Initial Outcomes After Unicompartmental Tibiofemoral Bipolar Osteochondral and Meniscal Allograft Transplantation in the Knee Using MOPS-Preserved Fresh (Viable) Tissues

Abstract

Background: Unicompartmental tibiofemoral bipolar osteochondral allograft transplantation (OCAT) with meniscal allograft transplantation (MAT) has not historically been associated with consistently successful outcomes for treatment of knee articular cartilage defects with meniscal deficiency. Hypothesis: Primary OCAT and MAT using fresh tissues will be associated with successful short-term outcomes based on statistically significant and clinically meaningful improvements in pain and function in the majority of patients. Study Design: Case series; Level of evidence, 4. Methods: Patients were prospectively enrolled into a registry for outcomes after OCAT and MAT. Patients included those who underwent primary OCAT and MAT using Missouri Osteochondral Preservation System (MOPS)–preserved allografts for treatment of large bipolar tibiofemoral articular cartilage defects with meniscal deficiency and had a minimum of 2-year follow-up data. Results: A total of 76 patients (n = 52 male; 68%) met inclusion criteria (mean follow-up, 52 months). The mean age was 41.1 years (range, 15-69 years), and the mean body mass index was 28.9 (range, 17-46); 48 patients underwent another OCAT in addition to the unicompartmental bipolar tibiofemoral OCAT and MAT; 23 patients (30.3%) were documented to be nonadherent to the prescribed postoperative restriction and rehabilitation protocol. The initial success rate (>2 years) was 77.6%, with 8 patients (10.5%) undergoing revision and 9 (11.8%) converting to arthroplasty. Variables associated with an increased risk for treatment failure (revision or arthroplasty) included ipsilateral osteotomy ( P = .046; odds ratio [OR] = 3.3), ipsilateral concurrent procedure ( P = .0057; OR = 5.5), and nonadherence ( P = .0009; OR = 7.2). None of the patients undergoing revision surgery required arthroplasty at the time of data analysis such that the overall success rate for primary and revision unicompartmental bipolar OCA plus MAT was 88.2%. There were statistically significant ( P < .0001) and clinically important improvements for all patient-reported outcomes at each annual follow-up time point. Conclusion: Unicompartmental tibiofemoral bipolar OCAT and MAT can result in successful short-term outcomes (2-6 years) and satisfaction in the majority of patients (78%). Primary MOPS-preserved OCAT with MAT for treatment of femoral condyle and tibial plateau articular cartilage defects with concurrent meniscal deficiency was associated with statistically significant and clinically meaningful improvements in patient-reported measures of pain and function.

Accelerated versus Standard Rehabilitation after Meniscus Allograft Transplantation in the Knee

“…These protocol differences were implemented based on previously reported results associated with early weightbearing after MAT 7 in conjunction with evidence-based advances in allograft preservation methods, 7,21,28 MAT fixation techniques, 7,[24][25][26]28 and patient management strategies 7,12,21,30 that directly or indirectly mitigate known mechanisms of MAT failure. In the present study, these differences were associated with patient safety based on a lower treatment failure rate, better patient adherence to the prescribed postoperative rehabilitation protocol, and greater improvement in PROMs after MAT when compared with the standard rehabilitation cohort.…”

“…In previous studies, prescribed rehabilitation after MAT has typically included limited weightbearing and restricted knee range of motion for a minimum of 4-6 weeks, progressive return to full weight-bearing and ROM by 6-12 weeks post-operatively, and return to athletic activities no sooner than 9 months after MAT. 5,[13][14][15][16]22 The key differences for the accelerated rehabilitation protocol used in the present study included:  Earlier initiation and faster progression of weightbearing  < 90-degrees of flexion extended by 1 month  Earlier return to straight line jogging and release to full plyometric, cutting, and jumping activities These protocol differences were implemented based on previously reported results associated with early weightbearing after MAT 7 in conjunction with evidence-based advances in allograft preservation methods 7,21,28 , MAT fixation techniques 7,[24][25][26]28 , and patient management strategies 7,12,21,30 that directly or indirectly mitigate known mechanisms of MAT failure. In the This article is protected by copyright.…”

“…5,[13][14][15][16][17][18] However, nonadherence is common and can be associated with undesirable outcomes and patient dissatisfaction. 12,[19][20][21] While no evidence for an optimal management protocol following MAT has been established, the majority of those outlined in the peer-reviewed literature advocate for limited weight-bearing and restricted knee range of motion (ROM) for 4 to 6 weeks, followed by a progressive return to full weight-bearing and full ROM by 6 to 12 weeks postoperatively. 9,11,13,22 Recommended timing for return to athletic activities varies widely, but is typically not prior to 9 months after MAT.…”

Multi-Surface Cartilage Defects about the Knee Treated with Cartilage Restoration Procedures Show Good Outcomes and Survivorship at Minimum 2-Year Follow-Up

“…However, despite numerous recent advances in the field of cartilage restoration, the short-term, midterm, and longterm results of these procedures remain mixed in the literature. [2][3][4][5] Although the incidence of multi-surface grade-IV chondral or osteochondral defects about the knee has yet to be elucidated, it is not uncommon for patients to present with grade-IV chondral or osteochondral defects on multiple surfaces of a joint, particularly in joints such as the knee, that experience high loads during weight-bearing. These lesions can be severely debilitating, and patients with focal chondral defects can have an impairment in their quality of life to the same degree as a patient with end-stage knee osteoarthritis.…”

Influence of Concomitant Meniscal Allograft Transplantation on Midterm Outcomes After Osteochondral Allograft Transplantation: A Comparative Matched-Pair Analysis

“…45 Because of this challenging combination of pathologies and with recent advances in tissue preservation, transplantation techniques, and postoperative rehabilitation techniques, concurrent OCAT 1 MAT is considered a biologic joint restoration option in these common and complex cases. 5,6,8,43,44 Taken together, OCAT 1 MAT can be considered symbiotic procedures given a complementary spectrum of indications and reciprocal contraindications. 14 However, few outcomes of concomitant OCAT 1 MAT have been reported in the literature, and the effects of concomitant MAT on outcomes of OCAT as a strategy for knee joint preservation have rarely been discussed.…”