2015 ISAKOS Biennial Congress ePoster #1514
Fresh Osteochondral Allografts in the Knee: Comparison of Primary Transplantation Versus Transplantation After Failure of Previous Cartilage Repair Surgery
Guilherme Gracitelli, MD, La Jolla, CA UNITED STATES
Gokhan Meric, Assoc. Prof., Istanbul TURKEY
Dustin Briggs, MD, La Jolla, CA UNITED STATES
Pamela Pulido, MD, La Jolla, CA UNITED STATES
Julie McCauley, MPHc, La Jolla, CA UNITED STATES
Joao Carlos Belloti, MD, PhD, Sao Paulo , Sao Paulo BRAZIL
William Bugbee, MD, La Jolla, CA UNITED STATES
Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA
FDA Status Cleared
Summary: Favorable results were shown in both groups with significant improvement of functional scores and excellent survivorship. Previous cartilage surgery did not adversely affect the outcome of OCA transplantation.
In most treatment algorithms, osteochondral allograft (OCA) transplantation is regarded as an alternative salvage procedure when other previous reparative treatments fail.
The purpose of this study was to compare the outcomes of a retrospective matched-pair cohort of (1) primary OCA transplantation with (2) OCA transplantation after failure of previous cartilage repair surgery.
Study Design: Retrospective Cohort
Our OCA database was used to identify 49 knees that had OCA transplantation performed as a primary treatment (Group 1) and 49 knees that underwent OCA transplantation after failure of previous cartilage repair (Group 2). All patients had a minimum of 2 years follow-up. Patients in each group were matched for age (± 5 years), diagnosis (osteochondral lesion, degenerative chondral lesion, traumatic chondral injury) and graft size (small <5 cm2; medium 5-10 cm2, large >10 cm2). The groups had similar body mass indexes, gender distributions, and graft locations (femoral condyle, patella and trochlea); failure was defined as any reoperation resulting in removal of the graft. Functional outcomes were evaluated using the modified Merle d'Aubigné-Postel (18-point) scale, International Knee Documentation Committee (IKDC) subjective knee evaluation form, Knee Osteoarthritis and injury Outcomes Scores (KOOS) scale, and the Knee Society function (KS-F) scale. Patient satisfaction using a five point scale from “extremely satisfied” to “dissatisfied” was recorded at latest follow-up.
Twelve of 49 knees (25%) in Group 1 had reoperations, compared with 20 of 49 knees (41%) in Group 2 (p=0.085). The OCA was classified as a failure in six knees (12%) in Group 1 and seven knees (14%) in Group 2 (p=0.766). At 10 years of follow-up, survivorship of the graft was 85.7% and 86.7% in Groups 1 and Group 2, respectively. Both groups showed improvement in pain and function on all subjective scores from preoperatively to latest follow-up (all p<0.001). Eighty-eight percent of patients in Group 1 and 98% in Group 2 were “satisfied” or “extremely satisfied” with the OCA transplantation.
Favorable results were shown in both groups with significant improvement of functional scores and excellent survivorship. Previous cartilage surgery did not adversely affect the outcome of OCA transplantation.
Keywords: Osteochondral allograft transplantation; cartilage repair; matched cohort