scholarly journals Do Outcomes of Osteochondral Allograft Transplantation Differ Based on Age

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0012 ◽  
Author(s):  
Rachel M. Frank ◽  
Simon Lee ◽  
Sarah Glen Poland ◽  
Brian J. Cole
Keyword(s):  
Failure Rate ◽  
Reoperation Rate ◽  
Patient Reported Outcome ◽  
Osteochondral Allograft ◽  
Chi Square ◽  
Allograft Transplantation ◽  
Patient Reported ◽  
Similar Survival ◽  
The Impact

Objectives: Osteochondral allograft transplantation (OAT) is being performed with increasing frequency, though to date, the impact of patient age on outcomes and failure rates has not been assessed. The purpose of this study was to determine clinical outcomes for patients over 40 years of age undergoing OAT compared to a cohort of patients under 40. Methods: A review of prospectively collected data of patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years was conducted. Patients <40 or ≥40 years were grouped. The reoperation rate, failure rate, timing of reoperation, procedures performed, findings at surgery, and patient reported outcome scores were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at 2nd look arthroscopy. Descriptive statistics, fisher’s exact or chi-square testing, and Mann-Whitney U testing were performed, with P<0.05 set as significant. Results: A total of 170 patients who underwent OAT with an average follow-up of 5.0±2.7 years (range, 2.0-15.1) were included; 115 patients <40 years (average age 27.6±7.31 years, 58 males, 57 females) and 55 patients ≥40 years (average age 44.9±4.0 years, 33 males, 22 females). There were no differences detected in the number of pre-OAT surgeries between the groups (<40: 2.70±1.91; ≥40: 2.13±1.04; P=0.085). The ≥40 patients demonstrated significantly higher BMI (<40: 25.94±5.02 kg/m2; ≥40: 28.11±5.22 kg/m2; P=0.018), higher prevalence of workers’ compensation patients (<40: 17%; ≥40: 33%; P=0.028), and lower prevalence of concomitant distal femoral osteotomy (<40: 8%; ≥40: 0%; P=0.028). There were no differences detected in reoperation rate (<40: 38%; ≥40: 36%; P=0.867), time to reoperation (<40: 2.12±1.90; ≥40: 3.43±3.43; P=0.126), or failure rate (<40: 13%; ≥40: 16%; P=0.639) between each group. Patients in both groups demonstrated significant improvement in Lysholm, IKCD, KOOS, WOMAC, and SF-12 physical subscale as compared to preoperative values (P>0.05 for all for both groups). The SF-12 mental subscale was not significantly improved at final follow-up for either group. The older group demonstrated significantly higher Lysholm (P=0.045) and KOOS-sport (P=0.015) scores compared to the younger group at final recent follow-up. There were no other significant differences in patient reported outcomes scores, other concomitant surgeries, or defect sizes. Conclusion: Patients ≥40 years of age undergoing OAT have similar survival and reoperation rates at 5 years following surgery compared to younger patients. The <40 patients demonstrated lower Lysholm and KOOS-sport scores, potentially attributable to higher expectations of return to function post-operatively as compared to older patients. This information can be used to counsel patients when being offered OAT as part of a knee joint preservation strategy.

Do Outcomes of Osteochondral Allograft Transplantation Differ Based on Age and Sex? A Comparative Matched Group Analysis

2017 ◽  
Vol 46 (1) ◽  
pp. 181-191 ◽  
Author(s):  
Rachel M. Frank ◽  
Eric J. Cotter ◽  
Simon Lee ◽  
Sarah Poland ◽  
Brian J. Cole
Keyword(s):  
Failure Rate ◽  
Older Patients ◽  
Reoperation Rate ◽  
Osteochondral Allograft ◽  
Male And Female ◽  
Female Patients ◽  
Allograft Transplantation ◽  
Outcome Scores ◽  
Male Patients

