Rehabilitation and Postoperative Management Practices After Osteochondral Allograft Transplants to the Distal Femur: A Report From the Metrics of Osteochondral Allografts (MOCA) Study Group 2016 Survey

Abstract

Context: We present the current spectrum of postoperative management practices for patients receiving distal femur osteochondral allograft (OCA) transplants.

Evidence acquisition: The Joint Restoration Foundation database was examined in cooperation with the Metrics of Osteochondral Allografts study group to identify 121 surgeons who had performed at least 1 OCA transplant in the past year; 63% of surgeons responded.

Study design: Clinical survey.

Level of evidence: Level 3.

Results: Postoperative weightbearing restrictions ranged from immediate nonweightbearing with full weightbearing by 12 weeks to immediate weightbearing as tolerated. Most surgeons who performed fewer (<10) OCA transplants per year followed the most restrictive protocol, while surgeons who performed more (>20) OCA transplants per year followed the least restrictive protocol. One-third of surgeons with the most restrictive protocol were more likely to change their protocol to be less restrictive over time, while none of those with the least restrictive protocol changed their protocol over time. Fifty-five percent of surgeons permitted return to full activity at 26 weeks, while 27% of surgeons lifted restrictions at 16 weeks.

Conclusion: Characterization of the spectrum of postoperative management practices after OCA transplantation provides a foundation for future investigations regarding patient outcomes and associated cost to establish best practice guidelines. Fundamentally, surgeons with more experience with this procedure tended to be more aggressive with their postoperative rehabilitation guidelines. Most commonly, rehabilitation provided for some degree of limited weightbearing; however, the spectrum also included immediate full weightbearing practices.

Keywords: cartilage; knee; osteochondral allograft; rehabilitation; weightbearing.

Figure 1.

(a) Surgeons’ years of experience in osteochondral allograft (OCA) transplantation. (b) Number of OCA transplants performed per year.

Figure 2.

Postoperative weightbearing protocols from most restrictive to least restrictive. FWB, full weightbearing; NWB, nonweightbearing; TTWB, toe-touch weightbearing; WBAT, weightbearing as tolerated.

Figure 3.

Number of weeks until unrestricted activity was allowed.

Figure 4.

Restrictiveness of initial rehabilitation protocol (most to least) as a function of number of osteochondral allograft (OCA) transplantations performed per year.

Figure 5.

Dependence of time to unrestricted activity (weeks) on initial rehabilitation protocol (most restrictive to least restrictive).

Figure 6.

Dependence of change in rehabilitation protocol (to less restrictive, no change, to more restrictive) on the initial rehabilitation approach (most restrictive to least restrictive).

Figure 7.

Reasons given for change in rehabilitation protocol by those respondents who changed their protocol over time. Many respondents chose more than 1 reason for the protocol change.

Figure 8.

Change in rehabilitation protocol (more restrictive, less restrictive, no change) as a function of experience with osteochondral allograft (OCA) transplantation (years).