Knee Outcome Survey-Activities Of Daily Living Research Articles

Return to Work after Primary Total Knee Arthroplasty: The First Polish Pilot Retrospective Study.

(1) Background: Total knee arthroplasty (TKA) performed on working-age patients significantly affects the participation of such patients in social life. A retrospective study was conducted to determine the return to work (RTW) rate after TKA. The goal of this study was to provide reference data for the Polish population and identify the factors impacting patients' decisions to return to or resign from work, relative to their functional performance. (2) Methods: This retrospective study involved 48 patients. An interview related to RTW was carried out to identify the factors impacting a patient's decision to return to or resign from work. Functional performance was assessed using the Knee Outcome Survey-Activities of Daily Living (KOS-ADL) scale. (3) Results: Before TKA, 15 individuals (31.25%) qualified for the study did not work and were receiving welfare benefits. After the surgery, 23 individuals (47.9% of those working prior to TKA) did not return to work. The number of those who did not work after TKA increased to 38 (79.17%), which was a significant change. The mean level of functional performance after TKA assessed using KOS-ADL was 75.89. (4) Conclusions: The findings show that the rate of RTW after TKA in Poland is significantly lower than that in other countries. The reasons for this situation, as shown in the study, may be related to the lack of an occupational rehabilitation system, resulting in a paucity of information about the possibility to return to work and about opportunities for retraining.

Recovery of Quadriceps Strength and Knee Function Using Adjuvant EMG-BF After Primary ACL Reconstruction

Introduction: Immobility and limited usage of operated limbs lead to weakness and atrophy of the muscle after anterior cruciate ligament (ACL) reconstruction. However, training programs for preventing biomechanical risk factors such as lower limb alignment and increased muscular contraction are very limited. Thus, the current study was carried out to evaluate the recovery of quadriceps muscle strength and the improvement of knee function using adjuvant electromyographic biofeedback (EMG-BF) after ACL reconstruction. Methods: This prospective randomized controlled trial was conducted among 40 patients (20=EMG-BF group, 20=Control group) with ACL reconstruction, who were referred to Akhtar Hospital from 2021 to 2022. In the EMG-BF group, EMG BFB was added to the standard rehabilitation protocol, and in the control group, the standard rehabilitation protocol with full postoperative weight-bearing, knee brace (zero degree of extension, 90 degrees of flexion), and electrical stimulation with maximal voluntary isometric knee extension was performed. Each group was intervened for 4 weeks and three sessions of 30 minutes per week. It should be noted that each patient participated in 16 outpatient physiotherapy sessions after surgery. Nicholas Hand-Held Dynamometer (HHD) was used for measuring quadriceps strength, and Knee Outcome Survey-Activities of Daily Living (KOS-ADLs) and Knee Outcome Survey Sports Activities Scale (KOS-SAS) questionnaires were used for assessing the knee function. Results: Four weeks after the treatment, the EMG-BF group showed a significant increase in quadriceps strength (P=0.0001). Quadriceps strength had a significant difference before and after 4 weeks of intervention (P=0.0001), but in the control group, no significant difference was observed (P=0.368). The EMG-BF group had a significant increase in KOS-ADLs and KOS-SAS scores after 4 weeks of intervention (P=0.0001). Conclusion: In our study, isometric strengthening of quadriceps with adjuvant EMG-BF significantly increased the strength of quadriceps and knee function during 4 weeks. EMG-BF is a low risk, low cost, and less invasive intervention and has high safety and adjustment ability. It is a valuable adjuvant method for achieving better functional recovery in a shorter time.

Improved Outcomes Following a Care Guideline Implementation: Part 1 of an Analysis of 12 355 Patients After Total Knee Arthroplasty.

