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IntroductionOsteochondral autograft and allograft transplantation is an
accepted treatment strategy for chondral and osteochondral
defects of the knee and shoulder. The purpose of this study was
to retrospectively review the clinical outcome and graft
morphology in patients with symptomatic osteochondral lesions
treated with osteochondral transplantation.
Hypothesis: The novel center-hole technique for graft impaction
will lead to similar clinical outcomes and will potentially protect
articular cartilage by promoting chondrocyte viability.
MethodsBetween 2006 and 2009 five patients with
symptomatic chondral or osteochondral defects (four
knees, one shoulder) were treated with either
autologous osteochondral transplantation (two) or
osteochondral allograft transplantation (three). The
grafts were press-fit using either standard impaction or
the center-hole technique. Frozen allograft plugs were
used to backfill the autograft donor site in two knees.
Mean age at the time of surgery was thirty-one years.
The mean lesion size was 312 mm2. Clinical
assessment was performed postoperatively using the
International Knee Documentation Committee
(IKDC) score, activity of daily living of the Knee
Outcome Survey (ADL) score, and Short Form-36
(SF-36) at most recent follow-up. Magnetic resonance
imaging was used to evaluate the morphologic and
signal characteristics of the implanted grafts and the
ConclusionsOsteochondral transplantation is an effective treatment
for osteochondral defects in the knee and shoulder. In
our series there was a significant improvement in all
three mean clinical outcome scores. MRI can be a
valuable tool for postoperative evaluation of graft
cartilage and osteointegration. On MRI the center-
hole technique led to increased signal within the bone.
This resolved on subsequent MRI and may not have
any important clinical significance. From a technical
standpoint, this technique allows greater control of the
graft during insertion. Center-hole technique is a
viable alternative to standard impaction resulting in
similar clinical outcome scores, while potentially
improving long term graft survival due to increased
chondrocyte viability at the time of implantation.
Ben B. Bedford, MD, Aruna M. Seneviratne, MD, Stephen J. Nicholas, MD
Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), Lenox Hill Hospital, New York
ResultsFive patients met the study criteria with a mean
duration of follow-up of 15.6 months (range, four to
thirty-one months). The mean preoperative IKDC
score was 61.2 ± 17.5 and improved to 77.3 ± 22.3 (p= .016). The mean preoperative ADL score was 73 ± 9.3 and improved to 88.5 ± 10.3 (p=.008). The mean SF-
36 score also improved from 83.4 ± 4.6 to 90.7 ± 5.9
(p=.013). At a mean follow-up of 15.8 months
cartilage sensitive MRI demonstrated a flush plug
appearance in all patients and osseous trabecular
incorporation in 75% of patients. The graft cartilage
had preserved thickness and was isointense to
surrounding cartilage in all patients. With the
exception of increased temporary bone edema in 50%
of patients, the graft properties were similar in those
press-fit with the center-hole technique to those
Clinical Evaluation of a Novel Technique of Impacting Osteochondral Grafts:
Center-Hole Technique vs. Standard Impaction
AcknowledgmentsDr. Michael Vazquez
signal characteristics of the implanted grafts and the
surrounding cartilage. Standard statistical methods
using a paired Student’s t-test were used to analyze the
data.
press-fit with the center-hole technique to those
treated with standard impaction.Threshold for chondrocyteapoptosis
4.5 MPa
MRI T2 Mapping Assess Collagen OrientationOrange = Short T2 values (collagen perpendicular to subchondral plate)
Yellow = Longer T2 values (more random collagen orientation)
Correlates with polarized light microscopy
Standard Center Hole
Center
Hole
Standard
Live/Dead Staining of In-Vitro section of Hyaline Cartilage
Red = Dead Chondrocytes
Green = Live Chondrocytes
Screw is placed in center of graft
Then impacted into recipient site
Screw removed
Distribution of ForceDistribution of Force
Standard Technique Center Hole Technique
Additional Informationwww.nismat.org
www.nyorthodoc.com
www.lenoxhillhospital.org
IntroductionOsteochondral autograft and allograft transplantation is an
accepted treatment strategy for chondral and osteochondral
defects of the knee and shoulder. The purpose of this study was
to retrospectively review the clinical outcome and graft
morphology in patients with symptomatic osteochondral lesions
treated with osteochondral transplantation.
