Background: Fresh-stored osteochondral allografts have been used successfully to resurface large chondral and osteochondral defects of the knee. However, there are limited data available for the return to athletic activity.
Purpose: To review the rate of return to athletic activity after osteochondral allograft transplantation in the knee and to identify any potential risk factors for not returning to sport.
Study Design: Case series; Level of evidence, 4.
Methods: Forty-three athletes were treated with fresh-stored osteochondral allograft transplantation for symptomatic large chondral or osteochondral defects of the knee from 2000 to 2010. The average age of the athletes (30 men, 13 women) was 32.9 years (range, 18-49 years). Patients were prospectively evaluated by International Knee Documentation Committee (IKDC), activities of daily living scale of the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, and Cincinnati Sports Activity Scale scores. A multivariable regression analysis was performed to identify potential risk factors for failure to return to sport at the preinjury level.
Results: At an average 2.5-year follow-up, limited return to sport was possible in 38 of 43 athletes (88%), with full return to the preinjury level achieved in 34 of 43 athletes (79%). In these 34 athletes, time to return to sport was 9.6 ± 3.0 months. Age ≥25 years (P = .04) and preoperative duration of symptoms greater than 12 months (odds ratio, 37; P = .003) negatively affected the ability to return to sport. In the athletes who returned to their previous level of competition, IKDC (P < .001), KOOS (P = .02), and Marx Activity Rating Scale (P < .001) scores were all significantly greater than in those athletes who did not return to sport.
Conclusion: Osteochondral allograft transplantation in an athletic population for chondral and osteochondral defects in the knee allows for a high rate of return to sport. Risk factors for not returning to sport included age ≥25 years and preoperative duration of symptoms ≥12 months.
Background: No biomechanical study has been performed analyzing the merits of reconstructing the popliteofibular ligament (PFL) through a tibial tunnel with an anatomic reconstruction of the posterolateral knee.
Hypothesis: There is no difference in an anatomic posterolateral knee reconstruction with or without a PFL reconstruction placed through a tibial tunnel in restoring knee motion to the intact, uninjured state, and the knee is not overconstrained with this reconstruction.
Study Design: Controlled laboratory study.
Methods: Eight paired knees were tested in the intact state and then sectioned to simulate a grade III posterolateral knee injury. The reconstruction for the first paired knee reconstructed the PFL (through a tibial tunnel), popliteus tendon, and fibular collateral ligament (group 1); the matched knee reconstruction involved only the popliteus tendon and fibular collateral ligament (group 2).
Results: Reconstructions for group 1 knees restored knee motion to the intact state for all tested conditions at all knee flexion angles with no overconstraint of the knee. Without reconstructing the PFL (group 2), small but significant increases in motion were found for varus translation at 0° (3.0°), 20° (3.1°), and 60° (3.8°) of knee flexion compared with the intact state. At 60° and 90° of flexion, the reconstruction for group 2 had small but significant increases in internal rotation compared with the intact state (1.3° and 1.8°, respectively).
Conclusion: Inclusion of the PFL through a tibial tunnel as part of an anatomic posterolateral knee reconstruction restores knee stability back to the intact state and does not overconstrain the knee. Furthermore, inclusion of the PFL through a tibial tunnel restored normal internal rotation.
Clinical Relevance: The PFL should be included in anatomic reconstructions of grade III posterolateral knee injuries with placement through a tibial tunnel to best restore the intact, preinjury knee motion state and, most notably, normal internal rotation without evidence of overconstraint of the knee.