Background: The effect of patient age or sex on outcomes after osteochondral allograft transplantation (OCA) has not been assessed. Purpose: To determine clinical outcomes for male and female patients aged ≥40 years undergoing OCA compared with a group of patients aged <40 years. Study Design: Cohort study; Level of evidence, 3. Methods: A review of prospectively collected data of consecutive patients who underwent OCA by a single surgeon with a minimum follow-up of 2 years was conducted. The reoperation rate, failure rate, and patient-reported outcome scores were reviewed. All outcomes were compared between patients aged <40 or ≥40 years, with subgroup analyses conducted based on patient sex. Failure was defined as revision OCA, conversion to knee arthroplasty, or gross appearance of graft failure at second-look arthroscopic surgery. Descriptive statistics, Fisher exact or chi-square testing, and Mann-Whitney U testing were performed, with P < .05 set as significant. Results: A total of 170 patients (of 212 eligible patients; 80.2% follow-up) who underwent OCA with a mean follow-up of 5.0 ± 2.7 years (range, 2.0-15.1 years) were included, with 115 patients aged <40 years (mean age, 27.6 ± 7.3 years; 58 male, 57 female) and 55 patients aged ≥40 years (mean age, 44.9 ± 4.0 years; 33 male, 22 female). There were no differences in the number of pre-OCA procedures between the groups ( P = .085). There were no differences in the reoperation rate (<40 years: 38%; ≥40 years: 36%; P = .867), time to reoperation (<40 years: 2.12 ± 1.90 years; ≥40 years: 3.43 ± 3.43 years; P = .126), or failure rate (<40 years: 13%; ≥40 years: 16%; P = .639) between the older and younger groups. Patients in both groups demonstrated significant improvement in Lysholm (both: P < .001), International Knee Documentation Committee (IKDC) (both: P < .001), Knee Injury and Osteoarthritis Outcome Score (KOOS) (both: P < .001), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (both: P < .001), and Short Form–12 (SF-12) physical (both: P < .001) scores compared with preoperative values. Patients aged ≥40 years demonstrated significantly higher KOOS symptom ( P = .015) subscores compared with patients aged <40 years. There were no significant differences in the number of complications, outcome scores, or time to failure between the sexes. In patients aged <40 years, female patients experienced failure significantly more quickly than male patients ( P = .039). In contrast, in patients aged ≥40 years, male patients experienced failure significantly more quickly than female patients ( P = .046). Conclusion: This study provides evidence that OCA is a safe and reliable treatment option for osteochondral defects in patients aged ≥40 years. Male and female patients had similar outcomes. Patients aged <40 years demonstrated lower KOOS symptom subscores postoperatively compared with older patients, potentially attributable to higher expectations of return to function postoperatively as compared with older patients.

scholarly journals Return to Sport After Large Single-Surface, Multisurface, or Bipolar Osteochondral Allograft Transplantation in the Knee Using Shell Grafts

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712096792
Author(s):  
James L. Cook ◽  
Kylee Rucinski ◽  
Cory R. Crecelius ◽  
Richard Ma ◽  
James P. Stannard
Keyword(s):  
Femoral Condyle ◽  
Case Series ◽  
Return To Sport ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Osteochondral Allograft ◽  
Level Of Evidence ◽  
Recreational Athletes ◽  
Patient Reported

Background: Return to sport (RTS) after osteochondral allograft (OCA) transplantation for large unipolar femoral condyle defects has been consistent, but many athletes are affected by more severe lesions. Purpose: To examine outcomes for athletes who have undergone large single-surface, multisurface, or bipolar shell OCA transplantation in the knee. Study Design: Case series; Level of evidence, 4. Methods: Data from a prospective OCA transplantation registry were assessed for athletes who underwent knee transplantation for the first time (primary transplant) between June 2015 and March 2018 for injury or overuse-related articular defects. Inclusion criteria were preinjury Tegner level ≥5 and documented type and level of sport (or elite unit active military duty); in addition, patients were required to have a minimum of 1-year follow-up outcomes, including RTS data. Patient characteristics, surgery type, Tegner level, RTS, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures were assessed and compared for statistically significant differences. Results: There were 37 included athletes (mean age, 34 years; range, 15-69 years; mean body mass index, 26.2 kg/m2; range, 18-35 kg/m2) who underwent large single-surface (n = 17), multisurface (n = 4), or bipolar (n = 16) OCA transplantation. The highest preinjury median Tegner level was 9 (mean, 7.9 ± 1.7; range, 5-10). At the final follow-up, 25 patients (68%) had returned to sport; 17 (68%) returned to the same or higher level of sport compared with the highest preinjury level. The median time to RTS was 16 months (range, 7-26 months). Elite unit military, competitive collegiate, and competitive high school athletes returned at a significantly higher proportion ( P < .046) than did recreational athletes. For all patients, the Tegner level at the final follow-up (median, 6; mean, 6.1 ± 2.7; range, 1-10) was significantly lower than that at the highest preinjury level ( P = .007). PROMs were significantly improved at the final follow-up compared with preoperative levels and reached or exceeded clinically meaningful differences. OCA revisions were performed in 2 patients (5%), and failures requiring total knee arthroplasty occurred in 2 patients (5%), all of whom were recreational athletes. Noncompliance was documented in 4 athletes (11%) and was 15.5 times more likely ( P = .049) to be associated with failure or a need for revision than for compliant patients. Conclusion: Large single-surface, multisurface, or bipolar shell OCA knee transplantations in athletes resulted in two-thirds of these patients returning to sport at 16 to 24 months after transplantation. Combined, the revision and failure rates were 10%; thus, 90% of patients were considered to have successful 2- to 4-year outcomes with significant improvements in pain and function, even when patients did not RTS.

