Outcomes of Patellofemoral Osteochondral Lesions Treated With Structural Grafts in Patients Older Than 40 Years

Background Chondral lesions in the patellofemoral compartment represent a difficult entity to treat among active patients, with no clear consensus on the optimal treatment strategy. The purpose of this study was to review the functional outcomes of patients >40 years old with primary patellofemoral osteochondral lesions who underwent a cartilage restoration procedure with a structural graft. Methods Following institutional review board approval, 35 patients >40 years treated for patellofemoral chondral or osteochondral injuries were retrospectively identified. Seventeen (47%) had prior surgery (mean 1.4 procedures, range 1-4). Average follow-up was 3.6 ± 1.6 years. Average patient age was 51.5 years (range 40-72 years); 54% were male. Twenty-six (74%) had isolated trochlear lesions, 7 had isolated patellar lesions (20%), while 2 (6%) had bipolar lesions. Twenty patients (57%) were treated with synthetic biphasic scaffold plugs (SS), 9 (26%) with fresh osteochondral allograft (OCA) and 6 (17%) with osteochondral autograft transfer (OAT). Outcomes were measured with validated measures: Activity of Daily Living Score (ADL), International Knee Documentation Committee (IKDC) Subjective Evaluation form, and Marx Activity Scale (MAS). Results The average lesion size for the entire cohort was 3.1 ± 1.7 cm2. Average defect size was 2.6 ± 1.7 cm2 for the SS group, 4.3±1.5 cm2 for the OCA group, and 2.9 ± 0.8 cm2 for the OAT group ( P > 0.051). Outcome scores for the entire population demonstrated significant improvement in ADL ( P = 0.002) and IKDC scores ( P = 0.004) between baseline and final follow-up, while MAS scores were maintained ( P = 0.51). Conclusion Structural grafts are a viable treatment option for symptomatic focal osteochondral lesions of the patellofemoral joint in patients 40 years and older, with anticipated improvements in pain and function and maintenance of preoperative activity levels.

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No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽

10.1177/19476035211021911 ◽

2021 ◽

pp. 194760352110219

Author(s):

Danielle H. Markus ◽

Anna M. Blaeser ◽

Eoghan T. Hurley ◽

Brian J. Mannino ◽

Kirk A. Campbell ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Knee Injury ◽

Lesion Size ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Radiographic Outcomes ◽

Significant Difference ◽

Patient Reported ◽

The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

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Fresh Osteochondral Allograft Transplantation for Fractures of the Knee

Cartilage ◽

10.1177/1947603516657640 ◽

2016 ◽

Vol 8 (2) ◽

pp. 155-161 ◽

Cited By ~ 9

Author(s):

Guilherme C. Gracitelli ◽

Luis Eduardo Passarelli Tirico ◽

Julie C. McCauley ◽

Pamela A. Pulido ◽

William D. Bugbee

Keyword(s):

Treatment Option ◽

Femoral Condyle ◽

International Knee Documentation Committee ◽

Salvage Treatment ◽

Osteochondral Allograft ◽

Successful Outcome ◽

Osteochondral Lesions ◽

Knee Fracture ◽

Fresh Osteochondral Allograft

Objective The purpose of this study was to evaluate functional outcomes and allograft survivorship among patients with knee fracture who underwent fresh osteochondral allograft (OCA) transplantation as a salvage treatment option. Design Retrospective analysis of prospectively collected data. Setting Department of Orthopaedic Surgery at one hospital. Patients Fresh OCAs were implanted for osteochondral lesions after knee fracture in 24 males and 15 females with an average age of 34 years. Twenty-nine lesions (74%) were tibial plateau fractures, 6 (15%) were femoral condyle fractures, and 4 (10%) were patella fractures. Main Outcome Measurements Clinical evaluation included modified Merle d’Aubigné-Postel (18-point), International Knee Documentation Committee, and Knee Society function scores, and patient satisfaction. Failure of OCA was defined as revision OCA or conversion to total knee arthroplasty (TKA). Results Nineteen of 39 knees (49%) had further surgery. Ten knees (26%) were considered OCA failures (3 OCA revisions, 6 TKA, and 1 patellectomy). Survivorship of the OCA was 82.6% at 5 years and 69.6% at 10 years. Among the 29 knees (74%) that had the OCA still in situ, median follow-up was 6.6 years. Pain and function improved from preoperative to latest follow-up; 83% of patients reported satisfaction with OCA results. Conclusion OCA transplantation is a useful salvage treatment option for osteochondral lesions caused by knee fracture. Although the reoperation rate was high, successful outcome was associated with significant clinical improvement.

