A Bedside-to-Bench-to-Bedside Journey to Advance Osteochondral Allograft Transplantation towards Biologic Joint Restoration.

More than 70 million adults in the United States are impacted by osteoarthritis (OA). Symptomatic articular cartilage loss that progresses to debilitating OA is being diagnosed more frequently and earlier in life, such that a growing number of active patients are faced with life-altering healthcare decisions at increasingly younger ages. Joint replacement surgeries, in the form of various artificial arthroplasties, are reliable operations, especially for older (>65 years), more sedentary patients with end-stage OA, but have major limitations for younger, more active patients.

Outcomes associated with hip preservation using osteochondral allograft transplants and acetabular labrum reconstruction.

Background: Osteochondral allograft (OCA) transplantation with or without labral reconstruction is considered a hip preservation surgical treatment option for young, active patients. This study aims to report early outcomes for use of OCA and labrum allograft transplants for patients treated for symptomatic femoral head chondral damage and/or acetabular labrum deficiency after implementation of a comprehensive joint restoration approach.

Methods: 33 patients from a lifelong registry were included for analysis.

Predictors of Pain Management Outcomes Following Orthopaedic Surgery: A Systematic Review.

Background: Up to 80% of patients in the United States report dissatisfaction with pain management following orthopaedic surgery. Inadequate pain management is linked to negative outcomes, including increased costs, readmission rates, and chronic pain risk. Traditional pain management protocols often emphasise the biological components of pain, overlooking psychological and social.

Midterm Outcomes After Osteochondral Allograft Transplantation in the Knee Using High-Chondrocyte Viability Grafts.

Background: Osteochondral allograft transplantation (OCAT) has become a standard-of-care treatment option for patients with large symptomatic articular defects. Recent advances in allograft science and OCAT protocols have been reported to result in consistently robust outcomes after OCAT in the knee. However, only short-term comparisons have been reported, and analyses are lacking for treatment failure risk factors that account for confounding variables.

Enrollment in a Behavioral Health Program Positively Impacts 2-Year Cumulative Survival Rates in Osteochondral Allograft Transplant Patients.

Emerging evidence suggests that patients' behavioral health may influence outcomes after osteochondral allograft transplantation (OCAT). A comprehensive behavioral health program (BHP) including preoperative screening and education, and postoperative counseling and support, led by a health behavior psychologist was implemented for patients considering OCAT. We hypothesized that patients undergoing knee OCAT and enrolled in the BHP would have a significantly higher 2-year graft survival rate than those not enrolled.

Donor-recipient age- or sex-mismatched osteochondral allografts do not adversely affect cumulative graft survival rates after transplantation in the knee.

Background: Osteochondral allograft transplantation (OCAT) can be performed without the need for blood-type matching or anti-rejection medications. However, other donor-recipient mismatch variables could influence outcomes. Therefore, it is critical to examine the impacts of sex and age mismatching on functional OCA survival.

Initial Outcomes following Fresh Meniscus Allograft Transplantation in the Knee.

Based on recent evidence-based advances in meniscus allograft transplantation (MAT), fresh (viable) meniscus allografts have potential for mitigating key risk factors associated with MAT failure, and preclinical and clinical data have verified the safety of fresh meniscus allografts as well as possible efficacy advantages compared with fresh-frozen meniscus allografts. The objective of this study was to prospectively assess clinical outcomes for the initial cohort of patients undergoing MAT using fresh meniscus allografts at our center. Patients who were prospectively enrolled in a dedicated registry were included for analyses when they had undergone primary MAT using a fresh meniscus allograft for treatment of medial and/or lateral meniscus deficiency with at least 1-year follow-up data recorded.

Outcomes following open acetabular labrum reconstruction: Comparing fresh-frozen tendon with fresh meniscus allograft transplantation.

Background: Symptomatic acetabular labral insufficiency in young, active patients is often treated with labral repair or reconstruction using fresh-frozen allografts. However, fresh-frozen tendon allografts do not have tissue or material properties that closely mimic acetabular labral fibrocartilage. Recent studies suggest meniscal allografts may be a better biomechanical, geometric, and material alternative for acetabular labrum reconstruction (ALR).

Accelerated versus Standard Rehabilitation after Meniscus Allograft Transplantation in the Knee.

Meniscus allograft transplantation (MAT) is a proven treatment option for patients with symptomatic irreparable meniscus deficiency. When patients are adherent to prescribed postoperative restriction and rehabilitation protocols, outcomes after MAT are considered good to excellent. However, nonadherence to standard protocols is common and can be associated with undesirable outcomes and patient dissatisfaction.