OBJECTIVE: To describe the application and examine the influence of a continuous quality improvement intervention, which had a goal of standardizing care to reduce the proportion of patients who do not have a meaningful improvement in patient-reported outcomes following total knee arthroplasty (TKA). DESIGN: Continuous quality improvement. METHODS: A physical therapy (PT) care guideline was initiated in 2013 for patients following TKA. The Knee Outcome Survey - Activities of Daily Living (KOS-ADL) was measured at every visit, and scores were extracted from a clinical outcomes database to calculate the proportion of patients who did not achieve a minimal clinically important difference. Based on logistic regression analysis, we compared the proportion of patients who did not progress on the KOS-ADL in a non-care guideline group (2008-2012) to a care guideline (CG) group (2014-2019). RESULTS: This study included 12 355 patients (aged 18-92 years) following TKA incurring at least 3 PT visits from 2008 to 2019. The percentage of patients who did not progress in the non-care guideline group was 25.8% and in the care guideline group 14.3% (P<0.001). The relationship between care guideline adherence and lack of progression on the KOS-ADL was statistically significant, X2 (df = 1) = 148.7, P<.001. CONCLUSION: The percentage of patients who did not achieve meaningful progress on the KOS-ADL declined significantly in the 6 years after implementing a TKA care guideline without an increase in the number of clinical visits. The standardized care guideline was associated with meaningful improvements for patients following TKA when applied in conjunction with PT access to outcome data, feedback through audits, performance goals, and financial incentives. J Orthop Sports Phys Ther 2023;53(3):143-150. Epub: 12 December 2022. doi:10.2519/jospt.2022.11369.

Improved Outcomes with Arthroscopic Bone Marrow Aspirate Concentrate and Cartilage-Derived Matrix Implantation versus Chondroplasty for the Treatment of Focal Chondral Defects of the Knee Joint: A Retrospective Case Series

PurposeTo compare the outcomes of patients undergoing treatment of focal chondral defects (FCDs) of the knee joint with chondroplasty versus bone marrow aspirate concentrate (BMAC) and cartilage-derived matrix (CDM) implantation.MethodsA retrospective chart review was performed for patients diagnosed with Outerbridge grade 3-4 FCDs. Patients were included if they were treated arthroscopically with BMAC/CDM implantation or chondroplasty alone between March 2016 and May 2019 and had more than 1-year follow-up. Postoperative outcomes included the visual analog scale (VAS) for pain; University of California, Los Angeles (UCLA) activity scores; Knee Outcome Survey (KOS) Activities of Daily Living (ADL) and Sports subscores; postoperative corticosteroid or hyaluronic acid injections; subsequent surgeries; and conversion to total knee arthroplasty.ResultsA total of 98 patients were identified with a mean follow-up in BMAC/CDM of 24 months (range 13-41 months) and in chondroplasty of 44 months (range 34-55 months). A subanalysis was performed to control for significant differences in age, which yielded 39 patients, ages 40-60 years. Within the subanalysis group, mean VAS scores were significantly lower in the BMAC/CDM group (1.7 vs 4.4; P = .005) and mean UCLA scores were significantly greater (7.1 vs 5.0; P = .002). Mean improvement in VAS and UCLA scores were similar between the BMAC/CDM and chondroplasty groups (–3.7 vs –1.3; P = .71, 1.9 vs 0.1; P = .14, respectively). Mean KOS ADL and Sports subscores were significantly greater among patients in the BMAC/CDM group (87% vs 55%; P = .001, 71% vs 41%; P = .002, respectively). There were no differences in postoperative injections, subsequent surgeries, or conversion to total knee arthroplasty between the BMAC/CDM and chondroplasty groups.ConclusionsPatients with grade 3-4 FCDs of the knee had improved postoperative outcomes when treated with BMAC/CDM implantation versus chondroplasty alone, as evidenced by a significant improvement in VAS and UCLA scores and significantly greater postoperative KOS ADL, and KOS Sport subscores.Level of EvidenceIV, therapeutic case series.

