Defects in articular cartilage and subchondral bone can be caused by trauma, cancer, or other arthropathies. Fresh or delayed-fresh osteochondral allograft transplantation (OCA) is a technique used to repair (osteo)chondral defects. The procedure involves taking a core of the injured cartilage and underlying bone from the patient and replacing it with a size-matched transplant of mature hyaline cartilage and subchondral bone from a cadaver donor. The aim of our report was to evaluate the efficacy and safety of OCA for the treatment of (osteo)chondral defects, compared to other surgical management.

One randomised controlled trial was identified, which investigated OCA to treat ankle defects. In addition, one case series investigating ankle defects, included for the assessment of safety only, and four case series investigating knee defects were identified. No relevant evidence was identified for other joints. The overall quality of the included evidence was low or very low for the reported outcomes.

The current evidence is not sufficient to prove that OCA for the knee and other joints, for the treatment of osteochondral defects, is more effective and equally safe than other surgical procedures. Furthermore, the prospective single-arm studies had insufficient power to demonstrate treatment efficacy. The inclusion of OCA in the Austrian hospital benefit catalogue is therefore not recommended.