Background: Focal chondral and osteochondral defects in the knee are often difficult to treat. One solution is the use of osteochondral allograft (OCA) transplantation. The literature deliberates lesions located in the medial femoral condyle (MFC), but little is discussed regarding the lateral femoral condyle (LFC). Purpose: To compare graft survivorship and patient-reported outcomes (PROs) among patients who underwent OCA transplantation of the LFC to the MFC. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 319 patients who underwent primary OCA transplantation of the LFC (n = 111) and MFC (n = 208) were identified. Reoperations were recorded, and OCA failure was defined as allograft removal. PROs included the Knee injury and Osteoarthritis Outcomes Score (KOOS), the International Knee Documentation Committee (IKDC) score, the modified Merle d’Aubigné-Postel score, and satisfaction. Results: Patients with MFC grafts were older than those with LFC grafts (33 and 26 years, respectively; P < .001) and had a slightly higher body mass index (25.6 and 24.4 kg/m 2 , respectively; P = .039). Diagnosis, sex, and allograft size did not differ between groups. Reoperations occurred in 27.9% of MFC grafts and 26.1% of LFC grafts ( P = .737). OCA failure occurred in 12% of MFC grafts and 9% of LFC grafts ( P = .413). The 10-year survivorship was 88% for MFC grafts and 92.9% for LFC grafts ( P = .543). Among in situ allografts, the mean follow-up duration was 9.4 years for MFC grafts and 8.6 years for LFC grafts ( P = .313). At the latest follow-up, the IKDC pain subscale and total scores were similar, but function subscale scores differed significantly between LFC (6.8 ± 2.4) and MFC (7.5 ± 2.1) patients ( P = .019). KOOS and Merle d’Aubigné-Postel scores were similar between patients with MFC and LFC grafts. Patients with MFC grafts reported higher satisfaction than those with LFC grafts (93.7% vs 86.3%, respectively; P = .041). Conclusion: OCA transplantation of the LFC demonstrates high graft survivorship and significant improvement in PROs at mid-term follow-up. Clinical outcomes, reoperation rates, and survivorship were comparable to OCA transplantation of the MFC. These findings suggest that OCA transplantation of the LFC represents a reliable treatment option in appropriately selected patients.

Background: The effect of donor tissue characteristics on osteochondral allograft (OCA) efficacy for treating chondral and osteochondral lesions of the knee is poorly understood. Studies on graft storage time show inconsistent effects on clinical outcomes, and research on donor-specific factors remains limited. Purpose: To (1) assess the association between donor characteristics and graft storage time with allograft recipient survivorship; and (2) determine whether patient-reported outcomes and satisfaction differed across donor characteristics. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 220 patients (236 knees) who underwent primary fresh OCA transplantation of the knee with a minimum 2-year follow-up were included in this study. Patients with degenerative indications were excluded. Failure (defined as further procedure such as removal or revision) and survivorship rates were compared between patients receiving OCA grafts from donors aged ≤20 or >20 years, with a body mass index (BMI) ≤30 or >30 kg/m 2 , of the same sex (sex-matched) or different sex (sex-mismatched), released early (1-14 days) or late (15-28 days). International Knee Documentation Committee (IKDC) scores and satisfaction were compared between groups. Results: The mean follow-up was 8.2 years. Grafts from older donors (>20 years) had a significantly higher failure rate than grafts from younger donors (11.7% vs 3.7%; P = .039). Ten-year survival was 89.3% in the older donor group and 100% in the younger donor group. OCA failure rate for early-release grafts (22.7%) was significantly higher than late-release grafts (6%) ( P = .002). Survivorship was 85.6% at 10 years for early-release grafts and 96.1% for late-release grafts. Grafts from older donors were 6.96 times more likely to fail than grafts from younger donors ( P = .039), and early-release grafts were 6.90 times more likely to fail than late-release grafts ( P = .002). Donor BMI and sex matching did not impact failure rate or survivorship. IKDC scores and satisfaction did not differ statistically between donor characteristic groups. Conclusion: These findings suggest that donor age should be considered for OCA transplantation and that shorter graft storage times, donor BMI, and sex matching may not be required for successful clinical outcomes.