Pre-operative Mental Health Predicts Clinically Meaningful Outcomes after Osteochondral Allograft for Cartilage Defects of the Knee: A Machine Learning Analysis

Objectives:Fresh osteochondral allograft transplantation (OCA) is an effective method of treating symptomatic cartilage defects of the knee. This cartilage restoration technique involves the single-stage implantation of viable, mature hyaline cartilage into chondral or osteochondral lesion. Predictive models for reaching the clinically meaningful outcome among patients undergoing OCA for cartilage lesions of the knee remain under investigation. The purpose of the study was to apply machine learning to determine which preoperative variables are predictive for achieving the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) at one and two years after OCA for cartilage lesions of the knee.Methods:Data were analyzed for patients who underwent OCA of the knee by a two high-volume fellowship-trained cartilage surgeons before May 1, 2018. The International Knee Documentation Committee (IKDC) subjective form, Knee Outcome Survey-Activities of Daily Living (KOS-ADL), and Mental Component (MCS) and Physical Component (PCS) Summaries of the SF-36 were administered preoperatively and at one and two-years postoperatively. A total of 84 predictive models were created using 7 unique architectures to detect achievement of the MCID for each of the four outcome measures and the SCB for the IKDC and KOS-ADL at both timepoints. Data inputted into the models included prior and concomitant surgical history, laterality, sex, age, body mass index (BMI), intraoperative findings, and patient-reported outcome measures (PROMs). Shapley additive explanations (SHAP) analysis identified predictors of reaching the MCID and SCB.Results:Of the 185 patients who underwent OCA for the knee and met eligibility criteria from an institutional cartilage registry, 135 (73%) patients were available for one-year follow-up and 153 (83%) patients with two-year follow-up. In predicting outcomes after OCA in terms of the IKDC, KOS-ADL, MCS, and PCS at one and two years, AUCs of the top performing models ranged from fair (0.72) to excellent (0.94). Lower baseline mental health (MCS), higher baseline physical health (PCS) and knee function scores (KOS-ADL, IKDC subjective), lower baseline activity demand (Marx, Cincinnati Sports), worse pain symptoms (Cincinnati pain, SF36 pain), and higher BMI were thematic predictors contributing to failure to achieve the MCID or SCB at one and two-years postoperatively.Conclusions:Our machine learning models were effective in predicting outcomes and elucidating the relationships between baseline factors contributing to achieving the MICID for osteochondral allograft transplantation of the knee. Patients who preoperatively report poor mental health, catastrophize pain symptoms, compensate with higher physical health and knee function, and exhibit lower activity demands are at risk for failing to reach clinically meaningful outcomes after OCA of the knee.

Effect of Preoperative Imaging and Patient Factors on Clinically Meaningful Outcomes and Quality of Life After Osteochondral Allograft Transplantation: A Machine Learning Analysis of Cartilage Defects of the Knee

Background: Fresh osteochondral allograft transplantation (OCA) is an effective method of treating symptomatic cartilage defects of the knee. This restoration technique involves the single-stage implantation of viable, mature hyaline cartilage into a chondral or osteochondral lesion. The extent to which preoperative imaging and patient factors predict achieving clinically meaningful outcomes among patients undergoing OCA for cartilage lesions of the knee remains unknown. Purpose: To determine the predictive relationship of preoperative imaging, preoperative patient-reported outcome measures (PROMs), and patient demographics with achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for functional and quality-of-life PROMs at 2 years after OCA for symptomatic cartilage defects of the knee. Study Design: Case-control study; Level of evidence, 3 Methods: Data were analyzed for patients who underwent OCA before May 1, 2018, by 2 high-volume fellowship-trained cartilage surgeons. The International Knee Documentation Committee (IKDC) subjective form, Knee Outcome Survey–Activities of Daily Living (KOS-ADL), and mental and physical component summaries of the SF-36 were administered preoperatively and at 2 years postoperatively. A total of 42 predictive models were created using 7 unique architectures to detect achievement of the MCID for each of the 4 outcome measures and the SCB for the IKDC and KOS-ADL. Data inputted into the models included sex, age, body mass index, baseline PROMs, lesion size, concomitant ligamentous or meniscal tear, and presence of “bone bruise” or osseous edema. Shapley additive explanations plot analysis identified predictors of reaching the MCID and SCB. Results: Of the 185 patients who underwent OCA for the knee and met eligibility criteria from an institutional cartilage registry, 153 (83%) had 2-year follow-up. Preoperative magnetic resonance imaging (MRI), baseline PROMs, and patient demographics best predicted reaching the 2-year MCID and SCB of the IKDC and KOS-ADL PROMs, with areas under the receiver operating characteristic curve of the top-performing models ranging from good (0.88) to excellent (0.91). MRI faired poorly (areas under the curve, 0.60-0.68) in predicting the MCID for the mental and physical component summaries. Higher body mass index, knee malalignment, absence of preoperative osseous edema, concomitant anterior cruciate ligament or meniscal injury, larger defect size, and the implantation of >1 OCA graft were consistent findings contributing to failure to achieve the MCID or SCB at 2 years postoperatively. Conclusion: Our machine learning models demonstrated that preoperative MRI, baseline PROMs, and patient demographics reliably predict the ability to reach clinically meaningful thresholds for functional knee outcomes 2 years after OCA for cartilage defects. Although clinical improvement in knee function can be reliably predicted, improvements in quality of life after OCA depend on a comprehensive preoperative assessment of the patient’s perception of his or her mental and physical health. Absence of osseous edema, concomitant anterior cruciate ligament or meniscal injury, larger lesion size on MRI, knee malalignment, and elevated body mass index are predictive of failure to achieve 2-year functional benefits after OCA of the knee.

