Abstract
Objectives:To report the clinical outcomes of snowman technique osteochondral allograft transplantation (OCA) and clinical outcomes of multifocal OCA.Methods:Consecutive patients who underwent either a primary snowman OCA or multifocal (i.e. bipolar patellofemoral, patellofemoral and a condyle or bicondylar) with a minimum 2-year follow-up by a single surgeon from 4/2003 to 4/2015 were isolated. Failure was defined as revision OCA, conversion to arthroplasty, or gross appearance of graft degeneration on 2nd look arthroscopy.Results:Twenty-six patients (28 knees) were isolated with 22 patients (24 knees; 85.7%) having 2-year clinical follow-up. Nine of 11 patients (81.8%) who underwent isolated condylar snowman allografts met inclusion criteria at mean follow-up of 7.4±3.6 years, while 13 additional patients (15 knees; 88.2%) underwent multifocal OCA at mean follow-up of 6.4±3.9 years. All 9 patients who received isolated snowman OCA were to the medial femoral condyle. Reoperations were common with 44.4% (N=4) of the snowman group and 20% of multifocal OCA (N=3) undergoing at least 1 reoperation. There were 3 failures (33.3%) in the snowman technique group at a mean 7.7±5.5 years and 1 failure in the multifocal OCA group at 4.5 years. All 4 failures underwent TKA. Patients who underwent multifocal OCA demonstrated significant improvements in the International Knee Documentation Committee score, Knee Injury and Osteoarthritis subscores, Western Ontario and McMaster Universities Osteoarthritis Index subscores, and the Short-Form-12 physical component (P <0.05 for all). Patients who underwent snowman OCA demonstrated significant improvement in KOOS pain subscore and WOMAC overall scores (P<0.05 for both) Table 1].Conclusion:While in a small cohort, patients who underwent snowman OCA had a high rate of reoperation (44.4%) and a high rate of failure (33.3%). Comparatively, patients who underwent multifocal OCA had reoperation and graft survival rates comparable to published literature for focal OCA.Table 1:Patient-reported clinical outcome measures for both snowman technique osteochondral allografts and multifocal grafts Multifocal Osteochondral Allograft Transplantation PreoperativePostoperativeP Value MeanSDMeanSD Marx 1.671.606.133.570.285 Lysholm 41.839.3155.0013.620.237 IKDC 32.715.0252.9212.55 0.010 KOOS - Pain 51.489.5965.2810.570.155 KOOS - Symptom 56.259.9966.079.47 0.025 KOOS - ADL 58.709.4777.2110.18 0.026 KOOS - Sport 18.339.1940.3614.66 0.026 KOOS - QOL 11.985.4141.0716.16 0.005 WOMAC - Pain 8.821.816.071.810.212 WOMAC - Stiffness 4.000.892.930.89 0.046 WOMAC - Function 28.185.2015.366.79 0.037 WOMAC - Overall 37.558.7315.937.96 0.047 SF-12 Physical 33.624.0744.655.250.011 SF-12 Mental 53.145.1055.113.370.859 Snowman Technique Osteochondral Allograft Transplantation Marx 0.000.002.330.76N/A Lysholm 37.173.8366.1714.750.138 IKDC 29.342.5454.1413.290.285 KOOS - Pain 44.915.5172.629.77 0.043 KOOS - Symptom 46.435.3066.3311.240.080 KOOS - ADL 56.8613.2582.3511.090.345 KOOS - Sport 17.503.0653.5719.350.223 KOOS - QOL 19.797.2449.1114.710.104 WOMAC - Pain 9.171.936.002.470.109 WOMAC - Stiffness 4.830.862.710.750.068 WOMAC - Function 29.509.0812.007.430.345 WOMAC - Overall 45.1710.4510.716.18 0.043 SF-12 Physical 45.013.0341.455.400.686 SF-12 Mental 52.615.1355.717.480.500
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