Effects of Compliance With Procedure-Specific Postoperative Rehabilitation Protocols on Initial Outcomes After Osteochondral and Meniscal Allograft Transplantation in the Knee

Abstract

Background: Osteochondral and meniscal allograft transplantation have been performed in the knee for more than 40 years, with the number of patients treated each year growing as allograft quantity and quality increase. To date, the effects of postoperative management on outcomes after these procedures have received relatively little focus in the peer-reviewed literature. Hypothesis: Compliance with the recommended postoperative management protocol will be associated with significantly higher initial success and significantly lower revision and failure rates for patients undergoing osteochondral and/or meniscal allograft transplantation in the knee. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were prospectively enrolled into a dedicated registry designed to follow outcomes after osteochondral and/or meniscal allograft transplantation. Patients were included when at least 1 year of follow-up data were available, including data on complications and reoperations, patient-reported outcome measures, compliance with rehabilitation, revisions, or failures, based on the electronic medical record and communication logs with patients’ outpatient physical therapists. Results: For patients meeting the inclusion criteria (N = 162), compliance with the prescribed procedure-specific postoperative management protocol was associated with significantly higher 1- to 3-year success and significantly lower revision and failure rates. Specifically, patients who were compliant were 6.3 times less likely to need allograft revision or total knee arthroplasty and 7.5 times more likely to have a successful outcome at 1 to 3 years after osteochondral and/or meniscal allograft transplantation. In addition to noncompliance, older patient age and higher body mass index were associated with inferior short-term outcomes in this cohort. Conclusion: These data suggest that compliance with procedure-specific postoperative rehabilitation protocols is associated with higher success, lower revision, and lower failure rates for patients undergoing osteochondral and meniscal allograft transplantation. Given these results showing the importance of these modifiable risk factors, our center has devoted resources to preoperative patient assessment and communication to provide education, set appropriate expectations, identify and address modifiable risk factors, impediments, and noncompliance, and monitor and adjust postoperative care as indicated.

Patient-Reported Outcomes for Large Bipolar Osteochondral Allograft Transplantation in Combination with Realignment Osteotomies for the Knee

“…[32][33][34][35][36][37][38][39] Procedure-specific postoperative management protocols were prescribed to each patient; all patients received verbal and written instructions regarding postoperative rehabilitation. 20 Patients in this study were advised to maintain 6 weeks of nonweight-bearing activity and low-impact activity for 12 months after surgery. These instructions were also directly communicated to the outpatient physical therapist identified by the patient to be involved in their postoperative care.…”

Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment

“…OCA transplantation is a cartilage restoration technique that overcomes the limitations of OAT but has been impeded by acceptable donor tissue availability, inconsistent allograft bone incorporation for larger grafts, and unreliable outcomes after multisurface or bipolar OCA transplantation in the knee. 3,[115][116][117][118] Key factors that influence these impediments include OCA chondrocyte viability at time of transplantation, surgical im-plantation techniques, patient immune responses, and patient compliance with prescribed postoperative rehabilitation protocols. 3,[116][117][118][119][120][121][122][123][124][125][126][127] Donor chondrocyte viability is critical to OCA transplantation success and has recently been addressed with a novel tissue preservation system.…”

“…3,[115][116][117][118] Key factors that influence these impediments include OCA chondrocyte viability at time of transplantation, surgical im-plantation techniques, patient immune responses, and patient compliance with prescribed postoperative rehabilitation protocols. 3,[116][117][118][119][120][121][122][123][124][125][126][127] Donor chondrocyte viability is critical to OCA transplantation success and has recently been addressed with a novel tissue preservation system. 3,[116][117][118][119]123,128 OCA bone integration rates have been improved by preimplantation graft preparation techniques, use of autogenous bone marrow aspirate concentrate, improved implantation and fixation methods, and in-depth patient education and monitoring for postoperative rehabilitation protocols.…”

“…3,[116][117][118][119][120][121][122][123][124][125][126][127] Donor chondrocyte viability is critical to OCA transplantation success and has recently been addressed with a novel tissue preservation system. 3,[116][117][118][119]123,128 OCA bone integration rates have been improved by preimplantation graft preparation techniques, use of autogenous bone marrow aspirate concentrate, improved implantation and fixation methods, and in-depth patient education and monitoring for postoperative rehabilitation protocols. 117,118,[129][130][131][132][133] While OCAs are not associated with immunorejection, subrejection immune responses likely influence cellular repopulation and revascularization of OCA bone, degradation of donor cartilage and bone, and whole-joint inflammatory and fibrosis responses that influence treatment success.…”

“…3,[116][117][118][119]123,128 OCA bone integration rates have been improved by preimplantation graft preparation techniques, use of autogenous bone marrow aspirate concentrate, improved implantation and fixation methods, and in-depth patient education and monitoring for postoperative rehabilitation protocols. 117,118,[129][130][131][132][133] While OCAs are not associated with immunorejection, subrejection immune responses likely influence cellular repopulation and revascularization of OCA bone, degradation of donor cartilage and bone, and whole-joint inflammatory and fibrosis responses that influence treatment success. [134][135][136][137][138] Intact hyaline cartilage tissue is considered to be an immunoprivileged tissue; however, bone and bone marrow elements are not and are likely the primary instigators of any untoward immune responses that occur in association with OCA transplantation.…”