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Comparative Study
. 2024 Sep;15(3):240-249.
doi: 10.1177/19476035231226218. Epub 2024 Jan 29.

Subchondral Bone Alignment in Osteochondral Allograft Transplants for Large Oval Defects of the Medial Femoral Condyle: Comparison of Lateral versus Medial Femoral Condyle Donors

Kelly M R Taylor  1 , Conor S Locke  2 , Timothy S Mologne  3 , William D Bugbee  4 , John A Grant  1
Affiliations
Comparative Study

Subchondral Bone Alignment in Osteochondral Allograft Transplants for Large Oval Defects of the Medial Femoral Condyle: Comparison of Lateral versus Medial Femoral Condyle Donors

Kelly M R Taylor et al. Cartilage. 2024 Sep.

Abstract

Objective: Supply-demand mismatch of medial femoral condyle (MFC) osteochondral allografts (OCAs) remains a rate-limiting factor in the treatment of osteochondral defects of the femoral condyle. Surface contour mapping was used to determine whether a contralateral lateral femoral condyle (LFC) versus ipsilateral MFC OCA differs in the alignment of donor:native subchondral bone for large osteochondral defects of the MFC.

Design: Thirty fresh-frozen human femoral condyles were matched by tibial width into 10 groups of 3 condyles (MFC recipient, MFC donor, and LFC donor) each for 3 cartilage surgeons (90 condyles). The recipient MFC was imaged using nano-computed tomography scan. Donor oval grafts were harvested from each matched condyle and transplanted into a 17 mm × 36 mm defect created in the recipient condyle. Following the first transplant, the recipient condyle was imaged and superimposed on the native condyle nano-CT scan. The donor plug was removed and the process repeated for the other donor. Surface height deviation and circumferential step-off height deviation were compared between native and donor subchondral bone surfaces for each transplant.

Results: There was no statistically significant difference in mean subchondral bone surface deviation (LFC = 0.87 mm, MFC = 0.76 mm, P = 0.07) nor circumferential step-off height (LFC = 0.93 mm, MFC = 0.85 mm, P = 0.09) between the LFC and MFC plugs. There were no significant differences in outcomes between surgeons.

Conclusions: There were no significant differences in subchondral bone circumferential step-off or surface deviation between ipsilateral MFC and contralateral LFC oval-shaped OCAs for 17 mm × 36 mm defects of the MFC.

Keywords: cartilage transplant; osteochondral allograft; subchondral bone.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Kelly M.R. Taylor: None declared; Conor S. Locke: None declared; Timothy S. Mologne: JRF Ortho, Arthrex; William D. Bugbee: JRF Ortho, Arthrex; John A. Grant: JRF Ortho, Arthrex, Vericel, Aesculap Biologics.

Figures

Figure 1.
Figure 1.
Implanted oval cartilage graft.
Figure 2.
Figure 2.
Surface deviation. (A) Volumes from each group (native + 2 grafts) were aligned for accurate measurement between the surfaces. Using DragonFly, surface deviation (dRMS, proud or sunken) was measured as the normal distance between the native subchondral bone surface and the subchondral surface of the transplanted donor graft. Measurements for MFC and LFC donor sites were compared (B).
Figure 3.
Figure 3.
Division of the cartilage grafts into anterior, posterior, medial, and lateral segments. Due to the oval shape of the transplant, the segments were not all equal size.
Figure 4.
Figure 4.
Measurement of subchondral bone step-off height at the interface between the graft and the surrounding native bone. Step-off height (hRMS) was measured at 0.3-mm increments around the edge of graft and measured as the difference in subchondral bone height between the graft and surrounding native bone.
Figure 5.
Figure 5.
Subchondral bone surface deviation (dRMS) was not significantly affected by donor condyle or graft quadrant.
Figure 6.
Figure 6.
Subchondral bone step-off height (hRMS) was not significantly affected by donor condyle or graft quadrant except in the anterior quadrant between the lateral femoral condyle and medial femoral condyle donors (*P = 0.03).
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