Two-Year Outcomes of ACL Reconstruction With Osteochondral Allograft Transplantation Versus Isolated ACL Reconstruction: A Matched Cohort Study.

Background

Osteochondral allograft transplantation (OCA) has been established as a viable restorative chondral procedure, although few studies have examined its effectiveness in the setting of anterior cruciate ligament (ACL) reconstruction.

Purpose

To compare self-reported function and return-to-sport rates after ACL reconstruction with OCA to those of matched controls undergoing isolated ACL reconstruction.

Study design

Cohort study; Level of evidence, 3.

Methods

A retrospective matched cohort study was conducted utilizing a single-surgeon database of patients undergoing ACL reconstruction between 2016 and 2021. Included patients were 15 to 70 years of age, underwent ACL reconstruction with OCA, and desired to return to sport. Patients were age and sex matched to a cohort of patients who underwent isolated ACL reconstruction. Baseline characteristics were collected along with preinjury Marx score and surgical details. Outcomes at time of return to sport included self-reported function, time to return to sport, range of motion, and single-leg squat and hopping performance. Two-year outcomes included Single Assessment Numeric Evaluation (SANE) scores, return-to-sport rates, and reinjury rates. Between-group differences were analyzed utilizing chi-square analyses and 1-way analysis of variance with an a priori α value of .05.

Results

A total of 43 patients who underwent ACL reconstruction with OCA were identified and matched to 43 patients who underwent isolated ACL reconstruction. Patients in the ACL reconstruction with OCA group reported lower preinjury Marx scores (3.9 ± 5.7 vs 9.6 ± 5.9; P < .001). The ACL reconstruction with OCA group demonstrated a longer time to return to sport (9.1 ± 4.1 months vs 7.9 ± 3.4 months; P = .040); however, no differences existed between groups for all self-reported and objective outcomes at the time of return to sport. At 2 years, no differences existed regarding SANE scores (85.4 ± 12.1 vs 87.0 ± 13.5; P = .334), ACL graft reinjury rate (4.7% vs 2.3%; P = .481), and return to prior level of sport rates (69.8% vs 72.1%; P = .387).

Conclusion

Patients undergoing ACL reconstruction with OCA demonstrate similar self-reported function and return-to-sport rates, along with a delayed time to return to sport, to those undergoing isolated ACL reconstruction. A majority (83.7%) of patients undergoing ACL reconstruction with OCA can return to level 1 to 3 sports with low graft failure rates.