Outcomes of Bulk Fresh Osteochondral Allografts for Cartilage Restoration in the Knee

• Published in: Journal of bone and joint surgery. American volume 2021-11, Vol.103 (22), p.2115-2125
• Main Authors: Daud, Anser, Safir, Oleg A., Gross, Allan E., Kuzyk, Paul R.T.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Allografts - transplantation; Amputation - statistics & numerical data; Arthrodesis - statistics & numerical data; Arthroplasty, Replacement, Knee - statistics & numerical data; Bone Transplantation - methods; Bone Transplantation - statistics & numerical data; Cartilage, Articular - transplantation; Child; Female; Follow-Up Studies; Graft Survival; Humans; Knee Injuries - complications; Knee Injuries - surgery; Knee Joint - surgery; Male; Middle Aged; Osteoarthritis - epidemiology; Osteoarthritis - etiology; Osteoarthritis - prevention & control; Osteoarthritis - surgery; Reoperation - statistics & numerical data; Risk Factors; Transplantation, Homologous - methods; Transplantation, Homologous - statistics & numerical data; Treatment Outcome; Young Adult
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.20.00350

Symptomatic osteochondral defects of the knee in young patients can cause substantial disability and predispose to osteoarthritis. Fresh osteochondral allografts (FOCAs) are a treatment option for such defects. With our institution having one of the longest-running FOCA programs, we investigated the long-term outcomes of bulk FOCA in the knee, focusing on graft survivorship, function, complications, and reoperation. A total of 244 patients underwent bulk FOCA in the knee from 1972 to 2018, with a mean age of 37.8 years (range, 10 to 75 years) and a mean follow-up of 9.0 years (range, 1.0 to 29.8 years). Cartilage defects were very large and uncontained, such that they were not amenable to plug transplantation. Survivorship according to Kaplan-Meier analysis was the primary outcome, and failure was defined as conversion to total knee arthroplasty, repeat allograft, graft removal, knee arthrodesis, or amputation. Functional outcome was evaluated with use of the modified Hospital for Special Surgery (mHSS) score, and radiographic evidence of osteoarthritis was classified with use of the Kellgren-Lawrence grading scale. Graft survivorship was 86.6% at 5 years, 73.3% at 10 years, 58.1% at 15 years, 43.7% at 20 years, 31.9% at 25 years, and 22.6% at 30 years. The most common complications were pain (14.8%), malalignment (13.9%), and stiffness (5.8%). A total of 93 grafts (38.1%) failed at a mean of 11.0 years (range, 0.5 to 34.0 years). The mean mHSS score improved significantly, from 68.7 (range, 19 to 91) preoperatively to 80.3 (range, 52 to 100) at the time of the latest follow-up (p < 0.001). Preoperative mHSS score had a negative correlation with Kellgren-Lawrence grade at the time of the latest follow-up. Multivariate analysis revealed that graft location (i.e., medial-sided or multiple grafts) and increased age were significantly negatively associated with survival. Ten-year survival was >80% in patients below 50 years old, but 60 years old. Bulk FOCA provided promising long-term graft survival and functional improvement in patients