Variable Return-to-Sport Rates with Improved Pain and Patient-Reported Outcomes Following Osteochondral Allograft Transplantation: A Systematic Review.

Abstract

Osteochondral allograft transplantation (OCA) of the knee is a reliable surgical technique for managing symptomatic full-thickness chondral lesions ≥2 cm² in young and active patients. There is a need for comprehensive analysis of recent studies among a growing body of literature to better understand the outcomes of OCA among athletic patients, particularly in terms of return to sports participation and graft longevity. To systematically review existing literature reporting the return-to-sport (RTS) outcomes and patient-reported outcome measures (PROMs) following OCA of the knee among athletic patients. A systematic review was performed in PubMed, Web of Science, and Embase from database inception through December 22, 2024. Studies that reported RTS outcomes after knee OCA were included. Data were analyzed descriptively, and methodological quality was assessed using the Methodological Index for Non-Randomized Studies. Inclusion criteria were met by 13 studies involving 699 patients. The mean patient age was 31.8 years (range 15.2-52.6), with a mean follow-up of 59.9 months (range 24-87.5). Reported RTS rates ranged from 59.4 to 90.9%. The mean time to RTS ranged from 9.0 to 14.6 months; one study documented a median RTS time of 16 months. Between 27.3 and 79.1% of athletes made RTS at the same level, 13.5 to 63.6% at higher levels, and 9.1 to 31.6% at lower levels. Significant (p < 0.05) improvements were noted in Tegner (delta -1.8 to 1.4), Visual Analog Scale-Pain (delta -5.7 to -3.7), and International Knee Documentation Committee scores (delta 25 to 33.0). The most common complications were deep vein thrombosis/pulmonary embolism (1.3%), symptomatic hardware (0.72%), and infections (0.72%). Graft failure ranged from 0 to 10.8%, and reoperation from 0 to 50%. OCA of the knee demonstrates variable RTS rates, with improved postoperative pain and outcomes scores. Graft failure occurred in 0 to 10.8% of patients. IV, Systematic Review of Level III and IV studies.