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The information on this page is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment.

Always seek the advice of your doctor or other qualified health professional with any questions you may have regarding a medical condition.

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Osteochondral Allograft Transplantation (Fresh Donor Cartilage)

Transplant of fresh cartilage and bone from deceased donor to repair large cartilage defects - used for massive cartilage damage (more than 6-10 cm²) too large for other repairs, preserves patient's own joint and delays joint replacement by 10-15 years in young active patients

📅Last reviewed: January 2025🏥Bones & Joints

📖What is Osteochondral Allograft Transplantation (Fresh Donor Cartilage)?

Transplant of fresh cartilage and bone from deceased donor to repair large cartilage defects - used for massive cartilage damage (more than 6-10 cm²) too large for other repairs, preserves patient's own joint and delays joint replacement by 10-15 years in young active patients

🔬What Causes It?

  • MASSIVE TRAUMATIC CARTILAGE DAMAGE - high-energy injury (car accident, fall from height) causing extensive cartilage and bone loss from femoral condyle, tibial plateau, or talus (ankle bone)
  • FAILED PREVIOUS CARTILAGE REPAIR - patient underwent microfracture, OATS, or ACI (autologous chondrocyte implantation) but repair failed, defect enlarged, now too large for revision with patient's own tissue
  • OSTEOCHONDRITIS DISSECANS (OCD) - large unstable fragment of cartilage and bone separated from joint surface creating massive defect (common in knee medial femoral condyle, talus dome)
  • POST-TRAUMATIC ARTHRITIS IN YOUNG PATIENT - after fracture into joint surface (tibial plateau fracture, pilon fracture), severe localized arthritis develops but patient too young (under 40 years) for joint replacement
  • TUMOR RESECTION - benign tumor (giant cell tumor) or low-grade malignancy removed from bone near joint surface, creates large defect requiring reconstruction with allograft
  • AVASCULAR NECROSIS - bone death from steroid use or alcohol causing collapse and secondary cartilage damage (femoral condyle, talus dome most common)

⚠️Risk Factors

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You may be at higher risk if:

  • AGE under 40 years - osteochondral allograft is SALVAGE procedure for young patients with massive defects too young for joint replacement (trying to buy 10-15 years before needing total joint replacement)
  • PREVIOUS CARTILAGE SURGERY FAILURE - failed microfracture, OATS, or ACI with progressive defect enlargement (revision cartilage repair has higher failure rate)
  • HIGH-ENERGY TRAUMA HISTORY - motor vehicle accident, fall from height, industrial injury causing extensive cartilage and bone damage
  • DEFECT SIZE more than 6-10 cm² - too large for OATS (limited donor cartilage) or ACI (cell-based repair struggles with very large defects)
  • BONE LOSS associated with cartilage damage - osteochondral defect with more than 5-10mm bone depth (requires bone + cartilage replacement, not just cartilage)
  • COMPETITIVE ATHLETES - attempting to return to high-level sport after massive injury (allograft gives best chance but still difficult)

🛡️Prevention

  • Prompt appropriate treatment of acute cartilage injuries (early ACL reconstruction prevents secondary cartilage damage from instability)
  • Address focal cartilage defects BEFORE they enlarge (small defects can be treated with microfracture or OATS, delaying allows progression to massive defect requiring allograft)
  • Correct joint malalignment early (varus or valgus deformity accelerates focal cartilage breakdown - osteotomy before defect becomes massive)
  • Weight management (obesity dramatically accelerates cartilage breakdown - every 5kg weight loss reduces knee load by 20-30kg)
  • Avoid total meniscectomy in young patients (preserve meniscus when possible - removal increases cartilage contact stress and accelerates degeneration)
  • Realistic expectations for cartilage repair (microfracture and OATS deteriorate over 10-15 years - need ongoing monitoring and willingness to consider allograft or joint replacement before defect becomes massive)