Immune Hypersensitivity Is Associated With Higher Graft Failure Rate After Osteochondral Allograft Transplantation of the Knee

PurposeThe purpose of the present study is to analyze the effects of one or more patient reported allergies on clinical outcomes, in particular graft failure rate, and patient reported outcomes following osteochondral allograft transplantation (OCA) of the knee.MethodsRetrospective review of patients that underwent knee OCA with a minimum of 2-year follow-up. Subjects were initially divided into two cohorts those with at least one allergy and those without any allergies. Clinical outcomes assessed included graft failure, reoperation rates, deep vein thrombosis/pulmonary embolism (DVT/PE) and manipulation under anesthesia/lysis of adhesions (MUA/LOA). Patient reported outcomes (PROs) assessed including the Visual Analog Scale (VAS) for pain and satisfaction, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and return to sport rates were compared.Results285 patients were included with mean clinical follow-up of 4.8 ± 2.0 years. The allergy cohort had a significantly higher rate of graft failure (p=0.008). In a regression analysis controlling for confounding variables graft failure remained significantly associated with presence of medication allergies (OR= 3.631 (95% CI :1.139-11.577), p=0.029). Furthermore, an increasing number of allergies was associated with an increased rate of graft failure (OR= 1.644 (95% CI :1.074-2.515), p=0.022). There was no difference in rate of reoperation, complications, infection, MUA/LOA. Of the 100 patients who completed PROs there was no difference in VAS satisfaction, pain, and any of the KOOS outcome scores or return to sport.ConclusionThe presence of one or more patient reported allergies was shown to be significantly associated with OCA graft failure. Furthermore, increasing number of patients reported allergies was associated with a higher rate of graft failure. However, there were no significant differences in VAS satisfaction or pain, KOOS symptom, quality of life, pain or return to sport in patients with at least one patient reported allergy and those without allergies.Level of EvidenceIII, Retrospective cohort study The purpose of the present study is to analyze the effects of one or more patient reported allergies on clinical outcomes, in particular graft failure rate, and patient reported outcomes following osteochondral allograft transplantation (OCA) of the knee. Retrospective review of patients that underwent knee OCA with a minimum of 2-year follow-up. Subjects were initially divided into two cohorts those with at least one allergy and those without any allergies. Clinical outcomes assessed included graft failure, reoperation rates, deep vein thrombosis/pulmonary embolism (DVT/PE) and manipulation under anesthesia/lysis of adhesions (MUA/LOA). Patient reported outcomes (PROs) assessed including the Visual Analog Scale (VAS) for pain and satisfaction, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and return to sport rates were compared. 285 patients were included with mean clinical follow-up of 4.8 ± 2.0 years. The allergy cohort had a significantly higher rate of graft failure (p=0.008). In a regression analysis controlling for confounding variables graft failure remained significantly associated with presence of medication allergies (OR= 3.631 (95% CI :1.139-11.577), p=0.029). Furthermore, an increasing number of allergies was associated with an increased rate of graft failure (OR= 1.644 (95% CI :1.074-2.515), p=0.022). There was no difference in rate of reoperation, complications, infection, MUA/LOA. Of the 100 patients who completed PROs there was no difference in VAS satisfaction, pain, and any of the KOOS outcome scores or return to sport. The presence of one or more patient reported allergies was shown to be significantly associated with OCA graft failure. Furthermore, increasing number of patients reported allergies was associated with a higher rate of graft failure. However, there were no significant differences in VAS satisfaction or pain, KOOS symptom, quality of life, pain or return to sport in patients with at least one patient reported allergy and those without allergies.