Additional surgery after the index procedure is common, with ankle arthroscopy, hardware removal, nonunion or malunion of malleolar osteotomy, supramalleolar or calcaneal osteotomy been described. Osteochondral allograft transplantation is a technique that over the past 15 years has been employed for treatment of osteochondral lesions of the. Osteochondral allograft allows for optimal matching of graft and lesion morphology while providing structural support. This condition is also known as osteochondritis dissecans ocd of the talus or a talar osteochondral lesion ocl. These new techniques are easier to perform and have a lower patient morbidity in comparison to an osteochondral allograft transplant system procedure. Ankle cartilage repair osteochondral allograft transplant. Maintain your operative dressing, loosen bandage if swelling of the foot or ankle occurs. Fresh osteochondral allografts are currently used to treat a broad spectrum of osteoarticular lesions, ranging from focal osteochondral defects, where a partial or unipolar graft is generally used, to established osteoarthritis, where a total or bipolar graft is required.
Fresh osteochondral allograft for the treatment of. Bipolar fresh osteochondral allograft transplantation of. Osteochondral allograft transplantation surgery edina foot. Orthopaedic foot and ankle society aofas score, pain visual analog scale vas score. Bipolar fresh osteochondral allograft transplantation of the. Osteochondral allograft transplantation is indicated for large lesions that have affected the cartilage and subchondral beneath cartilage bone. Health technology brief osteochondral allograft transplantation for articular disorders of the ankle. What is bulk allograft transplantation for osteochondral lesions of the talus. In fact, the first documented use of fresh allografts was by erich lexer1 in 1908. Total knee replacement versus osteochondral allograft in proximal tibia bone tumours. Large osteochondral defects of the talus present a treatment challenge. Allografting or, to give its full name, fresh osteochondral allograft transplantation oca is an operation in which a damaged or diseased area of a joint is reconstructed using a bone and cartilage transplant. When cartilage is injured, the smooth surface can become rough. Osteochondral allograft transplantation in the knee is an alternative to joint replacement that may be used to treat a young and healthy population with symptomatic cartilage defects.
These osteochondral bioimplants allow orthopedic surgeons to transplant mature hyaline cartilage with viable chondrocytes and subchondral bone into recipients damaged articular. Listing a study does not mean it has been evaluated by the u. Consider the pros and cons in choosing osteochondral. Large, symptomatic, focal chondral, and osteochondral lesions of the ankle are treated with osteochondral autograft allograft transplantation oat procedure, a reconstructive bone grafting. There are two menisci in the kneea medial meniscus and a lateral meniscus. Fresh osteochondral total ankle allograft transplantation has been reported in the literature with survival rates between 50% and 92% at 1 to 12years followup. The surgical steps and technical aspects of the procedure parallel those for a typical total ankle. We previously reported on a cohort of 86 ankles that had undergone bipolar oca of the tibiotalar joint and now present the results after longer, midterm followup mean, 9. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Fresh osteochondral allograft transplantation is an effective salvage strategy for revision of failed cartilage repair commentary on an article by tim wang, md, et al clinical and mri outcomes of fresh osteochondral allograft transplantation after. Massive allograft implantation following radical resection of high. Brian cole specializes in shoulder, elbow and knee surgery. While osteochondral autografts and allografts can be used to successfully treat cartilage lesions, each has assets and liabilities. Patients should have a functional ankle motion, closed growth plates, absence of.
Osteochondral allograft transplantation surgery oats is a procedure that replaces damaged cartilage in the knee with healthy cartilage from a donor, relieving pain and restoring movement and function to the joint. These authors evaluate the effectiveness of procedures such as microfracture and arthroscopy, and recent innovations such as juvenile particulate chondrocyte allografts. Relevant outcomes are symptoms, functional outcomes, quality of life, and treatmentrelated morbidity. He has a dedicated clinical staff and assistants to assist in delivering highquality and expert care. Osteochondral allografts are composed of fresh donor tissue and are procured from tissue banks that follow strict safety guidelines. Osteochondral lesions can occur in any joint, but are most common in the knee and ankle. Osteochondral allografts have been used for many years with reported patient satisfaction rates over 90% bugbee w. Pdf osteochondral allograft transplantation in the ankle. Despite the benefits of a fresh osteochondral allograft, this procedure must be reserved for salvage of cases that have failed arthroscopic debridement or osteochondral autograft transfer.