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OUTCOMES OF BIOABSORBABLE FIXATION OF OSTEOCHONDRAL INJURIES IN THE PEDIATRIC AND ADOLESCENT KNEE

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00172 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0017

Author(s):

Shawn Nguyen ◽

Katie L. Fletcher ◽

John A. Schlechter

Keyword(s):

Internal Fixation ◽

Children And Adolescents ◽

Operating Room ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Bioabsorbable Implants ◽

Surgeon Experience ◽

Outcome Scores ◽

Osteochondral Injuries

Background: Osteochondral lesions (OCL), including osteochondritis dissecans (OCD) and traumatic osteochondral fractures (OCF), are often encountered when treating injuries affecting the pediatric and adolescent knee. There are an array of treatment options depending upon lesion size, location, chronicity, and equally important, surgeon experience. There is a potential for healing in children and adolescents that may not be present in adults and the intent of internal fixation is to reduce and restore the injured hyaline cartilage and underlying bone. Stable fixation utilizing bioabsorbable implants offers a possibility of OCL healing without the need for implant removal or a major restorative procedure such as an osteochondral autograft transfer, osteochondral allograft, or autologous chondrocyte implantation, therefore avoiding the associated costs and potential morbidity. The purpose of our study was to review the mid-term outcomes of internal fixation with bioabsorbable implants of osteochondral injuries of the knee in children and adolescents. Methods: An IRB approved retrospective review of patients younger than 18 years old who had internal fixation of knee OCLs with bioabsorbable implants was performed. All those included had a minimum 2-year follow-up and completed validated outcome scores (Pedi-IKDC, Tegner, Lysholm). Medical records were reviewed from 2009 to 2015 for patient demographics, intraoperative details, and postoperative outcomes. Pedi-IKDC and Tegner-Lysholm functional outcome scores were used to assess overall outcomes at final follow-up. Return to the operating room was recorded. All cases were performed at a single tertiary pediatric institution by a single pediatric fellowship trained orthopedic surgeon. Results: There were a total of 35 children and adolescents that had a knee OCL that underwent internal fixation with bioabsorbable implants. 7 patients were lost to follow-up with a final cohort of 28 of the 35 patients (80%). Average follow-up was 44 months (range 24-97 months). Average age was 14.7 years. Out of the 28 children, 14 had OCD and 14 OCFs. The average number of bioabsorbable darts and screws used per intervention was 2 and 1, respectively. The average Pedi-IKDC and Lysholm scoring at final follow-up was 89.5 and 91, respectively. Five patients returned to the operating room following the primary procedure: 2 for manipulation under anesthesia related to OCL fixation, 1 for a planned staged ACL reconstruction, 1 for MPFL reconstruction for recurrent patella instability following the index procedure, and 1 patient returned secondary to a proud implant that was in-turn debrided. None of the 28 patients underwent a revision cartilage procedure. Conclusion: The use of bioabsorbable implants (screws and darts) in children and adolescents appears to be a safe and efficacious treatment with good functional outcomes at mid-term follow up and in this cohort there was no need for a revision cartilage procedure. Larger multi-center longer-term follow studies are needed.

