PMID- 33428427
OWN - NLM
STAT- MEDLINE
DCOM- 20210210
LR  - 20210210
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 49
IP  - 2
DP  - 2021 Feb
TI  - Osteochondral Allograft Transplant for Focal Cartilage Defects of the Femoral 
      Condyles: Clinically Significant Outcomes, Failures, and Survival at a Minimum 
      5-Year Follow-up.
PG  - 467-475
LID - 10.1177/0363546520980087 [doi]
AB  - BACKGROUND: Osteochondral allograft (OCA) transplant for symptomatic focal 
      cartilage defects in the knee has demonstrated favorable short- to midterm 
      outcomes. However, the reoperation rate is high, and literature on mid- to 
      long-term outcomes is limited. PURPOSE: To analyze clinically significant 
      outcomes (CSOs), failures, and graft survival rates after OCA transplant of the 
      femoral condyles at a minimum 5-year follow-up. STUDY DESIGN: Case series; Level 
      of evidence, 4. METHODS: Review of a prospectively maintained database of 205 
      consecutive patients who had primary OCA transplant was performed to identify 
      patients with a minimum of 5 years of follow-up. Outcomes including 
      patient-reported outcomes (PROs), CSOs, complications, reoperation rate, and 
      failures were evaluated. Failure was defined as revision cartilage procedure, 
      conversion to knee arthroplasty, or macroscopic graft failure confirmed using 
      second-look arthroscopy. Patient preoperative and surgical factors were assessed 
      for their association with outcomes. RESULTS: A total of 160 patients (78.0% 
      follow-up) underwent OCA transplant with a mean follow-up of 7.7 +/- 2.7 years 
      (range, 5.0-16.3 years). Mean age at the time of surgery was 31.9 +/- 10.7 years, 
      with a mean symptom duration of 5.8 +/- 6.3 years. All mean PRO scores 
      significantly improved, with 75.0% of patients achieving minimal clinically 
      important difference (MCID), and 58.9% of patients achieving significant clinical 
      benefit for the International Knee Documentation Committee score at final 
      follow-up. The reoperation rate was 39.4% and was associated with a lower 
      probability of achieving MCID. However, most patients undergoing reoperation did 
      not proceed to failure at final follow-up (63.4% of total reoperations). A total 
      of 34 (21.3%) patients had failures overall, and the 5- and 10-year survival 
      rates were 86.2% and 81.8%, respectively. Failure was independently associated 
      with greater body mass index, longer symptom duration, number of previous 
      procedures, and previous failed cartilage debridement. Athletes were protected 
      against failure. Survival rates over time were not affected by OCA site (P = 
      .154), previous cartilage or meniscal procedure (P = .287 and P = .284, 
      respectively), or concomitant procedures at the time of OCA transplant (P = 
      .140). CONCLUSION: OCA transplant was associated with significant clinical 
      improvement and durability at mid- to long-term follow-up, with 5- and 10-year 
      survival rates of 86.2% and 81.8%, respectively. Maintenance of CSOs can be 
      expected in the majority of patients at a mean of 7.7 years after OCA transplant. 
      Although the reoperation rate was high (39.4%) and could have adversely affected 
      chances of maintaining MCID, most patients did not have failure at long-term 
      follow-up.
FAU - Gilat, Ron
AU  - Gilat R
AD  - Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
AD  - Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, 
      Tel Aviv, Israel.
FAU - Haunschild, Eric D
AU  - Haunschild ED
AD  - Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
FAU - Huddleston, Hailey P
AU  - Huddleston HP
AD  - Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
FAU - Tauro, Tracy M
AU  - Tauro TM
AD  - Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
FAU - Patel, Sumit
AU  - Patel S
AD  - Chicago Medical School at Rosalind Franklin University, Chicago, Illinois, USA.
FAU - Wolfson, Theodore S
AU  - Wolfson TS
AD  - Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
FAU - Parvaresh, Kevin C
AU  - Parvaresh KC
AD  - Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
FAU - Yanke, Adam B
AU  - Yanke AB
AD  - Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
FAU - Cole, Brian J
AU  - Cole BJ
AD  - Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
LA  - eng
PT  - Journal Article
DEP - 20210111
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Adult
MH  - Allografts
MH  - *Bone Transplantation
MH  - Cartilage, Articular/*transplantation
MH  - Follow-Up Studies
MH  - Humans
MH  - Knee Joint/*surgery
MH  - Reoperation
MH  - Survival Rate
MH  - Young Adult
OTO - NOTNLM
OT  - OAG
OT  - OCA
OT  - cartilage restoration
OT  - focal cartilage defect
OT  - osteochondral allograft transplant
EDAT- 2021/01/12 06:00
MHDA- 2021/02/11 06:00
CRDT- 2021/01/11 17:09
PHST- 2021/01/12 06:00 [pubmed]
PHST- 2021/02/11 06:00 [medline]
PHST- 2021/01/11 17:09 [entrez]
AID - 10.1177/0363546520980087 [doi]
PST - ppublish
SO  - Am J Sports Med. 2021 Feb;49(2):467-475. doi: 10.1177/0363546520980087. Epub 2021 
      Jan 11.