Allograft transplants involve the transplantation of a piece of cartilage and subchondral bone from a source outside of the patient to fill in the osteochondral defect. Treating osteochondral lesions of the talus can pose challenges and delayed diagnosis due to late presentation after an ankle sprain. Available exclusively from conmed through mtf biologics, osteochondral allografts with the missouri osteochondral allograft preservation system mops. Osteochondral allograftautograft transplantation oat. On occasion, the cartilage injury exposes the underlying bone. Chondrofix osteochondral allograft transforms the repair of fullthickness osteochondral lesions to a new level of convenience. Over the past 15 years, this technology has been translated to the treatment of osteochondral lesions and endstage arthritis of the ankle. A fresh shell or plug of bone and cartilage harvested from a cadaver is transplanted to fill a fullthickness chondral or osteochondral defect. Fresh osteochondral allograft reimbursement reference document. Bipolar osteochondral allograft transplantation of the. Osteochondral allograft transplantation surgery is a procedure that replaces damaged cartilage in the ankle with healthy cartilage from a donor, relieving pain. That makes now the perfect time to study up on how to choose between osteochondral graft codes 27415, 27416, 29866 and 29867. Like an autograft, it is a block of cartilage and bone.
Osteochondral allograft transplantation system oats of the ankle. At the american orthopaedic society for sports medicine. Evidence for these operations is limited and consists primarily of case. Osteochondral lesions of the talus are chondral defects often caused by acute trauma to the ankle such as sprains and fractures. Chondrofix allograft is the first offtheshelf osteochondral allograft. Osteochondral allografting, also called oats, osteochondral transfer, or mosaicplasty, involves transplantation of a piece of articular cartilage and attached subchondral bone from a cadaver donor to a damaged region of the articular surface of a joint. Intermediate outcomes of fresh talar osteochondral allograft. Osteochondral allograft transplant surgery is a graft procedure similar to osteochondral autograft transfer system, but using graft material from preserved cadaver cartilage.
Arthroscopicassisted osteochondral allograft transplantation for. Fresh osteochondral total ankle allograft transplantation for. Many studies on human allograft transplantation reported little or no histological evidence of immunomediated pathology or transplant rejection. Addressing osteochondral lesions of the talus podiatry today. Osteochondral allograft transplantation surgery is a procedure that replaces damaged cartilage in the ankle with healthy cartilage from a donor, relieving pain and restoring movement and function to the joint. Osteochondral allograft and autograft transplantation. Osteochondral defects and osteonecrosis affect both children and adults. Osteochondral allograft oatsmosaicplasty transplantation of the knee. Osteochondral allograft transfer for treatment of osteochondral. Mr imaging of cartilage repair in the knee and ankle. Displacement or collapse of the fragment of bone leads to cartilage damage and eventual ankle arthritis. Osteochondral allograft transplantation for osteochondral. Osteochondral autograft and allograft transplantation in the.
For a young patient with endstage arthritis, bipolar fresh osteochondral allograft transplantation is a treatment alternative to ankle arthrodesis. Ankle cartilage repair osteochondral allograft transplant surgery. It is normal for the knee to bleed and swell following surgery if blood soaks onto the bandage, do not become alarmed. Full text osteochondral allograft transplantation in the ankle. Oats of the ankle is a surgical procedure to treat.
Osteochondral allograft transplantation surgery for. Osteochondral allograft transplantation effective for. It is tested for any possible disease transmission. Dec 11, 2019 osteochondral allograft transplantation for osteochondral defects of the knee. Osteochondral lesions of the talus olts are ankle joint injuries involving damage to the joint surface cartilage andor underlying ankle bone talus. Cartilage is the smooth coating on the end of the bones that provides cushioning and support for comfortable and fluid movement of the joints. Rehabilitation guidelines following osteochondral allograft.
Osteochondral allograft transplantation in the ankle. A normal, healthy ankle joint is made up of smooth cartilage supported by strong bone underneath. Position statement the use of osteochondral transplantation. The goal of this study was to present the results of total ankle allografts from another institution. Patients will follow a managed postoperative rehabilitation protocol that is standard for those that have had an osteochondral allograft to their ankle. Although there is a potential to delay or avoid arthrodesis or total ankle arthroplasty in younger patients. If a cartilage defect is too large for an autograft, an allograft may be considered. Osteochondral allograft oca transplantation is a useful alternative for treatment of posttraumatic ankle arthritis in young patients but has a. Fresh osteochondral allograft reimbursement reference.
An allograft is a tissue graft taken from a cadaver donor. Osteochondral allograft transplantation surgery edina. The mr imaging features that may be observed after cartilage repair in the knee and ankle are described in detail, and the. Our fresh graft osteochondral graft program is designed to offer a variety of allograft choices for joint reconstruction procedures to repair articular cartilage and subchondral bone defects. Osteochondral allograft oca transplantation is a useful alternative for treatment of posttraumatic ankle arthritis in young patients but has a relatively high failure rate and further. Generally, osteochondral allograft transplantation is considered as a rescue. The transplanted tissue provides the hyaline cartilage.
Bipolar osteochondral allograft transplantation of the tibiotalar joint for ankle arthritis. Gross and colleagues 34 were the first to report on the use of fresh osteochondral allograft tissue in the ankle. Ostgeochondral autograft transplantation for the ankle. Similar to osteochondral autograft, allograft replaces the entire osteochondral unit. Ostempowski experience with fresh osteochondral allografting in the management of chondral and osteochondral injuries extends over many decades. These menisci are semilunar wedges that sit between the femur thigh bone and tibia shin. Mar 20, 2008 don t miss what the term autografts reveals for 27416 and 29866 cpt 2008 brought you 27416, an allnew mosaicplasty code. Osteochondral allograft transplantation in the ankle since pj ac is a relativ ely new technique for treatment of ol t, there are limited published results. Osteochondral allograft transplantation med diagnostics. Fresh osteochondral allograft for the treatment of cartilage defects of the talus.
