Osteochondral Allografts for Large Osteochondral Lesions of the Knee Joint: Indications, Surgical Techniques and Results



1 Department of Orthopedic Surgery, “La Paz” University Hospital-IdiPaz, Madrid, Spain.

2 MSK Lab, Imperial College London, UK


The main indications for osteochondral allografts (OCA) transplantation of the knee are the following: 
Symptomatic full-thickness cartilage lesions greater than 3 cm2
; deep lesions with subchondral damage; 
and revision techniques when a previous surgical procedure has failed. Dowel and shell t echniques are 
the two most commonly used for OCA transplantation. The dowel technique is appropriate in most 
cartilage lesions; however, geometrically irregular lesions may need the shell technique. Factors related 
to better outcomes after OCA transplantation are the following: unipolar lesions; patients younger than 
30 years; traumatic lesions; and when the treatment is carried out within 12 months from the onset of 
symptoms. A systematic review found a survivorship rate of 89% at 5 years. Other systematic review 
showed a mean failure rate of 25% at 12 years with a reoperation rate of 36%. Seventy -two per cent of 
the failures were conversion to total knee arthroplasty (TKA) (68%) or unicompartmental knee 
arthroplasty (UKA) (4%). Twenty-eight per cent of failures were graft removal, graft fixation, 
and graft revision. In this systematic review, patellofemoral lesions (83%) had a higher reoperation rate 
than lesions affecting the tibial plateau or the femoral condyles. Overall, OCA transplantation showed 
a successful result in 75% of patients at 12 years follow-up.
Level of evidence: III


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Volume 10, Issue 3
March 2022
Pages 245-251
  • Receive Date: 10 September 2020
  • Revise Date: 27 February 2022
  • Accept Date: 30 January 2021
  • First Publish Date: 25 November 2021