Two-Year Outcomes of ACL Reconstruction With Osteochondral Allograft Transplantation Versus Isolated ACL Reconstruction: A Matched Cohort Study

Abstract

Background:

Osteochondral allograft transplantation (OCA) has been established as a viable restorative chondral procedure, although few studies have examined its effectiveness in the setting of anterior cruciate ligament (ACL) reconstruction.

Purpose:

To compare self-reported function and return-to-sport rates after ACL reconstruction with OCA to those of matched controls undergoing isolated ACL reconstruction.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective matched cohort study was conducted utilizing a single-surgeon database of patients undergoing ACL reconstruction between 2016 and 2021. Included patients were 15 to 70 years of age, underwent ACL reconstruction with OCA, and desired to return to sport. Patients were age and sex matched to a cohort of patients who underwent isolated ACL reconstruction. Baseline characteristics were collected along with preinjury Marx score and surgical details. Outcomes at time of return to sport included self-reported function, time to return to sport, range of motion, and single-leg squat and hopping performance. Two-year outcomes included Single Assessment Numeric Evaluation (SANE) scores, return-to-sport rates, and reinjury rates. Between-group differences were analyzed utilizing chi-square analyses and 1-way analysis of variance with an a priori α value of .05.

Results:

A total of 43 patients who underwent ACL reconstruction with OCA were identified and matched to 43 patients who underwent isolated ACL reconstruction. Patients in the ACL reconstruction with OCA group reported lower preinjury Marx scores (3.9 ± 5.7 vs 9.6 ± 5.9; P < .001). The ACL reconstruction with OCA group demonstrated a longer time to return to sport (9.1 ± 4.1 months vs 7.9 ± 3.4 months; P = .040); however, no differences existed between groups for all self-reported and objective outcomes at the time of return to sport. At 2 years, no differences existed regarding SANE scores (85.4 ± 12.1 vs 87.0 ± 13.5; P = .334), ACL graft reinjury rate (4.7% vs 2.3%; P = .481), and return to prior level of sport rates (69.8% vs 72.1%; P = .387).

Conclusion:

Patients undergoing ACL reconstruction with OCA demonstrate similar self-reported function and return-to-sport rates, along with a delayed time to return to sport, to those undergoing isolated ACL reconstruction. A majority (83.7%) of patients undergoing ACL reconstruction with OCA can return to level 1 to 3 sports with low graft failure rates.

Keywords

osteochondral transplant ACL reconstruction return to sport

Chondral lesions are frequently observed in patients undergoing knee arthroscopy, with up to 19% of patients undergoing anterior cruciate ligament (ACL) reconstruction demonstrating chondral pathology at the time of surgery.^20,25 Symptoms of chondral lesions range in severity and often include deep knee pain, effusion, and mechanical symptoms.^13,20 These injuries may impact recovery and have been associated with suboptimal postoperative outcomes after ACL reconstruction.^8,22 Osteochondral allograft transplantation (OCA) has been suggested as a viable restorative procedure in the presence of large (>2 cm²) lesions or when alternative procedures (osteochondral autograft transplantation [OATS] or autologous chondrocyte implantation) may not be adequate. The proposed benefits of the OCA are its low failure rates, earlier progression to full weightbearing, and potential for improved longevity and durability when compared to palliative and repair procedures.^11,14,20 While several studies have demonstrated the efficacy of a concomitant OATS procedure in the setting of ACL reconstruction,^1,11,19,22 little is known about the outcomes after ACL reconstruction with OCA.

A systematic review of 19 studies reported that patients undergoing isolated OCA demonstrated favorable outcomes with high satisfaction rates.⁵ Krych et al¹⁶ reported high return-to-sport rates after isolated OCA, with 79% of athletes returning to their prior level of sport. Additional systematic reviews have reported return-to-sport rates after knee OCA ranging from 75% to 82%⁶ and a mean return-to-sport timeline of 9.6 months.¹⁵ A recent study of professional athletes noted that 73% returned to sport after knee OCA at a mean of 1.22 years postsurgery.² Despite this growing body of evidence examining outcomes after isolated OCA, only 2 studies (n = 56) have examined outcomes after OCA in the setting of previous or concomitant ACL reconstruction.^26,27 They reported that a history of ACL reconstruction did not negatively impact OCA outcomes or have a significant impact on failure rates. Furthermore, patients demonstrated similar reoperation rates, graft survival rates, International Knee Documentation Committee (IKDC) scores, Knee injury and Osteoarthritis Outcome Scores, and Cincinnati Knee Rating System scores when compared to those receiving an isolated OCA.^26,27 Of note, only 14 of the patients in these 2 studies underwent a concomitant ACL reconstruction with OCA, while the majority of patients underwent OCA after a previous ACL reconstruction.

