title: Revision osteochondral allograft transplantations: do they work?
abstract: BACKGROUND
  Primary fresh osteochondral allograft transplantation is a useful treatment option for osteochondral lesions in the knee. Clinical failure of primary osteochondral allograft transplantation may require further surgery, including revision osteochondral allograft transplantation.
  
  
  OBJECTIVE
  To evaluate outcomes of patients who have undergone revision osteochondral allograft transplantation of the knee.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  This series included 33 patients (33 knees) who underwent revision osteochondral allograft transplantation between 1983 and 2012, were at least 2 years out from surgery, and had a minimum 2-year follow-up. Clinical evaluations included the International Knee Documentation Committee pain, function, and total scores; Knee Society function score; and modified Merle d'Aubigné and Postel scale. Failure of the revision allograft was defined as conversion to partial or total knee arthroplasty.
  
  
  RESULTS
  The mean follow-up after revision osteochondral allograft transplantation was 10 years, with 75% of patients having more than 5 years' follow-up. Thirteen patients (39%) had failed results after revision osteochondral allograft transplantation, with a mean time to failure of 5.5 years. The remaining 20 patients (61%) had surviving revision allografts, with a mean graft survival of 10 years. Mean pain and function scores at the last follow-up were improved. Survivorship of the revision allograft was 61% at 10 years.
  
  
  CONCLUSIONS
  Revision osteochondral allograft transplantation of the knee demonstrated acceptable clinical outcomes, although they were inferior to primary allograft transplantation procedures. Revision osteochondral allograft transplantation may be considered an option for patients with a failed primary osteochondral allograft.
authors: William D. Bugbee, Scripps Clinic, Division of Orthopaedic Surgery, 10666 North Torrey Pines Road, MS116, La Jolla, CA 92037. Bugbee.William@scrippshealth.org.
authors: Melissa T
authors: MT
authors: Horton
authors: Pamela A
authors: PA
authors: Pulido
authors: Julie C
authors: JC
authors: McCauley
authors: William D
authors: WD
authors: Bugbee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054544:Arthroplasty, Subchondral / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D055815:Young Adult
keywords: allografts; articular cartilage; knee; osteochondral graft failure; primary osteochondral allograft; revision osteochondral allograft