Fresh osteochondral allografting

The treatment of articular cartilage defects in the knee is a difficult challenge. Fresh, small-fragment osteochondral allografting is a technique involving the transplantation of articular (hyaline) cartilage into the defective joint surface. The graft, a composite of living cartilage and a thin layer of underlying subchondral bone, provides a mature matrix with viable chondrocytes along with an osseous component that provides a surface for fixation and integration with the host. Fresh allografting is particularly useful in larger lesions (greater than 2 cms) or when associated osseous defects are present. Clinical experience with fresh osteochondral allografts now extends over 2 decades. Up to 90% of individuals treated for femoral condyle lesions are improved. The allograft tissue appears well tolerated by the host, with documented long-term survival of chondrocytes and intact matrix. Successful clinical outcomes have established fresh osteochondral allografting as an appropriate alternative in the treatment of chondral and osteochondral lesions of the knee.