Background: Osteochondral allograft (OCA) transplantation has demonstrated reliable long-term outcomes in treating chondral and osteochondral lesions of the knee. Although several pre- and intraoperative factors associated with graft failure have been identified, the temporal distribution of graft failures after OCA transplantation has not been described. Purpose: To evaluate the timing and rate of graft failure after knee OCA transplantation and to report conditional survivorship (CS) to inform postoperative patient counseling. Study Design: Case series; Level of evidence, 4. Methods: We identified 288 knees (267 patients) that underwent OCA transplantation by a single surgeon between 1997 and 2015, with a minimum follow-up of 10 years. Graft failure was defined as any reoperation requiring removal of the allograft. Nonfailure reoperation was defined as any surgical procedure on the affected knee that did not involve graft removal. Rates of graft failure and nonfailure reoperation were estimated using piecewise linear regression applied to inverse Kaplan-Meier curves. Kaplan-Meier analysis estimated overall and 10-year CS. Results: The median patient age was 33.1 years (range, 11-68 years), and 58% were male. Overall graft survivorship was 78% at 10 years. Graft failure occurred in 64 knees (22%) at a median of 2.7 years (range, 0.3-23.6) postoperatively. Annual failure rates were 4.9% in the first 3 years postoperatively and decreased to 1.5% from 3 to 10 years. Nonfailure reoperations occurred in 48 knees, with a median of 1.5 years postoperatively, and followed a similar temporal pattern, with most occurring in the early postoperative period. CS analysis demonstrated that grafts remaining in situ at 4 years postoperatively had a 90% probability of survival to 10 years. Conclusion: OCA transplantation of the knee demonstrated an overall 10-year graft survivorship of 78%. Graft failures were not uniformly distributed over time, with the highest failure rates occurring during the early postoperative period and substantially decreasing after 3 years postoperatively to a low steady-state of 1.5% annually. This temporal pattern was also noted with nonfailure reoperations, which occurred predominantly during the early postoperative period. CS analysis offers a patient-centered approach for interpreting these findings and may inform postoperative patient counseling.

BACKGROUND:There are few studies reporting the midterm outcomes of osteochondral allograft (OCA) transplantation for chondral lesions in the patellofemoral joint, particularly in patients who are not receiving a high rate of concomitant realignment procedures. PURPOSE:To report clinical outcomes among patients undergoing OCA transplantation of the patellofemoral joint, and compare differences between patellar, trochlear, and bipolar (patellar and trochlear) grafts. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:The authors identified 127 knees that underwent OCA transplantation in the patellofemoral compartment (51 patella, 47 trochlea, 29 bipolar patella and trochlea). A concomitant tibial tubercle osteotomy was performed in 5 knees (4%). Reoperations were documented, and OCA failure was defined as any reoperation that involved removal of the allograft. International Knee Documentation Committee (IKDC) subjective knee score, Knee injury and Osteoarthritis Outcome Score (KOOS), and satisfaction were assessed preoperatively and postoperatively with a minimum 2-year follow-up. RESULTS:Reoperations occurred in 49 knees (39%) at a median time to first reoperation of 1.9 years, and did not differ among patellar (47%), trochlear (30%), and bipolar (38%) grafts (P = .214). OCA failures occurred in 20 knees (16%) at a median of 4.4 years postoperatively. The failure rates for trochlear (9%), patellar (20%), and bipolar grafts (21%) did not differ (P = .227). Graft survivorship rates at 5 and 10 years were 91% and 82%, respectively (85% and 78% for patellar grafts, 100% and 93% for trochlear grafts, and 87% and 68% for bipolar grafts (P = .120). Among grafts in situ, the mean follow-up duration was 7.5 years (range, 2-19 years). Patients had significant improvements in IKDC and KOOS values at the latest follow-up (all P < .05), with no statistically significant differences among groups. Overall, 77% of cases reported being satisfied with the OCA transplantation (80% in the patellar group, 78% in the trochlear group, and 68% in the patellar and trochlear group; P = .555). CONCLUSION:Patients undergoing patellofemoral OCA transplantation exhibited high survival rates at 5 and 10 years, along with improved patient-reported outcomes when performed without concomitant tibial tubercle osteotomy. Trochlear grafts had greater survivorship than isolated patellar or bipolar grafts, and outcomes were comparable to those of OCA transplantation performed in the femoral condyles.

