Osteochondral autograft and allograft for knee cartilage injuries—an international Delphi consensus statement

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on osteochondral autograft (OATS) and osteochondral allograft (OCA) in the setting of cartilage defects in the knee. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Twenty-seven questions were generated on OATS and OCA, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 27 total questions and consensus statements on OATS and OCA developed from 3 rounds of voting, 0 achieved unanimous consensus, 11 achieved strong consensus, 7 achieved consensus, and 9 did not achieve consensus. Conclusions: The statements that achieved strong consensus pertained to the contraindications of OATS and OCA, the preferred site for harvest, storage conditions and timeframe for grafting, site preparation, surgical approach, graft step-off, impact of multiple grafts on clinical outcome, and ways to minimize complications. The statements that did not reach consensus regarded indications for OATS, locations for OATS and OCA, backfilling, sizing, supplemental fixation, marrow venting, and the use of orthobiologics for OCA.