OCA Transplantation After Failed Knee Microfracture

While osteochondral allograft (OCA) transplantation has demonstrated excellent clinical outcomes and return to sport, there is little evidence in the literature on the effectiveness of OCA transplants as a revision procedure after failed previous microfracture. Researchers in New York set out to change that.

The team conducted a prospective, hospital-wide cartilage registry from the Hospital for Special Surgery to identify patients over age 18 years with minimum two-year follow-up who had undergone revision OCA transplantation after previous failed microfracture in the knee. A matched control cohort was also identified that underwent a primary OCA procedure for comparison.

Shawn Anthony, M.D., is assistant professor of Orthopaedic Surgery and Sports Medicine at the Icahn School of Medicine at Mount Sinai. He told OTW, “Whether treating professional athletes or weekend warriors, orthopedic surgeons frequently treat cartilage injuries in the knee. Microfracture is commonly used as a first-line treatment of cartilage lesions in the knee despite multiple long-term outcomes studies showing worsening outcomes and failure with time. Osteochondral allograft (OCA) transplantation has been shown to provide excellent outcomes and return to sport; however, there is little evidence in the literature on the effectiveness of OCA transplants as a revision procedure after failed previous microfracture. The purpose of this study was to compare clinical outcomes of patients undergoing fresh OCA transplantation after failed microfracture to a matched control cohort undergoing initial treatment with OCA transplantation.”

“The primary finding of this study was that OCA transplantation after failed previous microfracture produced favorable and equivalent outcomes to primary OCA transplantation. This study demonstrated improved functional outcomes and high patient satisfaction at minimum two years of follow-up in both primary and revision cohorts.”

Asked how this work differs from other research, he noted, “Previous research has shown that worse outcomes after revision cartilage procedures such as autologous chondrocyte implantation (ACI). ACI has a significantly higher rate of failure in the largest lesions and particularly in those patients who underwent microfracture of the defect in a prior surgical procedure. This study showed that OCA transplantation can provide pain relief and improve functional outcomes in patients with large lesion size and prior microfracture.”

“OCA transplantation should be discussed with patients as a viable and durable treatment option for large cartilage lesions whether for initial treatment or after failed microfracture. The Sports Medicine Service at Mount Sinai Health System is at the forefront of research on joint preservation and advanced cartilage repair techniques that include OCA transplantation as well as biological therapies for cartilage repair and regeneration. Cartilage injuries are among the most difficult to treat problems facing orthopedic surgeons, and OCA transplantation can provide an effective joint preserving option for patients.”