomes with greater than 2 years follow-up. Arthroscopy. 2018;34(4):1044-1051. doi:10.1016/j.arthro.2017.09.040

60.

Harb

von Horn

Gocalek

, et al. Lactated Ringer-based storage solutions are equally well suited for the storage of fresh osteochondral allografts as cell culture medium-based storage solutions. Injury. 2017;48(7):1302-1308. doi:10.1016/j.injury.2017.05.009

61.

Hevesi

Denbeigh

Paggi

, et al. Fresh osteochondral allograft transplantation in the knee: a viability and histologic analysis for optimizing graft viability and expanding existing standard processed graft resources using a living donor cartilage program. Cartilage. 2021;13:948S-956S. doi:10.1177/1947603519880330

62.

Hinckel

Thomas

Vellios

, et al. Algorithm for treatment of focal cartilage defects of the knee: classic and new procedures. Cartilage. 2021;13:473S-495S. doi:10.1177/1947603521993219

63.

Hohmann

Tetsworth

. Large osteochondral lesions of the femoral condyles: treatment with fresh frozen and irradiated allograft using the Mega OATS technique. Knee. 2016;23(3):436-441. doi:10.1016/j.knee.2016.01.020

64.

Hozo

Djulbegovic

Hozo

. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13. doi:10.1186/1471-2288-5-13

65.

Hsu

Tirico

Lin

Pulido

Bugbee

. Osteochondral allograft transplantation and opening wedge tibial osteotomy: clinical results of a combined single procedure. Cartilage. 2018;9(3):248-254. doi:10.1177/1947603517710307

66.

Jackson

Drayer

Samona

, et al. Osteochondral allograft transplantation surgery for osteochondral lesions of the talus in athletes. J Foot Ankle Surg. 2019;58(4):623-627. doi:10.1053/j.jfas.2018.11.020

67.

Janis

Kaplansky

DeCarbo

. Early clinical experience with a fresh talar transplant inlay allograft for the treatment of osteochondral lesions of the talus. J Am Podiatr Med Assoc. 2010;100(1):25-34. doi:10.7547/1000025

68.

Jeng

Kadakia

White

Myerson

. Fresh osteochondral total ankle allograft transplantation for the treatment of ankle arthritis. Foot Ankle Int. 2008;29(6):554-560. doi:10.3113/FAI.2008.0554

69.

Jeuken

van Hugten

Roth

, et al. A systematic review of focal cartilage defect treatments in middle-aged versus younger patients. Orthop J Sports Med. 2021;9(10):23259671211031244. doi:10.1177/23259671211031244

70.

Johnson

Garcia

, et al. High short-term failure rate associated with decellularized osteochondral allograft for treatment of knee cartilage lesions. Arthroscopy. 2017;33(12):2219-2227. doi:10.1016/j.arthro.2017.07.018

71.

Karataglis

Learmonth

. Management of big osteochondral defects of the knee using osteochondral allografts with the MEGA-OATS technique. Knee. 2005;12(5):389-393. doi:10.1016/j.knee.2004.12.008

72.

Khanna

Tushinski

Drexler

, et al. Cartilage restoration of the hip using fresh osteochondral allograft: resurfacing the potholes. Bone Joint J. 2014;96-B(11)(suppl A):11-16. doi:10.1302/0301-620X.96B11.34734

73.

Kosashvili

Raz

Backstein

, et al. Fresh-stored osteochondral allografts for the treatment of femoral head defects: surgical technique and preliminary results. Int Orthop. 2013;37(6):1001-1006. doi:10.1007/s00264-013-1868-7

74.

Krych

Robertson

Williams

. Return to athletic activity after osteochondral allograft transplantation in the knee. Am J Sports Med. 2012;40(5):1053-1059. doi:10.1177/0363546511435780

75.

Kunze

Ramkumar

Manzi

, et al. Risk factors for failure after osteochondral allograft transplantation of the knee: a systematic review and exploratory meta-analysis. Am J Sports Med. 2023;51(5):1356–1367. doi:10.1177/03635465211063901

76.

LaPrade

Botker

Herzog

Agel

. Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles: a prospective outcomes study. J Bone Joint Surg Am. 2009;91(4):805-811. doi:10.2106/JBJS.H.00703

77.

Lee

Frank

Christian

Cole

. Analysis of defect size and ratio to condylar size with respect to outcomes after isolated osteochondral allograft transplantation. Am J Sports Med. 2019;47(7):1601-1612. doi:10.1177/0363546519841378

78.

