Abstract
Objectives:
Chondral injuries are prevalent among patients sustaining ACL injury, ranging from 7%-68% of cases based upon current literature. Osteochondral allograft transplant (OCA) is utilized as a treatment approach for managing chondral injuries, however there is limited evidence regarding the functional performance, complications, and level of return to sports participation following OCA in the setting of ACLR. Therefore, the purpose of this study was to compare self-reported function, complications, and return to sport rates after OCA with concomitant ACLR in comparison to age and gender matched controls undergoing isolated ACLR.
Methods:
A matched case-control study (level of evidence, II) was conducted in accordance with the STrengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines using a single surgeon database of subjects undergoing ACLR with/or without a concomitant OCA from 2016-2021. Males and females ages 15-70 were eligible for participation and excluded if they sustained a multi-ligamentous knee injury. Patients undergoing isolated ACLR were case-control matched by age and gender to the experimental group (ACL + OCA) using fuzziness levels ‘2’ and ‘0’, respectively. Baseline demographics and pre-injury activity level as indicated by MARX activity scale were obtained. Return to sport testing included evaluation of knee range of motion, single-leg balance, single leg hop and pro-agility (limb symmetry indices). Two-year outcomes were evaluated using self-reported function [Single Assessment Numerical Evaluation (SANE) score], level of sports participation, ACL graft re-injury rates, and post-operative complications. Between group differences were analyzed utilizing chi-square analyses and one-way analysis of variance (ANOVA) with an a priori α = .05 and SPSS version 29 (IBM, Chicago IL, USA).
Results:
From a sample of 1,978 patients undergoing ACLR, 86 individuals (n = 43, Isolated ACLR vs n = 43, ACLR + OCA) were enrolled in the study. At baseline, the ACL+OCA group exhibited lower preinjury level of function as determined by MARX score (3.9 ±5.7 vs 9.8 ±5.9, P = .001). The ACLR + OCA group demonstrated longer time to return to sport compared to the matched control group (9.1 ±4.1mo vs 7.9 ±3.4mo, P = .040). There were no differences observed for knee ROM deficits, quadriceps strength, hop testing or agility between groups at the time of return to sport (P > .05). At two-years, there were no differences in self-reported SANE score, rate of ACL graft reinjury, complications, or rate of return to sport between groups (P > .05).
Conclusions:
Patients undergoing ACLR with concomitant OCA exhibit no differences self-reported or objective functional performance, postoperative complications, and return to sport rates at two-years when compared to age and gender matched controls undergoing isolated ACLR. The addition of OCA may lengthen the time of return to sport when performed in the setting of ACLR. Individuals undergoing ACLR with a concomitant group may display lower pre-injury activity levels and longer rehabilitation timelines for return to sport when compared to isolated ACLR. However, at 2-years, both patient groups should display similar levels of the return to sport, function, and complication rates. We recommend larger clinical trials be conducted to confirm these results.