Return to Sport After Large Single-Surface, Multisurface, or Bipolar Osteochondral Allograft Transplantation in the Knee Using Shell Grafts

Abstract

Background: Return to sport (RTS) after osteochondral allograft (OCA) transplantation for large unipolar femoral condyle defects has been consistent, but many athletes are affected by more severe lesions.

Purpose: To examine outcomes for athletes who have undergone large single-surface, multisurface, or bipolar shell OCA transplantation in the knee.

Study design: Case series; Level of evidence, 4.

Methods: Data from a prospective OCA transplantation registry were assessed for athletes who underwent knee transplantation for the first time (primary transplant) between June 2015 and March 2018 for injury or overuse-related articular defects. Inclusion criteria were preinjury Tegner level ≥5 and documented type and level of sport (or elite unit active military duty); in addition, patients were required to have a minimum of 1-year follow-up outcomes, including RTS data. Patient characteristics, surgery type, Tegner level, RTS, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures were assessed and compared for statistically significant differences.

Results: There were 37 included athletes (mean age, 34 years; range, 15-69 years; mean body mass index, 26.2 kg/m2; range, 18-35 kg/m2) who underwent large single-surface (n = 17), multisurface (n = 4), or bipolar (n = 16) OCA transplantation. The highest preinjury median Tegner level was 9 (mean, 7.9 ± 1.7; range, 5-10). At the final follow-up, 25 patients (68%) had returned to sport; 17 (68%) returned to the same or higher level of sport compared with the highest preinjury level. The median time to RTS was 16 months (range, 7-26 months). Elite unit military, competitive collegiate, and competitive high school athletes returned at a significantly higher proportion (P < .046) than did recreational athletes. For all patients, the Tegner level at the final follow-up (median, 6; mean, 6.1 ± 2.7; range, 1-10) was significantly lower than that at the highest preinjury level (P = .007). PROMs were significantly improved at the final follow-up compared with preoperative levels and reached or exceeded clinically meaningful differences. OCA revisions were performed in 2 patients (5%), and failures requiring total knee arthroplasty occurred in 2 patients (5%), all of whom were recreational athletes. Noncompliance was documented in 4 athletes (11%) and was 15.5 times more likely (P = .049) to be associated with failure or a need for revision than for compliant patients.

Conclusion: Large single-surface, multisurface, or bipolar shell OCA knee transplantations in athletes resulted in two-thirds of these patients returning to sport at 16 to 24 months after transplantation. Combined, the revision and failure rates were 10%; thus, 90% of patients were considered to have successful 2- to 4-year outcomes with significant improvements in pain and function, even when patients did not RTS.

Keywords: knee; meniscal allograft; osteochondral allograft; outcomes; transplantation.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.L.C. is a member of the medical board of trustees of the Musculoskeletal Transplant Foundation (MTF), which licenses the Missouri Osteochondral Preservation System (MOPS) used in the allograft procedures described in this study. J.L.C. and J.P.S. have received funding from the US Department of Defense and MTF related to this line of research conducted at the University of Missouri. J.L.C. has also received research support from Arthrex, the Coulter Foundation, DePuy Synthes, GE Healthcare, Merial, the MTF, Purina, and Zimmer Biomet; consulting fees from Arthrex and Trupanion; and speaking fees and royalties from Arthrex; and is a board member for the Midwest Transplant Network and MTF. J.P.S. has received research support from the Coulter Foundation; consulting fees from Acelity, Arthrex, DePuy Synthes, NuVasive, Orthopedic Designs North America, and Smith & Nephew; nonconsulting fees from Arthrex and Smtih & Nephew; faculty/speaker fees from DePuy; and royalties from Thieme. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2021.

Figures

Figure 1.

Intraoperative images of (A) a large single-surface medial femoral condyle shell osteochondral allograft (OCA) transplant and (B) a bipolar medial femoral condyle OCA and medial tibial plateau OCA with attached medial meniscal allograft from patients included in the present study.