scholarly journals Reoperation and Failure Rate at Six Years Following Revision ACL Reconstruction: A MARS Cohort Study

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0029
Author(s):  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Reoperation Rate ◽  
Patient Reported Outcome ◽  
Young Cohort ◽  
Revision Procedure ◽  
Revision Acl Reconstruction ◽  
Patient Reported ◽  
Surgical Data

Objectives: Revision anterior cruciate ligament (ACL) reconstruction remains a challenge for orthopaedic surgeons, as results are persistently inferior to those of primary reconstructions. There is very limited data regarding outcomes at 6 years following revision ACL surgery. The purpose of this study was to report the rate of reoperation, further revision, and conversion to total knee arthroplasty (TKA) in a large cohort of revision ACL reconstructions Methods: Patients undergoing revision ACL reconstructions were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique, and a series of validated patient-reported outcome instruments. Patients were followed up by questionnaire and telephone at 6 years following index revision surgery and asked if they had undergone any further surgical procedures to either knee. If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Results: Six-year follow-up subsequent surgical data was available for 951/1234 patients (77%). In this available cohort, 556 (58%) were male, mean age was 28 years (range 12-61 years) and mean BMI was 26.1 (range 17.1-47.5). Allograft was used in 510 (54%) cases, BTB autograft in 234 (25%), soft tissue autograft in 174 (18%) and other grafts were used in the remaining 33 (3%). Their index surgery was their first revision ACL reconstruction in 822 (86.4%), in 108 (11.4%) it was their second, and in 21 (2.2%) it was their third or greater. This revision procedure was a mean of 5.7 years (range 0.1-26 years) from their prior ACL reconstruction. At six years following the index revision procedure, 16.2% of the cohort underwent at least 1 subsequent surgical procedure on their index knee. Of the reoperations, 29% were meniscal procedures (71% meniscectomy, 18% repair), 21% were articular cartilage procedures (79% chondroplasty, 15% microfracture, 3% OATS, 3% ACI), 11% were for arthrofibrosis, 9% for hardware removal, and 6% were for a subsequent revision ACL reconstruction. Surprisingly, only 5% reported having undergone a subsequent TKA on their ipsilateral knee. During this same 6-year follow-up period, 6% of the cohort (n=53 patients) underwent a subsequent surgery on their contralateral knee, of which 36 were ACL reconstructions. Conclusion: Our data shows that there is a reoperation rate of greater than 15% following ACL revision, which is an important point of discussion between surgeons and their patients. Of particular interest is that there was a 6% rate of recurrent ACL failure and 5% rate of subsequent TKA in this young cohort 6 years following a revision ACL reconstruction.

Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

2017 ◽  
Vol 39 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Samuel B. Adams ◽  
Travis J. Dekker ◽  
Adam P. Schiff ◽  
Christopher P. Gross ◽  
James A. Nunley ◽  
...  
Keyword(s):  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Salvage Procedure ◽  
Prospective Evaluation ◽  
Allograft Transplantation ◽  
Structural Allograft ◽  
Additional Surgery ◽  
Sf 36 ◽  
Patient Reported

