Abstract
Objectives:
Fresh osteochondral allograft transplantation (FOCA) have been used successfully to treat large chondral and osteochondral defects of the knee. The purpose of the present study was to determine the efficacy of this treatment in patients older than 40, in comparison to a cohort 39 and younger.
Methods:
We utilized a prospective database of 107 consecutive patients, with baseline PRO data receiving osteochondral allograft transplantation to the knee from a single surgeon practice over 8 years (March 2007-July 2015). Patient and donor characteristics were routinely collected, as were patient annual PRO measures, principally International Knee Documentation Committee (IKDC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Table 1 summarizes cohort demographics; 68 patients completed surveys at a minimum of 24 month follow-up and were categorized into two cohorts based on age at surgery. Group A (study group) consisted of 33 patient’s forty years of age and greater, 8 women and 25 men, with a mean age of 52.8 years (40-68) and average final up of 3.5 years. Group B (control group) consisted of 35 patient’s less than forty years, 12 women and 23 men, with a mean age of 27.8 years (15-39) and average final follow up of 2.6 years.
Results:
Both groups showed a significant improvement in outcome KOOS and IKDC scores at 12 months, 24 months and final follow up. 11 patients (31%) in the control cohort and 8 patients (24%) in study cohort underwent a second surgery on the index knee after the OCA transplantation. A statistically significant improvement in the study group from baseline to final follow-up (p<.02) was seen for all KOOS subscores (Symptom:+ 4.83, Pain: +13.05, ADL: +17.44, Sports: +14.48, QOL: +25.3) and IKDC (+22.46). A statistically significant improvement in the control group from baseline to final follow-up (p<.02) was seen for all 5 KOOS subscores; (Symptom:+15.22, Pain: +8.68, ADL: +18.52, Sports: +30, QOL: +32.71) and IKDC (+32.9). In the study group, the maximum improvements (112% of baseline, 45% of baseline) were seen in the KOOS QOL and sports respectively. Similar changes in the control group included 138% improvement from baseline KOOS QOL and 83.3% for sports. Despite this, there was no significant difference between the two groups with respect to any average KOOS subscore or IKDC score, at any time during the observation period.
Conclusion:
There was no significant difference between the group’s outcomes data at final follow up. This implies the efficacy of OCA transplantation in adults forty years of age and older is similar to that of younger adults. Interestingly, we saw the greatest improvement in each of the two cohorts in the quality of life subscale of the KOOS. Significant sustained improvements in the symptom, ADL and pain subscales of the KOOS and IKDC were also observed in both groups. Overall, patients over 40 years benefit in a similar manner to younger patients after FOCA and these benefits appear greatest for Quality of Life.
| Clinical Information | Study Group | Control Group |
|---|---|---|
| No. of patients studied | 33 | 35 |
| Mean age at time of surgery (range) | 52.8 (40-68) | 27.8 (15-39) |
| Body Mass Index, kg/m2 (range) | 28.1 (22.3-38.4) | 26.5 (19.4-34.0) |
| No. of knees with previous surgery (%) | 27 (81) | 33 (94) |
| Mean No. of previous surgeries (range) | 1.1 (1-3) | 1.1 (1-3) |
| Location of graft, No. | ||
| Lateralfemoral condyle | 8 | 20 |
| Medial femoral condyle | 21 | 11 |
| Other | 4 | 4 |