Association Between Preoperative Mental Health and Clinically Meaningful Outcomes After Osteochondral Allograft for Cartilage Defects of the Knee: A Machine Learning Analysis

Background: Fresh osteochondral allograft transplantation (OCA) is an effective method of treating symptomatic cartilage defects of the knee. This cartilage restoration technique involves the single-stage implantation of viable, mature hyaline cartilage into the chondral or osteochondral lesion. Predictive models for reaching the clinically meaningful outcome among patients undergoing OCA for cartilage lesions of the knee remain under investigation. Purpose: To apply machine learning to determine which preoperative variables are predictive for achieving the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) at 1 and 2 years after OCA for cartilage lesions of the knee. Study Design: Case-control study; Level of evidence, 3. Methods: Data were analyzed for patients who underwent OCA of the knee by 2 high-volume fellowship-trained cartilage surgeons before May 1, 2018. The International Knee Documentation Committee questionnaire (IKDC), Knee Outcome Survey–Activities of Daily Living (KOS-ADL), and Mental Component (MCS) and Physical Component (PCS) Summaries of the 36-Item Short Form Health Survey (SF-36) were administered preoperatively and at 1 and 2 years postoperatively. A total of 84 predictive models were created using 7 unique architectures to detect achievement of the MCID for each of the 4 outcome measures and the SCB for the IKDC and KOS-ADL at both time points. Data inputted into the models included previous and concomitant surgical history, laterality, sex, age, body mass index (BMI), intraoperative findings, and patient-reported outcome measures (PROMs). Shapley Additive Explanations (SHAP) analysis identified predictors of reaching the MCID and SCB. Results: Of the 185 patients who underwent OCA for the knee and met eligibility criteria from an institutional cartilage registry, 135 (73%) patients were available for the 1-year follow-up and 153 (83%) patients for the 2-year follow-up. In predicting outcomes after OCA in terms of the IKDC, KOS-ADL, MCS, and PCS at 1 and 2 years, areas under the receiver operating characteristic curve (AUCs) of the top-performing models ranged from fair (0.72) to excellent (0.94). Lower baseline mental health (MCS), higher baseline physical health (PCS) and knee function scores (KOS-ADL, IKDC Subjective), lower baseline activity demand (Marx, Cincinnati sports), worse pain symptoms (Cincinnati pain, SF-36 pain), and higher BMI were thematic predictors contributing to failure to achieve the MCID or SCB at 1 and 2 years postoperatively. Conclusion: Our machine learning models were effective in predicting outcomes and elucidating the relationships between baseline factors contributing to achieving the MCID for OCA of the knee. Patients who preoperatively report poor mental health, catastrophize pain symptoms, compensate with higher physical health and knee function, and exhibit lower activity demands are at risk for failing to reach clinically meaningful outcomes after OCA of the knee.

Development of the Persian Version of Knee Outcome Survey Activities for Daily Living Scale.

