Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation

Tírico, Luis Eduardo Passarelli; McCauley, Julie C.; Pulido, Pamela A.; Bugbee, William D.

doi:10.1177/0363546517746106

Cited by 42 publications

(42 citation statements)

References 22 publications

(29 reference statements)

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“…In fact, none of the patient- or lesion-associated parameters contributed significantly to the regression model of the KOOS Pain. This finding is in accordance with the results of a recently published study by Tirico and colleagues 36 in which the authors concluded that the size of the lesion had no influence on clinical outcomes in patients after OCA transplantation. While showing that patient sex has significant predictive value for postoperative KOOS Sport/Recreation, Tegner, and Lysholm scores, this study, in contrast to previous studies, 1 , 12 , 22 , 27 did not find any predictive value of patient age, BMI, OCA size, or patellar lesions for clinical outcomes at a minimum follow-up of 24 months.…”

Section: Discussionsupporting

confidence: 92%

Mental Health Has No Predictive Association With Self-Assessed Knee Outcome Scores in Patients After Osteochondral Allograft Transplantation of the Knee

Ackermann

Ogura

Duerr

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Patient-reported outcome (PRO) measures are progressively utilized as evaluation tools in preoperative and postoperative assessments in orthopaedic practice. Identifying the potential utility of psychosocial factors to predict patient-reported pain and functional outcomes is of increasing interest to determine which patients will derive the greatest benefit from surgical treatment.Purpose/Hypothesis:The purpose of this study was to determine potential predictive associations between the preoperative 12-Item Short Form Health Survey Mental Component Summary (SF-12 MCS) score, patient characteristics or osteochondral allograft (OCA) morphology, and PROs in patients who underwent OCA transplantation. We hypothesized that poor preoperative mental health is associated with diminished PROs at final follow-up.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 67 patients with a mean follow-up of 2.7 ± 1.0 years (range, 2-6 years) with complete preoperative and at least 24-month postoperative SF-12 MCS, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores were included in this study. Pearson correlation coefficients and linear regression models were used to distinguish associations between age, sex, smoking status, body mass index, workers’ compensation, previous surgery, concomitant surgery, number of grafts, defect location, total graft size, SF-12 MCS score, and postoperative PRO scores as well as their improvement from baseline (delta).Results:The SF-12 MCS showed significant correlation with the KOOS Activities of Daily Living subscale (P = .015), KOOS Sport/Recreation subscale (P = .024), and IKDC (P = .039). In the multivariable linear regression models, the SF-12 MCS had no predictive association with any PRO measure. Patient sex contributed significantly to the final regression models of the KOOS Sport/Recreation (P = .042), Tegner score (P = .024), and Lysholm score (P = .031). The SF-12 MCS showed no bivariate correlation with changes in any PRO score (delta) (P > .05).Conclusion:Preoperative mental health status did not predict perceived functional outcomes as assessed by PRO measures at final follow-up. Female sex was negatively correlated with KOOS Sport/Recreation, Tegner, and Lysholm scores.

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Section: Discussionsupporting

confidence: 92%

Mental Health Has No Predictive Association With Self-Assessed Knee Outcome Scores in Patients After Osteochondral Allograft Transplantation of the Knee

Ackermann

Ogura

Duerr

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…Tirico et al [ 62 ] examined results of OCA by size of condylar defect in 156 knees from 1998 to 2014. The average graft area was 6.4 cm 2 , range 2.3–11.5 cm 2 .…”

Section: Evidence: Primary Studiesmentioning

confidence: 99%

The cost-effectiveness of osteochondral allograft transplantation in the knee

Mistry

Metcalfe

Smith

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. They are used to repair combined defects of articular cartilage and bone. Such defects often occur in people far too young to have knee arthroplasty, for whom the main alternative to OCA is conservative symptomatic care, which will not prevent development of osteoarthritis. The aim of this report was to assess the cost-effectiveness of osteochondral allograft transplantation in the knee. Methods Systematic review of evidence on clinical effectiveness and economic modelling. Results The evidence on osteochondral allograft transplantation comes from observational studies, but often based on good quality prospective registries of all patients having such surgery. Without controlled trials, it was necessary to use historical cohorts to assess the effect of osteochondral grafts. There is good evidence that OCA are clinically effective with a high graft survival rate over 20 years. If an OCA graft fails, there is some evidence that revision with a second OCA is also effective, though less so than primary OCA. Economic modelling showed that osteochondral allograft transplantation was highly cost-effective, with costs per quality adjusted life year much lower than many other treatments considered cost effective. Conclusions Osteochondral allograft transplantation appears highly cost-effective though the cost per quality adjusted life year varies according to the widely varying costs of allografts. Based on one small study, revision OCA also appears very cost-effective, but more evidence is needed. Level of evidence II. Electronic supplementary material The online version of this article (10.1007/s00167-019-05392-8) contains supplementary material, which is available to authorized users.

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“… 21 In a recent study, Tírico et al reported that the size of the lesion does not influence the outcomes of OCA for isolated femoral defects. 75 …”

Section: Complicationsmentioning

confidence: 99%

Large Osteochondral Allografts of the Knee: Surgical Technique and Indications

Pisanu

Cottino

Rosso

et al. 2018

Joints

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Large osteochondral allograft (OCA) transplant has become a valid alternative to restore articular surface in challenging articular lesions in young and active patients, either in primary or in revision procedures. Several studies support the effectiveness and safety of OCA, but costs and graft availability limit their use. The indications are the treatment of symptomatic full-thickness cartilage lesions greater than 3 cm 2 , deep lesions with subchondral damage, or revision procedures when a previous treatment has failed. The goal of the transplant is to restore the articular surface with a biological implant, allow return to daily/sports activities, relieve symptoms, and delay knee arthroplasty. Grafts can be fresh, fresh-frozen, or cryopreserved; these different storage procedures significantly affect cell viability, immunogenicity, and duration of the storage. Dowel and shell technique are the two most commonly used procedures for OCA transplantation. While most cartilage lesions can be treated with the dowel technique, large and/or geometrically irregular lesions should be treated with the shell technique. OCA transplantation for the knee has demonstrated reliable mid- to long-term results in terms of graft survival and patient satisfaction. Best results are reported: in unipolar lesions, in patients younger than 30 years, in traumatic lesions and when the treatment is performed within 12 months from the onset of symptoms.

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Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation

Abstract: The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee.

Cited by 42 publications

References 22 publications

Mental Health Has No Predictive Association With Self-Assessed Knee Outcome Scores in Patients After Osteochondral Allograft Transplantation of the Knee

Mental Health Has No Predictive Association With Self-Assessed Knee Outcome Scores in Patients After Osteochondral Allograft Transplantation of the Knee

The cost-effectiveness of osteochondral allograft transplantation in the knee

Large Osteochondral Allografts of the Knee: Surgical Technique and Indications

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