While the OCA procedure shows promise as a strategy to address chondral defects in the ACL-deficient knee, there is a lack of evidence examining long-term outcomes and return-to-sport rates in this population. Additionally, no studies have compared clinical outcomes after an ACL reconstruction with OCA to those of a matched cohort undergoing isolated ACL reconstruction. Therefore, the purpose of this study was to compare self-reported function and return-to-sport rates after ACL reconstruction with OCA to matched controls undergoing isolated ACL reconstruction. We hypothesized that patients undergoing ACL reconstruction with OCA would exhibit no differences in self-reported function and return-to-sport rates.

Methods

A retrospective matched cohort study was conducted in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines using a single-surgeon (W.R.L.) database of patients who underwent ACL reconstruction between 2016 and 2021. Oral and written consents were obtained in accordance with the University of Texas Health Science Center Institutional Review Board (IRB No. HSC-MH-14-0734), and the trial was registered with ClinicalTrials.gov (NCT03704376). Included patients underwent ACL reconstruction with OCA, were between 15 and 70 years of age, and desired to return to sport. Patients were selected for the ACL reconstruction with OCA procedure if they demonstrated full-thickness, symptomatic chondral lesions ≥15 mm in the setting of an ACL-deficient knee. The chondral lesions were considered symptomatic if patients reported the presence of pain and/or mechanical symptoms with functional activities. Patients were excluded if they underwent a multiligament knee reconstruction or did not desire to return to activity. Patients in the ACL reconstruction with OCA group were then matched to patients who underwent ACL reconstruction without OCA. Matching was conducted for age (within 2 years) and sex (exact match).

Data Collection

Baseline characteristics were collected for all patients, including age, sex, body mass index (BMI), and preinjury activity level as indicated by Marx score.¹⁷ Surgical reports were reviewed to identify graft types and concomitant procedures and ensure that patients underwent ACL reconstruction and OCA within the same procedure. At time of return to sport, outcomes included IKDC scores,¹² knee range of motion (ROM), single-leg squat performance,⁹ and performance on a single-leg hop testing battery.²¹ Three trials were completed on each limb for single-leg squat and hop testing, and then limb symmetry indices (LSIs) were calculated based on the best trial on each limb. Time of return to sport was defined as the time of medical clearance for full participation in sport. Two-year outcomes were collected through an automated electronic survey or telephone communication. Outcomes at 2 years included the Single Assessment Numeric Evaluation (SANE) score,²³ graft reinjury rate, complications, and current level of sports participation.⁷

Surgical Procedure

In the setting of autograft ACL reconstruction, the surgeon first began with harvest of patellar tendon or quadriceps tendon, followed by arthroscopy. Anatomic single-bundle ACL reconstruction was performed as previously described with patellar tendon autograft, free quadriceps tendon autograft, or an Achilles allograft, with tunnels drilled and grafts passed and fixed before converting to the open portion of the procedure.⁴ The ACL graft was chosen based on patient age, native tendon quality, tendon length, and surgeon or patient preference. The OCA graft was sourced and matched in alignment with the size of the patient, laterality, and the size of the defect. OCA grafts were stored on arrival based on the recommendation of the tissue company (refrigeration or ambient temperature). Depending on the location of the osteochondral defect, either a medial or lateral parapatellar arthrotomy was then made and appropriate retractors were placed. The osteochondral defect was identified, the appropriately sized cannulated cylindrical sizer was selected and centered over the defect, and then a guide wire was drilled through the sizing cylinder perpendicular to the lesion.²⁴ Over the guide wire, an appropriately sized reamer and then dilator were used to prepare the recipient site to a depth of 6 to 8 mm. After reaming, the defect was marked at 12 o'clock, and its depth was then measured at the 3-, 6-, 9-, and 12-o’clock positions to appropriately size the donor graft. A No. 15 scalpel was used to sharply debride defect edges.

