Comparison of Revision and Primary Osteochondral Allograft Transplantation at Midterm Follow-up: Patient Reported Outcomes, Survivorship, and Reoperation Rates

Background: Previous studies have observed promising short-term outcomes after revision osteochondral allograft (OCA) transplantation. However, few studies have examined midterm outcomes after revision OCA transplantation.Purpose: To examine midterm outcomes after revision OCA transplantation of the femoral condyle and evaluate reoperation and survivorship compared with a matched cohort of patients who underwent primary OCA transplantation.Study Design: Cohort study; Level of evidence, 3.Methods: A retrospective review of prospectively collected data identified patients undergoing revision OCA transplantation to the femoral condyle between 1999 and 2018 (minimum 5-year follow-up). A 1:2 cohort of patients who underwent revision OCA transplantation to patients who underwent primary OCA transplantation, matched by defect size, age, sex, and body mass index, was created. Patient-reported outcome measures and the incidence of reoperations or graft failures were collected. Failure was defined as subchondral collapse of the OCA transplantation as confirmed via second-look arthroscopy, revision OCA transplantation, or conversion to knee arthroplasty.Results: Fifteen patients who underwent revision OCA transplantation were matched to 30 patients who underwent primary OCA transplantation. The mean follow-up in the revision OCA transplantation group was 9.3 +/- 3.0 years (range, 5.1-14.7 years), with a mean age of 31.4 +/- 10.0 years (range, 19.9-52.7 years) and a mean body mass index of 25.9 +/- 3.4 (range, 20.8-30.4). Revision OCA transplantation was performed to the lateral condyle in 53% of cases (8/15). A concomitant procedure was performed in 73% of patients (11/15), most commonly involving meniscal allograft transplantation (73% [8/11]), followed by realignment osteotomy (27% [3/11]). The Patient Acceptable Symptom State was achieved by a majority of patients who underwent revision OCA transplantation for all patient-reported outcome measures examined (International Knee Documentation Committee, 70%; Lysholm, 83%; Knee injury and Osteoarthritis Outcome Score [KOOS] Pain, 100%; KOOS Symptoms, 70%, KOOS Sport, 90%; KOOS Activities of Daily Living, 80%; KOOS Quality of Life, 80%), and there was no difference in the proportion of patients the Patient Acceptable Symptom State when compared with those undergoing primary OCA transplantation (P >= .070) (see Table 3). Eight patients (53%) underwent revision OCA transplantation reoperation at a mean time of 3.9 +/- 3.7 years (range, 0.6-11.2 years). Failures were observed in 20% (3/15) of patients who underwent revision OCA transplantation at a mean of 4.3 +/- 1.9 years (range, 1.7-6.4 years). Graft survivorship free from reoperation (P = .905; revision 53% [8/15], primary 43% [13/30]) and failure (P = .577; revision 13% [2/15], primary 20% [6/30]) was not significantly different between revision and primary groups.Conclusion: High rates of Patient Acceptable Symptom State achievement were observed after revision OCA transplantation. Although limited by sample size, no significant difference in graft survivorship free from failure was appreciated between revision versus primary OCA transplantation groups.