Over the past 25 years, I’ve worked closely with my dedicated team at Midwest Orthopaedics at Rush to improve how we treat complex knee injuries—especially damage to the cartilage, which doesn’t heal on its own. Our focus has been on a surgical technique called osteochondral allograft transplantation (OCA), a procedure that has restored function and hope to thousands of patients, many of whom thought their only remaining option was a full knee replacement.
Our recently published research, recognized with the 2025 OREF Clinical Research Award, reflects decades of translational science, surgical innovation, and outcome tracking. I’d like to take this opportunity to share, in simple terms, what OCA is, who it helps, and how our team’s work is shaping the future of cartilage restoration.
What Is OCA?
When the cartilage in your knee gets damaged—whether from trauma, repetitive stress, or conditions like osteochondritis dissecans—it can leave you in constant pain. Unlike bone, cartilage doesn’t regenerate well. That’s where OCA comes in. It involves transplanting a plug of healthy cartilage and bone from a donor into the damaged area, restoring both the surface and the structure of the joint.
Think of it as replacing a worn-out tile in a floor: the goal is a perfect fit that lets the joint glide smoothly again.
What We’ve Learned from 1,500+ Surgeries
At our high-volume center, we’ve performed over 1,500 OCA procedures and used that data to better understand who benefits the most—and how we can make the procedure even more effective. Here’s what stood out:
- Long-term durability: At 10 years post-surgery, over 80% of patients had functioning grafts without needing a knee replacement.
- Age matters—but not as much as you’d think: Patients under 30 tended to do best, but age alone wasn’t a dealbreaker. Success was more tied to overall joint health and surgical timing.
- Athletes return to sport: About 75% of high-level athletes return to play, often within 8 to 12 months, many at the same or even higher level.
- Revision is possible: If the first graft fails, a second OCA can still offer excellent outcomes—especially if we identify and address the original cause of failure.
Behind the Scenes: Science in the OR
A big part of our research focused on how to make OCA safer and more predictable:
- We discovered that donor cartilage can be safely preserved for up to 28 days, giving surgeons more flexibility and increasing graft availability.
- We fine-tuned how grafts are rewarmed before implantation to preserve cell health.
- We tested 3D imaging and matching techniques to better fit donor tissue to patient anatomy—even using iPhones for surgical planning in newer cases.
- We reduced complications by learning how impaction forces, surgical tools, and lavage solutions affect graft health.
All these small refinements add up to major improvements in patient outcomes.
Matching Patients to Procedures
One of our key takeaways is that success with OCA depends on choosing the right patient at the right time. We developed clinical decision-making algorithms, including machine learning tools, to help personalize treatment plans. We now consider factors like:
- Lesion size and location
- Knee alignment and ligament stability
- Prior surgeries and physical demands
- Even subtle changes on MRI, like bone marrow edema
By combining science, experience, and technology, we’re now better equipped to counsel patients about their options and expected outcomes.
The Future of Cartilage Restoration
The field is evolving rapidly, and I’m proud to say our team has been at the forefront of that change. From publishing surgical techniques and rehabilitation protocols to designing new instruments and software tools, we’ve worked hard to bring this procedure into mainstream orthopedics—safely and successfully.
For many patients, OCA has become a life-changing alternative to total knee replacement. It lets us preserve the natural joint, reduce pain, and restore the ability to move freely again—whether you’re an elite athlete or just want to enjoy a walk with your grandkids.
Final Thoughts
Cartilage injuries used to feel like a dead end. But today, with the right tools, the right team, and the right patient selection, we can offer a true second chance. If you or someone you care about is struggling with knee pain and has been told there are “no good options,” I want you to know: there’s hope—and we’re here to help.
Reference:
Cole, B. J., Gilat, R., Chahla, J., Chubinskaya, S., Frank, R. M., & Yanke, A. B. (2025). Optimizing patient outcomes following osteochondral allograft transplantation: The impact of 25 years of translational and clinical research [Manuscript submitted for publication]. Rush University Medical Center.