Background: The knee outcome survey-activities of daily living (KOS-ADL) scale is a self-reported measure to determine knee function and symptoms in individuals suffering from a variety of knee disorders. The present study aimed to assess the validity, reliability, and cross-cultural adaptation of the Persian version of the KOS-ADL scale.Methods: In this cross-sectional and psychometric study, 130 patients (14 men and 116 women) with different grades of knee osteoarthritis were recruited. The construct validity of the scale was examined through the correlation between the domains of KOS-ADL and the subclasses of the knee injury and osteoarthritis outcome score (KOOS). To assess the test-retest reliability, 40 of the participants were requested to fill in the questionnaire again with an 8-day interval. The internal consistency of the questionnaire and its subclasses was evaluated with Cronbach’s alpha coefficient. To evaluate construct validity, concurrent construct validity was examined with a correlation matrix using Pearson’s correlation coefficients between the KOS-ADL domains and KOOS total score and subclasses. The test-retest reliability was analyzed using the intra-class correlation coefficient (ICC). The Kappa coefficient was used to determine the intra-rater agreement. Results: The Persian version of the KOS-ADL scale had good reliability (ICC=0.79) and internal consistency (α=0.92). There was a good correlation between the KOS-ADL total score and KOOS subclasses (r≥0.71, P≤0.001). Conclusion: The Persian version of the KOS-ADL scale is a valid and reliable instrument to evaluate the symptoms and functional status of people suffering from knee osteoarthritis.

Particulate Juvenile Articular Cartilage vs Osteochondral Allograft for Patellar Cartilage Defects: A Matched Cohort Analysis

Objectives:Management of full-thickness cartilage defects of the patella remains a significant clinical challenge. Osteochondral allograft transplantation (OCA) is a reliable cartilage restoration procedure for large chondral defects of the knee. OCA reports good long-term outcomes for condylar defects but limited literature on outcomes of patellar defects. Since 2007, particulated juvenile articular cartilage (PJAC) has been used as an alternative method of cartilage restoration. PJAC has demonstrated promising early clinical outcomes, however, no studies have directly compared the clinical and patient reported outcomes of PJAC and OCA for management of full thickness chondral defects of the patella.Methods:Prospective data was collected for patients within our institutional cartilage registry who underwent OCA or PJAC using DeNovo NT (Zimmer-Biomet) for management of grade 4 cartilage defects of the patella. OCA patients were matched to PJAC patients by age, sex and BMI. Patient characteristics and minimum 2-year patient reported outcomes (PROMs) (Knee Outcome Survey-Activities of Daily Living (KOS-ADL) score, International Knee Documentation Committee (IKDC) score, Short Form 36 (SF-36) pain rating, and Marx Activity Rating Scale) and self-reported general overall knee condition were reported.Results:There were 28 patients eligible for analysis (14 OCA, 14 PJAC). Demographics of the two groups are outlined in Table 1. The mean age of the entire cohort was 38.4 +/- 11.4 years with a mean BMI of 24.6 +/- 3.1. One patient in each group had bipolar transplantation (patella and trochlea). OCA patients had more previous surgeries (1.4 vs 0.4) (p<0.01) and significantly larger chondral defects (4.6 cm2 vs. 2.5 cm2) (p<0.01) than PJAC patients.Patient reported outcomes are reported in Figure 1. IKDC, KOS-ADL and SF-36-Pain scores improved by 17, 16 and 14 points for OCA compared to 17, 11, and 23 points for PJAC at last follow-up (average 3.5 years) (p>0.05). Both groups met the published MCID for IKDC (17 pts) and KOS-ADL (10 pts) for osteochondral grafts. There was no significant difference between OCA and PJAC for all postoperative PROMs. The reoperation rate for OCA and PJAC was 36% and 50% respectively (p>0.05). There were 4 graft failures in the PJAC group (29%) and 1 failure in the OCA group (6%) (p>0.05). The failed OCA underwent manipulation and lysis of adhesions for post-operative stiffness at 7 months and arthroscopic synovectomy for synovitis at 8 months after OCA. The four failed PJAC patients underwent revision to OCA (at 8 months), chondroplasty of the graft (at 10 and 26 months), and revision to TKA (at 78 months). Reoperations are further described in Table 2. Conclusion: In a matched cohort analysis, both PJAC and OCA demonstrated significant clinical improvement in patient reported outcomes with no significant difference between the two groups at mean 3.5 years. Larger investigational studies are needed to determine optimal indications for use of PJAC versus OCA for management of focal cartilage defects of the patella.Table 1.Patient Characteristics by Group OCA PJAC P value Age (y)39.137.80.77Sex (M:F)4:104:101BMI24.424.80.77Mean # of Prior Surgeries1.430.360.0038Defect Area ()4.602.480.0007Defect Location (Coronal) (n)Central Third-10Medial Facet- 1Lateral Facet- 3Central Third- 7Medial Facet- 5Lateral Facet- 2NA Concomitant Procedures (n)Tibial tubercle transfer- 2Distal femoral osteotomy- 1MPFL reconstruction- 1Tibial tubercle transfer- 5MPFL reconstruction-1NATable 2.Reoperations and Graft Failures for PJAC and OCAPJAC (7 Patients)Time from surgery (mos)OCA (5 patients)Time from Surgery (mos)MUA2MUA, lysis of adhesions, fat pad debridement, anterior capsular release 7OCA patella, tibial tubercle transfer*7I&D and synovectomy *8Chondroplasty patella (grade III/IV changes of graft); fat pad excision, patella tendon release*10HWR tibial tubercle11HWR tibial tubercle16HWR distal femur19HWR tibial tubercle, fat pad excision, patellar tendon release, Chondroplasty medial femoral condyle23Tibial tubercle transfer; OCA patella (15 mm graft)**58Chrondoplasty patella (grade III/IV changes of graft); HWR tibial tubercle*26Lysis of adhesions, medial meniscectomy, HWR tibial tubercle74Total knee replacement*78 *Graft failure Same patient** performed in different location; previous OCA was intactHWR=hardware removal; I&D= irrigation and debridement; MUA=manipulation under anesthesia