BACKGROUND:Systemic corticosteroids are playing an increasingly important role in elective total knee arthroplasty (TKA) to aid in postoperative recovery. Corticosteroids reduce inflammation that can cause pain, limit range of motion (ROM), and prolong narcotic use following TKA. Dexamethasone and methylprednisolone are corticosteroids used perioperatively during TKA, but, to our knowledge, a comparative analysis assessing pain and narcotic use has not been done. We sought to determine if a difference exists between these two medications in reducing pain and narcotic usage while also assessing clinical outcomes and complications. METHODS:A nonrandomized prospective cohort study was performed of 350 patients undergoing primary unilateral TKA; 200 patients received an oral dexamethasone, and 150 patients received an oral methylprednisolone taper. The primary outcome measures included pain levels and narcotic consumption recorded by patients over the first 30 days after surgery. Pain scores were implemented utilizing the visual analog scale. Narcotic usage was converted to oral morphine milligram equivalents (MMEs). Lengths of hospital stay, knee ROMs, complications, and hospital readmissions were collected. RESULTS:Patients taking methylprednisolone reported significantly lower pain than patients taking dexamethasone on postoperative days three to seven and nine (all P < 0.05), with no significant differences through day 30. There were no statistically significant differences in MMEs between groups during the first postoperative month. There were no differences in lengths of stay, ROMs, complications, or hospital readmissions. CONCLUSIONS:A novel prospective study is presented comparing dexamethasone versus methylprednisolone, assessing narcotic usage and pain scores following TKA. Patients who received methylprednisolone taper reported statistically significantly lower postoperative pain scores compared to those receiving dexamethasone. Narcotic MMEs and complication rates were similar. Methylprednisolone demonstrated similar clinical outcomes and may be preferred for its more controlled tapering profile and greater ease of prescription and patient compliance than dexamethasone.

INTRODUCTION:Osteochondral lesions of the femoral head in young patients are a rare but challenging clinical problem. Fresh osteochondral allograft (OCA) transplantation has been proposed as one potential treatment option that may improve function and delay hip arthroplasty. However, there is a paucity of published data. The purpose of this study was to assess allograft survivorship and patient-reported outcomes in patients undergoing OCA transplantation for osteochondral lesions of the femoral head. METHODS:Sixteen patients (16 hips) who underwent femoral head OCA transplantation for the treatment of avascular necrosis between 1985 and 2021 were included. Mean age was 21.0±10.1 years (range: 11.6 to 43.5 y) and 56% were male. Mean allograft diameter was 26.9±4.2 mm (range: 20 to 35 mm) and mean thickness was 10.2±3.2 mm (range: 5 to 15 mm). We evaluated the frequency and type of further surgery, Hip Disability and Osteoarthritis Outcome Score (HOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and UCLA function score. Clinical failure was defined as conversion to total hip arthroplasty. RESULTS:Six of 16 hips (38%) experienced clinical failure (5 total hip arthroplasties and 1 resurfacing arthroplasty), with a mean time to failure of 3.6±2.6 years (range: 1.0 to 8.5 y). Allograft survivorship for patients under age 18 was 85.7% at 3 years and 42.9% at 5 years compared with patients over age 18 years who experienced a survivorship of 66.7% at 3 and 5 years ( P =0.911). Of the remaining 10 hips, the mean follow-up duration was 4.1 years (range: 1.9 to 7.4 y). At the latest follow-up, mean HOOS was 74.5±20.2 (range: 48.6 to 100), mean WOMAC was 79.9±18.2 (range: 56.1 to 100), mean mHHS was 74.9±20.9 (range: 41 to 100.1), and mean UCLA score was 7.0±2.7 (range: 4 to 10). CONCLUSIONS:Young patients with large chondral lesions of the femoral head may benefit from fresh OCA transplantation, but failure rates remain quite high for this challenging patient population. OCA can be considered as a useful treatment option that preserves function and delays the need for arthroplasty in young individuals with osteochondral lesions of the femoral head.

