Patient Factors, Donor Age, and Graft Storage Duration Affect Osteochondral Allograft Outcomes in Knees with or without Comorbidities

Abstract

Limited data exists defining preoperative variables that affect outcomes after osteochondral allograft transplantation (OAT) in the knee. In this retrospective study, we examined 75 patients who underwent OAT for large (≥2 cm) grade IV cartilage defects in the femoral condyle. Patient variables evaluated included the following: smoking, workers compensation, body mass index (BMI), pre-injury activity level, number, and the type of co-morbidities in the operated knee, lesion location and number of grafts placed. OCA donor age and graft storage duration from procurement were also evaluated. Preoperative and postoperative visual analogue scale (VAS) pain scores were the primary outcome measure. Overall, 53 patients (71%) had successful outcomes, with 81% of patients without co-morbidities having successful outcomes. Active patients were significantly ( = 0.023) more likely to have a successful outcome than low activity patients. Patients with BMI <35 were 4 times more likely to have a successful outcome ( = 0.01). There were no significant differences based on donor age. Patients with transplanted grafts stored >28 days were significantly ( = 0.048) and 2.6 times more likely to have an unsuccessful outcome. This study provides new evidence for preoperative patient factors and graft variables that may influence the overall outcome after osteochondral transplantation in the knee.

Biologic Joint Repair Strategies: The Mizzou BioJoint Story

“…Data from our laboratory revealed that mean chondrocyte viability in SOC OCAs (n ¼ 24, storage days ranging from 16 to 21 days) obtained from 2 tissue banks and designated for transplantation into patients was only 62% (unpublished data). Clinical data from 75 patients who underwent OCA transplantation at our center for treatment of large (>2 cm 2 ) articular defects of the femoral condyle showed that graft storage of >28 days at 4 C prior to implantation was associated with a significantly and 2.6 times lower likelihood of a successful outcome (Nuelle et al 2017), which matches data from others (LaPrade et al 2009). The other major factors to alter clinical outcomes after OCA transplantation include patients' preoperative activity levels, body mass index (Nuelle et al 2017), and surgical techniques for graft creation and implantation.…”

“…Clinical data from 75 patients who underwent OCA transplantation at our center for treatment of large (>2 cm 2 ) articular defects of the femoral condyle showed that graft storage of >28 days at 4 C prior to implantation was associated with a significantly and 2.6 times lower likelihood of a successful outcome (Nuelle et al 2017), which matches data from others (LaPrade et al 2009). The other major factors to alter clinical outcomes after OCA transplantation include patients' preoperative activity levels, body mass index (Nuelle et al 2017), and surgical techniques for graft creation and implantation. Therefore, our team of orthopedic clinicians and scientists designed and implemented a comparative translational research approach to address quantity, quality, and technique limitations for successful OCA transplantation in canine and human patients.…”

Osteochondral Allograft Transplantation and Osteochondral Autograft Transfer

“…15 The effect of BMI on OCA survival is unclear and demonstrates mixed results at short to intermediate term follow-up. 19,20 In other studies, age over 50 years old, symptom duration greater than D 3 3 X X1 year have also been identified to be associated with inferior outcomes. [21][22][23] The location of the chondral defect, extent of chondral disease, and concomitant pathology may also affect the outcome of OCA.…”

Metabolic responses of osteochondral allografts to re‐warming

“…A safe and effective surgical treatment for large (>2.5 cm 2 ) articular defects is osteochondral allograft (OCA) transplantation . Fresh OCA transplantation has been associated with 88% return to sport and greater than 75% 10‐year survival rates for treatment of large femoral condyle lesions . However, reoperation and failure rates average 30.2% and 18.2%, respectively, which suggests methods for addressing current limitations are needed.…”

“…One of the major causes of failure for OCA transplantation is loss of essential chondrocyte viability during the preservation and storage period of tissue prior to eligible patient matching and transplantation. Essential chondrocyte viability for OCAs is considered to be at least 70% of day 0 viable chondrocyte density with successful preclinical and clinical outcomes strongly corresponding to this key metric for graft quality . While chondrocyte viability at time of OCA transplantation has been reported to be a contributing factor to successful outcomes, it is also possible that metabolic responses of the OCA in transitioning from storage temperature to body temperature may contribute to mechanisms causing failure.…”