Will an Osteochondral Allograft (OCA) Transplant help me?

An osteochondral allograft transplant is a surgical procedure used to treat damaged cartilage in a joint, commonly the knee, by transplanting a graft containing bone and cartilage from a donor (allograft). This procedure is typically indicated for patients with focal cartilage defects that do not respond to conservative treatments and for those who are not ideal candidates for other cartilage repair techniques such as microfracture or autologous chondrocyte implantation.

Indications for Osteochondral Allograft Transplant

1. Focal Cartilage Defects

   • Large or deep defects in the cartilage that expose the underlying bone, often due to injury or degenerative changes.

2. Failed Previous Treatments

   • When other cartilage repair procedures, such as microfracture, have failed to provide relief.

3. Young, Active Patients

   • Typically recommended for younger, active patients who have significant cartilage damage but wish to maintain a high level of activity.

4. Osteochondritis Dissecans

   • Suitable for patients with osteochondritis dissecans, a condition where a piece of cartilage and underlying bone become detached from the end of a bone due to lack of blood flow.

5. Avascular Necrosis

   • Patients with avascular necrosis, where bone tissue dies due to lack of blood supply, can benefit if the necrosis affects the joint surface.

Procedure Overview

1. Assessment and Planning

   • Detailed imaging studies (MRI, CT) are performed to assess the size and location of the cartilage defect. The surgeon uses this information to select an appropriately sized allograft.

2. Graft Harvesting

   • The allograft is sourced from a tissue bank. It includes both cartilage and underlying bone, and is carefully matched to the size and contour of the patient’s defect.

3. Preparation of the Defect Site

   • The surgeon cleans and prepares the damaged area, removing any loose or damaged cartilage and bone to create a stable base for the graft.

4. Implantation of the Allograft

   • The allograft is shaped to fit the defect precisely and is then implanted into the prepared site. It is secured using specialized surgical techniques to ensure it remains in place and integrates well with the surrounding tissue.

5. Post-Surgical Care

   • The patient undergoes a period of immobilization followed by a structured rehabilitation program to ensure proper integration and healing of the graft.

Benefits

• Restoration of Joint Function

  • The procedure aims to restore the smooth, pain-free movement of the joint by replacing the damaged cartilage with healthy tissue.

• Long-Term Relief

  • It offers the potential for long-term relief from pain and improved joint function, particularly for patients with significant cartilage damage.

• Avoidance of Joint Replacement

  • For younger patients, it can delay or even prevent the need for joint replacement surgery.

Risks and Complications

• Graft Rejection

  • Although rare, there is a risk that the body may reject the donor tissue.

• Infection

  • As with any surgery, there is a risk of infection, which is managed with proper surgical techniques and postoperative care.

• Incomplete Integration

  • The graft may not fully integrate with the surrounding bone and cartilage, potentially leading to failure.

• Degeneration

  • Over time, the transplanted tissue may undergo degenerative changes similar to the original cartilage.

Summary

Osteochondral allograft transplantation is a valuable option for patients with significant cartilage defects who are seeking to restore joint function and alleviate pain. The success of the procedure depends on careful patient selection, precise surgical technique, and adherence to postoperative rehabilitation protocols. Consulting with an orthopedic surgeon specialized in cartilage repair is essential to determine if this treatment is suitable based on the patient's specific condition and overall health.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.