Osteochondral allograft (OCA) transplantation is a successful treatment option for focal chondral and osteochondral lesions; however, outcomes vary by patient and intraoperative variables. Previous studies have compared outcomes of OCA transplantation using basic descriptive and surgical data; nonetheless, they do not account for possible confounding variables. The purpose of this study was to report overall survivorship of OCA transplantation using a large, long-term registry from a specialty cartilage practice and utilize a multivariable model to identify factors that best predict treatment failure. The use of a multivariable analysis allows for the simultaneous assessment of multiple risk factors while controlling for the influence of confounding factors. Case series; Level of evidence, 4. We identified 527 patients (560 knees) who underwent OCA transplantation between 1997 and 2021 for focal chondral lesions by a single surgeon and had a minimum follow-up of 2 years. Treatment failure was defined as any surgery involving the removal of the allograft or conversion to arthroplasty. Variables associated with treatment failure in univariate analyses were included in a multivariable logistic regression model to identify those with the greatest effect. The mean age of the participants was 32.6 years, the mean follow-up was 8.2 years, and 62% were men. Treatment failure occurred in 89 knees (15.9%) at a median of 3.9 years postoperatively. Graft survivorship was 89% at 5 years, 83% at 10 years, and 75% at 15 years. Univariate analysis identified patient age, body mass index (BMI), diagnosis type, anatomic location, number of grafts, total graft size, and number of previous surgeries to be associated with treatment failure. However, in the multivariate analysis, only patient age, BMI, diagnosis, and graft size independently predicted a higher risk of treatment failure after controlling for other variables. Specifically, patients who were aged ≥30 years were 2.13 times more likely than younger patients to experience a treatment failure. Patients with a BMI of ≥30 kg/m2 were 2.24 times more likely to experience treatment failure compared with patients with a BMI of <30 kg/m2. Patients with degenerative chondral lesions, avascular necrosis, or osteoarthritis were more likely to experience treatment failure compared with patients with osteochondritis dissecans. Grafts with a total surface area of >8 cm2 were 2.12 times more likely to fail than those ≤8 cm2. OCA transplantation performed in all settings yielded effective long-term results, with graft survivorship of 83% at 10 years postoperatively. Patient age ≥30 years, BMI of ≥30 kg/m2, diagnosis, and graft size >8 cm2 were independently associated with a higher risk of treatment failure when controlling for other variables. Understanding the effect of clinical variables in a multivariable model is useful for counseling patients on the odds of treatment failure.

Background: Total hip arthroplasty (THA) is generally considered a successful operation for patients with advanced hip arthritis. Hip abductor pathology can lead to diminished outcomes. The prevalence of hip abductor pathology in patients undergoing THA is not well described. Methods: Our institution’s arthroplasty registry was queried to identify patients undergoing THA who had preoperative magnetic resonance imaging (MRI) of the hip or pelvis. MRIs were reviewed for presence of abductor (gluteus medius or gluteus minimus) tendon injury. Dysfunction of the abductor musculotendinous units was assessed by grading fatty infiltration of the muscle bellies using the Goutallier/Fuchs classification. Results: A total of 1090 primary THAs were performed during the study period, and 118 (10.8%) patients had a preoperative MRI of the hip or pelvis ≤12 months prior to surgery. Among the 118 patients who had an MRI, abductor tendon tears were diagnosed in 33 patients (28.0%), and tendinosis was noted in 106 patients (89.8%). Conclusions: There is a high prevalence of hip abductor pathology in patients presenting for THA. Clinicians should evaluate patients for signs of abductor tendon pathology when presenting for consideration of THA. Careful examination and MRI may be helpful to further evaluate the status of the gluteus minimus and gluteus medius musculotendinous units.

