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Osteochondral Allograft Transplantation

Knee cartilage defects can result in significant pain and dysfunction in active patients. Articular cartilage defects have a limited ability to heal because they do not have a blood supply. Cartilage lesions that expose the underlying bone are extremely painful. Untreated, they often progress to early osteoarthritis and debilitating pain, particularly in young and active patients.

Cartilage defects are common, occurring in up to 60% of patients undergoing arthroscopic knee surgery. They come in various sizes, depths, and locations. They range from small, isolated lesions in patients with low activity levels who have no symptoms, to large full thickness defects with exposed underlying bone in patients with higher activity demands. Symptoms include pain, locking, catching, swelling and dysfunction and create a risk for posttraumatic osteoarthritis. For young active patients who are eager to return to a high level of activity, joint preservation with cartilage restoration is the mainstay of treatment.

Focal or localized cartilage defects can progress to diffuse cartilage damage over time. When the diffuse cartilage damage continues to progress it is known as osteoarthritis.

Osteoarthritis is a leading cause of disability. In the early stages it is treated with conservative management including activity modification, anti-inflammatory medications (NSAIDs), bracing, muscle strengthening and steroid and hyaluronic acid injections. When these fail, surgery is indicated.

Cartilage restoration treatment decisions are based on the lesion size and location, whether underlying bone is exposed and the patient’s age and activity level, as well as the patient’s goals and commitment to rehabilitation. A patient’s overall alignment is also critical in the management of cartilage restoration surgery.

Osteochondral allograft transplantation (OCA) is a surgical procedure used to treat damage to the articular cartilage and underlying bone. OCA involves taking a healthy donor tissue graft and implanting it into the damaged area. The goal is to provide a new surface for the joint, which will allow for normal joint function and motion.

It is the preferred treatment for large, full thickness cartilage injuries with underlying bone damage in the knee.  It can also be used to treat a failed cartilage repair. Freshly obtained donor cartilage ensures the best outcome. It has well-established safety, efficacy, and durability. It has demonstrated excellent results with a high rate of return to sport and a 90% survival at ten years. At 20 years it remains in 70% of patients.

Osteochondral allograft transplantation is indicated for primary surgical management of large, full thickness cartilage defects and osteochondral defects of the thighbone or patella (kneecap) in patients who are active and wish to maintain an active lifestyle and preserve their knee. The recovery includes up to 6 weeks of crutch use, and four to six months of physical therapy. Dr. Patel will discuss an ind.

During preoperative planning the patient will receive x-rays and an MRI to determine the size of the defect. Diagnostic arthroscopy is recommended for further evaluation of the size, location, and severity of the lesion and to verify that the patient is a candidate for the fresh osteochondral allograft procedure.

Osteochondral allograft transplantation is a single – stage open surgical procedure performed under general anesthesia, to treat large cartilage defects and the underlying bone. During the procedure the recipient site is prepared, and measurements are taken. The fresh osteochondral allograft is obtained from a cadaver donor.  Dr. Patel removes the damaged cartilage and bone. He then size-matches the cartilage and bone graft to match the size of the defect and transfers it into the cartilage defects to restore the articular surface.

After surgery, strict compliance with a rehabilitation protocol is vital to optimal recovery.

There are several advantages of OCA over other treatment options, such as microfracture or total joint replacement. First, OCA is less invasive than total joint replacement. Second, OCA preserves the native anatomy of the joint and restores hyaline cartilage, which helps to maintain joint function. Third, OCA has a lower risk of reoperation and longer survival than microfracture.

Dr. Ronak M. Patel is a double board-certified orthopaedic surgeon and sports medicine physician. He completed his bachelor’s degree, medical degree, and residency training at Northwestern University. He, then completed his fellowship training at the Cleveland Clinic. He specializes in the treatment of complex knee, shoulder and elbow injuries and degenerative conditions. Contact him to schedule a consultation to learn more about how he can help you return to the life you love and the activities that make life worth living. He serves teens and adults in Chicagoland and NW Indiana.

At a Glance

Ronak M. Patel M.D.

  • Double Board-Certified, Fellowship-Trained Orthopaedic Surgeon
  • Past Team Physician to the Cavaliers (NBA), Browns (NFL) and Guardians (MLB)
  • Published over 49 publications and 10 book chapters
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