Return to Sport and Recreational Activity Following Osteochondral Allograft Transplantation in the Knee

OBJECTIVES: Osteochondral allograft (OCA) transplantation is an integral part of the cartilage repair paradigm. There is little data regarding return to sport or recreational activity after OCA. The purpose of the present study was to 1) determine if athletic patients undergoing OCA returned to sport, 2) assess reason(s) why in those who did not, 3) and ascertain patient and graft-related characteristics that differed between those who returned or did not return to sport. METHODS: Our institution’s OCA database was used to identify 149 knees in 142 patients who participated in sport or recreational activity prior to cartilage injury (45% highly-competitive athletes and 55% well-trained and frequently sporting) and had a minimum follow-up of 1 year (Table 1). The average age was 31 years and 59% were male. The majority of patients (68%) sustained a sports-related injury to their knee and 89% had undergone previous surgery (mean 2.1). Median time from onset of symptoms to OCA transplantation was 2.7 years. Pre-injury and postoperative participation in sport or recreational activity was collected. Patients not returning to their pre-injury level of sport were mailed a questionnaire to assess why, which included knee and lifestyle-related reason(s). Standard objective and subjective outcome measures were also obtained. Further surgery on the operative knee was documented. RESULTS: At a mean follow-up of 6 years, 76% (113 of 149 knees) returned to sport or recreational activity. Among the 113, 28% returned to the same level of pre-injury sport, 48% partially returned (returned to one or more but not all of the same sports or activities), and 25% returned to a different sport or activity. Among the 24% (36 of 149 knees) who did not return to sport or activity, reasons included lifestyle events such as starting a family, changing careers, end of organized sports, knee-related issues, and worry about re-injuring the knee. Postoperatively, 79% of knees were able to participate in a high level of activity (moderate, strenuous, or very strenuous activities), and 71% reported having “very good” to “excellent” function. Thirty-eight of 149 knees (26%) had further surgery following the OCA, of which 14 knees (9% of entire cohort) were considered OCA failures. Survivorship of the OCA at 6 years was 90%. Patients who did not return to sport following OCA were more likely to be female, have injured their knee in an activity other than sports, and had a larger graft size (Table 1). Diagnosis and anatomical location also differed between groups. CONCLUSION: OCA transplantation is a successful treatment option for athletes and highly active patients who sustain a cartilage injury to their knee. The majority of patients (76%) returned to sport or recreational activity following the OCA and 28% of those patients returned to the same level of pre-injury sport or activity. Patients often reported that their failure to return to sport was due to lifestyle characteristics such as family or career changes rather than knee-related problems.