BACKGROUND:Total knee arthroplasty (TKA) is a well-established treatment option for advanced knee osteoarthritis, yet some patients remain unsatisfied after surgery. Evaluation of various psychosocial parameters may improve patient optimization and outcomes. The primary aim was to assess whether preoperative resilience remained stable and influenced decision regret postoperatively while the secondary aim was to evaluate its correlation with joint-specific and global health patient-reported outcome measures. METHODS:A total of 1,269 patients undergoing elective unilateral TKA were included. Patients completed the Brief Resilience Scale preoperatively and postoperatively and were stratified into low, normal, and high resilience cohorts. Decision regret scale scores were obtained postoperatively, and patients were stratified into no regret, mild regret, and moderate/severe regret cohorts. Patients' knee pain and function were assessed using the Knee Osteoarthritis Outcome Score Joint Replacement survey. Physical and mental quality of life was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS-10). RESULTS:Preoperatively, 8% of patients were categorized as having low resilience, 67% had normal resilience, and 25% had high resilience. Resilience among each cohort remained relatively static. A statistically significant negative correlation between Brief Resilience Scale and decision regret scale scores was observed at 12-month follow-up ( P < 0.001). The high resilience cohort demonstrated the lowest decision regret scale scores at all time points. The low resilience cohort reported higher decision regret scale scores at all time points but had the most improvement over the 12-month follow-up ( P < 0.001). Knee Osteoarthritis Outcome Score Joint Replacement scores had a weak-to-low positive correlation with preoperative resilience ( r = 0.29, P = 0.05). Preoperative resilience had a low positive correlation with PROMIS-10 Physical scores ( r = 0.36, P < 0.05), but a moderately strong positive correlation with PROMIS-10 Mental scores ( r = 0.47, P < 0.05). CONCLUSION:Preoperative resilience can markedly influence decision regret after TKA. These findings are valuable because they can help surgeons appropriately counsel patients, leading to improved satisfaction after surgery.

BACKGROUND:Fresh osteochondral allograft (OCA) transplantation is an established treatment option for patients with chondral or osteochondral lesions of the knee. Predictably positive outcomes are seen in situations of focal or isolated cartilage defects. However, OCA transplantation may also be performed in more complex joint salvage situations in young patients. PURPOSE:To evaluate survivorship and outcomes in patients who underwent OCA transplantation for large bipolar lesions of the knee. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:Fresh OCAs were implanted for bipolar chondral lesions in 86 patients (89 knees) between 1983 and 2020. A total of 37 male and 52 female knees with a mean patient age of 37.9 years (range, 14.5-66.0 years) were treated. Surgical indications included degenerative chondral lesions, osteoarthritis, osteochondritis dissecans, traumatic chondral injuries, and previous failed OCAs. The clinical evaluation included the modified Merle d'Aubigné-Postel score, International Knee Documentation Committee (IKDC) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Outcomes were collected during outpatient clinic visits or via mail. The minimum follow-up was 2 years. Additional procedures after OCA transplantation were documented. OCA failure was defined as a reoperation that involved removal of the allograft. RESULTS:There were 81 knees (91.0%) that had undergone previous surgery, with a mean of 3.2 previous procedures (range, 1-11). The mean treated defect surface area was 16.7 cm2. Graft failure occurred in 31 knees (34.8%). Reoperations (including failures) occurred in 46 knees (51.7%). The mean time to failure was 4.8 years. Survivorship of the bipolar OCA was 73.8% at 5 years, 66.6% at 10 years, and 58.9% at 15 years. Among the 58 knees (65.2%) in which the OCA was still in situ, the mean follow-up was 11.3 years (range, 2.1-27.6 years). The mean modified Merle d'Aubigné-Postel score improved from 12.4 to 14.8 points; 64.3% of knees (36/56 with available data) were considered successful with a score ≥15. The mean IKDC pain score improved from 6.3 to 4.0, and the mean IKDC function score improved from 2.9 to 6.2. The KOOS symptoms, pain, activities of daily living, sports/recreation, and quality of life subscores all increased postoperatively by a mean of 19.7, 25.9, 27.1, 35.4, and 36.4, respectively. CONCLUSION:OCA transplantation is a salvage treatment option for large bipolar cartilage lesions of the knee with acceptable survivorship and significant clinical improvement in a challenging patient population.