Fibulin-3 serum and urine levels in the diagnosis and severity assessment of primary knee osteoarthritis.

ObjectivesOsteoarthritis (OA) is the most widespread joint disease and is a major cause of joint pain and disability in the middle aged and elderly population. The diagnosis of OA is based on clinical and radiographic changes that occur late after disease progression, and hence does not allow early detection of structural damage. Therefore, there is an acute need for reliable biochemical markers that can facilitate its earlier diagnosis. This study was commenced to identify fibulin-3 levels in serum and urine of patients with primary knee OA and to investigate their relationship with severity of the disease.Material and methodsFifty female patients with primary knee OA were compared to 25 healthy female controls. Fibulin-3 in serum and urine were measured using enzyme-linked immunosorbent assay (ELISA). Severity of knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and the Knee Outcome Survey Activities of Daily Living (KOS-ADL) scale. Radiographic grading of knee OA was performed by Kellgren-Lawrence (K-L) criteria.ResultsSerum and urine fibulin-3 were higher in patients (286.00 ±145.00 ng/ml and 104.60 ±32.73 ng/ml, respectively) than in controls (26.00 ±5.77 ng/ml and 13.60 ±4.21 ng/ml, respectively). Fibulin-3 in serum and urine correlated (p < 0.001) with each other (r = 0.930) and with the severity of knee pain by WOMAC index (r = 0.909 and 0.928, respectively), inversely correlated with KOS-ADL (r = –0.913 and –0.953, respectively), and with radiographic grading of K-L (r = 0.855 and 0.875, respectively).ConclusionsFibulin-3 serves as a biomarker of knee OA disease severity and could predict disease progression. Assessing urine fibulin-3 could be an applicable and easy method to diagnose knee OA and to follow up disease progression.

