Osteochondral Allografts: A Great Option for OLT William Bugbee, - - PowerPoint PPT Presentation

Osteochondral Allografts:

A Great Option for OLT

William Bugbee, MD Scripps Clinic, La Jolla CA USA University of California, San Diego

Disclosure

• Joint Restoration Foundation

– Consultant, research support

• Arthrex

– consultant

• FDA

– Medical advisory committee: Cellular, tissue and gene therapy

A shell allograft is not “bulky”

Subchondral Bone and the Osteochondral Unit

• Integrated organ

system

• Very interdependent

structure-function relationship

Osteochondral Replacement Has Many Advantages

• Mature hyaline cartilage
• No cell or tissue differentiation required
• Bone healing paradigm
• Replace diseased subchondral bone
• Quick and simple rehabilitation

The Osteochondral Allograft Paradigm

• Cartilage is an ideal tissue

for transplantation

• Transplantation of mature

hyaline cartilage

• Viable chondrocytes
• Intact osteochondral unit
• Bone healing vs. chondral

tissue regeneration

When Do I Use Allografts in the Talus?

• Osteochondral lesions (OLT)

– Large volume cystic lesions (primary Rx)

• Salvage of smaller lesions
• Osteonecrosis
• Traumatic defects
• Selected cases of PTOA
• Fresh talus allografts are

relatively easy to obtain (in US)

Surgical Techniques

• Approaches

– Medial malleolar osteotomy – Lateral malleolar osteotomy – Anterior approach – External fixation joint distraction

• The type of approach does

not appear to affect clinical

• utcome
• Consider morbidity of
• steotomy

My Preference

Görtz S, Bugbee WD. Oper Tech Orthop 2006, 16(4):244-249.

• Anterior approach
• External fixation (optional)
• Joint distraction
• Modest plafondplasty
• Onlay partial talus graft
• Fixation with absorbable pins
• r darts or small metallic

screws

• 6-12 weeks non wt bearing

But Why Should You Consider Allografts in the Talus?

Everyone that has used them and published results has a good experience!

• 9 studies, 155 patients
• Patient age 30-44 years
• 2/3 medial lesions
• Graft size 1.5-6.0 cm2
• Mean follow up 2-11 years

6 yrs Gross 2001, Raikin 2009, Hahn 2010, Gortz 2010, Janis 2010, Adams 2011, Berlet 2011, Daniels 2011, El-Rashidy 2011

Clinical Outcome Summary OCA for OLT

• Patient satisfaction 75-100%
• Improvement in ankle score (AOFAS) 27-

46 points

– mean post op 79-83

• Complications and reoperations

– 0-50%

• 12 graft failures (8%) requiring revision,

arthrodesis or arthroplasty

Recent Systematic Review

• 5 studies, 91 patients
• 39 years, 45 month

mean f/u

• AOFAS 40 80
• VAS 7.1 2.7
• 25% had reoperations
• 13.2% failure
• 8.8% converted to

arthrodesis or TAA

My Long Term f/u

• 20 patients
• 34 years, 53% male
• 11 medial, 9 lateral
• Mean graft size 3.75 cm2 (1.7-6.4)
• 9.7 year f/u (2-18)
• 93% less pain and better function
• 87% satisfied
• 100% would have procedure again
• 5/20 reoperation
• 3 failures

81% 10 year survivorship 8 years post-op

OCA for OLT is a Great Option

Thank You