Treatment failures (revision or arthroplasty) after knee osteochondral allograft transplantation with minimum two-year follow-up.

Background: Knee osteochondral allograft transplantation (OCAT) has been associated with good short- to mid-term outcomes, however, treatment failures occur more frequently than desired. This study used data from a lifelong outcomes registry to analyze knee OCAT treatment failure rates, variables associated with knee OCAT treatment failures, and outcomes after revision or arthroplasty surgery for knee OCAT treatment failures.

Methods: Patient outcomes were followed after knee OCAT performed using standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS®) allografts.

Patient Adherence Following Knee Surgery: Evidence-Based Practices to Equip Patients for Success.

Patient adherence with postoperative wound care, activity restrictions, rehabilitation, medication, and follow-up protocols is paramount to achieving optimal outcomes following knee surgery. However, the ability to adhere to prescribed postoperative protocols is dependent on multiple factors both in and out of the patient's control. The goals of this review article are (1) to outline key factors contributing to patient nonadherence with treatment protocols following knee surgery and (2) to synthesize current management strategies and tools for optimizing patient adherence in order to facilitate efficient and effective implementation by orthopaedic health care teams.

Integrated Care for Comprehensive Management of Patients with Osteoarthritis: Program Development and Implementation.

Treatment of symptomatic osteoarthritis (OA) is often complicated by comorbidities, which put patients at potentially higher risks following operative interventions. Management of these comorbidities is usually separate from orthopaedic care, with patients invited to return to their orthopaedic surgeon once surgical risk factors are better controlled. However, this practice can lead to disjointed care, resulting in uncertainty, mistrust, unmanaged pain, and dissatisfaction for patients.

Effects of Patient Assessment and Education by an Integrated Care Team on Postoperative Adherence and Failure Rates After Osteochondral Allograft and Meniscal Allograft Transplantation in the Knee.

Background: Patient nonadherence with prescribed rehabilitation protocols is associated with up to 16 times higher likelihood of treatment failure after osteochondral allograft transplantation (OCA) and meniscal allograft transplantation.

Hypothesis: Patients who completed counseling with an orthopaedic health behavior psychologist as part of an evidence-based shift in practice at our institution would have significantly lower rates of nonadherence and surgical treatment failure versus patients who did not participate in counseling.

Study Design: Cohort study; Level of evidence, 2.

Initial Outcomes After Unicompartmental Tibiofemoral Bipolar Osteochondral and Meniscal Allograft Transplantation in the Knee Using MOPS-Preserved Fresh (Viable) Tissues.

Background: Unicompartmental tibiofemoral bipolar osteochondral allograft transplantation (OCAT) with meniscal allograft transplantation (MAT) has not historically been associated with consistently successful outcomes for treatment of knee articular cartilage defects with meniscal deficiency.

Hypothesis: Primary OCAT and MAT using fresh tissues will be associated with successful short-term outcomes based on statistically significant and clinically meaningful improvements in pain and function in the majority of patients.

Study Design: Case series; Level of evidence, 4.

The Missouri Osteochondral Preservation System Is Associated With Better Short-Term Outcomes Than Standard Preservation Methods When Performing Osteochondral Allograft Transplantation Using Shell Grafts for Patellofemoral Lesions.

Purpose: To compare outcomes after whole-surface osteochondral allograft (OCA) transplantation using shell grafts for treatment of patellofemoral joint lesions with respect to surfaces treated and OCA preservation method.

Methods: With institutional review board approval and informed consent, patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. Patients who received patellofemoral shell OCA to treat the entire articular surface of the patella, trochlea, or both, and with a minimum of 2-year follow-up data, including patient-reported outcome measures (PROMs), failures, and complications, were included.

Biologic Joint Restoration: A Translational Research Success Story.

Treatment options that result in consistently successful outcomes for young and active patients with joint disorders are needed. This article summarizes two decades of rigorous research using a bedside-to-bench- to-bedside translational approach based on the One Health - One Medicine concept that culminated in successful clinical use of biologic joint restoration options for treatment of knee, hip, ankle, and shoulder problems in this growing patient population.

Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee.

Background: Treatment of multisurface articular cartilage lesions of the knee is a challenging problem.

Hypothesis: Large multisurface cartilage defects in the knee can be successfully managed with transplantation of high chondrocyte viability osteochondral allografts (OCAs) to result in statistically significant improvements in patient-reported outcome measures of pain and function.

