Paper 55: Osteochondral allograft transplantation is successful in patients aged 40-49

Objectives: Historically, osteochondral allograft (OCA) transplantation has been indicated for young, active patients with large focal osteochondral lesions. Consequently, 40 years of age has been frequently cited as an arbitrary upper age threshold for OCA transplantation. Large chondral defects in middle-aged patients pose a clinical challenge, as traditional arthroplasty is not ideal due to concerns about implant longevity and incompatibility with patients' postoperative activity goals. However, age-related factors such as prior surgeries, long-standing defects, and high body mass index have been shown to impact graft survival, suggesting that age alone may not be the sole determinant of OCA success. The purpose of this study was to compare graft survivorship and patient-reported outcomes measures (PROMs) following OCA transplantation in patients aged <40 and 40-49.
Methods: Patient demographics (age, BMI, gender, surgical history) and surgical details (laterality, diagnosis, anatomic location, number of plug grafts, concomitant procedures, graft size) were extracted from our intuition's IRB-approved prospective OCA registry. Failure was defined as graft removal or conversion to arthroplasty. PROMs and satisfaction were recorded at latest follow-up. Statistical analyses compared demographics, surgical details, failure/reoperation rate, and PROMs between those aged <40 and 40-49.
Results: This study included 489 patients (518 knees) with mean ages of 26.4 (391 knees) in patients <40 and 44.0 (127 knees) in patients 40-49. Among demographic and surgical variables, only diagnosis and anatomic location significantly differed by age. No difference in failure rates was observed between patients <40 and those aged 40-49 (p=0.640). Survival probabilities at 5, 10, and 15 years were 90.7%, 86%, and 74.3%, respectively, for patients under 40 and 89.8%, 83.7%, and 80.2% for those aged 40 to 49 (Figure 1.). The log-rank test revealed no significant differences in survival distributions across age groups (p=0.733). After controlling for all variables in logistic regression analysis, age still was not a significant predictor of failure (p = 0.849). Excluding failures, patients <40 and between 40-49 showed significant PROM improvement across all categories, with procedure satisfaction rates of 86.7% and 82.8%, respectively. PROMs and satisfaction did not significantly differ between age groups.
Conclusions: Patients aged 40-49 had outcomes comparable to those <40. Surgeons can remain confident in using OCA transplantation as a treatment option for patients in this age group.