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Cartilage resurfacing with precut fresh osteochondral core allografts (SS-43)

      Objective: To familiarize the clinician with the development of a new and simple method to resurface full-thickness cartilage defects of the knee. Methods: Large articular cartilage defects of the knee can be managed with various methods. These include mosaicplasty and chondrocyte reimplantation which can be technically difficult, associated with a prolonged recovery period and expensive. Fresh chondral allografts can now be preserved for as long as twenty one days with maintenance of chondrocyte viability. Precut full-thickness osteochondral core allografts are now available in 2 mm incremental sizes from 10 to 20 mm in diameter. The grafts are harvested from multiple sites on the donor femoral condyle to orthotopically match the recipient defect. The required size of the donor osteochondral plug is determined by prior arthroscopy or an MRI utilizing 3 plane high resolution sequencing with fast-spin echo proton density. The graft can be inserted arthroscopically or via a mini-arthrotomy on an out-patient basis. No internal fixation is required. Range of motion and early weight bearing is encouraged. Results: Twenty-three grafts have been inserted over the past 38 months. Six cases have undergone follow-up arthroscopy with visualization of the graft and cartilage biopsy. Excellent maintenance of the resurfaced cartilage site has been observed in all cases. Chondrocyte viability has been observed to be in the range of 80%. Conclusions: This new, easily reproducible process provides the simplest and most cost effective method for cartilage resurfacing of large femoral condyle defects and is associated with low morbidity and early recovery.