The Knee Diaries: rejection of Osteochondral Allograft

Left: X-ray of the patient's right knee shows the transplanted tissue attached to the Tibia by means of 3 screws. A 59-year-old Massachusetts female was presented with concern for right knee rejection of a bone/cartilage transplant, recurring dislocation, and instability of the knee for several years. Patient had been plagued with a knee problem since a skiing accident 10 years ago. A year after initial injury, a metal plate was attached to strengthen the knee joint, followed by an Osteochondral Allograft surgical procedure which transplants a cartilage section and attached bone from a cadaver donor to the damaged region of the joint surface. She required crutches to aid walking for nearly one year and subsequently developed Osteoporosis in the knee's right lower extremity while her body began rejection of the transplant. Despite the unsuccessful procedures (to avoid knee replacement), a second Osteochondral Allograft was undertaken, followed by more non-weight-bearing ambulation which continued and heightened the osteoporosis condition. Patient upon entering The Center for Regenerative Medicine sought assistance to prevent possible rejection and potential future knee replacement. Otherwise healthy, patient uses Fosomax for Osteoporosis relief and anti-inflammatory medications. Well-educated (Ph.D in Physical Therapy), her family history is non-contributory.

Discussion: Department of Orthopedic Surgery and Rehabilitation, University of California, San Diego: The following are the results of a study of 58 patients with recent Osteochondral allograft knee transplants: Most patients in this study mostly had severe, Osteochondritis Dissecans, a traumatic defect or osteonecrosis of the femoral condyle, a painful, healed depressed fracture or traumatic defect of the tibialplateau, and unicompartmental traumatic Osteoarthritis of the knee. All patients reported disabling pain after failure of attempts to correct problems surgically. Of 39 patients available for follow-up study after allograft transplants, nine (22.5 per cent) failed and of those patients with unicompartmental traumatic arthritis, the rate of success was only 30 per cent.

Case Study Date: 7/7/2006