Long-Term Results of Treating Large Posttraumatic Tibial Plateau Lesions with Fresh Osteochondral Allograft Transplantation
Bibliographic record
Abstract
BACKGROUND: The use of fresh osteochondral allograft (FOCA) transplantation is a treatment option for large posttraumatic tibial osteochondral defects in young, high-demand patients. We aimed to assess the long-term outcomes of this procedure and factors impacting graft survivorship. METHODS: Evaluated were patients with a posttraumatic tibial plateau defect of >3 cm in diameter and >1 cm in depth who were treated with use of a FOCA, with or without a realignment osteotomy, before September 2007. The primary outcome was survivorship according to Kaplan-Meier analysis, with conversion to arthroplasty or another allograft procedure as the end point. The secondary outcome was the functional outcome of knees with a surviving FOCA, as assessed using the modified Hospital for Special Surgery (mHSS) scoring system. Multivariate Cox regression analysis of the role of potential variables was performed for both outcomes. RESULTS: Included were 113 patients (67 female) with a mean age at the time of the index surgery of 43 years (range, 24 to 72 years) and a mean follow-up of 13.8 years (range, 1.7 to 34 years). Forty-eight conversions to arthroplasty or another FOCA procedure had been performed at a mean of 11.6 years (range, 1.7 to 34 years) after the index surgery. The remaining 65 patients had a mean follow-up of 15.5 years (range, 4.3 to 31.7 years). The mean mHSS score among those with a surviving FOCA was 85.5 (range, 56 to 100) at the most recent follow-up, which was significantly higher than the preoperative value of 69 (range, 48 to 85) (p < 0.001). Graft survivorship was 90% at 5 years, 79% at 10 years, 64% at 15 years, and 47% at 20 years. Complications included infection (1.8%), nonunion (0.9%), and knee pain from hardware (8.8%). Multivariate analysis revealed that older age at the time of surgery, involvement of the medial plateau, and a higher number of previous surgeries were inversely associated with graft survivorship. Having a Workers' Compensation file was associated with less improvement in the mHSS score, and the score tended to decline over time for knees with a surviving FOCA. CONCLUSIONS: FOCA transplantation is a viable option for posttraumatic tibial osteochondral defects, with satisfactory survivorship and functional outcome. Although approximately half of the patients in our study demonstrated graft failure by 20 years, FOCA was an excellent option that delayed the need for arthroplasty. Older patients, those with medial defects, and those with multiple previous surgeries had a less favorable prognosis. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".