Combination of osteochondral allograft transplantation and particulated juvenile articular cartilage to treat osteochondral defects leads to low failure rates after a minimum of 2-year follow-up

Osteochondral allograft (OCA) transplantation effectively treats osteochondral defects using circular dowels. However, covering large or irregular defects with single plugs or two plug techniques sacrifices normal cartilage. This study assesses failure rates of combining OCA transplantation with Particulated Juvenile Allograft Cartilage (PJAC), a soft cartilage paste, for treating large, irregular osteochondral lesions. This case series included OCA transplantation combined with PJAC and a minimum 2-year follow-up. Demographics, surgical data (defect and allograft size, and whether PJAC was inserted adjacent to or between two grafts), and failure rates were collected. Failure was defined as subchondral collapse of OCA confirmed by MRI or second-look arthroscopy, revision/removal of the primary OCA, or conversion to arthroplasty. Thirty-five patients were included. Mean age was 33.7±8.8 years-old (range, 15 to 49); follow-up, 3.9±1.4 years (range, 2.1 to 6.7); BMI 27.8±5.0 kg/m 2 ; defect size 4.9±3 cm 2 , and the mean OCA diameter was 1.9±0.7 cm. PJAC was inserted around the OCA in 28 patients (80.0%), and between two grafts in 7 (20%) patients. Four cases of failure occurred (11.4%), with a mean time-to-failure of 3.7±1.9 years (range, 2.1 to 6.4). Among failed cases, PJAC placement was around the OCA in 3 cases, and between two grafts in one case and defect size was larger compared to cases when graft remained intact. Combining different methods of treatment for osteochondral defects may increase advantages and overcome drawbacks of each technique. The combination of OCA and PJAC appears to be a viable strategy for the management of large, irregular osteochondral lesions.