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Refrigerated Osteoarticular Allografts to Treat Articular Cartilage Defects of the Femoral CondylesA Prospective Outcomes Study
Robert F. LaPrade, MD, PhD1; Jesse Botker, MD1; Mary Herzog, MD1; Julie Agel, ATC1
1 Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, R-200, Minneapolis, MN 55454. E-mail address for R.F. LaPrade: lapra001@umn.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Apr 01;91(4):805-811. doi: 10.2106/JBJS.H.00703
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Background: Because of concerns about infections with the use of fresh osteoarticular allografts, osteoarticular allografts are currently stored hypothermically for a minimum of fourteen days to allow for serologic and microbiologic testing prior to implantation. Refrigerated osteoarticular allograft transplants are often used to treat symptomatic chondral and osteochondral defects in young, active patients. Chondrocyte viability has been shown to decrease substantially when allografts are stored for longer than twenty-eight days. The purpose of this study was to examine the clinical and functional outcomes of patients receiving refrigerated osteoarticular allografts between fifteen and twenty-eight days after procurement.

Methods: Twenty-three consecutive patients (twenty-three knees) who underwent treatment of focal articular cartilage defects of the femoral condyles with refrigerated osteoarticular grafts were prospectively followed for an average of three years. The average age of the implanted refrigerated allografts was 20.3 days. The patients were assessed preoperatively and postoperatively with validated outcome surveys.

Results: The mean modified Cincinnati knee ratings significantly improved from baseline to the time of the final follow-up, with an increase from 27.3 to 36.5 on the subscale rating for function (p < 0.01), from 21.9 to 32.5 on the subscale rating for symptoms (p < 0.03), and from 49.2 to 69.0 for the overall score (p < 0.02). The mean International Knee Documentation Committee subjective score improved from 52 points at baseline to 68.5 points at the time of the final follow-up (p < 0.03). A significant improvement was also found for effusions and functional testing (the single-leg hop) (p < 0.001 for both). Radiographic evaluation at the time of the final follow-up revealed that twenty-two of the twenty-three grafts were in stable position with good osseous incorporation into host bone. No graft failure was encountered.

Conclusions: Transplantation of refrigerated osteoarticular allografts stored between fifteen and twenty-eight days provides significant functional and clinical improvement after an average follow-up of three years in patients treated for a full-thickness osteochondral defect of the femoral condyle, with similar outcomes to historical reports of patients with fresh allograft implants.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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