Does Treatment of the Tibia Matter in Bipolar Chondral Defects of the Knee? Clinical Outcomes with Greater Than 2 Years Follow-up.

PURPOSE: To compare the osteochondral allograft (OCA) outcomes of bipolar defects with isolated femoral defects and to investigate the optimal treatment of bipolar defects by comparing femoral OCA with tibial debridement to femoral OCA and tibial microfracture. METHODS: A series of patients with 2-year follow-up from March 2004 to September 2015 after femoral OCA for bipolar chondral defects was identified. Group 1 contained patients with tibial defects treated with debridement and group 2 contained patients with microfractured tibial defects. A third group (group 3) with isolated femoral defects treated with OCA was identified and matched by gender, body mass index (BMI), laterality, and OCA size to groups 1 and 2. Patient-specific, defect-specific, intraoperative, and postoperative data including patient-reported outcomes were collected on all patients. The study groups were compared using analyses of variance, paired sample t tests, and χ-square analyses. RESULTS: Thirty-six patients who had femoral OCA for bipolar lesions were identified with 20 patients in group 1 and 16 patients in group 2. Group 3 had 20 patients. There were no differences between the 3 groups in terms of gender (P = .616), BMI (P = .271), number of previous surgeries (P = .451), femoral or tibial defect size (P = .296), and OCA size (P = .981). Preoperative to postoperative patient-reported clinical outcomes (PROs) revealed statistical and clinically meaningful improvement in all 3 groups, but did not differ between groups. Patient-specific and defect-specific factors did not correlate with PROs. The graft survivorship for group 1 was 85% at 4.5 years, 100% for group 2 at 2.5 years, and 95% for group 3 at 3.8 years. CONCLUSIONS: Regardless of tibial treatment, patients with bipolar defects treated with femoral OCA have clinically meaningful improvements in PROs and excellent graft survivorship comparable to isolated femoral OCAs at more than 2 years. LEVEL OF EVIDENCE: Level III, case-control study.

Clinical Outcomes of Osteochondral Allograft Transplantation for Secondary Treatment of Osteochondritis Dissecans of the Knee in Skeletally Mature Patients.

PURPOSE: To report clinical outcomes of osteochondral allograft transplantation (OCA) for skeletally mature patients with osteochondritis dissecans (OCD) lesions of the knee in whom prior surgical intervention has failed, and to describe return-to-sport (RTS) rates and any predictive demographic or preoperative variables associated with a higher likelihood to RTS. METHODS: Patients who underwent OCA by a single surgeon (B.J.C.) between October 1, 2002, and November 30, 2014, for a diagnosis of OCD with a minimum of 2 years' follow-up were included. Demographic, surgical history, operative, and postoperative data points including RTS were analyzed for all patients collectively, with subanalysis to identify any demographic and operative variables associated with the ability to RTS. Failure was defined as revision OCA, gross appearance of graft failure on second-look arthroscopy, or conversion to arthroplasty. RESULTS: We identified 41 consecutive patients (43 knees), with 37 patients (39 knees, comprising 26 male and 13 female knees) available for clinical follow-up at an average of 7.29 ± 3.30 years. There was significant improvement (P < .05) in all patient-reported outcome scores, with the exception of the Short Form 12 mental subscale (P = .910). Most patients (81.6%) reported being either mostly satisfied or completely satisfied at final follow-up. Of patients self-identifying as athletes preoperatively (n = 22), 18 (81.8%) achieved RTS at an average of 14.0 ± 8.7 months. Athletes with failure to RTS had a significantly greater body mass index (RTS, 24.68 ± 3.67; no RTS, 27.82 ± 0.69; P = .005). Subsequent surgery was performed in 14 patients (35.9%), and primary OCA failed in 2 patients at an average of 6.2 ± 3.8 years. CONCLUSIONS: OCA is a successful secondary surgical treatment for OCD of the knee in skeletally mature patients and leads to clinically meaningful improvements in patient-reported outcome scores and high patient satisfaction and RTS rates in low-level athletes at an average of 7.29 years' follow-up. Athletes with failure to RTS were found to have a significantly higher body mass index. Although reoperation may be common after OCA (35.9%), the failure rate is low (5.1%) in this series. LEVEL OF EVIDENCE: Level IV, case series.

5 Points on Meniscal Allograft Transplantation.

Meniscus allograft transplantation (MAT) has yielded excellent long-term functional outcomes when performed in properly indicated patients. When evaluating a patient for potential MAT, it is imperative to evaluate past medical history and past surgical procedures. The ideal MAT candidate is a chronologically and physiologically young patient (<50 years) with symptomatic meniscal deficiency. Existing pathology in the knee needs to be carefully considered and issues such as malalignment, cartilage defects, and/or ligamentous instability may require a staged or concomitant procedure. Once an ideal candidate is identified, graft selection and preparation are critical steps to ensure a proper fit and long-term viability of the meniscus. When selecting the graft, accurate measurements must be taken, and this is most commonly performed using plain radiographs for this. Graft fixation can be accomplished by placing vertical mattress sutures and tying those down with the knee in full extension.