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SF-36 Physical Component Score Is Predictive of Achieving a Clinically Meaningful Improvement after Osteochondral Allograft Transplantation of the Femur

Cartilage ◽

10.1177/1947603520958132 ◽

2020 ◽

pp. 194760352095813

Author(s):

Kwadwo A. Owusu-Akyaw ◽

Jennifer Bido ◽

Tyler Warner ◽

Scott A. Rodeo ◽

Riley J. Williams

Keyword(s):

Short Form ◽

Femoral Condyle ◽

Lesion Size ◽

Osteochondral Allograft ◽

Physical Component Score ◽

Osteochondral Lesions ◽

Meaningful Improvement ◽

Sf 36

Background Osteochondral allograft (OCA) transplantation is an increasingly common treatment for patients with symptomatic focal chondral lesions of the knee. There has been increasing interest in determining predictive factors to maximize patient benefit after this operation. The aim of the present study is to evaluate the predictive association of the physical component (PCS) and mental component (MCS) scores of the Short Form 36 (SF-36) questionnaire for achievement of the minimal clinically important difference (MCID) after OCA transplantation. Methods This retrospective study of a longitudinally maintained institutional registry included 91 patients who had undergone OCA transplantation for symptomatic focal osteochondral lesions of the femoral condyle. Included patients were those with complete preoperative questionnaires for the SF-36 and IKDC and completed postoperative IKDC at 2-year follow-up. Multivariate analysis was performed evaluating predictive association of the preoperative MCS and PCS with achievement of the MCID for the IKDC questionnaire. Results Logistic multivariate modeling demonstrated a statistically significant association between lower preoperative PCS and achievement of the MCID ( P = 0.022). A defect diameter >2 cm was also associated with achievement of MCID ( P = 0.049). Preoperative MCS did not demonstrate a significant association ( P = 0.09) with achievement of the MCID. Conclusions For this cohort of 91 patients, the preoperative SF-36 PCS and lesion size were predictive of achievement of the MCID at 2-year follow-up after femoral OCA transplantation. These findings support an important role of baseline physical health scores for predicting which patients will obtain a meaningful clinical benefit from this surgery.

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Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211007439 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110074

Author(s):

Jakob Ackermann ◽

Fabio A. Casari ◽

Christoph Germann ◽

Lizzy Weigelt ◽

Stephan H. Wirth ◽

...

Keyword(s):

Magnetic Resonance ◽

Clinical Outcomes ◽

Cartilage Repair ◽

Ankle Instability ◽

Lesion Size ◽

Lateral Ligament ◽

Osteochondral Lesions ◽

Level Of Evidence ◽

Radiographic Outcomes

Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

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Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation

The American Journal of Sports Medicine ◽

10.1177/0363546517746106 ◽

2018 ◽

Vol 46 (4) ◽

pp. 900-907 ◽

Cited By ~ 15

Author(s):

Luis E.P. Tírico ◽

Julie C. McCauley ◽

Pamela A. Pulido ◽

William D. Bugbee

Keyword(s):

Cartilage Repair ◽

Femoral Condyle ◽

Relative Size ◽

Surgical Techniques ◽

Lesion Size ◽

Osteochondral Allograft ◽

Fresh Osteochondral Allograft ◽

Graft Area ◽

The Mean

Background: Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. Purpose: To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm2 (range, 2.3-11.5 cm2). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed. Results: The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%. Conclusion: The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee.

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Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus

Foot & Ankle International ◽

10.1177/1071100720949861 ◽

2020 ◽

pp. 107110072094986

Author(s):

Chung-Hua Chu ◽

Ing-Ho Chen ◽

Kai-Chiang Yang ◽

Chen-Chie Wang

Keyword(s):

Short Form ◽

Case Series ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Midterm Results ◽

