New York, NY—July 19, 2010
“This is the first study to show that people who undergo osteochondral allograft transplantation can return to sports,” said Riley Williams, III, M.D., director of the Institute for Cartilage Repair at Hospital for Special Surgery (HSS) who led the study. “Most doctors have thought that by the time you get to this transplant surgery as an option, the expectation is that the patient is just going to be able to walk around and not do sports, and that is how most doctors counsel patients. Based on the data in this study, physicians can expect athletic patients treated with this option to return to sports.” According to the study, 84% of patients undergoing the surgery can return to some level of athletic activity and 60% can return to high level sports.
Osteochondral defects, damaged chunks of bone or cartilage in the knee, can be caused by a traumatic sports injury, such as a direct blow to the knee, or by a congenital bone disease called Osteochondritis Dissecans which can cause the bone to crumble. People with the congenital condition have abnormal bone in the knee and after a couple of decades of running on this injury, the cartilage that overlies the abnormal bone collapses. The chunks of bone and cartilage damaged can be as big as 15 to 30 millimeters in size, according to Dr. Williams. People with these defects experience pain and their knee may lock.
Surgeons can treat patients with this knee damage by transplanting fresh bone and cartilage into the injured area. They create a circular hole, take the damaged bone and cartilage out, and insert the transplanted tissue. “It’s just like a broken bone. It heals,” said Dr. Williams, a full-time member of the Sports Medicine & Shoulder Service at HSS. Doctors obtain the fresh tissue from tissue banks at places such as the Musculoskeletal Transplant Foundation. The surgery is done as an outpatient procedure, the patient goes home on crutches, and recovery takes about three to six months.
Prior to this study, doctors knew the surgery was often successful, but did not think that athletes would be able to return to sports. To find out if this was true, investigators mined data from a registry of patients with the condition at HSS. They included patients seen between 2000 and 2008 who had at least one year of followup. Patients had to be younger than 50 and participate in athletics three days per week prior to their injury. They could not have any concurrent procedures such as an ACL reconstruction or meniscal repair.
Questionnaires that evaluated physical activity were administered prior to surgery and at followup intervals. Twenty-five patients met the eligibility criteria and were available for followup evaluation. With an average followup of a little over four years, 15 patients (60%) said they had returned to athletics and 6 (24%) reported limited athletic participation. The average Tegner questionnaire score at followup was 4.6, which is equivalent to the ability to do cycling and light jogging.
“Of the 25 patients, only three could do sports immediately before surgery,” Dr. Williams said. “By the end of the study, all those patients could do at least light jogging and cycling according to the Tegner score and could do things including tennis, squash and golf.”
The new study disproves the notion that the transplant surgery is only a salvage procedure. “Doctors typically did not expect that patients would get back to sports or high level activity after this surgery,” Dr. Williams said. “If patients have had a reasonable experience with sports prior to having this surgery, then the overwhelming majority of the patients can get back to sports.”
Other authors of the study, all in the Sports Medicine and Shoulder Service at HSS, are Russell F. Warren M.D, attending orthopedic surgeon; Scott A. Rodeo, M.D., attending orthopedic surgeon; and Thomas L. Wickiewicz, M.D., attending orthopedic surgeon.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.