Clinically Meaningful Improvement After Treatment of Cartilage Defects of the Knee With Osteochondral Grafts

Background: Mosaicplasty and fresh osteochondral allograft transplantation (OCA) are popular cartilage restoration techniques that involve the single-stage implantation of viable, mature hyaline cartilage–bone dowels into chondral lesions of the knee. Recently, there has been greater focus on what represents a clinically relevant change in outcomes reporting, and commonly applied metrics for measuring clinical significance include the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). Purpose: To define the MCID and SCB after mosaicplasty or OCA for the International Knee Documentation Committee (IKDC) subjective form and Knee Outcome Survey–Activities of Daily Living (KOS-ADL) and to determine patient factors that are predictive of achieving the MCID and SCB after mosaicplasty or OCA. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: An institutional cartilage registry was reviewed to identify patients who underwent mosaicplasty or OCA. The decision to perform either mosaicplasty or OCA was generally based on chondral defect size. The IKDC and KOS-ADL were administered preoperatively and at a minimum of 2 years postoperatively. Patient responses to the outcome measures were aggregated, and the MCID and SCB of these outcome scores were calculated with anchor-based methods. Multivariate analysis adjusted for age and sex was performed to identify patient factors predictive of achieving the MCID and SCB. Results: Of the 372 eligible patients, 151 (41%) were lost to follow-up, 46 (12%) had incomplete preoperative outcome scores and 2 were treated with OCA of the tibia and therefore excluded. In total, 173 knees were analyzed (n = 173 patients; mean age, 33.0 years; 37% female). Seventy-five (43%) and 98 (57%) knees were treated with mosaicplasty and OCA, respectively. The mean ± SD MCIDs for the IKDC and KOS-ADL were 17 ± 3.9 and 10 ± 3.7, respectively. The SCBs for the IKDC and KOS-ADL were 30 ± 6.9 and 17 ± 3.9, respectively. Univariate analysis demonstrated no association between procedure (mosaicplasty or OCA) and likelihood of achieving the MCID or SCB. In the multivariate analysis, lower preoperative IKDC and KOS-ADL scores, higher preoperative Marx Activity Rating Scale scores, lower preoperative 36-Item Short Form Health Survey pain scores, and a history of ≤1 prior ipsilateral knee surgical procedure were predictive of achieving the MCID and/or SCB. Conclusion: These values can be used to define a clinically meaningful improvement for future outcome studies. For surgeons considering mosaicplasty or OCA for their patients, these results can help guide clinical decision making and manage patient expectations before surgery.

Clinical and MRI Outcomes of Fresh Osteochondral Allograft Transplantation After Failed Cartilage Repair Surgery in the Knee.

Fresh osteochondral allograft transplantation is an appealing option to address a failed cartilage repair surgical procedure, given the ability to treat large lesions and to address the subchondral osseous changes commonly seen in the revision setting. We hypothesized that osteochondral allograft transplantation after failed cartilage repair would result in low failure rates and improved function and that improved graft incorporation on postoperative magnetic resonance imaging (MRI) would correlate with a superior clinical outcome. A retrospective review of prospectively collected data was used to identify 43 patients treated with fresh osteochondral allograft transplantation after a previous cartilage repair surgical procedure and having a minimum follow-up of 2 years. Clinical outcomes were evaluated using the Short Form-36 (SF-36) score, International Knee Documentation Committee (IKDC) Subjective Knee Score, Marx Activity Scale, Knee Outcome Survey-Activities of Daily Living (KOS-ADL) Questionnaire, Cincinnati Sports Activity Score, and Cincinnati Overall Symptom Assessment. Postoperative MRI scans were obtained at a mean time of 19.7 months and were independently reviewed by a musculoskeletal radiologist using the Osteochondral Allograft MRI Scoring System (OCAMRISS). At a mean 3.5-year follow-up after osteochondral allograft transplantation, significant improvements (p < 0.05) in SF-36 Physical Function, SF-36 Pain, KOS-ADL, IKDC Subjective Knee Score, and Cincinnati Overall Symptom Assessment were seen. Over 90% of grafts remained in situ at the time of the latest follow-up, although 17 knees (40%) underwent reoperation, the majority for arthroscopic debridement or manipulation for stiffness. Body mass index (BMI) of >30 kg/m was associated with worse clinical outcomes. The mean total OCAMRISS score demonstrated poorer allograft integration in patients with graft failure, but the total score did not meaningfully correlate with clinical outcome scores. However, better individual articular cartilage appearance and osseous integration subscores were associated with better clinical outcome scores. Significant improvements in pain and function were seen following fresh osteochondral allograft transplantation after failed cartilage repair, with an overall graft survival rate of >90%. Patients with greater bone and cartilage incorporation on MRI had superior clinical outcomes, although persistent osseous edema was frequently seen. We concluded that osteochondral allograft transplantation is an effective salvage treatment after failed cartilage repair and recommend further evaluation of techniques to optimize graft integration. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Condyle-Specific Matching Does Not Improve Midterm Clinical Outcomes of Osteochondral Allograft Transplantation in the Knee.