León

Mei

Safir

Gross

Kuzyk

. Long-term results of fresh osteochondral allografts and realignment osteotomy for cartilage repair in the knee. Bone Joint J. 2019;101-B(1)(suppl A):46-52. doi:10.1302/0301-620X.101B1.BJJ-2018-0407.R1

79.

Levy

Görtz

Pulido

McCauley

Bugbee

. Do fresh osteochondral allografts successfully treat femoral condyle lesions? Clin Orthop Relat Res. 2013;471(1):231-237. doi:10.1007/s11999-012-2556-4

80.

Lin

Wang

Burge

, et al. Osteochondral allograft transplant of the patella using femoral condylar allografts: magnetic resonance imaging and clinical outcomes at minimum 2-year follow-up. Orthop J Sports Med. 2020;8(10):2325967120960088. doi:10.1177/2325967120960088

81.

Liu

Agarwalla

Christian

, et al. Return to sport following high tibial osteotomy with concomitant osteochondral allograft transplantation. Am J Sports Med. 2020;48(8):1945-1952. doi:10.1177/0363546520920626

82.

Luk

Stoker

Teixeiro

, et al. Systematic review of osteochondral allograft transplant immunology: how we can further optimize outcomes. J Knee Surg. 2021;34(1):30-38. doi:10.1055/s-0040-1721670

83.

Lyon

Nissen

Liu

Curtin

. Can fresh osteochondral allografts restore function in juveniles with osteochondritis dissecans of the knee? Clin Orthop Relat Res. 2013;471(4):1166-1173. doi:10.1007/s11999-012-2523-0

84.

Marcheggiani Muccioli

Rinaldi

Lullini

, et al. Mid-term outcomes following fresh-frozen humeral head osteochondral allograft reconstruction for reverse Hill Sachs lesion: a case series. BMC Musculoskelet Disord. 2021;22(1):768. doi:10.1186/s12891-021-04657-z

85.

Markus

Hurley

Haskel

, et al. High return to sport in patients over 45 years of age undergoing osteochondral allograft transplantation for isolated chondral defects in the knee. Cartilage. 2021;13(1)(suppl):915S-919S. doi:10.1177/19476035211046008

86.

Matthews

Brutico

Abraham

, et al. Differences in clinical and functional outcomes between osteochondral allograft transplantation and autologous chondrocyte implantation for the treatment of focal articular cartilage defects. Orthop J Sports Med. 2022;10(2):23259671211058425. doi:10.1177/23259671211058425

87.

McCarthy

Meyer

Weber

, et al. Can competitive athletes return to high-level play after osteochondral allograft transplantation of the knee? Arthroscopy. 2017;33(9):1712-1717. doi:10.1016/j.arthro.2017.03.020

88.

Meehan

McFarlin

Bugbee

Brage

. Fresh ankle osteochondral allograft transplantation for tibiotalar joint arthritis. Foot Ankle Int. 2005;26(10):793-802. doi:10.1177/107110070502601002

89.

Melugin

Ridley

Bernard

, et al. Prospective outcomes of cryopreserved osteochondral allograft for patellofemoral cartilage defects at minimum 2-year follow-up. Cartilage. 2021;13(1)(suppl):1014S-1021S. doi:10.1177/1947603520903420

90.

Meric

Gracitelli

Görtz

De Young

Bugbee

. Fresh osteochondral allograft transplantation for bipolar reciprocal osteochondral lesions of the knee. Am J Sports Med. 2015;43(3):709-714. doi:10.1177/0363546514562549

91.

Merkely

Ackermann

Farina

, et al. Shorter storage time is strongly associated with improved graft survivorship at 5 years after osteochondral allograft transplantation. Am J Sports Med. 2020;48(13):3170-3176. doi:10.1177/0363546520956311

92.

Merkely

Ackermann

Gomoll

. The role of hypertension in cartilage restoration: increased failure rate after autologous chondrocyte implantation but not after osteochondral allograft transplantation. Cartilage. 2021;13(1)(suppl):1306S-1314S. doi:10.1177/1947603519900792

93.

Merkely

Farina

Leite

, et al. Association of sex mismatch between donor and recipient with graft survivorship at 5 years after osteochondral allograft transplantation. Am J Sports Med. 2022;50(3):681-688. doi:10.1177/03635465211068872

94.

Merkely

Ogura

Ackermann

Barbieri Mestriner

Gomoll

. Clinical outcomes after revision of autologous chondrocyte implantation to osteochondral allograft transplantation for large chondral defects: a comparative matched-group analysis. Cartilage. 2021;12(2):155-161. doi:10.1177/1947603519833136

95.