Background: Structural or bulk osteochondral allograft transplantation for shoulder talar osteochondral lesions as a salvage procedure has demonstrated efficacy in several retrospective reviews. The purpose of this study was to evaluate prospectively patients who received fresh structural allograft transplantation to the talus. Methods: Prospective evaluation of a consecutive series of patients who underwent fresh structural allograft transplantation for an osteochondral lesion of the talus (OLT) was performed. Preoperative magnetic resonance imaging (MRI) and/or computed tomography (CT) and plain radiographs were obtained on all patients. The following patient-reported outcomes questionnaires were administered preoperatively and yearly after surgery: 100-mm visual analog scale (VAS) pain scale, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Short Form 36 (SF-36), and the Short Musculoskeletal Functional Assessment (SMFA). Preoperative and postoperative radiographs were assessed for allograft incorporation and subsequent arthritis. Fourteen patients with an average age of 40 years (range, 18-69) and a mean follow-up of 55 months (range, 24-97) underwent structural fresh osteochondral allograft transplantation to the talar shoulder. Results: The average size of the OLT was 2269 mm3 (range, 813-8366) based on CT imaging and 5797 mm3 (range, 1136-12 489) based on MRI imaging. There was significant ( P < .05) improvement in the VAS pain, AOFAS scale, SF-36, and SMFA scores. Five (36%) of the patients required additional surgery for pain and stiffness. Two patients had cartilage delamination and were considered treatment failures. Therefore, the success rate was 86% (12/14). Conclusion: Significant improvement in pain and function was achieved with structural allograft transplantation for large OLTs at midterm follow-up. This was a safe and effective treatment option in this small series for large OLTs. Level of Evidence: Level IV, prospective case series.

Outcomes of Osteochondral Allograft Transplantation With and Without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis

2018 ◽  
Vol 46 (3) ◽  
pp. 573-580 ◽  
Author(s):  
Rachel M. Frank ◽  
Simon Lee ◽  
Eric J. Cotter ◽  
Charles P. Hannon ◽  
Timothy Leroux ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Lateral Femoral Condyle ◽  
Osteochondral Allograft ◽  
Failure Rates ◽  
Meniscus Allograft Transplantation ◽  
Joint Preservation ◽  
Allograft Transplantation ◽  
Meniscus Allograft ◽  
Patient Reported

Background: Osteochondral allograft transplantation (OCA) is often performed with concomitant meniscus allograft transplantation (MAT) as a strategy for knee joint preservation, although to date, the effect of concomitant MAT on outcomes and failure rates after OCA has not been assessed. Purpose: To determine clinical outcomes for patients undergoing OCA with MAT as compared with a matched cohort of patients undergoing isolated OCA. Study Design: Control study; Level of evidence, 3. Methods: Patients who underwent OCA of the medial or lateral femoral condyle without concomitant MAT by a single surgeon were compared with a matched group of patients who underwent OCA with concomitant MAT (ipsilateral compartment). The patients were matched per age, sex, body mass index, and number of previous ipsilateral knee operations ±1. Patient-reported outcomes, complications, reoperations, and survival rates were compared between groups. Results: One hundred patients undergoing OCA (50 isolated, 50 with MAT) with a mean ± SD follow-up of 4.9 ± 2.7 years (minimum, 2 years) were included (age, 31.7 ± 9.8 years; 52% male). Significantly more patients underwent OCA to the medial femoral condyle (n = 59) than the lateral femoral condyle (n = 41, P < .0001). Patients underwent 2.7 ± 1.7 operations on the ipsilateral knee before OCA. There were no significant differences between the groups regarding reoperation rate (n = 18 for OCA with MAT, n = 17 for OCA without MAT, P = .834), time to reoperation (2.2 ± 2.4 years for OCA with MAT, 3.4 ± 2.7 years for OCA without MAT, P = .149), or failure rates (n = 7 [14%] for OCA with MAT, n = 7 [14%] for OCA without MAT, P > .999). There were no significant differences in patient-reported clinical outcome scores between the groups at final follow-up. There was no significant difference in failure rates between patients undergoing medial femoral condyle OCA (n = 12, 15.3%) and lateral femoral condyle OCA (n = 5, 12.2%, P = .665). Conclusion: These results imply that with appropriate surgical indications to address meniscus deficiency in patients otherwise indicated for OCA and despite the added surgical time and complexity of concomitant MAT, outcomes are favorable, with an 86% OCA graft survivorship at 5 years. This information can be used to counsel patients undergoing OCA with concomitant MAT as part of a knee joint preservation strategy.

