Do Outcomes of Osteochondral Allograft Transplantation Differ Based on Age and Sex? A Comparative Matched Group Analysis

Frank, Rachel M.; Cotter, Eric J.; Lee, Simon; Poland, Sarah; Cole, Brian J.

doi:10.1177/0363546517739625

Cited by 47 publications

(76 citation statements)

References 26 publications

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“…With a longer follow-up and more experience in cartilage restoration for older patients with focal cartilage lesions and without osteoarthritis, we hope to eventually further define the role of biological restoration as a method for long-term joint preservation or a bridge to total joint replacement based on the clinical situation. When added to recent studies conducted by Frank et al 8 and Wang et al, 15 our longitudinal regression modeling results and clinical outcomes support the position that OCA transplantation is a reasonable treatment modality for older patients based on age alone.…”

Section: Resultssupporting

confidence: 75%

“…A third limitation is the lack of demographic factors, including smoking and workers’ compensation status, which may be age-dependent confounding variables. Frank et al 8 reported a significantly higher proportion of workers’ compensation claims but no difference in clinical outcomes in the older group relative to the younger group; however, they did not assess specifically for interactions between variables.…”

Section: Discussionmentioning

confidence: 99%

“…Recent data suggest that OCA transplantation in adults older than 40 years has equivalent outcomes to those of younger patients and may be a reliable interim treatment for cartilage defects in the knee to delay total joint replacement. 8,15…”

mentioning

confidence: 99%

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Efficacy of Fresh Osteochondral Allograft Transplantation in the Knee for Adults 40 Years and Older

Anderson

Robinson

Wiedrick

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Osteochondral allograft (OCA) transplantation has become a standard therapy for cartilage restoration in young patients.Purpose:To determine the efficacy of fresh OCA transplantation for focal cartilage lesions in patients aged ≥40 years compared with a group of patients aged ≤39 years.Study Design:Cohort study; Level of evidence, 3.Methods:A database was used to identify patients who underwent fresh OCA transplantation in the knee in a single-surgeon practice over a 10-year period and who completed baseline patient-reported outcome (PRO) questionnaires, including the International Knee Documentation Committee (IKDC); Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of Pain, Symptoms, Activities of Daily Living, Quality of Life (QOL), and Sports & Recreation; and Veterans RAND 12-Item Health Survey (VR-12). Patients who completed the same PRO measures at a minimum 12-month follow-up were categorized into 2 groups based on age at surgery and were observed longitudinally. Mixed-model regression was used to predict longitudinal growth curves for each PRO score while controlling for confounding patient and surgical variables.Results:The study group consisted of 38 patients with a mean age of 52.32 years (range, 40-69 years) and mean final follow-up of 44.47 ± 24.32 months. The control group consisted of 42 patients with a mean age of 27.19 years (range, 15-39 years) and mean final follow-up of 33.75 ± 19.53 months. A statistically significant improvement from baseline to final follow-up was seen for the IKDC score and all 5 KOOS subscores in both the study and the control groups (P < .01 in 10 of 12 comparisons and P < .05 for the other 2 comparisons). Maximum improvements were seen in the KOOS QOL and Sports & Recreation subscores for both groups. There was no statistically significant difference between groups in the change from baseline to final follow-up or in differences at any time point in model-based longitudinal projections for any PRO score through 5 years.Conclusion:There was a significant improvement of outcomes for both groups, with no statistically significant difference between groups over longitudinal follow-up. The efficacy of fresh OCA transplantation in adults aged ≥40 years with a focal chondral lesion and without osteoarthritis is similar to that of younger adults, and benefits are greatest for the KOOS QOL and Sports & Recreation subscales, which reflect functional outcomes.

