Return to an Athletic Lifestyle After Osteochondral Allograft Transplantation of the Knee

• Published in: The American journal of sports medicine 2013-09, Vol.41 (9), p.2083-2089
• Main Authors: Shaha, James S., Cook, Jay B., Rowles, Douglas J., Bottoni, Craig R., Shaha, Steven H., Tokish, John M.
• Format: Article
• Language: English
• Subjects: Adult; Arthroplasty, Subchondral; Athletes; Female; Humans; Joint surgery; Knee; Knee Injuries - surgery; Knee Joint - surgery; Life Style; Male; Military Personnel - statistics & numerical data; Physical fitness; Recovery of Function; Retrospective Studies; Sports medicine; Transplantation, Homologous; Transplants & implants; Young Adult
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546513494355

Background: Osteochondral allograft transplantation (OATS) is a treatment option that provides the ability to restore large areas of hyaline cartilage anatomy and structure without donor site morbidity and promising results have been reported in returning patients to some previous activities. However, no study has reported on the durability of return to activity in a setting where it is an occupational requirement. Hypothesis: Osteochondral allograft transplantation is less successful in returning patients to activity in a population in which physical fitness is a job requirement as opposed to a recreational goal. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was conducted of 38 consecutive OATS procedures performed at a single military institution by 1 of 4 sports medicine fellowship–trained orthopaedic surgeons. All patients were on active duty at the time of the index procedure, and data were collected on demographics, return to duty, Knee Injury and Osteoarthritis Outcome Score (KOOS), and ultimate effect on military duty. Success was defined as the ability to return to the preinjury military occupational specialty (MOS) with no duty-limiting restrictions. Results: The mean lesion size treated was 487.0 ± 178.7 mm2. The overall rate of return to full duty was 28.9% (11/38). An additional 28.9% (11/38) were able to return to limited activity with permanent duty modifications. An alarming 42.1% (16/38) were unable to return to military activity because of their operative knee. When analyzed for return to sport, only 5.3% (2/38) of patients were able to return to their preinjury level. Eleven patients underwent concomitant procedures. Statistical power was maintained by analyzing data in aggregate for cases with versus without concomitant procedures. When the 11 undergoing concomitant procedures were removed from the data set, the rate of return to full activity was 33.3% (9/27), with 22.3% (6/27) returning to limited activity and 44.4% (12/27) unable to return to activity. In this subset, 7.4% (2/27) were able to return to a preinjury level of sport. The KOOS values were significantly higher in the full activity group when compared with the limited and no activity groups (P < .01). Branch of service was a significant predictor of outcome, with Marine Corps and Navy service members more likely to return to full activity compared with Army and Air Force members. A MOS of combat arms was a significant predictor of a poor o