Survival and Reoperation Rate Following Osteochondral Allograft Transplantation: Analysis of Failures for 100 Transplants at 5-year Follow-up

OBJECTIVES: The purpose of this study was to quantify survival for osteochondral allograft transplantation (OAT) and report findings at reoperation. METHODS: A retrospective review of a prospectively collected database of patients who underwent OAT by a single surgeon with a minimum follow-up duration of 2-years was conducted. The reoperation rate, timing of reoperation, procedure performed at reoperation, and findings at surgery were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at 2(nd)look arthroscopy. Descriptive statistics, log-rank testing, cross-tabulation, and chi-square testing were performed, with P<0.05 set as significant. RESULTS: 100 patients (average age 32.7±10.2 years; 53 males, 47 females) who underwent OAT at an average follow-up of 4.9±2.5 years (range, 2.0 to 11.3) were included. Ninety-five patients (95%) underwent an average of 2.7±1.7 prior surgical procedures on the ipsilateral knee prior to OAT. The average defect size was 452.7±181.6 mm(2) and was located on the medial femoral condyle in 63 patients (63%). Fifty-one percent of OATs were isolated, while 49% were performed with concomitant procedures including meniscus allograft transplantation (MAT) in 27 (27%). Fifty-three patients (53%) returned to the operating room at an average 2.8±2.7 years, with 26% of these patients (14/53) undergoing additional reoperations (range, 1-3 additional reoperations). Arthroscopic debridement was performed in 91% of the initial reoperations (48/53); 55% of reoperations (29/53) were performed within 2 years of the index OAT. Twenty patients (20%) were considered failures at an average 4.0±2.7 years following index OAT either due to revision OAT (N=6), conversion to arthroplasty (N=10), or appearance of poorly incorporated allograft at arthroscopy (N=4). Patients requiring multiple reoperations had an odds ratio of 7.25 (95% CI, 1.85 to 28.37) of OAT failure (P=0.004), while patients requiring secondary surgery within 2 years had an odds radio of 1.35 (95% CI, 0.48 to 3.82) for OAT failure (P>0.05). Patients with concomitant MAT and OAT were more likely to progress to failure (odds ratio 2.4, 95% CI 0.87 to 3.28). Excluding the failed patients, statistically and clinically significant improvements were found in all outcomes assessments at final follow-up, including Lysholm, IKDC, KOOS, and SF-12 (P<0.001 for all). CONCLUSION: In this series, there was a 53% reoperation rate for OAT, with arthroscopic debridement being the most common surgical treatment (91%), and an80% allograft survival rate at average of 5 years. Those requiring additional surgery still benefited, having a 70% allograft survival rate, but were at an increased risk of failure, with patients requiring multiple reoperations having an odds ratio of 7.25 for failure. This information can be used to counsel patients on the risks and implications of reoperation following OAT.