Clinical Outcomes of Revision Osteochondral Allograft Transplantation

Abstract

To assess the survivorship, clinical outcomes, and radiographic outcomes of patients who have undergone revision osteochondral allograft (OCA) to the knee in a retrospective case series. Nine patients who underwent revision OCA by the senior author between January 2003 and December 2015 with a minimum follow up of 2years were reviewed retrospectively. Patients completed patient-reported outcome surveys containing the visual analog scale, the International Knee Documentation Committee, the Knee injury and Osteoarthritis Outcome Score, Lysholm score, and the Short-Form 12. Radiographic analysis included anteroposterior view graded via the Kellgren and Lawrence scale. Complications and reoperations were analyzed, with failure defined as conversion to arthroplasty. (Institutional review board 15050301.) RESULTS: One of 10 consecutive patients was lost to follow up, for an overall follow-up rate of 90% (5males, 4 females); mean follow up, 4.53 ± 3.17years. The median patient age at the time of revision OCA was 33years (interquartile range [IQR], 8.6), the median defect size was 4.0cm2 (IQR, 0), and the median time from index OCA to revision OCA was 2.9years (IQR, 1.9). Five patients (50%) underwent subsequent surgery at a median of 1.92years (IQR, 7.25), with 1 progressing to arthroplasty at 23months after revision OCA, for an overall failure rate of 11%. There were no significant differences in any of the patient-reported outcome assessments compared with prerevision OCA (postindex OCA) values at final follow up (P > .05 for all). Similarly, there were no significant differences in Kellgren and Lawrence score before and after surgery (P= .1). At a mean 4.5years following revision OCA, there was an 89% graft survivorship rate in a series of 9 patients, with no statistical changes in the radiographic progression of arthritis. Level IV, case series.