Osteochondral Allograft Transplantation in the Patellofemoral Joint: A Systematic Review

2018 ◽  
Vol 47 (12) ◽  
pp. 3009-3018 ◽  
Author(s):  
Jorge Chahla ◽  
Matthew C. Sweet ◽  
Kelechi R. Okoroha ◽  
Benedict U. Nwachukwu ◽  
Betina Hinckel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Patellofemoral Joint ◽  
Osteochondral Allograft ◽  
Cochrane Central Register ◽  
Failure Rates ◽  
Allograft Transplantation ◽  
Chondral Defects ◽  
Patient Reported

Background: The initial focus of cartilage restoration algorithms has been on the femur; however, the patellofemoral compartment accounts for 20% to 30% of significant symptomatic chondral pathologies. While patellofemoral compartment treatment involves a completely unique subset of comorbidities, with a comprehensive and thoughtful approach many patients may benefit from osteochondral allograft treatment. Purpose: To perform a systematic review of clinical outcomes and failure rates after osteochondral allograft transplantation (OCA) of the patellofemoral joint at a minimum 18-month follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature regarding the existing evidence for clinical outcomes and failure rates of OCA for patellofemoral joint chondral defects was performed with the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1990 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCA for the treatment of chondral defects in the patellofemoral joint, English language, minimum follow-up of 18 months, minimum study size of 5 patients, and human studies. The methodological quality of each study was assessed with a modified version of the Coleman methodology score. Results: The systematic search identified 8 studies with a total of 129 patients. The methods of graft procurement and storage time included fresh (121 patients, 93.8%), and cryopreserved (8 patients, 6.2%) grafts. The mean survival rate was 87.9% at 5 years and 77.2% at 10 years. The following outcome scores showed significant improvement from pre- to postoperative status: modified d’Aubigné-Postel, International Knee Documentation Committee, Knee Society Score–Function, and Lysholm Knee Score. Conclusion: OCA of the patellofemoral joint results in improved patient-reported outcome measures with high patient satisfaction rates. Five- and 10-year survival rates of 87.9% and 77.2%, respectively, can be expected after this procedure. These findings should be taken with caution, as a high percentage of patellofemoral osteochondral allografts were associated with concomitant procedures; therefore, further research is warranted to determine the effect of isolated osteochondral transplantations.

Analysis of Defect Size and Ratio to Condylar Size With Respect to Outcomes After Isolated Osteochondral Allograft Transplantation

2019 ◽  
Vol 47 (7) ◽  
pp. 1601-1612 ◽  
Author(s):  
Simon Lee ◽  
Rachel M. Frank ◽  
David R. Christian ◽  
Brian J. Cole
Keyword(s):  
Osteochondral Defect ◽  
Short Form ◽  
Femoral Condyle ◽  
Defect Size ◽  
Osteochondral Allograft ◽  
Preoperative Imaging ◽  
Level Of Evidence ◽  
Allograft Transplantation ◽  
Patient Reported

Background: Osteochondral allograft transplantation (OCA) is a successful knee joint preservation technique; however, the effects of defect size and defect size:condyle ratio (DSCR) are poorly understood. Purpose: To quantify clinical outcomes of isolated OCA of the knee based on defect size and DSCR. Study Design: Cohort study; Level of evidence, 3. Methods: Data from patients who underwent OCA of the knee without major concomitant procedures by a single surgeon were analyzed at a minimum follow-up of 2 years. Osteochondral defect size was measured intraoperatively, and femoral condyle size was measured with preoperative imaging. Patient-reported outcomes, reoperations, and survival rates were analyzed per defect size and DSCR, comparing males and females and patients <40 and ≥40 years old. Results: Sixty-eight patients were included, of whom 57% were male (mean ± SD: age, 34.5 ± 10.3 years; follow-up, 5.2 ± 2.6 years). Mean osteochondral defect size and DSCR were 3.48 ± 1.72 cm2 and 0.2 ± 0.1, respectively. Defect size was larger among males as compared with females (3.97 ± 1.71 cm2 vs 2.81 ± 1.16 cm2, P = .005), while DSCRs were not significantly different between sexes ( P = .609). The cohort as a whole demonstrated improvements in the following scores: Lysholm, International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and 12-Item Short Form Health Survey Physical ( P < .05). There were 27 reoperations (39.7%) at a mean of 2.5 ± 1.92 years and 8 failures (11.8%) at a mean of 2.62 ± 1.3 years. Mean DCSR was higher among patients with graft failure (0.26 ± 0.20 vs 0.19 ± 0.07, P = .049). After stratification by age, failures among patients ≥40 years old were associated with a larger defect size (mean 5.37 ± 3.50 cm2 vs 3.22 ± 1.32 cm2, P = .03) and higher DSCR (mean 0.30 ± 0.25 vs 0.19 ± 0.06, P = .05) when compared with nonfailures. Failures among patients <40 years old were not significantly associated with defect size or DSCR ( P > .05) as compared with nonfailures. Conclusion: Patients undergoing isolated OCA transplantation demonstrated significant clinical improvements and a graft survival of 88.2% at 5.2 years. Failures overall were associated with a larger DSCR, and failures among patients ≥40 years old with a larger DSCR and larger defect size. Increasing defect size among males was positively correlated with some improved outcomes, although this was not maintained in analysis of the DSCR, suggesting similar prognosis after OCA regardless of sex. Clinical Relevance: Failed osteochondral allografts are associated with larger defect sizes and defect:condyle ratios in this study, providing additional information to surgeons for appropriate patient consultation.