Level Of Evidence ◽

Allograft Transplantation ◽

Fresh Frozen ◽

The Mean

Background: Osteochondral lesions of the talus (OLT) are relatively common. Following the failure of conservative treatment, many operative options have yielded varied results. In this study, midterm outcomes after fresh-frozen osteochondral allograft transplantation for the treatment of OLT were evaluated. Methods: Twenty-five patients (12 women and 13 men) with a mean age 40.4 (range 18-70) years between 2009 and 2014 were enrolled. Of 25 ankles, 3, 13, 4, and 4 were involved with the talus at Raikin zone 3, 4, 6, and 7 as well as one coexisted with zone 4 and 6 lesion. The mean OLT area was 1.82 cm2 (range, 1.1-3.0). The mean follow-up period was 5.5 years (range, 4-9.3). Outcomes evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale score, and 12-item Short Form Health Survey (SF-12). Result: AOFAS ankle-hindfoot score increased from 74 preoperatively to 94 at 2 years postoperatively ( P < .001) and the SF-12 physical health component scores increased from 32 to 46 points ( P < .001). Incorporation was inspected in all patients in the latest follow-up, and graft subsidence and radiolucency were observed in 2 and 7 cases, respectively, whereas graft collapse and revision OLT graft were not observed. Bone sclerosis was found in 6 of 25 patients. Conclusion: With respect to midterm results, fresh, frozen-stored allograft transplantation might be an option in the management of symptomatic OLT. Level of Evidence: Level IV, retrospective case series.

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A Systematic Review of Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00382 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0038

Author(s):

Gregory F. Pereira ◽

John Steele ◽

Amanda N. Fletcher ◽

Samuel B. Adams ◽

Ryan B. Clement

Keyword(s):

Systematic Review ◽

Survival Rate ◽

Graft Survival ◽

Graft Survival Rate ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Cochrane Central Register ◽

Allograft Transplantation ◽

Fresh Osteochondral Allograft

Category: Ankle Introduction/Purpose: The term osteochondral lesion of the talus (OLT) refers to any pathology of the talar articular cartilage and corresponding subchondral bone. In general, OLTs can pose a formidable treatment challenge to the orthopaedic surgeon due to the poor intrinsic ability of cartilage to heal as well as the tenuous vascular supply to the talus. Although many treatment options exist, including microfracture, retrograde drilling, autologous chondrocyte implantation (ACI), and osteochondral autograft transfer system (OATS) these options may be inadequate to treat large cartilage lesions. Osteochondral allografts have demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement. To our knowledge, this is the first systematic review of outcomes after fresh osteochondral allograft transplantation for OLTs. Methods: PudMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Medline were searched using PRISMA guidelines. Studies that evaluated outcomes in adult patients after fresh osteochondral allograft transplantation for chondral defects of the talus were included. Operative results, according to standardized scoring systems, such as the AOFAS Ankle/Hindfoot scale and the Visual Analog Scale were compared across various studies. The methodological quality of the included studies was assessed using the Coleman methodology score. Results: There were a total of 12 eligible studies reporting on 191 patients with OLTs with an average follow-up of 56.8 months (range 6-240). The mean age was 37.5 (range 17-74) years and the overall graft survival rate was 86.6%. The AOFAS Ankle/Hindfoot score was obtained pre- and postoperatively in 6 of the 12 studies and had significant improvements in each (P<0.05). Similarly, the VAS pain score was evaluated in 5 of the 12 studies and showed significant decreases (P<0.05) from pre- to postoperatively with an aggregate mean preoperative VAS score of 7.3 and an aggregate postoperative value of 2.6. The reported short-term complication rate was 0%. The overall failure rate was 13.4% and 21.6% percent of patients had subsequent procedures. Conclusion: The treatment of osteochondral lesions of the talus remains a challenge to orthopaedic surgeons. From this systematic review, one can conclude that osteochondral allograft transplantation for osteochondral lesions of the talus results in predictably favorable outcomes with an impressive graft survival rate and high satisfaction rates at intermediate follow-up. [Table: see text]

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Development of a Fresh Osteochondral Allograft Program Outside North America

Cartilage ◽

10.1177/1947603515618484 ◽

2015 ◽

Vol 7 (3) ◽

pp. 222-228 ◽

Cited By ~ 10

Author(s):

Luís Eduardo Passarelli Tírico ◽

Marco Kawamura Demange ◽

Luiz Augusto Ubirajara Santos ◽

Márcia Uchoa de Rezende ◽

Camilo Partezani Helito ◽

...