Mirzayan

Charles

Batech

Suh

DeWitt

. Bipolar osteochondral allograft transplantation of the patella and trochlea. Cartilage. 2020;11(4):431-440. doi:10.1177/1947603518796124

96.

Mirzayan

Lim

. Fresh osteochondral allograft transplantation for osteochondritis dissecans of the capitellum in baseball players. J Shoulder Elbow Surg. 2016;25(11):1839-1847. doi:10.1016/j.jse.2016.08.006

97.

Murphy

Pennock

Bugbee

. Osteochondral allograft transplantation of the knee in the pediatric and adolescent population. Am J Sports Med. 2014;42(3):635-640. doi:10.1177/0363546513516747

98.

Nuelle

Cook

Stannard

. Patient factors, donor age, and graft storage duration affect osteochondral allograft outcomes in knees with or without comorbidities. J Knee Surg. 2017;30(2):179-184. doi:10.1055/s-0036-1584183

99.

Ogura

Ackermann

Mestriner

Merkely

Gomoll

. The minimal clinically important difference and substantial clinical benefit in the patient-reported outcome measures of patients undergoing osteochondral allograft transplantation in the knee. Cartilage. 2021;12(1):42-50. doi:10.1177/1947603518812552

100.

Oladeji

Cook

Stannard

Crist

. Large fresh osteochondral allografts for the hip: growing the evidence. Hip Int. 2018;28(3):284-290. doi:10.5301/hipint.5000568

101.

Oladeji

Dreger

Pratte

, et al. Total knee arthroplasty versus osteochondral allograft: prevalence and risk factors following tibial plateau fractures. J Knee Surg. 2019;32(4):380-386. doi:10.1055/s-0038-1641593

102.

Oladeji

Stannard

Cook

, et al. Effects of autogenous bone marrow aspirate concentrate on radiographic integration of femoral condylar osteochondral allografts. Am J Sports Med. 2017;45(12):2797-2803. doi:10.1177/0363546517715725

103.

Orr

Dunn

Heida

, et al. Results and functional outcomes of structural fresh osteochondral allograft transfer for treatment of osteochondral lesions of the talus in a highly active population. Foot Ankle Spec. 2017;10(2):125-132. doi:10.1177/1938640016666924

104.

Owusu-Akyaw

Bido

Warner

Rodeo

Williams

. SF-36 physical component score is predictive of achieving a clinically meaningful improvement after osteochondral allograft transplantation of the femur. Cartilage. 2021;13:853S-859S. doi:10.1177/1947603520958132

105.

Page

Moher

Bossuyt

, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:N160. doi:10.1136/bmj.n160

106.

Pearle

Warren

Rodeo

. Basic science of articular cartilage and osteoarthritis. Clin Sports Med. 2005;24(1):1-12. doi:10.1016/j.csm.2004.08.007

107.

Raikin

. Fresh osteochondral allografts for large-volume cystic osteochondral defects of the talus. J Bone Joint Surg Am. 2009;91(12):2818-2826. doi:10.2106/JBJS.I.00398

108.

Ramkumar

Karnuta

Haeberle

, et al. Effect of preoperative imaging and patient factors on clinically meaningful outcomes and quality of life after osteochondral allograft transplantation: a machine learning analysis of cartilage defects of the knee. Am J Sports Med. 2021;49(8):2177-2186. doi:10.1177/03635465211015179

109.

Rauck

Wang

Tao

Williams

. Chondral delamination of fresh osteochondral allografts after implantation in the knee: a matched cohort analysis. Cartilage. 2019;10(4):402-407. doi:10.1177/1947603518777576

110.

Raz

Safir

Backstein

Lee

Gross

. Distal femoral fresh osteochondral allografts: follow-up at a mean of twenty-two years. J Bone Joint Surg Am. 2014;96(13):1101-1107. doi:10.2106/JBJS.M.00769

111.

Riff

Huddleston

Cole

Yanke

. Autologous chondrocyte implantation and osteochondral allograft transplantation render comparable outcomes in the setting of failed marrow stimulation. Am J Sports Med. 2020;48(4):861-870. doi:10.1177/0363546520902434

112.

Riff

Yanke

Shin

Romeo

Cole

. Midterm results of osteochondral allograft transplantation to the humeral head. J Shoulder Elbow Surg. 2017;26(7):e207-e215. doi:10.1016/j.jse.2016.11.053

113.

Sadr

Pulido

McCauley

Bugbee

. Osteochondral allograft transplantation in patients with osteochondritis dissecans of the knee. Am J Sports Med. 2016;44(11):2870-2875. doi:10.1177/0363546516657526

114.

