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Mehran Soleymanha (Ass. Prof. GUMS , Knee surgery fellowship, SBUMS, Akhtar Hospital)

Fresh Osteochondral proximal tibia and Lateral meniscal allograft transplant. Mehran Soleymanha (Ass. Prof. GUMS , Knee surgery fellowship, SBUMS, Akhtar Hospital). I.O.A - Dec . 22. 2016. major treatment challenge. Painfull knee in young active patients

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Mehran Soleymanha (Ass. Prof. GUMS , Knee surgery fellowship, SBUMS, Akhtar Hospital)

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  1. Fresh Osteochondral proximal tibia and Lateral meniscal allograft transplant Mehran Soleymanha (Ass. Prof. GUMS , Knee surgery fellowship, SBUMS, Akhtar Hospital) I.O.A - Dec . 22. 2016

  2. major treatment challenge • Painfull knee in young active patients • Large osteoarticular injuries with subchondral bone loss • Meniscus-deficient knee • loss of normal joint function Gonzalez-Lomas G, et al. Osteochondral Proximal Tibial and Lateral Meniscal Allograft Transplant. Arthrosc Tech. 2016

  3. Treatment Options • Arthrodesis • significant joint dysfunction • Arthroplasty ( TKA & UKA ) • is a suitable option in older patients • In young highly active patients, prosthetic loosening and failure requiring revision is inevitable • Unloading osteotomy • does not address the repair of the osteoarticulardefect • result in ligamentous redundancy with excess loading of the contralateral joint compartment contributing to early degenerative changes • Biological treatment options Fagan, R. et al. Use of large osteochondral allografts in reconstruction of traumatic uncontained distal femoral defects. J Orthopaedics. 2014

  4. Biological options aim • restore articular surface congruity • reestablish normal joint kinematics Farr, J. et al. Clinical cartilage restoration: evolution and overview. Clin Orthop Relat Res. 2011

  5. Indications • Painful • meniscus-deficient knee with full-thickness articular cartilage defects • Focal degenerative or traumatic osteochondral lesions • Focal complex osteochondral and meniscal pathologies that have failed one or more previous surgical treatments • normal to near normal knee alignment and ligamentous stability Getgood A., et al. Combined osteochondral allograft and meniscal allograft transplantation: a survivorship analysis. Knee Surg Sport Traumatol . 2015

  6. Radiograph & CT scan Gonzalez-Lomas G, et al. Osteochondral Proximal Tibial and Lateral Meniscal Allograft Transplant. Arthrosc Tech. 2016

  7. Approach lateral parapatellar arthrotomy

  8. Plateau Preparation UKA tibial guide

  9. Plateau Preparation Proximal tibial cut

  10. Osteochondral Allograft Preparation

  11. Introduction of Allograft

  12. Introduction of Allograft Provisional pin fixation

  13. Meniscus suturing

  14. Post-op management • W.B • 0 - 2 weeks ……………. NWB • 2 - 6 weeks …………….. PWB • Crutch & Hinged knee brace ………………. 0-6 week • ROM • 0 – 2 weeks full Ext • 2-6 weeks 0-90̊ • 6-8 weeks full ROM Gonzalez-Lomas G, et al. Osteochondral Proximal Tibial and Lateral Meniscal Allograft Transplant. Arthrosc Tech. 2016

  15. 2 months post-op

  16. 2 months post-op

  17. Pearls and Pitfalls

  18. Advantage • Restores articular cartilage and chondroprotective effect of meniscus • Good option for young patients with osteochondral and meniscal pathology who want to avoid joint arthroplasty • Especially useful in the treatment of posttraumatic arthritis, such as following tibial plateau fractures • resurface large areas of damaged articular cartilage with mature hyaline cartilage Gonzalez-Lomas G, et al. Osteochondral Proximal Tibial and Lateral Meniscal Allograft Transplant. Arthrosc Tech. 2016

  19. disadvantage • High rate of reoperation …….. Up to 50% require at least 1 additional procedure • requires normal knee alignment • Trend toward worse outcomes with significant knee osteoarthritisdparticularly • bipolar osteoarthritis Gonzalez-Lomas G, et al. Osteochondral Proximal Tibial and Lateral Meniscal Allograft Transplant. Arthrosc Tech. 2016

  20. Fresh allografts • better chondrocyte viability compared to cryopreserved and fresh frozen grafts • Cellular viability and number were reduced during storage • in the frozen grafts, integration scant or didn’t occur, on the cartilage side • good clinical and functional outcomes even at longer-term follow-up De Caro , F. et al. Large fresh osteochondral allografts of the knee: a systematic clinical and basic science review of the literature. Arthroscopy. 2015

  21. limitations • availability of grafts (cost and difficulty in finding matching fresh donors ) • increased immunogenicity of fresh grafts • increased risk of disease transmission from the donor. De Caro , F. et al. Large fresh osteochondral allografts of the knee: a systematic clinical and basic science review of the literature. Arthroscopy. 2015

  22. THANKS

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