Osteochondral allograft transplantation in the knee is an effective procedure to treat isolated and complex pathologies of articular cartilage. Osteochondral allograft transplantation has an overall high graft survivorship, ranging between 78% to 91% at 10 years. Patients report significant improvements in pain and function and high satisfaction.

BACKGROUND:Total hip arthroplasty and total knee arthroplasty rank among the most prevalent orthopaedic procedures performed globally. Early mobilization postarthroplasty reduces complications, shortens length of stay, and optimizes recovery. However, the incidence of falls remains high, leading to complications and increased costs. Ensuring patient safety during mobilization is critical to minimizing fall risks. METHODS:In 2014, our institution created a supervised patient ambulation program called "No One Walks Alone" (NOWA). A retrospective review of patients undergoing total knee arthroplasty or total hip arthroplasty between 2011 and 2017 was conducted. The inclusion criteria spanned the preimplementation group (2011 to 2013) (N = 3069) and the postimplementation group (2015 to 2017) (N = 3947). Patients in the postimplementation group were enrolled in the "No One Walks Alone" supervised ambulation program. Data on patient demographics, procedures, hospital stay, fall rates, and postfall complications were collected. A logistic regression analysis was done to identify fall risk factors, and statistical analyses were used to compare outcomes between the patient groups. RESULTS:Inpatient fall rates decreased from 2.5 to 1.0 per 1000 inpatient days between the preimplementation and postimplementation groups, respectively. The difference in fall rates between the two periods was statistically significant (P value < 0.002). Fall-related complications were notably reduced in the postimplementation group. In addition, the postimplementation group saw a statistically and clinically notable reduction in average length of stay in the hospital compared with the preimplementation group by 0.75 days (P value < 0.001). CONCLUSION:Implementation of a supervised ambulation program was found to markedly reduce fall rates, length of stay, and fall-related complications, demonstrating the importance of proactive interventions to improve patient safety following arthroplasty.

Bracing options for the therapeutic and preventative treatment of cartilage injury and osteoarthrosis have traditionally been understudied and underutilized due to poor patient compliance and a lack of published clinical efficacy data. However, recent advancements in 3-dimensional printing, biomechanical analysis of the joint, and dynamic joint unloading technologies are re-establishing bracing as an effective, low-cost, and low-risk non-surgical treatment option. When combined with other operative and non-operative methods in a data-based approach, bracing may offer improved outcomes in therapeutic, palliative, and prophylactic applications for cartilage disease and injury.

