Summary
Most patients develop new osteochondral lesions following knee osteochondral allograft transplantation.
Abstract
Introduction
Osteochondral allograft transplantation (OCA) addresses knee articular cartilage defects. Limited literature exists on the prevalence or risk factors for new osteochondral lesions (NOL) following knee OCA.
Methods
A retrospective review was conducted on patients who underwent OCA from August 2010 to November 2021 at a single academic institution. Inclusion criteria were a minimum 2-year follow-up, pre-operative MRI within 1 year of surgery, and post-operative MRI at least 2 years after surgery. NOL were recorded from post-operative MRIs. Demographic data, including age, sex, and BMI, were collected. Complications assessed included graft failure, infection, reoperation rates, DVT/PE, and MUA/LOA. Graft failure was defined as subchondral collapse on imaging, removal or revision of primary OCA, or conversion to arthroplasty. Patients completed surveys for VAS pain and satisfaction, KOOS, and return to sport.
Results
Of 330 patients who underwent unilateral OCA, 285 had a minimum of 2 years of follow-up, but only 31 had both pre-operative and post-operative MRIs. Of these, 20 (64.5%) had at least one NOL on post-operative MRI. Nine patients (32.3%) had two NOL, and one had three. There was no significant difference in age (p=0.242), sex (p=0.849), or BMI (p=0.814) between patients with and without NOL. Logistic regression showed no significant correlation between these variables and NOL development. There was a significant difference in time between surgery and post-op MRI (3.32 ± 1.3 years vs. 2.62 ± 0.54 years, p=0.042). There was no significant difference in VAS satisfaction (p=0.266), VAS pain (p=0.893), return to sport (p=0.350), KOOS Symptoms (p=0.681), KOOS Pain (p=0.737), or KOOS Quality of Life (p=0.257) between patients with and without NOL.
Conclusion
Most patients had NOL post-OCA. Patients should be counseled on the potential for developing NOL. There was no difference in demographic variables or patient-reported outcomes between patients with and without NO following knee OCA.