Patellofemoral Osteochondral Allograft Transplantation
Purpose: To describe the indications, surgical technique and rehabilitation for using a fresh osteochondral allograft (OCA) in patellofemoral reconstruction.
- While patellofemoral cartilage defects are common, there are three main indications for using an OCA transplant:
- Defects that have extensive damage to the subchondral bone
- Defects that are due to severe trochlear dysplasia
- Osteoarthritis in young patients who are not candidates for arthroplasty.
- Depending on the size and severity of the defect, a dowel press-fit technique or a shell technique can be utilized.
- The shell technique is a more challenging procedure and is often used in cases where the defect is very large, or when matching the curvature is more difficult.
- Tissue banks can determine appropriate graft matches through the use of a patient’s magnetic resonance images.
- Unless other concurrent procedures are being performed, patellofemoral resurfacing does not require prolonged weight bearing restrictions. Immediate ambulation with the knee locked in full extension is permitted as tolerated.
- There is limited literature on outcomes but success has been described in more than 2/3 of patients.
JRF Ortho Take Away: The complex anatomy of the patellofemoral region makes resurfacing in this area a challenging procedure. However, successful outcomes with the press-fit and shell technique have been described.
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Authors: Andreas H. Gomoll, Jack Farr, Betina Hinckel
Published: Operative Techniques in Sports Medicine
Institution: Brigham and Women’s Hospital