On the back table, the osteochondral allograft plug was fashioned from the femoral hemicondyle, whole femur, or patella using an allograft workstation.²⁴ With the allograft tightly secured in the workstation, the appropriate radius of curvature and location to match the recipient site were identified and the appropriate diameter circular sizer was secured into place. The appropriately sized circular reamer was then placed into the guide, and a cylindrical allograft dowel was harvested, ensuring cool irrigation was used to prevent thermal necrosis. Once harvested, the plug was then trimmed to match the depth of the recipient site, and bone was bulleted to aid in graft passage. Before implantation, the allograft was irrigated with pulse lavage to remove any marrow elements.

The graft was then brought to the operative table, 12-o’clock markings were matched, and the graft was press-fit into place in the recipient site by hand first and then with gentle impaction with tamp as needed. In the setting of oversized, unshouldered, or some trochlear lesions where press-fitting was not adequate, headless compression screws were utilized to secure grafts.

Rehabilitation Protocol

Patients in the ACL reconstruction with OCA group had protected weightbearing (2 weeks of toe-touch weightbearing followed by 2 weeks of partial weightbearing) and flexion ROM (0°-90°) for the first 4 weeks after surgery. At 4 weeks, they progressed to full weightbearing and ROM as tolerated and followed a standardized postoperative protocol including the restoration of gait and strength. At 4 months, patients in the ACL reconstruction with OCA group initiated jogging on a body weight–supported treadmill (AlterG) once cleared by the surgeon. Patients then progressed through running, jumping, and sport-specific progressions at the discretion of the treating surgeon and physical therapist. The patients in the isolated ACL reconstruction group followed a similar standardized rehabilitation protocol with early ROM and weightbearing precautions determined by concomitant meniscal procedures.

Statistical Analysis

A retrospective sample of convenience was collected of patients who underwent ACL reconstruction with OCA. An a priori power analysis was conducted based on a moderate effect size (d = 0.5), a 2-tailed a priori alpha level of .05, and a power of 0.80. Based on this, the estimated sample size was 64 patients per group, for a total of 128 patients. Between-group differences in baseline patient characteristics and surgical report information were assessed using independent t tests for continuous data and chi-square analysis for categorical data. Generalized linear models and nonparametric equivalents were used for all statistical comparisons. Statistical analyses were performed using SPSS Statistics (Version 24; IBM Corp) software. A statistical level of significance of α < .05 was used for all models.

Results

A total of 43 patients were identified who underwent ACL reconstruction with OCA along with 43 matched controls who underwent isolated ACL reconstruction (Figure 1). Baseline descriptive data are shown in Table 1. No significant differences existed between groups regarding age, sex, height, weight, BMI, or ACL graft type. The ACL reconstruction with OCA group demonstrated significantly lower preinjury activity levels via Marx scores (3.9 ± 5.7 vs 9.6 ± 5.9; P < .001).

Table 1

Baseline Characteristics ^a

	ACL + OCA (n = 43)	Isolated ACL (n = 43)	P Value
Age, y ^b	33.1 ± 11.2	32.4 ± 11.6	.818
Female sex, % ^b	44.2	44.2	>.999
Height, inches	69.4 ± 3.9	67.6 ± 3.5	.194
Weight, lb	190.8 ± 43.0	163.3 ± 35.7	.286
BMI, kg/m²	28.3 ± 5.7	25.1 ± 4.2	.377
ACL graft type (%)	Patellar tendon (32.6), quadriceps tendon (25.6), CL patellar tendon (2.3), Achilles allograft (39.5)	Patellar tendon (34.9), quadriceps tendon (32.6), CL patellar tendon (0.0), Achilles allograft (32.6)	.965
Preinjury activity level (Marx score)	3.9 ± 5.7	9.6 ± 5.9	<.001

Data are presented as mean ± SD. Boldface type indicates statistical significance (P≤ .05). ACL, anterior cruciate ligament; BMI, body mass index; CL, contralateral; OCA, osteochondral allograft transplant.

Matching variable.

Table 2 demonstrates the outcomes at the time of clearance to return to sport for both groups. The ACL reconstruction with OCA group demonstrated a delayed time of return to sport (9.1 ± 4.1 months vs 7.9 ± 3.4 months; P = .040). No significant differences existed between groups at the time of return to sport for any subjective (IKDC) or objective (ROM, single-leg squat, single-leg hop performance) outcomes.

