Comparison of Outcomes of Osteochondral Transplantation with Autografts and Allografts for Osteochondral Lesions of the Talus

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1 Comparison of Outcomes of Osteochondral Transplantation with Autografts and Allografts for Osteochondral Lesions of the Talus Yoshiharu Shimozono, MD, Eoghan T Hurley, MB, BCh, Timothy W Deyer, MD, John G. Kennedy, MD, MCh, MMSc, FFSEM, FRCS(Orth) NYU Langone Health, NYU Orthopedic Hospital

2 Yoshiharu Shimozono, MD I have no financial conflict to disclose. 2

3 Introduction Autograft transfer outcomes Good to Excellent at mid-term 90% of professional athletes return to sports Concern - Knee donor site morbidity Reported incidence rate : low Fraser FAI 2016 Prompt the use of allograft plug Good outcome of allograft plug El-Rashidy H et al. JBJS 2011 Similar results compared to autograft Ahmed J et al. FAI 2016 Paucity of data comparing allograft and autograft plug for OLT No studies compared using both clinical and MRI outcomes 3

4 Purpose To compare the clinical and radiological outcomes following autograft and allograft transplantation for OLT 4

5 Methods Retrospective comparative study Graft transfer >10mm or > 100mm 2 Failed BMS, cystic lesion After discussion of risks and benefits of each procedure, all pts were given the option of either auto- or allograft OATS system (Arthrex) Autograft harvested from ipsilateral femoral condyle Allograft Fresh OCA Cores (JRF; Joint Restoration Foundation) CBMA 5

6 Methods Data collection Pt demographics Clinical outcomes FAOS, SF-12 MRI evaluation Chondral wear or fissures in the graft Cyst formation MOCART score 6

7 Results Total 41 pts Autograft 25 pts, Allograft 16 pts 2 years f/u No diff in demographic variables 7

8 Results Clinical outcomes FAOS Autograft Allograft p Autograft > Allograft FAOS, SF-12 Preop Postop SF-12 Preop Postop Multivariate regression analysis after adjusting age, gender and preop FAOS Allograft FAOS 11 points lower SF-12 9 points lower 8

9 Results -MRI- Autograft Allograft p MOCART Pts w/ cysts 10 (43%) 10 (67%) No. of cysts No. of cysts /pt Cyst diameter (mm) Cyst location Graft Inferior Peripheral 1 (8%) 4 (31%) 8 (62%) 9 (47%) 2 (11%) 8 (42%) Chondral wear or fissures over the graft 1 (4%) 8 (53%) <

10 Results Complications & Additional surgeries Autograft Allograft p Total, n 1 (4%) 7 (43%) < Graft Failure 0 5 (31%) 3: Large cysts (Debridement, BioCartilage, retrograde drilling) 2: Nonunion (Autograft revision) < Unrelated to graft 1 (4%) 1: Hardware removal 2 (13%) 1: Debridement for scar 1: Delayed union of osteotomy site

11 Discussion Better clinical results in Autograft Higher failure rate in Allograft (31%) Chondral wear Poor chondrocyte cell viability 80% viability of chondrocytes (JRF allograft plug) May not be enough in some cases Cook JL, et al AJSM 2016 Poor neovascularization? Cyst in the graft 33% of allograft to ankle poor vascular infill Neri S et al. JBJS 2013 BMAC did not provide sufficient biologic potential Nonunion Subclinical immune response? Pulsating water jet 11

12 In small nonrandomized study, osteochondral autogrfat transplantation provided significantly better clinical and MRI outcomes than allograft with 2 years follow-up Increased chondral wear and loss, poor osseous integration and increased cyst formation is cause for concern. Conclusions 12

13 References El-Rashidy H, Villacis D, Omar I, Kelikian AS. Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am Sep;93(17): Ahmad J, Jones K. Comparison of osteochondral autografts and allografts for treatment of recurrent or large talar osteochondral lesions. Foot Ankle Int Jan;37(1): Kennedy JG, Murawski CD. The Treatment of osteochondral lesions of the talus with autologous osteochondral transplantation and bone marrow aspirate concentrate: surgical technique. Cartilage Oct;2(4): JRF Ortho. Fresh OCA Cores. Available at: Neri S, Vannini F, Desando G, Grigolo B, Ruffilli A, Buda R, Facchini A, Giannini S. Ankle bipolar fresh osteochondral allograft survivorship and integration: transplanted tissue genetic typing and phenotypic characteristics. J Bone Joint Surg Am Oct;95(20): Cook JL, Stannard JP, Stoker AM, Bozynski CC, Kuroki K, Cook CR, Pfeiffer FM. Importance of donor chondrocyte viability for osteochondral allografts. Am J Sports Med May;44(5): Division Name or Footer