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Cartilage graft transplantation is frequently used in the treatment of chondral and osteochondral lesions, most commonly in the knee. These procedures can serve to improve the quality of life for those with pathology of the cartilage within joints and alleviate symptoms. This activity will serve to highlight the challenges of cartilage transplants, as well as illuminate the roles of various members of the interprofessional team in the successful management of such joint pathology. Objectives: Review the anatomical structures necessary to understand cartilage graft transplantation. Describe the technique involved in cartilage graft transplantation. Summarize the indications for a cartilage graft transplantation procedure. Outline the role of collaboration and communication within the interprofessional team caring for patients with cartilage graft transplantation to improve clinical outcomes. Access free multiple choice questions on this topic.

Joint pain is a complex problem facing medical practitioners that has its origin in a host of conditions, injuries, and diseases. Between 2013 and 2015 alone, an estimated 54.4 million United States (US) adults (22.7%) annually were told by a doctor that they had some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia.[1] Physicians, researchers, and other medical providers have, for centuries, sought to understand the etiology and causes of joint pain in an effort to develop effective treatments to alleviate discomfort. Joint pain and/or arthritis is one of the most prevalent and expensive conditions known to humankind. In 2013, the American national medical costs attributable to arthritis were $140 billion.[2] Additionally, with the aging population of most countries, the cost of treating arthritis is expected to double if not triple in the next several decades. As such, the need to find effective treatments, both medical and surgical, for the loss of articular cartilage is both important and financially imperative. The human knee is perhaps the most common joint to suffer the effects of articular cartilage loss. In a population of patients greater than 45-years-old, the age-standardized prevalence of radiographic osteoarthritis (OA) of the knee was reported to be between 19.2% (Framingham Study) to 27.8% (Johnston County Osteoarthritis Project).[3] Additionally, in the Third National Health and Nutrition Examination Survey (NHANES III), nearly 37% of participants age 60 years or older had radiographic evidence of knee osteoarthritis.[3] Thus, much attention has been turned to finding an effective method whereby the damaged or deficient articular hyaline cartilage can be restored to the knee.

The human knee is perhaps the most common joint to suffer the effects of articular cartilage loss. In a population of patients greater than 45-years-old, the age-standardized prevalence of radiographic osteoarthritis (OA) of the knee was reported to be between 19.2% (Framingham Study) to 27.8% (Johnston County Osteoarthritis Project).[3] Additionally, in the Third National Health and Nutrition Examination Survey (NHANES III), nearly 37% of participants age 60 years or older had radiographic evidence of knee osteoarthritis.[3] Thus, much attention has been turned to finding an effective method whereby the damaged or deficient articular hyaline cartilage can be restored to the knee. One method of surgically restoring a viable articular surface to the knee joint whose hyaline cartilage surface has been injured is through osteochondral allograft transplantation. Osteochondral allograft transplantation is an effective treatment when the source of knee pain is a large chondral defect or in the cases of post-traumatic arthritis.[4] Ultimately, osteochondral allograft transplantation involves transferring allograft articular cartilage and subchondral bone that is appropriately size-matched to fill chondral defects with matured hyaline cartilage.[5] Were one to describe this technique in a commonly understood metaphor, it would simulate the repair of a pot or chuckhole in the street by size match insertion of transplanted asphalt along with its attached subsurface roadbed into the defect.

As with any surgical procedure, pain, bleeding, damage to surrounding anatomic structures, and infection are a risk, albeit low compared to many surgeries in the hands of a skilled arthroscopist. Outside of the general complications associated with any surgical procedure, graft failure is of the greatest concern. While patients who undergo osteochondral allograft transplantation for traumatic or idiopathic injuries have a reported graft survival of 100%, cartilaginous defects caused by post-traumatic arthritis, osteonecrosis, or osteochondrosis have a lower rate of graft survival.[5] Ultimately, the underlying cause of the index deficit should be considered. If the cause of a patient's cartilaginous defect is due to an anatomic or medical derangement, failure to address the cause of the deficiency will inevitably lead to failure of the procedure and potential exacerbation of the joint insufficiency.

Management of painful joint pathology requires an interprofessional approach that includes the patient in his care and supports a return to activities that may be limited by his or her disease process. Non-surgical management is the first-line treatment for a painful joint, and physicians and therapists must communicate and work together to help patients find solutions to their pain limitations. When non-operative measures fail, surgery may be considered. Any time surgery is undertaken, medical practitioners must have a good surgical team in place. Surgical techs, nurses, and surgeons must work together seamlessly in the operating room to provide the patient with the highest likelihood of a successful outcome. The surgeon must then communicate with the physical therapist, who is vital to providing the patient with the appropriate post-operative protocol to ensure a safe return to function post-operatively. [Level 5]