Purpose
To compare failure rates and clinical outcomes of osteochondral allograft transplantation
(OCA) in anterior cruciate ligament (ACL)-intact versus ACL-reconstructed knees at
midterm follow-up.
Methods
After a priori power analysis, a prospective registry of patients treated with OCA
for focal chondral lesions ≥2 cm2 in size with minimum 2-year follow-up was used to match ACL-reconstructed knees with
ACL-intact knees by age, sex, and primary chondral defect location. Exclusion criteria
included meniscus transplantation, realignment osteotomy, or other ligamentous injury.
Complications, reoperations, and patient responses to validated outcome measures were
reviewed. Failure was defined by any procedure involving allograft removal/revision
or conversion to arthroplasty. Kaplan-Meier analysis and multivariate Cox regression
were performed to evaluate the association of ACL reconstruction (ACLR) with failure.
Results
A total of 50 ACL-intact and 25 ACL-reconstructed (18 prior, 7 concomitant) OCA patients
were analyzed. The mean age was 36.2 years (range, 14-62 years). Mean follow-up was
3.9 years (range, 2-14 years). Patient demographics and chondral lesion characteristics
were similar between groups. ACL-reconstructed patients averaged 2.2 ± 1.9 prior surgeries
on the ipsilateral knee compared with 1.4 ± 1.4 surgeries for ACL-intact patients
(P = .014). Grafts used for the last ACLR included bone-patellar tendon-bone autograft,
hamstring autograft, Achilles tendon allograft, and tibialis allograft (data available
for only 11 of 25 patients). At final follow-up, 22% of ACL-intact and 32% of ACL-reconstructed
patients had undergone reoperation. OCA survivorship was 90% and 96% at 2 years and
79% and 85% at 5 years in ACL-intact and ACL-reconstructed patients, respectively
(P = .774). ACLR was not independently associated with failure. Both groups demonstrated
clinically significant improvements in the Short Form-36 pain and physical functioning,
International Knee Documentation Committee subjective, and Knee Outcome Survey—Activities
of Daily Living scores at final follow-up (P < .001), with no significant differences in preoperative, postoperative, and change
scores between groups.
Conclusions
OCA in the setting of prior or concomitant ACLR does not portend higher failure rates
or compromise clinical outcomes.
Level of Evidence
Level III, retrospective comparative study.
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Article info
Publication history
Published online: August 08, 2017
Accepted:
June 19,
2017
Received:
February 15,
2017
Footnotes
The authors report the following potential conflicts of interest or sources of funding: R.J.W. receives support from the J. Robert Gladden Society, Arthrex, Cymedica, R2T2 Laboratories, Histogenics, Zimmer, and Springer. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Institutional Review Board approval (no. 2013-024) was obtained for the prospective registry used in this study.
Identification
Copyright
© 2017 Published by Elsevier on behalf of the Arthroscopy Association of North America
