Abstract
Introduction
Young, high-demand patients with large post-traumatic tibial osteochondral defects are difficult to treat. Fresh osteochondral allografting is a joint-preserving treatment option that is well-established for such defects. Our objectives were to investigate the long-term graft survivorships, functional outcomes and associated complications for this technique.
Methods
We prospectively recruited patients who had received fresh osteochondral allografts for post-traumatic tibial plateau defects over 3cm in diameter and 1cm in depth with a minimum of 5 years follow-up. The grafts were retrieved within 24 hours, stored in cefalozolin/bacitracin solution at 4°C, non-irradiated and used within 72 hours. Tissue matching was not performed but joints were matched for size and morphology. Realignment osteotomies were performed for malaligned limbs. The Modified Hospital for Knee Surgery Scoring System (MHKSS) was used for functional outcome measure. Kaplan-Meier survivorship analysis was performed with conversion to TKR as end point for graft failure.
Results
Of 132 patients identified, 14 were lost to follow-up and 37 had less than 5 years follow-up, leaving 81 patients. There were 29 conversions to TKR at a mean of 12 (3-23) years post-operatively. The remaining 52 patients had a mean MHKSS score of 83 (49-100) with a mean follow-up of 11.7 (5-34) years. The Kaplan-Meier graft survivorships were 94% at 5 years (SE 2.7), 83% at 10 years (SE 4.6), 62% at 15 years (SE 7.4) and 45% at 20 years (SE 8.5). Associated complications included infection (1.2%) treated by 2-stage TKR, graft collapse (8.6%) treated by TKR, osteotomy and conservatively and knee pain relieved by hardware removal (7.4%).
Conclusion
Fresh osteochondral allograft is a successful treatment option for large post-traumatic tibial osteochondral defects in young patients, with satisfactory long term survivorships and functional outcomes with acceptable complication rates.
