In this article, you will find everything you need to know about Osteochondral Allograft transplantation, its alternatives, and advanced regenerative treatments like Prolotherapy.
- What is an Osteochondral Allograft?
- Causes and Cartilage Defects of the Knee
- Methods of Correcting Cartilage Defects
- Indications and Contraindications
- The Osteochondral Allograft Procedure
- Cost of Osteochondral Allograft
- Side Effects
- Prolotherapy as an Alternative Treatment
- Rehabilitation and Recovery
- Complications and Challenges
- Patient Stories and Experiences
- Summary
- Author Bio
- Contact ProHealth Clinic
- References
What is an Osteochondral Allograft?
An Osteochondral Allograft (OCA) is a surgical treatment used when knee cartilage damage occurs in multiple dimensions, depths, or locations. Damage can range from minor superficial lesions to large, full-thickness, multifocal defects. Chondral injuries are often observed in younger patients, affecting roughly 60% of individuals undergoing knee arthroscopy. Osteochondral allograft transplantation is particularly suitable for young active patients and active patients with larger lesions who wish to maintain an active lifestyle.
Cartilage defects may result from acute trauma or repetitive stress, leading to softening, flap tears, fissures, or delamination of the cartilage. Chondral defects and osteochondral defects often involve both the cartilage and the underlying subchondral bone, and large osteochondral lesions are especially challenging to treat. In osteochondral allograft transplantation, damaged cartilage and subchondral bone are the primary targets for repair.
Causes and Cartilage Defects of the Knee
Defects in the articular cartilage may arise from:
- Acute trauma or injury
- Repetitive microtrauma or overloading
- Osteochondritis dissecans (OCD)
- Osteonecrosis
- Previous failed cartilage repair
Previous injuries, ligamentous instability, and limb malalignment are associated conditions that can contribute to the development of cartilage defects. A thorough physical exam is essential to assess for signs of ligamentous instability, meniscal injury, and limb malalignment. Articular cartilage defects and articular cartilage lesions can occur in various locations, including the patellofemoral joint. These defects cause pain, reduced function, and may progress if untreated.
Methods of Correcting Articular Cartilage Defects of the Knee
Surgical management is often required for significant cartilage defects. Treatment options include:
- Abrasion arthroplasty
- Autologous chondrocyte implantation (ACI)
- Microfracture
- Drilling
- Osteochondral autograft transfer (OAT)
- Osteochondral allograft transplantation (OCA)
- Osteochondral autograft transplantation
- Autologous chondrocyte transplantation
Each technique has limitations. Marrow stimulation techniques create fibrocartilage, which is inferior to hyaline cartilage. OAT has donor site morbidity, and small procedures are ineffective for lesions >2 cm². Cell-based therapies like MACI and staged ACI are alternatives for larger defects. OCA is a one-stage surgical procedure that uses full-thickness hyaline cartilage, avoiding donor morbidity and restoring native anatomy. Fresh osteochondral allografts and fresh grafts are preferred for optimal outcomes, as they maintain high chondrocyte viability and cartilage properties. The choice of surgical technique and precise osteochondral grafting are critical for successful graft integration and patient recovery. High tibial osteotomy may be considered in cases with malalignment to realign the tibia and reduce joint load. The surgical procedure plays a key role in treating articular cartilage defects and restoring joint function.
Indications and Contraindications
Indications
- Large (>2-3 cm²), full-thickness (grade 3-4) femoral condyle lesions
- Tibial or patellofemoral defects refractory to conservative treatment
- Post-traumatic or idiopathic lesions
- Lesions from OCD, osteonecrosis, or failed previous repair
Contraindications
- Current tobacco use
- BMI > 35 kg/m²
- Inflammatory joint conditions
- Diffuse degenerative changes
- Uncorrected knee pathologies (malalignment, ligament insufficiency, meniscal deficiency)
The Fresh Osteochondral Allograft Transplantation Procedure
The procedure is performed under general anesthesia and is typically performed through an open incision to allow precise access to the defect. The knee is examined, and biologic aides like PRP may be prepared. Fresh osteochondral allograft transplantation uses grafts from a deceased donor, ideally matched to the same location as the cartilage defect for optimal compatibility and healing.