Objective Supply-demand mismatch of medial femoral condyle (MFC) osteochondral allografts (OCAs) remains a rate-limiting factor in the treatment of osteochondral defects of the femoral condyle. Surface contour mapping was used to determine whether a contralateral lateral femoral condyle (LFC) versus ipsilateral MFC OCA differs in the alignment of donor:native subchondral bone for large osteochondral defects of the MFC. Design Thirty fresh-frozen human femoral condyles were matched by tibial width into 10 groups of 3 condyles (MFC recipient, MFC donor, and LFC donor) each for 3 cartilage surgeons (90 condyles). The recipient MFC was imaged using nano-computed tomography scan. Donor oval grafts were harvested from each matched condyle and transplanted into a 17 mm × 36 mm defect created in the recipient condyle. Following the first transplant, the recipient condyle was imaged and superimposed on the native condyle nano-CT scan. The donor plug was removed and the process repeated for the other donor. Surface height deviation and circumferential step-off height deviation were compared between native and donor subchondral bone surfaces for each transplant. Results There was no statistically significant difference in mean subchondral bone surface deviation (LFC = 0.87 mm, MFC = 0.76 mm, P = 0.07) nor circumferential step-off height (LFC = 0.93 mm, MFC = 0.85 mm, P = 0.09) between the LFC and MFC plugs. There were no significant differences in outcomes between surgeons. Conclusions There were no significant differences in subchondral bone circumferential step-off or surface deviation between ipsilateral MFC and contralateral LFC oval-shaped OCAs for 17 mm × 36 mm defects of the MFC.

BACKGROUND:Fresh osteochondral allograft (OCA) transplantation is a viable treatment option for osteochondral defects of the talus. However, sufficient data are not available on patients' participation in sports or recreational activities after the procedure.PURPOSE:To assess whether patients undergoing OCA transplantation of the talus participated in sports or recreational activities postoperatively.STUDY DESIGN:Case series; level of evidence, 4.METHODS:A total of 36 ankles in 34 patients underwent OCA transplantation of the talus. At a mean follow-up of 9.2 years, information on participation in sports or recreational activities pre- and postoperatively was obtained, as well as postoperative pain, function, and satisfaction.RESULTS:The mean age at the time of surgery was 36.1 years (range, 20.5-57.7 years), and 50% of patients were men. The mean graft size was 3.6 cm2 (range, 1-7.2 cm2) or 41.1% of the talar dome. Before the injury, 63.9% of patients (23/36 ankles) reported being highly competitive athletes or well trained and frequently sporting; 36.1% of patients (13/36 ankles) reported sometimes sporting or were nonsporting. Also, 66.7% of patients (24/36 ankles) were able to participate in sports or recreational activities after OCA transplantation and 50% (18/36 ankles) were still participating in sports or recreational activities at the latest follow-up. In a subset of well-trained or highly competitive athletes, 73.9% (17/23 ankles) were able to return to sports or recreational activities at any point after OCA transplantation, and 65.2% (15/23 ankles) were still participating at the latest follow-up. Further surgery occurred in 16.7% of patients (6/36 ankles). Graft survivorship was 94.3% at 5 years and 85.3% at 10 years. There was a significant improvement in the mean Olerud-Molander Ankle Scores, and the mean Foot and Ankle Ability Measure scores were high postoperatively. Moreover, 79.4% of patients (27/34 ankles) were either satisfied or extremely satisfied with the allograft surgery.CONCLUSION:Fresh OCA transplantation is a reasonable surgical option for osteochondral defects of the talus for young, active patients who have failed previous operative management or have massive defects.

Background: The purpose of this study was to evaluate whether there were differences in patient-reported outcomes, operative times, satisfaction scores, and complications between patients undergoing total hip arthroplasty (THA) performed through a direct anterior approach on a specialized traction table or a regular operating room table. Methods: Patients who underwent a direct anterior approach THA on a specialized table or a regular table with a minimum 1-year follow-up were included. Patient-reported outcome measures and THA satisfaction were recorded. Demographics, complications, and operative times (both in-room and surgical time) were evaluated. Three hundred twenty-two patients were included with 217 (67.4%) undergoing anterior THA on the specialized table and 105 (32.6%) on a regular table. Results: Outcome measures were similar at 4 months and 1 year postoperatively. Average operative time was 87 minutes (range, 50-160) and 90 minutes (range, 35-197) for the specialized table and regular table groups (P = .314). Average total in room time was 123 minutes (range, 87-201) and 120 minutes (range, 62-255) for the specialized table and regular table groups (P = .564). Satisfaction rates between groups did not differ (P = .564). No differences were found in complication rates at 4 months (P = .814) or 1 year (P = .547). Conclusions: This study shows that the direct anterior approach for THA can be safely and efficiently performed on either a specialized traction table or a regular table. Surgeons should continue to utilize the approach and set-up they are most comfortable with to achieve an optimal outcome for the patient.