A 20yearold collegiate basketball player presents with a 1year history of left knee pain accompanied by clicking, catching, and effusions. Osteochondral allograft transplantation is a technique that has been employed for the treatment of olt and involves replacing defects in bone and articular. Osteochondral allograft transplantation med diagnostics rehab. Longterm followup of revision osteochondral allograft. Chondrofix osteochondral allograft coding reference guide. Success rates of osteochondral allograft of the talus are reported to range between 73% and 100%. Oct 05, 2017 bipolar osteochondral allograft transplantation of the tibiotalar joint for ankle arthritis.
Osteochondral allografts are regulated by the fda as human cell or tissue products. There is variability with respect to the terms used to describe osteochondral grafting with. Open osteochondral allograft to replace the cartilage that is grade four on the tibia andor talus. View product feature bicompartment allograft combination femoral trochlea and condyle osteochondral allograft view product feature distal tibia distal tibia is used for resurfacing ankle or shoulder cartilage defects with mature hyaline cartilage and strong bone. The cartilage can be torn, crushed or damaged and, in. Indications for osteochondral allograft transplantation.
Scheduling a procedure with a fresh allograft requires patients to be oncall so that upon graft availability, the graft may be. Osteochondral lesions of the talus are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, particularly in association with sports injuries 1, 2. Transplantation is indicated for extremely large lesions and those with continued pain following other surgical treatments. Indications for osteochondral allograft transplantation full text. Dont miss what the term autografts reveals for 27416 and 29866 cpt 2008 brought you 27416, an allnew mosaicplasty code. The results of this study may help active young patients and their surgeons to better understand outcomes and options in their shared decisionmaking process. Osteochondral allograft transplantation is an option for the treatment of selected athletes with large olts, as well as lesions that are refractory to marrow stimulation techniques. Arthrex has a long standing partnership with leading tissue banks to provide fresh osteochondral allografts oca for use in joint restoration procedures. Fresh osteochondral allograft transplantation can be used for large lesions without the donorsite morbidity associated with other procedures such as autologous chondrocyte implantation or osteochondral autograft transfer. Osteochondral allograft transplantation musculoskeletal key.
Each graft combines inherent qualities of donor human bone. Osteochondral allograft transplantation is a technique that was first developed to treat cartilage pathology in the knee. When it comes to the treatment of osteochondral lesions, new techniques and developments such as bone marrow aspirate and denovo graft have increased the number of options available. An alternative option is bipolar fresh osteochondral allograft oca transplantation of the tibiotalar joint.
Journal of the american academy of orthopaedic surgeons. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Each graft combines inherent qualities of donor human bone and cartilage with the advantages of simplicity and safety. Osteochondral allograft transplantation for osteochondral defects of the knee. Oct 18, 2018 indications for osteochondral allograft transplantation the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Rehabilitation guidelines following osteochondral allograft or autograft transplantation oats there are two types of cartilage in the kneemeniscus and articular cartilage. Fresh osteochondral allograft transplantation is an. For osteochondral lesions of the talus or the tibia, a fresh osteochondral allograft transplant can be fashioned to match a specific defect and is useful for large, cystic or uncontained lesions. Range of motion and patientreported outcome measures proms including vas pain score, aofas, and promis mobility as well as.
Articular cartilage covers the ends of bones in joints throughout the body. This information is provided as a coding guide based on the experiences of clinicians with whom we have worked with over the years, and is not intended to increase or maximize the reimbursement by any payer. There is some indication that allograft cartilage does not integrate as well, and transplantation involves some risk of infection. With the inclusion of scores before revision for those with graft failure, themean visual analog. Orr and coworkers found that while fresh bulk allograft transplantation is an excellent surgical option for middleage patients, failure was higher in a younger population with greater physical demands. Bulk allograft transplantation footcaremd foot and ankle. An osteochondral lesion of the talus olt is an area of abnormal, damaged cartilage and bone on the top of the talus bone the lower bone of the ankle joint. Jul 01, 2008 osteochondral allograft transplantation. The cartilage cells can survive the transplantation only if the tissue is fresh, which means it has not been exposed to. The cartilage cells can survive the transplantation only if the tissue is fresh, which means it has not been exposed to radiation or prolonged freezing. We examined the success of osteochondral allograft oca transplantation in 149 knees, and found 1, or 76% of those treated with the surgery. Osteochondral allograft of the talus pubmed central pmc. Fresh ocas allow the surgeon to transplant mature, hyaline cartilage with viable chondrocytes and subchondral bone in a single procedure.
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