Abstract
Objectives:
Prior studies have observed promising short-term outcomes following revision osteochondral allograft (OCA) transplantation, resulting in significant improvement in pain relief, functional outcomes, and quality of life. However, few studies have examined midterm (minimum 5-year) outcomes following revision OCA transplantation. The purpose of this study is to examine midterm outcomes following revision OCA transplantation to the femoral condyle, as well as evaluating reoperation and survivorship, compared to a matched cohort undergoing primary OCA transplantation.
Methods:
A retrospective review of prospectively collected data was performed to identify patients undergoing revision OCA transplantation to the femoral condyle between 1999-2018 with a minimum of 5-year follow-up. A 1:2 cohort of revision: primary OCA patients, matched based on defect size, age, and body mass index (BMI) were identified. Lysholm, International Knee Documentation Committee (IKDC) subjective form, and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales were collected, as well as the incidence of reoperations or graft failures. Reoperation was defined as any subsequent surgery in the index compartment. Failure was defined as subsequent arthroplasty or revision cartilage procedure. Previously determined thresholds for achievement of clinically significant outcomes were utilized.
Results:
A total 15 patients undergoing revision OCAs were successfully matched to 30 patients undergoing primary OCA. Mean follow-up following revision OCA was 9.3 ± 3.0 years (range: 5.1 - 14.7). Mean age in patients undergoing revision OCA was 31.1 ± 9.7 years (range: 19.9 - 52.7) with a mean BMI of 25.9 ± 3.4 kg/m2 (range: 20.8 - 30.4). Revision OCA was performed to the lateral condyle in 53% of cases (n = 8/15), with 73%; (n = 11/15) of patients undergoing a concomitant procedure. The mean time between initial and revision OCA was 2.9 ± 1.4 years (range: 1.2 - 6.2). Reoperations were performed in 60% (n = 9/15) of revision OCA patients at a mean time of 4.7 ± 4.2 years (range: 0.6 - 11.2). Failures were observed in 13% (n = 2/15) of revision OCA patients, with total knee arthroplasty performed at a mean of 4.9 ± 3.4 years (range: 2.9 - 8.9). Graft survivorship free from reoperation (p = .568) and failure (p = .753) were not significantly different between revision and primary groups. Patient acceptable symptomatic state (PASS) was achieved following revision OCA patients for IKDC (70%), Lysholm (83%), and KOOS subset questionnaires (Symptoms [70%], Pain [100%], Activities of Daily Living [80%], Sport [90%], and Quality of Life [80%]).
Conclusions:
At a mean of 9.3 years following revision OCA, 67% of patients required reoperation, with 13% undergoing arthroplasty. No significant difference in graft survivorship free from failure or reoperation was appreciated between revision versus primary OCA groups. Achievement of PASS was observed for multiple outcome measures following revision OCA.