Hypothesis: The novel center-hole technique for graft impaction
will lead to similar clinical outcomes and will potentially protect
articular cartilage by promoting chondrocyte viability.
MethodsBetween 2006 and 2009 five patients with
symptomatic chondral or osteochondral defects (four
knees, one shoulder) were treated with either
autologous osteochondral transplantation (two) or
osteochondral allograft transplantation (three). The
grafts were press-fit using either standard impaction or
the center-hole technique. Frozen allograft plugs were
used to backfill the autograft donor site in two knees.
Mean age at the time of surgery was thirty-one years.
The mean lesion size was 312 mm2. Clinical
assessment was performed postoperatively using the
International Knee Documentation Committee
(IKDC) score, activity of daily living of the Knee
Outcome Survey (ADL) score, and Short Form-36
(SF-36) at most recent follow-up. Magnetic resonance
imaging was used to evaluate the morphologic and
signal characteristics of the implanted grafts and the
ConclusionsOsteochondral transplantation is an effective treatment
for osteochondral defects in the knee and shoulder. In
our series there was a significant improvement in all
three mean clinical outcome scores. MRI can be a
valuable tool for postoperative evaluation of graft
cartilage and osteointegration. On MRI the center-
hole technique led to increased signal within the bone.
This resolved on subsequent MRI and may not have
any important clinical significance. From a technical
standpoint, this technique allows greater control of the
graft during insertion. Center-hole technique is a
viable alternative to standard impaction resulting in
similar clinical outcome scores, while potentially
improving long term graft survival due to increased
chondrocyte viability at the time of implantation.
Ben B. Bedford, MD, Aruna M. Seneviratne, MD, Stephen J. Nicholas, MD
Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), Lenox Hill Hospital, New York
ResultsFive patients met the study criteria with a mean
duration of follow-up of 15.6 months (range, four to
thirty-one months). The mean preoperative IKDC
score was 61.2 ± 17.5 and improved to 77.3 ± 22.3 (p= .016). The mean preoperative ADL score was 73 ± 9.3 and improved to 88.5 ± 10.3 (p=.008). The mean SF-
36 score also improved from 83.4 ± 4.6 to 90.7 ± 5.9
(p=.013). At a mean follow-up of 15.8 months
cartilage sensitive MRI demonstrated a flush plug
appearance in all patients and osseous trabecular
incorporation in 75% of patients. The graft cartilage
had preserved thickness and was isointense to
surrounding cartilage in all patients. With the
exception of increased temporary bone edema in 50%
of patients, the graft properties were similar in those
press-fit with the center-hole technique to those
Clinical Evaluation of a Novel Technique of Impacting Osteochondral Grafts:
Center-Hole Technique vs. Standard Impaction
AcknowledgmentsDr. Michael Vazquez
signal characteristics of the implanted grafts and the
surrounding cartilage. Standard statistical methods
using a paired Student’s t-test were used to analyze the
data.
press-fit with the center-hole technique to those
treated with standard impaction.Threshold for chondrocyteapoptosis
4.5 MPa
MRI T2 Mapping Assess Collagen OrientationOrange = Short T2 values (collagen perpendicular to subchondral plate)
Yellow = Longer T2 values (more random collagen orientation)
Correlates with polarized light microscopy
Standard Center Hole
Center
Hole
Standard
Live/Dead Staining of In-Vitro section of Hyaline Cartilage
Red = Dead Chondrocytes
Green = Live Chondrocytes
Screw is placed in center of graft
Then impacted into recipient site
Screw removed
Distribution of ForceDistribution of Force
Standard Technique Center Hole Technique
Additional Informationwww.nismat.org
www.nyorthodoc.com
www.lenoxhillhospital.org
IntroductionOsteochondral autograft and allograft transplantation is an
accepted treatment strategy for chondral and osteochondral
defects of the knee and shoulder. The purpose of this study was
to retrospectively review the clinical outcome and graft
morphology in patients with symptomatic osteochondral lesions
treated with osteochondral transplantation.
