Comparison of Patient-Reported Outcomes for Immediate Unrestricted Weightbearing Versus Restricted Rehabilitation Protocols After Osteochondral Allograft Transplantation to the Distal Femur.

Background

There is no standardized rehabilitation protocol after osteochondral allograft (OCA) transplantation surgery to the distal femur. The spectrum of recommendations includes restrictions to toe-touch weightbearing (TTWB) for 6 weeks and immediate weightbearing as tolerated (WBAT).

Purpose/Hypothesis

The purpose of this study was to compare outcomes for immediate unrestricted WBAT to restricted TTWB after OCA transplantation to the distal femur. It was hypothesized that the immediate WBAT protocol would be noninferior to delayed, restricted TTWB.

Study Design

Retrospective cohort study.

Methods

A total of 74 patients who underwent press-fit, dowel technique OCA transplantation to the femoral condyle(s) for contained (International Cartilage Repair Society grade 3-4) lesions were identified in the Metrics of Osteochondral Allograft multicenter database: 36 patients (18 women/18 men) who were prescribed TTWB were allocated to the control cohort and 38 patients (21 women/17 men) who were prescribed WBAT were allocated to the test cohort. Baseline characteristics were similar except for larger grafts in test patients (3.4 vs 2.7 cm

Results

The mean follow-up was 2 years (range, 1-5 years) in both cohorts. Both cohorts showed significant improvement in all PRO scores, with no significant between-group differences in failure rates, final PRO scores, or PRO changes from baseline. There were 3 cases of failure in each cohort (control cohort: allograft revision [n = 2], debridement [n = 1]; test cohort: chondroplasty [n = 2], conversion to total knee arthroplasty [n = 1]). Regression analysis showed that adjusted differences in final PRO scores based on weightbearing protocol were minor and less than MCIDs when controlling for age, sex, graft size, BMI, and allograft location. Analysis of the MCIDs with respect to the lower bounds of the confidence intervals indicated that WBAT was noninferior to TTWB with a reasonable degree of confidence (range, 84.1%-99.9% confidence).

Conclusion

Results indicated that immediate unrestricted WBAT after OCA transplantation to the distal femur was equally safe and effective compared to restricted TTWB.

Informations de copyright

© The Author(s) 2024.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: B.J.C. has received consulting fees from Endo Pharmaceuticals, Acumed, Aesculap Biologics, Arthrex, Bioventus, DJO, Vericel, Anika Therapeutics, Ossio, and Pacira Pharmaceuticals; nonconsulting fees from Arthrex, Vericel, Terumo BCT, and Pacira Pharmaceuticals; royalties from Arthrex; education payments from Endo Pharmaceuticals; hospitality payments from GE Healthcare; and honoraria from Vericel. A.B.Y. has received consulting fees from Stryker, JRF Ortho, and Olympus America; nonconsulting fees from Arthrex; education payments from Medwest Associates; and honoraria from JRF Ortho. D.C.C. has received consulting fees from JRF Ortho and Vericel, nonconsulting fees from Arthrex, education payments from Steelhead Surgical, and honoraria from JRF Ortho. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.