Salem

Chaudhry

Lucenti

Tucker

Freedman

. The importance of staging arthroscopy for chondral defects of the knee. J Knee Surg. 2022;35(2):145-149. doi:10.1055/s-0040-1713126

115.

Schmidt

Tírico

McCauley

Bugbee

. Fresh osteochondral allograft transplantation: is graft storage time associated with clinical outcomes and graft survivorship? Am J Sports Med. 2017;45(10):2260-2266. doi:10.1177/0363546517704846

116.

Schmidt

Schulte

Schwarz

, et al. Fresh osteochondral allografts-procurement and tissue donation in Europe. Injury. 2017;48(7):1296-1301. doi:10.1016/j.injury.2017.05.008

117.

Scully

Parada

Arrington

. Allograft osteochondral transplantation in the knee in the active duty population. Mil Med. 2011;176(10):1196-1201. doi:10.7205/milmed-d-10-00443

118.

Shimozono

Hurley

Nguyen

Deyer

Kennedy

. Allograft compared with autograft in osteochondral transplantation for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 2018;100(21):1838-1844. doi:10.2106/JBJS.17.01508

119.

Skelley

Kurtenbach

Kimber

Piatt

Noonan

. Return-to-sport review for current cartilage treatments. J Knee Surg. 2021;34(1):39-46. doi:10.1055/s-0040-1721669

120.

Sochacki

Varshneya

Calcei

, et al. Comparison of autologous chondrocyte implantation and osteochondral allograft transplantation of the knee in a large insurance database: reoperation rate, complications, and cost analysis. Cartilage. 2021;13(1)(suppl):1187S-1194S. doi:10.1177/1947603520967065

121.

Stadnyk

Sevick

Elliott

Jomha

. The effect of cryoprotectant vehicle solution on cartilage cell viability following vitrification. Cell Tissue Bank. 2022;23(1):31-41. doi:10.1007/s10561-021-09906-y

122.

Stannard

Cook

. Prospective assessment of outcomes after primary unipolar, multisurface, and bipolar osteochondral allograft transplantations in the knee: a comparison of 2 preservation methods. Am J Sports Med. 2020;48(6):1356-1364. doi:10.1177/0363546520907101

123.

Stannard

Schreiner

. Fresh osteochondral allograft transplants in the knee: bipolar and beyond. J Knee Surg. 2020;33(12):1172-1179. doi:10.1055/s-0040-1714366

124.

Stark

Rao

Gleason

, et al. Rehabilitation and return-to-play criteria after fresh osteochondral allograft transplantation: a systematic review. Orthop J Sports Med. 2021;9(7):23259671211017135. doi:10.1177/23259671211017135

125.

Stoker

Stannard

Kuroki

, et al. Validation of the Missouri Osteochondral Allograft Preservation System for the maintenance of osteochondral allograft quality during prolonged storage. Am J Sports Med. 2018;46(1):58-65. doi:10.1177/0363546517727516

126.

Tabbaa

Guilak

Sah

Bugbee

. Fresh osteochondral and chondral allograft preservation and storage media: a systematic review of the literature. Am J Sports Med. 2022;50(6):1702-1716. doi:10.1177/03635465211016832

127.

Thomas

Shaw

Waterman

. Outcomes after fresh osteochondral allograft transplantation for medium to large chondral defects of the knee. Orthop J Sports Med. 2019;7(3):2325967119832299. doi:10.1177/2325967119832299

128.

Tírico

Early

McCauley

Bugbee

. Fresh osteochondral allograft transplantation for spontaneous osteonecrosis of the knee: a case series. Orthop J Sports Med. 2017;5(10):2325967117730540. doi:10.1177/2325967117730540

129.

Tírico

McCauley

Pulido

Bugbee

. Does anterior cruciate ligament reconstruction affect the outcome of osteochondral allograft transplantation? A matched cohort study with a mean follow-up of 6 years. Am J Sports Med. 2018;46(8):1836-1843. doi:10.1177/0363546518767636

130.

Tírico

McCauley

Pulido

Bugbee

. Lesion size does not predict outcomes in fresh osteochondral allograft transplantation. Am J Sports Med. 2018;46(4):900-907. doi:10.1177/0363546517746106

131.

Tírico

McCauley

Pulido

Bugbee

. Osteochondral allograft transplantation of the femoral condyle utilizing a thin plug graft technique. Am J Sports Med. 2019;47(7):1613-1620. doi:10.1177/0363546519844212

132.