Hypothesis: The novel center-hole technique for graft impaction
will lead to similar clinical outcomes and will potentially protect
articular cartilage by promoting chondrocyte viability.
MethodsBetween 2006 and 2009 five patients with
symptomatic chondral or osteochondral defects (four
knees, one shoulder) were treated with either
autologous osteochondral transplantation (two) or
osteochondral allograft transplantation (three). The
grafts were press-fit using either standard impaction or
the center-hole technique. Frozen allograft plugs were
used to backfill the autograft donor site in two knees.
Mean age at the time of surgery was thirty-one years.
The mean lesion size was 312 mm2. Clinical
assessment was performed postoperatively using the
International Knee Documentation Committee
(IKDC) score, activity of daily living of the Knee
Outcome Survey (ADL) score, and Short Form-36
(SF-36) at most recent follow-up. Magnetic resonance
imaging was used to evaluate the morphologic and
signal characteristics of the implanted grafts and the
ConclusionsOsteochondral transplantation is an effective treatment
for osteochondral defects in the knee and shoulder. In
our series there was a significant improvement in all
three mean clinical outcome scores. MRI can be a
valuable tool for postoperative evaluation of graft
cartilage and osteointegration. On MRI the center-
hole technique led to increased signal within the bone.
This resolved on subsequent MRI and may not have
any important clinical significance. From a technical
standpoint, this technique allows greater control of the
graft during insertion. Center-hole technique is a
viable alternative to standard impaction resulting in
similar clinical outcome scores, while potentially
improving long term graft survival due to increased
chondrocyte viability at the time of implantation.
Ben B. Bedford, MD, Aruna M. Seneviratne, MD, Stephen J. Nicholas, MD
Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), Lenox Hill Hospital, New York
ResultsFive patients met the study criteria with a mean
duration of follow-up of 15.6 months (range, four to
thirty-one months). The mean preoperative IKDC
score was 61.2 ± 17.5 and improved to 77.3 ± 22.3 (p= .016). The mean preoperative ADL score was 73 ± 9.3 and improved to 88.5 ± 10.3 (p=.008). The mean SF-
36 score also improved from 83.4 ± 4.6 to 90.7 ± 5.9
(p=.013). At a mean follow-up of 15.8 months
cartilage sensitive MRI demonstrated a flush plug
appearance in all patients and osseous trabecular
incorporation in 75% of patients. The graft cartilage
had preserved thickness and was isointense to
surrounding cartilage in all patients. With the
exception of increased temporary bone edema in 50%
of patients, the graft properties were similar in those
press-fit with the center-hole technique to those
Clinical Evaluation of a Novel Technique of Impacting Osteochondral Grafts:
Center-Hole Technique vs. Standard Impaction
AcknowledgmentsDr. Michael Vazquez
signal characteristics of the implanted grafts and the
surrounding cartilage. Standard statistical methods
using a paired Student’s t-test were used to analyze the
data.
press-fit with the center-hole technique to those
treated with standard impaction.Threshold for chondrocyteapoptosis
4.5 MPa
MRI T2 Mapping Assess Collagen OrientationOrange = Short T2 values (collagen perpendicular to subchondral plate)
Yellow = Longer T2 values (more random collagen orientation)
Correlates with polarized light microscopy
Standard Center Hole
Center
Hole
Standard
Live/Dead Staining of In-Vitro section of Hyaline Cartilage
Red = Dead Chondrocytes
Green = Live Chondrocytes
Screw is placed in center of graft
Then impacted into recipient site
Screw removed
Distribution of ForceDistribution of Force
Standard Technique Center Hole Technique
Additional Informationwww.nismat.org
www.nyorthodoc.com
www.lenoxhillhospital.org