Long-term Outcomes After Osteochondral Allograft: A Systematic Review at Long-term Follow-up of 12.3 Years

Andrew T. Assenmacher, Ayoosh Pareek, Patrick J. Reardon, Jeffrey A. Macalena, Michael J. Stuart, Aaron J. Krych

Research output: Contribution to journalReview articlepeer-review

127 Scopus citations


Purpose To (1) evaluate long-term outcomes of osteochondral allograft (OCA) with regard to clinical outcome scores, reoperation and failure rates, and (2) examine if certain factors predispose patients to worse outcomes. Methods A comprehensive review was performed with specific inclusion criteria for studies with long-term outcomes after OCA. Studies reported on patient clinical scores such as Hospital for Special Surgery score, Knee Society Score (knee and function score), and Lysholm score. Reoperation and failure rates were recorded for each study. Modified Coleman Methodology Scores assessed study methodological quality. Results Five studies with a total of 291 patients (55% male, 45% female) and average age of 34.8 years (range, 15 to 69 years) were included. Of all lesions, 67% were on the femoral condyles, 29% on the tibial plateau, and 4% were patellofemoral. All scores (Knee Society Function Score, Knee Society Knee Score, and Lysholm score) have significant mean improvement from preoperative to final follow-up. The mean postoperative Hospital for Special Surgery score was 84.1. The mean failure rate was 25% at 12.3 years with a reoperation rate of 36%. A total of 72% of the failures were conversion to total (68%) or unicompartmental (4%) knee arthroplasty and 28% involved graft removal, graft fixation, and graft revision. Patellofemoral lesions (83%) had a significantly higher reoperation rate than lesions involving the tibial plateau or the femoral condyles (34%, P =.01). Conclusions Overall, OCA demonstrated significant improvements in clinical outcome scores and good durability with successful outcomes in 75% of the patients at 12.3 years after surgery. Patellofemoral lesions are associated with decreased clinical improvement and more frequent reoperations. The orthopaedic literature is limited by heterogeneity in surgical technique, lesion and patient characteristics, and reporting of nonstandardized outcome measures. Level of Evidence Level IV, systematic review of Level II and IV studies.

Original languageEnglish (US)
Pages (from-to)2160-2168
Number of pages9
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Issue number10
StatePublished - Oct 1 2016

Bibliographical note

Funding Information:
The authors report the following potential conflicts of interest or sources of funding: J.A.M. receives support from Arthrex and Smith & Nephew. M.J.S. receives support from Arthrex and Stryker. He is also member of the editorial board for the American Journal of Sports Medicine. A.J.K. receives support from Arthrex, Arthritis Foundation, and Histogenics.

Publisher Copyright:
© 2016 Arthroscopy Association of North America

Copyright 2017 Elsevier B.V., All rights reserved.


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