Tírico

McCauley

Pulido

Demange

Bugbee

. Is patient satisfaction associated with clinical outcomes after osteochondral allograft transplantation in the knee? Am J Sports Med. 2019;47(1):82-87. doi:10.1177/0363546518812420

133.

van Diepen

Dahmen

Altink

Stufkens

Kerkhoffs

. Location distribution of 2,087 osteochondral lesions of the talus. Cartilage. 2021;13:1344S-1353S. doi:10.1177/1947603520954510

134.

Wan

Wang

Liu

Tong

. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135. doi:10.1186/1471-2288-14-135

135.

Wang

Chang

Coxe

, et al. Clinically meaningful improvement after treatment of cartilage defects of the knee with osteochondral grafts. Am J Sports Med. 2019;47(1):71-81. doi:10.1177/0363546518808030

136.

Wang

Coxe

Balazs

, et al. Graft-recipient anteroposterior mismatch does not affect the midterm clinical outcomes of osteochondral allograft transplantation of the femoral condyle. Am J Sports Med. 2018;46(10):2441-2448. doi:10.1177/0363546518782939

137.

Wang

Eliasberg

Wang

, et al. Similar outcomes after osteochondral allograft transplantation in anterior cruciate ligament-intact and -reconstructed knees: a comparative matched-group analysis with minimum 2-year follow-up. Arthroscopy. 2017;33(12):2198-2207. doi:10.1016/j.arthro.2017.06.034

138.

Wang

Jones

Eliasberg

, et al. Condyle-specific matching does not improve midterm clinical outcomes of osteochondral allograft transplantation in the knee. J Bone Joint Surg Am. 2017;99(19):1614-1620. doi:10.2106/JBJS.16.01542

139.

Wang

Kalia

Eliasberg

, et al. Osteochondral allograft transplantation of the knee in patients aged 40 years and older. Am J Sports Med. 2018;46(3):581-589. doi:10.1177/0363546517741465

140.

Wang

Rebolledo

Dare

, et al. Osteochondral allograft transplantation of the knee in patients with an elevated body mass index. Cartilage. 2019;10(2):214-221. doi:10.1177/1947603518754630

141.

Wang

Burge

, et al. Clinical and MRI outcomes of fresh osteochondral allograft transplantation after failed cartilage repair surgery in the knee. J Bone Joint Surg Am. 2018;100(22):1949-1959. doi:10.2106/JBJS.17.01418

142.

Williams

Ranawat

Potter

Carter

Warren

. Fresh stored allografts for the treatment of osteochondral defects of the knee. J Bone Joint Surg Am. 2007;89(4):718-726. doi:10.2106/JBJS.F.00625

143.

Wright-Chisem

Cohn

Kunze

, et al. Do self-reported drug allergies influence clinically significant outcome improvement following osteochondral allograft transplantation? A nested cohort study. Cartilage. 2021;13:868S-872S. doi:10.1177/1947603520976770

144.

Yañez Arauz

Del Vecchio

Bilbao

Raimondi

. Osteochondral lesions of the talus treatment with fresh frozen allograft. Foot Ankle Surg. 2017;23(4):296-301. doi:10.1016/j.fas.2016.09.002

145.

Zhuo

Zhu

Pan

. Osteochondral allograft transplantation for large Hill-Sachs lesions: a retrospective case series with a minimum 2-year follow-up. J Orthop Surg Res. 2019;14(1):344. doi:10.1186/s13018-019-1366-8

Characteristics and Clinical Outcomes After Osteochondral Allograft Transplantation for Treating Articular Cartilage Defects: Systematic Review and Single-Arm Meta-analysis of Studies From 2001 to 2020

Abstract

Background:

Purpose:

Study Design:

Methods:

Results:

Conclusion:

Keywords

Methods

Search Strategy

Study Selection

Data Extraction

Statistical Analysis

Results

Search Results

Overall Characteristics and Clinical Outcomes of OCA

Temporal Trends and Country and Injury Site Distributions

Patient Characteristics

Allograft Characteristics

Overall Clinical Outcomes of OCA

OCA of the Knee

Patient Characteristics and Allograft Details of Knee OCA

Clinical Outcomes of Knee OCA

OCA of the Ankle

Patient Characteristics and Allograft Details of Ankle OCA

Clinical Outcomes of Ankle OCA

OCA of the Shoulder, Hip, and Elbow

Discussion

Limitations

Conclusion

Footnotes

§

‖

¶

#

**

††

‡‡

§§

‖ ‖

¶¶

##

a

b

References