Paper 11: Clinical Outcomes and Return to Sport Following Patellofemoral Osteochondral Allograft with and Without Concomitant Tibial Tubercle Osteotomy: A Retrospective Cohort Study

OBJECTIVES: This study aimed to evaluate the rate of graft failure, return to sport (RTS), and clinical outcomes in patients undergoing osteochondral allograft (OCA) transplantation in the patellofemoral (PF) joint with concomitant tibial tuberosity osteotomy (TTO) compared to those undergoing an isolated PF OCA transplantation. METHODS: This is a retrospective review of patients who underwent PF OCA transplantation with or without TTO at a single institution. Patients with a primary patellar or trochlear lesion were included. Those undergoing revision OCA, medial patellofemoral ligament reconstruction (MPLFR), or who had a prior TTO were excluded. Graft failure was defined as cartilage procedure revision, chondroplasty, or conversion to joint replacement. Knee pain and functional outcomes were assessed with Visual Analog Scale (VAS), Knee Injury and Osteoarthritis Outcome Score Joint Restoration (KOOS JR), and Tegner Activity Scale. Additionally, patients were asked about preoperative and postoperative sports activity to determine rate of RTS. RESULTS: A total of 40 patients met inclusion criteria for the study; 35 were available for follow-up at an average of 31.6 ± 7.8 months. The cohort had 20 female (64%) and 15 male (36%) patients; the average age was 34 ± 8 years. Graft failure rates were 7.7% and 22.7% in the PF OCA + TTO and isolated PF OCA groups, respectively (p= 0.254). There were no significant differences in RTS between groups (p=0.668). Among patients who returned to sport at a lower level, those in the OCA + TTO group unanimously cited pain as the primary reason (100%), while most in the isolated OCA group cited fear of re-injury instead (66.7%). Patients who underwent concomitant OCA + TTO experienced reported lower KOOS scores (p=0.009). However, after adjusting for covariates, there was no significant association between TTO (p=0.86) and KOOS. CONCLUSIONS: In this study population, patients undergoing OCA with concomitant TTO were found to have comparable return to sport rates compared to patients who underwent an isolated OCA. Both cohorts showed improvements in pain levels and functional outcomes from baseline. However, patients undergoing combined OCA and TTO exhibited higher pain levels with activity and cited pain as the primary reason for return at a lower level of performance. These findings highlight the need for additional well-powered studies to further investigate clinical and functional outcomes following OCA and concomitant TTO to offload the PF compartment.