OPEN OSTEOCHONDRAL AUTOGRAFT TRANSFER RESULTS IN MORE FREQUENT REOPERATION THAN OPEN ALLOGRAFT TRANSFER IN THE PEDIATRIC KNEE

Abstract

Background:Osteochondral autograft (OAU) and allograft (OAL) transfer are surgical options for sizeable articular cartilage lesions in the knee. In the pediatric population, there is little data on the patients undergoing these procedures or evidence to support one technique over another. Specifically, the rate of reoperation in these young patients is unknown.Hypothesis/Purpose:The purpose of this study is to compare the rate of reoperation in children and adolescents undergoing OAU or OAL of the knee in a nationally representative population.Methods:The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing open or arthroscopic OAU and OAL between 2012 and 2018. Demographic information was collected for each subject as well as data regarding subsequent reoperations, readmissions, and returns to the emergency department. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors.Results:A total of 732 subjects with a mean age of 15.4±2.4 years were included in the analysis. Of these, 393 (53.7%) initially underwent OAL (273 open, 120 arthroscopic) and 339 (46.3%) underwent OAU (137 open, 202 arthroscopic). The overall reoperation rate was 144/732 (19.7%) at a median of 198 days (range 17-1604 days) after the index operation. This rate was similar between OAL and OAU. In 18 subjects (2.5%), OAU, OAL, or autologous chondrocyte implantation (ACI) was performed at the time of revision surgery. When analyzing only open procedures, 25.5% of open OAU patients underwent a repeat procedure compared to 16.5% of open OAL patients (p=0.03). After adjusting for other factors in a multivariate model, those who initially underwent open OAU had 1.7 times higher odds of requiring a future reoperation than an open OAL patient (95% CI 1.1-2.8, p=0.04). There was no difference in the rate of repeat surgery among arthroscopic procedures or when comparing open to arthroscopic operations.Conclusion:While 19.7% of children and adolescents undergoing OAU or OAL eventually require repeat surgery, the rate at which revision OAU, OAL, or ACI is performed is 2.5%. Patients undergoing open OAU have 1.7 times higher odds of ultimately requiring a reoperation than those undergoing open OAL, even when adjusting for confounding factors.