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. 2025 Mar 17:70:88-94.
doi: 10.1016/j.jor.2025.03.040. eCollection 2025 Dec.

Mid-term failure rates, timing, and mechanisms for osteochondral allograft transplantation in the knee: Characterizing risk factors and identifying modifiable variables

James L Cook  1   2 , Kylee Rucinski  1   2 , Cory R Crecelius  1   2 , Clayton W Nuelle  1   2 , James P Stannard  1   2
Affiliations

Mid-term failure rates, timing, and mechanisms for osteochondral allograft transplantation in the knee: Characterizing risk factors and identifying modifiable variables

James L Cook et al. J Orthop. .

Abstract

Background: Knee osteochondral allograft transplantation (OCAT) is consistently successful, however, higher failure rates for multisurface and bipolar OCATs persist. Failure mechanisms have involved OCA erosion, delamination, degeneration, fracture, and/or fragmentation, and progression of joint disease, associated with older patient age, higher BMI, male sex, nicotine use, comorbidities, low chondrocyte viability, larger OCA volume, and bipolar OCAT.

Methods: Patient outcomes were prospectively followed after primary knee OCAT and analyzed for failure mechanisms categorized as OCA Cartilage, OCA Bone, Meniscus Allograft, Joint Disease Progression, or Unknown. Cases were included when OCAT was performed >5 years prior; all failure cases were included regardless of final follow-up (FFU) time. Failure and non-failure cohorts, and failure mechanism subcohorts, were compared based on patient sex, age, BMI, nicotine use, concurrent procedures, OCAT surgery type, and adherence.

Results: There were 186 cases in 184 patients (n = 112 males; mean age = 37.1 years; mean BMI = 28.5 kg/m2; mean FFU = 79 months). Initial failure rate was 23.1% (n = 43) with mechanisms attributed to OCA Bone (n = 15; 34.9%), Meniscus (n = 13; 30.2%), Joint Disease Progress (n = 11; 25.6%), OCA Cartilage (n = 2; 4.7%), or Unknown (n = 2; 4.7%). Risk factors included concurrent ligament reconstruction, ipsilateral osteotomy, and tibiofemoral bipolar + OCAT. However, older age and higher BMI, as well as potential barriers for post-operative adherence should be considered during patient selection.

Conclusions: Recent advances have mitigated key risk factors, such that reductions in knee OCAT failure rates with improvements in function, mental health, and quality of life have been more consistently realized.

Level of evidence: 2, prospective cohort study.

Keywords: Knee; Osteochondral allografts; Outcomes; Patient registry; Transplantation.

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Conflict of interest statement

The author group reports the following disclosures. James L Cook: reports the following disclosures: AANA: Research support AO Trauma: Research support Advanced Research Projects Agency for Health: Research support Arthrex, Inc: IP royalties; Paid consultant; Research support Boehringer Ingelheim: Paid consultant Collagen Matrix Inc: Paid consultant; Research support GE Healthcare: Research support Journal of Knee Surgery: Editorial or governing board Midwest Transplant Network: Board or committee member Musculoskeletal Transplant Foundation/MTF Biologics: Board or committee member; IP royalties; Research support National Institutes of Health (NIAMS & NICHD): Research support OREF: Research support PCORI: Research support Thieme: Publishing royalties, financial or material support Trupanion: Paid consultant U.S. Department of Defense: Research support Kylee Rucinski: reports the following disclosures:· National Institutes of Health: Research support Advanced Research Projects Agency for Health: Research support Cory Crecelius: nothing to disclose Clayton W Nuelle: reports the following disclosures:· AAOS: Board or committee member American Orthopaedic Society for Sports Medicine: Board or committee member AO Foundation: Other financial or material support· Arthrex, Inc: Paid presenter or speaker Arthroscopy: Editorial or governing board; Publishing royalties, financial or material support Arthroscopy Association of North America: Board or committee member Guidepoint Consulting: Paid consultant Vericel, Inc.: Paid presenter or speaker James P Stannard: reports the following disclosures:· Arthrex, Inc: Paid consultant; Research support DePuy, A Johnson & Johnson Company: Paid consultant Journal of Knee Surgery: Editorial or governing board· National Institutes of Health (NIAMS & NICHD): Research support Orthopedic Designs North America: Paid consultant Smith & Nephew: Paid consultant Thieme: Publishing royalties, financial or material support U.S. Department of Defense: Research support

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