Template Sizing
Parapatellar arthrotomy is performed based on lesion location. Templates measure the defect, and edges are scored for graft fitting.
Reaming
A socket is reamed to the required depth (7-8 mm max), using irrigation to prevent heat damage, until healthy bone is exposed.
Allograft Preparation
The donor osteochondral plug (15–28 days old) is warmed in saline, trimmed to match the defect, and protected with a graft workstation. Coring reamers and irrigation prevent heat necrosis during trimming.
Implantation
The graft is cleansed with pulsed lavage to remove bone marrow residues, minimizing immune reaction. If biologics were prepared, the graft may be soaked in PRP.
Insertion
A press-fit technique aligns the graft with surrounding cartilage. Copious irrigation follows, and the wound is closed in layers.
Cost of Osteochondral Allograft
The procedure cost varies based on graft pricing, typically around $10,000. Your specialist can provide a precise estimate.
Side Effects
- Graft rejection
- Limited availability
- High cost
- Risk of disease transmission
- Reduced chondrocyte viability post-harvest
- Short implantation window at tissue banks
- Persistent pain, which may indicate graft failure or complications
Prolotherapy as an Alternative Treatment
Prolotherapy is a minimally invasive regenerative treatment for cartilage damage and joint injuries. It involves injecting a natural solution with tiny needles, stimulating collagen production to repair cartilage and ligaments. By targeting the root cause, Prolotherapy may offer long-term relief and reduce the need for invasive surgeries like OCA.
Rehabilitation and Recovery
- Initial rest to allow healing
- Structured postoperative rehabilitation and physical therapy, including early motion and gradual progression of weight bearing, to promote optimal graft incorporation and functional recovery
- Targeted exercises for quadriceps, hamstrings, gluteals, and core
- Progression to sport-specific activities, guided by sports med expertise to ensure safe and effective return to sport protocols
Patients are usually able to return to high-impact activities after several months, depending on lesion size and procedure complexity.
Complications and Challenges
- Chronic pain or inflammation
- Local infections or immune reactions
- Joint space issues requiring aspiration or culture
- Femoral artery involvement (rare)
Patient Stories and Experiences
Patients often face physical and emotional challenges during recovery. Structured rehabilitation programs and gradual return to activity are key for successful outcomes. Many patients report significant improvement in function and pain after OCA or complementary Prolotherapy treatments.
Summary
Osteochondral Allograft transplantation provides a one-stage solution for large, full-thickness knee cartilage defects. While alternatives like cell-based therapies and Prolotherapy exist, OCA remains the gold standard for restoring native cartilage structure and function. Proper rehabilitation, prevention of complications, and personalized care improve long-term outcomes.
Author Bio
Having performed over 10,000 procedures, Mr. Oliver Eaton is one of the UK’s leading practitioners in treating Osteochondral Allograft and cartilage injuries. Patients travel from across the UK, Europe, and the Middle East for his expertise. With over 12 years of clinical experience, Oliver specializes in helping patients understand their knee conditions and providing effective treatment.
He qualified in Prolozone Therapy and Prolotherapy in the USA with the American Academy of Ozonotherapy, and continued training at the Royal Society of Medicine, Charing Cross Hospital, Keele University’s Anatomy & Surgical Training Centre, and Heidelberg University. He has treated elite athletes, including Olympic and Commonwealth medallists.
LinkedIn: https://www.linkedin.com/in/oliver-eaton-4338225b/
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References
- Haber DB, Logan CA, Murphy CP, Sanchez A, LaPrade RF, Provencher MT. Osteochondral Allograft Transplantation for the Knee: Post-Operative Rehabilitation. Int J Sports Phys Ther. 2019;14(3):487-499. doi:10.26603/ijspt20190487
- Mistry H, Metcalfe A, Smith N, et al. The cost-effectiveness of osteochondral allograft transplantation in the knee. Knee Surg Sports Traumatol Arthrosc. 2019;27(6):1739-1753. doi:10.1007/s00167-019-05392-8
- Aleexev M. Autograft or allograft. AAOS. Jan, 2019. https://www.aaos.org/aaosnow/2019/oct/clinical/clinical01