Table 2

Outcomes at Time of Return to Sport ^a

	ACL + OCA (n = 43)	Isolated ACL (n = 43)	P Value
Time to return to sport, mo	9.1 ± 4.1	7.9 ± 3.4	.040
IKDC score	87.4 ± 11.3	89.0 ± 12.4	.659
Knee extension ROM deficit, deg	1.8 ± 2.7	1.5 ± 2.0	.746
Knee flexion ROM deficit, deg	3.5 ± 3.9	3.0 ± 3.6	.684
Single-leg squat LSI, %	96.1 ± 6.0	95.2 ± 7.3	.803
Single-leg hop LSI, %	92.5 ± 8.9	94.2 ± 9.3	.541
Triple-hop LSI, %	94.6 ± 10.2	92.3 ± 7.9	.733
Crossover hop LSI, %	91.0 ± 9.8	92.4 ± 10.3	.770
6-m timed hop, %	94.5 ± 10.2	92.9 ± 11.0	.637

Data are presented as mean ± SD. Boldface type indicates statistical significance (P≤ .05). ACL, anterior cruciate ligament; IKDC, International Knee Documentation Committee; LSI, limb symmetry index; OCA, osteochondral allograft transplant; ROM, range of motion.

Two-year follow-up outcomes are reported in Table 3. No significant between-group differences existed for ACL graft failure rate (P = .481), infections (P = .845), anterior knee pain (P = .181), SANE score (P = .334), and return-to-sport rates at 2 years. Of the 43 patients who underwent ACL reconstruction with OCA, 36 (83.7%) returned to level 1 to 3 sports, 30 (69.8%) returned to their prior level of sport, and 19 (44.2%) returned to cutting and pivoting sports.

Table 3

Two-Year Follow-up Outcomes ^a

	ACL + OCA (n = 43)	Isolated ACL (n = 43)	P Value
Knee function score (SANE: 0-100)	85.4 ± 12.1	87.0 ± 13.5	.334
ACL graft failure, %	4.7	2.3	.481
Anterior knee pain, %	7.0	11.6	.181
Infections, %	2.3	0.0	.845
Return to sport (levels 1-3), %	83.7	86.2	.709
Return to prior level of sport, %	69.8	72.1	.387
Return to cutting/pivoting sports, %	44.2	51.2	.264

Data are presented as mean ± SD or percentage. ACL, anterior cruciate ligament; OCA, osteochondral allograft transplant; SANE, Single Assessment Numeric Evaluation.

Discussion

These results confirm our hypothesis that patients undergoing ACL reconstruction with OCA demonstrate no differences in self-reported function and return-to-sport rates compared to matched controls undergoing isolated ACL reconstruction. To our knowledge, this is the first matched study to examine patient outcomes and return-to-sport rates after ACL reconstruction with OCA. No between-group differences existed regarding ACL graft reinjury rates, self-reported function, and return to cutting and pivoting sport rates. Patients undergoing ACL reconstruction with OCA demonstrated a longer time to clearance to return to sport, although this may be explained by the longer postoperative precautions dictated by the OCA. These results suggest that patients undergoing ACL reconstruction with OCA can achieve similar function with a delayed return-to-sport time compared to those undergoing isolated ACL reconstruction; however, larger studies are needed to confirm these results.

The ACL reconstruction with OCA cohort in this study demonstrated similar baseline characteristics to previous studies.^26,27 No significant differences existed between groups regarding age, height, weight, BMI, or ACL graft type. The mean age in our ACL reconstruction with OCA cohort was 33.1 years, whereas previous studies reported mean ages of 38.6²⁷ and 35.0²⁶ years. However, preinjury Marx scores were significantly lower in the ACL reconstruction with OCA group, although approaching those previously reported by Wang et al (4.4).²⁷ This lower preinjury activity level may indicate that those undergoing eventual OCA may not engage in frequent cutting, pivoting, and deceleration activities, although this could be explained by age, previous knee injuries/surgeries, and lifestyle choices in those who demonstrate significant chondral wear.