Study Design: Cohort study; Level of evidence, 3.

Are All Unloader Braces Created Equal? Recommendations for Evidence-Based Implementation of Unloader Braces for Patients with Unicompartmental Knee OA.

Unicompartmental knee osteoarthritis (UKOA) is a complex issue that is estimated to affect roughly 28% of patients with knee OA, and can result in severe cartilage degeneration, meniscus deficiency, and concomitant varus or valgus malalignment. This malalignment results in abnormally high joint reaction forces in the affected compartment, which can elicit pain, cause dysfunction, and exacerbate joint degradation. For more than two decades, the use of knee unloader braces has been advocated as a cost-effective option for symptomatic management of UKOA.

Prospective, Randomized Clinical Trial Comparing a Novel Motion-Assistive Device to Standard Physical Therapy for Initial Management of Knee Range of Motion after Primary Total Knee Arthroplasty.

This prospective randomized clinical trial assessed a novel device for initial management of knee range of motion (ROM), pain, and function after total knee arthroplasty (TKA). Primary TKA patients with preoperative ROM of at least 5° to 115° were randomized to initial knee motion management: Mizzou BioJoint Flex-novel motion-assistive device with prescribed physical therapy or standard physical therapy-prescribed physical therapy. ROM, pain score, and knee injury and osteoarthritis score for joint replacement (KOOSjr) were obtained preoperatively and 2 weeks, 6 weeks, and 3 months postoperatively.

Return to Sport After Large Single-Surface, Multisurface, or Bipolar Osteochondral Allograft Transplantation in the Knee Using Shell Grafts.

Background: Return to sport (RTS) after osteochondral allograft (OCA) transplantation for large unipolar femoral condyle defects has been consistent, but many athletes are affected by more severe lesions.

Purpose: To examine outcomes for athletes who have undergone large single-surface, multisurface, or bipolar shell OCA transplantation in the knee.

Study Design: Case series; Level of evidence, 4.

Changes in knee range of motion after large osteochondral allograft transplantations.

Background: Our study purpose was to determine if primary osteochondral allograft (OCA) transplant surgeries for large (>4 cm) single-surface, multisurface, or bipolar articular defects in the knee would be associated with significant gains in knee range of motion (ROM) at ≥1-year follow-up when compared to preoperative ROM.

Methods: Patients were prospectively enrolled into a dedicated registry to follow outcomes after OCA with or without meniscal allograft transplantation using Missouri Osteochondral Preservation System (MOPS)-preserved allografts. Patients were included if they had surgery to repair at least one osteochondral defect, and when at least one year of ROM data and Visual Analog Scale pain scores were available.

Postoperative Management for Articular Cartilage Surgery in the Knee.

The postoperative rehabilitation team plays a crucial role in optimizing outcomes after articular cartilage surgery. A comprehensive approach to postoperative physical therapy that considers the type of surgery, location in the knee, concurrent procedures, and patient-specific factors is imperative. While postoperative rehabilitation protocols should be specific to the patient and type of surgery performed and include phased rehabilitation goals and activities, the key principles for postoperative rehabilitation apply across the spectrum of articular cartilage surgeries and patients.

Outcomes associated with behavioral evaluation and counseling for patients undergoing orthopaedic surgery - A systematic review.

Osteochondral allograft transplantation can be an effective way to treat cartilage defects in the knee. The objective of this systematic review was to evaluate available research on the effects of preoperative behavioral evaluation and counseling on the outcomes for patients undergoing orthopaedic surgery with emphasis on osteochondral allograft transplantation in the knee. This systematic review of best current evidence indicates that psychological distress and untreated mental health issues are strongly associated with unfavorable outcomes after treatment of orthopaedic disorders, underscoring the need to incorporate behavioral screening and counseling into a comprehensive patient management protocol that improves outcomes for patients.

Effects of Compliance With Procedure-Specific Postoperative Rehabilitation Protocols on Initial Outcomes After Osteochondral and Meniscal Allograft Transplantation in the Knee.

Background: Osteochondral and meniscal allograft transplantation have been performed in the knee for more than 40 years, with the number of patients treated each year growing as allograft quantity and quality increase. To date, the effects of postoperative management on outcomes after these procedures have received relatively little focus in the peer-reviewed literature.

Hypothesis: Compliance with the recommended postoperative management protocol will be associated with significantly higher initial success and significantly lower revision and failure rates for patients undergoing osteochondral and/or meniscal allograft transplantation in the knee.