Abstract
Objectives:
To report outcomes and associated risk factors for treatment failure (revision surgery or conversion to arthroplasty) in a consecutive series of patients undergoing concurrent femoral condyle osteochondral allograft (OCA) and meniscus allograft (MAT) transplantation using advances in tissue preservation and surgical techniques.
Methods:
Patients who underwent primary femoral condyle OCA transplantation and concomitant MAT (OCAT+MAT) between 2016-2020 with minimum 2-year follow up data regarding complications, failures, adherence, and patient reported outcome measures (PROMs) were analyzed. Patients who required OCA and/or MAT revision or conversion to artificial arthroplasty were defined as treatment failures. Patient reported outcome measures (PROMs) including VAS pain, IKDC, SANE, PROMIS Global Health and Physical Function, were collected at 3 and 6 months and then yearly after transplantation.
Fisher’s exact tests were used to compare proportions and repeated measures ANOVA tests were used to compare longitudinal PROMs data for statistically significant (p<0.05) differences.
Results:
A total of 21 consecutively enrolled patients met inclusion criteria with mean age of 35 (15-54) years and mean BMI of 27 (19-36) kg/m2. OCAT+MAT was performed in the medial compartment in 14 cases and lateral compartment in 7 cases. Realignment osteotomies were performed in 4 cases. Initial success rate (mean follow-up of 44 mos) was 76% based on 1 revision and 4 arthroplasties performed. Overall success rate was 81% based on successful revision. Statistically significant (p<0.002) and clinically meaningful improvements were noted for all measured PROMs (VAS pain, IKDC, SANE, PROMIS) at 2-year follow up. Patients requiring conversion to arthroplasty were significantly older (mean age, 48.3 v 32.2 years, p=0.0076) than patients with successful outcomes. Nonadherence with postoperative restrictions and rehabilitation protocol was an independent risk factor for conversion to arthroplasty (p=0.022, OR=42).
Conclusions:
Combined femoral condyle OCA and meniscus allograft transplantation was associated with successful short- to mid-term outcomes in 81% of cases. Older age and nonadherenceto postoperative protocols are risk factors for decreased outcomes.