Purpose
The objectives of this study were (1) to conduct a systematic review of clinical outcomes
after osteochondral allograft transplantation in the knee and (2) to identify patient-,
defect-, and graft-specific prognostic factors.
Methods
We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled
Trials. Studies that evaluated clinical outcomes in adult patients after osteochondral
allograft transplantation for chondral defects in the knee were included. Pooled analyses
for pertinent continuous and dichotomous variables were performed where appropriate.
Results
There were 19 eligible studies resulting in a total of 644 knees with a mean follow-up
of 58 months (range, 19 to 120 months). The overall follow-up rate was 93% (595 of
644). The mean age was 37 years (range, 20 to 62 years), and 303 patients (63%) were
men. The methods of procurement and storage time included fresh (61%), prolonged fresh
(24%), and fresh frozen (15%). With regard to etiology, the most common indications
for transplantation included post-traumatic (38%), osteochondritis dissecans (30%),
osteonecrosis from all causes (12%), and idiopathic (11%). Forty-six percent of patients
had concomitant procedures, and the mean defect size across studies was 6.3 cm2. The overall satisfaction rate was 86%. Sixty-five percent of patients (72 of 110)
showed little to no arthritis at final follow-up. The reported short-term complication
rate was 2.4%, and the overall failure rate was 18%. Heterogeneity in functional outcome
measures precluded a meta-analysis; a qualitative synthesis allowed for the identification
of several positive and negative prognostic factors.
Conclusions
Osteochondral allograft transplantation for focal and diffuse (single-compartment)
chondral defects results in predictably favorable outcomes and high satisfaction rates
at intermediate follow-up. Patients with osteochondritis dissecans and traumatic and
idiopathic etiologies have more favorable outcomes, as do younger patients with unipolar
lesions and short symptom duration. Future studies should include comparative control
groups and use established outcome instruments that will allow for pooling of data
across studies.
Level of Evidence
Level IV, systematic review of Level IV studies.
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Article info
Publication history
Accepted:
December 4,
2012
Received:
November 2,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