Condyle-specific matching for osteochondral allograft transplantation (OCA) pairs donor and recipient condyles in an attempt to minimize articular incongruity. While the majority of cartilage defects are located on the medial femoral condyle, lateral femoral condyles are more commonly available as a graft source. The purpose of this study was to compare the clinical outcomes of patients treated with non-orthotopic (lateral-to-medial condyle or medial-to-lateral condyle) OCA with those treated with traditional orthotopic (medial-to-medial condyle or lateral-to-lateral condyle) OCA. We hypothesized that clinical outcomes would be similar between groups at midterm follow-up. A retrospective review of prospectively collected data on patients treated with OCA from 2000 to 2014 was conducted. Seventy-seven patients with a full-thickness cartilage defect of a femoral condyle were treated with either orthotopic (n = 50) or non-orthotopic (n = 27) OCA. A minimum follow-up of 2 years was required for analysis. Patients in each group were matched according to sex, age, and total chondral defect size. Reoperations and patient responses to validated outcome measures were reviewed. Failure was defined as any revision cartilage procedure or conversion to knee arthroplasty. The mean duration of follow-up was 4.0 years (range, 2 to 16 years). The orthotopic and non-orthotopic OCA groups were comparable in terms of demographics, the mean number of prior ipsilateral knee operations, and the percentage of concomitant procedures at baseline. Reoperation (p = 0.427) and failure (p = 0.917) rates did not differ significantly between groups. Both groups demonstrated significant increases in the Short Form-36 (SF-36) physical functioning and pain, International Knee Documentation Committee (IKDC), and Knee Outcome Survey-Activities of Daily Living (KOS-ADL) scores compared with baseline (p < 0.004). Outcome scores (baseline and postoperative) and change scores did not differ significantly between groups. Clinical outcomes do not differ between patients treated with orthotopic OCA and those treated with non-orthotopic OCA, suggesting that condyle-specific matching may not be necessary. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effect of Physical Therapy Visits on Clinical Outcomes Following Anterior Cruciate Ligament Reconstruction With and Without Concurrent Meniscal Repair.

Health care payment reform has increased employers and health insurance companies' incentive to take measures to control the rising costs of medical care in the United States. To date, limited research has investigated the influence outpatient physical therapy (PT) visits have on clinical outcomes following anterior cruciate ligament reconstruction (ACLR) with and without a concurrent meniscal repair. To examine the relationship between the number of PT visits and patient-reported outcome scores following ACLR outpatient rehabilitation. Retrospective cohort. 2b. Patients following ACLR with (n = 62) and without (n = 328) meniscal repair were identified through an electronic medical record database. Patients with more PT visits had higher knee outcome survey-activities of daily living (KOS-ADL) change scores (P = .01) following ACLR without meniscal repair. Younger patients yielded significantly higher KOS-ADL change scores (P = .05) in the same cohort. Patients in the semisupervised PT visit strata recorded an 11.1 higher KOS-ADL change score compared with patients within the unsupervised PT visit stratum (P = .02). Younger patients also yielded significantly larger reductions in numeric pain (P = .01) following ACLR without meniscal repair. No significant differences were found between PT visits and either patient-reported outcome following ACLR with meniscal repair. Our findings suggest that younger patients and those in a semisupervised PT visit model have superior patient-reported outcomes following ACLR without meniscal repair. Preliminary findings indicate no relationship with PT visits and patient-reported outcomes in patients after ACLR with meniscal repair surgery. These findings promote an alternative model to outpatient PT following ACLR without meniscal repair that may be more clinically effective and value based. There appears to be a need for patients to undergo a balanced regimen of supervised PT and effective interventions that can be conducted independently.