A longer time to clearance to return to sport (9.1 ± 4.1 months vs 7.9 ± 3.4 months) was observed in the ACL reconstruction with OCA group, although their mean return-to-sport time of 9 months is similar to common recommendations for those undergoing isolated ACL reconstruction¹⁰ and the timelines reported in isolated OCA cohorts.^15,16 This difference may be explained by the delayed ROM and weightbearing postoperative precautions in this group. No differences existed between groups regarding IKDC scores at time of return to sport or ROM, single-leg squat LSI, or single-leg hop testing LSI values. These results suggest that clinicians may expect patients undergoing ACL reconstruction with OCA to ultimately achieve similar return-to-sport rates and functional testing performance to those undergoing isolated ACL reconstruction, although at a longer timeline.

At 2 years, no differences existed between groups regarding self-reported knee function (SANE scores) and return-to-sport rates. Nearly 70% of patients in the ACL reconstruction with OCA group returned to their prior level of sport, while 83.7% returned to level 1 to 3 sports and 44.2% returned to cutting and pivoting sports. These rates are similar to those reported in patients undergoing isolated ACL reconstruction, where 65% of young athletes return to their prior level of sport and 55% return to competitive sports.³ Previous studies have reported return-to-sport rates after knee OCA of 75% to 82%⁶ and return to prior level of sport rates of 66.7% to 79%,^2,18 which are in alignment with the findings of this study. The return-to-sport rates in the ACL reconstruction with OCA cohort may have been influenced by the difference in Marx scores between groups; however, a similar percentage of patients returned to cutting and pivoting sports in each group. Patients undergoing ACL reconstruction with OCA reported SANE scores of 85.4, which is similar to those reported in isolated ACL cohorts²³ and higher than the IKDC scores reported in previous studies.^26,27

The limitations of this study include its retrospective design, sample size, and lack of quadriceps strength testing at the time of return to sport. The study was underpowered as it did not meet the a priori sample size estimate of 64 patients per group. Future studies of larger cohorts are needed to better understand this population and confirm these preliminary results. As ACL reconstruction with OCA is a rare procedure, adequately powered studies may be difficult to achieve, as this investigation is currently the largest reported cohort to date. Because all patients underwent surgery by a highly trained single surgeon and completed standardized rehabilitation with frequent physician follow-ups, the findings of this study may have limitations when generalized to a broader population. Although time of clearance to return to sport was reported, data regarding time of return to previous level of competition or performance may have provided better insight into functional recovery timelines. A significant difference was observed in preinjury Marx scores between groups in this study, indicating a baseline difference in prior activity level that may have influenced outcomes and recovery. Future studies should match these cohorts on additional descriptive variables (Marx score, graft type, etc) to better highlight the impact of the OCA on recovery. Future studies should subgroup patients based on OCA location or additional concomitant procedures (osteotomy, meniscal transplant) and examine outcomes at periods beyond 2 years to assess longer-term success rates of this restorative procedure and longevity of the OCA grafts.

Conclusion

Footnotes

Final revision submitted May 10, 2026; accepted May 19, 2026.

One or more of the authors has declared the following potential conflict of interest or source of funding: B.G. reported a consulting or advisory relationship with Arthrex. W.R.L. reported a consulting or advisory relationship with Arthrex, Don Joy, and MedInc; and speaking and lecture fees from Arthrex.

Ethical approval for this study was obtained from the University of Texas Health Science Center, Houston (HSC-MH-14-0734).

ORCID iDs

Bonnie Gregory

Lane Bailey

Steven Higbie

References

Alfredson

Thorsen

Lorentzon

Treatment of tear of the anterior cruciate ligament combined with localised deep cartilage defects in the knee with ligament reconstruction and autologous periosteum transplantation. Knee Surg Sports Traumatol Arthrosc. 1999;7(2):69-74.

Allahabadi

Quigley

Frazier

Joyce

Cole

BJ.

Outcomes and return to sport after knee osteochondral allograft transplant in professional athletes. Orthop J Sports Med. 2024;12(2):23259671241226738.

Ardern

Taylor

Feller

Webster

KE.

Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543-1552.

Bailey

Weldon

Kleihege

, et al. Platelet-rich plasma augmentation of meniscal repair in the setting of anterior cruciate ligament reconstruction. Am J Sports Med. 2021;49(12):3287-3292.