scholarly journals Comparison of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation of the Knee in a Large Insurance Database: Reoperation Rate, Complications, and Cost Analysis

Cartilage ◽  
2020 ◽  
pp. 194760352096706
Author(s):  
Kyle R. Sochacki ◽  
Kunal Varshneya ◽  
Jacob G. Calcei ◽  
Marc R. Safran ◽  
Geoffrey D. Abrams ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Reoperation Rate ◽  
Osteochondral Allograft ◽  
Complication Rates ◽  
Allograft Transplantation ◽  
Chondrocyte Implantation ◽  
Reoperation Rates ◽  
Insurance Database ◽  
Autologous Chondrocyte

Objective To compare (1) the reoperation rates, (2) risk factors for reoperation, (3) 30-day complication rates, and (4) cost differences between autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) of the knee in a large insurance database. Design Subjects who underwent knee ACI (Current Procedural Terminology [CPT] code 27412) or OCA (CPT code 27415) with minimum 2-year follow-up were queried from a national insurance database. Reoperation was defined by ipsilateral knee procedure after index surgery. Multivariate logistic regression models were built to determine the effect of independent variables (age, sex, tobacco use, obesity, diabetes, and concomitant osteotomy) on reoperation rates. The 30-day complication rates were assessed using ICD-9-CM codes. The cost of the procedures per patient was calculated. Statistical comparisons were made. All P values were reported with significance set at P < 0.05. Results A total of 909 subjects (315 ACI and 594 OCA) were included (mean follow-up 39.2 months). There was a significantly higher reoperation rate after index ACI compared with OCA (67.6% vs. 40.4%, P < 0.0001). Concomitant osteotomy at the time of index procedure significantly reduced the risk for reoperation in both groups (odds ratio [OR] 0.2, P < 0.0001 and OR 0.2, P = 0.009). The complication rates were similar between ACI (1.6%) and OCA (1.2%) groups ( P = 0.24). Day of surgery payments were significantly higher after ACI compared with OCA ( P = 0.013). Conclusions Autologous chondrocyte implantation had significantly higher reoperation rates and cost with similar complication rates compared with OCA. Concomitant osteotomy significantly reduced the risk for reoperation in both groups.

scholarly journals Impact of surgical site infection on patients’ outcome after fixation of tibial plateau fractures: a retrospective multicenter study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ralf Henkelmann ◽  
Richard Glaab ◽  
Meinhard Mende ◽  
Christopher Ull ◽  
Philipp-Johannes Braun ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Tibial Plateau ◽  
Patient Reported Outcome ◽  
Tibial Plateau Fractures ◽  
Site Infection ◽  
Patient Reported ◽  
Outcome Scores ◽  
The Impact ◽  
Retrospective Multicenter Study

