Abstract
Objectives:
To evaluate whether donor and recipient factors such as donor age, sex mismatch, and time from death to graft implantation affect graft survival following knee osteochondral allograft (OCA) transplantation.
Methods:
Patients undergoing OCA transplantation in the knee from 2003-2016 were prospectively followed. Inclusion criteria consisted of primary OCA transplantation and minimum 2-year follow-up. Patient and donor demographic data were collected. Patients were evaluated for failure, defined as (1) subchondral collapse of the OCA as confirmed on postoperative MRI scans, or via second-look arthroscopy in the setting of persistent symptoms, (2) removal or revision of the primary OCA, or (3) conversion to arthroplasty. Multivariate cox proportional hazards modelling was utilized to evaluate associations between demographic variables and graft failure.
Results:
A total of 220 patients undergoing OCA transplantation met inclusion criteria and were followed for a mean of 5.9 ± 2.8 years (range: 2.0 – 16.3, Table 1). The most common concomitant procedure was meniscal allograft transplantation (Table 2). A mismatch in donor and recipient sex was present for significantly more female patients (65%) than male patients (10%, p < 0.001). The mean days from donor death until implantation was 24.1 days (range: 15 – 28). Thirty-nine patients (18%) met criteria for graft failure at a mean of 4.3 ± 3.2 years (Table 3). Log-rank testing did not determine a difference in survivability between those with a donor-recipient sex mismatch for female or male patients (P = .130 and .831, respectively). Upon multivariate cox regression, no association existed between donor-recipient sex mismatch or time from donor death to implantation with graft survival. Of note, increased donor age was associated with failure for female patients (P = .020) and trended towards significance in males (P = .166).
Conclusions:
OCA graft survival appears to be most strongly influenced by donor age. In contrast to previous historic data, no substantial survival difference was noted for sex mismatched donors and recipients. These data can help inform graft selection and outcome optimization following OCA.
