Extract
Treatment of osteochondral defects of >3 cm in diameter and >1 cm in
depth following trauma or treatment of a neoplasm is a challenge. Surgical
options include the use of an osteochondral allograft, arthrodesis, or joint
arthroplasty. The longevity of a prosthesis may be too short in young active
patients, and arthrodesis may be unacceptable to them. This limits the
surgical choice to implantation of an osteochondral
allograft1-15.
The success of an osteochondral allograft depends on the viability of the
articular
cartilage3,16
and the stability of the graft bone-host bone
interface10,13,17.
Freezing grafts to preserve them has been shown to kill chondrocytes and limit
graft
survival13,14,18-22.
Therefore, the technique of using fresh avascular osteochondral shell
allografts with ex vivo preservation in saline solution at 4°C was
developed23-26.
With this technique, tissues are harvested within twenty-four hours after the
donor's death, and grafts with a shell of bone subjacent to the articular
cartilage are then implanted. Chondrocytes in an allograft implanted with this
technique have been reported to survive for up to seventeen
years16. In the
present report, we describe a case in which the graft survived for twenty-five
years posttransplantation and in which graft chondrocytes appeared to be
viable under light and electron microscopy. The patient was informed that data
concerning the case would be submitted for publication.