Fresh Thinking on Fresh Osteochondral Allografts
A proprietary approach to osteochondral allograft transplantation promises some better results in a tough population
What’s the Claim?
Patients undergoing bipolar osteochondral allograft transplantation plus meniscal allografting using a proprietary approach to graft preservation (the Missouri Osteochondral Preservation System, MOPS) had clinically important improvements in pain and function that were maintained at a minimum of two years (mean 52 months) after surgery. The authors claimed a “success rate” of nearly 80% at that time point, but we note that they identified 30% of the initial group of patients as “nonadherent to the prescribed restriction and rehabilitation protocol” and removed them from the analysis. More than 20% of the group they included went on to have a revision procedure (10.5%) or a conversion to arthroplasty (11.8%). They identified three factors as being associated with revision or arthroplasty: nonadherence (odds ratio [OR] = 7.2), an ipsilateral concurrent procedure (OR = 5.5), and ipsilateral osteotomy (OR = 3.3).
How’s It Stack Up?
Generally favorably, with some important caveats. This is a patient population for whom we have few good options. Large “kissing” lesions on the femur and tibia alongside severe meniscal damage typically represents a contraindication to biologic reconstruction, and often a fast-track to premature arthroplasty. If we take the authors’ claims at face value (that just over 20% of the patients had a reoperation or conversion to arthoplasty), that is far superior to what a recent systematic review suggests is the case for patients with bipolar lesions like these.