Objectives: Focal chondral and osteochondral defects in the knee are problematic and are often difficult to treat. One solution is the use of osteochondral allograft (OCA) transplantation. A majority of the literature deliberates lesions located to the medial femoral condyle (MFC), but little is discussed regarding the lateral femoral condyle (LFC). Given the limited data, the purpose of this study was to compare graft survivorship and patient-reported outcomes (PROs) among patients who underwent OCA transplantation of the MFC or LFC. Methods: A total of 208 patients who underwent primary OCA transplantation of the MFC and 111 patients who underwent primary OCA transplantation of the LFC between 1997 and 2021 were identified from a prospectively collected single-surgeon cartilage registry. Overall, 66% were male and the mean age was 30.5 years. Most patients presented for OCA for osteochondritis dissecans (57%). Mean allograft size was 6.7 cm2. All patients had a minimum 2-year follow-up. Reoperations following the OCA transplantation were captured. Failure of the allograft was defined as removal of the graft (OCA revision or conversion to arthroplasty). PROs were measured both pre and postoperatively using the Knee Injury and Osteoarthritis Outcomes Scores (KOOS), International Knee Documentation Committee (IKDC), and Merle d’Aubigné-Postel scales. Patient satisfaction was also assessed. Results: Patients with MFC grafts were older than patients with LFC grafts (33 years and 26 years respectively; p<0.001) and had a slightly higher BMI (25.6 and 24.4 respectively; p=0.039). There were no differences between groups in regard to diagnosis, sex, number of allografts transplanted, or size of the allograft. Reoperations occurred in 27.9% of patients with MFC grafts and 26.1% of patients with LFC grafts (p=0.737). OCA failure occurred in 12% of MFC grafts and 9% of LFC grafts (p=0.413). The 10-year survivorship was 88% for MFC grafts and 92.9% for LFC grafts (p=0.543) (Figure 1). Among patients who had the allograft in situ at latest follow-up, the mean follow-up duration was 9.4 years for MFC grafts and 8.6 years for LFC grafts (p=0.313). At latest follow-up, KOOS, IKDC, and Merle d’Aubigné-Postel scores were similar between patients with MFC and LFC grafts. Patients with MFC grafts reported a slightly higher rate of satisfaction compared to patients with LFC grafts (93.7% and 86.3% respectively, p=0.041). Conclusions: Little data is available comparing treatment of medial and lateral femoral condyle lesions with osteochondral allografts. Clinical perception is that LFC lesions have inferior outcome to MFC lesions, but we did not find this to be true. We found little difference in reoperation rates and survivorship, as well as patient-reported clinical outcomes as measured on the KOOS, IKDC, and Merle d’Aubigné-Postel scales. There was a small difference in patient satisfaction. We conclude that there is similar outcome when using allografts for either medial or lateral femoral condyle lesions.

Background: Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized. Purpose: To evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d'Aubigne-Postel score, and overall patient satisfaction score. Results: The mean mechanical tibiofemoral angle for patients with varus alignment was 3.9 degrees of varus (range, 1.1 degrees to 8.9 degrees) and for patients with nonvarus alignment it was 0.02 degrees of valgus (range, 3.6 degrees varus to 4.6 degrees valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group (P = .918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group (P = .336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%. Conclusion: Patients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment.