Arthroscopy - 2026-09-17 - Journal Article; Review
Osteochondral Allograft Transplantation of the Patellofemoral Joint Shows High Short- to Midterm Survivorship but Variable Long-Term Outcomes: A Systematic Review.
Jones M, Mowers CC, Mays L, Bocheuski E, Childers JT, Jackson GR, DeFroda SF, Nuelle C
Topics
Key Takeaway
Patellofemoral OCA transplantation yields statistically significant functional improvements across all 7 included studies, but long-term failure rates range from 0% to 25% with conversion to arthroplasty as the primary failure endpoint.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This systematic review evaluated clinical outcomes, failure rates, and graft survivorship after patellofemoral OCA transplantation with minimum 2-year follow-up across 7 studies published 1990–2024. OCA was a revision procedure in 57.8%–100% of patients, and all studies reported significant improvements in IKDC, KOS-ADL, and modified d'Aubigné-Postel scores. Failure rates ranged from 0% to 25%, with conversion to arthroplasty as the primary failure definition.
Key Limitation
The included studies are heterogeneous in lesion size, location (patella vs. trochlea vs. bipolar), surgical technique, and failure definitions, making any comparison of survivorship rates across studies unreliable.
Original Abstract
PURPOSE
To evaluate clinical outcomes, complication and failure rates, and graft survivorship after patellofemoral osteochondral allograft (OCA) transplantation with a minimum follow-up of 2 years.
METHODS
A systematic review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, and Cochrane databases were queried in June 2025 for English-language human studies on OCA transplantation of the patellofemoral joint with ≥2-year follow-up. Data including patient demographics, lesion characteristics, surgical techniques, prior surgery, outcomes, complications, and failures were extracted. Descriptive statistics were calculated, including mean delta values for reported scores. Study quality was assessed using the modified Coleman Methodology Score and risk of bias with Methodological Index for Non-Randomized Studies criteria in the included studies.
RESULTS
A total of 7 studies published between 1990 and 2024 met inclusion criteria, encompassing anywhere from 8 to 40 patients with an age range of 12 to 64 years and follow-up of 24 to 238.8 months. OCA was most frequently performed as a revision procedure, with 57.8% to 100% of patients having undergone at least 1 prior surgery. All studies reported statistically significant improvements (P < .05) in functional outcomes, including International Knee Documentation Committee, Knee Outcome Survey Activities of Daily Living, and modified d'Aubigné-Postel scores. Reported failure rates ranged from 0% to 25%, with most studies citing conversion to arthroplasty as the primary endpoint for failure.
CONCLUSIONS
OCA transplantation of the patellofemoral joint showed meaningful improvements in patient-reported outcomes and satisfaction, with high short- to midterm graft survivorship. Long-term graft survivorship was variable because of graft reoperation and conversion arthroplasty.
LEVEL OF EVIDENCE
Level IV, systematic review of Level III and IV studies.