Fresh osteochondral allograft transplantation for knee full-thickness articular cartilage lesions using femoral head of living donors: short-term results.

BACKGROUND: Fresh osteochondral allograft transplantation is a good treatment option of cartilage defects. However, this treatment option is not available in all countries due to limited graft availability and tissue banks limitations. The purpose of this study is to assess the short term functional and imaging outcomes of fresh osteochondral allograft transplantation in the knee using the femoral head of living donors. HYPOTHESIS: Fresh osteochondral allografts from the femoral heads of living donors is a valid graft source for management of distal Femur cartilage defects. This technique can improve functional knee scores with good radiological outcomes. STUDY DESIGN: Prospective case series. METHODS: Fifteen patients with full thickness cartilage defects of the distal femur underwent osteochondral allograft transplantation from the femoral heads of living donors. Grafts were transplanted by both shell and multiple dowels techniques. The average follow up duration was 18.3 months (range, 12-25 months). Patients were evaluated by Lysholm and International Knee Documentation Committee (IKDC) scores, radiography and MR imaging using Osteochondral Allograft MRI Scoring System (OCAMRISS). RESULTS: There was a statistically significant improvement (P < 0.001) in both Lysholm and IKDC average scores at 6 months and 12 months postoperative. Postoperative MRI was done at an average 6.8 months (range, 5-11 months) postoperative. The mean total OCAMRISS score was 3.4 (range, 1-7). A second look arthroscopy was done in four patients and showed intact articular cartilage in all three patients. CONCLUSION: Femoral head of living donors is a valid new source for fresh osteochondral allograft transplantation of knee osteochondral lesions. Short term results showed improvement in clinical assessment scores. Follow up imaging showed graft incorporation and good MRI scores.

Early ambulation and good outcomes after using combined nail plate construct for fixation of distal femoral fractures: a retrospective series of 14 cases.

BACKGROUND: Combined nail/plate technique is a relatively novel method for surgically managing distal femur fractures. It was supposed to allow for early weight bearing and achieve adequate fixation that allow for good bone healing. This study aims to describe our single institution experience of treating distal femur fractures using the combined nail/plate technique. METHODOLOGY: This is a retrospective study of 14 cases who had AO/OTA fractures 33A_C that were managed with this technique. Patients mean age was 67.6 years and all of them had either obvious osteopenia/osteoporosis or comminuted fractures. RESULTS: With early postoperative weight bearing, after a mean follow up of 13.2 months, all the patients were able to return to preinjury activity level. None of the cases were revised for union related problems. Adequate bone healing was noticed after a mean of 16.8 weeks postoperatively. At the final follow up, the mean Oxford knee score was 42 (range 34-46). CONCLUSION: The combined nail/plate technique provides adequate fixation method that allows for early weight bearing and good functional outcomes. More studies, ideally comparative are needed to properly assess the cost benefit of this technique compared to other techniques.