Primary Diagnosis, Higher Preoperative Baseline Function, and Female Sex Are Associated With Failure to Achieve the Minimal Clinically Important Difference After Osteochondral Allograft Transplantation in the Knee Among Patients With Intact Grafts: A Multivariable Analysis

PURPOSE: To identify factors independently associated with failure to achieve the minimal clinically important difference (MCID) in International Knee Documentation Committee (IKDC) total score after osteochondral allograft transplantation in the knee among patients with intact grafts at a minimum of 22-month follow-up. METHODS: This retrospective cohort study used a prospectively maintained registry of patients who underwent osteochondral allograft transplantation between 1997 and 2023 by a single surgeon. Patients with an intact graft and IKDC score at baseline and a minimum of 22-month postoperative follow-up were included. Failure to achieve the MCID was defined as <11-point increase in IKDC score. Variables significant in univariate analysis were included in a multivariable logistic regression model. RESULTS: A total of 339 patients (354 knees) were included. The median patient age was 30.4 years and 61% were men. Mean follow-up was 9.4 ± 5.7 years (range: 22 months to 24.4 years). Failure to achieve the MCID occurred in 80 knees (22.6%). Primary diagnosis, higher preoperative IKDC scores, and female sex were significantly associated with increased odds of failing to achieve the MCID. Compared with osteochondritis dissecans, degenerative chondral lesions (2.17 times, P = .036), fracture (7.4 times, P < .001), and osteoarthritis (3.5 times, P = .014) displayed increased odds of failing to achieve the MCID. For each 1-point increase in preoperative IKDC score, the odds of not achieving the MCID increased by 4%. Female patients had 2.4-fold higher odds of failing to achieve the MCID (P = .002). CONCLUSIONS: Among patients with intact grafts at a minimum of 2 years after osteochondral allograft transplantation in the knee, 22.6% did not achieve the MCID in IKDC total score. The multivariable logistic regression analysis identified primary diagnosis, higher preoperative IKDC scores, and female sex as variables independently associated with decreased likelihood of achieving the MCID. LEVEL OF EVIDENCE: Level IV, retrospective case series.