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Outcomes of Osteochondral Allograft Transplantation with versus without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis
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ABSTRACTS
Introduction: To review the outcomes of arthroscopic Bankart repair for anterior shoulder instability in an adolescent population participating in collision and contact sports. Methods: A retrospective review of 39 shoulders in 37 adolescent ( 19 years) athletes who underwent primary arthroscopic Bankart repair using suture anchors with at least 2-year follow-up. All patients had a history of trauma to their shoulder resulting in an anterior dislocation. Outcome measures included patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), and Rowe scores. Recurrence of dislocation, and return to sporting activity were also assessed. Results: The average age at the time of surgery was 16.9 years (range, 15-19 years), and the average follow-up was 6.4 years (range, 4.3-10.0 years). 58.6% of patients participated in collision sports. Time to surgery after the initial dislocation episode was 9.2 months (range, 0.5-36.2 months). Four shoulders (10.3%) had dislocation events postoperatively. 78.1% of patients returned to sports at the same level of competition. Average VAS was 0.49 1.01 and the average ASES and Rowe scores were 92.8 12.59 and 85.0 24.19, respectively. Univariate analyses demonstrated that subjective functional outcomes were negatively correlated with recurrence (ASES, P ¼ 0.005; Rowe, P ¼ 0.001) and failure to return to sport (ASES, P ¼ 0.016; Rowe, P ¼ 0.004). Independent variables shown to have no significant relationship to functional outcomes included age, follow-up, number of preoperative dislocations, time to surgery, sport classification, competition level, tear extent, number of anchors, concurrent HillSachs lesions, and repair of a SLAP lesion. Conclusion: Arthroscopic Bankart repair is an effective surgical option for traumatic shoulder instability in adolescents participating in collision and contact sports. At a minimum of 4-year follow-up, arthroscopic Bankart repair effectively restored stability in 90% of cases; 80% returned to their preinjury level of sport. Outcomes of Osteochondral Allograft Transplantation with versus without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis SS-69 May 20, 2017, 1:00 PM RACHEL FRANK, M.D., PRESENTING AUTHOR SIMON LEE, M.P.H. SARAH POLAND, B.A. TIMOTHY LEROUX, M.D. BRIAN COLE, M.D. Introduction: The purpose of this study was to compare outcomes for patients undergoing osteochondral allograft transplantation (OAT) with concomitant meniscus allograft transplantation (MAT) to patients undergoing isolated OAT. Methods: Consecutive patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years
were reviewed. Patients undergoing OAT without concomitant MAT were compared to a matched group of patients undergoing OAT with concomitant MAT. Patients were matched by age, sex, previous knee surgery, and concomitant ligamentous surgery. Reoperation rates, failure rates, and patient reported outcome scores were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at 2nd look arthroscopy. Results: 100 patients (average age 32.29.9 years; 52% males) who underwent OAT (50 isolated, 50 with MAT) with an average follow-up of 4.82.7 years (range, 2.015.1) were included. A total of 38 patients underwent reoperation at an average 2.42.2 years, with 24% (9/38) undergoing additional reoperations (range, 1-2). MAT patients did not have significantly different reoperation rates (MAT: 40%; non-MAT: 36%), time to reoperation (MAT: 2.202.31 years; non-MAT: 2.562.11 years) or failure rates (14% vs. 14%) compared to non-MAT patients (P>0.05 for all). Both MAT and non-MAT patients showed significant improvement in Lysholm, IKCD, KOOS, WOMAC, and SF-12 physical subscale compared to preoperative values (P>0.05 for all for both groups). There were no significant differences detected in the defect size or defect:condyle size ratio between the 2 groups (P>0.05 for both). Conclusion: Patients undergoing OAT with MAT have similar survival rates, reoperation rates, and clinical outcomes compared to patients undergoing isolated OAT at an average follow-up of 5 years. This implies that with appropriate surgical indications, despite the added surgical time and complexity of concomitant MAT, outcomes are favorable, with an 86% graft survival rate at 5 years. Second Generation Autologous Chondrocyte Implantation in the Patella: Short-Term Pain Relief and Functional Outcomes among U.S. Army Service members SS-70 May 20, 2017, 1:05 PM BRIAN WATERMAN, M.D., PRESENTING AUTHOR NICHOLAS ZARKADIS, D.O. MICHAEL ZACCHILLI, M.D. COURTNEY HOLLAND, M.D. ALISON KINSLER, M.D. MICHAEL TODD, D.O. PHILIP BELMONT, M.D. MARK PALLIS, D.O. Introduction: To evaluate the functional outcomes of autologous chondrocyte implantation(ACI) for high-grade patellofemoral chondral defects in a predominately young, high-demand military demographic. Methods: All beneficiaries undergoing ACI for high-grade patellofemoral chondral defects were identified from two high-volume military medical centers between 2007-2014. Inclusion criteria required second-generation technique (Vericel, Inc; Boston, MA) with a type I/III collagen membrane and minimum two-year surveillance, although patients with knee-related medical discharge were