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Section: Resultssupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Efficacy of Fresh Osteochondral Allograft Transplantation in the Knee for Adults 40 Years and Older

Anderson

Robinson

Wiedrick

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…Additionally, patients were not stratified regarding sex or age, variables that were previously shown to affect OCA outcomes. 9,19,70…”

mentioning

confidence: 99%

Analysis of Defect Size and Ratio to Condylar Size With Respect to Outcomes After Isolated Osteochondral Allograft Transplantation

et al. 2019

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Background: Osteochondral allograft transplantation (OCA) is a successful knee joint preservation technique; however, the effects of defect size and defect size:condyle ratio (DSCR) are poorly understood. Purpose: To quantify clinical outcomes of isolated OCA of the knee based on defect size and DSCR. Study Design: Cohort study; Level of evidence, 3. Methods: Data from patients who underwent OCA of the knee without major concomitant procedures by a single surgeon were analyzed at a minimum follow-up of 2 years. Osteochondral defect size was measured intraoperatively, and femoral condyle size was measured with preoperative imaging. Patient-reported outcomes, reoperations, and survival rates were analyzed per defect size and DSCR, comparing males and females and patients <40 and ≥40 years old. Results: Sixty-eight patients were included, of whom 57% were male (mean ± SD: age, 34.5 ± 10.3 years; follow-up, 5.2 ± 2.6 years). Mean osteochondral defect size and DSCR were 3.48 ± 1.72 cm2 and 0.2 ± 0.1, respectively. Defect size was larger among males as compared with females (3.97 ± 1.71 cm2 vs 2.81 ± 1.16 cm2, P = .005), while DSCRs were not significantly different between sexes ( P = .609). The cohort as a whole demonstrated improvements in the following scores: Lysholm, International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and 12-Item Short Form Health Survey Physical ( P < .05). There were 27 reoperations (39.7%) at a mean of 2.5 ± 1.92 years and 8 failures (11.8%) at a mean of 2.62 ± 1.3 years. Mean DCSR was higher among patients with graft failure (0.26 ± 0.20 vs 0.19 ± 0.07, P = .049). After stratification by age, failures among patients ≥40 years old were associated with a larger defect size (mean 5.37 ± 3.50 cm2 vs 3.22 ± 1.32 cm2, P = .03) and higher DSCR (mean 0.30 ± 0.25 vs 0.19 ± 0.06, P = .05) when compared with nonfailures. Failures among patients <40 years old were not significantly associated with defect size or DSCR ( P > .05) as compared with nonfailures. Conclusion: Patients undergoing isolated OCA transplantation demonstrated significant clinical improvements and a graft survival of 88.2% at 5.2 years. Failures overall were associated with a larger DSCR, and failures among patients ≥40 years old with a larger DSCR and larger defect size. Increasing defect size among males was positively correlated with some improved outcomes, although this was not maintained in analysis of the DSCR, suggesting similar prognosis after OCA regardless of sex. Clinical Relevance: Failed osteochondral allografts are associated with larger defect sizes and defect:condyle ratios in this study, providing additional information to surgeons for appropriate patient consultation.

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“…20,26 Patients who have multifocal or bipolar reciprocal lesions often have additional injuries of the knee, such as meniscal tears or insufficiency, but are less than 50 years of age and lead active lifestyles. 10 Furthermore, there are limited published data regarding the clinical outcomes of patients treated with OCA with the dowel technique, that is, 2 overlapping allograft plugs for a single, elongated, or oblique lesion in the knee. 18…”

mentioning

confidence: 99%

Clinical Outcomes of Multifocal Osteochondral Allograft Transplantation of the Knee: An Analysis of Overlapping Grafts and Multifocal Lesions

et al. 2018

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Patients who underwent unicondylar, multiplug OCA using the snowman technique demonstrated inferior clinical outcomes, higher reoperation rates, and greater failure rates than those who underwent isolated single-graft transplantation. By contrast, multifocal OCA may be a viable knee preservation technique for young, active patients with multicompartmental chondral disease, leading to improved clinical outcomes and low reoperation and failure rates at midterm follow-up.

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Do Outcomes of Osteochondral Allograft Transplantation Differ Based on Age and Sex? A Comparative Matched Group Analysis

Cited by 47 publications

References 26 publications

Efficacy of Fresh Osteochondral Allograft Transplantation in the Knee for Adults 40 Years and Older

Efficacy of Fresh Osteochondral Allograft Transplantation in the Knee for Adults 40 Years and Older

Analysis of Defect Size and Ratio to Condylar Size With Respect to Outcomes After Isolated Osteochondral Allograft Transplantation

Clinical Outcomes of Multifocal Osteochondral Allograft Transplantation of the Knee: An Analysis of Overlapping Grafts and Multifocal Lesions

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