March 8, 2024
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Osteoarticular Allografts
Articular Cartilage Damage Treatment
Articular cartilage, a specialized tissue within joints, faces constant stress and is highly susceptible to traumatic injury or degeneration, particularly in weight-bearing joints like the knee. When individuals, ranging from teenagers to middle-aged adults, exhibit localized full-thickness cartilage or cartilage and bone defects, this signifies a localized area of osteoarthritis.
For patients with significant defects, especially those involving bone, a fresh osteoarticular allograft stands as an effective treatment for cartilage deficiency. These allografts are sourced from young donors whose knee size matches that of the affected patient.
The evaluation process to determine a patient’s suitability for a fresh osteoarticular allograft is crucial. Assessment of alignment ensures avoidance of additional stress on the affected compartment. The patient should also have intact ligaments to prevent instability, or they should be eligible for concurrent ligament reconstruction if necessary. Furthermore, confirming the presence of a normal amount of meniscus is essential to provide joint cushioning and prevent overloading. It’s also imperative to ensure the absence of cartilage lesions on the opposing articular cartilage surface, known as “bipolar lesions,” as these do not respond well to cartilage resurfacing procedures. Additionally, obtaining sizing X-rays of the knee helps determine the appropriate size for the donor graft in the future.
At drraviteja.com, we prioritize meticulous patient evaluation to determine the suitability of fresh osteoarticular allografts, offering individuals advanced treatments tailored to their specific needs for enhanced joint health and function.
Description of Osteoarticular Allografts
Implanting a fresh osteoarticular allograft requires an open incision to access the joint. In most knee locations, these incisions can be kept small to prevent quadriceps muscle shutdown. However, in challenging locations, larger incisions may be necessary to ensure proper graft placement.
A critical factor for the success of osteoarticular allografts is transplanting a refrigerated allograft within the first 15-28 days postoperatively. It takes 14 days to assess the grafts for viral or bacterial contaminants. We aim to implant the grafts as soon as they pass testing to provide the most viable cells to the patient.
Fresh osteoarticular allografts have shown significant functional and clinical improvement after an average follow-up of three years in our patients treated for full-thickness osteochondral defects of the femoral condyle. These outcomes align with historical reports from other centers for patients treated with fresh osteoarticular allograft implants.
It is crucial to conduct a careful assessment to determine whether a patient is a suitable candidate for this surgery. While this procedure may not cure arthritis, many patients experience significant improvement for 10 years or more. Essentially, this procedure serves as a “biologic resurfacing,” but it’s important to note that not all patients can return to full impact activities afterward.
At drraviteja.com, we prioritize thorough patient assessments to determine the suitability of fresh osteoarticular allografts. We offer advanced treatments tailored to individual needs, aiming to improve joint health and function.
Are you a candidate for an osteoarticular allograft procedure?
There are two ways to initiate a consultation with Dr. Ravi Teja Rudraraju
You can provide current X-rays and/or MRIs for a clinical case review with with Dr. Ravi Teja Rudraraju
You can schedule an office consultation with Dr. Ravi Teja Rudraraju
Frequently Asked Questions
An osteoarticular allograft is a composite piece of bone and cartilage obtained from a young donor and implanted into a full-thickness cartilage defect within the knee. Proper sizing and thorough testing for bacteria and viruses, typically requiring at least 14 days, are essential. The depth of the implanted bone should not exceed 1 cm to minimize rejection risk or cyst formation due to residual blood products. The donor bone heals over time through creeping substitution, a process that may take 1 to 2 years for thorough incorporation. With appropriate rehabilitation and patient selection, osteoarticular allografts are considered the gold standard for treating knee cartilage defects.
Several factors contribute to successful osteoarticular allograft transplantation. Firstly, patients should have normal or correctable alignment to ensure weight distribution into the planned compartment. Adequate meniscal cushioning in the same compartment is crucial for shock absorption and prolonged graft durability. Knee stability is another key consideration, as unstable knees can compromise graft outcomes. Correcting ligament instability, often during the allograft procedure, maximizes patient outcomes. Additionally, the condition of the cartilage on the opposing surface of the donor graft should be normal or nearly normal, as significant wear reduces the success rate. Therefore, the basic workup for osteoarticular allograft candidacy includes assessing alignment, ligament stability, meniscal presence, and the condition of opposing cartilage surfaces.
Distal femoral osteoarticular allografts involve grafts obtained from either the medial or lateral femoral condyles at the end of the thigh bone. Medial femoral condyle grafts are more common, while lateral femoral condyle grafts tend to be larger. When performed on appropriately selected patients, distal femoral osteoarticular allografts are among the most successful cartilage resurfacing procedures available.
Conclusion:
At drraviteja.com, we prioritize comprehensive patient evaluations and advanced surgical techniques to ensure optimal outcomes for individuals undergoing osteoarticular allograft procedures.
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