ABSTRACTS
Introduction: To review the outcomes of arthroscopic Bankart repair for anterior shoulder instability in an adolescent population participating in collision and contact sports. Methods: A retrospective review of 39 shoulders in 37 adolescent ( 19 years) athletes who underwent primary arthroscopic Bankart repair using suture anchors with at least 2-year follow-up. All patients had a history of trauma to their shoulder resulting in an anterior dislocation. Outcome measures included patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), and Rowe scores. Recurrence of dislocation, and return to sporting activity were also assessed. Results: The average age at the time of surgery was 16.9 years (range, 15-19 years), and the average follow-up was 6.4 years (range, 4.3-10.0 years). 58.6% of patients participated in collision sports. Time to surgery after the initial dislocation episode was 9.2 months (range, 0.5-36.2 months). Four shoulders (10.3%) had dislocation events postoperatively. 78.1% of patients returned to sports at the same level of competition. Average VAS was 0.49 1.01 and the average ASES and Rowe scores were 92.8 12.59 and 85.0 24.19, respectively. Univariate analyses demonstrated that subjective functional outcomes were negatively correlated with recurrence (ASES, P ¼ 0.005; Rowe, P ¼ 0.001) and failure to return to sport (ASES, P ¼ 0.016; Rowe, P ¼ 0.004). Independent variables shown to have no significant relationship to functional outcomes included age, follow-up, number of preoperative dislocations, time to surgery, sport classification, competition level, tear extent, number of anchors, concurrent HillSachs lesions, and repair of a SLAP lesion. Conclusion: Arthroscopic Bankart repair is an effective surgical option for traumatic shoulder instability in adolescents participating in collision and contact sports. At a minimum of 4-year follow-up, arthroscopic Bankart repair effectively restored stability in 90% of cases; 80% returned to their preinjury level of sport. Outcomes of Osteochondral Allograft Transplantation with versus without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis SS-69 May 20, 2017, 1:00 PM RACHEL FRANK, M.D., PRESENTING AUTHOR SIMON LEE, M.P.H. SARAH POLAND, B.A. TIMOTHY LEROUX, M.D. BRIAN COLE, M.D. Introduction: The purpose of this study was to compare outcomes for patients undergoing osteochondral allograft transplantation (OAT) with concomitant meniscus allograft transplantation (MAT) to patients undergoing isolated OAT. Methods: Consecutive patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years
were reviewed. Patients undergoing OAT without concomitant MAT were compared to a matched group of patients undergoing OAT with concomitant MAT. Patients were matched by age, sex, previous knee surgery, and concomitant ligamentous surgery. Reoperation rates, failure rates, and patient reported outcome scores were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at 2nd look arthroscopy. Results: 100 patients (average age 32.29.9 years; 52% males) who underwent OAT (50 isolated, 50 with MAT) with an average follow-up of 4.82.7 years (range, 2.015.1) were included. A total of 38 patients underwent reoperation at an average 2.42.2 years, with 24% (9/38) undergoing additional reoperations (range, 1-2). MAT patients did not have significantly different reoperation rates (MAT: 40%; non-MAT: 36%), time to reoperation (MAT: 2.202.31 years; non-MAT: 2.562.11 years) or failure rates (14% vs. 14%) compared to non-MAT patients (P>0.05 for all). Both MAT and non-MAT patients showed significant improvement in Lysholm, IKCD, KOOS, WOMAC, and SF-12 physical subscale compared to preoperative values (P>0.05 for all for both groups). There were no significant differences detected in the defect size or defect:condyle size ratio between the 2 groups (P>0.05 for both). Conclusion: Patients undergoing OAT with MAT have similar survival rates, reoperation rates, and clinical outcomes compared to patients undergoing isolated OAT at an average follow-up of 5 years. This implies that with appropriate surgical indications, despite the added surgical time and complexity of concomitant MAT, outcomes are favorable, with an 86% graft survival rate at 5 years. Second Generation Autologous Chondrocyte Implantation in the Patella: Short-Term Pain Relief and Functional Outcomes among U.S. Army Service members SS-70 May 20, 2017, 1:05 PM BRIAN WATERMAN, M.D., PRESENTING AUTHOR NICHOLAS ZARKADIS, D.O. MICHAEL ZACCHILLI, M.D. COURTNEY HOLLAND, M.D. ALISON KINSLER, M.D. MICHAEL TODD, D.O. PHILIP BELMONT, M.D. MARK PALLIS, D.O. Introduction: To evaluate the functional outcomes of autologous chondrocyte implantation(ACI) for high-grade patellofemoral chondral defects in a predominately young, high-demand military demographic. Methods: All beneficiaries undergoing ACI for high-grade patellofemoral chondral defects were identified from two high-volume military medical centers between 2007-2014. Inclusion criteria required second-generation technique (Vericel, Inc; Boston, MA) with a type I/III collagen membrane and minimum two-year surveillance, although patients with knee-related medical discharge were