Systematic Review
Outcomes of Osteochondral Allograft Transplantation in the Knee

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Purpose

The objectives of this study were (1) to conduct a systematic review of clinical outcomes after osteochondral allograft transplantation in the knee and (2) to identify patient-, defect-, and graft-specific prognostic factors.

Methods

We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials. Studies that evaluated clinical outcomes in adult patients after osteochondral allograft transplantation for chondral defects in the knee were included. Pooled analyses for pertinent continuous and dichotomous variables were performed where appropriate.

Results

There were 19 eligible studies resulting in a total of 644 knees with a mean follow-up of 58 months (range, 19 to 120 months). The overall follow-up rate was 93% (595 of 644). The mean age was 37 years (range, 20 to 62 years), and 303 patients (63%) were men. The methods of procurement and storage time included fresh (61%), prolonged fresh (24%), and fresh frozen (15%). With regard to etiology, the most common indications for transplantation included post-traumatic (38%), osteochondritis dissecans (30%), osteonecrosis from all causes (12%), and idiopathic (11%). Forty-six percent of patients had concomitant procedures, and the mean defect size across studies was 6.3 cm2. The overall satisfaction rate was 86%. Sixty-five percent of patients (72 of 110) showed little to no arthritis at final follow-up. The reported short-term complication rate was 2.4%, and the overall failure rate was 18%. Heterogeneity in functional outcome measures precluded a meta-analysis; a qualitative synthesis allowed for the identification of several positive and negative prognostic factors.

Conclusions

Osteochondral allograft transplantation for focal and diffuse (single-compartment) chondral defects results in predictably favorable outcomes and high satisfaction rates at intermediate follow-up. Patients with osteochondritis dissecans and traumatic and idiopathic etiologies have more favorable outcomes, as do younger patients with unipolar lesions and short symptom duration. Future studies should include comparative control groups and use established outcome instruments that will allow for pooling of data across studies.

Level of Evidence

Level IV, systematic review of Level IV studies.

Section snippets

Literature Search

With the aid of an experienced librarian, we searched PubMed (1948 to week 2 of July 2012), Medline (1946 to week 1 of July 2102), EMBASE (1947 to week 27 of 2012), and the Cochrane Central Register of Controlled Trials (to week 2 of July 2012). This was performed using the following key words: (knee) AND (cartilage OR chondral OR osteochondral) AND (transplant*) AND (allograft). General search terms were used to prevent the possibility of missing relevant studies. The references of all

Results

The search results are summarized in Fig 1. Approximately 144 articles from Medline, 168 articles from EMBASE, 3 articles from the Cochrane Central Register of Controlled Trials, and 389 articles from PubMed were cited over a 64-year period (1948 to 2012), for a total of 704 articles. After duplicates were removed, 441 articles remained. After titles were reviewed and excluded for the following, 186 articles remained: sites unrelated to the knee (e.g., shoulder, talus, or hip), isolated

Discussion

Since Gross et al.29 popularized the concept of osteochondral allograft transplantation in the mid 1970s, there has been increasing attention on this cartilage restoration technique for managing patients with both focal and diffuse (single-compartment) osteochondral defects in the knee.30 Our systematic review involved a qualitative synthesis of 19 Level IV case series over a period of approximately 30 years. Given the heterogeneity of clinical outcome measures used across studies and over

Conclusions

Osteochondral allograft transplantation for focal and diffuse (single-compartment) chondral defects results in predictably favorable outcomes and high satisfaction rates at intermediate follow-up. Patients with OCD, traumatic and idiopathic etiologies have more favorable outcomes, as do younger patients with unipolar lesions and short symptom duration. Future studies should include comparative control groups and use established outcome instruments that will allow for pooling of data across

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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