Efficacy of Fresh Osteochondral Allograft Transplantation in the Knee for Adults 40 Years and Older

Abstract

Background: Osteochondral allograft (OCA) transplantation has become a standard therapy for cartilage restoration in young patients.

Purpose: To determine the efficacy of fresh OCA transplantation for focal cartilage lesions in patients aged ≥40 years compared with a group of patients aged ≤39 years.

Study design: Cohort study; Level of evidence, 3.

Methods: A database was used to identify patients who underwent fresh OCA transplantation in the knee in a single-surgeon practice over a 10-year period and who completed baseline patient-reported outcome (PRO) questionnaires, including the International Knee Documentation Committee (IKDC); Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of Pain, Symptoms, Activities of Daily Living, Quality of Life (QOL), and Sports & Recreation; and Veterans RAND 12-Item Health Survey (VR-12). Patients who completed the same PRO measures at a minimum 12-month follow-up were categorized into 2 groups based on age at surgery and were observed longitudinally. Mixed-model regression was used to predict longitudinal growth curves for each PRO score while controlling for confounding patient and surgical variables.

Results: The study group consisted of 38 patients with a mean age of 52.32 years (range, 40-69 years) and mean final follow-up of 44.47 ± 24.32 months. The control group consisted of 42 patients with a mean age of 27.19 years (range, 15-39 years) and mean final follow-up of 33.75 ± 19.53 months. A statistically significant improvement from baseline to final follow-up was seen for the IKDC score and all 5 KOOS subscores in both the study and the control groups (P < .01 in 10 of 12 comparisons and P < .05 for the other 2 comparisons). Maximum improvements were seen in the KOOS QOL and Sports & Recreation subscores for both groups. There was no statistically significant difference between groups in the change from baseline to final follow-up or in differences at any time point in model-based longitudinal projections for any PRO score through 5 years.

Conclusion: There was a significant improvement of outcomes for both groups, with no statistically significant difference between groups over longitudinal follow-up. The efficacy of fresh OCA transplantation in adults aged ≥40 years with a focal chondral lesion and without osteoarthritis is similar to that of younger adults, and benefits are greatest for the KOOS QOL and Sports & Recreation subscales, which reflect functional outcomes.

Keywords: age; articular cartilage; knee; osteochondral allograft transplantation; patient-reported outcomes.

Figure 1.

(A) Representative longitudinal model-based regression for the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QOL) (mean [95% CI]), accounting for potential confounding factors, including offset of age at surgery from the mean age for the group (ie, age offset from 27.19 years in the ≤39-year group and from 52.32 years in the ≥40-year group), body mass index at surgery, sex, size of the lesion, prior surgery, and number of grafts. (B) Representative difference between growth trajectories for the younger and older patient groups.

Figure A1.

Longitudinal model-based regression for each patient-reported outcome measure (mean [95% CI]), accounting for potential confounding factors, including offset of age at surgery from the mean age for the group (ie, age offset from 27.19 years in the ≤39-year group and from 52.32 years in the ≥40-year group), body mass index at surgery, sex, size of the lesion, prior surgery, and number of grafts. IKDC, International Knee Documentation Committee; KOOSADL, Knee injury and Osteoarthritis Outcome Score Activities of Daily Living subscore; KOOSPAIN, Knee injury and Osteoarthritis Outcome Score Pain subscore; KOOSQOL, Knee injury and Osteoarthritis Outcome Score Quality of Life subscore; KOOSSPORT, Knee injury and Osteoarthritis Outcome Score Sports & Recreation subscore; KOOSSYMP, Knee injury and Osteoarthritis Outcome Score Symptoms subscore; VR12MENT, Veterans RAND 12-Item Health Survey (VR-12) mental score; VR12PHYS, VR-12 physical score.