Fresh osteochondral allograft (FOCA) transplantation of the knee a rare used technique in Europe with long term good results

Background: Articular cartilage injuries of the knee frequently affect young, active populations, with localized defects occurring in approximately 20% of arthroscopic cases. While knee arthroplasty in this demographic is associated with high failure rates and low satisfaction, fresh osteochondral allograft (FOCA) transplantation offers a biological alternative for restoring joint surfaces using metabolically active chondrocytes.

Objective: This review evaluates the clinical indications, surgical methodologies, and long-term outcomes of FOCA transplantation for the treatment of localized femoral, patellar, and tibial osteochondral defects.

Key Points: FOCA is indicated for large or uncontained lesions, failed cell-based repairs, and salvage procedures. Success depends on maintaining chondrocyte viability through storage at 4°C or 37°C, with transplantation ideally occurring within 14 to 28 days of harvest. Surgical techniques include the dowel (plug) method for contained defects and the shell (resurfacing) method for extensive or asymmetric lesions. Addressing concomitant pathologies, such as axial malalignment, ligamentous instability, and meniscal deficiency, is mandatory to prevent graft failure. Long-term data indicate survival rates for femoral condyle grafts of approximately 82% at 10 years and 66% at 20 years. Outcomes for the patellofemoral joint are generally less favorable, particularly in bipolar reciprocal lesions, with 10-year survival rates reported at 78.1%.

Conclusion: FOCA transplantation is an effective biological reconstruction for large knee defects in young patients, potentially delaying prosthetic replacement. Optimal outcomes require precise patient selection, correction of joint biomechanics, and meticulous surgical execution to ensure graft incorporation and functional restoration.