Abstract Background Surgical site infection (SSI) occurs in 3–10 % of patients with surgically treated tibial plateau fractures. This study aimed to evaluate the impact of SSI on patients’ outcome after fixation of tibial plateau fractures. Methods We conducted a retrospective multicenter study in seven participating level I trauma centers between January 2005 and December 2014. All participating centers followed up with patients with SSI. In addition, three centers followed up with patients without SSI as a reference group. Descriptive data and follow-up data with patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Lysholm knee scoring scale score) were evaluated. Results In summary, 287 patients (41 with SSI and 246 without SSI; average 50.7 years) with an average follow-up of 75.9 ± 35.9 months were included in this study. Patients with SSI had a significantly poorer overall KOOS (KOOS5) (48.7 ± 23.2 versus [vs.] 71.5 ± 23.5; p < 0.001) and Lysholm knee scoring scale score (51.4 ± 24.0 vs. 71.4 ± 23.5; p < 0.001) than patients without SSI. This significant difference was also evident in the KOOS subscores for pain, symptoms, activities of daily living (ADL), and quality of life (QoL). SSI remained an important factor in multivariable models after adjusting for potential confounders. Clinically relevant differences in the KOOS5 and KOOS subscores for symptoms, pain, and ADL were found between those with SSI and without SSI even after adjustment. Furthermore, the number of previous diseases, Arbeitsgemeinschaft für Osteosynthesefragen Foundation (AO) C fractures, and compartment syndrome were found to be additional factors related to poor outcome. Conclusions Compared to previous studies, validated patient-reported outcome scores demonstrated that the impact of SSI in patients with surgically treated tibial plateau fractures is dramatic, in terms of not only pain and symptoms but also in ADL and QoL, compared to that in patients without SSI.

Osteochondral Allograft Transplantation of the Knee: Analysis of Failures at 5 Years

2017 ◽  
Vol 45 (4) ◽  
pp. 864-874 ◽  
Author(s):  
Rachel M. Frank ◽  
Simon Lee ◽  
David Levy ◽  
Sarah Poland ◽  
Maggie Smith ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Short Form ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Reoperation Rate ◽  
Osteochondral Allograft ◽  
Arthroscopic Debridement ◽  
Level Of Evidence ◽  
Allograft Transplantation

Background: Osteochondral allograft transplantation (OAT) is being performed with increasing frequency, and the need for reoperations is not uncommon. Purpose: To quantify survival for OAT and report findings at reoperations. Study Design: Case series; Level of evidence, 4. Methods: A review of prospectively collected data of 224 consecutive patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years was conducted. The reoperation rate, timing of reoperation, procedure performed, and findings at surgery were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at second-look arthroscopic surgery. Results: A total of 180 patients (mean [±SD] age, 32.7 ± 10.4 years; 52% male) who underwent OAT with a mean follow-up of 5.0 ± 2.7 years met the inclusion criteria (80% follow-up). Of these, 172 patients (96%) underwent a mean of 2.5 ± 1.7 prior surgical procedures on the ipsilateral knee before OAT. Forty-eight percent of OAT procedures were isolated, while 52% were performed with concomitant procedures including meniscus allograft transplantation (MAT) in 65 (36%). Sixty-six patients (37%) underwent a reoperation at a mean of 2.5 ± 2.5 years, with 32% (21/66) undergoing additional reoperations (range, 1-3). Arthroscopic debridement was performed in 91% of patients with initial reoperations, with 83% showing evidence of an intact graft; of these, 9 ultimately progressed to failure at a mean of 4.1 ± 1.9 years. A total of 24 patients (13%) were considered failures at a mean of 3.6 ± 2.6 years after the index OAT procedure because of revision OAT (n = 7), conversion to arthroplasty (n= 12), or appearance of a poorly incorporated allograft at arthroscopic surgery (n = 5). The number of previous surgical procedures was independently predictive of reoperations and failure; body mass index was independently predictive of failure. Excluding the failed patients, statistically and clinically significant improvements were found in the Lysholm score, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Short Form–12 physical component summary at final follow-up ( P < .001 for all), with inferior outcomes (albeit overall improved) in patients who underwent a reoperation. Conclusion: In this series, there was a 37% reoperation rate and an 87% allograft survival rate at a mean of 5 years after OAT. The number of previous ipsilateral knee surgical procedures was predictive of reoperations and failure. Of the patients who underwent arthroscopic debridement with an intact graft at the time of arthroscopic surgery, 82% experienced significantly improved outcomes, while 18% ultimately progressed to failure. This information can be used to counsel patients on the implications of a reoperation after OAT.

Sign in / Sign up

Export Citation Format

Share Document