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Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee

BACKGROUND: Treatment of multisurface articular cartilage lesions of the knee is a challenging problem. HYPOTHESIS: Large multisurface cartilage defects in the knee can be successfully managed with transplantation of high chondrocyte viability osteochondral allografts (OCAs) to result in statistical...

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Autores principales: Cook, James L., Rucinski, Kylee, Crecelius, Cory, Fenkell, Blake, Stannard, James P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201314/
https://www.ncbi.nlm.nih.gov/pubmed/35722176
http://dx.doi.org/10.1177/23259671221102452
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author Cook, James L.
Rucinski, Kylee
Crecelius, Cory
Fenkell, Blake
Stannard, James P.
author_facet Cook, James L.
Rucinski, Kylee
Crecelius, Cory
Fenkell, Blake
Stannard, James P.
author_sort Cook, James L.
collection PubMed
description BACKGROUND: Treatment of multisurface articular cartilage lesions of the knee is a challenging problem. HYPOTHESIS: Large multisurface cartilage defects in the knee can be successfully managed with transplantation of high chondrocyte viability osteochondral allografts (OCAs) to result in statistically significant improvements in patient-reported outcome measures of pain and function. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. The study included patients who received OCA transplantation for multisurface unipolar defects in 1 knee and had minimum 2-year follow-up data, including patient-reported outcome measures, failures, reoperations, and complications. The OCA transplants had been stored using 2 methods: standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS). Preoperative data were compared with outcomes at 1 year and final follow-up, and risk factors for revision surgery or failure (total knee arthroplasty) were analyzed. RESULTS: The sample included 25 patients with a mean age of 37.2 years (range, 13-51 years), body mass index of 27.7 (range, 18-38), and follow-up of 45.1 months (median, 49 months; range, 24-68 months). OCAs stored using SP were transplanted into 6 patients, and those stored using MOPS were transplanted into 19 patients. The initial success rate was significantly higher for MOPS OCAs (94.7%) than SP OCAs (33.3%). There were statistically significant improvements in all patient-reported outcomes at 1 year and final follow-up in the MOPS cohort (P < .0001 for all). Revision surgery/failure was significantly associated with patients who were nonadherent to the prescribed postoperative restrictions and rehabilitation protocols (P = .038; odds ratio = 13.5) and with OCAs that had a viable chondrocyte density <70% of the established reference range mean at transplantation (P = .0037; odds ratio = 76). CONCLUSION: OCA transplantation for treatment of large multisurface cartilage defects in the knee resulted in a 94.7% initial success rate when grafts with high viable chondrocyte density (≥70%) were used and when patients strictly adhered to prescribed postoperative rehabilitation protocols. Successful outcomes were associated with statistically significant improvements in patient-reported outcome measures of pain and function.
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spelling pubmed-92013142022-06-17 Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee Cook, James L. Rucinski, Kylee Crecelius, Cory Fenkell, Blake Stannard, James P. Orthop J Sports Med Article BACKGROUND: Treatment of multisurface articular cartilage lesions of the knee is a challenging problem. HYPOTHESIS: Large multisurface cartilage defects in the knee can be successfully managed with transplantation of high chondrocyte viability osteochondral allografts (OCAs) to result in statistically significant improvements in patient-reported outcome measures of pain and function. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. The study included patients who received OCA transplantation for multisurface unipolar defects in 1 knee and had minimum 2-year follow-up data, including patient-reported outcome measures, failures, reoperations, and complications. The OCA transplants had been stored using 2 methods: standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS). Preoperative data were compared with outcomes at 1 year and final follow-up, and risk factors for revision surgery or failure (total knee arthroplasty) were analyzed. RESULTS: The sample included 25 patients with a mean age of 37.2 years (range, 13-51 years), body mass index of 27.7 (range, 18-38), and follow-up of 45.1 months (median, 49 months; range, 24-68 months). OCAs stored using SP were transplanted into 6 patients, and those stored using MOPS were transplanted into 19 patients. The initial success rate was significantly higher for MOPS OCAs (94.7%) than SP OCAs (33.3%). There were statistically significant improvements in all patient-reported outcomes at 1 year and final follow-up in the MOPS cohort (P < .0001 for all). Revision surgery/failure was significantly associated with patients who were nonadherent to the prescribed postoperative restrictions and rehabilitation protocols (P = .038; odds ratio = 13.5) and with OCAs that had a viable chondrocyte density <70% of the established reference range mean at transplantation (P = .0037; odds ratio = 76). CONCLUSION: OCA transplantation for treatment of large multisurface cartilage defects in the knee resulted in a 94.7% initial success rate when grafts with high viable chondrocyte density (≥70%) were used and when patients strictly adhered to prescribed postoperative rehabilitation protocols. Successful outcomes were associated with statistically significant improvements in patient-reported outcome measures of pain and function. SAGE Publications 2022-06-14 /pmc/articles/PMC9201314/ /pubmed/35722176 http://dx.doi.org/10.1177/23259671221102452 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Cook, James L.
Rucinski, Kylee
Crecelius, Cory
Fenkell, Blake
Stannard, James P.
Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee
title Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee
title_full Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee
title_fullStr Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee
title_full_unstemmed Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee
title_short Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee
title_sort assessment of outcomes after multisurface osteochondral allograft transplantations in the knee
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201314/
https://www.ncbi.nlm.nih.gov/pubmed/35722176
http://dx.doi.org/10.1177/23259671221102452
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