Outcome following isolated osteochondral allograft transplantation of the femoral trochlea

Abstract

Objectives: Osteochondral allograft (OCA) transplantation is a recognized treatment modality for cartilage damage in the knee. Few reports on outcomes of OCA in the patellofemoral joint and no reports on lesions isolated to the femoral trochlea are available. The goal of this study was to evaluate graft survivorship and clinical outcomes in patients who had an OCA of the femoral trochlea. Methods: Twenty-nine knees in twenty-eight patients (mean age, 30. 2 years; range 12-47 years) were treated with fresh OCA transplant limited to the femoral trochlea. There were eight females and twenty males. Minimum followup was 2 years. The primary outcome was graft survivorship. Pain and function were assessed by the Modified Merle d’Aubigné-Postel (18-point) scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society function (KS-F), International Knee Documentation Committee (IKDC) and UCLA activity scores. The OCA patient satisfaction score (five point scale from extremely satisfied to extremely unsatisfied) was reported. Results: Mean follow-up was 7.0 years (range 2.1-19.9 years) with 65.5% of patients with more than five years of follow-up. Graft survivorship was 91.7% at a mean of 7.0 years. One patient was converted to a total knee arthroplasty at 7.6 years after allograft surgery. Mean Modified Merle d’Aubigné-Postel (18-point) scale improved from 13.0 to 16.1, mean KS-F score from 65.6 to 85.2 and mean IKDC from 38.5 to 71.9. Mean UCLA score postoperatively was 7.9 and mean KOOS QOL (quality of life) scores improved from 34.0 preoperatively to 75.1 postoperatively. Eighty-nine percent of patients were extremely satisfied or satisfied with the outcome of surgery. Conclusion: Fresh OCA transplantation appears to have good results in this cohort of patients with advanced articular cartilage damage to the femoral trochlea. The procedure resulted in improved pain and function and could delay the need for patellofemoral or total knee arthroplasty for many years.