Abstract
Background: Osteochondral allograft (OCA) transplantation has evolved into a first-line treatment for large chondral and osteochondral defects, aided by advancements in storage protocols and a growing body of clinical evidence supporting successful clinical outcomes and long-term survivorship. Despite the body of literature supporting OCAs, there still remains controversy and debate in the surgical application of OCA, especially where high-level evidence is lacking. Purpose: To develop consensus among an expert group with extensive clinical and scientific experience in OCA, addressing controversies in the treatment of chondral and osteochondral defects with OCA transplantation. Study Design: Consensus statement. Methods: A focus group of clinical experts on OCA cartilage restoration participated in a 3-round modified Delphi process to generate a list of statements and establish consensus. Questions and statements were initially developed on specific topics that lack scientific evidence and lead to debate and controversy in the clinical community. In-person discussion occurred where statements were not agreed on after 2 rounds of voting. After final voting, the percentage of agreement and level of consensus were characterized. A systematic literature review was performed, and the level of evidence and grade were established for each statement. Results: Seventeen statements spanning surgical technique, graft matching, indications, and rehabilitation reached consensus after the final round of voting. Of the 17 statements that reached consensus, 11 received unanimous (100%) agreement, and 6 received strong (80%-99%) agreement. Conclusion: The outcomes of this study led to the establishment of consensus statements that provide guidance on surgical and perioperative management of OCAs. The findings also provided insights on topics requiring more research or high-quality studies to further establish consensus and provide stronger evidence.
| Original language | English |
|---|---|
| Journal | Orthopaedic Journal of Sports Medicine |
| Volume | 9 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2021 |
Bibliographical note
Publisher Copyright:© The Author(s) 2021.
Funding
One or more of the authors has declared the following potential conflict of interest or source of funding: S.G. has received education payments from Arthrex and Goode Surgical, consulting fees from JRF, and honoraria from JRF and Vericel. D.G.J. has received education payments from Arthrex; consulting fees from Acumed, Amniox Medical, Aastrom BioSciences, and Medical Device Business Services; speaking fees from Aastrom BioSciences and Linvatec; honoraria from Flexion, Musculoskeletal Transplant Foundation, and Vericel; and hospitality payments form Aesculap and Zimmer Biomet. J.D.P. has received education payments from Pylant Medical. D.C.C. has received consulting fees from Arthrosurface and DePuy, honoraria from JRF, and hospitality payments from Steelhead Surgical. W.D.B. has received consulting fees from Arthrex, Encore Medical, JRF, DePuy/Medical Device Business Services, and Orthalign; has received royalties from DePuy, Smith & Nephew, and Zimmer Biomet; and has stock/stock options in Orthalign. B.J.C. has received education payments from Medwest; consulting fees from Acumed, Aesculap Biologics, Anika Therapeutics, Arthrex, Bioventus, Flexion Therapeutics, Geistlich Pharma, Smith & Nephew, Vericel, and Zimmer Biomet; speaking fees from Arthrex and Lifenet Health; hospitality payments from GE Healthcare; honoraria from Vericel; and royalties from Arthrex and DJO. J.F. has received education payments from Crossroads Orthopedics; consulting fees from Aastrom Biosciences, Aesculap, Arthrex, Collagen Matrix, Exactech, DePuy, Organogenesis, and RTI Surgical; nonconsulting fees from Arthrex and Vericel; honoraria from JRF and Vericel; royalties from DePuy and Organogenesis; and hospitality payments from Skeletal Kinetics. J.E.F. has received education payments from Peerless Surgical, Linvatec, and Zimmer Biomet and consulting and nonconsulting fees from Smith & Nephew. A.H.G. has received consulting fees from Aastrom, Flexion, JRF, Smith & Nephew, and Vericel; nonconsulting fees from Aastrom and LifeNet Health; honoraria from Fidia Pharma, JRF, and Vericel; and royalties from Organogenesis. A.J.K. has received grant support from Exactech; consulting fees from Arthrex, JRF, and Responsive Arthroscopy; honoraria from JRF, MTF, and Vericel; and royalties from Arthrex. C.L. has received consulting fees from Aastrom, Sanofi-Aventis, Vericel, and Zimmer Biomet; nonconsulting fees from Aesculap, Arthrosurface, and Vericel; and honoraria from Arthrosurface, JRF, and Vericel. B.R.M. has received education payments from Arthrex; consulting fees from Arthrex, BioMarin Pharmaceutical, DePuy, and Exactech; and nonconsulting fees from Arthrex. P.R.M. has received hospitality payments from Arthrex. R.M. has received education payments from Arthrex and SportsTek Medical, nonconsulting fees from Arthrex, and royalties from Zimmer Biomet. T.S.M. has received education support from Arthrex and consulting fees and honoraria from JRF. M.T.P. has received consulting fees, speaking fees, and royalties from Arthrex; royalties from Arthrosurface; honoraria from Flexion; and consulting fees and honoraria from JRF. S.A.R. has received consulting fees from Flexion Therapeutics, nonconsulting fees from Smith & Nephew, honoraria from Fidia Pharma, and royalties from Zimmer Biomet. E.D.S. has received education payments from Arthrex and hospitality payments from Axogen and Liberty Surgical. C.J.W. has received consulting fees and nonconsulting fees from Smith & Nephew, royalties from Arthrosurface, and hospitality payments from Arthrex and Stryker. R.J.W. has received education payments, nonconsulting fees, consulting fees, and royalties from Arthrex. A.B.Y. has received education payments from Arthrex and Medwest, consulting fees from Aastrom Biosciences and Olympus, and honoraria from JRF. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
| Funders | Funder number |
|---|---|
| Musculoskeletal Transplant Foundation | |
| Arthrex | |
| Jacobs Research Funds |
ASJC Scopus Subject Areas
- Orthopedics and Sports Medicine