Osteochondral Allograft Transplantation of the Knee in “Ideal” Candidates: Clinical Outcomes and Graft Survivorship

Abstract

Objectives:Osteochondral allograft (OCA) transplantation of the knee is an effective treatment for chondral and osteochondral lesions, but graft survivorship and clinical outcomes vary by patient-specific factors. Fresh OCA are often used for large or complex lesions or in the revision cartilage repair setting, but recent literature suggests that the most ideal candidates for OCA transplantation may be young patients with a small lesion on the femoral condyle or trochlea due to osteochondritis dissecans or chondral trauma. The purpose of this study was to assess outcomes following OCA transplantation in a cohort of “ideal” candidates.Methods:We identified 91 patients (97 knees) who underwent primary OCA transplantation for osteochondritis dissecans (88%) or a traumatic chondral injury (12%), were age 30 years or younger, and had an isolated lesion(s) of the femoral condyle or trochlea less than 8 cm2. Mean age was 20 years and 70% were male. Lesions were located on the femoral condyle (85%) or trochlea (15%). One graft was used in 85% of knees and two grafts were used in 15%. Mean total graft area was 5.2 cm2. Evaluation included pain, function, satisfaction, and reoperations. OCA failure was defined as revision allografting or conversion to arthroplasty. Median follow-up was 5.7 years (range 2-17 years).Results:Seventeen knees (18%) underwent reoperations. Two knees (2%) were classified as OCA failures (one revision OCA at 2.7 years and one conversion to unicompartmental arthroplasty at 10.2 years). Survivorship was 99% at 5 and 10 years. Pain and function improved (Table 1.), and 93% of patients were satisfied with the results of the OCA transplantation.Conclusion:In this cohort of “ideal” cartilage repair patients undergoing OCA transplantation, graft survivorship and clinical outcomes were excellent, with high satisfaction, pain relief, and functional improvement. Outcomes were equal or superior to other cartilage repair techniques.Table 1.Clinical outcome scoresMeasurePreoperative Mean SDFollow-up MeanSDModified Merle d’Aubigné-Postel14.32.016.61.9IKDC Pain5.02.72.42.1 Function3.91.87.72.2 Total50.019.279.018.1KOOS Symptoms67.616.984.013.7 Pain73.717.590.512.4 Activities of daily living80.316.195.59.6 Sports and recreation41.226.874.824.2 Quality of life32.720.069.723.2All comparisons had a p-value <0.001