Keyword(s):

Culture Media ◽

International Knee Documentation Committee ◽

Osteochondral Allograft ◽

Tissue Banks ◽

Transplant Program ◽

Process Modification ◽

Fresh Osteochondral Allograft ◽

Tissue Contamination ◽

Osteochondral Allografts

Objective To standardize and to develop a fresh osteochondral allograft protocol of procurement, processing and surgical utilization in Brazil. This study describes the steps recommended to make fresh osteochondral allografts a viable treatment option in a country without previous fresh allograft availability. Design The process involves regulatory process modification, developing and establishing procurement, and processing and surgical protocols. Results Legislation: Fresh osteochondral allografts were not feasible in Brazil until 2009 because the law prohibited preservation of fresh grafts at tissue banks. We approved an amendment that made it legal to preserve fresh grafts for 30 days from 2°C to 6°C in tissue banks. Procurement: We changed the protocol of procurement to decrease tissue contamination. All tissues were procured in an operating room. Processing: Processing of the grafts took place within 12 hours of tissue recovery. A serum-free culture media with antibiotics was developed to store the grafts. Surgeries: We have performed 8 fresh osteochondral allografts on 8 knees obtaining grafts from 5 donors. Mean preoperative International Knee Documentation Committee (IKDC) score was 31.99 ± 13.4, improving to 81.26 ± 14.7 at an average of 24 months’ follow-up. Preoperative Knee Injury and Oseoarthritis Outcome Score (KOOS) score was 46.8 ± 20.9 and rose to 85.24 ± 13.9 after 24 months. Mean preoperative Merle D’Aubigne-Postel score was 8.75 ± 2.25 rising to 16.1 ± 2.59 at 24 months’ follow-up. Conclusion To our knowledge, this is the first report of fresh osteochondral allograft transplantation in South America. We believe that this experience may be of value for physicians in countries that are trying to establish an osteochondral allograft transplant program.

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Osteochondral Allograft Transplantation of the Knee in Patients with an Elevated Body Mass Index

Cartilage ◽

10.1177/1947603518754630 ◽

2018 ◽

Vol 10 (2) ◽

pp. 214-221 ◽

Cited By ~ 5

Author(s):

Dean Wang ◽

Brian J. Rebolledo ◽

David M. Dare ◽

Mollyann D. Pais ◽

Matthew R. Cohn ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Short Form ◽

International Knee Documentation Committee ◽

Osteochondral Allograft ◽

Cartilage Defects ◽

Elevated Body Mass Index ◽

Allograft Transplantation ◽

Patient Responses

Objective To characterize the graft survivorship and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee in patients with an elevated body mass index (BMI). Design Prospective data on 38 consecutive patients with a BMI ≥30 kg/m2 treated with OCA from 2000 to 2015 were reviewed. Complications, reoperations, and patient responses to validated outcome measures were examined. Failures were defined by any removal/revision of the allograft or conversion to arthroplasty. Results Thirty-one knees in 31 patients (mean age, 35.4 years [range, 17-61 years]; 87% male) met the inclusion criteria. Mean BMI was 32.9 kg/m2 (range, 30-39 kg/m2). Mean chondral defect size was 6.4 cm2 (range, 1.0-15.3 cm2). Prior to OCA, 23 patients (74%) had undergone previous surgery to the ipsilateral knee. Mean duration of follow-up was 4.1 years (range, 2-11 years). After OCA, 5 knees (13%) underwent conversion to unicompartmental (1) or total (4) knee arthroplasty. Two- and 5-year graft survivorship were 87% and 83%, respectively. At final follow-up, clinically significant improvements were noted in the pain (49.3-72.6) and physical functioning (52.9-81.3) subscales of the Short Form–36 ( P ≤ 0.001), International Knee Documentation Committee subjective form (43.5-67.0; P = 0.002), Knee Outcome Survey–Activities of Daily Living (58.2-80.4; P = 0.002), and overall condition subscale of the Cincinnati Knee Rating System (4.7-6.9; P = 0.046). Conclusions OCA can be a successful midterm treatment option for focal cartilage defects of the knee in select patients with a BMI ≥30 kg/m2.

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