Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Table 1 Location of allografts from Murphy et al[27]

Location	Number
Femur
Medial condyle	18
Lateral condyle	15
Trochlea	2
Patella	3
Tibial plateau	1
Multiple sites	4

Table 2 Pre-operative and post-operative comparison of outcome measures from study by Murphy et al[27]

Outcome measure	Pre-operative	Post-operative
IKDC scores
Pain	5.7 ± 2.7 (0-10)	2.5 ± 2.4 (0-8)
Function	3.7 ± 1.9 (0-9)	7.8 ± 1.7 (4-10)
Total	42.0 ± 16.6 (14-98)	75.2 ± 20.2 (33-100)
Modified D'Aubigne Postel 18-point score	13.1 ± 2.1 (9-18)	16.6 ± 1.6 (12-18)
Knee Society Function score	69.3 ± 18.8 (45-100)	89.4 ± 16.3 (40-100)

Results presented as mean ± SD (range). All comparisons statistically significant (P < 0.05). IKDC: International Knee Documentation Committee.

Table 3 Demographic details of all studies included in review

Ref.	Population	Indication	Location	Patientno.	No. ofknees	Meanage (yr)	Meanfollow up	Failurerate
Bakay et al[6]	-	Osteoarthritis; post-traumatic; OCD; chondromalacia	MFC, LFC, T, P, bipolar	18	33	48	19 mo	-
Ghazavi et al[30]	Young, active patients	Post-traumatic	MFC, LFC, T, bipolar, P	123	126	35	7.5 yr	15%
Langer et al[4]	Young, active patients	Post-traumatic; OCD; osteonecrosis; osteoarthritis	MFC, LFC	60	60	27	10 yr	20%
Gross et al[5]	Young, active patients	Tibial plateaus fractures	T	65	65	42.8	11.8 yr	32%
Jamali et al[35]	-	Post-traumatic; patella subluxation; primary patellofemoral arthrosis; primary chondromalacia patellae	P, FT	18	20		94 mo	28%
Colangeli et al[31]	-	Proximal tibia bone tumour	T	8	8	23.1	37 mo	-
Davidson et al[19]	-	OCD; post-traumatic	MFC, FT	8	10	32.6	40 mo	-
Emmerson et al[24]	-	OCD	MFC, LFC	64	66	28.6	7.7 yr	15%
McCulloch et al[21]	-	Degenerative; post-traumatic; OCD; osteonecrosis	MFC, LFC	25	25	35	35 mo	4%
Williams et al[8]	-	Full-thickness cartilage defect; OCD; osteonecrosis	MFC, LFC	19	19	34	48 mo	21%
Pearsall et al[3]	-	Full-thickness cartilage defect	MFC, LFC, FT, P	48	24 allografts	46	37.1 mo	19%
Muscolo et al[32]	-	Proximal tibia bone tumour; previous allograft failure	T	52	58	24	10.3 yr	39%
Krych et al[28]	Athletes	Post-traumatic; non-traumatic focal chondral and osteochondral lesion; OCD	MFC, LFC, FT, multiple sites	43	43	32.9	2.5 yr	-
Murphy et al[27]	Pediatric and adolescent population	OCD; avascular necrosis; post-traumatic; osteochondral fracture; degenerative lesion	MFC, LFC, FT, P, T, multiple sites	39	43	16.4	8.4 yr	12%
Raz et al[29]	Young, active patients	Post-traumatic; OCD	MFC, LFC	58	58	28	21.8 yr	22%

MFC: Medial femoral condyle; LFC: Lateral femoral condyle; FT: Femoral trochlea; P: Patella; T: Tibia; OCD: Osteochondritis dissecans.

Table 4 Summary of survivorship analysis of all studies included in review

Ref.	Location	No. of knees	Survivorship
			5 yr (%)	10 yr (%)	15 yr (%)	20 yr (%)	25 yr (%)
Bakay et al[6]	MFC, LFC, T, P, bipolar	33	-	-	-	-	-
Ghazavi et al[30]	MFC, LFC, T, bipolar, P	126	95	71	66	-	-
Langer et al[4]	MFC, LFC	60	95	85	-	-	-
Gross et al[5]	T	65	95	80	-	-	-
Jamali et al[35]	P, FT	20	-	67	-	-	-
Colangeli et al[31]	T	8	-	-	-	-	-
Davidson et al[19]	MFC, FT	10	-	-	-	-	-
Emmerson et al[24]	MFC, LFC	66	91	76	76	-	-
McCulloch et al[21]	MFC, LFC	25	-	-	-	-	-
Williams et al[8]	MFC, LFC	19	-	-	-	-	-
Pearsall et al[3]	MFC, LFC, FT, P	24	-	-	-	-	-
Muscolo et al[32]	T	58	65	65	-	-	-
Krych et al[28]	MFC, LFC, FT, multiple sites	43	-	-	-	-	-
Murphy et al[27]	MFC, LFC, FT, P, T, multiple sites	43	-	-	-	-	-
Raz et al[29]	MFC, LFC	58	-	91	84	69	59

MFC: Medial femoral condyle; LFC: Lateral femoral condyle; FT: Femoral trochlea; P: Patella; T: Tibia.

