Over 2,000 patients have spoken…or at least their condyles have.
HSS: Condyle-Specific Matching for OCA Not So Helpful
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New research from Hospital for Special Surgery (HSS) in New York indicates that condyle-specific matching for osteochondral allograft transplantation (OCA) is not especially helpful.
Their work, “Condyle-Specific Matching Does Not Improve Midterm Clinical Outcomes of Osteochondral Allograft Transplantation in the Knee,” appears in the October 4, 2017 edition of The Journal of Bone and Joint Surgery.
Riley J. Williams, III, M.D. is an orthopedic surgeon at HSS. He commented to OTW, “Over the past 15 years the utility of fresh osteochondral grafts has been demonstrated by several established orthopedic researchers, including Brian Cole, M.D., William Bugby, M.D. and myself. We have shown that it is better to use the whole tissue for transplantation when patients have cartilage defects. The issue, however, is one of supply of the condyles. If there is a medial condyle lesion, many surgeons think that you must have a donor’s medial condyle.”
“That has never been my way of thinking or metric. I don’t think the size of the implants (typically 22-30mm) necessitated that. I could always find some place on the medial or lateral condyle that matched up with the affected area in the knee.”
In this retrospective review, Dr. Williams and colleagues used records from over 2,000 patients in the HSS cartilage registry who were treated with OCA from 2000 to 2014.
Dr. Williams told OTW, “We matched patients for age, sex, and size of chondral defect; our mean followup was four years. We found no difference in reoperation rates or failure rates. This has been my experience for many years, but it was necessary to have a very large study in order to prove it. I think a vast number of surgeons will be pleased because they will now know that they can use graft from many sources.”
“Despite the fact that we didn’t observe any differences in noncondylar-specific matching there is still a significant amount of surgeons who will assess the contour, size, and location of the graft. One still needs to be technically excellent and careful about where you harvest and implant the graft.”
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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