Chahal

Gross

, et al. Outcomes of osteochondral allograft transplantation in the knee. Arthroscopy. 2013;29(3):575-588.

Crawford

Schumaier

Glogovac

Grawe

BM.

Return to sport and sports-specific outcomes after osteochondral allograft transplantation in the knee: a systematic review of studies with at least 2 years’ mean follow-up. Arthroscopy. 2019;35(6):1880-1889.

Daniel

Stone

Dobson

, et al. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med. 1994;22(5):632-644.

Filardo

de Caro

Andriolo

, et al. Do cartilage lesions affect the clinical outcome of anterior cruciate ligament reconstruction? A systematic review. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3061-3075.

Garrison

Bothwell

Wolf

Aryal

Thigpen

CA.

Y balance test anterior reach symmetry at three months is related to single leg functional performance at time of return to sports following anterior cruciate ligament reconstruction. Int J Sports Phys Ther. 2015;10(5):602-611.

10.

Grindem

Snyder-Mackler

Moksnes

Engebretsen

Risberg

MA.

Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-808.

11.

Gudas

Kalesinskas

Kimtys

, et al. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy. 2005;21(9):1066-1075.

12.

Irrgang

Anderson

Boland

, et al. Development and validation of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2001;29(5):600-613.

13.

Kao

Allen

CR.

Evaluation and management of osteochondral lesions of the knee. Phys Sportsmed. 2011;39(4):60-69.

14.

Kosiur

Collins

RA.

Weight-bearing compared with non-weight-bearing following osteochondral autograft transfer for small defects in weight-bearing areas in the femoral articular cartilage of the knee. J Bone Joint Surg Am. 2014;96(16):e136.

15.

Krych

Pareek

King

, et al. Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3186-3196.

16.

Krych

Robertson

Williams

III ; Cartilage Study Group. Return to athletic activity after osteochondral allograft transplantation in the knee. Am J Sports Med. 2012;40(5):1053-1059.

17.

Marx

Stump

Jones

Wickiewicz

Warren

RF.

Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med. 2001;29(2):213-218.

18.

Nielsen

McCauley

Pulido

Bugbee

WD.

Return to sport and recreational activity after osteochondral allograft transplantation in the knee. Am J Sports Med. 2017;45(7):1608-1614.

19.

Picart

Papin

Steltzlen

Boisrenoult

Pujol

Functional outcome of osteochondral autograft is equivalent in stable knee and in anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res. 2021;107(2):102792.

20.

Richter

Tanksley

Miller

MD.

Osteochondral autograft transplantation: a review of the surgical technique and outcomes. Sports Med Arthrosc Rev. 2016;24(2):74-78.

21.

Ross

Langford

Whelan

PJ.

Test-retest reliability of 4 single-leg horizontal hop tests. J Strength Cond Res. 2002;16(4):617-622.

22.

Rotterud

Sivertsen

Forssblad

Engebretsen

Aroen

Effect of meniscal and focal cartilage lesions on patient-reported outcome after anterior cruciate ligament reconstruction: a nationwide cohort study from Norway and Sweden of 8476 patients with 2-year follow-up. Am J Sports Med. 2013;41(3):535-543.

23.

Shelbourne

Barnes

Gray

Correlation of a Single Assessment Numeric Evaluation (SANE) rating with modified Cincinnati Knee Rating System and IKDC subjective total scores for patients after ACL reconstruction or knee arthroscopy. Am J Sports Med. 2012;40(11):2487-2491.

24.

Stone

Christian

Redondo

, et al. Osteochondral allograft transplantation and osteochondral autograft transfer. Oper Tech Sports Med. 2018;26(3):183-188.

25.

Tandogan

Taser

Kayaalp

, et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc. 2004;12(4):262-270.

26.

Tirico

LEP

McCauley

Pulido

Bugbee

. Does anterior cruciate ligament reconstruction affect the outcome of osteochondral allograft transplantation? A matched cohort study with a mean follow-up of 6 years. Am J Sports Med. 2018;46(8):1836-1843.

27.

Wang

Eliasberg

Wang

, et al. Similar outcomes after osteochondral allograft transplantation in anterior cruciate ligament-intact and -reconstructed knees: a comparative matched-group analysis with minimum 2-year follow-up. Arthroscopy. 2017;33(12):2198-2207.