Table 5 Summary of outcome scores and results of all studies included in review

Ref.	Location	No. ofknees	D'Aubigneand Postel		HSS		IKDC		Lysholm		KSS		KSF		ADL		MTS		ISLS		SF-12		SF-36		Tegner		Outerbridge		Marx
			1	2	1	2	1	2	1	2	1	2	1	2	1	2	1	2	1	2	1	2	1	2	1	2	1	2	1	2
Bakay et al[6]	MFC, LFC, T, P, bipolar	33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Ghazavi et al[30]	MFC, LFC, T, bipolar, P	126	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Gross et al[5]	MFC, LFC	60	-	-	-	83/100	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Gross et al[23]	T	65	-	-	-	85.3/100	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Jamali et al[35]	P, FT	20	11.7	16.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Colangeli et al[31]	T	8	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Davidson et al[19]	MFC, FT	10	-	-	-	-	27	79	37	78	-	-	-	-	-	-	-	-	-	-	-	-	38	51	4.3	5.3	4.3	0.6	-	-
Emmerson et al[24]	MFC, LFC	66	13	16.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
McCulloch et al[21]	MFC, LFC	25	-	-	-	-	29	58	39	67	-	-	-	-	-	-	-	-	-	-	36	40	-	-	-	-	-	-	-	-
Williams et al[8]	MFC, LFC	19	-	-	-	-	-	-	-	-	-	-	-	-	56	70	-	-	-	-	-	-	51	66	-	-	-	-	-	-
Pearsall et al[20]	MFC, LFC, FT, P	24	-	-	-	-	-	-	-	-	110	119	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Muscolo et al[32]	T	58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26/30	-	87%	-	-	-	-	-	-	-	-	-	-
Krych et al[28]	MFC, LFC, FT, multiple sites	43	-	-	-	-	46	79	-	-	-	-	-	-	62	82	-	-	-	-	-	-	-	-	-	-	-	-	5.5	8.4
Murphy et al[27]	MFC, LFC, FT, P, T, multiple sites	43	13.1	16.6	-	-	42	75	-	-	-	-	69.3	89.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Raz et al[29]	MFC, LFC	58	-	-	-	86/100	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-

1: Pre-operative; 2: Post-operative; IKDC: International Knee Documentation Criteria; SF-36: Short form 36; SF-12: Short form 12; KSS: Knee society score; KSF: Knee society function score; ADL: Activities of daily living; HSS: Hospital for special surgery; MTS: Musculoskeletal tumour Society; ISLS: International Society of Limb Salvage radiographic; MFC: Medial femoral condyle; LFC: Lateral femoral condyle; FT: Femoral trochlea.

Table 6 Summary of Knee injury and osteoarthritis outcome scores of study by McCulloch et al[21]

Year	Ref.	Location	No. of knees	KOOS Pain		KOOS Symptoms		KOOS ADL		KOOS SRF		KOOS QOL
				Pre-operative	Post-operative	Pre-operative	Post-operative	Pre-operative	Post-operative	Pre-operative	Post-operative	Pre-operative	Post-operative
2007	McCulloch et al[21]	MFC, LFC	25	43	73	46	64	56	83	18	46	22	50

KOOS: Knee injury and osteoarthritis outcome score; ADL: Activities of Daily Living; SRF: Sports and Recreation Function; QOL: Quality of life; MFC: Medial femoral condyle; LFC: Lateral femoral condyle.

Table 7 Summary of Western Ontario and McMaster Universities Osteoarthritis index score of study by Pearsall et al Post-operative considerations

Year	Ref.	Location	No. of knees	WOMAC Pain		WOMAC Stiffness		WOMAC Function
				Pre-operative	Post-operative	Pre-operative	Post-operative	Pre-operative	Post-operative
2008	Pearsall et al[20]	MFC, LFC, FT, P	24	10.9	14.5	4.1	5.6	38.3	49.7

WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; MFC: Medial femoral condyle; LFC: Lateral femoral condyle; FT: Femoral trochlea.